Cinnarizine for the prophylaxis of migraine associated vertigo: a retrospective study

Abstract Objective To assess the efficacy and safety of cinnarizine for the prophylaxis of migraine associated vertigo in the vestibular migraine and migraine with brainstem aura. Background Vestibular migraine and migraine with brainstem aura are two principal clinical syndromes that frequently are associated with vertigo. Since cinnarizine is a well-tolerated calcium channel blocker which has acceptable effect on both vertigo and migraine headache, we carried out this study to evaluate the efficacy and safety of this medication in vestibular migraine and also migraine with brainstem aura associated with vertigo. Methods This was a retrospective, single-center, open-label, investigation of the effects of cinnarizine on vestibular migraine and migraine with associated with vertigo. We assessed the change in monthly frequency of vertigo and also frequency, duration and intensity of migraine attacks after one, two and three months of cinnarizine administration. Results The mean frequency of vertigo and also the mean frequency, duration and intensity of migraine headaches per month were reduced significantly after three months of cinnarizine therapy (all p &lt; 0.001). Conclusion This study suggests that cinnarizine is safe and effective in reducing both headache and vertigo aspects of “migraine plus vertigo” among the patients who suffer from either vestibular migraine or migraine with brainstem aura associated with vertigo. </jats:sec

Oculomotor Function Testing and White Matter Integrity in Patients with Post-Concussion Syndrome

Objectives: To assess self-paced saccadic (SPS) eye movements in patients with postconcussion syndrome (PCS), and use diffusion tensor imaging (DTI) to determine the white matter (WM) neural correlates of these eye movements. Methods: Fifty-nine PCS patients with at least two concussions performed the SPS task. We evaluated the relationships between the number of SPS and the number of self-reported symptoms and integrity of major WM tracts involved in visual processing (uncinate fasciculus (UF), cingulum (Cg), superior longitudinal fasciculus, and corpus callosum). Results: Number of SPS was negatively correlated with the total number of symptoms patients reported (r=-0.419, p=0.026). Positive correlations were seen between number of SPS and fractional anisotropy of left UF and left Cg (r=0.421, p=0.013; and r=0.452, p=0.008; respectively). Conclusion: SPS testing may reflect symptom burden in patients with PCS and since it is associated with WM integrity, it could be a diagnostic biomarker in patients with PCS.M.Sc

Oculomotor Function Testing and White Matter Integrity in Patients with Post-Concussion Syndrome

Objectives: To assess self-paced saccadic (SPS) eye movements in patients with postconcussion syndrome (PCS), and use diffusion tensor imaging (DTI) to determine the white matter (WM) neural correlates of these eye movements. Methods: Fifty-nine PCS patients with at least two concussions performed the SPS task. We evaluated the relationships between the number of SPS and the number of self-reported symptoms and integrity of major WM tracts involved in visual processing (uncinate fasciculus (UF), cingulum (Cg), superior longitudinal fasciculus, and corpus callosum). Results: Number of SPS was negatively correlated with the total number of symptoms patients reported (r=-0.419, p=0.026). Positive correlations were seen between number of SPS and fractional anisotropy of left UF and left Cg (r=0.421, p=0.013; and r=0.452, p=0.008; respectively). Conclusion: SPS testing may reflect symptom burden in patients with PCS and since it is associated with WM integrity, it could be a diagnostic biomarker in patients with PCS.M.Sc

Effects of Laparoscopic Roux-en-Y Gastric Bypass on Anthropometric Characteristics, Hypertension, Type 2 Diabetes Mellitus and Metabolic Syndrome: An Iranian Experience

 Background: Surgically induced weight loss is a treatment option for the management of obesity and the related common disorders. This study evaluated the beneficial effects of bariatric surgery on metabolic profile and the prevalence of metabolic syndrome (MetS) among Iranian patients.Materials and Methods: A prospective observational study was performed on 26 morbidly obese patients scheduled for bariatric surgery, using laparoscopic Roux-en-Y gastric bypass (LRYGB). The parameters of hypertension, type 2 diabetes mellitus (T2DM), hyperlipidemia, MetS prevalence, and anthropometric measurements of Iranian patients, were recorded, at the preoperative visit and in follow-ups. The follow-up was performed for a median of 12 months, and the change in MetS prevalence and its componnts were assesed.Results: LRYGB induced a mean weight loss of 69.0±21.2%, after 12 months. Preoperative MetS was diagnosed in 21 patients (84%) and decreased to 6 patients (24%) after LRYGB (P=0.001). Likewise, the prevalence of hypertension was significantly decreased from 76% (pre-LRYGB values) to 20% (post-LRYGB values) (P=0.001). The prevalence of T2DM was also decreased from 20% to 8% (P=0.5).Conclusion: According to our results, RYGB produced a rapid and significant weight loss and improvement in hypertension and MetS within one year but there was a controversy about the improvement of T2DM, in Iranian morbidly obese patients.</jats:p

Abstract 080: Continuous Automated Stroke Screening Software for Early Detection of Neurological Impairment

Introduction Stroke is the second leading cause of death worldwide leaving up to 50 % of Survivor chronically disabled after their event. Early diagnosis and treatment can significantly lower mortality and morbidity, significantly reducing the economic burden of long‐term disability. Due to the painless nature of most stroke events, many lack the stimulus to seek emergency assistance, further compounded by a symptomatology of deficit resulting in being unaware of the symptoms or lacking the ability to call for help when needed. A continuous automated stroke screening software tool was developed to address these pitfalls in prehospital care, allowing for the early detection of neurological impairment and the release of a medical emergency alert to facilitate emergency medical care. Methods Python version 3.11.3, NumPy, OpenCV, and mediapipe were used for facial and hand land marking with mathematical models employed to detect eye gaze direction, facial symmetry, eyelid closure and left or right hand detection. Results We were able to demonstrate consistent performance of the final software to continuously detect the eye gaze deviation, or center in real time video capturing (Figure‐1). Software is also capable of detecting lower facial palsy through facial symmetry recognition of smiling to demonstrate a right or left sided palsy (Figure‐2). The ability to blink can be detected to differentiate motor neuron palsy and used as a measure of mental status demonstration of the ability to follow a simple midline command (Figure‐3). Detection of lateralizing hand presentation to the camera allows the software to be used in detecting hemi‐neglect, and antigravity muscle strength in upper extremity. (Figure 1‐3). Conclusion Our developed automated stroke screening software can be used for continuous, physician independent, monitoring of neurologic patients and the detection of acute deficits and emergency alert to facilitate early care. The software is designed for use in medical emergency alert systems, tele stroke assessments, and remote surveillance of the neurological examination in intensive care unit or patients in isolation. Here we present the initial software development and capability, we are currently studying our detection models on patients with neurological deficits in varied practice settings

Association Between Cerebrospinal Fluid Biomarkers and Age-related Brain Changes in Patients with Normal Pressure Hydrocephalus

AbstractOur study aimed to: 1)investigate the diagnostic utility of CSF Aβ42, t-tau, and p-tau to differentiate normal-pressure-hydrocephalus(NPH) from Alzheimer’s-disease(AD) and normal-controls; and 2)investigate if age and ventricular size affect the levels of CSF biomarkers in NPH patients. We recruited 131 participants: (a)Suspected-NPH: 72 with ventriculomegaly and clinical symptoms of NPH. These participants were then divided into two groups of 1)Probable-NPH (N = 38) and 2)Unlikely-NPH (N = 34) based on whether participants experienced gait improvement after removal of a large amount of CSF; (b)AD group: 30 participants with CSF biomarkers and cognitive symptoms consistent with AD; (c)Control-group: 29 participants who were cognitively and functionally normal. Lower levels of CSF Aβ42 and p-tau were observed in the probable-NPH compared to the normal controls(444.22 ± 163.3 vs. 1213.75 ± 556.5; and 26.05 ± 9.2 vs. 46.16 ± 13.3 pg/mL; respectively). Lower levels of CSF p-tau and t-tau were found in the probable-NPH compared to the AD(26.05 ± 9.2 vs. 114.95 ± 28.2; and 193.29 ± 92.3 vs. 822.65 ± 311.5 pg/mL; respectively) but the CSF-Aβ42 was low in both the probable-NPH and AD. CSF-Aβ42 correlated with age and Evans-index only in the probable-NPH(r = 0.460, p = 0.004; and r = −0.530, p = 0.001; respectively). Our study supports the hypothesis that age-related atrophy results in better Aβ42 clearance in the CSF because of the increase in the interstitial space.</jats:p