مجید غفارپور

Systemic inflammatory response occurs after ischemic events in stroke and is responsible for thrombosis progression. In this study, we are intended to evaluate association of C- Reactive Protein (CRP) as an inflammatory marker with acute cerebral ischemic attack variables, risk factors and mortality.
162 patients with acute ischemic stroke were enrolled in the study. Medical history was asked and physical examination was performed. Then venous blood samples were drawn from all of the patients at end of the first day.
Our results showed that association between high sensitive CRP (hsCRP) and early mortality in the patients with acute CVA was significant. 10% of patients were died within a week after the stroke onset. mean of CRP in died patients was 8.9±7 mg/dl and in survived patients was 2.2±5 mg/dl (p=0.0001). After multivariate analysis and adjusting variables for sex, age, history of heart disease, NIHSS Score and TOAST, we found hsCRP as an independent factor in predicting early onset mortality.
This study shows that hsCRP has a direct association with mortality within the first week after stroke and measuring hsCRP within the first hours after stroke may play an important role in determining of patients´ mortality risk.

Recent studies present a high prevalence of multiple sclerosis (MS) in Iran. Treatment with interferon is now the first choice in management of MS. CinnoVexTM (an interferon beta 1-a) is available in Iran, with achievement of the technology of producing beta interferon. The aim of the present study is to evaluate the efficacy and safety of CinnoVexTM in a national study named CINA study. This study was conducted from 2007 to 2008 in cities of Tehran, Isfahan, Mashhad, Tabriz, and Shiraz. Patients with relapsing/remitting MS with 16-50 years of age and EDSS

Multiple sclerosis(MS) is the most common inflammatory disease of central nervous system which is caused by an autoimmune process leading to destruction of myelin sheath. In this disease, CD4+ T–lymphocytes, mostly of TH1 phenotype, play important roles in destruction of neuronal tissues. Because of the probable etiologic participation of EBV virus in immunopathogenesis of MS, the aim of this study was to evaluate the relationship between serum levels of anti-Epstein Barr virus antibodies and production of TH1 and TH2 cytokines.Patients and A descriptive study was performed on 68 MS patients in different stages of the disease and 20 healthy individuals. Blood samples were taken and plasma levels of anti-EBNA-1 and VCA antibodies were determined by ELISA method. Then, peripheral blood mononuclear cells (PBMC) were isolated by Ficoll Hipaque separation and stimulated with PHA in optimal culture conditions. Concentrations of IFN-γ, IL-12 and IL-4 in culture supernatants were then measured by ELISA. Statistical analysis was performed by using SPSS version 16. Mann-Whitney, t-test,and Pearson correlation coefficient were used to compare the variables and find the correlation between them. P<0.005 was considered statistically significant. The mean levels of anti EBNA-1 and VCA antibodies were significantly higher in patients compared to controls (P=0.04, P=0.001 respectively). Concentrations of IFN-γ, IL-4 and IL-12 were also significantly higher in MS patients than healthy individuals (P=0.001, P=0.005, p=0.002 respectively). Although the ratios of IFN-γ to IL-4 and IL-12 to IL-4 were higher in MS patients than healthy individuals, this increase did not reach a significant level (P>0.05). A statistically significant correlation was found between anti EBNA-1 and VCA antibodies and IL-12 production (P =0.02, r=0.27& P=0.04, r=0.25 respectively) whereas no significant correlation was found between these antibodies and production of IFN-γ and IL-4 in MS patients. The significant correlation between the level of anti-Epstein Barr virus antibodies and IL-12 production in MS patients implies the probable role of this cytokine in skewing immune responses toward TH1 phenotype. It is possible that this putative viral agent in combination with other etiological agents is involved in the etiology and progression of the disease.

Homocysteimemia has been associated with increased risk for cerebralvasuclar disease and recurrent stroke. Homocysteinmia has primary atherogenic and prothrombotic properties. It can lead to both venous and arterial thrombosis by several mechanisms. We present a 45 years old female patient with hyperhomocysteinemia and past medical history of epilepsy, two strokes like attacks, livedo reticularis and a new ischemic stroke. Risk factors such as hypertension, diabetes, ischemic heart disease and hyperlipidemia were all absent. Hypercoagulation and vasculities tests were normal. Livedoretiularis was the clue in this patient that led us to consider homocysteinemia as the most probable diagnosis. This suggests that considering skin lesions in juvenile stroke may help to limit the differential diagnosis and treat the etiologic factor more rapidly.

There are many risk factors that predispose nurses to sleep disorders. In one hand, sleep disorder affects health and safety of nurses and patients and on the other hand, risk factors of this occupations raise the prevalance of sleep disorders and their complications. this study was done cross-sectionally on 190 nurses of Imam Khomeini hospital in Tehran, Iran. We used sleep impairment index for insomnia, Epworth sleepiness scale for excessive daytime sleepiness, Martinez method for obstructive sleep apnea syndrome, and sleep disorder was defined as insomnia or hypersomnolance. prevalence of sleep disorders, insomnia, excessive daytime sleepiness, obstructive sleep apnea syndrome, and narcolepsy was, 83.8%, 81.5%, 33.1%, 12.1%, 3.7%, respectively. Using multivariable model, just shift work was significantly effective on prevalence of sleep disorders. We determined the prevalence of important subtypes of sleep disorders in nurses by standard self-report questionnaires and physical exam. Many risk factors that other studies in western countries have shown their importance, cant affect the prevalence of sleep disorders in Iranian nurses. To find the true reason for this issue, we suggest that a study must be done to compare occupation definition, Job, and task of Iranian nurses with western nurses.

Neuroacanthocytosis is a progressive multisystem disease with a wide range of symptoms. The descriptive name of the disease refers to the presence of acanthocyt in peripheral blood. A full spectrum of movement disorders may be seen mainly oromandibular dystonia.we report a case of neuroacanthocytosis that manifested with orolingual dystonia and weight loss after dental extraction. Botulinum toxin injection was performed and led to dramatic resolution of his symptoms and disappearance of dystonia, but paroxysmal dyskainesia emerged after injection, that entailed to occasionally tongue biting.

Many studies have shown that about 45-65% of multiple sclerosis (M.S) patients suffer from cognitive impairments. Semantic memory as one of the subcategories of cognition is quite important for effective communication. In the present study, category-semantic memory was studied in order to evaluate the semantic memory organization in normal individuals and MS patients. Ninety voluntaries participated in this study. Participants comprise of 45 MS patients and 45 normal individuals. All participants were matched in terms of age, sex and education. Variables such as the reaction time and the number of correct responses for retrieval (recognition) of natural (animal and fruit) and artifact (object)

Background and Objectives Hashimoto s encephalopathy (HE) known as Steroid Responsive Encephalopathy associated with Autoimmune Thyroditis (SREAT) is a rare nervous system disease. HE was originally described by Brain et. al. in 1966 however its cause still remains unknown after about 40 years. Autoimmune vasculitis of CNS brain edema and anti-thyroid antibodies are considered some of the etiologies for HE. It is certain that HE is an autoimmune disease and not a thyroid system disease. HE patients may or may not have goiter. Some of the most common neurological manifestations of HE include: Confusion with altered consciousness seizures myoloclonus and cognitive problems. Presence of high titers of anti-thyroid antibodies in blood serum and CSF of HE patients is considered the most common laboratory test for diagnosis of HE. EEG abnormalities such as diffuse slowing and atypical tri-phasic brain waves are the most common findings in about ¾ HE patients. Brain CT-Scan is normal in majority of HE patients. Global or local hypo perfusion may be seen in SPECT scanning of the brain. MRI findings are abnormal in about 40% of HE patients. Patients with sub acute or acute onset of confusion seizure myoloclonus stroke-like episodes and amnesia whose laboratory serum and CSF tests indicate presence of high titers of anti- thyroid antibodies should be considered for having HE. Vascular myelopathies CJD HSP Myelinoclastic disease like PML SSPE ADE MS and DNL are some of the differential diagnosis of HE. Adrenal corticosteroids are the first line treatment for HE. Recurrent or steroid resistant HE cases may be treated by addition of other immunosuppressant drugs such as Azathioprine Cyclophosphamide or Methotrexate to the 1st line therapy. Keywords: Hashimoto Diseases; Encephalopathy; Thyroiditis Autoimmune; Thyroiditis Autoimmune Diagnosis; Thyroiditis Autoimmune Therapy.

Multiple sclerosis (MS) is an inflammatory disease of the central nervous system with multifocal areas of demyelination. Even with a better understanding of the mechanisms causing MS, immunological factors that indicate disease activity are only starting to be discovered. Chronic brain inflammation is often associated with an increase in production of IgG in the CSF as determined by the IgG index (normal ≤0.77) and oligoclonal bands (OCBs). Different studies have found variable correlations between these two factors and disease progression. We herein evaluate the correlation of IgG index and OCB with disease progression in Iranian MS patients. The IgG index was measured in 54 patients with multiple sclerosis.

Ultrasound (US) has been used in neuroprotection after cerebral ischemia, however the mechanism of action remains unclearly. We have previously shown the protective effect of ultrasound on infarction volume and brain edema in ischemic brain injured at normothermic condition. Ultrasound may also amplify the effect of fibrinolytic medications in thrombolysis process. We have also shown that hyperthermia can exacerbate cerebral ischemic injury and that the efficacy of tissue plasminogen activator (tPA) is reduced in the presence of hyperthermia. In this study, the effects of US alone or in combination with tPA on brain ischemic injury were evaluated.

Focal ischemic brain injury was induced by emblazing a pre-formed clot into the middle cerebral artery in rats. Principally, we examined whether US can reduce the perfusion deficits and, the damage of blood- brain barrier (BBB) in the ischemic injured brain. There are two series of experiments at this study. in the first series, animals were randomly assigned to four groups (n=7 per group) as follows: 1-control (saline), 2-US (1W/cm2, 10 duty cycle), 3- US+high- tPA (1W/cm2, 10 duty cycle +20 mg/kg) and 4- high -tPA (20 mg/kg). We also examined the effects of US and tPA on BBB integrity after ischemic injury. The animals were assigned into four groups (n=7 per group), treatment is the same as above. BBB permeability was assessed by the Evans blue (EB) extravasations method at 8 h after MCA occlusion. BBB permeability was evaluated by fluorescent detection of extravagated Evans blue dye and Perfusion deficits were analyzed using an Evans blue staining procedure. The perfused microvessels in the brain were visualized using fluorescent microscopy. Areas of perfusion deficits in the brain were traced, calculated and expressed in mm2.

The results showed that US improved neurological deficits significantly (p<0.05). The administration of US significantly decreased perfusion deficits and BBB permeability. In the control set, for the US+high tPA, high tPA only and US only groups, the mean perfusion deficits (±SD) were 14.32±3.15, 7.03±4.08, 5.92±1.90 and 9.14±3.37 mm2, respectively, 8 h after MCA occlusion (P<0.05).

These studies suggest that US is protective in a rat embolic model of stroke due to decreased perfusion deficits.