Introduction: Carotid Endarterectomy (CE) can be mentioned as a valuable theraputic method for primary and secondary prevention of stroke, provided it can be performed in vascular surgery centers with a low surgical risk. Thus, the present study aimed to assess prognosis of CE in high risk patients of an Iranian vascular surgery center.Methods: This prospective observational study consisted of 50 high risk CE patients during 2011-14 in Mashhad University of Medical Sciences. All the high risk CE were performed by a vascular surgeon and a surgical carotid shunt was placed in each CE. NEUROLOGIC evaluation was performed before CE and serial NEUROLOGIC axamination was done after CE by a neurologist. Surgical COMPLICATIONs including stroke, death and lower cranial nerve palsy were recorded for 30 days after operation.Results: The study results revealed that 80% of high risk CE patients had symptomatic carotid stenosis on the operation side and 80% had carotid stenosis contralateral to the operation side. Thirteen high risk CE were performed simultaneously with coronary artery by pass graft and 24 patients were demonstrated to have diabetes. Post surgical death and stroke in the high risk CE patients were reported 2% and 4%, respectively.Lower cranial nerve palsy appeared in 2% of patients.Conclusion: The 6% post operative stroke and death rate in the high risk CE patients are comparable to best vascular surgery centers in Europe and North America.

Background: Transient NEUROLOGICal symptoms (TNS), was described in patients recovering from spinal anesthesia with lidocaine but its etiology remains unknown this study was evaluated the influence of ambulation time on the occurrence of TNSs after spinal anesthesia with lidocaine 5%.Materials and Methods: This randomized clinical trial was conducted on 60 patients with American Society of Anesthesiologists Grades I and II, who were candidates for lower abdominal surgery in supine or lithotomy positions. Patients were randomly divided into early ambulation group (Group A) who were asked to start walking as soon as the anesthesia was diminished or to the late ambulation group (Group B) who walked after at least 12 h bedridden. Participants were contacted 2 days after spinal anesthesia to assess any type of pain at surgical or anesthesia injection site, muscle weakness, fatigue, vertigo, nausea, vomiting, headache, and difficult urination or defecation.Results: Four subjects (13.3%) in Group A and two patients (6.7%) in Group B had pain at anesthesia injection site (P=0.019). Fourteen patients in Group A (46.7%) and six patients in Group B (20%) had post-dural puncture headache (P=0.014). Participants in Group B reported difficult urination more than Group A (P=0.002). there were not statistically significant differences between two groups regarding frequency of fatigue, muscle weakness, vertigo, nausea, vomiting, difficult defecation, paresthesia, and the mean of visual analogue scale at the surgical site.Conclusion: Early ambulation after spinal anesthesia with lidocaine did not increase the risk of NEUROLOGIC COMPLICATION.

Inborn errors of organic acid metabolism are relatively recently recognized diseases with a wide spectrum of clinical signs and symptoms: ranging from asymptomatic, normal appearing children to death during first few days of life. In my presentation I will try to explain some of the most common clinical presentation of these disorder with stress on NEUROLOGIC findings. Organic acidemia usually have three clinical manifestations Severe neonatal form, Intermittent late-onset form and chronic progressive form. Recurrent coma, The main feature of these disorders is due to accumulation of toxic metabolites in Central Nervous system with direct effect on the function, while chronic accumulation of these materials may interfere with CNS development or cerebral metabolism leading to developmental delay. Severe neonatal forms Following a symptom free interval of a few days from birth, poor sucking and difficult feeding appears in the newborn, followed by unexplained and progressive coma. Seizures may appear during the course of the disease and EEG may show a burst-suppression pattern. During this stage most infants have axial hypotonia with peripheral dystonia, choreoathetosis, episodic opisthotonus and some repetitive bicycling and boxing movements. Associated biochemical abnormalities including metabolic acidosis, ketonuria and hyperammonemia also is usually present. The overall short-term prognosis with recent advances in medical care is improving. But later in life acute intercurrent episodes triggered by a stress often occur, which can be occasionally fatal. bulging fontanelle and cerebral edema may mimic CNS infection in these babies. Intermittent late-onset forms Recurrent attacks of coma or lethargy with ataxia can occur in childhood or even in adolescence or adulthood. These episodes may be frequent, though in between these the child is entirely normal. These attacks are precipitated by conditions that enhance protein catabolism (trauma, infection etc). Sometimes these episodes can lead to death or severe sequel. Seizure disorder is one of these sequels which is generalized in type with myoclonic seizure in infancy and childhood and later tonic-clonic and atypical absence seizures predominate.Also many of the survivors have acute or progressive extra pyramidal syndrome due to bilateral necrosis of basal ganglia. Chronic progressive forms Non specific Developmental delay, hypotonia, muscular weakness, microcephaly and seizures are rarely the only revealing signs in organic acidemia without any acute presentation. Seizures may become refractory to Anti Epileptic Drugs. In addition many asymptomatic or minimally symptomatic infants have been identified during tandem mass spectrometry newborn screening program. Cognitive deterioration associated with movement disorder such as dystonia or chorea may be caused by any form of organic aciduria.

Background: Behcet disease is a vasculitis with mucocutaneous, ocular, arthritic, vascular, and other manifestations. Its NEUROLOGIC manifestations (neuro-Behcet disease) are relatively rare, but they must be thoroughly investigated due to their grave prognosis.Review Summary: The frequency of NEUROLOGIC manifestations, more common in tnale Behcet patients, is between 5% and 30%. Both the central and peripheral nervous systems can be involved. Central nervous system manifestations can be divided into 2 main groups: (1) parenchymal involvement, which includes brainstem involvement, hemispheric manifestations, spinal cord lesions, and meningoencephalitic presentations; (2) nonparenchymal involvement, including dural sinus thrombosis, arterial occlusion, and/ aneurysms. Peripheral neuropathy and myopathy are relatively rare. Cerebrospinal fluid analysis reveals pleocytosis and elevated protein levels. Magnetic resonance imaging is the investigation of choice which often reveals iso-/hypointense lesions in T1-weighted images and hyper intense lesions in T2-weighted images, mostly in the mesodiencephalic junction, cerebellar peduncles, and other parts the brainstem. Corticosteroids and adjuvant immunosuppressive therapy are used for parenchymal manifestations, and corticosteroids and anticoagulants are used for treatment of dural sinus thrombosis.Conclusion: Neuro-Behcet disease must be considered in the differential diagnosis of stroke in young adults, multiple sclerosis, movement disorders, intracranial hypertension, intracranial sinovenous occlusive diseases, and other NEUROLOGIC syndromes.

Introduction: Exchange transfusion (ET) is an effective mode of therapy in the treatment of hyperbilirubinemia, but is associated with some COMPLICATIONs in 5-10% of the patients, especially in preterm newborns. The most important COMPLICATIONs following exchange transfusion are: Acidosis, thrombocytopenia, hypocalcemia, hyponatremia, hypoglycemia and transmitting infectious agents. This study aims to determine some COMPLICATIONs of exchange transfusion in neonatal hyperbilirueinemia in NICU of 22 Bahman 22nd Hospital in order to promote its safety and efficacy.Materials and Methods: In this study neonates with undergone exchange transfusion due to hyperbilirubinemia were evaluated over a period of 36 months in NICU of 22 Bahman 22nd Hospital from July 2005 to July 2008 in Mashhad. The questionnaires were completed according to the by patients’ data. The data were then and analyzed for statistical results.Results : Of the 28 neonates who entered the study, 3 required more than one ET. COMPLICATION of ET occurred in 24 neonates (85.7%).The most common COMPLICATIONs were being metabolic acidosis (67.9%) and thrombocytopenia (50%).Conclusion: In order to avoid COMPLICATIONs following exchange transfusion, it should be emphasized to have laboratory tests done. For instance, tests of platelet count and arterial blood gases are needed so that in cases of COMPLICATIONs, the available information can facilitate the treatment. They can be treated on time.

Context: We are going to face an epidemic of severe acute respiratory syndrome coronavirus (SARS-CoV-2) virus in our country. The main manifestation of this viral infection is respiratory and cardiovascular; however, up-to-date knowledge of its probable NEUROLOGIC COMPLICATIONs is highly needed. Evidence Acquisition: To provide up-to-date information on NEUROLOGIC manifestation on coronaviruses, we concisely reviewed the NEUROLOGIC manifestations and their COMPLICATIONs. Using the keywords, coronavirus, corona, human coronaviruses (HCoVs), SARS, Middle East respiratory syndrome-related (MERS), coronavirus disease 2019 (COVID-19), manifestations, COMPLICATIONs, and NEUROLOGIC, all the relevant articles were retrieved from PubMed, reviewed, and critically analyzed. Results: Although the main clinical manifestation of human coronaviruses is respiratory involvement and the main cause of death is acute respiratory failure, extra respiratory manifestations such as NEUROLOGIC findings have been reported. Fortunately, the NEUROLOGIC manifestations in COVID-19 have not been reported yet. Conclusions: We need well-designed studies to monitor NEUROLOGIC manifestations of COVID-19 in adults and children.

Children with rheumatic disorders may have a wide variety of clinical features ranging from fever or a simple arthritis to complex multisystem autoimmune diseases. Information about the prevalence of NEUROLOGICal manifestations in children with rheumatologic disorders is limited. This review describes the NEUROLOGIC COMPLICATIONs of childhood Rheumatic disease either solely or combined with symptoms of other organs involvement, as a primary manifestation or as a part of other symptoms, additionally.