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1.  Risk factors of short-term stroke recurrence in patients with minor ischemic cerebrovascular events 
ARYA Atherosclerosis  2013;9(2):119-127.
BACKGROUND
Assessing the risk of recurrent ischemic events in patients with transient ischemic attack (TIA) and minor ischemic stroke (MIS) is of a great importance in clinical practice.
METHODS
Consecutive patients with TIA or MIS who were visited in Ghaem Hospital, (Mashhad, Iran) were enrolled in a prospective cohort study during 2010 to 2011. Diagnosis of TIA or MIS was accomplished by a stroke neurologist. Only those who presented within 24 hours from the onset of symptoms were recruited. MIS was considered as an ischemic stroke with National Institutes of Health Stroke Scale (NIHSS) < 4. The endpoint of the study was a new ischemic cerebrovascular event or vascular death in 90 days and additionally in 3 days. The decision to admit and type of treatment in each case was left to the discretion of the stroke neurologist. The association between 20 potential factors with recurrent ischemic events in 3 and 90 days was investigated using univariate and multivariate analysis (MVA).
RESULTS
393 TIA patients (238 males and 155 females) and 118 MIS patients (77 males and 41 females) were enrolled in the study. Stroke occurred in 117 (23.2%) patients, TIA in 99 (19.6%), and there was 11 (2.2%) vascular deaths within 3 months in the total 511 patients with minor ischemic events. Crescendo TIAs and multiple TIAs were associated with greater risk of stroke in 3 days in a univariate analysis (OR = 5.12, P < 0.001) and (OR = 3.98, P = 0.003), respectively. Patients with index stroke had 11.5% lower risk of recurrent stroke in 3 days than patients with index TIA in multivariate analysis (OR = 0.115, P = 0.039). Diabetes was independently associated with 3 months stroke recurrence in the patients with minor ischemic events (OR = 2.65, P = 0.039).
CONCLUSION
Multiple and crescendo TIAs are the main predictors of stroke recurrence, derived from the univariate analysis of the patients with minor ischemic events.
PMCID: PMC3653243  PMID: 23690811
Transient Ischemic Attacks; Infarction; Brain; Recurrence; Risk
2.  Comparative interrater reliability of Asian Stroke Disability Scale, modified Rankin Scale and Barthel Index in patients with brain infarction 
ARYA Atherosclerosis  2012;8(3):153-157 .
BACKGROUND
This study tried to develop an Asian Stroke Disability Scale (ASDS) and compared its interrater reliability with modified Rankin Scale (mRS) and Barthel Index (BI).
METHODS
Three items including self-care, mobility, and daily activities were selected as variables for development of the ASDS. The variables were provisionally graded on a 2- to 4-point scale based on the importance of each item. Each of the variables was categorized into 3 categories. Afterward, 125 rater-patient assessments for each scale (mRS, BI, and ASDS) were performed on 25 stroke patients by 5 raters. For categorization of functional impairment as minor or major, the scores of mRS, BI and ASDS were categorized as ≤ 2 and > 2, < 90 and ≥ 90, and < 3 and ≥ 3, respectively.125 rater-patient assessments for each of the mRS, BI, and ASDS were performed on 25 stroke patients by five raters.
RESULTS
The quantitative variability of BI, mRS, and ASDS scores was not significant (P = 0.379; P = 0.780; and P = 0.835, respectively). Interrater variability of mRS, BI, and ASDS scores based on qualitative categorization was not significant (P = 1.000; P = 0.978; and P = 0.901, respectively). Paired interrater variability of mRS, BI, and ASDS scores based on qualitative categorization was not significant (P > 0.05).
CONCLUSION
The ASDS is easy to use, requires less than 1 minute to complete and is as valid as mRS and BI in assessment of functional impairment of patients with stroke.
PMCID: PMC3557011  PMID: 23359790
Stroke; Disability; Scale; Validation
3.  Results of Surgical and Non-Surgical Treatment of Aneurysms in Iran 
ARYA Atherosclerosis  2011;6(4):136-139.
BACKGROUND
Direct surgery or endovascular procedures are an accepted way of treating patients with Aneurismal Subarachnoid Haemorrhage (SAH). However the impact of invasive methods of treatment on results in developing countries may differ from that in developed countries.
METHODS
This is a prospective clinical study of consecutive patients with Subarachnoid Haemorrhage (SAH) admitted in Ghaem hospital in Mashhad during 2005-2010. The initial diagnosis and investigations were carried out by neurologists. The patients were divided into two groups. One received surgical treatment whilst the other group was managed medically. The decision as to the choice of method of treatment was made by the neurosurgeons. The initial medical treatment was standardised for all the patients. The rate of complications and mortality was compared in both medical and surgical groups.
RESULTS
20 SAH patients (52% females) with a mean age of 50.6±7 years were evaluated. The angiography revealed the presence of an aneurysm in 62 patients. 63.5% of patients received medical treatment and 37.5% underwent aneurysmal surgery. Difference of rebleeding rate in two therapeutic groups was not significant; χ2=0.014, P=0.91. The effect of rebleeding on mortality was not significant; χ2=2.54, P=0.14. Within 62 SAH patients with cerebral aneurysm, the mortality rate in both therapeutic groups was also not significantly different; χ2=0.16, P=0.77.
CONCLUSION
There is no significant difference in the mortality rate between the “surgical” and non “surgical” groups of patients with SAH. This could be due to delay in performance of surgery in neurovascular centers in Iran.
PMCID: PMC3347835  PMID: 22577431
Mortality; Subarachnoid; Surgery; Haemorrhage.
4.  Clinical Evaluation of Patients with Migraine Induced Stroke in Mashhad, Iran 
ARYA Atherosclerosis  2010;6(3):90-93.
BACKGROUND
Migraine Induced Stroke (MIS) is an important cause of brain infarction in the young people.
METHODS
Consecutive patients with MIS admitted in Ghaem hospital, Mashhad during 2006–2010 enrolled a prospective clinical study. All of the patients suspected to MIS had brain MRI with a 0.5 Tesla generation, Philips NT Intra, Netherland. All of the MIS patients underwent a standard battery of diagnostic investigations for detecting etiology of stroke. Disability of MIS patients was detected based on the modified Rankin scale at 90 days post stroke.
RESULTS
32 MIS patients (18 females, 14 males) with mean age 37.2 ± 3.8 years ranged 15–58 years were evaluated. Hypodense area of infarction corresponding to clinical manifestations was detected in MRI in 32% of our MIS patients. The mean disability score in our MIS patients was 1.09 ± 0.32, which is significantly lower than other stroke patients (z = 2.55, P = 0.007)
CONCLUSION
MIS is an important cause of stroke in Persian young adults which have good prognosis.
PMCID: PMC3347820  PMID: 22577422
Migraine; Stroke; Migraine Induced Stroke

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