Background: Changes in the lipid profile have been suggested as a risk factor for developing ischemic stroke.Their role in intra-cerebral hemorrhage, however, is not clear. The present study was designed to evaluate the lipid profile levels of patients who had experienced an acute stroke during the first 24-hour and to compare these levels in different patients suffering from the stroke, either hemorrhagic or ischemic, and healthy individuals.

INTRODUCTION: This study was conducted to investigate pattern and risk factors associated with the location of atherosclerotic occlusive lesions in cerebral vessels. Previous studies of patients with stroke or transient ischemic attack (TIA) suggest that extracranial atherosclerosis is more common in the white race. Noninvasive techniques such as duplex ultrasound, transcranial Doppler (TCD), and magnetic resonance angiography (MRA) allow vascular assessment of a more representative proportion of the patients, compared to conventional angiography alone.METHODS: We evaluated patients with cerebrovascular problems (stroke and/or TIA) during a period of 6 months, using duplex ultrasonography, TCD and MRA to detect significant stenosis according to standard criteria.RESULTS: Stenosis of extracranial and intracranial arteries was detected in 38% and 29% of cases, respectively. MCA was the most frequent involved intracranial artery (11% bilaterally and 5% unilaterally). Intracranial lesions tend to be multiple. There was no significant difference between men and women in terms of frequency and distribution of stenosis. No correlation was found between opium use and stenosis. The women had significantly more poor windows than men (P<0.05). The extracranial stenosis was significantly more frequent than intracranial stenosis (P<0.01).CONCLUSION: The relations between hypertension and extracranial stenosis, and diabetes and MCA stenosis were statistically significant. TCD seemed to be a better technique for evaluating intracranial lesions in men than in women.

Introduction: Cerebrovascular accidents (CVA) are the third and second common cause of death and morbidity in the world, respectively. Since high levels of serum lipids and atherosclerosis are one the risk factors of CVA, and also there are some reports about relation between atherosclerosis and earlobe crease (ELC), the present study was performed to verify any association between ELC and CVA.Materials and Methods: This study was designed as a case-control study. 55 patients with CVA (case group) and 55 patients without CVA (control group) were selected, and then presence of ELC and serum levels of cholesterol, LDL, HDL were measured in both control and case groups.Results: The prevalence of ELC in CVA patients was more than without CVA (%74.1 vs. %26.8- p<0.001). Mean level of Cholesterol and LDL were more in patients with CVA than without CVA (p<0.001). Also, mean level of HDL in CVA group was less than control group (p<0.001). Mean level of cholesterol and LDL were more and mean level of HDL was less in patients with ELC than patients without ELC (p<0.001).Conclusion: The prevalence of ELC in patients with CVA is more than in patients without CVA (OR: 7.81). Mean level of serum lipids in these patients were more than patients without CVA. CVA in patients with ELC is 7.81 times more common than without ELC. In due attention to high prevalence of ELC in patients with CVA, it seems ELC must be evaluated as a risk factor.

Introduction: Clinical use of the late responses during routine neurophysiological examination has significantly increased the diagnostic yield of the neurophysiological evaluation. The H max to M max ratio (H/M ratio) is considered a suitable index for illustrating the level of reflex excitability of the motor pool.Methods: In this study posterior tibial nerve H/M ratio changes in cerebrovascular accidents (CVA) evaluated. This investigation was carried out in 22 normal subjects aged 40-65 years with mean 52 years, and in 40 patients with CVA aged 42-63 years with mean 57 years.Results: In normal subjects no significant differences were found between the mean values observed between right and left sides. In patients significant increased H/M ratios in both sides with more in non-plegic leg (P<0.01) were found. The facilitation of Babinsky sign in patients is significantly associated with low H/M ratios (P=0.003). The H/M ratio changes were not significantly associated with severity of hemiplegia (P=0.3 for lower extremities, P=0.9 for upper extremities). The H/M ratio was increased in ischemic lesions (P<0.01), but in intracerebral hemorrhages the soleus H/M ratio increases in non-plegic side the same as the plegic side.Conclusion: The posterior tibial nerve H/M ratios are increased in CVA bilaterally due to decreased presynaptic inhibition Ia terminals, thus amplitude of H reflexes increased without increased amplitude of M response.

Background: Major clinical manifestations of antiphospholipid syndrome (APS) in the central nervous system are generally arterial thrombotic events and a number of non thrombotic neurologic syndromes. Antiphospholipid antibodies (APAs) are one of the important risk factors for cerebrovascular accidents (CVA). The aim of present study was to assess the relationship between APA titers and CVA in this clinically important age group. Methods: This case-control study was carried out on patients under 50 years old who had CVA (stroke or transient ischemic attack) in Shahid Sadoughi Hospital in Yazd (central Iran) from Dec 2003 until March 2005. In this study, 61 patients with CVA were compared with 68 age- and gender-matched control subjects. Lupus anticoagulant assay results and APA titers were assessed in both groups. Results: The mean value of IgM APA titers in patients with cerebrovascular accidents was 6.492 MPL (IgM antiphospholipid units) and 1.846 MPL in the control group. The difference between the two groups was significant (p-value: 0.000). In 12 (20%) of the patients with cerebrovascular accidents, IgM titers were higher than 10 MPL, one of whom had an IgM titer higher than 40 MPL. The mean value of IgG titers in the case group was 5.50 GPL (IgG antiphospholipid units) and 3.51 GPL in the control group. The difference between the two groups was significant (p-value: 0.012). Thirteen (21%) patients with cerebrovascular accidents had IgG titers higher than 10 GPL. The difference between the LA assay results was not significant between the two groups (p-value: 0.311). Conclusion: The present study showed a positive relationship between APL (IgM and IgG) titers and CVA in patients under 50 years old.

Background and Objective: Cerebrovascular accidents are one of the most common causes of disability and mortality in human population all over the world. Several factors such as age, sex, hypertension, hyperlipidemia and heart diseases are risk factors for stroke. Due to high prevalence of cerebrovascular accidents and its related risk factors and particularly heart diseases, we decided to study echocardiography findings in patients with cerebrovascular accidents.Materials and Methods: This descriptive study was conducted on 372 cerebrovascular patients who had been admitted to Zanjan Vali-e-Asr hospital in 2008. The data such as gender, age, type of cerebrovascular accidents, underlying disease and findings of echocardiography were collected and then they analyzed by appropriate software. Results: Of 372 patients, 181 were men (48.6%) and 191 were women (51.4%). Systolic function in 321 cases (86.3%) was normal and it was abnormal in 51 cases (13.7%). Diastolic function in 304 cases (81.9%) was normal and in 68 cases (18.1%) was abnormal. Twenty -two cases had mitral stenosis and 198 patients had mitral regurgitation, whereas 23 cases showed both of them. Nine cases had aortic stenosis; similarly 80 cases were found with aortic regurgitation and only 5 cases had both of them. 165 cases were found with tricuspid regurgitation, while 1 case had both regurgitation and stenosis. Sixty- three cases had ejection fraction below 40%. In one case there was a clot.Conclusion: High frequency of abnormal echocardiography findings in stroke leading to cardiac disorders is one of the most important risk factor of stroke. Thus, with echocardiography which is a non-invasive technique, many of heart problems can be diagnosed and consequently occurrence of cerebrovascular accidents can be prevented or treated.

Background: For tens of years, the benefit of reducing serum lipid levels in stroke prevention has been debated. Recent prospective trials have shown, however, that the use of pravastatin is effective in reducing the incidence of stroke. Methods: In order to determine the range of hyperlipidaemic disorders present in stroke victims in the province of Bushehr, 204 consecutive cases of cerebrovascular accident (CV A) (113 men and 91 women) hospitalised at the Fatemeh-ye Zahra Hospital in Bushehr underwent serum lipid profiling within 48 hours of stroke onset. Results: 67.6% of the patients were in their seventh or eighth decade of life. The prevalence, as reported by computer tomography, of haemorrhagic stroke (intracranial+subarachnoid haemorrhages), ischaemic stroke, and non-specific changes was 24.6, 31.4 and 25 percent, respectively. 31 cases (15.2%) were transient ischaemic attacks. 57.5% of patients had a ilistory of hypertension, 21.4% of diabetes mellitus, 51.5% of smoking, and 35.8% of visceral obesity. 50.5% of patients had a serum total cholesterol level of ≥200mgldl; 32.6% had serum triglyceride levels of ≥150mgldl, 28.4% had HDL-C levels <35mg/dl, and 51.1% of patients had LDL-C levels of ≥130mgldl. There was a correlation in men between smoking and LDL-C<130mg/dl. Conclusion: Lipoprotein disorders and an abnormal serum lipid profile are common findings in CV A patients in the province of Bushehr.

Objectives: Stroke is the main health problem of the elderly in the world. The disease may create a spiritual crisis in the person. The purpose of this study was to investigate the relationship between prayer and spiritual health of elderly patients with cerebrovascular accidents (CVA).Methods & Materials: In this correlational study, 142 patients with CVA were investigated in the Neurology Department of Bou Ali Sina Hospital in Sari City, Iran. Data collection was done by Ellison and Paloutzian spiritual health questionnaire and Meraviglia prayer questionnaire. The data were analyzed using SPSS 20 with descriptive parameters (mean and standard deviation) and Pearson correlation coefficient, t-test and 1-way ANOVA.Results: Of 142 patients, 64 (45.1%) were men and 78 (54.9%) were women. The mean age of the elderly was 72.97±7.67 years with the range of 60-95 years. The mean of total prayer scores was 181.62±25.50 and the highest score of prayer was related to prayer frequency with the mean of 96.47±22.3. The mean of total spiritual health scores was high (102.28±18.89), too. The relationship between prayer and spiritual health was direct and significant (P<0.001, r=0.602). There was significant relationship between age and spiritual health, too (P<0.001, r=0.607). There was no significant relationship between spiritual health and education level, job, and the marital status.Conclusion: Religious practice and prayer can be a powerful resource for coping with stressful situations and psycho-social support in patients with stroke.

Introduction: Dysphagia after cerebrovascular accidents can lead to various complications such as pneumonia and patient mortality. Evaluation of dysphagia in these patients by nurses is very important and nurses need to have dysphagia screening knowledge and performance in this area. The aim of this study was to determine the effect of dysphagia screening education in patients with cerebrovascular accidents on nurses knowledge and performance. Methods: This is a pre-and post-intervention study in which 80 nurses of the neurology and emergency departments were randomly divided into two groups of control (n = 40) and intervention (n = 40). The intervention of this study was the educational program of dysphagia evaluation in patients with cerebrovascular accidents. Data were collected using a demographic questionnaire, a researcher-made knowledge questionnaire and a performance appraisal checklist. Data was analyzed using descriptive and analytical statistical methods. Results: The results showed that the mean knowledge (P = 0. 075) and nurses’ performance (P = 0. 652) of dysphagia screening in the intervention and control groups before the intervention were not statistically significant. After the intervention, there was a statistically significant difference between the control and intervention groups in terms of the knowledge of nurses (P > 0. 001). The mean of nurses’ knowledge in the control group was 7. 63± 2. 25 and in the intervention group was 10. 65 ± 1. 47. Also, the performance of nurses in screening dysphagia was 3. 63 ± 2. 03 in the control group and 7. 85± 1. 84 in the intervention group, which was statistically significant (P > 0. 001). Conclusions: Education has an effect on nurses’ knowledge and performance in dysphagia screening in patients with cerebrovascular accidents. Implementing an educational program for nurses caring for these patients can help prevent pneumonia and increase patient safety.