Foad Abd-Allah

There is an accumulating volume of research into neurological manifestations of COVID-19. However, inconsistent study designs, inadequate controls, poorly-validated tests, and differing settings, interventions, and cultural norms weaken study quality, comparability, and thus the understanding of the spectrum, burden and pathophysiology of these complications. Therefore, a global COVID-19 Neuro Research Coalition, together with the WHO, has reviewed reports of COVID-19 neurological complications and harmonised clinical measures for future research. This will facilitate well-designed studies using precise, consistent case definitions of SARS-CoV2 infection and neurological complications, with standardised forms for pooled data analyses that non-specialists can use, including in low-income settings. This article is protected by copyright. All rights reserved.

INTRODUCTION: The National Institutes of Health Stroke Scale (NIHSS), the most commonly used tool to quantify neurological deficit in acute stroke, was initially developed in English. We present our experience in developing and validating an Arabic version of the NIHSS (arNIHSS).

METHODS:

RESULTS: In 6months, 137 patients were recruited (mean age±standard deviation 62±12years; 48 women). For interrater agreement, weighted kappa value ranged from 0.36 to 0.66 and intraclass correlation coefficient (ICC) for the whole scale was excellent at 0.95 (95% confidence interval [CI] 0.94-0.97). For intrarater agreement, weighted kappa ranged from 0.52 to 1.0 and the ICC was 0.94 (95% CI 0.87-0.98). The construct validity of the arNIHSS is demonstrated by its correlation with the DWI-ASPECT and the 3months mRS score (Spearman correlation -0.46 and 0.58 respectively; P<0.001 for both).

CONCLUSION: We developed and validated a culturally adapted Arabic version of the NIHSS. Further validation in other Arab countries is recommended.

BACKGROUND: World mapping is an important tool to visualize stroke burden and its trends in various regions and countries.

OBJECTIVES: To show geographic patterns of incidence, prevalence, mortality, disability-adjusted life years (DALYs) and years lived with disability (YLDs) and their trends for ischemic stroke and hemorrhagic stroke in the world for 1990-2013.

METHODOLOGY: Stroke incidence, prevalence, mortality, DALYs and YLDs were estimated following the general approach of the Global Burden of Disease (GBD) 2010 with several important improvements in methods. Data were updated for mortality (through April 2014) and stroke incidence, prevalence, case fatality and severity through 2013. Death was estimated using an ensemble modeling approach. A new software package, DisMod-MR 2.0, was used as part of a custom modeling process to estimate YLDs. All rates were age-standardized to new GBD estimates of global population. All estimates have been computed with 95% uncertainty intervals.

RESULTS: Age-standardized incidence, mortality, prevalence and DALYs/YLDs declined over the period from 1990 to 2013. However, the absolute number of people affected by stroke has substantially increased across all countries in the world over the same time period, suggesting that the global stroke burden continues to increase. There were significant geographical (country and regional) differences in stroke burden in the world, with the majority of the burden borne by low- and middle-income countries.

CONCLUSIONS: Global burden of stroke has continued to increase in spite of dramatic declines in age-standardized incidence, prevalence, mortality rates and disability. Population growth and aging have played an important role in the observed increase in stroke burden.

We report a case of a 37-year-old man presented with acute stroke and hepatorenal impairment which were associated with anabolic-androgenic steroids (AAS) abuse over 2 years. Despite the absence of apparent symptoms and signs of congestive heart failure at presentation, an AAS-induced dilated cardiomyopathy with multiple thrombi in the left ventricle was attributed to be the underlying cause of his condition. Awareness of the complications of AAS led to the prompt treatment of the initially unrecognised dilated cardiomyopathy, and improved the liver and kidney functions. However, the patient was exposed to a second severe ischaemic event, which led to his death. This unique and complex presentation of AAS complications opens for better recognition and treatment of their potentially fatal effects.

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 Addenbrookes's 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.

BACKGROUND: Atherosclerotic aortic arch plaques (AAP) have been linked to an increased risk of thrombo-embolic events as a cause of acute ischemic stroke of undetermined etiology.

OBJECTIVES: To find out the presence of atherosclerotic plaques in aortic arch and their potential role as a source of embolism in cerebral infarction of undetermined etiology.

METHODS: We performed trans-esophageal echocardiography (TEE) and multislice computerized tomography (MSCT) of the aortic arch on 30 patients with acute ischemic stroke of undetermined cause from a total series of 150 non-selected patients with acute ischemic stroke studied prospectively by clinical evaluation, laboratory investigations, cranial computed tomography, color coded duplex ultrasonography of the carotid arteries and transcranial Doppler (TCD).

RESULTS: Using trans-esophageal echocardiography eight patients (29.6%) had atherosclerotic aortic arch plaques, while using multislice computerized tomography atherosclerotic aortic arch plaques were revealed in twelve patients (40%). Atherosclerotic aortic arch plaques were significantly related to older age, male gender, hypertension, ischemic heart disease and low-grade atherosclerotic carotid lesions. Multislice computerized tomography of the aortic arch was more sensitive than trans-esophageal echocardiography in detecting the site, size and characters of atherosclerotic aortic arch plaques.

CONCLUSION: Atherosclerotic aortic arch plaques are a frequent finding in patients with acute ischemic stroke of undetermined cause supporting the hypothesis that aortic plaques have embolic potential. In addition, multislice computerized tomography is more sensitive than trans-esophageal echocardiography in detecting atherosclerotic aortic arch plaques and better characterization of these plaques especially relevant one.