Predictive value of variation in blood flow of the middle cerebral artery measured using transcranial Doppler sonography in patients with acute brain stroke

چکیده: زمینه و هدف: سونوگرافی داپلرترانس‌کرانیال (TCD) روشی غیر تهاجمی، ارزان، سریع و مفید در ارزیابی و تعیین محـل ایجاد پـاتولـوژی در بیماران مبتلا بـه سکتـه مغـزی حـاد بخصوص در محدوده شریان مغزی میانی (MCA) است. این تحقیق با هدف بررسی ارزش پیشگویی مقایسه وضعیت همودینامیک شریان مغزی میانی توسط سونوگرافی داپلر ترانس کرانیال و بررسی روند بهبود عملکرد این بیماران در طی 1 و 6 ماه بعد از شروع بیماری انجام شد. روش‌ بررسی: در یک مطالعه آینده نگر تعداد 102 بیمار مبتلا به سکته مغزی حاد مراجعه کننده به بخش نورولوژی بیمارستان سینا شهر همدان در طی سال 1384 مورد بررسی قرار گرفتند. جهت تمامی بیماران اقدامات درمانی معمول و CT Scan بدون ماده‌ی حاجب همچنین سونوگرافی داپلرترانس کرانیال در 24 ساعت اول بستری انجام گردید. بیماران بر حسب اطلاعات TCD به سه گروه دارای خونرسانی طبیعی دو طرفه (گروه اول)، خونرسانی غیر طبیعی یک طرفه (گروه دوم) و خونرسانی کاهش یافته دو طرفه (گروه سوم) تقسیم شدند. عملکرد حرکتی بیماران در طول بستری، یک ماه و 6 ماه بعد از ترخیص توسط یک متخصص نورولوژی مورد ارزیابی قرار گرفت. داده ها با استفاده از آزمون آماری کروسکال والیس تجزیه و تحلیل شد. یافته ها: میانگین سنی بیماران 67/12±39/65 سال و 48 مرد بودند. عملکرد حرکتی در سمت گرفتار، در هر سه گروه دارای روند بهبودی معنی‌داری بود (05/0

Epidemiologic assessment of trigeminal neuralgia in patients referred to the Imam clinic of Hamedan city during 2013-2015

Background: Trigeminal neuralgia is the most common disease of the fifth cranial nerve. This study aimed at evaluating the epidemiology of patients with the trigeminal neuralgia referred to Imam Clinic in Hamedan City, Iran. Materials and Methods: In this descriptive cross-sectional study, 40 patients with trigeminal neuralgia symptoms were studied. Diagnosis of patients was made based on the history, physical examination and paraclinical tests. Results: This study was conducted on 27 (67.5) females and 13 (32.5) males with the mean ages of 43.3±16.9 and 51.7±21.5 years, respectively (P=0.526).The incidence of this disease was higher among young women than others. The right side involvement was detected in 47.5, left side involvement in 40 and bilateral involvement in 12.5 of the cases. Regarding the engaged nerve branch, simultaneous engagement of maxillary and mandibular nerves was seen in 47.5, mandibular in 27.5, maxillary in 20, and ophthalmic in 5 of the individuals. The primary causes were seen in 42.5 and secondary causes in 57.5 of the cases. Among the secondary causes, face surgery and multiple sclerosis had the highest rate (39.1), followed by tumors (21.7). Also, 65 of the patients had normal MRI and 35 had abnormal one. Conclusion: Due to the similar symptoms of the disease such as dental pain, and also maxillofacial surgery in the elderly as one of the most common secondary causes of this disease, facial surgeons and dentists should know more about this disease to avoid unnecessary surgeries

Učinak atorvastatina na debljinu arterijske intime medije u bolesnika s ishemijskim moždanim udarom

Occlusion of the initial segment of internal carotid artery is the most common reason for vascular events in the brain. The purpose of this study was to investigate the effect of oneyear treatment with atorvastatin on intima-media thickness (IMT) of carotid arteries as a measure of atherosclerosis in stroke patients. In this prospective interventional study, 44 patients with ischemic stroke were investigated. Patients were treated with atorvastatin 40 mg once a day for one year. IMT of carotid arteries was measured by extracranial Doppler ultrasonography in the distal part of the common carotid artery at the beginning of the study, at 6 months and one year of treatment with atorvastatin. The IMT of both right and left carotid arteries decreased after 6- and 12-month atorvastatin treatment. Based on the results of this study, long-term administration of atorvastatin was associated with reduction in carotid artery IMT in patients with ischemic stroke. Such a decrease in IMT may prevent subsequent stroke or cardiovascular events in these patients.Blokada početnog dijela interne karotidne arterije najčešći je razlog vaskularnih ispada u mozgu. Namjera ovoga istraživanja bila je ispitati učinak jednogodišnje terapije atorvastatinom na debljinu intime medije (intima-media thickness, IMT) karotidnih arterija kao mjere ateroskleroze kod bolesnika s moždanim udarom. U ovoj prospektivnoj intervencijskoj studiji ispitana su 44 bolesnika s ishemijskim moždanim udarom. Bolesnici su liječeni atorvastatinom, 40 mg jedanput na dan kroz jednu godinu. IMT karotidnih arterija mjeren je ekstrakranijskom Doppler ultrasonografijom u distalnom dijelu zajedničke karotidne arterije na početku istraživanja te nakon 6 mjeseci i 12 mjeseci liječenja atorvastatinom. Zabilježeno je sniženje IMT i u desnoj i u lijevoj karotidnoj arteriji nakon 6 mjeseci i 12 mjeseci liječenja atorvastatinom. Rezultati ovoga istraživanja pokazuju da je dugotrajno uzimanje atorvastatina bilo udruženo sa smanjenjem IMT karotidnih arterija u bolesnika s ishemijskim moždanim udarom. Takvo sniženje IMT moglo bi spriječiti naknadni moždani udar ili kardiovaskularne ispade kod ovih bolesnika

The Comparative Study of Efficiency of Intravenous Heparin and Oral Aspirin on 48 Hours Beginning Primary Medication in Ischemic Stroke Patients

Objective: This study was done for comparing efficiency of Intravenous Heparin and Oral Aspirin among patients who had cerebral thrombi embolitic vascular accidents. Effectives of Heparin and Aspirin on prognosis and recovery of these patients were evaluated. Materials & Methods: This study was a clinical randomized trial. Patients were classified randomly in one of the heparin (n=32) and one group Aspirin (n=30) treatment. At first in the Heparin treatment group, patients were medicated by Heparin 100 IU/kg and then it was followed by 1000IU/hour for 48 hours. In the Aspirin treated group, whom took 325mg/day for 48 hours. The effectiveness of both treatments were evaluated after 48 hours on neuro-muscular, speech, vision, and sphincter function. Results: The results showed that both treatments were effective on improvement of neuro-muscular, speech, vision, and sphincter function, while Heparin effectiveness was more than Aspirin. Improvement of Nervous function in the Heparin group was 43.8% in compare of 33.3% for Aspirin (p=0.40). In addition, in the Heparin treatment group 56.3% of muscular dysfunction was attained optimum muscular function in compare of 33.3% with Aspirin (p=0.001). It was found significant relation for improvement of speech function in Heparin treatment group (P=0.01). There were not a significant finding relation for improvement of vision, and sphincter function between Heparin and Aspirin treated groups. Conclusion: Beginning primary medication with Heparin would be effective for achieving optimum function among patients with cerebral thrombi embolitic vascular accidents

Effect of intravenous sodium valproate vs dexamethasone on acute migraine headache: a double blind randomized clinical trial.

Despite the impact of sodium valproate and dexamethasone on migraine headache, the efficacy of the two drugs has not been properly investigated and compared. This trial compared the effect of the two drugs on acute migraine headache.This double blind randomized clinical trial was conducted on patients aged 18 to 65 years with acute migraine headache who referred to the emergency departments of Beasat and Farshchian Hospitals in Hamadan, Iran, from April 2012 to June 2014. Patients were randomly assigned to receive a single-dose of either 400 mg sodium valproate or 16 mg dexamethasone plus 50 ml saline normal solution within 15 min intravenously. The severity of headache in the two groups was evaluated at baseline, 0.5 and 2 hours later using the Visual Analog Scale (VAS) on a scale of 0 to 10.Of 104 patients enrolled, 72 patients remained for analysis. The effect of both sodium valproate and dexamethasone on acute migraine headache was statistically significant at 0.5 and 2 hours post-treatment compared to pre-treatment (P=0.001). The severity of headache based on VAS reduced form 8.20 (7.72, 8.68) before treatment to 5.31 (4.74, 5.89) and 3.66 (2.99, 4.33) at 0.5 and 2 hours after treatment, respectively, in patients receiving sodium valproate and from 8.46 (8.05, 8.86) before treatment to 5.46 (4.81, 6.11) and 3.59 (2.84, 4.35) at 0.5 and 2 hours after treatment, respectively, in patients receiving dexamethasone. Both drugs were highly effective in improvement of acute headache in patients without aura. However, sodium valproate significantly improved the acute headache in patients with aura but dexamethasone did not. The severity of headache based on VAS reduced form 8.50 (7.40, 9.60) before treatment to 4.67 (2.40, 6.93) and 3.50 (1.78, 5.22) at 0.5 and 2 hours after treatment, respectively, in patients with aura receiving sodium valproate and from 8.80 (7.76, 9.84) before treatment to 7.20 (4.98, 9.42) and 6.20 (2.43, 9.97) at 0.5 and 2 hours after treatment, respectively, in patients with aura receiving dexamethasone.This trial indicated that, in overall, intravenous sodium valproate is not superior to intravenous dexamethasone in treatment of acute migraine attacks. However, in patients with aura, only sodium valproate but not dexamethasone is effective in headache relief. This issue needs further investigations.ClinicalTrials.gov IRCT201202199014N1

Flowchart of progress through the trial.

<p>Flowchart of progress through the trial.</p

The effect of sodium valproate (n = 35) compared to dexamethasone (n = 37) on acute migraine headache, based on the VAS mean score of 1 to 10, using univariate (t-test) and repeated measures ANOVA analysis.

<p>The effect of sodium valproate (n = 35) compared to dexamethasone (n = 37) on acute migraine headache, based on the VAS mean score of 1 to 10, using univariate (t-test) and repeated measures ANOVA analysis.</p

Box plots based on the VAS mean score of 1 to 10 for migraine headache across intervention groups including sodium valproate (n = 35) and dexamethasone (n = 37)

<p>Box plots based on the VAS mean score of 1 to 10 for migraine headache across intervention groups including sodium valproate (n = 35) and dexamethasone (n = 37)</p

The effect of sodium valproate (n = 35) and dexamethasone (n = 37) on acute migraine headache pre-treatment compared to 0.5 and 2 hours post-treatment, based on the VAS mean score of 1 to 10, using a t-test.

<p>The effect of sodium valproate (n = 35) and dexamethasone (n = 37) on acute migraine headache pre-treatment compared to 0.5 and 2 hours post-treatment, based on the VAS mean score of 1 to 10, using a t-test.</p

Comparison of the treatment side effects among sodium valproate and dexamethasone groups 2 hours post-treatment.

<p>Comparison of the treatment side effects among sodium valproate and dexamethasone groups 2 hours post-treatment.</p