Search

Introduction: Stroke is a leading cause of economic burden in the Low Middle Income countries (LMIC’s). We want to study the outcome of acute strokes treated under Government scheme with minimal package (For Ischemic Stroke - 257 USD & For hemorrhagic stroke - 399 USD), but offered evidence-based stroke care other than thrombolysis. Methods: From January 2021 to March 2021, a total of 350 cases were treated in our Ankineedu stroke center. Out of these 125 (36%) acute stroke patients are treated under subsidized economical stroke care from admission to discharge. In-patient mortality, 3 months follow up and 1 year follow up recorded. All patients received standard medical treatment in Stroke unit with Antiplatelets, statins, DVT prophylaxis, Antihypertensives, dysphagia assessment, physiotherapy and Neurosurgery when required. All basic stroke investigations done - CT scan, MRI scan, MR Angio, Neck vessel doppler, Lipids, Renal Function test, RBS, ECG and ECHO. All patients discharged on secondary prevention. Average length of stay is 10 days. Results: There were 94 men and 31 women, age ranged from 18 years to 85 years (median 55 yrs). Type of stroke: Ischemic Stroke -74% and Haemorrhagic stroke - 26%, 4 patients (3.2%) underwent Neurosurgery. Risk factors: Hypertension - 82 (66%), Diabetes - 45 (36%), Cardiac problems - 17 (13.6%), Smoking - 20 (16%), Alcohol - 15 (12%). Total In-house mortality 5 (4%) and the remaining patients outcome at 3 months - Good outcome with modified rankin scale (mRS) 0-2 in 83 patients (66%), Fair Outcome with mRS (3-4) - 35 (28%), 1 patient (0.8%) bedridden and 1 patient (0.8%) died at home. Out of 125 patients, 60 patients (48%) came for 1 year follow up, of these 88% had mRS (0-2), 12% had mRS (3-5). Conclusion: In resource poor countries we can offer basic stroke care model to all needy patients with reasonable outcome. However, the follow up needs to be strengthened.

Strokes of the undetermined cause or cryptogenic strokes (CS) account for 30-40% of ischemic strokes. Paradoxical embolism secondary to patent foramen ovale (PFO) may be associated with CS. Transcranial Doppler (TCD) with bubble contrast is a noninvasive bedside tool for diagnosis of right-to-left shunt (RLS) with high sensitivity and specificity. Data on the prevalence of PFO in CS in India are lacking. We determined the prevalence of RLS likely secondary to PFO in cryptogenic young strokes of the north Indian population using TCD with bubble contrast.: In this hospital-based prospective cross-sectional study, TCD with bubble contrast was performed in 57 young (age 1545 years) CS and 50 healthy controls for the detection of RLS. The risk of paradoxical embolism (RoPE) score was calculated from various variables such as age, presence of cortical stroke on neuroimaging, and absence of vascular risk factors.: 57 young CS and 50 healthy controls were recruited. TCD with bubble contrast was positive in 31% cases vs 6% in controls (P = 0.001). All patients with TCD positive for RLS had superficial cortical infarcts (P = 0.03). The median RoPE score of our patients was 9 (range: 7-10).: There is a high prevalence of RLS likely secondary to PFO in cryptogenic young strokes in north India. TCD with bubble contrast is an excellent bedside tool for the detection of RLS.

Neurolymphomatosis, defined as invasion of cranial nerves and peripheral nerve roots, plexus or nerves by Non Hodgkin's Lymphoma is a very rare clinical entity. We describe a case of 69 years old gentleman, who presented to us with asymmetric, painful sensorimotor polyneuropathy. He was admitted with 2 months history of dry cough, constitutional symptoms, paraesthesias on right side of face along with painful asymmetrical quadriparesis. Nerve conduction studies were sugges- tive of asymmetrical sensorimotor axonal and demyelinating neuropathy. Cerebrospinal fluid ana- lysis revealed mild pleocytosis with raised protein. FDG-PET showed intense uptake in both adre- nals, abdominal lymph nodes, sacral nerve roots and brachial plexus. Fine needle aspiration cyto- logy of adrenal mass revealed evidence of diffuse large B cell Non Hodgkin's Lymphoma. As patient succumbed to illness, an autopsy was done, which revealed diffuse large B cell lymphoma involv- ing adrenals, brachial and lumbosacral plexuses. Our report provides important insights into a rare cause of painful demyelinating multiple mononeuropathy and emphasises on increasing role and diagnostic utility of PET imaging in evaluation of patients presenting with multiple mononeu- ropathy, especially with regards to paraneoplastic or neoplastic causes such as lymphoma. * Corresponding author.

Background Leptospirosis involves nervous system in around 10-15% of the cases, the commonest presentation being aseptic meningitis. Most of the clinical features of neuroleptospirosis are due to capillary endothelial damage and vasculitis. Ataxia is an extremely uncommon manifestation of Leptospirosis occuring in 1:800) . She was treated with intravenous ceftriaxone for 14 days following which she showed marked recovery. Conclusion The clinical features of neuroleptospirosis are varied, most of them resulting from endothelial damage and vasculitis. Immune mediated phenomenon with no structural damage is another possible mechanism leading to cerebellar ataxia. Cerebellar ataxia due to common tropical infections should be ruled out in the appropriate setting, as early institution of treatment can abate neurological morbidity. The case report highlights the importance of identifying a reversible cause of cerebellar ataixa due to a tropical infection, possibly due to a immune mediated phenomenon, and would be of interest to both internists and neurologists.

Background Unilateral isolated abducens palsy can occur due to any lesion from pons to orbit. The precise localization is made through the associated neurological signs. Parkinson syndrome is a symptom complex of unilateral abducens palsy with ipsilateral postganglionic Horner syndrome localizing the lesion to posterior cavernous sinus. Results We describe here a 55 year old lady who presented with headache and diplopia for 3 months. On examination she had right lateral rectus palsy and postganglionic Horner syndrome. No other neurological deficit was present. MRI brain and MRA of intracranial vessels showed aneurysm of the right cavernous internal carotid artery which was confirmed on cerebral angiography. Endovascular coiling was advised but refused by the patient and she was treated symptomatically Conclusions Parkinson syndrome gives precise localization to unilateral abducens palsy and hence is a valuable clinical pearl.