An Undiagnosed Case of Hypothalamic Hamartoma with a Rare Presentation.

Background. Hypothalamic hamartomas (HHs) are rare tumor-like malformations that may present with complex partial seizures refractory to anticonvulsants in adulthood. The condition may be misdiagnosed because of rarity. Case Presentation. We report a 25-year-old man with complaint of seizures presented by falling, tonic spasm of limbs, oral automatism, vocalization, and hypermotor activities. His seizures started at the age of one month and presented as eye deviation and upper limbs myoclonic jerk, followed by frequent seizures with variable frequency. The patient had delayed developmental milestones and was mentally retarded. He was hospitalized and underwent video-EEG monitoring and neuroimaging, and the diagnosis of HH was made. The patient became candidate for surgery after that. Conclusion. In this case, the underlying etiology of seizures was diagnosed after 25 years. HH is a rare condition and neurologists may encounter very small number of these cases during their practice. Therefore, they should consider it in patients who present with suspected signs and symptoms

Hemiballismus, Hyperphagia, and Behavioral Changes following Subthalamic Infarct

The function of subthalamic nucleus (STN) which is a part of the basal ganglia system is not clear, but it is hypothesized that this component might be involved in action selection. Unilateral damage to STN, which can commonly occur due to the small vessel stroke mainly, causes hemiballismus and sometimes hemichorea-hemiballismus. This paper deals with a 60-year-old patient with sudden onset of abnormal movements in his right limbs. He had increased appetite and hyperphagia and also developed mood and behavioral changes (aggressiveness, irritability, anxiety, and sometimes obscene speech). The magnetic resonance imaging revealed infarct area in left subthalamus. In our case, hemiballismus is caused by infarction in left subthalamic area. Occurrence of irritability, anxiety, and some behavioral changes such as aggressiveness and obscene speech can be explained by impairment of STN role in nonmotor behavior and cognitive function as a result of infarct

Clinical Epidemiologic Study of Admissions due to Neurologic Diseases during and after Ramadan Fasting, Sari, Iran, 2015

Background and purpose: Studies on neurological diseases in Ramadan reported different incidence rates, diurnal pattern, and risk factors. This study aimed at comparing the incidence of neurological diseases and their related factors in Ramadan and Shaval. Materials and methods: This cross-sectional study was performed in patients ≥16 years of age attending the Emergency Department in Sari Bu Ali Sina Hospital, from the 1st of Ramadan until the 30th of Shaval in 2015. Demographic data and other information associated with neurologic disorders were recorded using face-to-face interviews and the patient’s files. Results: In this study, the number of people hospitalized with neurological disorders was 166 during Ramadan and 150 in Shaval. There was no significant difference between the two months studied in frequency of admissions due to neurologic diseases (P=0.68). The most common diseases in Ramadan and Shaval were ischemic stroke (36.7% and 40%), seizure (27.1% and 23.3%), and headache (12% and 14.7%), respectively. We did not find any significant differences in gender, age, marital state, incidence and admission time, and risk factors for neurologic diseases between Ramadan and Shaval (P >0.05). Conclusion: In this study, the admission rate of most of neurological diseases were not significantly different in Ramadan and Shaval. Providing appropriate medical advices could considerably prevent neurological disorders in Ramadan

Relationship between Mitochondrial Dysfunction and Multiple Sclerosis: A Review Study

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system that inflammation, demyelination, oligodendrocyte loss, gliosis, axonal injury and neurodegeneration are the main histopathological hallmarks of the disease. Although MS was classically thought as a demyelinating disease, but axonal injury occurs commonly in acute inflammatory lesions. In MS microglial activation is not only responsible for inflammatory cascade but also creates degenerative cascade. The evidence has shown mitochondrial dysfunction plays an important role in axonal degeneration in all stages of MS due to neuronal cell loss and activation pro-inflammatory cytokines. Neuronal loss occurs as a result of apoptosis and necrosis and mitochondrial pathway is the main important system for apoptosis and this way was involved in neurodegenerative disorders such as MS. Hence in multiple sclerosis, mitochondrial dysfunction causes energy failure and then increases inflammation and demyelination in neurons

Ischemic Stroke as a Rare Manifestation of Aluminum Phosphide Poisoning: a Case Report

Aluminum phosphide (AlP) is a solid fumigant which is widely used for a suicide attempt in Iran. Although neurologic symptoms are commonly reported, cerebrovascular stenosis is rare in AlP poisoning. We described ischemic stroke as a delayed complication of AlP intoxication. A 30-year-old man was admitted because of sudden onset left side hemiplegia, 11 days after intentional ingestion of three rice tablets. Investigations revealed in situ thrombosis in right middle cerebral artery (MCA) while other causes of stroke in young adults were excluded. Ischemic stroke should be considered as a delayed complication of AlP intoxication even after the acute phase of intoxication

Factors Affecting the Length of Hospital Stay in Patients with Ischemic Stroke Treated by Intravenous Thrombolysis

Background and purpose: Ischemic stroke is one of the most common neurological diseases that leads to disability in many cases. The aim of this study was to investigate the factors affecting the duration of hospitalization in patients with ischemic stroke undergoing thrombolytic therapy. Materials and methods: This retrospective descriptive-analytical study was performed in consecutive adult patients with ischemic stroke who underwent thrombolytic treatment in Neurology Department of Sari Bu Ali Sina Hospital 2016-2018. Factors associated with duration of hospitalization were investigated. Results: The records of 173 patients (54.9% males) were studied and the mean age of patients was 68.5 ± 12.3 years. During hospitalization, pneumonia, urinary tract infection, and other infections were seen in 19.7%, 9.8%, and 1.2%, respectively. Among the patients, 12.7% experienced hemorrhagic complications. Duration of hospitalization was <7 days in 52.6% and ≥7 days in 47.4% of the patients. Length of hospitalization was significantly associated with hyperlipidemia (P=0.005), stroke severity (P=0.02), large vessel stroke (P<0.001), hemorrhagic complications (P=0.004), and nosocomial infections (P<0.001). Conclusion: Hyperlipidemia, stroke severity, complications of thrombolysis, and nosocomial infections affect the length of hospital stay in patients with ischemic stroke who received alteplase. Therefore, appropriate approach is needed in management of these patients to prevent and eliminate the aforementioned factors

Sleep-Related Seizures in Refractory Focal Epilepsy: Electroclinical Findings and Surgical Outcome

Background: Sleep Seizures (SSs) generally occur in refractory focal epilepsy, but their detailed characteristics and circadian patterns are still controversial. The effect of SSs on epilepsy surgery outcome has been addressed in few studies without definitive prognostic value.   Objectives: This study investigated the characteristics of SSs and their prognosis in refractory focal epilepsy. Materials & Methods: This retrospective cross-sectional study was conducted in the referral epilepsy center in Isfahan, Iran from 2011 to 2015. It investigated SSs in patients with refractory focal epilepsy who underwent pre-operative evaluation. Demographic data, electroclinical findings, pathology, and postsurgical outcomes were analyzed and compared to Wake Seizures (WSs).  Before the main analysis, Shapiro-Wilk test of normality was performed. Then the Independent sample t test, Chi-square test, Fisher’s exact test, Mann-Whitney U test and 1-way ANOVA were used to analyze the obtained data in SPSS. All probability tests were two-tailed and the level of significance was defined as P≤0.05. Results: A total of 371 seizures in 113 patients were studied. The sleep/wake seizure ratio in Temporal Lobe Epilepsy (TLE) and Extratemporal Lobe Epilepsy (ETLE) were 0.54 and 0.91, respectively. The peak incidence of SSs in TLE and ETLE were during 4.00 to 8.00 and 0.00 to 4.00, respectively. SSs were considerably associated with EEG changes before clinical signs. Ictal EEG localization was more successful in SSs of extratemporal origin. Based on pathology findings, Focal Cortical Dysplasia (FCD) was highly associated with SSs. Left epileptogenic zone and FCD accompanied a less favorable outcome in SSs. Conclusion: SSs are significantly more frequent in patients with ETLE and follow specific circadian patterns based on epileptogenic zone. Seizure semiology and EEG findings are in favor of more localized onset of epileptic activity in SSs of extratemporal origin. The side of epileptogenic zone, circadian pattern of seizures, well-defined epileptogenic lesion in MRI and pathology, could affect postsurgical outcomes in SSs

Comparing Psychometric Properties of GLFS-5 With GLFS-25 for Screening Locomotive Syndrome in Community-dwelling Iranian Older People

Objectives: Locomotive syndrome refers to reduced mobility due to impairment of locomotive organs. Because of the importance of screening locomotive syndrome among older people, this article is focused on psychometric characteristics of Geriatric Locomotive Function Scale (GLFS)-5 and comparing it with GLFS-25 in Iranian older adults Methods: This research was conducted on 320 older Iranian people. Validity and reliability of the GLFS-5 were examined and confirmed using Content Validity Index (CVI), factor analysis, correlation coefficient with the European Quality of Life Scale-5 Dimension (EQ-5D) questionnaire, the Cronbach α value for internal consistency, and intraclass correlation and Receiver Operating Characteristic (ROC) technique to determine the cutoff score for the locomotive syndrome. Results: In phase 1 of the study, 250 Iranian older people ≥60 years were analyzed. The factor analysis showed that the GLFS-25 is a multi-dimensional scale (Activities of Daily Livings [ADLs] and Quality of Life [QoL], pain, social relationship, and psychological status), and GLFS-5 is a one-dimensional scale (the ability to perform daily activities). The Cronbach α values for GLFS-25 and GLFS-5 were 0.93 and 0.84, respectively. As for association between the GLFS-25 and GLFS-5 with EQ-5D and Visual Analogue Scale (VAS) (health self-perceived), the Pearson correlation coefficients were 0.85 and -0.72 for GLFS-25 (P=0.01) and 0.82 and -0.67 for GLFS-5 (P=0.01), respectively. The cutoff scores to identify locomotive syndrome for the GLFS-25 and GLFS-5 were 16 and 4, respectively.  Discussion: Considering the good validity and reliability properties of the GLFS-5 compared to GLFS-25 and the more convenient use of this short version of the GLFS, its application is highly recommended for community-based screening of locomotive syndrome in Iranian older people