A 33-year-old woman with severe postpartum headache

 Patient was a 33-year-old woman underwent her first time cesarean section combined with spinal epidural anesthesia 5 days before and discharged the day after with good condition. She got severe headache with pain score about 8-9, 2 days after discharge from hospital. Her headache was severe, bilateral, pulsatile and almost likely sudden onset accompanied with nausea that mildly progressed after starting. She went to the hospital which her delivery was taken; with impression of Post Dural Puncture Headache (PDPH) 10mg IV morphine sulfate was administered totally and subsequently discharged home with relative decreased headache. The day after first headache attack, when she admitted in our Hospital, claimed that could not hold her baby for breast feeding. In minimental status examination, time disorientation was obvious but orientation to place and person was intact. In motor examination we found right side hemiparesis and also decreased right upper and lower limbs tone. Brain CT Scan and then MRI was performed and reveal massive cortico-subcortical hemorrhagic infarction on left parieto-occipital lobes. With attention due to significant nonhomogene occupying lesion, brain MRI with gadolinium and also MRV was per-formed.What is your doagnosis

Central Nervous System Tuberculosis: An Imaging-Focused Review of a Reemerging Disease

Central nervous system (CNS) tuberculosis is a potentially life threatening condition which is curable if the correct diagnosis is made in the early stages. Its clinical and radiologic manifestations may mimic other infectious and noninfectious neurological conditions. Hence, familiarity with the imaging presentations of various forms of CNS tuberculosis is essential in timely diagnosis, and thereby reducing the morbidity and mortality of this disease. In this review, we describe the imaging characteristics of the different forms of CNS tuberculosis, including meningitis, tuberculoma, miliary tuberculosis, abscess, cerebritis, and encephalopathy

Effectiveness of attributive retraining on epileptic male children’s mental health

Background: Epilepsy is relatively a common neurological disease in childhood. This disorder affects the ability of the children, their performance and their mental health. Purpose: The purpose of this study was to investigate effectiveness of attributive retraining on epileptic children’s mental health. Methods: In this quasi-experimental study a pre-test post-test design with control group was used. From the statistical population of Iran epilepsy association, 30 epileptic children [17 boys and 13 girls] were selected by accessible sampling and were divided in experimental and control group. General health questionnaire [Goldberg and Hiller, 1979] was used in this study. Experimental group were trained during 11 sessions [each session was 45 minutes and two sessions in each week] then the results were analyzed by Multi variable covariance analysis. Results: The results of analysis of covariance showed that physical symptoms, anxiety and insomnia, disorder in social function, depression was reduced significantly [p>0/01] after attribution retraining intervention in comparison with control group. Discussion: It can be concluded that attributive retraining can increase epileptic children’s mental health and it seems that it would be an appropriate intervention for increasing epileptic children’s mental health

Prevalence of Tremors in Patients With Multiple Sclerosis: A Cross-Sectional Study in Isfahan, Iran

Background: Multiple Sclerosis (MS) is a demyelinating disorder of the central nervous system. Tremors are a common problem in the patients suffering from MS which is mostly observed in the arms but can also affect the other body parts. There have been few studies on tremors among the MS patients.  Objectives: This study is the first to report the prevalence of tremor in a group of MS patients in Iran. We have also reported the possible associations between the presence of tremor and different forms of ataxia.  Materials & Methods: This study was performed on a group of MS patients in Alzahra hospital, Isfahan, Iran. Patients were interviewed, and a neurologist carried out the neurological examinations, including the evaluation of the type of tremor with the help of Expanded Disability Status Scale (EDSS); ataxia clinical scale for dysmetria, dysdiadochokinesia, dysarthria and gait ataxia. Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) part 3.15 to 3.17 was also used for tremor classification. Tremor-related disability and handicap were scored by using Disability and Handicap Questionnaires.  Results: Out of the 164 patients, 113 had tremor (69%) of which 23 were males (20%), and 90 were females (80%). A strong correlation between tremor and ataxia was reported while there were no correlations between tremor and patient’s gender, type of MS or the first clinical presentation. Twenty-three of the 164 patients suffered from the incapacitating tremor and had serious problems doing certain tasks. We also reported tremor to greatly affect the daily activities. Conclusion: The frequency of tremor in MS is relatively high. Strong correlation is between tremor and ataxia but not with the gender, the type of MS or the first clinical presentation. The tremor of MS greatly affected the activities of the daily living

Efficacy and Safety of MLC601 in the Treatment of Mild Cognitive Impairment: A Pilot, Randomized, Double-Blind, Placebo-Controlled Study

Background and Aim: Mild cognitive impairment (MCI) is characterized by declined cognitive function greater than that expected for a person’s age. The clinical significance of this condition is its possible progression to dementia. MLC601 is a natural neuroprotective medication that has shown promising effects in Alzheimer disease. Accordingly, we conducted this randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of MLC601 in MCI patients. Methods: Seventy-two patients with a diagnosis of MCI were recruited. The included participants were randomly assigned to groups to receive either MLC601 or placebo. An evaluation of global cognitive function was performed at baseline as well as at 3-month and 6-month follow-up visits. Global cognitive function was assessed by Mini-Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) scores. Efficacy was evaluated by comparing global function scores between the 2 groups during the study period. Safety assessment included adverse events (AEs) and abnormal laboratory results. Results: Seventy patients completed the study, 34 in the MLC601 group and 36 in the placebo group. The mean changes (±SD) in cognition scores over 6 months in the MLC601 group were –2.26 (±3.42) for the MMSE and 3.82 (±6.16) for the ADAS-cog; in the placebo group, they were –2.66 (±3.43) for the MMSE and 4.41 (±6.66) for the ADAS-cog. The cognition changes based on both MMSE and ADAS-cog scores were statistically significant between the placebo and the MLC601 group (p < 0.001). Only 5 patients (14.7%) reported minor AEs in the MLC601 group, the most commonly reported of which were gastrointestinal, none of them leading to patient withdrawal. Conclusion: MLC601 has shown promising efficacy and acceptable AEs in MCI patients

Effectiveness and Safety of MLC601 in the Treatment of Mild to Moderate Alzheimer's Disease: A Multicenter, Randomized Controlled Trial

Background: MLC601 is a possible modulator of amyloid precursor protein processing, and in a clinical trial study MLC601 showed some effectiveness in cognitive function in Alzheimer's disease (AD) patients. We aimed to evaluate the effectiveness and safety of MLC601 in the treatment of mild to moderate AD as compared to 3 approved cholinesterase inhibitors (ChEIs) including donepezil, rivastigmine and galantamine. Methods: In a multicenter, nonblinded, randomized controlled trial, 264 volunteers with AD were randomly divided into 4 groups of 66; groups 1, 2, 3 and 4 received donepezil, rivastigmine, MLC601 and galantamine, respectively. Subjects underwent a clinical diagnostic interview and a cognitive/functional battery including the Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale - Cognitive subscale (ADAS-Cog). Patients were visited every 4 months, and the score of cognition was recorded by the neurologists. Results: There were no significant differences in age, sex, marital status and baseline score of cognition among the 4 groups. In total, 39 patients (14.7%) left the study. Trend of cognition changes based on the modifications over the time for MMSE and ADAS-cog scores did not differ significantly among groups (p = 0.92 for MMSE and p = 0.87 for ADAS-Cog). Conclusion: MLC601 showed a promising safety profile and also efficacy compared to 3 FDA-approved ChEIs