Neurological Disorders

Post-stroke depression (PSD) is a widely encountered complexity of stroke, which is of notable importance. PSD ismultifactorial in origin; however, depression after stroke is unrecognized, infrequently diagnosed, and undertreated. Thisreview presents epidemiology, diagnosis and diagnostic tools, risk factors, and management of PSD. About one-third ofpatients experience depression after stroke. It is important to reliably screen and diagnose post-stroke depression aswell as measure its severity. PSD is associated with various risk factors and stroke characteristics. If left untreated, PSDcan worsen several other common post-stroke conditions. There is strong evidence that early initiation of antidepressanttherapy in non-depressed stroke patients is associated with reduced risk for the development and effective preventionof post-stroke depression. PSD needs special attention, and consensus should be reached regarding the diagnosis andmanagement of PSD.

Introduction: Status epilepticus management protocols have adopted the operational defining of generalizedconvulsive status epilepticus (GCSE) as “more than 5 minutes of either continuous seizures or two or more seizureswith incomplete recovery of consciousness in between.

Subjects and Methods: This study was conducted as a cross sectional observational study among 81 patientspresenting with generalized convulsive status epilepticus. The study was applied by comparing the steps of managementof GCSE at the Emergency Department of Suez Canal university hospital to the management guidelines of NeurocriticalCare Society in evaluation and management of GCSE.

Results: The study showed that (37%) of the studied patients had a history of epilepsy and (9%) of the patientshad a positive family history of epilepsy. It showed that the commonest causes of GCSE were AEDs noncompliance/Discontinuation, febrile seizures and cerebro-vascular stroke by a percentage of (30.8%, 19.7%, and 10%) respectively.It showed that adherence to the guidelines of the total studied patients who took the emergent therapy was (28.4%).Seizure termination occurred in (32%) of the patients after emergent therapy.

Conclusion: The present study revealed that the median percentage of adherence to NCS 2012 Guidelines forGCSE management in the Emergency Department of Suez Canal University Hospital was (55.7%) and the percentageof adherence for Emergent AEDs therapy was (28.4%), the percentage of adherence for Urgent AEDs control therapywas (45.5%) and the percentage of adherence for Refractory GCSE was (33.3%).

Objective: To report the first case of reversible cerebral vasoconstriction syndrome (RCVS) diagnosed when reversible cardiac wall motion akinesia was observed after the administration of atropine in a 28-year-old lady presenting 4 weeks post-partum with a 2-week history of thunderclap headache.
Case presentation: We present a case of a 28-year-old lady, who presented to the American University of Beirut Medical Center, with a history of migraine with visual auras and peri-partum pituitary hyperplasia, presenting 4 weeks postpartum with a 2-week history of thunderclap headache.
Results: RCVS comprises a group of diseases characterized by reversible focal segmental narrowing of cerebral vessels, usually accompanied by thunderclap headache and sometimes focal neurological deficits.
Conclusion: Several case reports and case series have described the association of this disorder with vascular manifestations outside the cerebral vasculature, including dissection of both external and internal branches of the carotid arteries, unruptured saccular berry aneurysms and fibromuscular dysplasia of the extracranial internal carotid artery (ICA). In this short report we describe a patient with reversible cerebral vasoconstriction associated with reversible cardiac wall abnormalities.

At this point in time there are only limited treatment options available for spinal cord injury (SCI) paralysis (e.g. implanted stimulation devices, stem cells). They are in clinical trials, complex, invasive, ill-affordable, and quality of outcome rather unpredictable. This author had presented two alternative treatment procedures based on over five decades of fundamental research on the functioning of the spinal cord motor system in 2009, 2013 and 2015. These are non-invasive, functional, and recovery predictable. The first one uses low-dose Botulinum toxin to select paralyzed limb muscles. The second consists of transient partial denervation of the muscles. They both operate on similar principles of synaptic competitive-learning (SCL) and rewiring. They focus on the spinal motoneuron, its synaptic connectivity, and spinal cord reflexes. They are (i) induce competition among neuromuscular synapses, (ii) modify the motoneurons’ soma sizes (Size principle) and thus their excitability-inhibitability, firing properties, (iii) resize the motor units of the paralyzed muscles, and (iv) reposition the synaptic memory weights impinging on the motoneurons. Animal model treated by the second procedure shows that even in complete cord injury, the residual networks of the isolated distal cord are capable of remarkable motor restoration (see videos). This paper now explains the precise mechanisms behind the restorative rewiring (SCL) therapy.

Background: Endovascular treatment (EVT) for acute ischemic stroke is guided by clinical trials assumed to have high external validity. To our knowledge, this assumption has not been rigorously examined.
Methods: Patients from two U.S. academic comprehensive stroke centers receiving endovascular treatment for acute ischemic stroke were retrospectively reviewed from January 2012 through December 2016. Clinical characteristics, treatment times, neuroimaging findings, and functional outcomes were compared to data from the pragmatic EVT trial, MR CLEAN. External validity was assessed quantitatively and qualitatively.
Results: 236 patients presenting with anterior circulation large vessel occlusion were included. 63% (148/236) would have met criteria for MR CLEAN; the primary reason for exclusion would have been a time from symptom onset to groin puncture greater than 6 hours. Ordinal shift analysis of 90 day modified Rankin scale (mRS) of our clinical practice did not differ from the intervention arm of MR CLEAN, (p=0.26). Favorable outcome (mRS 0-2) occurred in 35% of our combined practice and in 33% of the trial intervention arm (p=0.63). The rates of hemicraniectomy (3% vs. 6% p=0.09) and PH-2 type symptomatic intracerebral hemorrhage (5.1% vs. 6.0% p=0.55) did not differ between the two groups.
Conclusion: Our clinical experience was comparable to MRCLEAN, supporting the external validity of this trial to clinical practice. We treated patients who would have been excluded from this trial because of a longer time to groin puncture. Satisfactory results can be obtained with endovascular treatment, even when treating patients beyond 6 hours from symptom onset.