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Background The global population of 60 and over is rapidly increasing. The aging process seriously impacts postural control, resulting in decreased balance performance and a heightened risk of falls. This work aimed to study geriatrics’ static and dynamic balance using spatial and temporal posturography analysis. Methods The current study was an observational cross-sectional study on 60 subjects aged > 61 years and 40 subjects aged ≤ 60 years who were relatives of outpatient clinic patients. Studied individuals were subjected to clinical balance assessment and computerized dynamic posturography (CDP). Results The age of included geriatrics was 61–79 years, and 88.3% were males. There was a significant decline in Advanced Activities of Daily Living scale (AADLs), Montreal Cognitive Assessment scale (MoCA), and the Dynamic Gait Index (DGI) scales in older adults. There was a substantial decrease in CDP somatosensory, vision, and vestibular ratios in the older age group with p  < 0.001. There was a reduction in the stability rate platform and cancellation time and an increase in spectral power index in the elderly. There was no correlation between CDP visual, vestibular, and somatosensory functions and age, AADL, MoCA, and DGI single and dual-tasks scales. Conclusion There was a decrease in the stability rate platform and cancellation time and an increase in the spectral power that reflects the dynamic aspects of balance. CDP visual, vestibular, and somatosensory functions did not correlate with age, AADL, MoCA, DGI single- and dual-tasks scales, and medications.

BackgroundDisability in the upper limb in post-stroke survivors may have a variety of effects, particularly in the elderly, that require planning therapeutic actions to restore function. Thirty-four patients were randomly assigned to the control group (CON) and the Functional Electrical Stimulation (FES) group. For 12 weeks, the CON group received core stabilization exercises (CSEs). The FES group received (FES) for the interscapular muscles with CSEs for the first six weeks and completed the following six weeks with only CSEs. Patients were assessed at baseline, 6 and 12 weeks post-intervention. The trunk impairment scale (TIS) and the Postural Assessment Scale for Stroke (PASS) were used to assess trunk performance. A palpation meter was used to measure the scapular horizontal position (SP). Balance was assessed by the Berg Balance Scale (BBS), and the Timed Up-and-Go test (TUG). Function was assessed with Barthel Index (BI).ResultsBoth groups improved significantly (P < 0.001 for both groups, d = 1.1–3.7 for control group and d = 1.9–6.1 for FES group) post-treatment (at 6 and 12 weeks) in all outcomes except SP in the control group (P < 0.05 at both times, d = 0.6 at 6 weeks and 0.8 at 12 weeks).ConclusionFES for interscapular muscles may have positive effects on trunk performance, scapular position, balance, and function in stroke patients. Also, additional improvements were observed post-intervention compared to baseline. FES is recommended to be part of the rehabilitation program of elderly post-stroke patients.

•Essential tremor and tremor dominant Parkinson disease variant constitute the main causes of geriatric tremor.•Olfactory dysfunction is a consistent non-motor manifestations (NMM) of PD and and additional sign in ET patients.•Sniffin’ Sticks test as well as Olfactory bulb volume are valuable biomarkers that differentiate doubtful TDPD and ET cases. Essential tremor (ET) and tremor dominant Parkinson disease (TDPD) variant constitute the main causes of geriatric tremor which differentiation is not always an easy mission. The objective of this work was to study the olfactory performance in ET and PD patients for possible consideration as a differentiating biomarker. This study was performed on 36ET, 22 TDPD variant and 24 healthy controls subjects (HCS) submitted to extended n-butanol Sniffin’ Sticks test (SST) and olfactory bulbs volumetry (OBV). There were significant decreases in SST threshold, discrimination, identification and TDI variables in TDPD patients compared to ET and HCS. ET patients showed significant decrease in the same variables compared to HCS. Regarding OBV, there were significant decreases in TDPD patients compared to ET and HCS with nonsignificant difference between the 2-latter groups. Our results showed that TDI score of 25 can differentiate between TDPD and ET patients with sensitivity and specificity (94 %, 91 %) respectively. Olfactory assessment is a rapid, safe, and easily applicable biomarker that could differentiate TDPD from ET in doubtful cases.

BackgroundDuring the coronavirus disease of 2019 (COVID-19) pandemic, it would be so difficult to keep the balance between time-saving best stroke care and medical staff safety which obliges healthcare decision-makers to think extraordinarily. The objectives of this study were to evaluate the performance of the Tanta stroke chain (TSC) during the period of the study as well as to identify areas of strength and disparities of the system while dealing with the COVID-19 pandemic measures. The study was conducted on 492 acute ischemic stroke (AIS) patients who were divided into COVID-19 suspected (115 patients) and COVID-19 non-suspected (377 patients). The former group was further COVID-19 confirmed and COVID-19 negative patients. The latter group was subdivided according to the timing of the patient’s arrival at the hospital in the morning, evening, and night shifts group while the fourth group constitute those reached during shifting hours. Patients received early stroke management regarding the 2018 AHA/ASA guideline and its 2019 update.ResultsSuspected COVID-19 patients represented 23.37% of studied patients. Onset to needle time was significantly prolonged in suspected COVID-19 patients with little chance of utilizing IV thrombolysis (IVT) and consecutive higher morbidity and mortality rates. For COVID-19 non-suspected patients group, a higher rate of IVT utilization was noticed in those reached during the morning shift with a lower chance of utilization in those reached during the shifting hours.ConclusionCOVID-19 measures had an inverse effect on TSC logistics which needed upgrading of the service to better cope with the pandemic and to improve AIS patients’ functional outcomes.

BackgroundThe most dangerous and least curable type of stroke is spontaneous intracerebral hemorrhage (ICH), and prognosis is highly correlated with location and size in the posterior fossa. The objective of this work was to estimate the frequency of posterior fossa hemorrhage (PFH) in Tanta University Hospitals, as well as identify functional outcomes and mortality in PFH.MethodsThis study was performed on 33 posterior fossa hemorrhagic patients and 119 posterior ischemic stroke patients (PCIS) submitted to the CT brain and the MRI brain, using the following scales: GCS and NIHSS, and the intracerebral hemorrhage scale (ICH score).ResultsPosterior fossa hemorrhage (PFH) represents 16.83% of total hemorrhagic stroke in the ER. Vertigo and DCL are more common in PFH (60.6%, 48.4%) than in PCIS. 82% of PFH patients had hypertension (HTN) hemorrhage. The cerebellum is the most common site for PFH (48%), pontine (24%), thalamic (18%), and midbrain (9%). PFH had unfavorable outcomes in 55% of the studied patients; the MRS mean was 4; and 39% died in the follow-up.ConclusionPosterior fossa hemorrhage is a potentially serious neurovascular emergency associated with complex symptomatology. PFH demonstrates diverse prognoses depending on the location of the intracerebral hemorrhage and the size of the hematoma.

BackgroundStroke is the most common acquired neurological disease in the adult population worldwide with an incidence of 16 million new cases every year responsible for about 6.1 million deaths and 130.6 million disability-adjusted life-years (DALYs). The objectives of this work were to study the level of stroke awareness and the proper response for suspected stroke patients in urban and rural areas of Tanta City, Egypt. The study was conducted on 1869 Egyptian Citizens; 908 and 961 reside in urban and rural areas, respectively, who were submitted to a face-to-face interview using the stroke awareness questionnaire (Arabic version).ResultsRural participants showed a significant reduction in acute cerebrovascular stroke (CVS) awareness and knowledge including the most affected organ by CVS, what are the risk factors, what are the early stroke symptoms, is there specific treatment for acute ischemic stroke, and what is the proper reaction when confronted with a case of acute CVS?ConclusionUrban populations have better recognition of stroke risk factors, early stroke symptoms, and the proper response when confronted with a case of acute CVS when compared with rural people possibly due to better socioeconomic status and higher educational levels.

BackgroundSubcortical vascular cognitive impairment (SVCI) is a subtype of vascular cognitive impairment associated with extensive cerebral small vessel diseases (CSVDs) imaging biomarkers. The objectives of this work were to study the existence and patterns of gait and balance impairments in patients with SVCI due to CSVDs.MethodsThe study was conducted on 28 newly diagnosed SVCI patients and 22 healthy control subjects (HCS) submitted to the advanced activity of daily living scale (AADLs), Berg balance test (BBT), Montreal Cognitive Assessment Scale (MoCA), computerized dynamic posturography (CDP), vision-based 3-D skeletal data gait analysis, and brain MRI volumetric assessment.ResultsSVCI patients showed a significant decrease in AADLs as well as total cerebral white matter volume, total cerebral cortical volume, and mean cortical thickness which were proportional to the degree of cognitive impairment as measured by the MoCA score. Regarding CDP analysis, patients with SVCI revealed prolongation of cancelation time and spectral power for mid- and high frequencies in dynamic positions. In respect to gait analysis, there were significant decreases in mean stride length and mean cadence as well as increases in mean step width and left to right step length difference in the SVCI group compared to HCS while doing a single task. These variables get highly significant during the dual-task performance with a p value < 0.001 for each one.ConclusionPatients with SVCI suffer from gait and balance impairments that are proportional to the severity of their cognitive decline and greatly impair their ADLs.

BackgroundThe description of childhood absence epilepsy (CAE) a benign self-limited generalized epilepsy has become a matter of debate. The objectives of this work were to evaluate the existence of psychiatric and cognitive impairments among patients with typical CAE and to correlate their possible relation to seizure frequency, duration of epilepsy, IISL, and valproate therapy.MethodsThe study was conducted on 19 typical CAE patients receiving valproate therapy, 11 newly diagnosed CAE patients not receiving AEDs, and 30 healthy control subjects (HCS). Participants were subjected to medical history taking, EEG monitoring, child behavior checklist (CBCL), Stanford Binet Intelligence Scale 5th edition, and computerized psychometric tests that assess cognitive domains and executive functions.ResultsThe study revealed a high rate of cognitive and psychiatric dysfunctions in CAE patients. 53.3% of patients had psychiatric problems versus 16.6% in HCS. Attention deficit hyperactive disorder (ADHD) (26.6%), anxiety (16.6%), and depression (6.6%) were the most common psychiatric disorders in the patient group. Withdrawn/depressed symptoms, thought problems, social problems, and attention problems in CAE patients were significantly increased compared to HCS. At the same time, CAE patients perform worse in cognitive scales than HCS with comparable intelligent quotient (IQ) scores.ConclusionCognitive and psychiatric impairments in typical CAE patients appear multifactorial in origin with epilepsy-related factors including the duration of epilepsy and interictal spike load (IISL).

BackgroundHematoma expansion (HE) is the leading cause of early neurological deterioration, poor functional outcome, and increased mortality in patients with spontaneous intracerebral hemorrhage (S-ICH). The study aimed to estimate the risks and predictors of early HE in patients with S-ICH and the effect of this HE on patient’s survival and functional outcome.MethodsThis study was carried out on 72 patients with S-ICH submitted to baseline non-contrast brain CT (NCCT) and CT angiography for determination of hematoma site, size, border irregularity, blend sign, and spot sign score (SSS). Rescan was done 48 h after stroke onset or on clinical deterioration to resize the HV and diagnose HE. Modified Rankin Scale (MRS) was done 3 months after stroke onset to assess the effect of HE on patients’ physical dependence.ResultsHE occurred in 28/72 (38.9%) of included patients. Risks of HE included old age, smoking, elevated baseline mean arterial blood pressure, and high admission modified National Institute of Health stroke scale. NCCT predictors of HE included large volume, irregular border, and presence of blend sign. The presence of spot sign in early CTA is more accurate than NCCT predictors with 54%, 91%, 79%, and 75% for sensitivity, specificity, positive predictive value, and negative predictive value, respectively.ConclusionsHE is a major cause of early clinical deterioration, increased mortality, and poor functional outcome. Early CTA for detection of spot sign is indicated in patients with large volume, irregular border, and/or blend sign in NCCT.

BackgroundOlfactory dysfunction (OD) is a well-established nonmotor manifestations (NMM) of Parkinson disease (PD) which needs objective assessment for better understanding of the disease pathogenesis. The aim of this work was quantitative and qualitative assessment of olfactory performance in newly diagnosed PD patients.MethodsThis study was performed on 32 recently diagnosed PD patients and 24 healthy controls subjects (HCS) submitted to unified Parkinson’s disease rating scale–III (UPDRS–III), extended n-butanol Sniffin’ Sticks test (SST) and olfactory bulbs volumetry (OBV).ResultsThere were significant decreases in SST threshold, discrimination, identification, and TDI variables as well as OBV in PD patients compared to HCS. The olfactory performance was negatively correlated with disease duration but had no relation with PD severity as well as motor subtype.ConclusionOD is highly prevalent during the early stages of PD which is both measurable and specific with identification and discrimination impairments to certain odors which makes smell performance testing an important step in PD patients’ evaluation.