Farzad Fatehi

Cerebral Venous Sinus Thrombosis Risk Factors

Cerebral venous sinus thrombosis is an uncommon disease marked by clotting of blood in cerebral venous, or dural sinuses, and, in rare cases, cortical veins. It is a rare but potentially fatal cause of acute neurological deterioration previously related to otomastoid, orbit, and central face cutaneous infections. After the advent of antibiotics, it is more often related to neoplasm, pregnancy, puerperium, systemic diseases, dehydration, intracranial tumors, oral contraceptives, and coagulopathies are the most common causes, but in 30% of cases no underlying etiology can be identified. It has been found in association with fibrous thyroiditis, jugular thrombosis after catheterization, or idiopathic jugular vein stenosis. Other factors include surgery, head trauma, arteriovenous malformations, infection, paraneoplastic, and autoimmune disease. This article presents a comprehensive review of cerebral venous sinus thrombosis etiologies.

Raloxifene adjunctive therapy for postmenopausal women suffering from chronic schizophrenia: a randomized double-blind and placebo controlled trial

BackgroundCumulative evidence from epidemiological, preclinical and clinical studies suggests estrogens may have psychoprotective effects in schizophrenic patients. Selective Estrogen Receptor Modulators could have therapeutic benefits in schizophrenia for both sexes without being hazardous to gynecological tissues or having feminizing effects. Few studies have been conducted regarding the effects of raloxifene on postmenopausal women suffering from schizophrenia. We conducted this placebo-controlled trial to compare the add-on effect of raloxifene to risperidone versus risperidone with placebo.MethodsThis was an 8-week, parallel-group, placebo-controlled trial undertaken at two universities affiliated psychiatric Hospitals in Iran. Forty-six postmenopausal women with the definite diagnosis of schizophrenia were enrolled in the study. Patients received risperidone (6 mg/day in 3 divided doses) combined with either placebo (N = 23) or 120 mg/day of raloxifene (N = 23) for 8 weeks. Patients were assessed by a psychiatrist at baseline and at 2 and 8 weeks after the start of medical therapy. Efficacy was defined as the change from baseline to endpoint in score on Positive and Negative Syndrome Scale (PANSS).ResultsFor PANSS scores, the main effect comparing two types of intervention was not significant [F (1, 48) = 1.77, p = 0.18]. For positive subscale scores, there was marginal significant interaction between intervention type and time [F (2, 47) = 2.93, p = 0.06] and there was substantial main effect for time [F (2, 47) = 24.39, p = 0.001] within both groups showing reduction in positive subscale scores across the three time periods. In addition, the main effect comparing two types of intervention was significant [F (1, 48) = 3.78, p = 0.02]. On the other hand, for negative subscale scores, the main effect comparing two types of intervention was not significant [F (1, 48) = 1.43, p = 0.23]. For general subscale scores, the main effect comparing two types of intervention was not significant [F (1, 48) = 0.03, p = 0.86].ConclusionsAccording to our findings, raloxifene as an adjunctive treatment to risperidone was only superior in improvement of positive symptoms and it was not effective in treating negative and general psychopathology symptoms.Trial registrationThe trial was registered at the Iranian registry of clinical trials: IRCT201205131556N42

International clinimetric evaluation of the MG-QOL15, resulting in slight revision and subsequent validation of the MG-QOL15r.

Introduction: The MG‐QOL15 is a validated, health‐related quality of life (HRQOL) measure for myasthenia gravis (MG). Widespread use of the scale gave us the opportunity to further analyze its clinimetric properties. Methods: We first performed Rasch analysis on >1,300 15‐item Myasthenia Gravis Quality of Life scale (MG‐QOL15) completed surveys. Results were discussed during a conference call with specialists and biostatisticians. We decided to revise 3 items and prospectively evaluate the revised scale (MG‐QOL15r) using either 3, 4, or 5 responses. Rasch analysis was then performed on >1,300 MG‐QOL15r scales. Results: The MGQOL15r performed slightly better than the MG‐QOL15. The 3‐response option MG‐QOL15r demonstrated better clinimetric properties than the 4‐ or 5‐option scales. Relative distributions of item and person location estimates showed good coverage of disease severity. Conclusions: The MG‐QOL15r is now the preferred HRQOL instrument for MG because of improved clinimetrics and ease of use. This revision does not negate previous studies or interpretations of results using the MG‐QOL15. Muscle Nerve 54: 1015–1022, 2016

Multiple sclerosis and neurofibromatosis type 1: report of seven patients from Iran:

Introduction Co-occurrence of multiple sclerosis (MS) and neurofibromatosis type 1 (NF1) is rare. Case reports In this study, we describe the clinical and neuroimaging features of seven patients with NF1 and MS. In our patients, six patients with MS were women, in all of them history of NF1 existed. Three of our patients had primary progressive, one had secondary progressive MS, and three relapsing–remitting MS. Optic neuritis as presenting symptoms was seen in three patients, and motor manifestation as presenting symptom was observed in three patients. The risk of having both NF1 and MS seemed to be higher than would be expected based on the prevalence rates of the two diseases in the general population. Conclusion The findings of this study suggest a possible casual relationship between MS and NF1, indicating higher risk of MS among patients with NF1.

The Effect of Low-dose Combined Oral Contraceptive Pills on Brachial Artery Endothelial Function and Common Carotid Artery Intima–Media Thickness

BACKGROUND Combined oral contraceptives (COCs) are considered for their thrombogenicity and the risk of premature atherosclerosis and the stroke caused by them. The aim of this study was to evaluate the relationship between chronic use of low-dose COCs (ethinyl estradiol 30 mcg + levonorgestrel 150 mcg) and endothelial dysfunction and intima-media thickness. METHODS In a cross-sectional study, in 2011-2012, 60 healthy premenopausal women (30 cases of COC consumers and 30 controls as nonconsumers), aged between 25 and 45 years, participated in this study. They were current users for at least a 3-year period. Brachial artery flow-mediated dilatation (FMD) and common carotid artery intima-media thickness (CCA-IMT) were measured for the patients. RESULTS The mean duration of COC consumption was 54.03 ± 27.27 months in the case group. There was a significant FMD% difference between 2 groups of cases and controls: 11 ± 3.53 versus 15.80 ± 9.22 (P = .01). In addition, a significant mean CCA-IMT thickness difference was detected: .53 ± .07 versus .44 ± .08 (P = .00). However, after multiple regression analysis and adjusting for body mass index (BMI), in COC users, no significant association between COC consumption duration and FMD% and mean CCA-IMT was observed. CONCLUSIONS Prolonged used of low-dose COCs may cause changes in both endothelial function (measured by FMD%) and endothelial structure (measured by CCA-IMT). There was a nonsignificant inverse relationship between the duration of COC ingestion and FMD% and a nonsignificant positive relationship with CCA-IMT. Our results are in favor of early atherosclerotic changes in prolonged users of COCs.

Validation of the 15-item myasthenia gravis quality of life questionnaire (MG-QOL15) Persian version.

The 15‐item Myasthenia Gravis Quality Of Life (MG‐QOL15) questionnaire is a valid and reliable instrument for evaluation of myasthenia gravis (MG) associated disability. Our study aim was to assess its validity and reliability in the Iranian population.

Fahr’s disease: variable presentations in a family

Fahr’s disease or Striato-pallido-dentate calcification is a well-defined entity with familial or sporadic presentation and approximately two-thirds of the patients are symptomatic. Herein, we report on different manifestations and neuroimaging of six symptomatic members of a family with Fahr’s disease. It is significant that three symptom-free members of this family also had brain calcification on brain CT scan. The patients’ symptoms had started at different ages with diverse manifestations. The manifestations included extrapyramidal signs, behavioral abnormalities, memory deficits, atonic type of seizure, and ataxia. In further generations, symptoms started earlier.

Short-term effects of prolonged fasting on multiple sclerosis.

Fasting during Ramadan is mandatory for all healthy Muslim adults. During the fasting month, many physiological and biochemical changes occur that may be due to alterations in eating and sleeping patterns. A concern for Muslim multiple sclerosis (MS) patients is whether prolonged fasting might have an unfavorable impact on the course of their disease. The aim of this prospective study was to determine the effects of prolonged intermittent fasting on the course of MS in a cohort of patients who reside in Isfahan, Iran. The cohort consisted of 40 adult MS patients who fasted during Ramadan and 40 MS patients who did not fast. Only patients with mild disability (expanded disability status scale (EDSS) score ≤3) were included. All patients were followed for 6 months after Ramadan to assess their EDSS score changes and to record the number of clinical relapses. At the end of the study, no significant changes in EDSS or the frequency of clinical relapses were detected between the 2 groups (p > 0.05). Fasting had no short-term unfavorable effects on the disease course in MS patients with mild disability. However, larger multi-center prospective studies of longer duration are needed to validate the results of this study.

Amyotrophic lateral sclerosis progression: Iran-ALS clinical registry, a multicentre study.

Abstract This study was designed to evaluate ALS progression among different subgroups of Iranian patients. Three hundred and fifty-eight patients from centres around the country were registered and their progression rate was evaluated using several scores including Manual Muscle Test scoring (MMT) and the revised ALS Functional Rating Scale (ALSFRS-R). Progression rate was analysed separately in subgroups regarding gender, onset site, stage of disease and riluzole consumption. A significant difference in MMT deterioration rate (p = 0.01) was noted between those who used riluzole and those who did not. No significant difference was observed in progression rates between male/female and bulbar-onset/limb-onset groups using riluzole. In conclusion, riluzole has a significant effect on muscle force deterioration rate but not functional scale. Progression rate was not influenced by site of onset or gender.

Carotid intima-media thickness in subclinical hypothyroidism.

We refer to the recent article by Kong et al. (1) on ‘Deep vein thrombosis in stroke patients admitted to a rehabilitation unit in Singapore’ published in the International Journal of Stroke, which concluded that lower limb deep vein thrombosis was uncommon in stroke patients in Singapore. The prevalence of 9% as reported in the cohort of Singaporean stroke patients undergoing rehabilitation was uncommon by Western standards, but consistent with studies performed in Asian populations. Venous thromboembolism in Asian patients after stroke is well recognised to be less common when compared with Caucasian populations. In a recent review (2) the prevalence of venous thromboembolism after stroke ranged from 4 8% to 45% in Asian studies. This was lower when compared with Caucasian populations, where the prevalence varied from 11% to 80%. Thus, the low prevalence of poststroke deep venous thrombosis in Singapore is only true in relation to Western populations. We would also like to highlight a similar study among Asians, on the poststroke prevalence of deep vein thrombosis in patients admitted for stroke rehabilitation from Thailand(3). This study observed a prevalence of 6%, a lower prevalence rate than the figure observed by Kong et al. (1), but consistent with the reported literature. Interestingly, on multivariate analysis, swelling above or below the knee based on circumference measurement was found to be the only significant variable for the presence of deep venous thrombosis. We believe that a prevalence of 6–9% of poststroke deep venous thrombosis is clinically significant. In Asia, the condition is often wrongly perceived to be uncommon and is therefore neglected. Poststroke venous thromboembolism prophylaxis demands more emphasis in Asian clinical practice. One possible approach is to initiate a hospital-wide venous thromboembolism risk assessment, followed by prophylactic anticoagulation and other nonpharmacological methods in the presence of additional risk factors (2).