Objective: To study the effect of cerebral ischemic vascular insult on the localization of langua... more Objective: To study the effect of cerebral ischemic vascular insult on the localization of language areas as regard to automatic speech, initiation, and mutism. Materials and Methods: Seventy ischemic stroke patients were selected within the first 48 h of the onset of stroke with left hemis-pheric stroke with aphasia. Inclusion criteria: any age above seven years, both sexes, first ever clinical stroke, admitted within the first 2 days of stroke insult. Patients underwent careful history taking, neurological examination, routine laboratory investigations, echo cardiography, and caro-tid duplex and language assessments. Results: Automatic speech disorders were mainly seen along left insular, left supramarginal and left frontal inferior orbital lesions. Initiation difficulty is seen mainly along as left insular, left temporal superior and left periventricular lesions. Mutism is seen along left external capsule, left internal capsule, left pallidum, left frontal inferior orbital and le...
Study Objectives: Guillain-Barre syndrome (GBS) is an acute-onset, monophasic immune-mediated dis... more Study Objectives: Guillain-Barre syndrome (GBS) is an acute-onset, monophasic immune-mediated disorder of the peripheral nervous system that often follows an infection. The outcome and prognosis of GBS depend on many factors such as the etiology, clinical features, neurophysiology and immunological parameters. The aim of this study was to assess the factors (clinical, investigatory tools, and therapies) that may affect the outcome of patients with GBS. Patients and methods: this was an analytical observational study that was conducted at Ain Shams university hospitals and Kobri Elkoba Military Hospital including twenty patients with the diagnosis of Guillain Barre Syndrome in the duration from 2016 to 2018. This study included twenty patients with the diagnosis of GBS within two weeks from onset of neurologic symptoms, whom their diagnosis based on the established clinical criteria and verified by investigations. Patients were selected from both genders and aged from 18 to 65 years ...
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery
Background: Ankle-brachial index (ABI) is not only a marker of lower limb peripheral arterial dis... more Background: Ankle-brachial index (ABI) is not only a marker of lower limb peripheral arterial disease (PAD), but may also reflect the severity of systemic atherosclerosis. Objectives: To study the prevalence of abnormal ABI among the studied patients with ischemic stroke compared to general population, to assess the correlation between the ABI abnormality and different risk factors, and to study the relationship between ABI abnormality and severity of stroke. Materials and methods: A case control observational analytical study for 200 patients, 100 patients with ischemic stroke and 100 patients as control group matched to case group in age and sex excluding patients with cardioembolic stroke, stroke of undetermined etiology, or young patients. We obtained ABI measurement from all participants. Criteria for PAD diagnosis is an ABI of < 0.9. We assessed patients' group using magnetic resonance imaging, transthoracic echocardiography, electrocardiography, carotid duplex, hemoglobin A1C, and lipid profile. Severity of stroke was assessed by the National Institute of Health Stroke Scale (NIHSS). Results and conclusion: Abnormal ABI relative frequency is higher in stroke group compared to controls. The risk factors most frequently associated with abnormal ABI are diabetes mellitus and dyslipidemia with high statistical significance. In our study, no single stroke patient with abnormal ABI who is not diabetic. In stroke patients, abnormal ABI is relatively more associated with carotid stenosis, recurrent stroke, small vessel disease stroke, and mild to moderate stroke severity by the NIHSS yet with no statistical significance for any of them.
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 2015
Background Sophisticated analysis of seizure semiology and electroencephalography (EEG) has a sig... more Background Sophisticated analysis of seizure semiology and electroencephalography (EEG) has a significant role in lateralizing and localizing the epileptogenic zone. Hence, understanding the pathophysiology of epileptogenic dysrhythmia requires thorough knowledge of how to put the very different pieces of the puzzle together. Objective The aim of the study was to investigate the concordance between seizure semiology, electrophysiological generator, anatomical lesions, and neuropsychological evaluation in patients with partial epilepsy, and to identify the importance of ictal EEG recording and the diagnostic yield of other electrophysiological techniques. Patients and methods Thirty patients with a diagnosis of intractable partial epilepsy and lesional MRI were prospectively included. All of them were clinically evaluated and identified according to semiological seizure classification. Long-term video digital EEG with ictal recording was done, along with a source analysis (SA) study. Results Clinical evaluation by seizure semiology lateralized 73% of the cases and localized 80%. Ictal EEG lateralized 80% of cases and localized 66.9%. SA revealed a much superior power to lateralize and localize (96.7%) the epileptogenic zone, but what is more important is the added value of SA, as it lateralized and localized 96-100% of the cases that failed on semiology. SA has the highest expected value for additional lateralizing and localizing information ( ±7.73 and ±7.30, respectively). Conclusion Seizure semiology and ictal EEG recording with SA are the most accurate ways to lateralize and localize the epileptogenic zone in intractable partial epileptic cases, giving the patient a respectable chance to avoid other invasive diagnostic techniques.
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that... more Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that is being investigated for a variety of neurological and psychiatric conditions. Preliminary evidence suggests that tDCS may be useful in the treatment of Tourette Syndrome (TS). This paper reviews the literature on the use of tDCS in commonly occurring comorbid conditions that are relevant to its proposed use in TS. We describe the protocol for a double-blind, crossover, sham-controlled trial of tDCS (Trial ID: ACTRN12615000592549, registered at www.anzctr.org.au) investigating the efficacy, feasibility, safety, and tolerability of tDCS in patients with TS aged 12 years and over. The intervention consists of cathodal tDCS positioned over the Supplementary Motor Area. Patients receive either sham tDCS for three weeks followed by six weeks of active tDCS (1.4 mA, 18 sessions over six weeks), or six weeks of active sessions followed by three weeks of sham sessions, with follow-up at three and six months. Pilot findings from two patients are presented. There was a reduction in the frequency and intensity of patients' tics and premonitory urges, as well as evidence of improvements in inhibitory function, over the course of treatment. Larger scale studies are indicated to ascertain the maintenance of symptom improvement over time, as well as the long-term consequences of the repetitions of sessions.
Introduction Patients with Parkinson’s disease (PD) are prone to sleep disturbances and disorders... more Introduction Patients with Parkinson’s disease (PD) are prone to sleep disturbances and disorders with a prevalence of 78–98% (Norlinah et al., 2009). The prevalence of RBD in idiopathic Parkinson’s disease varies from 15% to 58% (Iranzo et al., 2009).The importance of RBD is that it is now considered as an early marker of developing Parkinson’s disease (Arnulf, 2012). Objective: study the clinical and polysomnographic characteristics of PD patients with versus without RBD. Materials and methods Thirty-six PD patients were enrolled from the Involuntary Movement outpatient clinic in Ain Shams University hospital and submitted to clinical assessment by UPDRS- III, Hamilton depression scale, structured sheet for sleep questionnaire, Mayo clinic sleep questionnaire to diagnose RBD, Pittsburgh sleep scale for sleep quality, Epwarth sleepiness scale to assess excessive day time sleepiness. In addition, REM sleep without atonia was assessed, in a one night video-polysomnography (PSG). Results Thirteen patients (36%) were found to have RBD clinically and confirmed by PSG. RBD patients were of older age (p = 0.086), higher disease severity (p = 0.52), shorter disease duration (p = 0.108), there is was no difference between the RBD+ve group and RBD−ve group as regard to tremors or rigidity as a predominant presentation. PSG analysis showed longer REM latency (p = 0.934), higher periodic leg movement index (PLMI) and respiratory disturbance index (RDI), p = 0.553, 0.198 respectively. Conclusion Our findings support the association between RBD and PD as well as the clinical relevance of sleep disturbances in PD. Association with shorter disease duration may support that it is an early marker of the disease.
Laryngeal electromyography (EMG) is an important tool in the study of laryngeal disorders. This r... more Laryngeal electromyography (EMG) is an important tool in the study of laryngeal disorders. This review considers the current state of the art. The general principles of EMG and of the laryngeal neuromotor control system are reviewed. Important criteria for interpreting EMG characteristics, including the motor unit action potential and spontaneous activity, are considered in the context of several pathologic conditions. Technical and clinical difficulties are reviewed.
The present investigation examines the effects of sickle cell crisis on peripheral auditory funct... more The present investigation examines the effects of sickle cell crisis on peripheral auditory function and auditory brainstem response (ABR). The study includes 10 homozygous sickle cell anemia patients with documented sickle cell (SS) hemoglobin. Testing was performed during the crisis and 1 month after it subsided. Unilateral high frequency hearing loss was found in three patients but persisted in only one of them. Abnormal ABR tracings occurred in four patients but reversed to normal in one of them. The study suggests a trend toward increased incidence of sensorineural hearing loss (SNHL) and ABR changes as frequency and severity of crisis episodes increases. The relationship between SNHL and ABR is analyzed and discussed.
Background: The Comprehensive Aphasia Test (CAT) is a new standardised test designed to assess a ... more Background: The Comprehensive Aphasia Test (CAT) is a new standardised test designed to assess a wide range of language functions in participants with acquired aphasia. In its present state, the CAT is not suitable to be used with Arabic-speaking participants due to language, cultural and regional differences. Aims: The aim of this article is to present a modified and standardised version of the CAT in order to provide a thorough assessment of aphasia among Arabic-speaking aphasic participants and to target intervention towards the disability associated with it. Methods and Procedures: The CAT was translated into Arabic and some subtests were modified to be socio-culturally suitable to the Egyptian population. The modified CAT was tested on a sample of 100 adult participants with aphasia due to stroke or post-traumatic damage attending the out-patients clinic of the Phoniatric Unit of Ain Shams University Hospitals and the Hearing and Speech Institute. A control group of 50 normal, adult, healthy volunteers was also tested. Outcomes and Results: Test–retest reliability checks as well as diverse validity checks were undertaken and their findings showed that the modified CAT is psychometrically well constructed and reveals a high degree of reliability and validity. Conclusions: The modified CAT provides an overview of the linguistic abilities and impairments of an aphasic person through a quick but comprehensive and standardised profile of language performance. Analyses showed the usefulness of the modified CAT battery as a reliable and valid tool for diagnosing aphasia and for targeting therapy towards specific goals.
Study Objectives: About a quarter of strokes and transient ischemic attacks occur in the vertebro... more Study Objectives: About a quarter of strokes and transient ischemic attacks occur in the vertebrobasilar distribution. Vertebrobasilar stroke is particularly prone to devastating consequences especially brain stem infarctions due to damage of the regional brain tissues that contain vital centers, and is associated with high rates of death and disability. Study Design: This was across sectional observational prospective hospital-based study conducted on 60 patients with first-ever acute posterior circulation ischemic stroke. The aim of the current study was to determine the relationship between different risk factors and different infarction patterns in posterior circulation; single small lacunar lesion, single large lesion, or multiple scattered lesions. Diagnosis of ischemic stroke and stroke subtypes were defined using the Trial of ORG 10,172 in Acute Stroke Treatment (TOAST) criteria as well as clinical and brain imaging features. Stroke severity using National Institutes of Health Stroke Scale (NIHSS) score was done on admission, after 24 hours from admission, and at 7 days from onset of symptoms. The patients functional status was assessed by modified Rankin scale (mRS) done on admission and on discharge from hospital and at 7-day follow up from onset of symptoms. Patients were classified according to infarction patterns into a single small lacunar lesion (group I), a single large lesion (group II), and multiple scattered lesions (group III) 20 patients in each group. Results: There was no significant difference between the three groups as regard the presence of vascular risk factors and the only significant difference as regard vascular risk factors was atrial fibrillation (AF). There was significant difference between the three groups as regard the occurrence of previous transient ischemic attacks (TIA). There was significant difference between the three groups as regard NIHSS score on admission, after 24 hours, and at 7 days from admission. There were significant differences between the three groups as regard mRS score at discharge and at 7-day follow up from the onset of symptoms and the degree of
COVID-19 is a pandemic disease which predominantly affects the respiratory system with high criti... more COVID-19 is a pandemic disease which predominantly affects the respiratory system with high critical care mortality and morbidity; however, it also causes multi-organ dysfunction in a subset of patients. Although causality between COVID-19 and mucormycosis remains unclear, many factors including glucocorticoids, worsening of blood glucose control, and viral-induced lymphopenia have been attributed to cause mucormycosis in patients with COVID-19. In COVID-19 patients, especially those who need oxygen support, inflammatory and cytokine storm or usage of steroids make the immune system weak. This may pave the way for opportunistic infections including mucormycosis. We report fourteen cases of COVID-19 infection, who developed rhino-orbito-cerebral mucormycosis, during treatment. Early recognition of this life-threatening infection is the key to allow for optimal treatment and improved outcomes. Keyword Rhino-orbito-cerebral mucormycosis • COVID-19 • Uncontrolled diabetes mellitus • Invasive fungal infection Abbreviations ROCM Rhino-orbito-cerebral CT Cerebral computed tomography MRI Magnetic resonance imaging DM Diabetes mellitus DKA Diabetic ketoacidosis HTN Hypertension FESS Functional endoscopic sinus surgery AIFR Acute invasive fungal rhinosinusitis AIDS Acquired immunodeficiency syndrome IL-6 Interleukin-6
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery
Introduction Stroke is a leading cause of disability worldwide with grave morbidity and mortality... more Introduction Stroke is a leading cause of disability worldwide with grave morbidity and mortality. Sleep and stroke have a definite intermingling neuropathological relationship, so along with expeditious acute management, efficient secondary prevention and consistent rehabilitation, sleep disorders’ management has a hand in offering a medical service up to the mark. Objective Screening of sleep disorders’ prevalence in patients who survived a previous stroke by applying simple questionnaires and to determine the correlation between these disorders and stroke’s demographic, clinical, and risk factor variables. Methods Cross-sectional prospective study on 75 stroke patients from stroke outpatient clinic and all patients were subjected to answer a sheet of sleep questionnaire, Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Apnea/Hypopnea Index (AHI), Arabic versions. Results A total of 70.6 % were found to have sleep disorders, 61.6% had poor sleep quality, 2...
Objectives: To study the prevalence of vitamin D deficiency among newly diagnosed multiple sclero... more Objectives: To study the prevalence of vitamin D deficiency among newly diagnosed multiple sclerosis patients. Patients and Methods: It is a case control cross matching age related study done on totally 40 subjects (20 patients are newly diagnosed as MS; patients don't start any medication for MS (naive patients) and 20 subjects are controls with the same age and sex). Base line vitamin D level was measured (i.e. vitamin D, 25-OH (total)) and MRI brain with contrast was done for all patients. Results: Low total vitamin D level was seen among 65% of patients with MS (13/20); however, this was only 20% of normal controls (4/20). Conclusion: Hypovitaminosis D is common in MS patients.
Objective: To study the prevalence of silent cerebral infarction in Type II diabetes mellitus. Pa... more Objective: To study the prevalence of silent cerebral infarction in Type II diabetes mellitus. Patients and Methods: The study was a prospective on 80 patients recruited from neurology, endocrine outpatient clinics. Patients were type II diabetics as described by the American Diabetes Association, 2011 criteria. All patients underwent full metabolic profiles to diagnose diabetes mellitus and MRI brain scans to detect cerebral infarction. Results: Silent cerebral infarctions were detected in 60% of patients (48/80 patients) predominately along periventricular white matter area and subcortical areas (Basal ganglia, Thalamus). Conclusion: Asymptomatic Type II diabetes mellitus patients could have vascular cerebral changes without neurological symptoms. MRI brain scans could be recommended as routine diagnosis (if possible) for early cerebral infarct detection in type II diabetic patients.
Objective: To study the effect of cerebral ischemic vascular insult on the localization of langua... more Objective: To study the effect of cerebral ischemic vascular insult on the localization of language areas as regard to automatic speech, initiation, and mutism. Materials and Methods: Seventy ischemic stroke patients were selected within the first 48 h of the onset of stroke with left hemis-pheric stroke with aphasia. Inclusion criteria: any age above seven years, both sexes, first ever clinical stroke, admitted within the first 2 days of stroke insult. Patients underwent careful history taking, neurological examination, routine laboratory investigations, echo cardiography, and caro-tid duplex and language assessments. Results: Automatic speech disorders were mainly seen along left insular, left supramarginal and left frontal inferior orbital lesions. Initiation difficulty is seen mainly along as left insular, left temporal superior and left periventricular lesions. Mutism is seen along left external capsule, left internal capsule, left pallidum, left frontal inferior orbital and le...
Study Objectives: Guillain-Barre syndrome (GBS) is an acute-onset, monophasic immune-mediated dis... more Study Objectives: Guillain-Barre syndrome (GBS) is an acute-onset, monophasic immune-mediated disorder of the peripheral nervous system that often follows an infection. The outcome and prognosis of GBS depend on many factors such as the etiology, clinical features, neurophysiology and immunological parameters. The aim of this study was to assess the factors (clinical, investigatory tools, and therapies) that may affect the outcome of patients with GBS. Patients and methods: this was an analytical observational study that was conducted at Ain Shams university hospitals and Kobri Elkoba Military Hospital including twenty patients with the diagnosis of Guillain Barre Syndrome in the duration from 2016 to 2018. This study included twenty patients with the diagnosis of GBS within two weeks from onset of neurologic symptoms, whom their diagnosis based on the established clinical criteria and verified by investigations. Patients were selected from both genders and aged from 18 to 65 years ...
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery
Background: Ankle-brachial index (ABI) is not only a marker of lower limb peripheral arterial dis... more Background: Ankle-brachial index (ABI) is not only a marker of lower limb peripheral arterial disease (PAD), but may also reflect the severity of systemic atherosclerosis. Objectives: To study the prevalence of abnormal ABI among the studied patients with ischemic stroke compared to general population, to assess the correlation between the ABI abnormality and different risk factors, and to study the relationship between ABI abnormality and severity of stroke. Materials and methods: A case control observational analytical study for 200 patients, 100 patients with ischemic stroke and 100 patients as control group matched to case group in age and sex excluding patients with cardioembolic stroke, stroke of undetermined etiology, or young patients. We obtained ABI measurement from all participants. Criteria for PAD diagnosis is an ABI of < 0.9. We assessed patients' group using magnetic resonance imaging, transthoracic echocardiography, electrocardiography, carotid duplex, hemoglobin A1C, and lipid profile. Severity of stroke was assessed by the National Institute of Health Stroke Scale (NIHSS). Results and conclusion: Abnormal ABI relative frequency is higher in stroke group compared to controls. The risk factors most frequently associated with abnormal ABI are diabetes mellitus and dyslipidemia with high statistical significance. In our study, no single stroke patient with abnormal ABI who is not diabetic. In stroke patients, abnormal ABI is relatively more associated with carotid stenosis, recurrent stroke, small vessel disease stroke, and mild to moderate stroke severity by the NIHSS yet with no statistical significance for any of them.
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery, 2015
Background Sophisticated analysis of seizure semiology and electroencephalography (EEG) has a sig... more Background Sophisticated analysis of seizure semiology and electroencephalography (EEG) has a significant role in lateralizing and localizing the epileptogenic zone. Hence, understanding the pathophysiology of epileptogenic dysrhythmia requires thorough knowledge of how to put the very different pieces of the puzzle together. Objective The aim of the study was to investigate the concordance between seizure semiology, electrophysiological generator, anatomical lesions, and neuropsychological evaluation in patients with partial epilepsy, and to identify the importance of ictal EEG recording and the diagnostic yield of other electrophysiological techniques. Patients and methods Thirty patients with a diagnosis of intractable partial epilepsy and lesional MRI were prospectively included. All of them were clinically evaluated and identified according to semiological seizure classification. Long-term video digital EEG with ictal recording was done, along with a source analysis (SA) study. Results Clinical evaluation by seizure semiology lateralized 73% of the cases and localized 80%. Ictal EEG lateralized 80% of cases and localized 66.9%. SA revealed a much superior power to lateralize and localize (96.7%) the epileptogenic zone, but what is more important is the added value of SA, as it lateralized and localized 96-100% of the cases that failed on semiology. SA has the highest expected value for additional lateralizing and localizing information ( ±7.73 and ±7.30, respectively). Conclusion Seizure semiology and ictal EEG recording with SA are the most accurate ways to lateralize and localize the epileptogenic zone in intractable partial epileptic cases, giving the patient a respectable chance to avoid other invasive diagnostic techniques.
Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that... more Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique that is being investigated for a variety of neurological and psychiatric conditions. Preliminary evidence suggests that tDCS may be useful in the treatment of Tourette Syndrome (TS). This paper reviews the literature on the use of tDCS in commonly occurring comorbid conditions that are relevant to its proposed use in TS. We describe the protocol for a double-blind, crossover, sham-controlled trial of tDCS (Trial ID: ACTRN12615000592549, registered at www.anzctr.org.au) investigating the efficacy, feasibility, safety, and tolerability of tDCS in patients with TS aged 12 years and over. The intervention consists of cathodal tDCS positioned over the Supplementary Motor Area. Patients receive either sham tDCS for three weeks followed by six weeks of active tDCS (1.4 mA, 18 sessions over six weeks), or six weeks of active sessions followed by three weeks of sham sessions, with follow-up at three and six months. Pilot findings from two patients are presented. There was a reduction in the frequency and intensity of patients' tics and premonitory urges, as well as evidence of improvements in inhibitory function, over the course of treatment. Larger scale studies are indicated to ascertain the maintenance of symptom improvement over time, as well as the long-term consequences of the repetitions of sessions.
Introduction Patients with Parkinson’s disease (PD) are prone to sleep disturbances and disorders... more Introduction Patients with Parkinson’s disease (PD) are prone to sleep disturbances and disorders with a prevalence of 78–98% (Norlinah et al., 2009). The prevalence of RBD in idiopathic Parkinson’s disease varies from 15% to 58% (Iranzo et al., 2009).The importance of RBD is that it is now considered as an early marker of developing Parkinson’s disease (Arnulf, 2012). Objective: study the clinical and polysomnographic characteristics of PD patients with versus without RBD. Materials and methods Thirty-six PD patients were enrolled from the Involuntary Movement outpatient clinic in Ain Shams University hospital and submitted to clinical assessment by UPDRS- III, Hamilton depression scale, structured sheet for sleep questionnaire, Mayo clinic sleep questionnaire to diagnose RBD, Pittsburgh sleep scale for sleep quality, Epwarth sleepiness scale to assess excessive day time sleepiness. In addition, REM sleep without atonia was assessed, in a one night video-polysomnography (PSG). Results Thirteen patients (36%) were found to have RBD clinically and confirmed by PSG. RBD patients were of older age (p = 0.086), higher disease severity (p = 0.52), shorter disease duration (p = 0.108), there is was no difference between the RBD+ve group and RBD−ve group as regard to tremors or rigidity as a predominant presentation. PSG analysis showed longer REM latency (p = 0.934), higher periodic leg movement index (PLMI) and respiratory disturbance index (RDI), p = 0.553, 0.198 respectively. Conclusion Our findings support the association between RBD and PD as well as the clinical relevance of sleep disturbances in PD. Association with shorter disease duration may support that it is an early marker of the disease.
Laryngeal electromyography (EMG) is an important tool in the study of laryngeal disorders. This r... more Laryngeal electromyography (EMG) is an important tool in the study of laryngeal disorders. This review considers the current state of the art. The general principles of EMG and of the laryngeal neuromotor control system are reviewed. Important criteria for interpreting EMG characteristics, including the motor unit action potential and spontaneous activity, are considered in the context of several pathologic conditions. Technical and clinical difficulties are reviewed.
The present investigation examines the effects of sickle cell crisis on peripheral auditory funct... more The present investigation examines the effects of sickle cell crisis on peripheral auditory function and auditory brainstem response (ABR). The study includes 10 homozygous sickle cell anemia patients with documented sickle cell (SS) hemoglobin. Testing was performed during the crisis and 1 month after it subsided. Unilateral high frequency hearing loss was found in three patients but persisted in only one of them. Abnormal ABR tracings occurred in four patients but reversed to normal in one of them. The study suggests a trend toward increased incidence of sensorineural hearing loss (SNHL) and ABR changes as frequency and severity of crisis episodes increases. The relationship between SNHL and ABR is analyzed and discussed.
Background: The Comprehensive Aphasia Test (CAT) is a new standardised test designed to assess a ... more Background: The Comprehensive Aphasia Test (CAT) is a new standardised test designed to assess a wide range of language functions in participants with acquired aphasia. In its present state, the CAT is not suitable to be used with Arabic-speaking participants due to language, cultural and regional differences. Aims: The aim of this article is to present a modified and standardised version of the CAT in order to provide a thorough assessment of aphasia among Arabic-speaking aphasic participants and to target intervention towards the disability associated with it. Methods and Procedures: The CAT was translated into Arabic and some subtests were modified to be socio-culturally suitable to the Egyptian population. The modified CAT was tested on a sample of 100 adult participants with aphasia due to stroke or post-traumatic damage attending the out-patients clinic of the Phoniatric Unit of Ain Shams University Hospitals and the Hearing and Speech Institute. A control group of 50 normal, adult, healthy volunteers was also tested. Outcomes and Results: Test–retest reliability checks as well as diverse validity checks were undertaken and their findings showed that the modified CAT is psychometrically well constructed and reveals a high degree of reliability and validity. Conclusions: The modified CAT provides an overview of the linguistic abilities and impairments of an aphasic person through a quick but comprehensive and standardised profile of language performance. Analyses showed the usefulness of the modified CAT battery as a reliable and valid tool for diagnosing aphasia and for targeting therapy towards specific goals.
Study Objectives: About a quarter of strokes and transient ischemic attacks occur in the vertebro... more Study Objectives: About a quarter of strokes and transient ischemic attacks occur in the vertebrobasilar distribution. Vertebrobasilar stroke is particularly prone to devastating consequences especially brain stem infarctions due to damage of the regional brain tissues that contain vital centers, and is associated with high rates of death and disability. Study Design: This was across sectional observational prospective hospital-based study conducted on 60 patients with first-ever acute posterior circulation ischemic stroke. The aim of the current study was to determine the relationship between different risk factors and different infarction patterns in posterior circulation; single small lacunar lesion, single large lesion, or multiple scattered lesions. Diagnosis of ischemic stroke and stroke subtypes were defined using the Trial of ORG 10,172 in Acute Stroke Treatment (TOAST) criteria as well as clinical and brain imaging features. Stroke severity using National Institutes of Health Stroke Scale (NIHSS) score was done on admission, after 24 hours from admission, and at 7 days from onset of symptoms. The patients functional status was assessed by modified Rankin scale (mRS) done on admission and on discharge from hospital and at 7-day follow up from onset of symptoms. Patients were classified according to infarction patterns into a single small lacunar lesion (group I), a single large lesion (group II), and multiple scattered lesions (group III) 20 patients in each group. Results: There was no significant difference between the three groups as regard the presence of vascular risk factors and the only significant difference as regard vascular risk factors was atrial fibrillation (AF). There was significant difference between the three groups as regard the occurrence of previous transient ischemic attacks (TIA). There was significant difference between the three groups as regard NIHSS score on admission, after 24 hours, and at 7 days from admission. There were significant differences between the three groups as regard mRS score at discharge and at 7-day follow up from the onset of symptoms and the degree of
COVID-19 is a pandemic disease which predominantly affects the respiratory system with high criti... more COVID-19 is a pandemic disease which predominantly affects the respiratory system with high critical care mortality and morbidity; however, it also causes multi-organ dysfunction in a subset of patients. Although causality between COVID-19 and mucormycosis remains unclear, many factors including glucocorticoids, worsening of blood glucose control, and viral-induced lymphopenia have been attributed to cause mucormycosis in patients with COVID-19. In COVID-19 patients, especially those who need oxygen support, inflammatory and cytokine storm or usage of steroids make the immune system weak. This may pave the way for opportunistic infections including mucormycosis. We report fourteen cases of COVID-19 infection, who developed rhino-orbito-cerebral mucormycosis, during treatment. Early recognition of this life-threatening infection is the key to allow for optimal treatment and improved outcomes. Keyword Rhino-orbito-cerebral mucormycosis • COVID-19 • Uncontrolled diabetes mellitus • Invasive fungal infection Abbreviations ROCM Rhino-orbito-cerebral CT Cerebral computed tomography MRI Magnetic resonance imaging DM Diabetes mellitus DKA Diabetic ketoacidosis HTN Hypertension FESS Functional endoscopic sinus surgery AIFR Acute invasive fungal rhinosinusitis AIDS Acquired immunodeficiency syndrome IL-6 Interleukin-6
The Egyptian Journal of Neurology, Psychiatry and Neurosurgery
Introduction Stroke is a leading cause of disability worldwide with grave morbidity and mortality... more Introduction Stroke is a leading cause of disability worldwide with grave morbidity and mortality. Sleep and stroke have a definite intermingling neuropathological relationship, so along with expeditious acute management, efficient secondary prevention and consistent rehabilitation, sleep disorders’ management has a hand in offering a medical service up to the mark. Objective Screening of sleep disorders’ prevalence in patients who survived a previous stroke by applying simple questionnaires and to determine the correlation between these disorders and stroke’s demographic, clinical, and risk factor variables. Methods Cross-sectional prospective study on 75 stroke patients from stroke outpatient clinic and all patients were subjected to answer a sheet of sleep questionnaire, Pittsburg Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Apnea/Hypopnea Index (AHI), Arabic versions. Results A total of 70.6 % were found to have sleep disorders, 61.6% had poor sleep quality, 2...
Objectives: To study the prevalence of vitamin D deficiency among newly diagnosed multiple sclero... more Objectives: To study the prevalence of vitamin D deficiency among newly diagnosed multiple sclerosis patients. Patients and Methods: It is a case control cross matching age related study done on totally 40 subjects (20 patients are newly diagnosed as MS; patients don't start any medication for MS (naive patients) and 20 subjects are controls with the same age and sex). Base line vitamin D level was measured (i.e. vitamin D, 25-OH (total)) and MRI brain with contrast was done for all patients. Results: Low total vitamin D level was seen among 65% of patients with MS (13/20); however, this was only 20% of normal controls (4/20). Conclusion: Hypovitaminosis D is common in MS patients.
Objective: To study the prevalence of silent cerebral infarction in Type II diabetes mellitus. Pa... more Objective: To study the prevalence of silent cerebral infarction in Type II diabetes mellitus. Patients and Methods: The study was a prospective on 80 patients recruited from neurology, endocrine outpatient clinics. Patients were type II diabetics as described by the American Diabetes Association, 2011 criteria. All patients underwent full metabolic profiles to diagnose diabetes mellitus and MRI brain scans to detect cerebral infarction. Results: Silent cerebral infarctions were detected in 60% of patients (48/80 patients) predominately along periventricular white matter area and subcortical areas (Basal ganglia, Thalamus). Conclusion: Asymptomatic Type II diabetes mellitus patients could have vascular cerebral changes without neurological symptoms. MRI brain scans could be recommended as routine diagnosis (if possible) for early cerebral infarct detection in type II diabetic patients.
Uploads
Papers by taha kamel