Tehran University Medical Journal

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Background: Major clinical manifestations of antiphospholipid syndrome (APS) in the central nervous system are generally arterial thrombotic events and a number of non-thrombotic neurologic syndromes. Antiphospholipid antibodies (APAs) are one of the important risk factors for cerebrovascular accidents (CVA). The aim of present study was to assess the relationship between APA titers and CVA in this clinically important age group.
Methods: This case-control study was carried out on patients under 50 years old who had CVA (stroke or transient ischemic attack) in Shahid Sadoughi Hospital in Yazd (central Iran) from Dec 2003 until March 2005. In this study, 61 patients with CVA were compared with 68 age- and gender-matched control subjects. Lupus anticoagulant assay results and APA titers were assessed in both groups.
Results: The mean value of IgM APA titers in patients with cerebrovascular accidents was 6.492 MPL (IgM antiphospholipid units) and 1.846 MPL in the control group. The difference between the two groups was significant (p-value: 0.000). In 12 (20%) of the patients with cerebrovascular accidents, IgM titers were higher than 10 MPL, one of whom had an IgM titer higher than 40 MPL. The mean value of IgG titers in the case group was 5.50 GPL (IgG antiphospholipid units) and 3.51 GPL in the control group. The difference between the two groups was significant (p-value: 0.012). Thirteen (21%) patients with cerebrovascular accidents had IgG titers higher than 10 GPL. The difference between the LA assay results was not significant between the two groups (p-value: 0.311).
Conclusion: The present study showed a positive relationship between APL (IgM and IgG) titers and CVA in patients under 50 years old.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Cerebrovascular accidents are the most common complications in premature neonates (gestational age <37 weeks). Intraventricular hemorrhage (IVH) and hydrocephaly are the most common presentations of these accidents. Premature neonates less than 28 week age or 1000 gr have maximum risk of cerebrovascular accidents with prevalence of 30 percent. Early screening in high risk pregnancies with real-time ultrasonography can detect these lesions and affect on final prognosis. The purpose of this study is evaluation of brain ultrasonongraphic findings of 60 premature neonates born in Yazd University Hospitals, Yazd, Iran and relationship between these findings and delivery types.
Methods: In this descriptive cross sectional study 60 cases of premature neonates (less than 37 week) who were born from January to July 2007 in Yazd hospitals were evaluated ultrasonographically to detect cerebrovascular accidents.
Results: Among 60 premature neonates, 52(86.67%) were low birth weight and 8(13.33%) neonates weighted more than 2500gr. IVH was seen in five (9.6%) LBW neonates and hydrocephaly was seen in five (9.6%) LBW neonates. One LBW neonate (1.9%) had haloprocencephaly. Eight normal weight neonates had no abnormal ultrasonographic findings.
Conclusion: All factors that induce preterm delivery and high risk pregnancies can increase cerebrovascular accidents in premature infants. Neonatal weight had most powerful relationship with neonatal ultrasonograohic findings.

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Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 Background: Shoulder pain is a common complication of cerebrovascular accidents.  This study was conducted to assess the effects of local injections of bupivacaine and triamcinolone acetate on shoulder joint pain and on restricted range of motion following brain events.
Methods: This single-blind clinical trial study included 35 patients with chronic shoulder pain (the controls) and 35 patients with chronic shoulder pain due to brain events (the case group). The study was done at Imam Hossein Hospital & Gandhi Day Clinic during the year 2008-2010. The patients in the two groups received bupivacaine and triamcinolone acetate for subacromial bursa injection and suprascapular nerve block by following the protocol described by Dangoisse et al. The patients were followed up for 12 weeks and they were evaluated for pain and range of motion 1, 6, and 12 weeks after the injections.
Results: The mean age of the patients was 60.9±9.07 years. Statistically significant improvements in pain score (P=0.001) and shoulder joint range of motion (P=0.001) were observed in patients with chronic shoulder pain versus patients with brain events 12 weeks after suprascapulare nerve block and subacromial bours injections by  bupivacaine and triamcinolone acetate.
Conclusion: Suprascapular nerve block and subacromial bursa injections of bupivacaine and triamcinolone acetate is a safe and efficacious treatment for the treatment of chronic shoulder pain and restricted range of motion but it is not efficacious or of significant value for the treatment of shoulder pain in patients with brain events.