The International Clinical Neuroscience Journal; 2022 in a Glance

Meisam Akhlaghdoust, Alireza Zali

International Clinical Neuroscience Journal, Vol. 10 No. 1 (2023), , Page e1

The acceptance rate in the ICNJ was 46% (rejection rate: 54%) in 2022 and the average peer review time was around three weeks. Overall, 32 papers, including 16 (50%) original articles, 8 (25%) case reports, 6 (18.75%) review articles, and 2 (6.25%) letters to the Editor were published in 2022. The most published topics in 2022 were COVID-19 (6 papers), mental health, and cancers. Most publications focused on COVID-19, as a common topic worldwide. Some of the articles were published as editorial letters.1,2 There were papers about COVID-19 and mental health1 and COVID-19 and headache.2
Six review papers were about “Upper Extremity Function After Stroke”, “Neurological Complications of COVID-19”, “Neuropathic Pain”, “Public Acceptance of the COVID-19 Vaccination”, “Consciousness in Sleep” and Molecular and Cellular Basis in Neurodegenerative Diseases”.3-8 Moreover, ICNJ presents eight rare, complex and challenging neurological and neurosurgical cases (“Fahr Syndrome and Syncope”, “Acute Hemifacial by Haemorrhagic Schwannoma”, “Multilevel Lumbar Spondylolisthesis”, “Convulsion Presentation of Parietal Meningioma”, “Coil Embolization in Pseudoaneurysm of the Supraglenoid Internal Carotid Artery”, “Physical Therapy for Erectile Dysfunction and Sensation”, “Traumatic Unilateral Basal Ganglia Haemorrhage”, and “Parenchymal Infarction After Subacute Subdural Hematoma Evacuation”).9-16 The editors and editorial board members of the journal believe that the publication of these cases can help develop good hypotheses for further studies in the future.
Sixteen published original articles present new and novel assessments, diagnostic methods, prevention, treatment, and approaches of neurological disease, and valuable epidemiological features and findings to be used worldwide.17-32
The International Clinical Neuroscience Journal is supported by Universal Scientific Education and Research Network (USERN). The goal of (ICNJ) is to continue publishing high quality and novel studies especially in areas of tissue engineering, molecular biology, personalized medicine, degenerative diseases and neuromodulation. We would like to invite all researchers from around the world to contribute to this journal. We appreciate the contributions of all the researchers and scientists who trusted the ICNJ.

Original / Research Article

Evaluation of Karnofsky Performance Scale as a Postsurgical Prognosis Criteria in Chronic Subdural Hematoma Cases: Discordance Between Clinical and Radiological Outcomes

Ziya Asan, Sercan Eroglu, Aydan Koysuren, Sezai Durmaz

International Clinical Neuroscience Journal, Vol. 10 No. 1 (2023), , Page e3

Background: Chronic subdural hematoma (CSDH) may cause neurological deficits as well as adverse effects on the patient’s general health status. Although CSDH cases are diagnosed in the advanced age group with a very high rate, clinical findings may not be related only to CSDH. The aim should be related to clinical recovery rather than radiological recovery for these cases. We aimed to evaluate Karnofsky’s score as a measurement criterion of postoperative clinical outcomes in patients with CSDH.
Methods: Cases operated for the diagnosis of CSDH were defined retrospectively. The cases that had been operated with this diagnosis were identified by examining the institution database records. Karnofsky scores equivalent to clinical status were performed by examining patient files. Karnofsky scoring before the symptomatic period was determined and compared with the Karnofsky score belonging to the late postoperative period. The clinical and radiological findings of the preoperative and postoperative periods were compared. Independent samples t test was used to reveal the difference between the two groups.
Results: Data of 184 cases were evaluated. Seventy-three cases were operated on the left, 51 cases on the right, and 60 cases bilaterally with the diagnosis of CSDH. Burrhole exploration was performed in 119 cases, and a craniotomy was performed in 65 cases. Although a significant decrease in hematoma thickness was detected radiologically in cases operated with the craniotomy method, a more significant improvement was observed in Karnofsky’s score in cases operated with the burrhole method. In younger patients, improvement in Karnofsky’s score was significantly higher.
Conclusion: The main aim should be to improve clinical status rather than radiological improvement in the treatment of CSDH cases. In the surgical treatment of these cases, it is possible to encounter a high rate of complications depending on age. It is possible to evaluate the postoperative status rationally with Karnofsky scoring. According to the preoperative Karnofsky scoring, deciding on the surgical technique may help reduce complications.

Apparent Diffusion Coefficient Values and Intra-tumoral Susceptibility Signals in Meningiomas and Schwannomas: Useful Tools for Challenging Cases

Sweta Swaika, Akshara Gupta, Sourabh Agarwal

International Clinical Neuroscience Journal, Vol. 10 No. 1 (2023), , Page e4

Background: We aimed to estimate the diagnostic accuracy of apparent diffusion coefficient values (ADC) and intra-tumoral susceptibility signals (ITSS) in differentiating meningiomas and schwannomas.
Methods: This retrospective study included 41 patients with 23 histopathologically proven meningiomas (20 patients with benign meningioma and 3 patients with high-grade meningioma) and 18 schwannomas. We calculated the mean ADC values and ADC ratio from ADC maps and intratumoral susceptibility signals (ITSS) in susceptibility-weighted imaging (SWI) for all patients. The quantitative variables were compared between the tumor groups using t test and the qualitative variables were compared between them using Chi-square test.
Results: In this study, the mean ADC value of meningiomas (0.86 ± 0.11×10-3 mm2/s, range 0.67-1.04) was lower than schwannomas (1.32 ± 0.16×10-3 mm2/s, range 1.10-1.65) with no overlap in the range of ADC values. The mean ADC ratio of schwannomas (2.0 ± 0.29, range 1.45- 2.58) was higher than meningiomas (1.24 ± 0.17, range 0.83-1.64) with some overlap. We found significant difference in mean ADC value and ADC ratio between meningiomas and schwannomas. The presence of intratumoral microhemorrhages (ITSS-H) in SWI was more suggestive of schwannomas and the presence of calcification was in favor of benign meningiomas. We did not find any significant difference in mean ADC value and ADC ratio between benign and high-grade meningiomas with considerable overlap in their range.
Conclusion: Additional magnetic resonance imaging findings such as ADC values and ITSS in SWI can help better pre-operative diagnosis of meningiomas and schwannomas, particularly in challenging patients.

Serum Matrix Metalloproteinase-9 Level and Previous Disease Activity in Relapsing-Remitting Multiple Sclerosis

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

International Clinical Neuroscience Journal, Vol. 10 No. 1 (2023), , Page e5

Background: Matrix metalloproteinase-9 (MMP-9) is a marker of blood-brain barrier destruction, that is elevated during clinical relapses in multiple sclerosis (MS). In between relapses, MMP-9 levels decline but remain higher than the normal population. This study aimed to investigate the relation between serum MMP-9 level and disease activity in MS during relapse-free periods.
Methods: This was a retrospective study conducted on adult patients with relapsing-remitting MS (RRMS) whose last relapse was ≥ 1 month ago. Serum MMP-9 was withdrawn at the time of recruitment and correlated with parameters of disease activity.
Results: Of the 40 patients recruited, 75% were women. The mean age was 36.2 ± 8.4 years, and the mean disease duration was 7 years. Patients’ median Expanded Disability Status Scale (EDSS) was 3.5 (IQR: 2.5-5.25), the median duration since the last relapse was 3 months, and the median duration since last corticosteroid administration was 6 months. On multivariate regression analysis, there was a significant association between serum MMP-9 levels and duration since the last relapse (B: -0.004, 95% CI: -0.007- -0.002, P = 0.001) as well as duration since the last corticosteroid intake (B: -0.003, 95% CI: -0.006- -0.001, P = 0.005).
Conclusion: Serum MMP-9 levels correlated with the duration since last relapse and duration since last corticosteroids administration during relapse-free periods.

Innovative Measures of Verhulst Diagram for Emotion Recognition using Eye-Blinking Variability

Atefeh Goshvarpour, Ateke Goshvarpour

International Clinical Neuroscience Journal, Vol. 10 No. 1 (2023), , Page e6

Background: The human body continuously reveals the status of several organs through biomedical signals. Over time, biomedical signal acquisition, monitoring, and analysis have captured the attention of many scientists for further prediction, diagnosis, decision-making, and recognition. Recently, building an intelligent emotion recognition system has become a challenging issue using the application of signal processing. Frequently, human emotion classification was proposed utilizing the internal body status in dealing with affective provocations. However, external states, such as eye movements, have been claimed to convey practical information about the participant’s emotions. In this study, we proposed an automatic emotion recognition scheme through the analysis of a single-modal eye-blinking variability.
Methods: Initially, the signal was transformed into a 2D space using the Verhulst diagram, a simple analysis based on the signal’s dynamics. Next, some innovative features were introduced to characterize the maps. Then, the extracted measures were inputted to the support vector machine (SVM) and k-nearest neighbor (kNN). The former classifier was evaluated with three kernel functions, including RBF, linear, and polynomial. The latter performances were examined with different values for k. Moreover, the classification results were assessed in two feature-set partitioning modes: a 5-fold and 10-fold cross-validation.
Results: The results showed a statistically significant difference between neutral/fear and neutral/sadness for all Verhulst indices. Also, the average values of these characteristics were higher for fear and sadness than those of other emotions. Our results indicated a maximum rate of 100% for the fear/neutral classification. Therefore, the suggested Verhulst-based approach was supremely talented in emotion classification and analysis using eye-blinking signals.
Conclusion: The novel biomarkers set the scene for designing a simple accurate emotion recognition system. Additionally, this experiment could fortify the territory of ocular affective computing, and open a new horizon for diagnosing or treating various emotion deficiency disorders.

Case Report

A Cervical Nerve Root Cavernoma – Atypical Presentation With Diagnostic Dilemma

Sandeep Moolchandani, Gaurav Tyagi, Nishant Yagnick, Sumit Sinha, Veer Singh Mehta

International Clinical Neuroscience Journal, Vol. 10 No. 1 (2023), , Page e2



Spinal cavernous angiomas are uncommon vascular malformations in spine accounting for 5-12% of all spinal vascular lesions. When present in intradural extra-medullary location, these usually present with radicular pain and neurological deficits due to mass effect (myelopathy). We here present an atypical presentation of cavernous angioma in a 54-year-old male with tinnitus, headache and sensorineural hearing loss. We have also reviewed 51 cases of intradural extramedullary cavernous angiomas including our case with respect to demographic and clinical profile.



Case Description


A 54-year-old male presented with tinnitus in left ear and occipital headache with neck pain and slight weakness of left-hand grip along with atrophy of thenar muscles. His PTA examination revealed mild left sensorineural earing loss. MRI of cervical spine showed T2WI heterogeneously hyperintense left intradural extramedullary lesion at C7 vertebral body level. It was avidly enhancing with contrast. Patient underwent C7 laminectomy with a midline durotomy and complete excision of the lesion under neuromonitoring with sacrifice of the C8 sensory root. His symptoms improved following the surgery.




Spinal nerve root cavernomas are extremely rare. They usually present with radicular or myelopathy symptoms due to compression. Repeated rupture or micro-bleeds can cause raised intracranial pressure features along with cranial nerve deficits. The diagnostic workup is not straight forward in these latter cases and the presence of cavernoma may be an unusual finding. The diagnosis of a cavernoma in an unusual location in the presence of cranial nerve dysfunction needs a high degree of diagnostic suspicion. Majority of these cavernomas have a nerve root origin or attachment. The optimal treatment is microsurgical en bloc resection which leads to an effective resolution of both the symptoms.

Coexistence of Cerebellopontine Angle Tumor and Frontal Convexity Meningioma at Distinct Location – A Rare Case Report and Review of Literature

Shalendra Singh, Aarthy Kumaraguru, Ankit Kumar, Munish Sood

International Clinical Neuroscience Journal, Vol. 10 No. 1 (2023), , Page e7

The perioperative management of brain tumors can be significantly impacted by the presence of another intracranial tumor at a distinct location. We report a rare case of an adult who developed two primary brain tumors, a frontal convexity meningioma and a cerebellopontine angle (CPA) tumor at anatomically disparate locations. In our patient, it was unambiguously decided to address the CPA tumor first as it had led to multiple cranial nerve palsies and obstructive hydrocephalus. The relevant literature helped us better extrapolate the patient presentation and management of this disastrous presentation swiftly.

Letter to Editor

Is Brain Fog a Temporary or Life-long Condition?

Afshan Niknafs

International Clinical Neuroscience Journal, Vol. 10 No. 1 (2023), , Page e8

In the 1880s, German physician Georg Greiner coined the concept of “brain fog” to describe the cognitive deficits associated with delirium. The term “brain fog” has been used intermittently since then to describe sluggish cognition. It gained popularity again in the 1990s as a way to describe chronic fatigue syndrome and some autoimmune diseases. However, there are no diagnostic criteria for brain fog and it is not a medical condition.1
The term “brain fog” describes cognitive difficulties that are increasingly used colloquially. Long-term COVID-19 is characterized by persistent symptoms following a COVID-19 diagnosis that cannot be explained by any other illness. Persistent symptoms following COVID-19 are often described as “brain fog.” Brain fog syndrome, which is associated with excessive academic strain, was revived in the 1960s and was included in the DSM-IV.2
As a result of post-COVID-19 infection, residual cognitive impairment (“brain fog”) often interferes with work and daily activities.3 Recent investigations have shown that fungal co-infections significantly affect the morbidity and mortality of patients with COVID-19.