Recurrent strokes are more likely to be disabling or fatal than first ever strokes. The aim of the study is to evaluate transthoracic echocardiographic (TTE) and clinical predictors in patients with first versus those...Recurrent strokes are more likely to be disabling or fatal than first ever strokes. The aim of the study is to evaluate transthoracic echocardiographic (TTE) and clinical predictors in patients with first versus those with recurrent ischemic strokes. A prospective observational comparative study of 217 patients admitted with ischemic strokes who were in sinus rhythm. Two groups of patients were simultaneously enrolled. The first group was 110 patients with first ischemic stroke and the second was 107 patients with recurrent ischemic stroke. TTE was done for all patients. Both echocardiographic and clinical risk factors were compared between both groups. Logistic regression analysis identified predictors for recurrent strokes. Among clinical risk factors hypertension, hyperlipidemia, family history of atherosclerotic vascular disease, prior coronary artery disease, peripheral vascular disease, and chronic kidney disease were significantly higher in recurrent stroke group. Multivariate logistic analysis identified age (OR, 1.03;95% CI, 1.01 - 1.07), hypertension (OR, 2.25;95% CI, 1.03 - 4.92), and hyperlipidemia (OR, 2.73;95% CI, 1.40 - 5.35), as predictors for recurrent ischemic strokes. Left ventricular diastolic dysfunction, left ventricular hypertrophy (LVH) and aortic sclerosis were significantly more common in the recurrent stroke group compared to the first stroke group. However, in multivariate logistic analysis only LVH (OR, 3.50;95% CI, 1.69 - 7.23), was identified as a predictor for recurrent strokes. Older age, hypertension, hyperlipidemia and left ventricular hypertrophy are significant predictors of recurrent ischemic strokes in patients with sinus rhythm. Those patients need more aggressive lipid lowering therapy and optimal blood pressure control.展开更多
Whereas paralysis is the hallmark for paralytic rabies, the precise pathological basis of paralysis is not known. It is unclear whether weakness results from involvement of anterior horn cells or of motor nerve fibers...Whereas paralysis is the hallmark for paralytic rabies, the precise pathological basis of paralysis is not known. It is unclear whether weakness results from involvement of anterior horn cells or of motor nerve fibers. There is also no conclusive data on the cause of the neuropathic pain which occurs at the bitten region, although it has been presumed to be related to sensory ganglionopathy. In this study, six laboratory-proven rabies patients (three paralytic and three furious) were assessed clinically and electrophysiologically. Our data suggests th at peripheral nerve dysfunction, most likely demyelination, contributes to the weakness in paralytic rabies. In furious rabies, progressive focal denervation, starting at the bitten segment, was evident even in the absence of demonstrable weakness and the electrophysiologic study suggested anterior horn cell dysfunctio n. In two paralytic and one furious rabies patients who had severe paresthesias as a prodrome, electrophysiologic studies suggested dorsal root ganglionopathy. Postmortem studies in two paralytic and one furious rabies patients, who had local neuropathic pain, showed severe dorsal root ganglionitis. Intense inflammation of the spinal nerve roots was observed more in paralytic rabies patients. Inflammation was mainly noted in the spinal cord segment corresponding to the bite in all cases; however, central chromatolysis of the anterior horn cells could be demonstrated only in furious rabies patient. We conclude that differential sites of neural involvement and possibly different neuropathogenetic mechanisms may explain the clinical diversity in human rabies.展开更多
Epilepsy is a common neurological disorder in neurology clinic. Levetiracetam is considered as one of common antiepileptic drugs used to manage epilepsy with good efficacy and tolerability profile. It is renally excre...Epilepsy is a common neurological disorder in neurology clinic. Levetiracetam is considered as one of common antiepileptic drugs used to manage epilepsy with good efficacy and tolerability profile. It is renally excreted and not depending on the cytochrome p450. It has adverse effects reported as somnolence, headaches, dizziness, depression and anxiety. Also, it was reported that levetiracetam can cause Acute kidney injury (AKI), renal profile disturbance, that may be related to its way of excretion and possible nephrotoxicity especially with high loading dose. We are reporting a young female patient with epilepsy presented to hospital with status epileptcus and started on loading dose of levetiracetam 3 grams and then maintenance dose of 1 gram twice daily seizure were controlled but she developed acute kidney injury that improved after discontinue leveriracetam and medical management without renal dialysis and discharged home in stable condition. Physician and health care providers should be aware of such rare adverse reaction and available management options for better patient care and outcome.展开更多
Background During the COVID-19 pandemic,decreased volumes of stroke admissions and mechanical thrombectomy were reported.The study’s objective was to examine whether subarachnoid haemorrhage(SAH)hospitalisations and ...Background During the COVID-19 pandemic,decreased volumes of stroke admissions and mechanical thrombectomy were reported.The study’s objective was to examine whether subarachnoid haemorrhage(SAH)hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.Methods We conducted a cross-sectional,retrospective,observational study across 6 continents,37 countries and 140 comprehensive stroke centres.Patients with the diagnosis of SAH,aneurysmal SAH,ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases,10th Revision,codes.The 3-month cumulative volume,monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before(1 year and immediately before)and during the pandemic,defined as 1 March-31 May 2020.The prior 1-year control period(1 March-31 May 2019)was obtained to account for seasonal variation.Findings There was a significant decline in SAH hospitalisations,with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic,representing a relative decline of 22.5%(95%CI−24.3%to−20.7%,p<0.0001).Embolisation of ruptured aneurysms declined with 1170-1035 procedures,respectively,representing an 11.5%(95%CI−13.5%to−9.8%,p=0.002)relative drop.Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations,a 24.9%relative decline(95%CI−28.0%to−22.1%,p<0.0001).A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1%(95%CI 32.3%to 50.6%,p=0.008)despite a decrease in SAH admissions in this tertile.Interpretation There was a relative decrease in the volume of SAH hospitalisations,aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic.These findings in SAH are consistent with a decrease in other emergencies,such as stroke and myocardial infarction.展开更多
An 89-year-old woman was admitted with a 3-day history of dysphagia and lower jaw twitching. She had a history of hypertension, diabetes mellitus, surgically corrected left proximal humeral fracture, and right C5 derm...An 89-year-old woman was admitted with a 3-day history of dysphagia and lower jaw twitching. She had a history of hypertension, diabetes mellitus, surgically corrected left proximal humeral fracture, and right C5 dermatome postherpetic neuralgia. The jaw twitching had caused dysphagia with an inability to drink liquids. Physical examination confirmed the persistent lower jaw myoclonus (Supplementary Video;http://links.lww.com/CM9/A48). The patient was fully conscious and had no twitching or nystagmus in any of her other extremities. The results of neurological examination and biochemical analysis (including complete blood profile, electrolyte level, random glucose concentration, renal function test, and liver function test) were all within the normal range. Computed tomography of the brain was unremarkable and an electroencephalogram showed no evidence of seizure. A careful review of her prescribed medications revealed the following: the patient complained of allodynia over the right C5 dermatome around 3 months prior and was prescribed gabapentin. The dosage of gabapentin was increased to 300 mg total dissolved solids (TDS) around 2 months prior. Creatinine levels were normal but her glomerular filtration rate, as estimated by the Cockcroft-Gault equation, was 36 mL/min.[1] Since the patient’s relatives supervised her medication intake, overdosage was not possible. Gabapentin was discontinued and replaced with pregabalin 50 mg BD and the patient was prescribed valium 2 mg TDS transiently. The jaw myoclonus subsided on the second day. After a consultation with a speech therapist, the patient resumed oral intake and remained tolerant of a normal diet. Upon review after 1 month, the patient remained free from jaw myoclonus.展开更多
文摘Recurrent strokes are more likely to be disabling or fatal than first ever strokes. The aim of the study is to evaluate transthoracic echocardiographic (TTE) and clinical predictors in patients with first versus those with recurrent ischemic strokes. A prospective observational comparative study of 217 patients admitted with ischemic strokes who were in sinus rhythm. Two groups of patients were simultaneously enrolled. The first group was 110 patients with first ischemic stroke and the second was 107 patients with recurrent ischemic stroke. TTE was done for all patients. Both echocardiographic and clinical risk factors were compared between both groups. Logistic regression analysis identified predictors for recurrent strokes. Among clinical risk factors hypertension, hyperlipidemia, family history of atherosclerotic vascular disease, prior coronary artery disease, peripheral vascular disease, and chronic kidney disease were significantly higher in recurrent stroke group. Multivariate logistic analysis identified age (OR, 1.03;95% CI, 1.01 - 1.07), hypertension (OR, 2.25;95% CI, 1.03 - 4.92), and hyperlipidemia (OR, 2.73;95% CI, 1.40 - 5.35), as predictors for recurrent ischemic strokes. Left ventricular diastolic dysfunction, left ventricular hypertrophy (LVH) and aortic sclerosis were significantly more common in the recurrent stroke group compared to the first stroke group. However, in multivariate logistic analysis only LVH (OR, 3.50;95% CI, 1.69 - 7.23), was identified as a predictor for recurrent strokes. Older age, hypertension, hyperlipidemia and left ventricular hypertrophy are significant predictors of recurrent ischemic strokes in patients with sinus rhythm. Those patients need more aggressive lipid lowering therapy and optimal blood pressure control.
文摘Whereas paralysis is the hallmark for paralytic rabies, the precise pathological basis of paralysis is not known. It is unclear whether weakness results from involvement of anterior horn cells or of motor nerve fibers. There is also no conclusive data on the cause of the neuropathic pain which occurs at the bitten region, although it has been presumed to be related to sensory ganglionopathy. In this study, six laboratory-proven rabies patients (three paralytic and three furious) were assessed clinically and electrophysiologically. Our data suggests th at peripheral nerve dysfunction, most likely demyelination, contributes to the weakness in paralytic rabies. In furious rabies, progressive focal denervation, starting at the bitten segment, was evident even in the absence of demonstrable weakness and the electrophysiologic study suggested anterior horn cell dysfunctio n. In two paralytic and one furious rabies patients who had severe paresthesias as a prodrome, electrophysiologic studies suggested dorsal root ganglionopathy. Postmortem studies in two paralytic and one furious rabies patients, who had local neuropathic pain, showed severe dorsal root ganglionitis. Intense inflammation of the spinal nerve roots was observed more in paralytic rabies patients. Inflammation was mainly noted in the spinal cord segment corresponding to the bite in all cases; however, central chromatolysis of the anterior horn cells could be demonstrated only in furious rabies patient. We conclude that differential sites of neural involvement and possibly different neuropathogenetic mechanisms may explain the clinical diversity in human rabies.
文摘Epilepsy is a common neurological disorder in neurology clinic. Levetiracetam is considered as one of common antiepileptic drugs used to manage epilepsy with good efficacy and tolerability profile. It is renally excreted and not depending on the cytochrome p450. It has adverse effects reported as somnolence, headaches, dizziness, depression and anxiety. Also, it was reported that levetiracetam can cause Acute kidney injury (AKI), renal profile disturbance, that may be related to its way of excretion and possible nephrotoxicity especially with high loading dose. We are reporting a young female patient with epilepsy presented to hospital with status epileptcus and started on loading dose of levetiracetam 3 grams and then maintenance dose of 1 gram twice daily seizure were controlled but she developed acute kidney injury that improved after discontinue leveriracetam and medical management without renal dialysis and discharged home in stable condition. Physician and health care providers should be aware of such rare adverse reaction and available management options for better patient care and outcome.
文摘Background During the COVID-19 pandemic,decreased volumes of stroke admissions and mechanical thrombectomy were reported.The study’s objective was to examine whether subarachnoid haemorrhage(SAH)hospitalisations and ruptured aneurysm coiling interventions demonstrated similar declines.Methods We conducted a cross-sectional,retrospective,observational study across 6 continents,37 countries and 140 comprehensive stroke centres.Patients with the diagnosis of SAH,aneurysmal SAH,ruptured aneurysm coiling interventions and COVID-19 were identified by prospective aneurysm databases or by International Classification of Diseases,10th Revision,codes.The 3-month cumulative volume,monthly volumes for SAH hospitalisations and ruptured aneurysm coiling procedures were compared for the period before(1 year and immediately before)and during the pandemic,defined as 1 March-31 May 2020.The prior 1-year control period(1 March-31 May 2019)was obtained to account for seasonal variation.Findings There was a significant decline in SAH hospitalisations,with 2044 admissions in the 3 months immediately before and 1585 admissions during the pandemic,representing a relative decline of 22.5%(95%CI−24.3%to−20.7%,p<0.0001).Embolisation of ruptured aneurysms declined with 1170-1035 procedures,respectively,representing an 11.5%(95%CI−13.5%to−9.8%,p=0.002)relative drop.Subgroup analysis was noted for aneurysmal SAH hospitalisation decline from 834 to 626 hospitalisations,a 24.9%relative decline(95%CI−28.0%to−22.1%,p<0.0001).A relative increase in ruptured aneurysm coiling was noted in low coiling volume hospitals of 41.1%(95%CI 32.3%to 50.6%,p=0.008)despite a decrease in SAH admissions in this tertile.Interpretation There was a relative decrease in the volume of SAH hospitalisations,aneurysmal SAH hospitalisations and ruptured aneurysm embolisations during the COVID-19 pandemic.These findings in SAH are consistent with a decrease in other emergencies,such as stroke and myocardial infarction.
文摘An 89-year-old woman was admitted with a 3-day history of dysphagia and lower jaw twitching. She had a history of hypertension, diabetes mellitus, surgically corrected left proximal humeral fracture, and right C5 dermatome postherpetic neuralgia. The jaw twitching had caused dysphagia with an inability to drink liquids. Physical examination confirmed the persistent lower jaw myoclonus (Supplementary Video;http://links.lww.com/CM9/A48). The patient was fully conscious and had no twitching or nystagmus in any of her other extremities. The results of neurological examination and biochemical analysis (including complete blood profile, electrolyte level, random glucose concentration, renal function test, and liver function test) were all within the normal range. Computed tomography of the brain was unremarkable and an electroencephalogram showed no evidence of seizure. A careful review of her prescribed medications revealed the following: the patient complained of allodynia over the right C5 dermatome around 3 months prior and was prescribed gabapentin. The dosage of gabapentin was increased to 300 mg total dissolved solids (TDS) around 2 months prior. Creatinine levels were normal but her glomerular filtration rate, as estimated by the Cockcroft-Gault equation, was 36 mL/min.[1] Since the patient’s relatives supervised her medication intake, overdosage was not possible. Gabapentin was discontinued and replaced with pregabalin 50 mg BD and the patient was prescribed valium 2 mg TDS transiently. The jaw myoclonus subsided on the second day. After a consultation with a speech therapist, the patient resumed oral intake and remained tolerant of a normal diet. Upon review after 1 month, the patient remained free from jaw myoclonus.
