Physiopathology of Dementia From the Perspective of Traditional Persian Medicine

The most common cognitive disorder that is disabling is dementia. During the medieval period, traditional Persian medicine was an outstanding source of medicine that was used as standard references in medical schools of in the West and Middle East. In ancient manuscripts of traditional Persian medicine, a condition has been introduced similar to dementi (raoonat and homgh). In this article, by collecting materials of traditional medicine texts on dementia, we aim to provide theories for further studies on this topics, as there is an obvious difference between traditional Persian medicine and modern medicine with regard to dementia; however, since modern medicine has not found a suitable response to treatment for all diseases, reviewing traditional Persian medicine for finding better treatment strategies is wise. Use of all medical potentials approved by the World Health Organization beside classic medicine like traditional medicine and considering the availability and acceptability among people is recommended

Prognostic Value of Doppler Ultrasound Findings in Patients with Middle Cerebral Artery Ischemic Stroke

Background: There is still no finding available about malignant clinical course in patients with middle cerebral artery stroke. The aim of this study was to compare Doppler ultrasound findings in patients with malignant and non-malignant middle cerebral artery stroke in order to obtain its prognostic value in detecting malignant course. Methods: This cross-sectional study was conducted on 40 patients with acute ischemic stroke in Shafa Hospital in Kerman, Iran, 2017. All patients were admitted within 24 hours of the onset of symptoms, and brain CT-scan was performed to confirm ischemic stroke. If more than 50% of the middle cerebral artery showed signs of hypo-density, it was considered as the massive MCA infarction (MMI), while others were excluded. In the first 24 hours, transcranial Doppler ultrasound was performed for all patients. Patients were then examined until discharge or death. In the case of fixed unilateral mydriasis in the clinical course or a displacement of more than 5 mm in septum pellucidum in the control CT-scan on days 3 to 7 (depending on the changes in the consciousness level), m-MCAI was diagnosed. Data were analyzed using SPSS. Results: In the malignant cases, the mean PSV and MFV in MCA in the contralateral side of the lesion were significantly higher than those in the non-malignant cases. A significant increase in mean PSV and MFV in ACA in the contralateral side of the lesion was found in the malignant cases compared to the non-malignant cases (P=0.01). Significant difference was observed in terms of mean RI of ICA of contralateral side of the lesion between malignant and non-malignant cases (P=0.02). Conclusion: Our study showed increase in PSV and MFV in MCA and ACA in the contralateral side of the lesion in cases that lead to malignancy, which can be helpful in early identification of cases that advance to malignancy

The Effects of Citicoline on Cerebrovascular Hemodynamic Status in Ischemic Stroke Patients

Introduction: Some recent studies have shown that citicoline improves clinical symptoms in patients with stroke. Citicoline's mechanism of action in improving the clinical symptoms is not recognized yet. The aim of this study was to evaluate the cerebrovascular hemodynamic status in patients with ischemic stroke treated with citicoline compared with the control group. Methods: In this study, 64 patients (20 male, 44 female) with supratentorial ischemic stroke were included. Patients underwent transcranial and extra cranial ultrasonography within 24 hours of admission and were divided into two equal groups (32 patients per group). One group was treated with citicoline (500 mg/day) and the second group was treated with placebo for one week. Then, patients underwent transcranial and extra cranial ultrasonography again. Data were analyzed by paired t-test and independent t-test. Results: In this study, no significant difference between the groups in terms of age, gender, cardiovascular factors and NIHSS was observed. Peak systolic velocity (PSV) in RCCA, RICA, RVA, LVA, and mean flow velocity (MFV) in RICA and LACA were significantly different between two groups. As there was no significant difference in confounding variables between the two groups, therefore, the difference in PSV and MFV between the groups may be due to citicoline. Conclusion: Prescription of citicoline for treatment of acute ischemic stroke is associated with hemodynamic changes in cerebral arteries. This finding can be one of the citicoline's mechanisms of action in ischemic stroke process

The Effects of Citicoline on Cerebrovascular Hemodynamic Status in Ischemic Stroke Patients

Introduction: Some recent studies have shown that citicoline improves clinical symptoms in patients with stroke. Citicoline's mechanism of action in improving the clinical symptoms is not recognized yet. The aim of this study was to evaluate the cerebrovascular hemodynamic status in patients with ischemic stroke treated with citicoline compared with the control group. Methods: In this study, 64 patients (20 male, 44 female) with supratentorial ischemic stroke were included. Patients underwent transcranial and extra cranial ultrasonography within 24 hours of admission and were divided into two equal groups (32 patients per group). One group was treated with citicoline (500 mg/day) and the second group was treated with placebo for one week. Then, patients underwent transcranial and extra cranial ultrasonography again. Data were analyzed by paired t-test and independent t-test. Results: In this study, no significant difference between the groups in terms of age, gender, cardiovascular factors and NIHSS was observed. Peak systolic velocity (PSV) in RCCA, RICA, RVA, LVA, and mean flow velocity (MFV) in RICA and LACA were significantly different between two groups. As there was no significant difference in confounding variables between the two groups, therefore, the difference in PSV and MFV between the groups may be due to citicoline. Conclusion: Prescription of citicoline for treatment of acute ischemic stroke is associated with hemodynamic changes in cerebral arteries. This finding can be one of the citicoline's mechanisms of action in ischemic stroke process

Outpatient treatment of migraine headache, can we use a dexamethasone containing regimen?

<ul> <li><strong>BACKGROUND</strong>: This research is aimed at determining the efficacy of intravenous dexamethasone and metoclopramide for treatment of acute migraine. Dexamethasone is a well-known drug for treatment of long lasting and recurrent migraine headaches. Metoclopramide is also used singularly or as an adjunct to treat the migraine attacks.</li> <li><strong>METHODS</strong>: In a simple randomized study, patients with acute migraine were administered either intravenous dexamethasone and metoclopramide or intramuscular dihydroergotamine. Headache and concurrent symptoms were rated at baseline and 1, 2, 4 and 24 hours post-injection. .</li> <li><strong>RESULTS</strong>: Analysis of headache severities indicated significant alleviation in both groups with time (p < 0.001). Side effects and concurrent symptoms did not show any significant difference between the two studied groups.</li> <li><strong>CONCLUSIONS</strong>: In emergency department, intravenous dexamethasone and metoclopramide may be considered as an effective and available treatment with few side effects especially for patients with long-lasing and intractable migraine attacks; however, it must be used limitedly.</li> <li><strong>KEYWORDS</strong>: Dexamethasone, metoclopramide, dihydroergotamine, migraine.</li> </ul&gt

A brain on a roller coaster: can the dopamine reward system act as a protagonist to subdue the ups and downs of bipolar disorder?

One of the most interesting but tenebrous parts of the bipolar disorder (BD) story is the switch between (hypo) mania and depression, which can give bipolar patients a thrilling, but somewhat perilous, ‘ride’. Numerous studies have pointed out that there are some recognizable differences (either state-dependent or state-independent) in several brain regions of people with BD, including components of the brain’s reward system. Understanding the underpinning mechanisms of high and low mood statuses in BD has potential, not only for the development of highly specific and selective pharmaceutical agents, but also for better treatment approaches and psychological interventions to manage BD and, thus, give patients a safer ride. Herein, we review evidence that supports involvement of the reward system in the pathophysiology of mood swings, with the main focus on the mesocorticolimbic dopaminergic neural circuitry. Principally using findings from neuroimaging studies, we aim to signpost readers as to how mood alterations may affect different areas of the reward system and how antipsychotic drugs can influence the activity of these brain areas. Finally, we critically evaluate the hypothesis that the mesocorticolimbic dopamine reward system may act as a functional rheostat for different mood states