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Background and Objective: Millions of women in the world use oral contraceptive pills (OCPs). On the other hand %16 to %19 of women suffer from migraine and many of them have tension headaches. These women may wonder whether the consumption of OCPs is harmful for them. This study carried out to determine the effects of combined low estrogen oral contraceptive pills on migraine and tension headaches. Materials and Methods: This case control study was done on 344 women which reffered to health care centers in Mashhad, Iran during 2009. Case group include 244 women which consumed oral contraceptive for at least three month. 100 women without OCPs consumption were considered as control group. The criteria of International Headache Society for migraine and tension headaches were used to diagnose headache. The severity and the frequency of headaches before and after the consumption of OCP were recorded. Data was analyzed by Chi-Square, Fisher exat, Logestic regresion and Wilcoxon tests. Results: The frequency of migraine headache was 5% and 6% in case and control groups respectively. This different was not significant (OR=0.88, 95%CI: 0.3-2.69, P=0.804). The frequency of tension headache in cases and controls was 12% and 10%, respectively. This different was not significant (OR=1.26, 95%CI: 0.56-2.86, P=0.055). Conclusion: This study showed that the consumption of OCPs, has no effects on the advent of migraine and tension headaches and do not increase the rate and severity of the attacks.

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Background and Objective: Multiple sclerosis is one of demyelinating disorder of CNS that is an uncommon cause of the sensorineural hearing loss. This study was done to determine the hearing loss in multiple sclerosis patients.

Materials and Methods: This case-control study was performed on 60 (44 women, 16 men) multiple sclerosis patients and 38 (27 women, 11 men) normal subjects by pure tone audiometery, otoacustic emissions and auditory brainstem responses in Gilan provine, Iran during 2010-11. Data was analyzed by using SPSS-17, Chi-Square and Fischer tests.

Results: 12.5% of case and 3.9% of the control ears had abnormal pure tone audiometery (P<0.05). The frequencies of abnormal HF-pure tone audiometery and two modalities of otoacustic emission did not show any significant differences in two groups. Abnormal autidory brainstem response of ears were observed in 20% and 9.2% of cases and controls, respectively (P<0.05). 20% of case and 9.2% of the control ears had abnormal auditory brainstem response (P<0.05). The absolute latencies of waves I, II and V had not significant differences between two groups. Inter peak latencies of I-III and III-V waves were observed in 10% and 11.7% in cases ears and 1.3% and zero percent in controls, respecticely. 6.7% of cases and 2.6% of control ears had retrocochlear abnormality.

Conclusion: Hearing loss detected by pure tone audiometery and auditory brainstem response is more common in multiple sclerosis compared to normal population.

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Background and Objective: Multiple Sclerosis is one of the most common and disabling neurological disease. Recent studies reported the possible role of serum uric acid in the pathogenesis of multiple sclerosis. This study was done to examine the role of serum uric acid in patients with multiple sclerosis. Materials and Methods: This case - control study was carried out on 70 multiple sclerosis patients as cases and 70 healthy subjects as controls in teaching hospital in Rafsanjan, Iran during 2010. The two groups were matched in age and gender. The serum uric acid level of subjects in case and control groups was measured by enzymatic colorimetric method. Data were analyzed using SPSS-17 and student t-test. Results: The mean serum uric acid level in cases and controls was 3.871±1.193 mg/dl and 4.171±1.39 mg/dl, respectively, this difference was not significant. Also, there was not significant relationship between serum uric acid level and gender in multiple sclerosis patients. Conclusion: This study indicated that the serum uric acid level is not changed in multiple sclerosis patients compared to controls.

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Background and Objective: Although multiple sclerosis is a disease affecting white matter of brain and spinal cord, but involvement of basal ganglions in some studies demonstrated a decrease in T2 sequence signals. This study was done to assess signal intensity of basal ganglions in T2 magnetic resonance imaging (MRI) in multiple sclerosis Materials and Methods: This case – control study was done on 30 multiple sclerosis patients and 30 controls in Imam Reza hospital, Kermanshah, Iran, during 2010. MRI images of multiple sclerosis of patients and control group were matched according to age and sex. The basal ganglia signals were identified based on involvement areas, number of plaques, and brain atrophy in T2 and flair sequences. Data were analyzed using SPSS-16, Chi-Square, Fisher exact test and independent t-tests. Results: Among the case group, 10 patients (33.3%) demonstrated low signals in right thalamus and 14 patients (46.7%) in left thalamus, which was statistically significant compared with control group (P<0.001). The presence of plaques in right and left globus pallidus was observed in 4 (13.3%) and 7 patients (23.3%) respectively. The presence of plaques in right and left thalamus was observed in 10 patients (33.3%) and 14 patients (46.7%) respectively, which was significant compared with control group (P<0.001). The presence of brain atrophy was observed in 18 patients (60%) in case groups and in one patient (3.3%) in control group (P<0.001). Conclusion: This study indicated that reduction of T2 signals in thalamus is a valuable finding in multiple sclerosis patients and it may facilitate the diagnosis of multiple sclerosis.

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Background and Objective: Several studies have shown that during stroke changes occur in some paraclinic parameters which may have either prognostic or diagnostic value, including electrocardiographic changes. This study was done to evaluate the prognostic value of prolonged QT segment in patients with ischemic stroke. Materials and Methods: This descriptive study with an easy convenient sampling was carried out on 175 patients (73 male and 102 female) with acute ischemic stroke whome have been diagnosed by brain imaging (computed tomography scan and magnetic resonance imaging). All patients were suffering from stroke for the first time and if they use any drug or have underlying disease except diabetes mellitus- hypertension- heart disease and hyperlipidemia were excluded. In the first 24 hours of admission, an electrocardiogram (ECG) were taken for measurement of QT segment and according to death or discharge, patients were divided into two groups, and the mean of QT segment (corrected QT) subsequently were assessed. Data were analyzed using SPSS-15, Chi-Square and independent t-tests. Results: Twenty patients died in the course of admission. The mean of QT segment (corrected QT) in dead patients was 471.15±61.70 and in discharged patients was 421.52±62.96 (P<0.05). The abundance of prolonged QT segment accompanied with death was more frequent. Hypertension, diabetes mellitus, hyperlipidemia and heart disease were significantly correlated with morbidity and mortality (P<0.05). There is no relation between mortality with age and sex. Conclusion: This study showed that mean of QT segment (corrected) and also cases of prolonged QT segment were abundant among dead patients, therefore prolongation of QT segment has prognostic value in patients with ischemic stroke.

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Background and Objective: The silent brain infarctions are common in first-ever stroke. Some recent studies show the possible role of silent brain infarction in ischemic stroke. The aim of this study was to evaluate the frequency of silent brain infarction in acute first-ever ischemic stroke and its association with stroke risk factors. Materials and Methods: This descriptive - analytical study was carried out on 203 (94 males, 109 females) patients with acute first-ever ischemic stroke in Shafa hospital in Kerman, Iran during 2010. The diagnosis of ischemic stroke was made by physical examination and was confirmed by MRI and CT Scan. A questionnaire containing demographic information and risk factors including hypertension, diabetes, hyperlipidemia, cigarette smoking, ischemic and non-ischemic heart disease for stroke as well as presence of silent stroke was completed for each patient. Data were analyzed using SPSS-16 and logistic regression test. Results: The mean age of patients was 62.56±17.35 years. Among our patients history of hypertension, hyperlipidemia, cigarette smoking, diabetes, history of ischemic heart disease, history of other cardiac disease and silent stroke were observed in 66 (32.5%), 26 (12.8%), 16 (7.9%), 40 (19.7%), 27 (13.3%), 16 (7.9%) and 31 (15.3%), respectively. The probability of silent stroke among patient with hyperlipidemia, was 3.7 times more than those without hyperlipidemia (95%CI: 1.556-12.780, P<0.05). There was no significant correlation between silent stroke and the above risk factors. Conclusion: Silent stroke was found in 15% of patients with ischemic stroke. Control of hyperlipidemia can have a vital role in the prevention of silent stroke.

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Background and Objective: Diabetes is a major risk factor for stroke. Some studies have shown that difference between clinical signs and prognosis in diabetic patients with stroke compared to non-diabetic patients with stroke is due to difference in pattern of cerebral vascular involvement. This study was done to compare the findings of extracranial and transcranial doppler sonography in diabetic and nondiabetic patients with thrombotic stroke. Materials and Methods: This case – control study was done on 70 diabetic patients and 70 non-diabetic patients with thrombotic stroke. All patients were new cases. Extracranial and transcranial doppler sonography was performed for all subjects. Results: Basilar artery stenosis was significantly more frequent in diabetic cases in comparison with non-diabetic patients (P<0.05). The prevalenc of posterior circulation stenosis in diabetic patients was significantly higher than non-diabetic patients (P<0.05). Conclusion: In diabetic patients, stenosis in vertebrobasilar circulation was more frequent. Higher morbidity and mortality in diabetic patients may be due to vascular stenosis pattern.

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Background and Objective: The Detection of neurologic signs for topographical disorders in central nerves system can prevent unnecessary neuroimaging techniques such as MRI. This study was performed to determine the diagnostic value of physical examination for topographic detection of infratentorial lesions in patients with cerebrovascular syndromes. Methods: This descriptive study was done on 200 patients with cerebrovascular syndrome in Qaem Hospital in Mashhad, north-east Iran during 2011. Regarding to topographic physical examination, sensitivity, specificity, positive and negative predictive value and accuracy of signs of syndromes were compared to MRI as gold standard method. Results: The accuracy of tetraparesis and crossed syndromes for localization of brain lesion in brainstem was 79% and 83%, respectively. The accuracy of hemiataxia for localization of brain lesion in ipsilateral cerebellar hemisphere was 98%. The accuracy of Wallenberg syndrome for localization of brain lesion in posterolateral medulla was 98%. Conclusion: Using clinical neuro-examination skills and accurate topographic physical examination can prevent unwanted MRI technique for the diagnoses of cerebrovascular syndromes.

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Background and Objective: Cardioembolic stroke account for one-fifth of ischemic stroke and atrial fibrillation is the most common underlying cause. Taking an oral anticoagulation (Warfarin) is an effective way of preventing ischemic stroke but bleeding complication is common. This study was carried out to evaluate the validation of HASBLED score in prediction of hemorrhagic complications in patients with brain ischemia and atrial fibrillation under warfarin therapy. Methods: In this cohort study 112 patients with non-valvular atrial fibrillation in term of major and minor bleeding complications were followed to the predictive value of HASBLED criteria for one year. Major bleeding complications defined as intracranial bleeding, bleeding leading to hospitalization, drop of hemoglubin of more than 2gr/dl or requiring transfusion. HASBLED criteria were defined as hypertension, abnormality in liver and renal function tests, history of stroke, history of bleeding, large fluctuations in coagulation tests results, age more than 65 years and an Anti-platelet and non steroidal anti-inflammatory drugs and alcohol use one point is awarded to each of the aboves. Results: During one year follow up, 10 (9.1%) of patients had major bleeding and 28 (25%) patients had minor bleeding. The risk of major bleeding was significantly related with a history of minor bleeding and HASBLED scores (P<0.05). The risk of minor bleeding was significantly related with warfarin toxicity and high INR (P<0.05). HASBLED score>3 was associated with the likelihood of major bleeding in future. Conclusion: Patients with HASBLED score>3 should be causious in initial stage of taking oral anticoagulant.

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Background and Objective: Migraine is common worldwide. In recent years, vitamin D deficiency has been shown as a global health issue. This study was done to determine the relationship between serum levels of vitamin D with migraine. Methods: This descriptive - analytical study was carried out on 76 patients (21 males, 55 females) with migraine aged 10-61 years olds. Serum vitamin D level of each patient was measured. Adjustments were done for age, sex, waist circumference, body mass index (BMI), number of chronic diseases, and education level. The multiple linear regressions were done to determine the relationship between serum levels of vitamin D with migraine. Results: Vitamin D defeicincy was seen in 13.2 of patients.The weak positive association was shown between serum vitamin D with headache (P<0.05), but no significant association was found between serum vitamin D level with migraine severity. Conclusion: No significant association was seen between serum levels of vitamin D with migraine severity.

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Background and Objective: Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease, leading to progressive disability, reduces daily activity and function and emerges with a wide range of physical symptoms. This study was done to determine the effect of relaxation on the physical symptoms in women with Multiple Sclerosis. Methods: In this clinical trial study, 50 patients with MS were randomly divided into relaxation and control groups. In the interventional group, Jacobson and Benson method was performed for 4 weeks, twice a week for 40 minutes and patients in the control group were received only care and routine medical treatment. Data was collected via fatigue severity scale (FSS), numerical rating scale (NRS) before, immediately after and two months after intervention. Results: The mean severity of fatigue score, before, immediately and two months after the intervention were not the same and time trends was effective on severity of fatigue score (P<0.05). The mean of fatigue score were significantly reduced in intervention group (immediately and two months after intervention) in compared to pre-intervention. The mean severity of pain score ,before, immediately and two months after the intervention were not the same and time trends was effective on mean severity of pain score (P<0.05). The mean intensity of pain score over time in the relaxation group non-significantly reduced in compared to the control group. Conclusion: Relaxation technique is effective as a low-cost, safe and easy method to reduce fatigue and pain in patients with MS.

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Acute necrotizing encephalopathy (ANEC) is a rare illness with high incidence in East Asia. It is accompanied with respiratory infection, gastrointestinal infections, and high fever with quick impaired consciousness, and convulsion. In this case report, Turkmen 6 month's girl that was introduced after an infection with no disease or clinical abnormalities. She was vaccinated accordingly; initially she had fever with generalized tonic-clonic convulsion (seizures) for 5 to 10 minutes level of consciousness decreased later on. She was transferred to Talghani Medicat Education center in nortern Iran. At the time of admition her vital signs were as below: RR: 30, GCS: 8-9, RP: 110, BP: 90/80. In the patient's history, there was neither Trauma history, nor food or drug poisoning, also no clinical history. After convulsion, the level of consciousness decreased and serum biochemistry showed normal electrolytes concentration. In further follow - up, AST increased to 98 units, ALT to 58 units, and ammonium to 215 units. In CSF Sample, protein level increased to 330 units, without any avidences of pleocytosis, blood, or Serum glucose drop. In CT without contract, hypodensity the cornea in thalamus and caudate cores were seen in 2 sides. The ventricles were normal and there were no signs of bleeding and pressure. In brain M.R.I, abnormal signal in 2 sides, blood samples cultivation, CSF, and testing urine for bacterial infection were negative. The patient was diagnosed with necrotizing encephalopathy and subsequently was treated with metyle prednisolone (20 mg daily). During hospitalization, level of consciousness increased and fever stopped. There was not recurrence of convulsion, but the patients still had some problems in moving, verbal and communication.

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Multiple sclerosis (MS) is a chronic inflammatory immune-mediated disease of the central nervous system. Despite extensive investigations, many aspects of etiology and pathophysiology remain unclear. In multiple sclerosis patients, immune system reacts against autologous proteins in the myelin membrane. Most evidences support the hypothesis that both genetic and environmental factors contribute to disease development. But after the failure of genetic findings to explain the reason for the unequal incidence of MS in identical twins, investigators focused further on environmental factors such as vitamin D deficiency, smoking, living in different latitudes and perhaps the most importantly the role of viruses in people whom are genetically susceptible to MS. There is increasing evidence that viruses may play important role in MS pathogenesis following environmental triggers. Recently, studies focused on the role of herpes virus family, especially Epstein-Barr virus, human herpes virus 6 (HHV-6) and Varicella Zoster virus, as the virus is prevalent in society. This review mainly focused on the identification of important viruses with key role in MS the mechanism behind pathogenesis and describes the animal models of MS. The results of researches are shown strong evidence of the virus or antibodies to viral components in active plaques in MS affected patients, but still cannot be stated with certainty that one or more specific viruses are simultaneously trigger the disease. Further studies are required to prove the pathogenesis of viruses in MS.

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Background and Objective: Stroke has a high prevalence and is associated with a high premature mortality rate. Thus, it is important to identify the effective factors in increasing the incidence of stroke. The aim of this study was to investigate the role of seasonal changes and environmental factors in the occurrence of stroke.
Methods: This descriptive-analytical study was done on 3,639 patients including 3,102 (85.3%) with ischemic stroke, 472 (12.9%) with intracerebral hemorrhage and 65 (1.9%) with subarachnoid hemorrhage patients. After measuring environmental factors such as air temperature, air pressure, humidity and geomagnetic field, admission data of stroke patients between 2015-2019 were extracted from the Sayyad Shirazi Hospital information system.
Results: The mean occurrence of intracerebral hemorrhage was highest in winter, especially in January and March, and lowest in summer, especially in July and August. Intracerebral hemorrhage had a positive significant correlation with air pressure (P=0.001, r=0.452) and a negative correlation with ambient temperature (P<0.001, r= - 0.457). Subarachnoid hemorrhage and ischemia were not related to the season or the month. It was also found that ischemic stroke had a significant positive correlation with geomagnetic field fluctuations. Subarachnoid hemorrhage was not associated with any of the variables, but intracerebral hemorrhage was significantly positively associated with air pressure and inversely associated with temperature.
Conclusion: This study illustrated that winter, low temperature, high air pressure and high geomagnetic fluctuations are associated with a higher risk of stroke. Therefore, the underlying physiopathological causes of this relationship should be carefully investigated in future studies.