Original/Research Article

Middle Cerebellar Peduncle Lesions and Their Relation to Affective and Cognitive Impairment in Multiple Sclerosis

Eman Hamdy, Ismail Ramadan, Jaidaa Mekky, Dina Gaber, Aya Abdel Galeel

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e1

Background: Cerebellum has long been known to modulate not only motor coordination but also affective and cognitive functions. This study aimed to assess the impact of middle cerebellar peduncle (MCP) lesions on affective and cognitive function in patients with multiple sclerosis (MS).

Methods: This was a cross-sectional study conducted on patients with relapsing-remitting MS (RRMS). All patients were subjected to 3-Tesla magnetic resonance imaging (3T MRI), brief international cognitive assessment for MS (BICAMS), and Depression, Anxiety, and Stress Score-21 (DASS-21) upon recruitment.

Results: Of the 30 patients recruited, 33.3% and 36.7% had right and left MCP lesions, respectively. Patients with right MCP lesions had significantly worse symbol digit modality test (SDMT) scores (P = 0.036), worse California verbal learning test (CVLT) immediate recall scores (P = 0.011), and worse CVLT delayed free recall scores (P = 0.049), whereas patients with left MCP lesions had lower DASS-21 scores (P < 0.005). On multivariate regression analysis, the presence of left MCP lesion was associated with an 8.9-point reduction in DASS-21 scores (CI: -16.985- -0.805, P = 0.033), whereas right MCP lesions did not have an independent effect on BICAMS scores after adjustment for age and educational level.

Conclusion: Left MCP lesions were associated with significantly lower DASS-21 scores, whereas none of the MCP lesions had an independent impact on cognition.

Volumetric Assessment of Extratemporal Structures in Patients With Temporal Lobe Epilepsy

Marjan Asadollahi, Elham Rahimian, Ali Akbar Asadi-Pooya, Majid Tahsini, Hans-Jürgen Huppertz, Nayyereh Akbari, Leila Simani

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e2

Background: We assessed the presence of brain volume loss in the extratemporal structures in patients with temporal lobe epilepsy (TLE). The associations between brain volume loss in these structures and epilepsy duration, magnetic resonance imaging (MRI) findings, and occurrence of focal to bilateral tonic-clonic seizures (TCS) were assessed.

Methods: In this cross-sectional study, all adult patients with drug-resistant TLE, who were admitted to the epilepsy monitoring unit at Loghman-Hakim Hospital, Tehran, Iran, during 2016-2020, were included. For all the participants, brain MRI was performed and patients with TLE were divided into two subgroups of those with hippocampal sclerosis (TLE-HS) and patients with normal-appearing brain MRI findings (TLE-no). Independent sample t test was applied to compare quantitative variables in the study groups. Pearson correlation test examined the correlation between the clinical and volumetric features.

Results: 203 participants (81 patients with TLE and 122 healthy controls) were studied. Compared with healthy controls, patients with TLE showed a decrease in their midbrain (P = 0.02) and thalamus (P = 0.01) volume. The degree of thalamic atrophy was more significant in TLE-HS (P = 0.03). Moreover, the degree of midbrain volume loss was more significant (P = 0.07) in patients who had TCS in the past two years (N = 31) compared with those who did not (N = 50). The volume of the thalamus (r: -0.252, P = 0.02) and pallidum (r: -0.255, P = 0.02) had inverse correlations with the epilepsy duration.

Conclusion: Patients with TLE have lower midbrain and thalamus volume compared with the healthy controls, which may be attributed to the seizure-induced injury. Midbrain atrophy may theoretically increase the risk of sudden unexpected death in epilepsy (SUDEP) because of the enhanced autonomic dysfunction.

Quiet Standing; Hidden Markov Model; Electromyography; Dynamic Balance.: In this study, three detecting approaches have been proposed and evaluated for online detection of balance situations during quiet standing. The applied methods were based on electromyography of the gastrocnemius muscles adopting the hidden Markov models.
Methods: The levels of postural stability during quiet standing were regarded as the hidden states of the Markov models while the zones in which the center of pressure lies within determines the level of stability. The Markov models were trained by using the well-known Baum-Welch algorithm. The performance of a single hidden Markov model, the multiple hidden Markov model, and the multiple hidden Markov model alongside an adaptive neuro-fuzzy inference system (ANFIS), were compared as three different detecting methods.
Results: The obtained results show the better and more promising performance of the method designed based on a combination of the hidden Markov models and optimized neuro-fuzzy system.
Conclusion: According to the results, using the combined detecting method yielded promising results.

Stereotactic iodine -125 brachytherapy for low grade glioma tumors treatment: A monte carlo study

shahrzad valizadeh, Elham Saeedzadeh, Alireza Zali, Hasanali Nedaei, Saeed Zare Ganjaroodi

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e9

Background: Stereotactic brachytherapy (SBT) is an appropriate method that has been used for brain tumors and metastases treatment for more than 40 years for many patients in the world. Also, Iodine-125 brachytherapy has been utilized in brain tumors for interstitial brachytherapy treatment since 1979. Even though the physical and biological feathers make these implants particularly attractive for minimal invasive treatment.

Method: In this paper, monte carlo simulation have been applied by the Gate code with 20 (MBq) activity for an iodine seed design for the low-grade glioma tumors treatment. Dosimetry feathers of this source were defined by the updated TG-43U1 recommendations. The absorbed dose distribution around the seed was calculated using the Gate code in liquid water.

Result: Results show, the ideal condition for brachytherapy are for tumors smaller than 4 (cm). As the larger tumor size, the absorption dose at the border of tumor and healthy tissue will be decreased and the implantation time for seeds will increase.

Conclusion: Placing an iodine-125 source inside the tumor is not sufficient due to the non-uniform dose distribution in the tumor and the length of treatment time. Using four iodine-125 sources eliminates the tumor, and also, a uniform dose distribution is created in the tumor and the implantation time will be reduced, respectively.

Predictors of 90-Day Functional Outcome Following Direct Mechanical Thrombectomy for Anterior Circulation Large Vessel Occlusion: A Prospective Study

Mohammed Anwar, Ossama Yassin Mansour, Hany Eldeeb, Sameh M. Said

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e10

Background: Mechanical thrombectomy (MT) is becoming a growing trend in the management of large vessel occlusion (LVO) during the past few decades, although data on the predictors of outcome following MT are scarce. We aimed to study the predictors of 90-day outcome in a cohort of patients with ischemic stroke with large-vessel occlusion.
Methods: This was a three-month prospective study of 40 patients with anterior circulation LVO who underwent MT and were followed up for three months with modified Rankin Score (mRS).
Results: Of the 40 patients recruited, 55% were men. M1 was the most common vessel occluded (32.5%) followed by internal carotid artery (ICA) and carotid trunk (20%). Tandem occlusion occurred in 25% of the cases. Among the demographic, clinical, radiological, and procedural variables studied, the factors that had a significant impact on the mRS at 3 months were age, diabetes mellitus (DM), hyperlipidemia, stroke mechanism, blood glucose level during procedure, post-procedural National Institutes of Health Stroke Scale (NIHSS), baseline Alberta stroke program early CT score (ASPECT) score, collaterals grade, and procedural thrombolysis in cerebral infarction (TICI) score (P < 0.05). On multivariate regression, patients’ age (B: 0.025, 95% CI: 0.001- 0.049, P = 0.038), post-procedural NIHSS (B: 0.192, 95% CI: 0.101–0.283, P < 0.001), and baseline ASPECT score (B: -0.442, 95% CI: -0.838- -0.046, P = 0.03) were the most independent factors to affect the mRS at 3 months.
Conclusion: Patients’ age, baseline ASPECT score and post-procedural NIHSS are significant predictors of 90-day outcome of large-vessel occlusion following MT.

Time-Frequency Distribution Analysis for Electroencephalogram Signals of Patients With Schizophrenia and Normal Participants

Malihe Sabeti, Ehsan Moradi, Mahsa Taghavi, Mokhtar Mohammadi, Reza Boostani

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e11

Background: Psychiatrists diagnose schizophrenia based on clinical symptoms such as disordered thinking, delusions, hallucinations, and severe distortion of daily functions. However, some of these symptoms are common with other mental illnesses such as bipolar mood disorder. Therefore, quantitative assessment of schizophrenia by analyzing a physiological-based data such as the electroencephalogram (EEG) signal is of interest. In this study, we analyze the spectrum and time-frequency distribution (TFD) of EEG signals to understand how schizophrenia affects these signals.
Methods: In this regard, EEG signals of 20 patients with schizophrenia and 20 age-matched participants (control group) were investigated. Several features including spectral flux, spectral flatness, spectral entropy, time-frequency (TF)-flux, TF-flatness, and TF-entropy were extracted from the EEG signals.
Results: Spectral flux (1.5388 ± 0.0038 and 1.5497 ± 0.0058 for the control and case groups, respectively, P = 0.0000), spectral entropy (0.8526 ± 0.0386 and 0.9018 ± 0.0428 for the control and case groups, respectively, P = 0.0004), spectral roll-off (0.3896 ± 0.0434 and 0.4245 ± 0.0410 for the control and case groups, respectively, P = 0.0129), spectral flatness (0.1401 ± 0.0063 and 0.1467 ± 0.0077 for the control and case groups, respectively, P = 0.0055), TF-flux (1.2675 ± 0.1806 and 1.5284 ± 0.2057 for the control and case groups, respectively, P = 0.0001) and TF-flatness (0.9980 ± 0.0000 and 0.9981 ± 0.0000 for the control and case groups, respectively, P = 0.0000) values in patients with schizophrenia were significantly greater than the control group in most EEG channels. This prominent irregularity may be caused by decreasing the synchronization of neurons in the frontal lobe.
Conclusion: Spectral and time frequency distribution analysis of EEG signals can be used as quantitative indexes for neurodynamic investigation in schizophrenia.

The Effectiveness of Acceptance and Commitment Therapy on Depression, Alexithymia and Hypertension in Patients with Coronary Heart Disease

Mojtaba Rahnama Zadeh, Hassan Ashayerih, Tahere Ranjbaripour, Alireza Kakavand, Farahnaz Meschi

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e15


 Background: According to recent studies, cardiovascular diseases have been the most prevalent cause of death and disability worldwide, one of the most hidden types of which is coronary heart disease. Coronary heart disease is mainly psychosomatic in nature and the role of psychological (especially personality) and social factors in its occurrence is very important. We aimed to evaluate the effectiveness of acceptance and commitment therapy (ACT) on depression, alexithymia, and hypertension in patients with cardiovascular diseases.

Methods: The was a quasi-experimental study with a pretest-posttest design, with a control group and baseline assessment after intervention and three-month follow-up. The statistical population included all patients with cardiovascular diseases referred to Imam Reza hospital in Amol city from July to December 2020. 24 patients were selected as the sample using purposeful sampling and assigned to equal experimental and control groups randomly. The study tools were a researcher-made demographic questionnaire (2019), Toronto Alexithymia Scale (1994), Beck Depression Inventory (1990), and acceptance and commitment treatment protocol (Hayes, 2012). Data were analyzed by repeated measures analysis of variance.

Results: We found that ACT had a significant effect on reducing depression, alexithymia, and hypertension.

Conclusion: Patients who participated in ACT sessions had lower rates of depression, alexithymia, and hypertension.

Relationship Between Post-traumatic Growth and Illness Perception and Emotion Regulation in Patients with Cancer

Shiva Rahimzadegan, Sajjad Basharpour, Niloofar Mikaeili, Mohammad Narimani

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e16

Background: Cancer diagnosis causes emotional problems and profound psychological helplessness in patients. We aimed to investigate the relationship between post-traumatic growth and disease perception and emotion regulation in patients with cancer.
Methods: The statistical population of this correlation study was all patients aged 18-65 years with breast, leukemia, and gastrointestinal cancer going to the oncology ward of Omid and Imam Khomeini hospitals in Urmia in the first half of 2021. 250 people (121 women and 129 men) were selected by the purposeful sampling method. Data collection tools included a post-traumatic growth questionnaire, a modified illness perception questionnaire, and the emotion regulation process strategies questionnaire. Pearson’s correlation test and multiple regression analysis were used for data analysis.
Results: The results showed that negative illness perception had a significant and negative relationship, and optimistic illness perception had a positive, meaningful relationship with post-traumatic growth (P < 0.05). Emotion regulation had a significant and positive association with post-traumatic growth (P < 0.05).
Conclusion: How to perceive the disease and emotion regulation strategies in patients with cancer have an influential role in promoting post-traumatic growth.

The Effectiveness of Empathy and Problem-Solving Skills Training on Social Self-efficacy and Mental Security of High School Boys

Adel Zarei, Behnam Makvandi, Parvin Ehtesham Zadeh, Sasan Bavi

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e17


 Background: Teaching empathy and problem-solving skills is effective in improving students’ self-efficacy and quality of social life. We aimed to compare the effectiveness of empathy and problem-solving skills training on social self-efficacy and psychological security of Assaluyeh second high school boys.

Methods: This was a quasi-experimental study on all male high school students in Assaluyeh in the academic year of 2019-2020, of whom 45 were purposefully selected and assigned to two experimental groups and controls group. One experimental group received empathy training and the other group received problem-solving training in eight 90-minute sessions. To collect data, the social self-efficacy and Maslow’s psychological security questionnaires were used. Analysis of covariance was done using SPSS-24 software.

Results: Empathy and problem-solving training were effective on social self-efficacy and psychological security of high school boys (P < 0.001). Also, no significant difference was found between the effectiveness of empathy skills training and problem-solving training on social self-efficacy and psychological security (P < 0.746).

Conclusion: Empathy and problem-solving training increased social self-efficacy as well as psychological security in high school boys.

Early detection of alzheimer’s disease with convolutional neural network

Elias Mazrooei, Mahi Azarnoosh, Majid Ghoshuni, Mohammad Mahdi Khalilzadeh

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e20

The main purpose of this study is to provide a method for early diagnosis of Alzheimer's disease. This disease reduces memory function by destroying neurons in the nervous system and reducing connections and neural interactions. Alzheimer's disease is on the rise and there is no cure for it. With the help of medical image processing, Alzheimer's disease is determined and the similarity of the characteristics of brain signals with medical images is determined. Then, by presenting the characteristics of effective brain signals, the mild Alzheimer's group is determined. The level of this disease should be diagnosed according to the relationship between this disease and different features in the brain signal and medical images. First, with appropriate preprocessing, nonlinear properties such as phase diagram, correlation dimension, entropy and Lyapunov exponential are extracted and classification is done using convolutional neural network. The use of deep learning methods, including channel neural network, can have more appropriate and accurate results among other classification methods. The accuracy of the results in the reminder period is 97.5% for the brain signal and 99% for the MRI images, which is an acceptable result.

Case Report

Fahr Syndrome and Syncope: Case Report and Clinical Radiological Characteristics

Luis Avellaneda, Marco Rojas, Karen Torres, Luis Cetina, Ledmar Vargas

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e4

Background: Fahr´s syndrome is a rare neurodegenerative entity, which consists of calcifications of the basal ganglia and cerebrospinal nuclei, which can be associated with neurological and neuropsychiatric symptoms. However, the difference between syndrome and Fahr’s disease is highlighted.
Case Report: a 55-year-old man with underlying thyroid disease undergoing treatment, debuted with syncope with posterior cranial trauma, which was admitted to the emergency service, performing imaging studies with findings compatible with Fahr´s syndrome.
Conclusion: syncope as a cardiac symptom in a patient with Fahr syndrome, metabolic and structural abnormalities ruled out must be.

Acute Hemifacial And Hemiparesis Caused By Hemorrhagic Vestibular Schwannoma; A Case Report

Sayedali Ahmadi, Jaber Hatam, Mahisa Mokhtari, Meysam Abolmaali, Eshagh Bahrami, Marjan Mirsalehi, Saleh Mohebbi

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e6

Vestibular schwannoma is a benign and common slow-growing tumor that develops on the vestibular divisions of cranial nerve VIII. Some risk factors may enhance intratumoral hemorrhage risk which leads to tumor management to early surgical procedures. Hence, we describe a 57-year-old man presented with hearing loss and a 5*8 mm vestibular schwannoma. Eight months later, the patient was referred with headache, nausea and vomiting, right hemifacial paresis, and hemiparesis. Magnetic resonance imaging (MRI) revealed a 45*35 mm hemorrhagic vestibular schwannoma. Surgical pathology reported hemorrhagic vestibular schwannoma. This was a rare case of hemorrhagic vestibular schwannoma with none of the established risk factors for the intratumoral hemorrhage and presented with Wallenberg-like syndrome. Many risk factors can cause hemorrhagic vestibular schwannoma. We present one case of small vestibular schwannoma without any predisposing of hemorrhage and acute onset of same side hemifacial paresis and hemiparesis.

Spondylolysis-induced Multilevel Lumbar Spondylolisthesis; Challenges in Lumbar Spine Surgery

Thi Phuong Hoai Dinh, Ngoc Thanh Van Duong, Trong Hieu Le, Thi Mai Dieu Tran, Dang Duong Pham, Vinh Lac Nguyen, Thanh Minh Nguyen

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e12

Lumbar spondylolysis and multilevel lumbar spondylolysis account for 4.4-5.8% and 0.3% of the general population, and multilevel lumbar spondylolysis resulting in spondylolisthesis is even rarer. Herein, we report two cases of three-level lumbar spondylolisthesis because of spondylolysis: A 49-year-old woman was admitted to the hospital for dull lower back pain over the past 8 months, with exacerbating symptoms when standing and walking. Spasticity at lumbar region and radiculopathy at S1 nerve root was found on examination and a 63-year-old man was admitted to the hospital because of numbness and perianal sensory disturbances with difficulty urinating 2 weeks ago, the symptoms gradually increased to the time of examination. Both patients were diagnosed with multilevel lumbar spondylolisthesis because of spondylolysis and were indicated for posterior lumbar interbody fusion (PLIF). After surgery, both patients recovered well without any significant complications. The improved treatment results suggest the application of PLIF technique to treat spondylolysis-induced multilevel lumbar spondylolisthesis.

Hemorrhagic Meningioma With Symptom of Convulsion: A Rare Presentation of Parietal Meningioma

Dinh Thi Phuong Hoai , Duong Ngoc Thanh Van, Phan Quoc Tho, Nguyen Ngoc Anh Thu, Le Trong Phuoc, Le Trong Hieu, Nguyen Vinh Lac, Vo Ba Tuong, Nguyen Thanh Minh

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e14

Meningioma is the most common, extra-axial, non-glial intracranial tumor with an incidence of 2.3-5.5/100 000, accounting for 20%-30% of all primary brain tumor diagnoses in adults. Meningiomas associated with intratumoral hemorrhage are very rare occurring in 0.5%-2.4%. of individuals. Herein, we report a rare case of hemorrhagic meningioma with the symptom of convulsion. The case was a 68-year-old woman admitted to the hospital with severe headache and convulsions. Computed tomography revealed an increase in heterogeneous lesion measuring 4 × 3 × 2.5 cm at the right parietal lobe. Brain magnetic resonance imaging (MRI) showed a grossly stable homogeneously enhancing extra-axial mass measuring 43 × 33 × 28 mm, small calcified peripheral, intratumoral hemorrhage. Histopathology showed a multi-celled meningioma with bleeding areas (WHO grade I).

Review Article

Effectiveness of Action Observation and Motor Imagery on Relearning Upper Extremity Function After Stroke: A Systematic Review and Meta-analysis

Nandana Welage, Michelle Bisssett, Kenneth N.K. Fong, Paul Fahey, Kristy Coxon, Karen P.Y. Liu

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e5

The effectiveness of action observation (AO) and motor imagery (MI) in high-quality studies with less risk of bias is rarely reported together. This systematic review evaluates the effectiveness of AO and MI on improving upper extremity function among people after stroke by combining evidence of studies with high methodological quality. Randomised controlled trials, with a score of 6 or above in the PEDro Scale, that examined the effects of AO or MI for people with stroke were selected. A narrative analysis and meta-analysis were conducted using the PRISMA guidelines. Ten randomised controlled trials from 11 articles met the inclusion criteria. The results of meta-analysis showed that AO had a small to moderate statistically significant effect on improving upper extremity motor function (standardized mean difference, SMD = 0.34; confidence interval, CI = 0.08, 0.59; P = 0.35; I2 = 0.00%) and no significant effect on MI (SMD = 0.08; CI = -0.26, 0.42; P = 0.65; I2 = 0.00%) when compared with the control intervention. Evidence was found in support of AO and it is recommended for people with acute or sub-acute stroke.

Neurological Complications of Corona Virus: A Mini-Review

Hedayat Sahraei, Mohammad Sahraei

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e8

Following the outbreak of COVID-19 disease, which is caused by the coronavirus, there were reports of neurological complications, indicating that virus infection may have risks involving the nervous system. Stroke, encephalopathy, moderate to severe headaches, anosmia and dysgeusia, hallucination, and depression were the most neurological complications reported. The most important neurological complication of COVID-19 is anosmia, which is caused by the infection of the olfactory support cells. Hallucination and depression have been observed in those admitted to the intensive care unit, which is primarily related to general inflammatory reactions. Although brain autopsies of people who have died because of COVID-19 have shown that the virus can be detected in brain tissue. Studies indicate that viral infection has only been detected in the vascular part of the blood-brain-barrier. Perhaps the most critical finding of coronavirus infection in the brain is the activation of astrocytes and microglia in patients with COVID-19, which dilates the cerebral arteries in the brainstem, allows killer T cells to enter brain tissue, and causes cytotoxic effects in this part of the brain. This review focused on the neurological complications associated with COVID-19 and the possible mechanisms underlying these complications.

Neuropathic Pain: Mechanism, Representation, Management and Treatment

Amir Saied Seddighi, Afsoun Seddighi, Mahsa Ghadirian, Alireza Zali, Seyed Mahmoud Tabatabaei Far

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e18


 Despite the development of screening tests and diagnostic tools, neuropathic pain is still identified as an underdiagnosed condition lacking proper epidemiological studies. It is difficult to estimate its incidence and prevalence the population. The objective of this narrative review is to summarize current knowledge concerning complications. The underlying mechanisms have also been reviewed in the development of diagnostic or treatment strategies in patients with neuropathic pain to investigate its unique symptoms. The main focus is concentrated on expansion of possible therapeutic options for neuropathic pain treatment. Many therapies are not effective and this often leads to a significant deterioration in the patients’ quality of life. So, the crucial and strategic role of therapeutics in guiding patients in the right direction should not be overlooked. The existing knowledge is so limited and has safety risks. It is truly important to provide alternative treatment strategies in selected patients with refractory neuropathic pain. Interventional therapies include different types of effective treatments for reducing neuropathic pain. Giving insight into recent findings on mechanisms of neuropathic pain may help understand and further develop strategies for correct diagnosis and successful treatment. 

Determinants of Public Acceptance of the COVID-19 Vaccine: A Systematic Review

Farzin Bagheri Sheykhangafshe, Hojjatollah Farahani, Parviz Azadfallah

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e19

Background: The coronavirus disease 2019 (COVID-19) pandemic can be considered as a global unity that has forced all countries to work together to treat it. Consistent with ongoing efforts to reduce the prevalence of COVID-19, building a safe and effective vaccine against COVID-19, which is recognized as a major achievement, is a priority for many developed countries around the world. In this regard, we aimed to investigate the determinants of public acceptance of COVID-19 vaccine.
Methods: In this review, published articles on the determinants of public acceptance of COVID-19 vaccine during 2020-2021 were reviewed. To obtain related scientific documents, the following keywords were searched in the title and abstract of published articles: Coronavirus 2019, COVID-19, and Vaccine acceptance, Resistance, Doubt, Vaccination, Determinants and Pandemics. Scientific databases such as Google Scholar, PubMed, Science Direct, Scopus and ProQuest were searched and all relevant English articles were listed. The PRISMA checklist was used to review and control the quality of articles.
Results: Initially, 372 English articles were retrieved and finally 19 articles were finally selected for comprehensive review and data extraction. The results showed that most people were more receptive to vaccines that produce 90%-95% efficacy and safety levels. Also, being a woman, low age, low-income level, being single, low education and lack of trust in the government were among the factors that reduced the acceptance of people for the COVID-19 vaccine. The most common reasons for people not participating in the vaccination process were fear of vaccine side effects, lack of confidence in vaccine efficacy, and safety levels.
Conclusion: Considering that a significant number of people in the world have a high acceptance of vaccines with 90%-95% safety levels. Measures need to be taken to speed up the vaccination process. Also, since most people are only afraid and anxious about the side effects caused by vaccines, it is necessary to increase people’s awareness and knowledge about the positive and negative consequences of vaccination.

Letter to Editor

Headache as a Significant Central Nervous System Manifestation of COVID-19 Infection

Saeideh Salehizadeh, Negar Bizhani, Zahra Arab-Mazar, Sara Rahmati Roodsari

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e7

Dear Editor,
In recent years, the world has witnessed the emergence of dangerous respiratory diseases with coronaviruses, including the severe acute respiratory syndrome (SARS) by the SARS-CoV, Middle East respiratory syndrome (MERS) by the MERS-CoV, and coronavirus disease 2019 (COVID-19) by the SARS-CoV-2. The disease now affects most countries in the world. Coronavirus is generally known to cause respiratory disease, but clinical and experimental studies show that this disorder affects several organs including the central nervous system (CNS).1-3
The CNS effects of COVID-19 are not well-known owing to being an emerging phenomenon, however, it is worth understanding. The virus enters the cells of the human body using the cellular receptor angiotensin-converting enzyme 2 (ACE2). In a normal condition, this receptor is expressed in very small amounts in the CNS. The virus can be transmitted to the CNS through systemic circulation or across the cribriform plate of the ethmoid bone in the early and secondary stages of COVID-19 infection. Broad spectrum of neurological manifestations such as ageusia, anosmia, headache, sensory disturbances and epilepsy have been observed in some patients. Anosmia and ageusia are common, and can occur in the absence of other clinical features. Unexpectedly, acute cerebrovascular disease due to hyper coagulation state is also emerging as an important complication. Altered level of consciousness and encephalitis are other presentations in patients with COVID-19.4,5 Almost all the articles reviewed focused on macro-and microscopic changes in the lungs, and only a handful of information from other organs and systemic findings were presented. Comprehensive study after autopsy in the brain is very important and more research needs to be done.6-9 A better understanding of the function of coronavirus in the CNS and accurate identification of the damage can help in treatment planning and prognosis of the disease.10,11 In addition, hypoxia may occur in the CNS (hypoxic ischemic encephalopathy) due to respiratory failure. Thrombotic microangiopathy can also occur.12 Hence, it is of paramount importance that in the early and uncomplicated stages of coronavirus infection, the patient’s CNS be examined. There is still insufficient information to provide a complete picture of the pathophysiology of SARS-CoV-2 infection. Careful clinical, diagnostic, and epidemiological studies are needed to help define the manifestations and burden of neurological disease caused by SARS-CoV-2. Precise case definitions must be used to distinguish non-specific complications of severe disease (e.g. hypoxic encephalopathy and critical care neuropathy).4 In light of the above mentioned, further studies on patients with progressive or worsening CNS findings should be performed more carefully to make the undiscovered effects of this virus on the CNS clearer to the world.
So far, we have mentioned CNS involvement in general and now we aim to give a brief summary of studies on headache attributed to COVID-19 infection. The reports on the neurological presentations are rising significantly and headache has the lead on the symptom list.
Headache associated with systemic infections is usually nonspecific and actually there are no particular distinguishing or characteristic features. It was reported that headache was a frequent symptom in COVID-19 infection and there was an extreme diversity in its characteristics.

Do not Forget People’s Mental Health

Poorya Davoodi, Atousa Hashemi, Negin Ahmadfakhredin, Melika Jourablou, Meisam Akhlaghdoust, Hasan Mosazadeh

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e13

The outbreak of coronavirus disease 2019 (COVID-19) has changed the typical lifestyle of people worldwide for nearly two years. Maybe before the onset of this pandemic, no one believed that a virus could change all aspects of life. COVID-19 has had a catastrophic effect worldwide, and it has led to more than 5 million deaths.1
Since the beginning of the COVID-19 pandemic, different factors such as emotional and exaggerated images and news, rumors, and misinformation about the origins and causes of the disease, have affected the lifestyle of the people, and many people have lost their family or friends., all leading to increased anxiety.2 The results of studies in the previous pandemics have shown that one of the most critical domains of harm is the mental health of people and the significant point is that the mental health of infected individuals was less affected than non-infected individuals. During the COVID-19 pandemic, different studies have evaluated the mental health of people. Fear and anxiety are common feelings that are experienced by patients with or suspected of COVID-19. A study published in 2020 showed that fear of illness results in increased anxiety and stress levels in patients, healthy individuals or health workers.