Early Neurological Deterioration After Acute Stroke; Mechanism and Predictors

Neurological deterioration after acute ischemic stroke (AIS)is a common occurrence, leading to increased mortality, morbidity, and poor quality of life among stroke survivors. Recognition of the individuals at a greater risk for neurological deterioration may contribute to making early decisions and monitoring the therapy. Neurological deterioration arises in up to 40% of subjects after AIS during hospitalization and is followed by neurological and functional debility. Numerous predictors have been devised that predict this progression. This includes preliminary assessment of the severity of stroke, brainstem infarction, hyperglycemia, atrial fibrillation, diabetes mellitus and substantial fluctuations in blood pressure. Sequential observations, in depth analysis, and skilled professionals in specific stroke centers are crucial in early recognition, prevention and management of neurological deterioration in AIS patients. Recent advancements in the neurological and vascular imaging have contributed to providing a better understanding of the underlying mechanisms, though several questions remain unanswered. There is an immense need to evaluate the risk of neurological deterioration after AIS. This concise review summarizes the published data and highlights the causes, mechanisms and the risk factors that influence the incidence of neurological deterioration in patients with AIS

Tacrolimus-associated posterior reversible Encephalopathy syndrome in allogenic Hematopoietic stem cell transplant

Tacrolimus is an immunosuppressive drug used to lower the risk of transplant rejection in individuals after solid organ or hematopoietic transplantation. Cases of posterior reversible encephalopathy syndrome (PRES) as a complication of tacrolimus therapy are infrequently documented. The pathogenesis of this phenomenon is not well understood. Here, we report a case of an 18-year-old female with a history of acute myeloid leukemia that developed PRES after undergoing an allogeneic stem cell transplant and subsequent immunosuppressive therapy with tacrolimus

Clinical Presentation of Alzheimer Disease (ad): a hospital based observational study.

Introduction: Alzheimer's disease (AD) is a neurodegenerative illness that mani-fests itself clinically and pathologically.Objective: To identify the various patterns of Alzheimer’s disease (AD) in adults.Methodology: A hospital based observational study was conducted in the Depart-ment of Neurology Jinnah Postgraduate Medical Centre (JPMC) Karachi, Pakistan from May 2018 to November 2019.Cases with complaint of memory impairment and/or cognitive impairment, with or without behavioral changes were included in the study. Acute delirious state uremia / hepatic encephalopathy hypo / hypergly-cemia and hypo / hypernatremia were excluded diagnosis. The main outcome measures were clinical patterns of AD with age and sex distribution, affective disor-der with cognitive impairment (Pseudo dementia) and affective disorder without cognitive impairment.Results: A sample of 51 cases (36 males and 15 females) with memory impairment was included. Age’s between 25-85years (mean 57years). Out of 51 cases 44 had probable /possible Alzheimer’s disease (AD) 03 had affective disorder with cogni-tive impairment (pseudo dementia), 04 patients had affective disorder without cognitive impairment. Among probable / possible cases of AD 23 (52.27%) had multi infarct dementia (having history of past cerebrovascular disease), same sta-tistics among Parkinson’s patient’s i.e. diagnosis was Parkinson’s disease with memory impairment were 18 (40.90%) followed by alcoholic dementia in 03 (6.8%). There was no definite Alzheimer’s disease case in this study.Conclusion: Vascular dementia not the definite Alzheimer’s disease is the com-monest memory impairment type presentation in our study. Among Parkinson’s disease patient’s dementia was found quite high in our study.Keywords: Alzheimer’s disease (AD), Vascular dementia (MID), Parkinson’s disease (PD), Cognition, Memory

Progressive paraplegia due to spinal dural arteriovenous fistula: A rare but treatable diagnosis that should not be missed

Spinal dural arteriovenous fistula (SDAVF) is the most common spinal vascular anomaly. It should always be considered in the differential diagnoses in a patient with progressive paraplegia or quadriplegia. We present a case of an elderly gentleman presenting with progressive paraplegia. The diagnosis was delayed as the previous physicians and radiologists missed the underlying key features of SDAVF on magnetic resonance imaging of the spine. Every neurologist and radiologist should be aware of these signs as SDAVF is mostly a treatable condition

Comparative Study of Cerebral Venous Thrombosis-risk factors, clinical course and outcome in Subjects with and without Covid-19 infection

Background/ Objective: Cerebral venous thrombosis (CVT) has been increasingly reported in patients with COVID-19. Most published literature is descriptive and focuses only on CVT in COVID-19 patients. The objective of our study is to compare CVT patients’ characteristics with and without an associated COVID-19 infection. Materials and Methods: This is a retrospective cross-sectional study. All adult patients with a confirmed diagnosis of CVT admitted to our hospital over a period of 30 months, from January 2019 to June 2021, were included. They were further divided into two groups, with and without COVID-19 infection. Results: A total of 115 CVT patients were included, 93 in non-COVID CVT and 22 in COVID CVT group. COVID-CVT patients were male predominant and of older age, with longer hospital stay, and higher inpatient mortality. COVID CVT patients presented with a higher frequency of headache (82% vs. 63%), seizures (64% vs. 37%, p=0.03), hemiparesis (41% vs. 24%), and visual changes (36% vs. 19%) as compared to non-COVID CVT patients. Venogram showed a higher frequency of superior sagittal sinus (64% vs. 42%) and internal jugular vein (23% vs. 12%) involvement in the COVID CVT cohort. More than 90% of patients in both groups received therapeutic anticoagulation. Mortality rates were higher in COVID CVT group (18% vs. 11%). Conclusion: COVID-CVT patients were male predominant and of older age, with higher hospital stay, and higher inpatient mortality as compared to non-covid CVT patients