Sandra M. Ahmed

Aerobic exercises enhance cognitive functions and brain derived neurotrophic factor in ischemic stroke patients

BACKGROUND Stroke is a leading cause of functional impairments. High percentage of these patients will experience some degree of cognitive affection, ranging from mild cognitive impairment to dementia. OBJECTIVE Demonstrate the role of aerobic exercises enhancing cognitive functions and its effect on Brain Derived Neurotrophic factor (BDNF) in post-ischemic stroke patients in the territory of anterior circulation. SUBJECTS AND METHODS We included thirty Egyptian ischemic stroke patients in the territory of anterior circulation. They were divided into 2 groups; group 1 (G1) were subjected to physiotherapy program without aerobic exercises and group 2 (G2) were subjected to the same previous program followed by aerobic exercises. Both groups were subjected to pre- and post-treatment Addenbrookess Cognitive Examination- Revised (ACER) and serum level of BDNF. RESULTS Our results showed a significant improvement in ACER score in G2 compared to G1 post-treatment (p = 0.017). BDNF serum level significantly increased in G2 post-treatment compared to pre-treatment (p = 0.001) and compared to G1 group (p = 0.0458). ACER improvement was positively correlated to increase in serum level of BDNF (r = 0.53, p = 0.044). CONCLUSION Aerobic exercises improve cognitive functions of ischemic stroke patients. This improvement is related to the increase in serum level of BDNF.

Epilepsy and antiepileptic drugs: risk factors for atherosclerosis

Introduction: Epilepsy is a chronic disease that affects metabolism either alone or through the antiepileptic drug (AED) treatment. A risk of atherosclerosis has been found in epileptic patients. Aim: Prove the potential role of epilepsy and/or its treatment as atherosclerotic risk factors. Subject and Methods: Forty Egyptian patients with primary idiopathic epilepsy were compared to 20 healthy controls. B-mode ultrasound examination of the common carotid artery intima-media thickness (CCA IMT), measurement of serum lipid profile, fibrinogen and high sensitive C-reactive protein were performed to both groups. Results: Patients had significantly increased right and left CCA IMT (p < 0.05); elevated levels of HDL (p < 0.01) and hs-CRP (p = 0.009) in comparison to control subjects. Positive correlation was found between IMT and hs-CRP (p < 0.05) as well as fibrinogen level (p < 0.05). Carbamazepine level was positively correlated to triglycerides (r = 0.748, p = 0.013) and Valproate level was positively correlated to hs-CRP serum level (r = 0.556, p = 0.032). Conclusion: Epilepsy and AEDs are potential risk factors for atherosclerosis. Weak relation between epilepsy and/or AEDs and lipid profile was found. Hs-CRP may be implicated in atherosclerosis in epileptic patients.

P227 Carpal tunnel syndrome grading using high-resolution ultrasonography

Introduction Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the wrist. The diagnosis of CTS has been a concern for physicians for a long time. The aim of this study is to evaluate the use of the median nerve (MN) cross-sectional area (CSA) in the wrist compared with the CSA in the forearm to grade the severity of carpal tunnel syndrome in Egyptian patients. Methods The cross sectional areas of the median nerve in the wrist and forearm were measured in 72 wrists that were diagnosed with carpal tunnel syndrome via nerve conduction studies (NCS) and 80 healthy wrists. The CTS group was subdivided into 3 subgroups (mild, moderate and severe CTS). The ratio of the cross sectional area of the median nerve in the wrist to that in the forearm (WFR) was used to calculate cutoff values for carpal tunnel syndrome grading. Results There were positive correlations between the CSAs of the MN in the wrist and MN conduction latency. At a WFR of 1.7, the high resolution ultrasonography (HRUS) showed 96.1% accuracy in the detection of carpal tunnel syndrome. Conclusion As the disease severity increased, the CSA in the wrist showed significant increase among all groups so HRUS could be used for carpal tunnel grading.

Is peripheral arterial disease associated with carotid artery disease in Egyptians? A pilot study

Background Atherosclerosis involves various vascular segments. The association of carotid artery disease (CAD) to peripheral arterial disease (PAD) is not well investigated in Egyptian patients. Objective In this pilot study, our aim was to examine the relationship between PAD and CAD in an Egyptian population. Patients and methods We examined 37 consecutive patients with PAD for the presence of CAD. Vascular and neurologic examination and duplex assessment of extracranial and intracranial carotid system and ankle-brachial index measurement were carried out to determine whether CAD is symptomatic or not. Results CAD was found in 20 (54.1%) patients. Eight (21.6%) patients had significant extracranial internal carotid stenosis and 13(37%) had intracranial stenosis and were more significantly above the age of 60 years. All patients with intracranial stenosis were men. PAD with RC6 was significantly associated with cerebrovascular events ( P = 0.001) and significant extracranial stenosis ( P = 0.013) and intracranial internal carotid stenosis ( P = 0.001). Conclusion Intracranial and extracranial carotid stenoses are commonly present in patients with critical PAD. Duplex ultrasound screening for CAD presence and severity may be of great benefit, especially in the elderly and patients with critical limb ischemia. These findings need to be further confirmed in a study on larger population of Egyptians.

Ultrasound evaluation of internal jugular valve incompetence (IJVI) in Egyptian patients with idiopathic intracranial hypertension (IIH)

BACKGROUND Idiopathic intracranial hypertension (IIH) is a clinical syndrome with no identified causative factor. Internal jugular valve incompetence (IJVI) has been linked to many neurological disorders such as idiopathic intracranial hypertension (IIH), transient global amnesia and cough-induced headache. Intact valves prevent efficiently retrograde flow into the internal jugular vein. AIM The aim of this study is to evaluate the competence of the jugular vein valves and its relationship to age, BMI, opening CSF pressure and MRV findings in IIH patients. SUBJECTS AND METHODS Twenty-five Egyptian female patients diagnosed with IIH according to the modified Dandy criteria, and 24 female controls, matched for age and BMI, were included and examined using color-coded duplex for IJVI during the Valsalva maneuver. The patients underwent lumbar puncture to measure the opening pressure, MRV, ophthalmic examination and laboratory work-up. RESULTS There was no statistically significant difference in the proportion of IJVI among the patients and controls (P=0.7). There was a statistically significant increase in the opening pressure and proportion of MRV abnormalities in the patients with IJVI compared to the patients without IJVI (P=0.03 and 0.007, respectively), but there were no statistically significant difference with regard to age, BMI, grade of papilledema and perimetry findings. CONCLUSION This study showed that there is no relationship between IJVI and IIH; thus, IJVI would be a rather normal finding. Further studies are recommended to confirm or rule out a possible relationship.

ID 248 – Therapeutic role of repetitive peripheral magnetic stimulation in carpal tunnel syndrome

Background Carpal tunnel syndrome (CTS) is one of the most common causes of upper limb neuropathic pain and tends to increase in severity as the disease progresses. It can significantly affect motor performance and different activities of daily living. Appropriate management should be implemented from the time of its symptoms onset. Many non-surgical treatment procedures were previously researched. However, repetitive peripheral magnetic stimulation (RPMS) for the treatment of carpal tunnel syndrome is not in such lists. Objectives To evaluate the therapeutic effects of RPMS in carpal tunnel syndrome. Methods: twenty participants were enrolled. Nerve conduction studies, Visual Analogue-pain-Scale (VAS) and RPMS were performed. Results significant pain reduction was found among patients with early CTS for up to a month after RPMS. Conclusions: RPMS can be considered as a noninvasive therapeutic tool for pain reduction in early CTS patients.