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 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 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 features make these implants particularly attractive for minimal invasive treatment, the main goal of this paper is to evaluate the I-125 seed time and dose reached to brain glioma tumors of different sizes for treatment using Monte Carlo modeling.
Methods: In this paper, Monte Carlo simulation has been applied by the Gate code with 20 (MBq) activity for an iodine seed design for low-grade glioma tumors treatment. Dosimetry features 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: The ideal condition for brachytherapy is for tumors smaller than 4 cm. With a 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 because of 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 Nonlinear Features of EEG Signal and MRI Images by Convolutional Neural Network

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

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

Background: 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.
Methods: 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.
Results: For 40 participants brain signals and MRI images were recorded during 4 phase protocol and after appropriate preprocessing, nonlinear properties such as phase diagram, correlation dimension, entropy, and Lyapunov exponential are extracted and classification is done using a convolutional neural network (CNN). The use of this deep learning method can have more appropriate and accurate results among other classification methods.
Conclusions: The accuracy of the results in the reminding phase is 97.5% for the brain signal and 99% for the MRI images, which is an acceptable result.

The Effect of Mirtazapine on Reducing Chronic Stress in Male Rats

Samira Barbar Shemirani, Mohammad Ali Nasiri Khalili, Seyed Mohammad Mahdavi, Amir Modarresi Chahardehi

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e21

Background: Mirtazapine (Mtz) has attracted attention for its anti-anxiety properties. We aimed to explore the impacts of chronic unpredictable stress (CUS) using Mtz treatment as a post-traumatic stress disorder (PTSD) drug and to determine body weight and plasma corticosterone levels at various times in rats.
Methods: Adult male Wistar rats were administered nine days of CUS in this research and then received Mtz after CUS or when the CUS began. At the end of the CUS protocol, the rats were subjected to the elevated plus maze (EPM) test and open-field test (OFT) (for anxiety-like behavior) followed by the forced swimming test (FST) and tail suspension test (TST) (for depression behavior). The CUS protocol included body weight measurement, a sucrose preference test (SPT), and plasma corticosterone (CORT) levels.
Results: Significantly decreased body weight and increased plasma CORT levels were seen in the CUS group. Mtz at 10 mg/kg significantly increased body weight in rats after being exposed to CUS, demonstrating anti-anxiety activity. The process was discovered to be linked with a decline in plasma CORT and no significant difference was seen with respect to body weight compared with the control group, as we found in one of the treated groups (Mtz after CUS).
Conclusion: A decrease in CORT levels in serum plasma and modulated body weight might be a key mechanism by which Mtz exerts its therapeutic potential as an antidepressant, and it would be safe to take orally after stressful conditions.

Predictors of Long-term Disability in Multiple Sclerosis: Real World Data from a Cohort of Egyptian Patients

Dina Elsayed Gaber, Farouk Talaat, Ismail Ramadan, Eman Hamdy, Amira Sayed

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e22

Background: Specification of prognostic factors in multiple sclerosis (MS) is crucial for clinicians to guide therapeutic protocols. This study aimed to identify demographic, clinical, and radiological factors associated with disability on a long-term basis in relapsing-remitting MS (RRMS) and secondary progressive MS (SPMS).
Methods: This was a retrospective study conducted on patients with RRMS and SPMS with a disease duration of at least 10 years. Demographic, clinical, and radiological parameters were collected from the medical records.
Results: During the study period, 217 patients were recruited with a mean disease duration of 14.9 ± 4.6 (range: 10-35) years. Regression analysis revealed that age (B = 0.071, CI: 0.00-0.132, P = 0.025), male sex (B = –0.825, CI: –1.444 to –0.206, P = 0.009), duration between first 2 attacks (B = -0.007, CI: -0.015-0.000, P = 0.037), and involvement of pyramidal (B = 0.754, CI: 0.051-1.457, P = 0.036) or cerebellar domains (B = 1.355, CI: 0.542-2.168, P = 0.001) at disease onset were the only parameters that had an independent effect on EDSS.
Conclusion: Predictors of long-term disability in our cohort were closely similar, but not typically identical to predictors reported in the literature. Age, male sex, short duration between first 2 relapses pyramidal and cerebellar affection were the strongest predictors of disability in patients with RRMS and SPMS.

Interferon Beta-1b Level in Parkinson’s Disease: Before and After SARS-CoV-2 Vaccination

Yaprak Donmez Cakil, Zeynep Gunes Ozunal, Sibel Karsidag, Sevki Şahin

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e23

Background: Parkinson’s disease (PD) is a neurodegenerative disease. Immune response varies after vaccination in different patients. We aimed to evaluate interferon beta-1b (IFNβ-1b) level in patients with PD in response to inactivated SARS-CoV-2 (CoronaVac) vaccination.
Methods: Eight patients with the diagnosis of idiopathic PD and followed in the outpatient clinic (stages 1-2) were enrolled. Total blood count was performed before vaccination. IFNβ-1b levels were measured by ELISA and motor examination was performed before and two hours after vaccination.
Results: IFNβ-1b levels increased in three patients, whereas no change was detected in one patient and the levels decreased in four patients. Divergent responses were found related to the time of diagnosis.
Conclusion: The time of PD diagnosis, as well as the age of the patients, may be responsible for the variability of the post-vaccine immune response.

Coronavirus Pandemic and Mental Health During Pregnancy

Zahra Naeiji, Yekta Parsa, Nazila Shokri, Hajar Abbasi, Athena Behforouz, Sina Nazemi, Atefeh Moridi

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e27

Background: COVID-19 is an enveloped RNA virus, declared as a pandemic in 2020. The pandemic and the policies around it for controlling the infection have caused major psychological stress on the population, especially a high-risk group: the pregnant women. This study evaluates the anxiety and depression of pregnant women, in the first six months of COVID-19 pandemic in Iran.
Methods: In this cross-sectional study, all pregnant women, visiting the obstetrics clinic of Mahdiyeh hospital, were enrolled in this study. Among them, women with no prior psychological disorder or use anti-anxiety or antidepressant drug were included in the study and were asked to complete the hospital anxiety and depression scale (HADS) questionnaire. Also, the demographic information, obstetrics history and past medical history of each patient were collected. Data were analyzed using SPSS software, version 22, using descriptive statistics (mean and standard deviation), t test, chi-square and Bonferroni post hoc tests. Significant levels were considered at P ≤ 0.05.
Results: Overall, 465 pregnant women with a mean ± SD age of 26.75 ± 5.71 years were included in the study. The mean ± SD HADS score of the women was 12.00 ± 6.09 and 240 (51.6%) of the women had abnormal HADS score. Among the demographic properties, a significant association was seen between gravidity and HADS score (P < 0.05).
Conclusion: COVID-19 can cause a considerable level of stress in women during their pregnancy, which can lead to adverse pregnancy outcomes. Among pregnant women, primigravida and multigravida (more than two previous pregnancy) ones were at higher risk of experiencing anxiety or depression.

Factors Associated With Neurological Manifestations in Patients With COVID-19

Mona Ramezani Ghamsari, Zahra Mirzaasgari, Mahsa Ziaee, Marjan Zeinali, Tara Khoeini, Mohammad Rezaei, Mohammad Mahdi Niksima, Ehsan Hajiramezanali, Hoda Derakhshani, Mahdi Yadollahzadeh, Parham Samimi Sedeh, Meysam Abolmaali

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e27

Background: The coronavirus disease 2019 (COVID-19) is the most terrible pandemic of a respiratory disease that we had in the past century. Most existing studies explore different manifestations in COVID-19. Few recent studies have described neurological manifestations of patients with COVID-19 but their associations with age, laboratory findings, and mortality rates have not been explored well.
Methods: This case-control study includes 263 patients with COVID-19 without neurological symptoms (control group) and all patients with COVID-19 with the central nervous system symptoms (n = 460, case group) hospitalized between February 2020 and April 2020. Data on demographic factors, medical history, symptoms, and laboratory tests, all are extracted from medical records.
Results: Out of 723 patients with confirmed SARS-CoV-2 infection, 460 (63.6%) were identified to have at least one neurological manifestation. The mean ages of patients with and without neurological manifestation were 60.6 ± 18.0 and 60.8 ± 15.7 years, respectively. The most common symptoms were myalgia (41%), headache (20.3%), and loss of consciousness (LOC) (16.5%). Women were more likely to develop a neurological manifestation (P = 0.001). Moreover, smoking history was significantly more in patients with neurological manifestations (P = 0.03). Also, we compared two groups in terms of tracheal intubation. The need for tracheal intubation was 19% and 12% in patients with and without neurological manifestations, respectively. Furthermore, the prevalence of intensive care unit (ICU) admission was 28% and 24% in patients with COVID-19, with and without neurological manifestations, respectively. Some of the neurological manifestations such as LOC, limbs weakness, and seizure might need more ICU admission and tracheal intubation. The frequency of comorbidities and the laboratory test results were almost similar between the two groups.
Conclusion: Myalgia, headache, and LOC were the most common neurological manifestations and their distributions varied depending on age. Only a few neurological manifestations were related to mortality and morbidity rates, while some of them occurred in mild cases.

Prevalence of Cardiac Anomalies in Children with Syndromic and Non-syndromic Craniosynostosis

Ali Riazi, Mahdi Vahidian , Mehrdad Larry; Donya Sheibani Tehrani; Mostafa Allami, Zahra Salehi ; Maryam Karimi ; Sarina Loghmani

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e30

Background: Craniosynostosis mostly occurs as a single abnormality; however, it may rarely occur concomitantly with other congenital abnormalities known as syndromic craniosynostosis. Cardiac anomalies are among the most common ones occurring coincidentally with craniosynostosis. Nevertheless, the information about the exact prevalence of cardiac anomalies in craniosynostosis has not been well-understood yet. We aimed to assess the prevalence of different cardiac anomalies that coincidence with craniosynostosis.
Method: This cross-sectional study was done on 145 patients with craniosynostosis from January 2015 to December 2019. 103 patients with a single-suture involvement were placed in the non-syndromic group, and the remaining 42 with pansynostosis or the clinical manifestations of Apert, Pfeiffer, Crouzon, and Carpenter syndromes in the syndromic group. The prevalence of cardiac anomalies was evaluated and compared between the groups.
Results: The prevalence of congenital cardiac anomalies was 22.3% and 50% in non-syndromic and syndromic cases, respectively (P = 0.001). Syndromic boys predominantly presented cardiac anomalies (P = 0.85), whereas non-syndromic girls were mostly affected by cardiac anomalies (P = 0.75). Age was not associated with congenital cardiac anomalies, neither in non-syndromic (P = 0.31) nor in syndromic (P = 0.26) patients. The number of affected sutures was not associated with cardiac anomalies (P > 0.05). Tricuspid regurgitation (TR) (16.7%), patent ductus arteriosus (PDA) (14.3%), and ventricular septal defect (VSD) (11.9%) were the most prominent anomalies found among the syndromic patients, while TR (8.7%), atrial septal defect (ASD) (3.9%), and PDA (3.9%) were common among the non-syndromic ones.
Conclusion: Congenital heart disease is a prevalent abnormality among children with craniosynostosis. Therefore, cardiac assessment in craniosynostosis is strongly recommended.

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

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

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).

Management of Traumatic Pseudoaneurysm of the Supraclinoid Internal Carotid Artery using Coil Embolization: A Case Report

Rohit Yadav, S I Sadique, Shubhamitra Chaudhari

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e24

Traumatic aneurysm of the internal carotid artery (ICA) occurs rarely, with an approximate incidence of 0.15% and 0.40% of total intracranial aneurysms. An interesting case of delayed presentation of pseudoaneurysm of the left ICA in a 61-year-old patient is reported here, who came to us for evaluation of blindness, proptosis, and ophthalmoparesis. This potentially life-threatening condition was successfully managed using coil embolization after complete evaluation and investigations.

Physical Therapy and Dry Needling for Erectile Dysfunction and Impaired Penile Sensation Following Reconstructive Surgeries of the Penis; A Case Report

Ghazal Kharaji, Mehrdad Bahramian, Narges Dabbaghipour, Mitra Molaeinezhad, Jan Dommerholt, Mehri Mehrad

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e25

Peyronie’s disease (PD) is a connective tissue disorder resulting from abnormal development of fibrotic and non-expandible thickened scar tissue in the penis. Surgical intervention might lead to other complications, including decreased sensation in the penis, persistent pain after surgery, and less-rigid erections. This study presents the physiotherapeutic assessment and management of a 33-year-old man with erectile dysfunction and impaired penile sensation following reconstructive surgeries of the penis. The patient was given physiotherapeutic interventions including dry needling (DN) and subcision of the scar and stretching exercise of the penis. After the 5th visit, the patient reported improvement in symptoms. This case report suggests that dry-needling and subcision techniques can improve pain and sexual well-being in patients with post-plication surgery problems.

Traumatic Unilateral Basal Ganglia Hemorrhage in a Pediatric Patient: A Case Report

Ziya Asan

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e28

Traumatic basal ganglia hemorrhages are among the very rare intracranial hemorrhages. In cases with bleeding in this region, high mortality and morbidity rates are encountered. This region contains many anatomically critical functional pathways. Basal ganglia hemorrhages are common in the elderly, and hypertension plays a role in its pathogenesis. Age-related comorbid factors are also relatively high in these patients. Basal ganglia hemorrhages are very rare in the pediatric age group. It can be predicted that the prognosis in this age group will be better than in the elderly. A 13-year-old man was followed up with the diagnosis of unilateral basal ganglia hemorrhage after falling from a bicycle. Right hemiparesis was present at the time of admission. Neurological findings of the patient, who was followed up with conservative treatment, completely recovered after one week. In control computed tomography examination, it was observed that the hematoma was completely resorbed. Herein, we present the clinical and radiological prognosis in a child with traumatic basal ganglia hemorrhage.

Parenchymal Infarction After Subacute Subdural Hematoma Evacuation: Case Report

Ziya Asan

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e29

Subacute subdural hematomas are among the least diagnosed group among subdural hematomas. Subacute subdural hematomas, defined as isodense on computed tomography examinations, are considered as bleeding hasting for one to three weeks. Although clinical findings are not sudden onset similar to acute subdural hematoma cases, they have a more progressive course compared to chronic subdural hematoma cases. Herein, we report a patient presented with sudden neurological deterioration who developed right hemispheric infarction and hemiparesis in the postoperative period.

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.

Investigating Consciousness in Sleep Studies: Evaluation of Key Dream Lucidity Induction Techniques

Berenika Maciejewicz

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e31


 Lucid dreaming is a rare phenomenon of consciousness emerging while asleep, most often during the rapid eye movement phase. It is estimated that over half of the world population have had at least one lucid dream in their lifetime and around one fourth report to have one episode of dreaming lucidity each month. Conscious dreaming happens when a dreamer becomes suddenly aware of being inside their own dream. This realization leads to immediate waking up in some people, while more experienced lucid dreamers report the ability to stay lucid within one’s dream and gain agency over its narrative, characters, and own actions and feelings. Scientists in sleep laboratories have invented numerous techniques and procedures intended to increase the frequency of conscious dreams. As researchers propose new protocols to induce lucidity, this analysis aims to address a pressing challenge to continue the evaluation of such experiments to aim for establishing empirically validating standards for this young field of research. A lot of new reported protocols are based on anecdotal or personal accounts. As such, they may contain some form of bias and omission, rendering the data as inconclusive. Another challenge is the lack of methodological standardization in protocols used. A recommended classification is to group the methods into three broad categories for dream lucidity induction: external stimulation, cognitive techniques including mnemonic methods and reality check protocols, and miscellaneous techniques, including pharmacological ways to induce lucidity.

Molecular and Cellular Basis of Misfolded Proteins in Neurodegenerative Diseases

Alireza Zali, Saeid Safari, Sara Rahmati Roodsari, Somayeh Niknazar

International Clinical Neuroscience Journal, Vol. 9 (2022), , Page e32

Neurodegeneration is characterized by a progressive loss of nerve structure and function which lead to cognitive impairment such as dementia. Neurodegenerative diseases (NDs) are partially caused by neuronal cell death and glial homeostasis. NDs such as Alzheimer’s disease (AD) and Parkinson’s disease (PD) can develop with aging. As well, in Huntington’s disease (HD) and amyotrophic lateral sclerosis (ALS), genetic mutations can affect CNS cell function. NDs occur through important processes including, protein misfolding and aggregation of misfolded proteins. These processes cause neurofibrillary tangles and plaques that result in neuronal cytotoxicity. Here, our intention is to shed light on some of the key roles of protein misfolding and aggregation in NDs. This review focuses specifically on understanding the molecular and cell-based mechanisms of protein misfolding and aggregation involved in the development of NDs.

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.