Neurology Section

Jeddah, Saudi Arabia

Neurology Section

Jeddah, Saudi Arabia
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Algahtani H.A.,Neurology Section | Abdu A.P.,Neurology Section | Shami A.M.,King Abdulaziz Medical City | Hassan A.E.,Saudi German Hospital | And 4 more authors.
Neurosciences | Year: 2011

Objectives: To analyze the clinical patterns, etiologies, treatment, and outcome of cerebral venous sinus thrombosis (CVST) in 2 major cities of Saudi Arabia, Jeddah and Al-Baha. Methods: One hundred and eleven patients diagnosed as CVST were identified from the medical records at King Abdulaziz Medical City, Jeddah, and King Fahad Hospital, Al-Baha, Saudi Arabia, from January 1990 through November 2010. We retrospectively analyzed the data, compared it with local and international studies, and reviewed the literature. Results: There were 92 adults and 19 children. Among adults, females predominated, while more boys were affected than girls. The mean age of onset was 29.5 years. The most common clinical presentations were headache, focal neurologic deficits, seizures, papilledema, and decreased level of consciousness. The main risk factors identified were pregnancy/ puerperium, antiphospholipid antibody syndrome, oral contraceptive pills, malignancy, and infections. Multiple sinuses were affected in 51 patients (45.9%). When a single sinus was involved, the superior sagittal sinus (24.3%) was the most common. Seventy-four patients recovered completely, 23 patients recovered partially, and 10 patients died. Bad prognostic factors included incurable co-morbid conditions, late presentation, and status epilepticus. Conclusions: Pregnancy/puerperium was the most common etiological factor in our series. Clinical features were similar to international series. Behçet's disease was not a major etiological factor in our series. Most patients had involvement of multiple sinuses. Prompt treatment with anticoagulation resulted in complete or partial recovery in 87.4% of patients.


Higgs M.H.,Neurology Section | Higgs M.H.,University of Washington | Spain W.J.,Neurology Section | Spain W.J.,University of Washington
Journal of Physiology | Year: 2011

Previous studies showed that cortical pyramidal neurones (PNs) have a dynamic spike threshold that functions as a high-pass filter, enhancing spike timing in response to high-frequency input. While it is commonly assumed that Na + channel inactivation is the primary mechanism of threshold accommodation, the possible role of K + channel activation in fast threshold changes has not been well characterized. The present study tested the hypothesis that low-voltage activated Kv1 channels affect threshold dynamics in layer 2-3 PNs, using α-dendrotoxin (DTX) or 4-aminopyridine (4-AP) to block these conductances. We found that Kv1 blockade reduced the dynamic changes of spike threshold in response to a variety of stimuli, including stimulus-evoked synaptic input, current steps and ramps of varied duration, and noise. Analysis of the responses to noise showed that Kv1 channels increased the coherence of spike output with high-frequency components of the stimulus. A simple model demonstrates that a dynamic spike threshold can account for this effect. Our results show that the Kv1 conductance is a major mechanism that contributes to the dynamic spike threshold and precise spike timing of cortical PNs. © 2011 The Authors. Journal compilation © 2011 The Physiological Society.


Algahtani H.A.,Neurology Section | Abdu A.P.,Neurology Section | Khojah I.M.,King Abdulaziz University | Al-Khathaami A.M.,Neurology Section
Annals of Saudi Medicine | Year: 2010

Scurvy has become rare in modern societies, but should be considered in malnourished persons, alcoholics, and in infants on unsupplemented milk diets who present with musculoskeletal pain or a bleeding tendency. The diagnosis of scurvy can be challenging because of the rare incidence and vague and nonspecific early symptoms. We report here a case of scurvy in a young boy who presented with an inability to walk and severe musculoskeletal pain. The diagnosis was established based on his clinical picture, radiological appearance, and low serum level of vitamin C. The patient responded well to vitamin C supplementation with full resolution of his symptoms. He regained his ability to walk and his family was happy and satisfied with the outcome of treatment. Although the incidence of scurvy has become low in Saudi Arabia, it can still occur and early recognition is important because of the excellent prognosis.


Calabrese M.,Neurology Section | Gajofatto A.,Neurology Section | Benedetti M.D.,Neurology Section
Expert Review of Neurotherapeutics | Year: 2014

In the past two decades, several pathological and radiological findings convincingly demonstrated that damage of the cortical and deep grey matter is a key issue in multiple sclerosis with a significant impact on physical and cognitive disability. Moreover, it has become increasingly evident that the effect of available therapies on the inflammatory white matter damage is not a guarantee of a meaningful effect on the neurodegenerative process mainly affecting the grey matter. Despite the efficacy of all approved disease-modifying drugs should be measured considering such a relevant aspect of the disease, data from clinical trials are few, scattered and heterogeneous. The aim of this review is to summarize the evidence so far acquired on the effect of reducing grey matter damage produced by current and emerging disease-modifying therapies for multiple sclerosis. © Informa UK, Ltd.


Calabrese M.,Neurology Section | Gajofatto A.,Neurology Section | Gobbin F.,Neurology Section | Turri G.,Neurology Section | And 5 more authors.
Multiple sclerosis (Houndmills, Basingstoke, England) | Year: 2015

OBJECTIVE: Although cognitive dysfunction is a relevant aspect of multiple sclerosis (MS) from the earliest disease phase, cognitive onset is unusual thus jeopardizing early and accurate diagnosis. Here we describe 12 patients presenting with cognitive dysfunction as primary manifestation of MS with either mild or no impairment in non-cognitive neurological domains.METHODS: Twelve patients with cognitive onset who were subsequently diagnosed with MS (CI-MS) were included in this retrospective study. Twelve cognitively normal MS patients (CN-MS), 12 healthy controls and four patients having progressive supranuclear palsy (PSP) served as the reference population.RESULTS: Ten CI-MS patients had progressive clinical course and all patients had late disease onset (median age = 49 years; range = 40-58 years). Among cognitive functions, frontal domains were the most involved. Compared to CN-MS and healthy controls, significant cortical and infratentorial atrophy characterized CI-MS patients. Selective atrophy of midbrain tegmentum with relative sparing of pons, known as "The Hummingbird sign," was observed in eight CI-MS and in three PSP patients.DISCUSSION: Our observation suggests that MS diagnosis should be taken into consideration in case of cognitive dysfunction, particularly when associated with slowly progressive disease course and severe cortical, cerebellar and brainstem atrophy even in the absence of other major neurological symptoms and signs. © The Author(s), 2014.


Bagert B.A.,Ochsner Clinic Foundation | Marder E.,Neurology Section | Marder E.,University of Texas Southwestern Medical Center | Stuve O.,Neurology Section | Stuve O.,University of Texas Southwestern Medical Center
Archives of Neurology | Year: 2011

Chronic cerebrospinal venous insufficiency has recently been proposed to be etiologic to multiple sclerosis. Independent investigation into this theory during the past 2 years has not succeeded in verifying this relationship. A critical analysis of the scientific methods used in the original studies of chronic cerebrospinal venous insufficiency in multiple sclerosis reveals several methodological problems with regard to potential bias and confounding. The current evidence calls into question whether chronic cerebrospinal venous insufficiency in multiple sclerosis exists at all. ©2011 American Medical Association. All rights reserved.


Larsen D.S.,Neurology Section
Journal of Neurologic Physical Therapy | Year: 2016

The Board of Directors of the Neurology Section of the APTA is proposing to change the name of the Section to the Academy of Neurologic Physical Therapy, APTA. In the past 2 years, the Geriatrics Section and the Section on Electrophysiology and Wound Management have both transitioned to the Academy of Geriatric Physical Therapy and the Academy of Clinical Electrophysiology and Wound Management (ACEWM). Although many sections are currently in discussions about doing so, the Neurology Section Board of Directors believes that the time is right to make this change. Here is a brief rationale and the answers to common questions that are expected about this proposed change. © Copyright 2016 Neurology Section, APTA.


Picelli A.,University of Verona | Bonetti P.,University of Verona | Fontana C.,University of Verona | Barausse M.,University of Verona | And 7 more authors.
Journal of Rehabilitation Medicine | Year: 2012

Objective: To investigate the accuracy of manual needle placement and electrical stimulation guidance, compared using ultrasonography, for injection of botulinum toxin type A into the gastrocnemius muscle of adults with spastic equinus. Design: Prospective clinical study. Subjects: A total of 81 adults with stroke who were scheduled to receive botulinum toxin type A injection into the gastrocnemius muscle. Methods: After randomization into two groups, each patient was injected into two sites at each head of the gastrocnemius muscle. The manual needle placement group (n = 42) underwent injections using anatomical landmarks and palpation. The electrical stimulation guidance group (n = 39) underwent injections under electrical stimulation guidance. The accuracy of needle placement and muscle thickness at each injection site were compared by means of ultrasonography. Results: The overall accuracy of manual needle placement and electrical stimulation guidance, measured using ultrasonography, was significantly higher for the gastrocnemius medialis than for the lateralis (92.0% vs 79.0%). The gastrocnemius medialis was significantly thicker than the lateralis (mean 13.25 mm (standard deviation (SD) 1.86 mm) vs 10.84 mm (SD 1.52 mm). Conclusion: Electrical stimulation guidance may be useful for injections into the gastrocnemius lateralis of adults with spastic equinus. However, neither manual needle placement nor electrical stimulation guidance showed complete accuracy, when measured using ultrasonography. © 2012 Foundation of Rehabilitation Information.


PubMed | Neurology Section
Type: Journal Article | Journal: The Journal of neuroscience : the official journal of the Society for Neuroscience | Year: 2012

While adaptation is widely thought to facilitate neural coding, the form of adaptation should depend on how the signals are encoded. Monaural neurons early in the interaural time difference (ITD) pathway encode the phase of sound input using spike timing rather than firing rate. Such neurons in chicken nucleus magnocellularis (NM) adapt to ongoing stimuli by increasing firing rate and decreasing spike timing precision. We measured NM neuron responses while adapting them to simulated physiological input, and used these responses to construct inputs to binaural coincidence detector neurons in nucleus laminaris (NL). Adaptation of spike timing in NM reduced ITD sensitivity in NL, demonstrating the dominant role of timing in the short-term plasticity as well as the immediate response of this sound localization circuit.


PubMed | Neurology Section
Type: Journal Article | Journal: The Journal of physiology | Year: 2011

Previous studies showed that cortical pyramidal neurones (PNs) have a dynamic spike threshold that functions as a high-pass filter, enhancing spike timing in response to high-frequency input. While it is commonly assumed that Na(+) channel inactivation is the primary mechanism of threshold accommodation, the possible role of K(+) channel activation in fast threshold changes has not been well characterized. The present study tested the hypothesis that low-voltage activated Kv1 channels affect threshold dynamics in layer 2-3 PNs, using -dendrotoxin (DTX) or 4-aminopyridine (4-AP) to block these conductances. We found that Kv1 blockade reduced the dynamic changes of spike threshold in response to a variety of stimuli, including stimulus-evoked synaptic input, current steps and ramps of varied duration, and noise. Analysis of the responses to noise showed that Kv1 channels increased the coherence of spike output with high-frequency components of the stimulus. A simple model demonstrates that a dynamic spike threshold can account for this effect. Our results show that the Kv1 conductance is a major mechanism that contributes to the dynamic spike threshold and precise spike timing of cortical PNs.

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