The discrimination between multiple sclerosis (MS) and other white matter lesions in adults is still problematic as multiple diseases have similar clinical and radiological findings, especially at the disease onset. This case–control study aimed to evaluate the efficacy of diffusion tensor imaging (DTI) and brain morphometry in the differentiation between adult MS and its magnetic resonance imaging (MRI) mimics.

Background/Objective(s)

In recent years, several studies have reported vascular abnormalities in patients with multiple sclerosis (MS). Epidemiological data suggest that patients with MS might have an increased risk of developing ischemic stroke. Imaging studies in patients with MS suggest a decrease in cerebral perfusion that affects widespread areas including the normal-appearing white matter (NAWM). In addition, MS has been associated with reduced CNS venous blood drainage, which is referred to as chronic cerebrospinal venous insufficiency (CCSVI).

Material(s) and Method(s)

Two groups were recruited in the present study:

First group: 30 patients from inpatient and outpatient Neuropsychiatry department in Assuit university hospital were diagnosed with MS according to the revised 2017 McDonald's criteria.

Second group: 30 healthy volunteer subjects matched with age, sex and education level.

Inclusion criteria: Patients diagnosed with MS or with clinically isolated syndrome (CIS) highly suggestive of MS according to revised 2017 McDonald's criteria; MS patients aged 18-60 years of both sexes; Expanded Disability Status Scale (EDSS) score 1-7.

Exclusion criteria: History or current evidence of CNS diseases; psychiatric or other drugs which may affect brain volume and cognition.

An assessment of cerebral circulation hemodynamics for both sides was done by the high resolution color duplex Philips Envisor C Ultrasound System with L 12-3 MHz linear transducer probe. Hamilton Depression Rating Scale (HDRS) and Mini-mental State Examination (MMSE) were used as neuropsychiatric assessment scales.

Result(s)

Cerebrovascular hemodynamic insufficiency was significantly prominent in patients with MS mainly in the anterior and posterior parts with lower affection of carotid circulation. Different significant correlation levels found between HDRS, MMSE, and EDSS and affected vessels indicated that the cerebral vessels changes affect the MS-related progression and disability.

Conclusion(s)

Patients with MS seem to have an increased risk for ischemic stroke. Endothelial dysfunction secondary to inflammatory responses or raised homocysteine concentrations might play a part, but reduced cerebral blood flow might predispose patients to the development of these ischemic brain lesions. The widespread cerebral hypoperfusion in MS seems not to be secondary to axonal degeneration, but might be a result of reduced axonal activity, reduced astrocyte energy metabolism, and perhaps increased blood concentrations of endothelin-1(ET-1). Impaired cerebral perfusion can be related to the cognitive manifestation of the disease, which is a common symptom associated with substantial decline in activities of daily living.

Background: Reducing pre- and in-hospital delays plays an important role in increasing the rate of intravenous thrombolysis (IVT) in patients with acute ischemic stroke. In Egypt, the IVT rate has increased steadily but is still far away from an ideal rate.

Aim: The study aimed to investigate the factors associated with pre- and in-hospital delays of IVT among patients with acute ischemic stroke coming from urban and rural communities.

Methods: This prospective, multicenter, observational cohort study was conducted from January 2018 to January 2019. Patients with acute ischemic stroke, who did not receive IVT, were included in the study. Patients were recruited from three large university stroke centers in Egypt, Assiut (south of Egypt), Tanta (north of Egypt), both serving urban and rural patients, and the University Hospital in Cairo (capital city), only serving an urban community. All participants underwent the National Institutes of Health Stroke Scale and full neurological assessment, urgent laboratory investigations, and computed tomography or magnetic resonance imaging to confirm the stroke diagnosis. The patients were subjected to a structured questionnaire that was designed to determine the parameters and time metrics for the pre- and in-hospital delays among patients from rural and urban regions.

Results: A total of 618 patients were included in the study, of which 364 patients (58.9%) lived in rural regions and 254 (41.1%) in urban regions. General demographic characteristics were similar between both groups. Approximately 73.3% of patients who arrived within the therapeutic time window were urban patients. The time from symptom onset till hospital arrival (onset to door time, ODT) was significantly longer among rural patients (738 ± 690 min) than urban patients (360 ± 342 min). Delayed onset to alarm time (OAT), initial misdiagnosis, and presentation to non-stroke-ready hospitals were the most common causes of pre-hospital delay and were significantly higher in rural patients. For patients arriving within the time window, the most common causes of in-hospital delays were prolonged laboratory investigations and imaging duration.

Conclusion: The limited availability of stroke-ready hospitals in rural Egypt leads to delays in stroke management, with subsequent treatment inequality of rural patients with acute stroke.

Background/Objective(s)

Multiple sclerosis (MS) is the most common disabling neurological disorder in young adults. It is an autoimmune disease affecting the central nervous system (CNS) resulting in severe physical and cognitive debilitation, and neurological difficulties. The objective of this study was to assess the signs and symptoms of MS among Egyptian adults.

Material(s) and Method(s)

People diagnosed with MS as per the 2017 McDonald Diagnostic Criteria have been included in the cross-sectional investigation. Adults of ages ranging from 30 to 50 years were included, with no demographic restrictions. Patients with disorders that impact cognition or cortical activity were excluded.

Result(s)

Results showed that the frequency of attacks varied from one to nine. The frequency of the affected lobes in the magnetic resonance imaging (MRI) varied from one to six. Only four patients' EEGs showed epileptic activity. Excluding the three patients who had progressive MS, all the others had relapsing remitting MS. The average Hamilton Depression Rating Scale (HAM-D) score was 24.96 ±7.24, with only five patients scoring normal, while 13 (40.6%), 2 (6.3%), and 12 (37.5%) patients had mild, moderate, and severe depression, respectively. The average Hamilton Anxiety Rating Scale (HAM-A) score was 24.56 ± 9.32, with only three patients scoring normal, while 21 (65.6%), 6 (18.8%) and 2 (6.3%) patients had mild, moderate and severe anxiety, respectively. Out of all patients included, 28.1% had Positive Pulfrick phenomenon, 40.6% had Positive Uthoff phenomenon, 84.4% had depression, 90.6% had anxiety, 12.5% had seizures.

Conclusion(s)

Patients with MS might experience several unique signs and symptoms that are misinterpreted and might lead to delayed dignosis.