Guillain–Barré Syndrome as a Neurological Complication of COVID-19 Infection: A Case Series and Review of the Literature

Background: The novel coronavirus (COVID-19) is a global pandemic. Although the main clinical manifestations of the COVID-19 infection has confined to the respiratory system, there is some evidence suggesting the neuro-invasive potential of the COVID-19. There are limited reports of Guillain–Barré syndrome (GBS) as a peripheral nervous system complication of COVID-19 infection.Methods and results: We described four patients with COVID-19 infection who developed acute polyneuropathy with a final diagnosis of Guillain–Barré syndrome.Conclusion: COVID-19 may have the potential to invade the peripheral nervous system. GBS, as one of the critical neurological complications of COVID-19, could be considered as a post-infectious event

Sex differences in cerebral venous sinus thrombosis after adenoviral vaccination against COVID-19

Introduction: Cerebral venous sinus thrombosis associated with vaccine-induced immune thrombotic thrombocytopenia (CVST-VITT) is a severe disease with high mortality. There are few data on sex differences in CVST-VITT. The aim of our study was to investigate the differences in presentation, treatment, clinical course, complications, and outcome of CVST-VITT between women and men. Patients and methods: We used data from an ongoing international registry on CVST-VITT. VITT was diagnosed according to the Pavord criteria. We compared the characteristics of CVST-VITT in women and men. Results: Of 133 patients with possible, probable, or definite CVST-VITT, 102 (77%) were women. Women were slightly younger [median age 42 (IQR 28–54) vs 45 (28–56)], presented more often with coma (26% vs 10%) and had a lower platelet count at presentation [median (IQR) 50x109/L (28–79) vs 68 (30–125)] than men. The nadir platelet count was lower in women [median (IQR) 34 (19–62) vs 53 (20–92)]. More women received endovascular treatment than men (15% vs 6%). Rates of treatment with intravenous immunoglobulins were similar (63% vs 66%), as were new venous thromboembolic events (14% vs 14%) and major bleeding complications (30% vs 20%). Rates of good functional outcome (modified Rankin Scale 0-2, 42% vs 45%) and in-hospital death (39% vs 41%) did not differ. Discussion and conclusions: Three quarters of CVST-VITT patients in this study were women. Women were more severely affected at presentation, but clinical course and outcome did not differ between women and men. VITT-specific treatments were overall similar, but more women received endovascular treatment.</p

A case report of pulsatile tinnitus as a symptom of brain arteriovenous malformation

Pulsatile tinnitus is the result of blood flow related sounds transmitted to the inner ear and coincides with heartbeat. Although pulsatile tinnitus is a rare entity, this symptom is most often indicative of a serious underlying disease in central nervous system. Unfortunately, this symptom is often not properly assessed by clinician that leads to delayed diagnosis of underlying brain pathology. In this report, a patient is presented with chief complaint of tinnitus that had many medical visits for 2 years. Finally, a cerebral vascular malformation was diagnosed with regards to physical examination and neuroimaging findings. Keywords: Tinnitus, Bruit, Central Nervous System Vascular Malformation

Effect a negative score on the exam results: A case report

Background: The main assumption in the exam scoring system consists of multiple choice questions is that the number of choice is limited, so if the student don’t knows the correct answer can guess it. The most common way to stop guessing, assigning a negative score. Objective: The aim of this study was to investigate the effect of negative score on the results of an exam. Methods: This article is descriptive study of student score and grades before and after applying a negative score, and then again after the changes done by the Department of Basic Sciences. Encompassing 58 scores entered in SPSS v19 and analyzed using paired t-test was performed. To clarify the relationship between students rank, the Spearman correlation test was used. Findings: The mean score before and after applying a negative score, and then again after the changes done by the Department are 11.59 ± SD 2.34, 10.90 ± SD 2.14 and 12.45 ± SD 2.19, respectively. T test results showed statistically significant differences between the mean scores of the three modes. (P value for all three <0.001) Spearman correlation coefficients between three models are the 0.94, 0.94 and 0.98 (P value for all three <0.001) Conclusions: Although the use of correction formulas has its fans, but the results of this study and the related literature indicates, using the correct formula for the prevention of guessing is not recommended to increase the credibility and differentiation and other methods may be used. Keywords: negative scores, exam, Medical School, Multiple choice questio

Evaluation of prevalence of headache in Multiple Sclerosis patients before & after the disease

Background: Multiple Sclerosis disease is a chronic disease of nervous system which causes different symptoms. Although headache is not a major symptom of this disease, but a lot of patients suffer from it. To specify the prevalence of headache and its’ types has an important role in diagnose, treatment and improvement the quality of patients’ life. Objective: Our goal of this study was to determine the prevalence of headache in multiple sclerosis patients, before and after the diagnosis of this disease. Methods: This cross-sectional descriptive epidemiologic study was performed on 150 multiple sclerosis patients referred to the neurology clinic of Qazvin in 2015. Data were recorded by history taking & physical examination the existence of headache before the MS diagnosis and at the time of study was evaluated by the patients’ data. Findings: Among participants, prevalence of headache before the MS diagnosis was 40%, which increased to 64% after that (P<0.001). The most common type of headache, before and after the affection was tension headache, which formed 58.3% and 70.8% of all headaches, respectively. The average rate of headache in the group with headache, before and after the diagnosis of MS was 5.8 and 5.76 days in month, which calculated 2.32 and 3.68 days in month in all patients, respectively. Conclusion: Prevalence of headache increases in multiple sclerosis patients. Patients suffer from headache almost 13% of their life day

The relationship between aortic valve calcification and risk of ischemic stroke

Background: Although most previous studies did not confirm the relationship between aortic valve calcification (AVC) and ischemic stroke, there are some case reports about the importance of AVC in occurrence of ischemic stroke. Objective: To investigate the relationship between aortic valve calcification and risk of ischemic stroke. Methods: This case-control study includes 600 patients (300 cases and 300 controls) admitted at Qazvin’s Bu-Ali Hospital from April 2014 to February 2015. Cases were selected from acute ischemic stroke patients admitted to the hospital Emergency Department and the control group consisted of non-stroke patients referred to cardiology clinic. Two groups were matched for sex, age and other vascular risk factors. All participants underwent transthoracic echocardiography. AVC was scored according to scaling system proposed by previous studies. Demographic, clinical and laboratory characteristics of all participants were also collected and the relationship between these parameters and echocardiographic findings were analysed using dependent t and chi-squared tests. P<0.05 was considered significant. Findings: Mean age of participants was 65.12±12.41 years (46.2% man). In 153 of stoke patients (51%), AVC was detected but only 35 participants (17.7%) of control group showed this abnormality (P<0.001). In case and control groups, aortic insufficiency was 54.3% (n=163) and 18.3% (n=55) respectively (P<0.001). Left ventricular hypertrophy was also more frequent in stroke patients (41.8% vs. 20.7%, P<0.001). Other cardiovascular risk factors were more in the patients of case group. However, the difference wasn’t statistically significant between two groups. Conclusion: According to this study, AVC and aortic insufficiency are related to ischemic stroke occurrence. More studies are needed to confirm these findings. Keywords: Ischemic Stroke, Aortic Valve Calcification, Aortic Insufficiency, Echocardiograph

Arachnoid cyst with spontaneous chronic subdural hematoma: Case report

Arachnoid cysts are developmental cerebral disorders that are mostly asymptomatic and diagnosed accidentally on routine brain imaging. Sometimes, these cysts can lead to serious complications such as intracystic and subdural hemorrhage. These hematomas often occur after minor head trauma but in some cases, hemorrhagic complication can occur without obvious predisposing insult. Our reported case is a 19 years old man admitted with acute neurological signs and diagnosed as subdural hematoma and treated without any history of recent head trauma. The only risk factor causing bleeding was arachnoid cyst. Keywords: Arachnoid cyst, Subdural hematoma, Head traum

Identification of two novel homozygous nonsense mutations in TRAPPC9 in two unrelated consanguineous families with intellectual Disability from Iran

Background: Pathogenic mutations in TRAPPC9 are associated with autosomal recessive Intellectual Disability (ID), a major public health issue that affects about 1–3% of children worldwide. Method: Clinical evaluation, magnetic resonance imaging, peripheral blood karyotype, Multiplex ligation-dependent probe amplification (MLPA), array CGH, and whole-exome sequencing were used to characterize etiology in three patients from two unrelated consanguineous families of Iranian descent with intellectual disability. Results: Whole-exome sequencing showed two novel homozygous nonsense mutations (c.937C>T) in exon 3 and (c.3103C>T) in exon 19 of TRAPPC9 (NM_031466.7) in two unrelated consanguineous families. Conclusion: The two novel variants found in TRAPPC9 caused truncated protein and clinical manifestations such as ID, developmental delay, microcephaly, and brain abnormalities in three patient