Biochemical, biomechanical and imaging biomarkers of ischemic stroke:Time for integrative thinking

Stroke is one of the leading causes of adult disability affecting millions of people worldwide. Post-stroke cognitive and motor impairments diminish quality of life and functional independence. There is an increased risk of having a second stroke and developing secondary conditions with long-term social and economic impacts. With increasing number of stroke incidents, shortage of medical professionals and limited budgets, health services are struggling to provide a care that can break the vicious cycle of stroke. Effective post-stroke recovery hinges on holistic, integrative and personalized care starting from improved diagnosis and treatment in clinics to continuous rehabilitation and support in the community. To improve stroke care pathways, there have been growing efforts in discovering biomarkers that can provide valuable insights into the neural, physiological and biomechanical consequences of stroke and how patients respond to new interventions. In this review paper, we aim to summarize recent biomarker discovery research focusing on three modalities (brain imaging, blood sampling and gait assessments), look at some established and forthcoming biomarkers, and discuss their usefulness and complementarity within the context of comprehensive stroke care. We also emphasize the importance of biomarker guided personalized interventions to enhance stroke treatment and post-stroke recovery.</p

Glomus Jugulare Tumor With Multiple Lower Cranial Nerves Palsy: Case Report

Scientific BACKGROUND: Glomus jugulare tumor is a rare and mostly benign type of paraganglioma localized in or around the jugular foramen. Pulsatile tinnitus, conductive hearing loss and aural fullness are the most common presenting symptoms. Moreover, it may cause significant lower cranial nerve deficits due to mass effect. Glomus jugulare tumors are generally slow-growing, benign lesions, however; their pronounced local aggressiveness frequently results in severe neurological deficits. CASE: A 63 year-old woman presented with VIII, IX, X, XI, XIIth cranial nerves palsy on the left side. Cranial imaging revealed a left-sided glomus jugulare tumor. The patient was considered to be of very high risk due to severe local invasion to surrounding bones and close proximity to vital structures and underwent gamma knife surgery. CONCLUSION: Signs of glomus jugulare tumors are related to tumor localization. These generally appear following a long silent period due to slow growth rate. Surgical option can be limited if the tumor is close to vital structures. Although rare, the diagnosis of glomus jugulare tumor should be kept in mind in cases of slowly developing multiple lower cranial nerves pals