Loss of circadian rhythm of blood pressure following acute stroke

BACKGROUND: Epidemiology of acute stroke in developing countries differs from that in the developed world, for example, the age at stroke, risk factors, subtypes of stroke and prognosis. Hypertension remains a dominant risk factor and prognostic indicator in patients with stroke in all communities. The risk of stroke is directly related to elevations of blood pressure. A number of clinical studies have shown that the control of hypertension leads to a reduction in the incidence of stroke in a community. However there is still considerable controversy surrounds the changes in blood pressure in various subtypes of strokes and problem of management of elevated BP after stroke. We studied the circadian rhythm of blood pressure in patients following acute stroke. METHODS: To study the circadian rhythm of blood pressure, fifty consecutive patients with an acute stroke who were admitted to medical emergency within 120 hours of onset were included in the study. After a detailed history and clinical examination, a continuous blood pressure monitor (Spacelab 90207) was attached on the side ipsilateral to intracranial lesion (unaffected arm). The blood pressure was recorded for 24 hours at 15 minutes interval during daytime (6.00 am–6.00 pm) and 20 minutes interval overnight (6 pm to 6 am). RESULTS: Risk factors for stroke in 50 patients included hypertension in 31(62%), diabetes mellitus in 4 (8%), smoking in 13 (26%) and previous history of transient ischemic attack in 7 (14%) patients. Mean systolic pressure and diastolic pressure at admission were higher in patients with hemorrhagic stroke -29 patients (177 ± 24 mmHg and 105 ± 19 mmHg respectively) compared to patients with ischemic strokes-21 patients (150 ± 36 mm Hg and 89 ± 18 mm Hg respectively, p value <0.01 in both comparisons). The normal diurnal variation in blood pressure (night time dipping of more than 10%) was abolished in 44 (88%) of patients. Out of 44 nondippers, 29 patients showed reverse dipping i.e. rise of BP during night time compared to day time levels. None of the risk factors, clinical or laboratory variables, type of stroke or blood pressure changes differed significantly between these two groups. CONCLUSIONS: Therefore, we showed a pathologically reduced or abolished circadian BP variation after stroke. Absence of normal dipping results in a higher 24 hour blood pressure load and may have more target organ damage than those with normal diurnal variation of blood pressure

Surveillance of stroke: WHO STEP-wise approach: A Chennai stroke unit report

Stroke is potentially the most devastating consequence of vascular disease, causing long-term disability and placing high medical, emotional, and financial burdens on the patient. WHO STEPS stroke surveillance study, provided the framework for our study of stroke patients in Chennai. In our center, we followed only the STEP 1 study and only hospital-based stroke data were collected. STEP 2 and 3 involved study of strokes in the community. We found that 78&#x0025; of our patients were in the 6th to 8th decades of life; 72&#x0025; had hypertension, either alone or in combination with other risk factors; 4 weeks after the stroke, 51&#x0025; of our patients were independent with regard to mobility and the activities of daily living, while 14&#x0025; had severe disability. We found a mortality rate of 14&#x0025;. We concluded that the incidence of stroke in the community can be decreased further by effective risk factor modification. The admission delay needs to be shortened from&#62; 48 h to less than 6 h. Our data also gave us fresh information about the recovery of motor function in stroke survivors at 28 days after the stroke

Maple syrup urine disease (branched-chain keto-aciduria) variant type manifesting as hyperkinetic behaviour and mental retardation: report of two cases

Two siblings with a variant type of Maple Syrup Urine Disease have been presented. They had mental retardation with hyperkinetic behaviour and skin and hair changes. They partially resemble the variant of Maple Syrup Urine Disease recently reported by Schulman et al. (1970). The inheritance was compatible with an autosomal recessive mode. The atypical features in our cases have been stressed. It is postulated that a partial deficiency of the enzyme system responsible for the decarboxylation of keto acids and chronic low dietary intake of protein could explain the longevity of our patients. A plea has been made for recognition of milder and variant forms of the disease, probably quite common, by appropriate investigations of mentally deficient children

High incidence of subacute sclerosing panencephalitis in south India.

During 1983-7 a clinical diagnosis of subacute sclerosing panencephalitis (SSPE) was confirmed by the detection of measles virus haemagglutination inhibiting antibody in the cerebrospinal fluid (CSF) in 81 subjects resident in Tamilnadu. The antibody titre (reciprocol of the end-point dilution) in the CSF ranged from 2 to 32 and in the sera from 8 to 2048. The CSF:serum ratios of titres were 1:4-1:64 in 80 cases and 1:128 in one case. The median age at onset of SSPE was 10 years and 97% of cases were diagnosed at stage 2 and beyond. Based on the geographic distribution of 72 cases in an estimated population of 8.4 million, the annual incidence of SSPE was calculated to be 2.14 per million population, or 4.3 cases per million children below 20 years. Assuming that only 10% of all cases would have reached the level of laboratory diagnosis, the incidence may be as high as 21 cases per million population