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Background/Aim: The North African and Middle Eastern region has high illiteracy rates among older people, making direct cognitive testing challenging. Validated screening instruments for dementia in Arabic are lacking. We aimed to validate the Arabic version of the 16-item Informant Questionnaire on Cognitive Decline for the Elderly (A-IQCODE 16) for screening for dementia through an informant. Methods: 236 Lebanese participants older than 65 years, 143 with normal cognition and 93 with mild-to-moderate dementia according to the DSM-IV criteria, and their informants were recruited. Half of the participants had no formal education. Interviewers blinded to the cognitive status of the participants administered the A-IQCODE 16 to the informants. The ability of the A-IQCODE 16 to screen for dementia was evaluated against the DSM-IV diagnoses. Results: The A-IQCODE 16 had excellent overall predictive power (area under the receiver operator characteristic curve = 0.96). A cutoff point of >3.34 yielded the best sensitivity (92.5%) and specificity (94.4%) for dementia screening. At this cutoff point, the discriminatory ability of the A-IQCODE 16 was comparable between participants with and those without formal education. Conclusion: The A-IQCODE 16 is not biased by education and is therefore useful as a brief screening tool for dementia among Arabic-speaking older adults with low education.

A critical step in the diagnosis of multiple sclerosis is to rule out a heterogeneous variety of multiple sclerosis mimickers, which is crucial in the era of powerful immune-modulator treatments. In this review, we discuss the background of toxocariasis in general, present central nervous system Toxocara infection as one of the multiple sclerosis mimickers in the Middle East, and share our experience about the diagnosis and management of this condition. This entity seems very relevant in a region such as the Middle East, where displacement of populations and conflict can result in non-hygienic food and water management bundles. The diagnosis should be entertained, especially when assessing patients with myelopathy. The presence of a single lesion in the spinal cord with inflammatory features should prompt serological testing for Toxocara IgG and IgM in serum and the cerebrospinal fluid. This infection is treatable, with the regimen of high-dose albendazole being one of the most accepted treatments. Although most cases exhibit a good prognosis, some have residual deficits localized to the affected spinal cord level.

Painful legs and moving toes syndrome is rare. It is predominantly diagnosed in middle-aged adults following a history of spinal cord surgery or trauma. The syndrome consists of abnormal repetitive movements, most commonly in the lower extremities, accompanied by pain in the affected limb. Pain usually precedes the movements. We report a case in a young patient that we believe was induced by the intake of a low-potency neuroleptic, which was prescribed to him for anxiety. The patient was treated with carbamazepine with mild relief of pain and later on with botulinum injection, which significantly reduced the movements and mildly improved the pain. After stopping the treatment, the beneficial effect lasted for about 3 months after which his condition gradually returned to its initial state.

A critical step in the diagnosis of multiple sclerosis is to rule out a heterogeneous variety of multiple sclerosis mimickers, which is crucial in the era of powerful immune-modulator treatments. In this review, we discuss the background of toxocariasis in general, present central nervous system Toxocara infection as one of the multiple sclerosis mimickers in the Middle East, and share our experience about the diagnosis and management of this condition. This entity seems very relevant in a region such as the Middle East, where displacement of populations and conflict can result in non-hygienic food and water management bundles. The diagnosis should be entertained, especially when assessing patients with myelopathy. The presence of a single lesion in the spinal cord with inflammatory features should prompt serological testing for Toxocara IgG and IgM in serum and the cerebrospinal fluid. This infection is treatable, with the regimen of high-dose albendazole being one of the most accepted treatments. Although most cases exhibit a good prognosis, some have residual deficits localized to the affected spinal cord level.

We describe a patient with acute lymphocytic leukemia and multidrug-resistant tuberculosis of the brain and spinal cord. Despite treatment with six antituberculous drugs and a steroid medication for 11 months, there was no appreciable clinical or radiological improvement in the patient's condition. Within 5 months of initiating adjunctive therapy with IFN-γ and granulocyte colony stimulating factors, substantial neurological and radiological improvement was noted. Therapy with IFN-γ was continued for 12 months, resulting in complete resolution of the lesions in the brain and spinal cord.

Pregabalin, the most recently approved antiepileptic drug, is a structural analog of GABA with a favorable pharmacokinetic profile. Pregabalin binds to the α2- subunit of a neuronal voltage-gated calcium channel and is believed to exert its anticonvulsant effect by modulating the release of specific neurotransmitters from hyperexcited presynaptic neurons. Animal models of epilepsy have suggested that this drug will be efficacious against partial-onset and generalized tonic-clonic seizures. Four pivotal, add-on clinical trials conducted in patients with partial-onset seizures demonstrated that pregabalin at daily doses of 150-600 mg is efficacious and associated with dose-dependent adverse events. Meta-analyses of efficacy and tolerability indicated that pregabalin is an efficacious and relatively well-tolerated antiepileptic drug.

We present two cases of middle-aged men with chronic hypertension presenting with acute severe hemicranial headache with otherwise a normal neurological examination. Investigation revealed occlusion of the ipsilateral middle cerebral artery. We reviewed the literature of ischaemic strokes with headache as the only manifestation and elaborated on the pathophysiology of headaches in ischaemic strokes.