Open Access Original Research Article

Prediction of 30-days Mortality of Intracerebral Hemorrhage by a Powerful but Easy to Use Intracerebral Hemorrhage Score

Ahmed Esmael, Mohammed El Sherif, Mohamed Saad

International Neuropsychiatric Disease Journal, Page 1-11
DOI: 10.9734/INDJ/2016/22414

Background: Spontaneous Intracerebral Hemorrhage (sICH) is one of the main reasons of morbidity and mortality globally. Many anticipating scales developed for sICH to be used in systematic clinical approach.

Objectives: To predict the mortality in cases of sICH meanwhile the first month by early assessment details applying a simplified ICH score.

Patients and Methods: This is a prospective study conducted on patients with sICH who admitted at convalescence and critical cases building in Mansoura University Hospitals (CCCB-MUH) during one year. Demographics of the patients, mortality as well as the clinic and radiologic findings of ICH were collected. The clinical scales {National institutes of Health Stroke Scale (NIHSS) scoring, Glasgow Coma Scale (GCS), and intracerebral hemorrhage score (ICHS)} were evaluated for all the patients at admission. Modified Rankin Scale (mRS) was evaluated after 30 days. 

Results: A total of 360 patients with sICH was studied, with a mean age of 62±14 years with males 55.8%. Through 30 days' fatality was 15% (n=54). Elderliness groups especially age ≥80 years were combined with the high statistically significant mortality rate (P < 0.00001). The most common risk factor for sICH was hypertension, smoking, diabetes mellitus, coagulation disorders, cardiac, hyperlipidemia, and history of previous stroke (72%, 34%, 19%, 15, 14%, 14% and 12% respectively). However, there was no statistical difference between survived and died cases in 30 days regarding risk factors in both groups. The radiological characters of cases showing significant very high mortality with larger hematoma volume ≥30 cm (P value =0.0001), followed by the infratentorial location of hematoma (P value =0.0007), then intraventricular hemorrhage (P value =0.0122). While midline shift and hydrocephalus were not associated with significantly high mortality (P= 0.076 & P= 0.125 respectively). Lower GCS was the most statistically significantly clinical scale correlated with high mortality (P < 0.00001), followed by mRS (P= 0.0002). While, NIHSS was less significantly correlated with high mortality (P < 0.0005). The variables that construct the sICH score were chosen from logistic regression, showing that GCS score was the most strongly correlated with thirty days' mortality (P < 0.001), then the age ≥80 years (P < 0.005) followed by the volume of ICH (P < 0.005), then the location of ICH (P < 0.007), and lastly the presence of intraventricular extension of blood (P < 0.05). All patients with the score of 5 and 6 were died in first thirty days, whereas no patient died in first thirty days with a score of 0. While, first thirty-day mortality for patients with scores of 4, 3, 2, and 1 were 77.7%, 63.6%, 19.6%, and 9.6% respectively. The ICH Score was specific  by 91.5% with a high negative predictive value for mortality by 94.1% and was sensitive by 93.4% with a high negative predictive value for good outcome by 92.7%. 

Conclusion: The ICHS is a valid clinical grading scale for 30 days' functional outcome after sICH.


Open Access Original Research Article

Can Glycosylated Hemoglobin and C-reactive Protein Levels Predict Development of Subclinical Neuropathy in Pre-diabetics?

Ahmed Esmael, Mohammad Abu-Hegazy, Amr Elrabat

International Neuropsychiatric Disease Journal, Page 1-8
DOI: 10.9734/INDJ/2016/22316

Background: Individuals with elevated glycosylated hemoglobin (HbA1c) have a higher rate of microvascular complications, especially peripheral neuropathy.

Objective: To  find the relation  between  elevated   (HbA1c) and the  occurrence of  peripheral  nerve dysfunction in prediabetic individuals and to find  the role of the  inflammatory marker as,  C-Reactive  Protein (CRP),  in  the  development  of  Diabetic Peripheral Neuropathy (DPN).

Methods: Screening was done for 80 pre-diabetic individuals and 40 control subjects presenting to the internal medicine clinics,  Mansoura University Hospital; Egypt, from August 2014 to July 2015. The pre-diabetic individuals (HBA1c: 6.0-6.5%)   and a control group of 40 subjects with HbA1c < 6%. All subjects underwent neurological examination, nerve conduction study of both peroneal and sural nerves, and measurement of HbA1c and CRP.

Results: The sural nerve Sensory Nerve Action Potential (SNAP) amplitude was significantly lower in pre-diabetics than in control group. Compound Muscle Action Potential (CMAP) of the peroneal nerve was lower significantly in pre-diabetics with subclinical neuropathy in comparison to controls. The peroneal and sural nerve amplitudes were significantly correlated to CRP, but not to HbA1c.

Conclusion: Axonal subclinical neuropathy occurs significantly more in pre-diabetics than in normal (control) individuals. The CRP is significantly correlated with the presence of the axonal subclinical neuropathy which indicates an underlying inflammatory role.


Open Access Original Research Article

Epilepsy among Cerebral Palsy Children: Clinical Predictors and Frequency

Osama Abdel Salam, Ahmed Esmael, Mohamed El-Sherif

International Neuropsychiatric Disease Journal, Page 1-8
DOI: 10.9734/INDJ/2016/22785

Introduction: Epilepsy is one of the most common neurological disorder in childhood. The risk of epilepsy is highest in children with brain abnormalities, such as cerebral palsy. There are a lot of studies showing that epilepsy varies from 12-19 percent in children with CP.

Objective: The objective of this study is to determine the relationship between cerebral palsy (CP) and epilepsy and how to predict development of seizures among cerebral palsy children.

Subject and Methods: A prospective study included 82 patients with cerebral palsy and history of seizure. Seizure were classified according to ILAE classification, an EEG and neuro-imaging were obtained in all cases. We analyzed the incidence of different types of epilepsy in relation to different subtypes of cerebral palsy. Other factors associated with epilepsy such as age of starting first attack, neonatal seizures and familial factors were also analyzed.

Results: In our study the most common risk factors were perinatal factors 40 patients (48.8%): 16 of them had epilepsy. While the less common risk factors were postnatal factors 10 patients (12.2%): 6 of them had epilepsy. The incidence of epilepsy in our sample was significantly higher with very sever types of CP affecting 58.8% of very sever CP (P = 0.007). In contrary the mild type of CP was significantly associated with 3% only of the prevalence of epilepsy (P = 0.05). Abnormal CT brain findings were found in only 19 (39.6%) patients and there was no abnormality in CT brain in 29(60.4%) patients. High prevalence of epilepsy was associated with neonatal seizures and positive family history of epilepsy (p<0.005).

Conclusions: Epilepsy among children with CP is common and the most common risk factors were perinatal factors. The predominant form of epilepsy was generalized. Brain CT imaging allowed definition of extent of associated brain damage and mostly significant frequency of abnormal findings were detected in epileptic CP children. 


Open Access Original Research Article

Quality of Life of Patients with Obsessive Compulsive Disorder in Saudi Arabia

Hissah M. Alghamdi, Abdel W. Awadalla

International Neuropsychiatric Disease Journal, Page 1-13
DOI: 10.9734/INDJ/2016/21468

Background: Obsessive compulsive disorder (OCD) is an anxiety disorder that involves recurrent obsessions and repetitive compulsions which are severe enough to cause clinically significant distress or impairment in social, occupational or other important areas of functioning of those who suffer from this chronic disorder.

Objective: The aim of this community-based study was to assess, comparatively the subjective quality of life (QOL) of patients with OCD and control group.

Methods: Participants with OCD and control general population group were assessed with the Yale Brown Obsessive Compulsive Scale (Y-BOCS) and Beck Depression Inventory -II (BDI-II) to ascertain severity of obsessive and compulsive symptoms and depression, respectively. The 26-WHOQOL instrument was used to assess the quality of life of both patients with OCD (n=60) and control group (n=67).

Results: The mean scores of patients with OCD related to four QOL domains were significantly lower compared with general population (p<0.01). Both participants with OCD (73.7%) and general population group (85%) were satisfied with their QOL. A 39% of variance in QOL of participants with OCD was explained only by obsessions.

Conclusions: Participants with OCD showed significant reduction in all four domains of QOL compared with general population group. The severity of obsessions contributed significantly to diminished QOL of patients with obsessive compulsive disorder with a trend showing that depression also affects their quality of life. This research calls for a larger controlled study in the community nationwide.


Open Access Review Article

Delusional Jealousy: A Brief Literature Review and a Case Report of 'Unfaithful Husband' with Sociocultural Repercussions

Naseem Akhtar Qureshi, Dalal Salem Al-Dossari, Abdullah Mohammad Al-Bedah, Sara O. Salem, Abdulhameed Al-Habeeb

International Neuropsychiatric Disease Journal, Page 1-18
DOI: 10.9734/INDJ/2016/22583

Background: Pure delusional jealousy [DJL] is an uncommon disorder and is characterized by unshakable false belief of infidelity, lack of hallucination, thought disorder and mood disturbance, and not associated with alcohol or other drug abuse or any co-morbid illness.

Objective: This paper aims to review qualitatively the relevant literature (2000-2015) and present a case of delusional jealousy.

Case History: A 31-year-old housewife with three minor children developed an unshakable belief that her husband was having an extramarital affair since 5 years and no longer loved her. She was diagnosed with delusional jealousy and was managed with aripiprazole and brief psychotherapy. Within three months, most of her symptoms improved, however she developed post-psychotic depression and attempted suicide by taking 125 mg diazepam. She was immediately rushed to a private hospital and admitted to the intensive care unit (ICU). She recovered within five days and was shifted to the public hospital for the management of depression, where she was stabilized and discharged after two weeks.

Conclusion: Typical and atypical antipsychotic drugs combined with psychotherapy are the main treatment options for patients with DJL with or without co-morbid physical and psychiatric disorders. Post-psychotic depression and suicide attempts, devastating biosocial consequences among patients with DJL need timely and appropriate interventions and continued follow up.