Background: Guillain-Barré Syndrome (GBS) is one of the most severe neurological diseases that causes marked disability and even death. Aim: The aim of this study is to investigate the role of the neutrophil-lymphocyte ratio (NLR) as a prognostic marker for GBS and response to treatment with plasmapheresis. Methods: Seventy-five subjects (35 GBS patients and 40 healthy controls) were recruited. Complete general and neurological examinations were performed and Hughes disability scale score was evaluated for assessing functional motor deficits in GBS patients. In addition, NLR, erythrocyte sedimentation rate, and C-reactive protein level were calculated. Results: NLR was significantly higher in GBS patients than in controls (p < 0.001) and was significantly higher in axonal form than other demyelinating and mixed subtypes (p < 0.02). Patients with a poor outcome had a significantly high NLR than patients with a good outcome (p = 0.006). NLR was also positively correlated with Hughes disability scale score (p < 0.001). The cut-off value for NLR to predict a good response of patients to plasmapheresis was ≤ 4.4. Interpretation: NLR may be a rapid, simple, inexpensive biomarker for predicting the severity of GBS, outcome of patients, and their response to plasmapheresis.
Background: Common peroneal mononeuropathy at the fibular neck (CPN) is one of the most frequent neuropathies of the lower extremities. Nerve conduction studies (NCS) have been used to confirm the diagnosis of CPN and localize common peroneal nerve abnormalities. High-resolution ultrasonography (HRUS) can aid in assessing the size of the common peroneal nerve. Aim: Was to evaluate the superficial peroneal sensory potential (SPSP) and HRUS role in the confirmation of CPN. Methods: This study was conducted on 70 patients presented with clinical and motor electrophysiological evidence of common peroneal neuropathy at the fibular neck and 70 controls. Clinical assessment, electrophysiological evaluations, and HRUS at the fibular neck were done. Results: All the patients were electrophysiologically proven to have common peroneal motor neuropathy at the fibular neck, and seven of them showed abnormalities in nerve conduction studies only. The patients showed smaller common peroneal nerve motor and sensory responses and much larger cross-sectional area (CSA) of the common peroneal nerve at the fibular neck when compared with the controls. NCS and EMG positive findings are the most significant factor related to the increased HRUS CSA. Affected SPSP is significantly detected in patients with axonal affection. CSA of common peroneal nerve at the fibular neck showed a significant positive correlation with body mass index, motor, and sensory latencies. Also, it showed a significant negative correlation with motor and sensory amplitudes. HRUS CSA localized the lesion at the fibular neck with sensitivity and specificity 83% and 53% respectively. CSA plus SPSP affection sensitivity and specificity in confirming CPN were 91.9% and 89%. Conclusion: HRUS CSA plus affected SPSP improve the diagnosis of CPN compared to standard electrophysiological criteria. Recommendation: Further studies on a wider scale for detection of their role in the prediction of prognosis in CPN.
Background Stroke represents the second leading cause of death in the world after myocardial infarction. Intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (alteplase, rt-PA) is the only pharmacological therapy that was approved for treatment within 4.5 h of acute ischemic stroke (AIS) onset. We aimed to predict the 3-month outcome of AIS patients who received alteplase regarding mortality, spontaneous intra-cerebral hemorrhage (sICH), and functional outcome in comparison with non-thrombolyzed patients and to evaluate the predictors of the outcome after 3 months. Methods All the clinical, National Institute of Health Stroke Scale (NIHSS) scores, radiological, and laboratory data of 40 AIS patients and received rt-PA during the period from 2016 to 2018 were collected and analyzed retrospectively. For comparison, 40 patients, as a control group, were selected to match the alteplase group as regards the baseline data and received regular treatment, rather than rt-PA within the first 24 h, that were obtained. The outcome of the thrombolyzed patients after 3 months was evaluated in comparison with controls by using a modified ranking scale. Results After a 90-day follow-up period, the death rate was slightly higher among the rt-PA group (7.5%) in comparison with the control group (5%). sICH occurred in 7.5% of the patients in the alteplase group and in 5% of the non-thrombolyzed patients; however, this difference was not significant. More patients had a favorable outcome (mRS = 0–2) in the rt-PA group than in the control group (65% vs 60%, OR 1.38, 95% CI 0.50–3.6, P = 0.51). NIHSS score on admission, body mass index (BMI) (≥ 30), and previous transient ischemic attacks (TIA)/previous ischemic stroke were significant predictors of outcome after IV thrombolysis. Age, sex, hypertension (HTN), diabetes mellitus (DM), dyslipidemia, smoking, atrial fibrillation (AF), stroke subtype, size of infarction, and hyperdense middle cerebral artery had a non-significant effect. Conclusion After 3 months of follow-up, rt-PA had a non-significant more increase of favorable outcome with increased risk of sICH and death than controls. Baseline NIHSS, BMI, and history of TIA or previous ischemic stroke were significant predictors of outcome after thrombolysis.
Background: The brain is a productive source of a variety of enzymes and any brain injury like a stroke to brain tissue could similarly result in an increase in these enzymes in cerebrospinal fluid and serum. Evaluation of these enzymes represents a simple method for the ischemic stroke subtype diagnosis and prognosis. Objective: This study aimed to determine the role of brain natriuretic peptide (BNP), D-dimer, creatine-kinase-MB (CK-MB), C-reactive protein (CRP) serum levels, and globulin/albumin ratio in the diagnosis of CES stroke and its ability to predict short-term outcome. Methods: This study was conducted on 96 patients with acute ischemic stroke, subdivided into two groups: group Ι was 48 patients with cardio-embolic stroke and group ΙΙ was 48 patients with non-cardio-embolic. All patients were subjected to the assessment of serum BNP, D-dimer and CK-MB, and CRP and globulin/albumin ratio within the first 24 h of stroke. In the third week, they were assessed by mRS. Results: The mean levels of BNP, D-dimer level, and CK-MB were significantly higher in patients with cardio-embolic stroke than in patients with non-cardio-embolic stroke (P < 0.001) and also were associated with poor short-term outcome. Conclusion: Elevated plasma levels of BNP, D-dimer levels, and CK-MB can be used as surrogate biomarkers for the diagnosis of cardio-embolic stroke and prediction of poor short-term outcomes.
Background: Several neuropeptides have concerned with epilepsy pathogenesis; ghrelin showed an anticonvulsant effect. There is a potential relation between its level and antiepileptic drug (AEDs) response.Objective: To evaluate ghrelin effect in adult epileptic patients and in response to AEDs. Materials and methods: This case control study included 40 adult epileptic patients and 40 healthy controls. Participants were subjected to history taking of seizure semiology, full general and neurological examination, electroencephalography, and cranial imaging. Fasting serum acylated ghrelin (AG), unacylated ghrelin (UAG), and urine AG levels were estimated to all participants by enzyme-linked immunosorbent assay (ELIZA).Results: Serum AG, UAG, and urine AG levels were statistically higher in epileptic patients than controls (p = 0.005, 0.003, and 0.018 respectively). A significant higher level of serum AG was found among generalized epileptic patients (p = 0.038). There was higher statistically significant levels of all measured parameters among poly therapy patients (p = 0.003, 0.013, and 0.001 respectively). Also, a higher statistical significant level of serum AG and UAG in AEDs-responsive patients was found (p < 0.001). Our results demonstrated significant positive correlation between all measured parameters (serum AG, UAG, and urine AG) and epilepsy duration (p = 0.001, 0.002, and 0.009 respectively). High serum AG and UAG levels were independently associated with longer epilepsy duration (p = 0.00 and 0.008) and better response to AEDs (p < 0.001). Conclusion: These results indicated that serum AG and UAG levels were significantly high in epileptic patients especially with prolonged epilepsy duration and good AEDs response.Trial registration: ClinicalTrials.gov NCT03926273 (22-04-2019) "retrospectively registered."
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