Lacunar strokes: a single institutional experience

Abstract: Objective: Lacunar ischemic strokes comprise approximately 25% of all ischemic strokes. We compared the risk factors and clinical pattern of this type of stroke between males and females. Methods: This observational study involved 50 consecutive patients with their first-ever lacunar stroke and was conducted at the department of neurology of Sulaimaniya general teaching hospital, Iraq from December 1, 2010 to March 1, 2013. Patients&#146; risk factors, clinical presentation, and strokes&#146; patterns were noted and a comparison was made between males and females. Results: Males (64%) outnumbered females (36%) with a male to female ration of 1.7. The mean age of males was 63 years while it was 61 years in females. Although hypertension was more common in females than in males, diabetes and smoking were more common in the latter group; however, there were no statistically significant differences between the 2 genders in terms of hypertension (P-value <0.3) and diabetes (P-value < 0.07) while smoking was strongly associated with male gender (P-value<0.0001). Pure motor hemiparesis, ataxic hemiparesis, pure sensory stroke, and dysarthria-clumsy hand syndrome were more common in males; only senori-motor stroke revealed a statistically significant difference in favor males (P-value<0.0001; 95% CI -1.7 to 19.2). There was no statistically significant difference in terms of which side of the brain was infarcted between males and females (P-value<0.4). Conclusion: Males around the age of 63 years were the main target for these lacunar strokes. Cigarette smoking and sensorimotor strokes were significantly associated with male gender. [Cukurova Med J 2013; 38(4.000): 659-666

Acute Spontaneous Posterior Fossa Subdural Hematoma

Acute posterior fossa subdural hematomas are rare and most of them are trauma-related. Non-traumatic ones have been reported in patients who had idiopathic thrombocytopenic purpura or those who had been receiving anticoagulant therapy. We report on the case of 57-year-old Iranian man who developed sudden severe occipital headache, drowsiness, repeated vomiting, and instability of stance and gait. He was neither hypertensive nor diabetic. No history of head trauma was obtained and he denied illicit drug or alcohol ingestion. A preliminary diagnosis of acute intra-cerebellar hemorrhage was made. His CT brain scan revealed an acute right-sided, extra-axial, crescent-shaped hyperdense area at the posterior fossa. His routine blood tests, platelets count, bleeding time, and coagulation profile were unremarkable. The patient had spontaneous acute infratentorial subdural hematoma. He was treated conservatively and discharged home well after 5 days. Since then, we could not follow-up him, clinically and radiologically because he went back to Iran. Our patient&#146;s presentation, clinical course, and imaging study have called for conservative management, as the overall presentation was relatively benign. Unless the diagnosis is entertained and the CT brain scan is well-interpreted, the diagnosis may easily escape detection

Valproic acid: Does it have an antiarrhythmic action?

Objective: The antiepileptic sodium valproate (valproic acid; VPA) is thought to possess an antiarrhythmic action. We aimed to explore whether this medication influences cardiac atrial ectopics or not. Methods: From December 1, 2009 to June 1, 2011, 80 consecutive patients who were newly diagnosed with cryptogenic generalized tonic-clonic seizures were enrolled in this prospective short-term longitudinal observational study, which was conducted at the Sulaimaniya General Teaching Hospital, Iraq. Forty patients were allocated to receive VPA and the rest (n=40) were given placebo. All patients underwent cardiac 24-hour Holter monitoring before and after one week of VPA or placebo administration. The minimum heart rate (MiHR) and maximum heart rate (MxHR) as well as the total number of atrial ectopics (TNAE) were evaluated. Results: VPA significantly reduced the MiHR, MxHR, and the TNAE. In the placebo group, the reduction in the MiHR was statistically significant while the reduction in the MxHR and the TNAE were not. However, the reduction in the target parameters in the VPA-treated group did not demonstrate a dose-dependent effect. When both groups were evaluated head-to-head for the reduction in the MiHR before and after week of therapy, there was no statistically significant difference between them. Conclusion: Sodium valproate therapy appears to be effective against atrial ectopic beats and may be used as an antiarrhythmic medication in patients who co-experience seizures and troublesome atrial ectopics. [Cukurova Med J 2013; 38(4.000): 592-600

Rheumatoid Arthritis and the Ankle-Brachial Pressure Index: Any Association?

Purpose: Several studies tried to assess the influence of rheumatoid arthritis (RA) on peripheral arteries and found an association with later development of intimal thickness and atherosclerosis. We tried to uncover the prevalence of subclinical peripheral vascular disease (PVD) in rheumatoid arthritis patients. Materials and Methods: This case control-study had involved sixty patients who were diagnosed with rheumatoid. Forty age, gender, and body mass index-matched healthy individuals were selected as the control group. All participants were non-smokers, non-hypertensive, and non-diabetics and had a normal lipid profile. The presence of peripheral arterial disease was evaluated by measuring the ankle-brachial pressure index (ABPI) at the level of each artery of the lower limbs. An index of &#8804;0.9 was considered abnormal and a possible reflection of an underlying PVD. Results: Twenty three (38%) out of the 60 RA patients demonstrated one or more abnormal arteries while only 3 (7.5%) out of the 40 control individuals had abnormal results (p-value <0.001). A statistically significant association was noted between abnormal ABPI and RA disease severity as indicated by C-reactive protein (P-value <0.003), ESR (P-value <0.002), and positive serum rheumatoid factor (P-value <0.01). However, age, gender, and disease duration showed no link with abnormal ABPI. Conclusion: A higher prevalence of abnormal ABPI, and hence a possible higher incidence of subclinical atherosclerosis, was found in patients with RA. Further analytic studies are required to assess the relationship of RA with PVD

Vague behavioral and personality changes and a misdiagnosis of complex partial epilepsy

Pancreatic insulinomas are rare endocrine tumors and their diagnosis needs a high index of suspicion. Several patients receive an initial misdiagnosis before the tumor is being finally detected. We report on two patients who presented with vague and bizarre personality and behavioral changes. One patient was initially diagnosed with hysteria and both eventually were diagnosed with complex partial epilepsy. They had not improved on anti-epileptic medications and their symptomatology continued to deteriorate. Their final diagnosis turned out to be pancreatic insulinoma. Because of the rarity of insulinomas as well as their diverse and non-pathognomonic symptoms, the diagnosis remains challenging and may quite well escape detection unless it is entertained. [Cukurova Med J 2014; 39(4.000): 860-867