The role of D-dimer in diagnosis of cerebral sinus venous thrombosis

Background: Cerebral sinus venous thrombosis (CSVT) is a fatal condition and should be considered in all patients with acute new onset headache. D-dimer has been shown to be a sensitive diagnostic tool in deep vein thrombosis and pulmonary thromboembolism. The purpose of this study was to investigate whether this test could be useful in the diagnosis of CSVT.Methods: In this prospective study, we reviewed patients referring to Nemazee hospital with presentations suggestive of CSVT. Diagnosis was established, using MRI and MRV. Serum D-dimer level was checked among 24 hours after hospital admission.Results: From 117 enrolled patients, 37 (31.6%) patients had CSVT. The reported D-dimer levels showed negative (< 500 ng/ml) in 21 (56.76%) and positive level in 16 (43.24 %) patients who had CSVT. Also, D-dimer was negative in 66 (82.5%) and positive in 14 (17.5%) patients who did not have CSVT. These results demonstrated a sensitivity of 43.24%, specificity of 82.5%, positive predictive value of 53.3%, and negative predictive value of 75.86%.Conclusion: Normal D-dimer levels make the presence of CSVT very unlikely; our study suggests that D-dimer test may guide us to approach patients who are suspected with CSVT in emergency situations with limited access to MRI/MRV. However, every patient with D-dimer level more than 500 ng/mL and high clinical suspicion of CSVT should undergo MRI/MRV. In addition, our results showed a negative D-dimer test was not a reliable assay to completely rule out CSVT. However, we recommend further studies to confirm our results

The Hospitalization Rate of Cerebral Venous Sinus Thrombosis before and during COVID-19 Pandemic Era: A Single-Center Retrospective Cohort Study

Objectives: There are several reports of the association between SARS-CoV-2 infection (COVID-19) and cerebral venous sinus thrombosis (CVST). In this study, we aimed to compare the hospitalization rate of CVST before and during the COVID-19 pandemic (before vaccination program). Materials and methods: In this retrospective cohort study, the hospitalization rate of adult CVST patients in Namazi hospital, a tertiary referral center in the south of Iran, was compared in two periods of time. We defined March 2018 to March 2019 as the pre-COVID-19 period and March 2020 to March 2021 as the COVID-19 period. Results: 50 and 77 adult CVST patients were hospitalized in the pre-COVID-19 and COVID-19 periods, respectively. The crude CVST hospitalization rate increased from 14.33 in the pre-COVID-19 period to 21.7 per million in the COVID-19 era (P = 0.021). However, after age and sex adjustment, the incremental trend in hospitalization rate was not significant (95% CrI: -2.2, 5.14). Patients \u3e 50-year-old were more often hospitalized in the COVID-19 period (P = 0.042). SARS-CoV-2 PCR test was done in 49.3% out of all COVID-19 period patients, which were positive in 6.5%. Modified Rankin Scale (mRS) score ≥3 at three-month follow-up was associated with age (P = 0.015) and malignancy (P = 0.014) in pre-COVID period; and was associated with age (P = 0.025), altered mental status on admission time (P\u3c0.001), malignancy (P = 0.041) and COVID-19 infection (P = 0.008) in COVID-19 period. Conclusion: Since there was a more dismal outcome in COVID-19 associated CVST, a high index of suspicion for CVST among COVID-19 positive is recommended

Epidemiology of familial multiple sclerosis in Iran: a national registry-based study

Background Admittedly, little is known about the epidemiological signatures of familial multiple sclerosis (FMS) in different geographical regions of Iran. Objective To determine the epidemiology and the risk of FMS incidence in several provinces of Iran with a different ethnic population including, Fars, Tehran, Isfahan (Persians), and Mazandaran (Mazanis), Kermanshah (Kurds), and Chaharmahal and Bakhtiari (Lors). Methods This cross-sectional registry-based study was performed on nationwide MS registry of Iran (NMSRI) data collected from 2018 to 2021. This system, registers baseline characteristics, clinical presentations and symptoms, diagnostic and treatments at regional and national levels. Results A total of 9200 patients including, 7003 (76.1%) female and 2197 (23.9%) male, were participated. About 19% of patients reported a family history of MS; the order from highest to lowest FMS prevalence was as follows: Fars (26.5%), Chaharmahal and Bakhtiari (21.1%), Tehran (20.5%), Isfahan (20.3%), Mazandaran (18.0%), and Kermanshah (12.5%). Of all FMS cases, 74.7% (1308 cases) were female and 25.3% (442 cases) were male. FMS occurrence was much more common in females than males (P-value = 0.001). Further, the mean age at onset was 30 years among FMS cases. A substantially higher probability of relapsing-remitting MS and secondary-progressive MS was found among FMS cases than sporadic MS (SMS) (P_value = 0.001). There was no significant difference in Expanded Disability Status Scale (EDSS) scores between FMS and SMS. The majority of FMS cases were observed among first-degree relatives, with the highest rate in siblings. There was a significant association between MS risk and positive familial history in both maternal and paternal aunt/uncle (P_value = 0.043 and P_value = 0.019, respectively). Multiple sclerosis occurrence among offspring of females was higher than males (P_value = 0.027). Conclusions In summary, our findings imply a noteworthy upward trend of FMS in Iran, even more than the global prevalence, which suggests a unique Atlas of FMS prevalence in this multi-ethnic population. Despite the highest rate of FMS within Persian and Lor ethnicities, no statistically significant difference was observed among the provinces

Coarse Tremor as the Only Sign of Perinatal Hemorrhagic Stroke: A Case Report

Background: Tremor which is the most common abnormal movement in the neonatal period might be a benign condition or the result of pathologic events and is divided into two subtypes, namely fine tremor and coarse tremor. Fine tremor is usually benign and results from some metabolic disturbance, such as hypoglycemia. On the other hand, coarse tremor is an indicator of brain insult and should be regarded as a central pathology comparable to intracranial hemorrhage and hypoxic-ischemic encephalopathy and requires further evaluations. Stroke is one of the most important associated pathologies that are readily missed in the neonatal period. The possibility of stroke should be suspected in all newborns in the presence of coarse tremor.Case report: Here, we will present a newborn with perinatal hemorrhagic stroke who was in good condition after birth with Apgar score of 9 and normal vital signs, birth weight, head circumference, length, and primitive reflexes; however, he had coarse tremor in both upper extremities in physical examination as the only sign of the hemorrhagic stroke.Conclusion: It is recommended that neonates with coarse tremor be investigated more carefully to rule out the structural brain pathology

One Year Survival and Quality of Life in Patients Successfully Discharged From Neuro Critical Care Unit

Objectives: Neuro-critical Intensive Care Units (NICUs) have functioned to deliver intensive medical care services for patients with acute neurology problems. However, physicians and ICU staff do not have any feedback about their patients and their abilities after successful discharge. Various studies have documented short-term survival in ICUs, but the long-term outcome and quality of life (QOL) are less studied. Methods: This is a retrospective cohort study over a period of one year from February 2011 to February 2012 (Shiraz, South of Iran). Patients' charts were used to collect the data. Survival and QOL after one year following NICU admission were assessed for surviving patients by a telephone interview with patients or their family members using Karnofsky Performance Scale (KPS).  Results: Out of 93 patients, 42(45.2%) were male, and 51(54.8%) were female. Malignant ischemic stroke (34%) was the most common cause followed by Guillain Barre Syndrome (21%). Among the living successfully discharged patients, 45% were able to perform normal activity and work without any special assistance. The patients who were unable to work were 28%, but they were able to live at home and care for their most personal needs. The patients who were unable to care for themselves were 3% and required institutional or hospital care. Over one year following discharge, 24% patients were passed away. Discussion: is lower in NICU survivors compared with general population; however, if patients' selection and out of hospital care are done appropriately and continuously, more patients can live independently or even come back to their work. Indeed, it is important to identify patients who benefit more from NICU during decision making for ICU admission. As a result, more efficient rehabilitation could be achieved in the future. However, our conclusions are only related to our ward and do not apply to the total population of critical neurology patients

Sneddon Syndrome with the Initial Presentation of Intracranial Hemorrhage: A Case Report

Sneddon syndrome (SS) is characterized by chronic, progressive arteriopathy, which causes ischemic stroke and skin lesions. It seems that thrombotic or embolic processes in the vessels may be involved in the pathology of this syndrome. Neurological symptoms always occur due to the ischemic events of the cerebrovascular system, and the associated cutaneous manifestations include deep blue skin lesions with irregular margins, known as livedo reticularis and livedo racemosa. Despite the ischemic events, hemorrhagic cerebral accidents are unusual in SS. Our case was apparently a normal woman with negative medical history who, despite the normal ischemic cerebral manifestations, initially presented with intracranial hemorrhage, which progressed to new skin lesions (livedo reticularis) after a few days. In the follow-up, the patient was diagnosed with SS

Multiple Sclerosis Diagnosed in a Woman With Von-Willebrand Disease: A Case Report

Background: Von-Willebrand Disease (VWD) is the most common inherited bleeding disorder with an autosomal inheritance pattern. Multiple Sclerosis (MS) is a neurological disease, causing neurodegeneration and demyelination of the central nervous system through autoimmune mechanisms, and is a major cause of non-traumatic disabilities in youths. Some studies have shown the higher plasma activity of Von-Willebrand Factor in the active phase of MS. However, we could not find any study reporting co-occurrence of VWD and MS. Case Presentation and Intervention: In this case report, we present a woman with VWD who had optic neuritis 8 years ago and a new onset right-side hemiparesis. She was finally diagnosed as a new case of MS. Conclusion: There is a case of both VWD and MS; however, further investigation is needed regarding the association of VWD and MS