Early recurrent ischemic stroke complicating intravenous thrombolysis for stroke: incidence and association with atrial fibrillation

<p><b>Background and Purpose:</b> Mechanisms of early neurologic deterioration after treatment with intravenous, recombinant, tissue-type plasminogen activator (IV rt-PA) include symptomatic intracerebral hemorrhage (SICH) and early recurrent ischemic stroke. We observed a number of cases of acute deterioration due to recurrent ischemic events.</p> <p><b>Methods:</b> We undertook a single-center, retrospective analysis of consecutive acute stroke patients treated with IV rt-PA between January 2006 and December 2008 to define the incidence of early neurologic deterioration (>= 4-point drop on the National Institutes of Health Stroke Scale within 72 hours) and its mechanism. Deterioration was attributed to SICH when associated with a PH1 or PH2 hemorrhage on postdeterioration computed tomography scans, to recurrent ischemic stroke when there was clinical and radiologic evidence of a new territorial infarction or new vessel occlusion, and otherwise to evolution of the incident stroke.</p> <p><b>Results:</b> Of 228 consecutive IV rt-PA-treated patients, 34 (15%) developed early neurologic deterioration, 18 (8%) secondary to incident strokes 10 (4.4%) due to SICH, and 6 (2.6%) due to early recurrent ischemic events, which were significantly associated with atrial fibrillation (present in 5 of 6 patients; 4 paroxysmal, 1 permanent). In 4 patients, sudden clinical deterioration developed during or shortly after IV rt-PA infusion, and in 2, deterioration developed 3 days later. All died 2 days to 2 weeks later. The single case without atrial fibrillation had a recurrent, contralateral, middle cerebral artery stroke during IV rt-PA infusion and multiple high-signal emboli detected by transcranial Doppler. Early recurrent ischemic stroke accounted for 5 of 12 (42%) cases of early neurologic deterioration in patients with atrial fibrillation.</p> <p><b>Conclusion:</b> In this single-center series, the incidence of early recurrent ischemic stroke after IV rt-PA was 2.6% and was associated with previous atrial fibrillation.</p&gt

Commitment and Conquest: The Case of British Rule in India

Contemporary historians usually attribute the East India Company's military success in India to its military strength, and to the mutual distrust of Indian regimes. We argue these explanations, though correct, are incomplete. The credibility of the Company's commitments, even though imperfect, was essential to its success.War, Colonialism, India

The mutiny and the merchants

The historiography of the Indian mutiny (1857–8) suggests that livelihood classes responded to the episode differently, but pays more attention to the agricultural classes than the urban commercial ones in studying the response. This article revises the economic history of the rebellion by showing that commercial interests were influenced by concerns over security of property, and that they, as much as landed interests, shaped the course of the rebellion

Custom, landownership and women: a colonial legislation in North India

"Our point of departure is the legislative impact on a localized agrarian structure within defined geographical limits and a delimited time-span. With special focus on the Awadh Taluqdari Succession Act of 1869, the paper is concerned with the sociological analysis of court and archival data drawn from the Faizabad district covering the period from 1869-1920s. In subjecting the historical and empirical evidence to closer scrutiny, we propose to highlight both the intended and unintended consequences of the legislation particularly for women. The article draws on rich empirical evidence from ruling families on matters relating to descent and clan membership, affinal links and kinship ties to explore whether or not the Act represented a complete rupture and the extent of which it was a modification of existing tendencies. To what extent was the flexibility of traditions and customs eroded and what were the strains' created in the process? In this sense the article explores the continuities and breaks with the past.

Between Qasbas and Cities: Language Shifts and Literary Continuities in North India in the Long Eighteenth Century

The cultural memory of Awadh is almost exclusively identified with Urdu poetry and courtesan culture, and already in the colonial period it came to stand as the epitome of the “last phase of Oriental culture” (‘Abdul Halim Sharar). But if instead of taking a retrospective, nostalgic view we approach literary culture in Awadh prospectively and multilingually and broaden our lens to consider not just the capitals, Faizabad and Lucknow, but also the qasbas (small towns), the small rural courts, the nearby growing city of Banaras, and the colonial capital of Calcutta, a different set of literary dynamics and shifts comes into view. The prevalent image of Awadh as identified with Urdu and Lucknow is not wrong, of course, but it does obscure the other stories, trajectories, and languages. This essay considers some of them. A multilingual and prospective approach helps us consider the circulation of literary tastes across the colonial divide and recognize the production of forgetfulness and ignorance that accompanied modern narratives of languages and literary histories, both colonial and Indian, and that made a host of texts “homeless” (Mohamad Tavakoli-Targhi)