Seyed Ali Mousavi

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.

Increasing female preponderance of multiple sclerosis in Isfahan, Iran: a population-based study

There is an overall increase in the worldwide prevalence and incidence of multiple sclerosis (MS). Studies from several countries also demonstrated an increase of female/male ratio over time denoting an increase in the incidence of MS particularly in women. In this study we sought to assess the trends in MS incidence and prevalence in males and females over recent decades in Isfahan, Iran, which differs from other regions in terms of environmental and lifestyle changes. We determined female/male ratio by year of birth (YOB) in 1584 patients with MS registered with Isfahan Multiple Sclerosis Society (IMSS) from April 2003 to August 2007. A comparison of sex ratio of MS patients by YOB showed a significant, progressive, gradual increase, with an apparent interruption in the late 1960s. In this study year of birth is a significant predictor for sex ratio (p < 0.001, χ2 = 17.130, Spearman’s rank correlation r = 0.893). Our findings show that there is a significant increase in the incidence of MS among females for the the last decades in the Isfahan province of Iran. This rapid increase may be related to changes in environmental interactions rather than genetic factors, and among them vitamin D insufficiency, enhanced diagnosis, and lifestyle changes appear to be more plausible causative factors.

Antiphospholipid antibodies: Paradigm in transition

ObjectivesThis is a critical review of anti-phospholipid antibodies (aPL). Most prior reviews focus on the aPL syndrome (APS), a thrombotic condition often marked by neurological disturbance. We bring to attention recent evidence that aPL may be equally relevant to non-thrombotic autoimmune conditions, notably, multiple sclerosis and ITP.OrganizationAfter a brief history, the recent proliferation of aPL target antigens is reviewed. The implication is that many more exist. Theories of aPL in thrombosis are then reviewed, concluding that all have merit but that aPL may have more diverse pathological consequences than now recognized. Next, conflicting results are explained by methodological differences. The lupus anticoagulant (LA) is then discussed. LA is the best predictor of thrombosis, but why this is true is not settled. Finally, aPL in non-thrombotic disorders is reviewed.ConclusionThe current paradigm of aPL holds that they are important in thrombosis, but they may have much wider clinical significance, possibly of special interest in neurology.

Stem cell therapy in amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disorder of upper and lower motor neurons, characterized by progressive muscular atrophy and weakness which culminates in death within 2-5 years. Despite various hypotheses about the responsible mechanisms, the etiology of ALS remains incompletely understood. However, it has been recently postulated that stem cell therapy could potentially target several mechanisms responsible for the etiology of ALS and other nervous system disorders, and could be regarded as one of the most promising therapeutic strategies for ALS treatment. We present a brief review of different methods of stem cell therapy in ALS patients and discuss the results with different cell types and routes of administration.

Epidemiology of amyotrophic lateral sclerosis in Isfahan, Iran.

Background:  Few studies are carried out on the epidemiology of amyotrophic lateral sclerosis (ALS) in Middle East with no reports from Iran.

Association between plasma homocysteine concentrations and extracranial carotid stenosis.

BACKGROUND Increasing epidemiologic data support a relationship between elevated plasma total homocysteine levels and an increased risk for vascular disease. Higher plasma total homocysteine (tHcy) levels have been associated with extracranial carotid atherosclerosis and cerebral infarction in whites. However, data regarding such associations are limited for Asians. This study examined the association between tHcy level and carotid stenosis in Iranian subjects. PATIENTS AND METHODS In this retrospective study, the subjects were 158 patients with ischemic stroke, including 105 with a normal tHcy level and 53 with a high tHcy level. We investigated the extracranial carotid arteries by ultrasonography and measured serum tHcy by the ELISA method in these two groups. RESULTS We found no meaningful association between a high tHcy level and carotid stenosis. DISCUSSION The lack of any meaningful difference in carotid stenosis between patients with normal and elevated tHcy levels is probably due to the low frequency of extracranial disease in the Asian population and to the nature of homocysteine atherosclerosis.

Evaluation of the neuroprotective effect of dextromethorphan in the acute phase of ischaemic stroke.

Introduction Stroke is the second leading cause of death in the world. However, there is still no approved neuroprotective drug for acute ischaemic stroke. To clarify the neuroprotective efficacy and safety of dextromethorphan in stroke, the following study was carried out. Material and methods Forty patients with acute stroke causing moderate deficit were randomized to be treated with either dextromethorphan 300 mg per day or placebo for 5 days. Plasma level of dextromethorphan and its active metabolite was not evaluated in this study. The NIHSS score was calculated on day 5 and the Barthel activities of daily living index and Rankin score were checked after 3 months by a blinded investigator. Collected data were analysed using the t-test and χ2 test. Results In the dextromethorphan-treated group, the mean NIHSS score was 16.8 ±3.9 at baseline, and was 14.2 ±4.8 for the placebo-treated group (p = 0.069). At day 5, there was also no significant difference regarding NIHSS score (p = 0.167). At the 3-month follow-up, there was no significant difference regarding Barthel scale and Rankin score between the dextromethorphan and placebo groups. Conclusions The results of our study suggest that although low-dose and short-term oral administration of dextromethorphan seems to be not neuroprotective, it does not worsen either patients’ condition or NIHSS score. Moreover, patients treated with dextromethorphan showed a significant reduction in seizures (complication after stroke), but had increased chance of MI and renal failure by almost 5% when compared to the placebo-treated groups. More prolonged studies with a higher number of cases are recommended.

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).

The comparison between prazosin versus clonidine effects on combat related P.T.S.D nightmares

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