Background Fibulin-5 and ischemia-modified albumin (IMA) levels increase in acute phase of cerebrovascular diseases, yet data regarding their levels in various stroke subtypes and correlation with severity and prognosis are still insufficient. This work aims to evaluate serum IMA and fibulin-5 as markers for early detection and predicting prognosis in acute cerebrovascular disease. Method This case-control study was done on 100 patients with first time stroke, assessed by the National Institute of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) within the first 24 h after stroke event, lesion volume was calculated, serum fibulin-5 and IMA levels were measured in the first few hours of stroke, and their levels were compared with levels measured in 75 control subjects. Three months later, stroke patients were assessed by the modified Rankin Scale (MRS). Results Fibulin-5 and IMA were significantly higher in the patient than in the control group and were positively correlated with lesion volume and NIHSS score but inversely correlated with GCS score. Fibulin-5 was statistically higher in hemorrhage group, whereas IMA was statistically higher in infarction group. MRS score was positively correlated with fibulin-5 levels at onset of stroke but not with IMA. Conclusion Fibulin-5 and ischemia-modified albumin are increased during the acute stroke phase and correlated with severity of stroke, but only fibulin-5 shows significant correlation with prognosis.

No abstract

Aortic dissection (AD) is a serious condition that causes transient or permanent neurological problems that include spinal cord ischemia (SCI), which occurs when AD extends into the descending aorta resulting in insufficient perfusion of segmental arteries that supplies the spinal cord. We report a 64-year-old male, presented with severe back pain, asymmetrical paresthesia, and weakness of both limbs, more in the left lower limb with loss of pinprick, temperature, and fine touch sensation on the lower left lower limb below the level of T5 with preserved proprioception and vibration and urine hesitancy. Computed tomography showed AD, Stanford type A, and spinal magnetic resonance imaging (MRI) showed hyperintense owl’s eye sign at T5. The patient was diagnosed as anterior spinal artery syndrome secondary to an AD and referred for aortic surgical repair with good functional outcome. In our review to cases of SCI due to AD, it was more common in males above 55 years, pain only found in 47.8% of patients, with anterior cord syndrome on top of the clinical presentations, and hypertension is the most common risk factor. MRI spine showed thoracic location predominance. Surgical or endovascular repair especially for type A and complicated type B should be considered to avoid complications, and cerebrospinal fluid drainage is a very useful tool in reversing SCI specially if done early with favorable outcome. Only the old age is associated with increased risk of mortality. Early diagnosis and appropriate management are crucial for better outcome.

Background: Migraine in children and adolescents is very common and can be associated with equivalents, psychiatric disorders, or abnormal electroencephalogram findings. Neurogenic inflammation is involved in migraine pathogenesis where pro-inflammatory cytokines play a significant role. Recent studies have demonstrated that serum bilirubin can be considered as an antioxidant and cytoprotective agent and that its concentration may be influenced in migraine by neurogenic inflammation. Various studies have observed reduced serum bilirubin in migrainous adults, and few studies investigated the association between serum bilirubin and migraine in children and adolescents. Objectives: To study the association between serum bilirubin and migraine in children and adolescents. Patients and method: Serum samples were collected from 40 migrainous children and adolescents and from 40 controls. Total, direct, and indirect bilirubin concentrations were measured. Headache features, migraine equivalents, psychiatric comorbidity, and electroencephalogram findings were documented in migraineurs. Results: Serum total, direct, and indirect bilirubin concentrations were significantly lower in migraineurs than controls. This was statistically significant associated with abnormal electroencephalogram findings during headachefree periods and not statistically significant associated with any headache feature, abnormal electroencephalogram findings during headache attacks, or psychiatric comorbidity. Conclusion: Serum bilirubin concentration is lower in migrainous children and adolescents compared to control, with no association with specific migraine type or features, and thus may be considered a useful marker for neurogenic inflammation in migraine.