Digital Subtraction Angiographic Pattern of Extracranial and Intracranial Atherosclerotic Arterial Stenosis among Ischemic Stroke Patients

Background: Stroke is the second leading cause of death in adult population throughout the world and is the most common cause of severe adult physical disability. Atherosclerotic stenosis is one of the predominant cause of ischemic stroke. The aim of this study was to evaluate the type, number and severity of intracranial and extracranial atherosclerotic stenosis and its association with different risk factors. Methods: This prospective observational study was conducted in the Department of Neurology, BSMMU, Dhaka, from July 2017 to August 2018. Only patients having significant (≥50%) symptomatic stenosis were included in this study. Results: In total 42 cases, 25 patients had extracranial stenosis, 13 patients had intracranial stenosis and 4 patients had both intracranial and extracranial stenosis. Overall 17 (40.47%) patients have intracranial involvement and 29 (69.04%) patients had extracranial involvement. The most commonly involved intracranial stenotic segment was MCA, present in 8 (32%) out of 25 intracranial segments followed by ICA 7 (28%) and intracranial vertebral artery 4(16%). Most commonly involved extracranial stenotic segment was ICA, present in 37 (77.08%) out of 48 extracranial segments. Diabetes was found to be the most common risk factor of intracranial stenosis (p value 0.022) while hypercholesterolemia was the major risk factor for severe (≥70%) stenosis. Conclusion: Extracranial arterial stenosis is more common than intracranial arterial stenosis. Anterior circulation stenosis is more common than posterior circulation stenosis. Intracranial stenosis is more prevalent in diabetic patients. Hypercholesterolemiaismore commonly seen in severe (e”70%) stenosis. Bangladesh Journal of Neuroscience 2017; Vol. 33 (2): 89-95

Association of Serum Homocysteine Level with Migraine in Adults

Background: Migraine is the second most common primary headache disorder that has close link to the neurovascular system. The exact pathogenesis of migraine is still not fully understood but several possible theories have been proposed. Hyperhomocysteinemia is one of the coincidental factors whose association with migraine is yet in obscure. Methods: This case control study was conducted in the department of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka. A total of 65 patients, who were diagnosed as migraine (with aura or without aura) according to ICHD-3 criteria, were considered as case group and another 65 patients (age and sex matched) with headache other than migraine were considered as control group. Serum homocysteine levels were estimated for both groups and other relevant investigations were done in selective cases. Comparison of serum homocysteine levels between two groups were done to see association of serum homocysteine level with migraine in adults. Results: A total of 50 women and 15 men with mean age of 31 (±10.41) years and 50 women and 15 men with mean age of 33 (±10.91) years constituted case and control groups, respectively. The mean (±SD) serum homocysteine level in case group 10.71 (±4.16) ìmol/L was significantly higher than control group 7.62 (±2.26) ìmol/L, (P <0.001).The mean value of serum homocysteine level in migraine without aura (MWOA) patients 11.87 (±4.18) ìmol/L was found significantly higher than migraine with aura (MWA) patients 8.23 (±1.51) ìmol/L, (p<0.05). There was no significant correlation between severity of migraine headache and frequency of migraine attack with serum homocysteine level. Conclusion: Serum homocysteine level was found significantly higher in migraineurs than non-migraineurs. Bangladesh Journal of Neuroscience 2017; Vol. 33 (2): 76-82

Association between Modifiable Risk Factors and Stroke Recurrence in Patients with First Ever Ischemic Stroke

Background: Stroke is the third leading cause of death in adult population throughout the world and is the most common cause of severe adult physical disability. It is increasing at an alarming rate in Asia including Bangladesh. The effect of recurrent stroke is devastating on patient as it is the main reason of mortality and morbidity among patients. Methods: A longitudinal, observational study was conducted from April 2018 to October 2018 in the department of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka. All the patients of first ever ischemic stroke confirmed by neuroimaging (CT scan of head / MRI of brain), meeting the inclusion and exclusion criteria were included in the study. Our study was performed with sixty stroke patients. We followed up patient up to 90 days and observed for stroke recurrence. Results: Present study showed among the 60 stroke patients, only 4 (6.67%) suffered from stroke recurrence within 3 months. In our study, uncontrolled systolic blood pressure (p=0.04), uncontrolled diastolic blood pressure (p=0.027), dyslipidaemia (p=0.001), smoking (p=0.0003) and antiplatelet discontinuation (p=0.0001) were significantly associated with stroke recurrence whereas uncontrolled diabetes mellitus (p=0.46) and presence of atrial fibrillation (p=0.057) had no significant association. Conclusion: Smoking, hypercholesterolemia, uncontrolled systolic &/or diastolic blood pressure and discontinuation of antiplatelet therapy were significantly associated with stroke recurrence in this population. Therefore, early identification and control of these risk factors are essential to prevent recurrent stroke, thereby decrease morbidity and mortality. Bangladesh Journal of Neuroscience 2017; Vol. 33 (2): 55-62

Guillain Barré Syndrome after Thrombolysis With Streptokinase for Acute Myocardial Infarction: A Case Report

We would like to report on a patient, a 52-year-old man with acute neurologic disorder, Guillain Barré Syndrome. He was successfully treated by intravenous immunoglobulin. The patient suffered from acute extensive anterior MI. 2 weeks after thrombolytic therapy with streptokinase, he developed GBS. Bangladesh Journal of Neuroscience 2017; Vol. 33 (2): 103-104

Association of Serum Uric Acid level in Patients with Alzheimer’s Disease

Background: Alzheimer’s disease is the most common cause of dementia. Uric acid is the end product of purine metabolism in humans and acts as a natural antioxidant, accounting up to 60% of the free radical scavenging activity in human blood to prevent free radicals induced oxidative cell injury. This study aimed to explore the association between serum uric acid level and cognitive impairment of Alzheimer’s disease patients compared to those of the non-demented age and sex matched controls. Methods: This case control study was carried out in the department of neurology, BSMMU, Dhaka. Total 116 patients were enrolled as study population after satisfying inclusion and exclusion criteria. Among them, 58 were grouped as case and rest 58 were control. All blood samples for serum uric acid were measured in the Biochemistry lab, Department of Biochemistry, BSMMU, Dhaka. Results: A signiûcant reduction of serum uric acid levels in the AD group was found compared to those of the control group (4.35±1.59 Vs 6.89±1.68) which was statistically significant (p<0.001). We also found a positive correlation between serum uric acid levels with severity of Alzheimer’s disease (rp = 0.633, P<0.001). Among demographic variables educational qualification was statistically significant (p=0.006) in AD patients. Conclusion: This study showed that oxidative injuries have an important role in the pathogenesis of AD. Higher levels of uric acid are associated with a decreased risk of dementia and better cognitive function later in life. Bangladesh Journal of Neuroscience 2017; Vol. 33 (2): 83-88

Association of Serum Magnesium Concentration with Alzheimer’s Disease

Background: Alzheimer’s disease is a neurodegenerative disease. It is the most common cause of dementia in individuals older than 60 years of age. Age is the most important risk factor for Alzheimer’s disease. It is important to identify modifiable risk factors. One such important modifiable risk factor is Magnesium, a trace element. The objective of the study was to see the association of serum Magnesium concentration with Alzheimer’s disease patients. Method: It was a case control study carried out in neurology department of BSMMU, Dhaka. Total 68 patients were enrolled as study population after satisfying inclusion and exclusion criteria. Among them, 34 were grouped as case and rest 34 were control. Serum Magnesium concentration was detected. Result: Serum Magnesium concentration was significantly lower in AD patients than that of control group [2.04±0.19 mg/dl vs 2.36±0.21 mg/dl. Conclusion: The results of our study revealed an expression that the trace element, Magnesium concentration has an association with Alzheimer’s disease. Bangladesh Journal of Neuroscience 2017; Vol. 33 (2): 70-75

Association of Insulin Resistance with Sodium Valproate Therapy among Epileptic Patient

Background: Epilepsy is a common neurological disorder. Sodium valproate is one of the commonest broad spectrum antiepileptic drugs and it is used worldwide. Weight gain is the common side effect which is known to be associated with insulin resistance. The aim of this study was to see the association of sodium valproate therapy with insulin resistance among epileptic patients. Methods: It was a cross-sectional analytical study. Total 102 patients (51 epileptic patients with valproate monotherapy for at least one year and another 51 age and sex matched newly diagnosed epileptic patients without any anti-epileptic drugs) were selected in this study. The study was carried out from March 2016 to April 2017 for one year in the epilepsy clinic and outpatient Department of Neurology at Bangabandhu Sheikh Mujib Medical University, Dhaka. Participants underwent anthropometric evaluations and biochemical tests including fasting blood sugar and fasting insulin level. Insulin resistance (IR) index was calculated. Result: In this study mean duration of valproate treatment was 3.12±1.26 years and mean sodium valproate dose was 1133±440.5 mg/day (17.7±6.65 mg/kg/day). This study revealed serum fasting insulin level in valproate group and non-valproate group was 11.05±4.86 (ìU/ml) and 7.39±2.01 (ìU/ml) respectively. Fasting blood glucose was 4.71±0.79 (mmol/L) in valproate group and 4.41±0.62 (mmol/L) in non- valproate group. Calculated IR index in valproate group and non-valproate group was 2.17±0.55 and 1.46±0.39 respectively. IR index, fasting insulin and blood glucose all were significantly higher in valproate group than non- valproate group. This study also revealed mild positive correlation of IR index with dose and duration of valproate treatment. Conclusion: Sodium valproate treated patient had significantly higher IR index than control group. Bangladesh Journal of Neuroscience 2017; Vol. 33 (2): 63-69

Association between Chlamydia Pneumonia Seropositivity and Ischemic Stroke: A Case-Control Study

Background: Apart from traditional risk factors, infectious agent might contribute to ischemic stroke. The aim of this study was to evaluate the association between Chlamydia pneumonia seropositivity and ischemic stroke. Methods: 42 ischemic stroke patients diagnosed by history, clinical examination and confirmed by CT scan or MRI of brain selected as case. The same number (42) of age and sex matched subjects having no history or clinical evidence of ischemic stroke were selected as control. Blood samples were collected within 2 to 14 days of ischemic stroke from indoor patients. Controls were collected from both indoor and outdoor patients with neurological disorders other than ischemic stroke. Anti-C. pneumoniae antibodies IgG and IgA were detected by ELISA (enzyme-linked immunosorbent assay) in the Department of Virology, Bangabandhu Sheikh Mujib Medical University (BSMMU). Results: Among the study population, 66.7% of cases and 45.2 % of control patients were seropositive to C. Pneumoniae IgG (OR: 2.42, 95% CI: 1.00 - 5.85, p = 0.048). Whereas IgA were positive in 81% of case and 57.1% of control (OR: 3.19, 95% CI: 1.19 - 8.52, p = 0.018). Seropositivity to IgA showed more significant results than IgG. Conclusion: There was a significant association between Chlamydia pneumonia seropositivity both IgG and IgA with ischemic stroke. Bangladesh Journal of Neuroscience 2017; Vol. 33 (2): 47-54

Utility of Serum Copper Level Estimation in Patients Suffering from Alzheimer’s Disease

Background: Alzheimer’s disease is the most common cause of dementia. Metals such as zinc , copper, iron are likely involved in the neurodegeneration of Alzheimer’s disease . Copper can catalyze a flux of reactive oxygen species that can damage functional and structural macromolecules in brain. Most studies found association of high serum copper level with Alzheimer’s disease but also some studies did not. Methods: Total 48 patients of Alzheimer’s disease who were diagnosed according to NIA-AA ( National institute of Aging – Alzheimer’s Association) recommendation ( revised NINCDS-ADRDA) criteria were taken as study population purposively and 42 age and sex matched control were selected. Fasting serum copper level were done for both groups. Comparison of serum copper level of Alzheimer’s patients with that of the control group were done to see association. Results : A total of 28 male and 20 female with mean age of 66.20 ± 9.42 (mean±SD) years, 22 male and 20 female with mean age of 63.54 ± 9.74 (mean±SD) years constituted as case and control groups, respectively. The mean of serum copper in case and control groups were 0.95 ± 0.37 versus 0.92 ± 0.25 mg/L (P > 0.05). The present study found that serum copper levels are non-significantly higher in patients with AD than control group, however it did not show a significant relationship with severity of dementia. Conclusion: So our suggestion was to perform a study work including total serum copper level , serum ceruloplasmin level and free serum copper level comparing between a large Alzheimer’s Disease patients group and age , sex matched apparently healthy control group to understand the copper dyshomeostasis in Alzheimer’ Disease. Bangladesh Journal of Neuroscience 2017; Vol. 33 (2): 96-102

Role of Calcitonin Gene Related Peptide (CGRP) in Migraine

Migraine is the second most primary headache. The prevalence of Migraine is 12% in the general population, including 18% in women and 6% in men. Migraine can start in childhood and adolescence and continue throughout lifespan. It is most prevalent among people in their 30s and 40s. Migraine is a debilitating hemicranial headache that is pulsating, aggravated by movement, nausea, vomiting and having sensitivity to light and sound, with or without aura. It can affect all aspects of life as work and school, parenting and family relationships and personal and leisure time. There are some theory regarding pathogenesis of migraine which includes cortical spreading depression, cortical spreading oligemia, activation of trigeminocervical complex leading to neuroinflammation & release of vasodialating neuropeptides which include calcitonin gene related peptide (CGRP), substance P, vasoactive intestinal polypeptide (VIP), nitric oxide (NO), and pituitary adenylate cyclase activating peptide (PACAP) & genetic factor. CGRP is a potent vasodilator and causes perivascular plasma protein extravasation and nociceptive pain. Newer medications target CGRP both for acute and preventive treatment of migraine. Bangladesh Journal of Neuroscience 2017; Vol. 33 (1): 39-43