fahimeh hajiakhoundi

Multiple sclerosis (MS) is a common inflammatory disease affecting the central nervous system, causing demyelination and axon loss. Cognitive impairment is also prevalent in patients. This study aims to measure magnetic resonance imaging (MRI) findings and their relation to cognitive impairments in MS patients.

This cross-sectional analytical study was conducted on 50 patients with a definite diagnosis of MS at Firoozgar Hospital in Tehran Province, Iran, from 2019 to 2021. MRI, complete neurological and psychological examinations, and information documented in the records were used to prepare a complete list of clinical, neurological, and psychological manifestations. The severity of these symptoms was assessed, and patients were scored according to the expanded disability status scale (EDSS), cholinergic pathways hyperintensities scale (CHIPS), and brief international cognitive assessment for multiple sclerosis (BICAMS) criteria.  

This study included 36 women and 14 men with a mean age of 34.14±9.4 years. Relapse and remission were observed in 70% of patients. CHIPS score had a significant relationship with spinal symptoms. Also, the BICAMS score of patients showed a significant relationship with limbic involvement in MRI. The third ventricular diameter and CHIPS score were positively correlated with the BICAMS score. Patients’ EDSS score had a significant relationship with the symbol digit modalities test (SDMT) score.  

In this study, a significant relationship is observed between the size of the third ventricle and the CHIPS score with decreased cognitive function in MS patients. Therefore, MRI can be used to suspect cognitive disorders in MS patients.

Serotonergic system hyperactivity at 5-HT2A receptors on glutamate neurons in the cerebral cortex is one of the pathways that is theoretically linked to psychosis. In addition to neurotransmitter dysfunction, volumetric studies have revealed the loss of cortical gray matter and ventricular enlargement in patients with schizophrenia, although there is no case-control research on patients with schizophrenia to evaluate echogenicity of raphe nuclei (RN) or diameter of the third ventricle (DTV). To address these issues, the present study assessed midbrain RN, as the main source of brain serotonin, and DTV, as an index of atrophy, by transcranial sonography (TCS) in a group of patients with schizophrenia.

Thirty patients with schizophrenia and 30 controls were assessed by TCS for RN echogenicity and DTV. TCS was done through a temporal bone window via a phased-array ultrasound using a 2.5 MHz transducer in a depth of 14-16 cm. RN echogenicity was assessed by a semi-quantitative visual scale and DTV was measured in the thalamic plane.

Twenty-three patients (76.5%) and 15 controls (50 %) showed hypoechogenicity of RN, which was marginally significant (P=0.06). DTV was on average larger in the experimental group (0.388 cm vs 0.234 cm, P<0.001).

Increased DTV in patients with schizophrenia is consistent with previous neuroimaging findings. However, marginally lower echogenicity of midbrain RN on TCS in schizophrenia is a new finding that supports the serotonin hypothesis of schizophrenia.

 Frontotemporal Dementia (FTD) is an uncommon type of dementia. The hallmark feature of FTD is the presentation with aphasia or behavioral changes which vary in different FTD subtypes. In this study, we propose a quantitative aphasia test as an additive diagnostic tool for differentiation of FTD subtypes.

 The applied study was conducted on 20 patients with FTD (13 men and 7 women) aged 58-78 years (Mean age=63±0.8 years) referred to dementia clinic of Rasul Akram Hospital in Tehran, Iran. Based on clinical diagnosis, patients were divided into three groups of behavioral variant (n=5), semantic dementia (n=4) and non-fluent aphasia (n=11). The Persian Western Aphasia Battery (P-WAB-1) test was performed on the patients to assess their aphasia severity based on its overall score (Aphasia Quotient). The score of each language section of the test was also reported for each study group, separately. After recording data, they were analyzed in SPSS v. 22 software using the whole rock analysis. Significance level of Aphasia Quotient score was measured separately for each study groups.

 Patients with non-fluent aphasia had problems only in the speech fluency domain, and their abilities in other domains remained intact.

 It seems that P-WAB-1 test is a useful tool for assessing the non-fluent aphasia in patients who suffer from progressive dementia. These patients should be referred to speech therapist for rehabilitation.

An impaired sense of smell has a remarkable impact on the quality of life. It is seen in a variety of neurodegenerative diseases such as Parkinson disease. In this study, we assessed the olfactory function in patients with Multiple Sclerosis (MS) by Sniff Magnitude Test (SMT). 

A cross-sectional study was conducted on 48 patients with MS. A questionnaire, including demographic and clinical variables, was completed for each patient. The SMT was used for the evaluation of olfactory function. 

Olfactory dysfunction was found in 14.6% of patients (8.3% hyposmia and 6.3% anosmia). Older age, longer disease duration, higher hospital admission rate, lower mini-mental status examination score, and secondary progressive course of MS were significantly related to olfactory dysfunction. 

Secondary progressive MS and markers of advanced disease toward neurodegenerative phase (including older age, longer disease duration, and lower cognitive function) can be associated with olfactory dysfunction in MS patients.

Many medical diseases and their related signs and symptoms are not identified in routine assessments in emergency departments. 

We investigated the prevalence of abnormal findings in physical examination of the patients who were newly admitted to emergency department (ED) of a psychiatric hospital. 

We studied 200 patients (143 males, 71.5%) who were recently admitted to the ED of a psychiatric university hospital during a 4-month period in 2018. A thorough physical and neurological examination was performed on each subject. 

Nearly all of the patients (99.3%) had at least one positive finding in physical (non-neurological) examination and 95% had at least one positive neurological finding. We also found at least one problem in gastrointestinal, respiratory or cardiac system of 22.1%, 24% and 33% of the subjects, respectively. The most frequent findings were in cranial nerve I (30%, more common in substance abuse disorder), and visual acuity (52.6%), as well as recent memory (%68.7), attention (%33.7), orientation to time (%29.5), hypokinetic movements (%28.1, more common in females and psychotic patients), akathisia (41.6%), and skin (%85.1, more common in substance abuse and personality disorders). T wave changes were seen in 31.9% and arrhythmia in 16% of the patients. 

Abnormal findings in examination of the patients admitted to EDs are very prevalent, but most of the abnormalities are not detected or reported in the routine ward examinations. More emphasis should be placed on the examination of olfactory nerve (especially in patients with substance abuse disorder), cognition (especially in older adults), extrapyramidal system, heart, abdomen and skin (especially in patients with personality disorder) during the first week of admission in a psychiatric emergency setting.

Ehlers-Danlos syndrome (EDS) is a rare congenital disorder of connective tissues which involves the skin and musculoskeletal system. There are also some reports for the involvement of the central and peripheral nervous systems. We want to present a very rare coassociation of EDS, spondylolisthesis, and Agenesis of the corpus callosum in an Iranian lady

Hashimoto encephalopathy (HE) is known as a steroid-responsive encephalopathy associated with autoimmune thyroiditis or nonvascular inflammation-related autoimmune meningoencephalitis. The average age of onset of HE is approximately 50 years; and it is more common in women. The onset of HE may be acute or subacute. The course of most HE cases is relapsing and remitting, which is similar to that of vasculitis and stroke. In this article, we present a previously healthy 32 years old; veterinarian male with palatal myoclonus, as a rare presentation of this disorder, and review the neurologic aspects of hashimoto encephalitis. The clinical presentation of HE is characterized by progressive cognitive decline tremor, transient aphasia, seizures, abnormal gait, sleep disorder and stroke-like episodes. Myoclonus, either generalized or multifocal, and tremor, often of the bilateral upper extremities, is the most frequently observed involuntary movements in HE.The rapidly progressive cognitive dysfunction and encephalopathies observed.