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There is growing evidence in support of ischemic stroke as a manifestation of COVID-19 infection. However, hemorrhagic transformation of ischemic stroke is rare. We present two cases of hemorrhagic infarction as presenting features in COVID-19 patients who did not have traditional cardiovascular risk factors for ischemic or hemorrhagic stroke. While the hemorrhagic infarct was from a large artery in one of the patients, the other patient had a small artery related hemorrhagic infarct. We highlighted the possible underlining mechanisms from the literature and the implication of hemorrhagic infarct for routine anticoagulant therapy in patients with COVID −19 related ischemic stroke.

Objectives In this study, we presented neuroradiologic findings and diagnoses of neurologic complications in a series of heart transplant recipients. Materials and methods A retrospective review was conducted at Baskent University Hospital. We searched the hospital and radiology databases and identified 109 heart transplant recipients. Thirty-one of these recipients had neuroradiologic evaluations secondary to presentation of neurologic symptoms after heart transplant, with 18 patients evaluated with computed tomography and 22 patients evaluated with magnetic resonance imaging (overlap of imaging-defined groups occurred in 9 recipients). Computed tomography and magnetic resonance imaging studies were retrieved from the Picture Archiving and Communication System, with each type of imaging retrospectively evaluated on consensus by 2 radiologists. Results Radiopathologic findings related to symptoms were detected in 12 of the 31 study patients. The most common abnormality was posterior reversible leukoencephalopathy syndrome (5 patients, 4.6%). The other abnormalities were ischemic stroke (3 patients, 2.8%), hemorrhagic stroke (1 patient, 0.9%), intracranial abscess (2 patients, 1.8%), and intracranial dissemination of sinusoidal fungal infection and related hemorrhagic infarct (1 patient, 0.9%). The other 19 heart transplant recipients who underwent computed tomography and/or magnetic resonance imaging for neurologic complaints showed no neuroradiologic findings related to neurologic symptoms. Conclusions Posterior reversible leukoencephalopathy syndrome and ischemic stroke were the most common neurologic complications in our heart transplant recipients. The other complications were hemorrhagic stroke, intracranial abscess, and intracranial dissemination of sinusoidal fungal infection. Neurologic complications are common in heart transplant recipients and should be identified promptly for early treatment. For the recognition of these complications, computed tomography should be performed for initial evaluation to rule out edema or hemorrhage. However, in the presence of serious neurologic symptoms that cannot be explained by computed tomography, magnetic resonance imaging should be indicated.

We report a case of a 12-year-old boy with an accessory spleen torsion. He presented with left-sided abdominal pain after trauma. A 4 cm oval mass without contrast enhancement was detected on contrast-enhanced computed tomography (CT), and ultrasound (US) showed a 4 cm oval mass below the spleen. The mass mainly consisted of high echoes similar to the spleen; the central part showed irregularly low echoes. Subsequent follow-up daily US examinations showed gradual expansion of the central low echoes with conspicuous hyperechoic dots. Discontinuation of the branch from the splenic artery to the mass was observed, both, on US and CT. These findings led to the diagnosis of a hemorrhagic infarct caused by torsion of the accessory spleen. Laparoscopy showed adherence of the accessory spleen to the omentum and colon by twisting four times around its axis. It was resected and confirmed the diagnosis of a torsioned accessory spleen.

Objectives The aim of the study is to assess the role of ultrafast (UF) magnetic resonance (MR) sequences in stroke imaging. Material and Methods We prospectively studied 85 patients having clinical suspicion of stroke referred for MR imaging (MRI) during August 2016 to July 2018. These patients were subjected to both conventional and UF MRI sequences. The patients were divided into six categories based on the pathologies encountered. Further subclassification was done based on the size of the lesions as ≤10 mm and >10 mm as seen separately in both UF and conventional MR sequences. The number and visibility of these lesions on conventional and UF MRI were compared. The image quality of all the subjects was also compared based on a scale categorized into excellent, satisfactory, and poor. The findings on conventional and UF imaging sequences were correlated with the final clinical diagnosis arrived at the time of discharge. Results In our study comprising 85 patients, 57 showed pathologies. The patients showing pathologies were assigned into the six categories as acute infarct (34 cases), acute hemorrhagic infarct (six cases), chronic infarct (17 cases), chronic hemorrhagic infarct (four cases), subacute infarct (three cases), and chronic hemorrhage (one case). The number of lesions seen on conventional and UF sequences were the same although there was a slight decrease in the size of the lesions on UF sequences as compared with conventional counterparts. The image quality using UF sequences was better in motion prone patients while conventional imaging showed better image quality in cooperative patients. Conclusion In motion prone patients, UF sequences are a suitable alternative for conventional sequences as they help in arriving at the diagnosis in lesser time, with reasonably good image quality, and without motion artifacts. In cooperative stroke patients, it is better to use conventional MR sequences as the image quality is better.

Background: Hemorrhagic transformation (HT) is a frequent complication of acute ischemic stroke (AIS). Mean platelet volume (MPV) is a marker of platelet function. The relationship between MPV and HT remains unclear. Methods: From January 1st, 2012 to December 31st 2016, we consecutively enrolled AIS patients admitted to the Department of Neurology of West China Hospital. MPV was measured on admission. HT was diagnosed by brain imaging and classified into hemorrhagic infarct (HI) and parenchymal hematoma (PH). Moreover, subjects were divided into tertiles according to MPV levels. Confounders were identified by univariate analysis and multivariate logistic regression was performed to explore the association between MPV and HT as well as HT subtypes. Also, a generalized additive model was used to investigate whether a non-linear association existed between MPV and HT. Results: A total of 783 AIS patients were included. 63 patients (8.0%) developed HT: 34 (4.3%) HI and 29 (3.7%) PH. It was observed that MPV positively correlated with HT. After adjustment for confounders, patients in the highest MPV tertile had a significantly increased risk of HT compared to patients in the lowest tertile (odds ratio 2.3, 95% confidence interval 1.0-5.4, P=0.04). The risk of HT increased step-wise across MPV tertiles (P for trend=0.04). MPV tertiles significantly correlated with HI rather than PH. The generalized additive model demonstrated a nonlinear association between MPV and HT (P=0.02). Conclusion: The risk of HT increased with increasing MPV level in a dose-dependent manner. Patients with elevated MPV levels were more likely to develop HI rather than PH.

Purpose We conducted a meta-analysis to determine the predictors of early-onset seizure in patients with cerebral venous sinus thrombosis (CVST) and to provide a basis for further clinical trials of prophylactic use of antiepileptic drugs in patients with CVST. Method The meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Relevant observational studies that investigated risk factors for early-onset seizures after CVST were retrieved from Pubmed and Embase databases. Odds ratios (OR) for early-onset seizures were calculated from the pooled data using the random effects model. Results Six observational studies (combined n = 1244) were included in this meta-analysis. Coma [OR, 2.265; 95% confidence interval (CI) 1.251–4.100], mental status (OR, 3.450; 95% CI 1.150–10.356), motor symptoms (OR, 3.726; 95% CI 2.519–5.514), involvement of cortical veins (OR, 3.574; 95% CI 2.521–5.068), supratentorial lesion (OR, 5.041; 95% CI 3.622–7.015), frontal lobe (OR, 3.481; 95% CI 1.703–7.114), parietal lobe (OR, 3.638; 95% CI 1.911–6.925), hemorrhagic lesions (OR, 2.505; 95% CI 1.485–4.225), and pregnancy (OR, 2.054; 95% CI 1.043–4.048) showed a significant association with early-onset seizures. Conclusion Involvement of a numer of specific cortical regions in the post-CVST phase may induce early-onset seizures, especially in the setting of concomitant hemorrhagic infarct or cortical vein involvement.

Cerebral venous sinus thrombosis (CVST) is an uncommon type of venous thromboembolism whose diagnosis is often difficult due to its vague and non-specific clinical findings. Sometimes, the diagnosis is delayed as the symptoms were considered to be attributable to the underlying etiology, especially in patients with brain tumors such as high-grade glioma (HGG). We described the case of a 60-year-old male patient who presented with headache, generalized seizures, and right hemiparesis soon after receiving brain radiation and temozolomide therapy for HGG of the left thalamus. Initially, his symptoms were considered to be due to his underlying tumor but the subsequent imaging revealed left transverse, left sigmoid, and superior sagittal sinus thrombosis with venous hemorrhagic infarct of the left occipitoparietal lobe. The patient was started on anticoagulant therapy and symptoms resolved completely within a month. Clinicians should always consider CVST in the differential diagnosis of non-specific neurological symptoms, especially in patients with underlying brain tumors.

Leiomyoma is a common benign tumor in women of reproductive age. Increasing the number of pregnancy has a significant role in reducing the risk of tumor development. Red degeneration is a rare complication and often occurs during pregnancy. However, its incidence in non-pregnant women is tremendously rare. Herein, we present a case of 51-year-old non-pregnant women with a history of 17 pregnancies, diagnosed with leiomyoma that underwent red degeneration.

Efficacy and safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) due to intracranial artery dissection (IAD) are currently not established. We aimed to present a single-center experience on IAD-related AIS treated by IVT. We selected all consecutive patients with IAD-related AIS treated by IVT from a prospectively constructed single-center acute stroke registry from 2003 to 2017. We reviewed demographical, clinical and neuroimaging data and recorded hemorrhagic complications, mortality within 7 days and modified Rankin Scale at 3-months. Out of 181 AISs related to cervicocephalic dissections, 10 (5.5%) were due to IAD and five of these patients received IVT. Among these five patients, median age was 62 years; hypertension and dyslipidemia were the most frequent vascular risk factors. IAD locations were distal internal carotid artery, middle cerebral artery (M1), anterior cerebral artery (A2), and, in two cases, the basilar artery. All anterior circulation IADs were occlusive or subocclusive, while the two basilar artery IADs caused arterial stenosis. After IVT, there were no subarachnoid or symptomatic intracranial hemorrhages. One patient had an asymptomatic hemorrhagic infarct type 1. Two patients died within 7 days from ischemic mass effect. The other three patients had favorable clinical outcomes at 3-months. In this small single-center case series of IAD-related AIS, thrombolysis seemed relatively safe. However, IVT efficacy and the likelihood of arterial recanalization are still uncertain in this context. Further studies are needed to assess the safety and efficacy of IVT in these patients.

Pregnancy and puerperium are risk factors for cerebral venous sinus thrombosis (CVST), a condition which nowadays is treated non-operatively. Decompressive craniectomy is reserved only for emergency settings. We present a 22-year-old pregnant lady, who was transferred at the emergency department with a reduced level of consciousness, headache, and nuchal rigidity. Her MRI study showed CVST, causing hemorrhagic infarct and midline shift. She underwent decompressive craniectomy with partial removal of the hemorrhagic parenchyma. Remarkably, she recovered without any neurological deficits regardless of the substantial temporal lobe damage, while the thrombus nearly resolved using anticoagulation. Decompressive craniectomy can be life-saving in selected CVST patients, followed by anticoagulantion to augment the recanalization process.

Background: Hemorrhagic transformation (HT) is a frequent complication of acute ischemic stroke (AIS). Red blood cell distribution width (RDW) is a cost-effective parameter associated with incidence and prognosis of cerebrovascular diseases. The purpose of this study was to assess whether RDW is associated with HT in AIS patients. Methods: AIS patients within 24 h from stroke onset between January 1, 2014, and December 31, 2018, were consecutively enrolled. Blood samples were collected. The primary outcome was HT, which was diagnosed by follow-up brain image and classified into hemorrhagic infarct (HI) and parenchymal hematoma (PH). Multivariate logistic regression analysis was performed to determine the relationship between RDW and HT as well as its subtypes. Potential effect modifier was identified by stratified logistic regression analysis. Results: Among the included 1383 patients, 220 (15.9%) developed HT (HI in 103 and PH in 117). Elevated RDW levels were associated with an increased risk of HT when 2 extreme tertiles were compared (OR 1.60, 95% CI 1.04–2.44, p = 0.031). The risk of HT increased stepwise across RDW tertiles (p for trend = 0.042). RDW significantly correlated with HI rather than PH. The association between RDW and HT could be modified by reperfusion therapy (p for interaction = 0.010), with no significant association between RDW and HT among patients underwent reperfusion therapy. Conclusions: Elevated RDW level was related to increased risk of HT among AIS patients without reperfusion therapy.

BackgroundMobile stroke units (MSUs) performance dependability and diagnostic yield of 16-slice, ultra-fast CT with auto-injection angiography (CTA) of the aortic arch/neck/circle of Willis has not been previously reported.MethodsWe performed a prospective observational study of the first-of-its kind MSU equipped with high resolution, 16-slice CT with multiphasic CTA. Field CT/CTA was performed on all suspected stroke patients regardless of symptom severity or resolution. Performance dependability, efficiency and diagnostic yield over 365 days was quantified.Results1031 MSU emergency activations occurred; of these, 629 (61%) were disregarded with unrelated diagnoses, and 402 patients transported: 245 (61%) ischemic or hemorrhagic stroke, 17 (4%) transient ischemic attack, 140 (35%) other neurologic emergencies. Total time from non-contrast CT/CTA start to images ready for viewing was 4.0 (IQR 3.5–4.5) min. Hemorrhagic stroke totaled 24 (10%): aneurysmal subarachnoid hemorrhage 3, hemorrhagic infarct 1, and 20 intraparenchymal hemorrhages (median intracerebral hemorrhage score was 2 (IQR 1–3), 4 (20%) spot sign positive). In 221 patients with ischemic stroke, 73 (33%) received alteplase with 31.5% treated within 60 min of onset. CTA revealed large vessel occlusion in 66 patients (30%) of which 9 (14%) were extracranial; 27 (41%) underwent thrombectomy with onset to puncture time averaging 141±90 min (median 112 (IQR 90–139) min) with full emergency department (ED) bypass. No imaging needed to be repeated for image quality; all patients were triaged correctly with no inter-hospital transfer required.ConclusionsMSU use of advanced imaging including multiphasic head/neck CTA is feasible, offers high LVO yield and enables full ED bypass.

We present an unprecedented case of torsion of a large ovarian cyst following colonoscopy. A 43-year-old female was found to have a 20 × 13 × 19 cm pelviabdominal mass possibly arising from the right ovary. Endoscopic evaluation was performed prior to planned resection of the ovarian mass. The patient experienced progressive lower abdominal pain after the procedure with a computed topography finding of torsion. She underwent exploratory laparotomy, right salpingo-oophorectomy with intra-operative frozen section and omentectomy. Final histology revealed features of benign serous cystadenoma with extensive haemorrhagic infarction in keeping with torsion. To our knowledge, this is the first reported case of torsion of a large ovarian cyst after colonoscopy. We propose a postulated mechanism of this patient’s ovarian torsion and urge clinicians to be cognizant of acute ovarian torsion as a cause of severe abdominal pain following endoscopy.

Introduction Recently, weeks after the COVID-19 prevalence, there were reports of brain involvement and neurologic presentations in the COVID-19. Case presentation We present five cases of COVID-19 and cerebrovascular events. A 34-year-old woman with IVH and ischemic stroke. A 60-year-old man with multiple small hemorrhagic foci and mild IVH in the occipital horn. A 63-year-old woman with large left parietooccipital intracerebral hemorrhage (ICH) and IVH. A 56-year-old man with left hemispheric and midbrain ICH, lateral ventricular IVH, and hydrocephalus. A 85-year-old woman with right parietal hemorrhagic infarct. The coagulation profile was normal in all of them. The chest CT scan showed the typical ground-glass appearance of COVID-19. Conclusions Recently, there were reports of brain involvement and neurologic presentations in the COVID-19. These reports and the present study necessitate the aimed and designed studies with emphasis on neurologic presentations in COVID-19 patients to illustrate the exact effects of coronavirus-2 on the central nervous system.

Background Isolated fallopian tube torsion associated with hydrosalpinx is a rare condition in the pediatric population. We present this unusual clinical case study in a sexually inactive girl. Case presentation a12-year-old Caucasian girl presented symptoms of acute abdominal pain. Pelvic ultrasound revealed a normal looking uterus and ovaries and next to left ovary a imaging compatible with hydrosalpinx. She was discharged 48 hours later after clinical monitoring with oral analgesia and normal blood workup. At 3 weeks, she was readmitted for acute abdominal pain. Leukocytosis with left shift and raised C-reactive protein were observed. Her clinical condition worsened, and complication of the preexisting hydrosalpinx was suspected. Exploratory laparoscopy confirmed torsion of the fallopian tube. Left salpingectomy was performed. Histopathologic study confirmed a fallopian tube with hemorrhagic infarct. Conclusion Torsion of the fallopian tube must be considered in the event of acute abdominal pain. Early diagnosis and trying conservative management with a view to preserving fertility in this group of patients are essential.

Posterior reversible encephalopathy syndrome (PRES) is one of the most common neurologic complications following hematopoietic stem cell transplantation (HSCT). We aimed to evaluate the incidence, clinical, and imaging features of PRES in pediatric patients with Fanconi anemia (FA) following HSCT. This prospective study included all post-HSCT patients with underlying FA disease between 2014 and 2017. Brain computed tomography scan and magnetic resonance imaging (MRI) were performed in all individuals who developed neurologic symptoms. PRES was diagnosed based on clinic-radiological evidence. Follow-up MRI was performed in all patients with PRES within two months. Forty-one patients with FA (28 males; mean age, 8.19 ± 3.25 years) were enrolled. Out of 15 patients with acute neurologic symptoms, PRES was diagnosed in 9 individuals (21.95% of the total cohort). The occurrence of PRES was significantly higher in patients who had a donor with a 1-locus mismatch (P= .02). Donor relation, stem cell source, and graft-versus-host disease grade did not have any significant association with the development of PRES. MRI showed asymmetric vasogenic edema in 5 patients, an overt infarct in 1 patient, and foci of microhemorrhages in 3 patients, 1 of whom developed a hemorrhagic infarct. This patient died shortly, and persistent microhemorrhages were noted in the other 2 patients. Our findings demonstrate a greater risk of developing PRES after HSCT in patients with FA compared with those with other diseases (21.95% versus 1% to 10%), and in contrast to its term, it might be irreversible and has adverse effects on HSCT outcomes. The increased vascular and endothelial fragility in FA may contribute to the higher frequency of PRES in these individuals.

Background A prospective, observational study was done at a tertiary care hospital in Western Maharashtra to describe the etiologies, clinical features, diagnosis and prognosis of cerebral venous sinus thrombosis in an Indian population. Methods 54 patients with clinical and MRI features suggestive of cerebral venous sinus thrombosis (CVST), were studied with detailed clinical evaluation and pro-thrombotic work up. All were followed up monthly for 6 months, to assess the response to therapy and clinical outcomes. Results The mean age of presentation was 35 years. Headache was the most common presenting symptom (94%) and hemi paresis (22%) was the most common neurological sign. The most common sinus involved was transverse sinus in 77% of cases. In the unprovoked CVST subset (n = 29), elevated factor VIII (72%) and protein C deficiency (24%) were the common prothrombotic states identified. In the provoked CVST subset (n = 18), puerperium (44%) and para-infectious (22%) accounted for majority cases. Idiopathic CVST accounted for 13% (7/54) in this study. A Modified Rankin Scale (MRS) of 0–1 was achieved in 96% of patients at the end of 6 months follow up with no mortality in this study. Conclusion CVST is an important yet under recognized cause of intracranial hypertension and stroke in young. Clinical presentation is extremely varied and a high index of suspicion is needed. Magnetic Resonance Imaging (MRI) brain with Magnetic Resonance Venography (MRV) is the current diagnostic modality of choice. Elevated factor VIII and puerperium are the common etiologies in an Indian population. Management with anticoagulants is safe and has excellent clinical outcomes.

Objective: Posttraumatic pituitary apoplexy (PPA) is a rare entity, especially in hormonally active pituitary adenomas. There are no case reports of PPA-like initial manifestations of prolactinoma.Methods: We present a case report of PPA in a 46-year-old patient with unknown macroprolactinoma. Likewise, we present a literature review of PPA.Results: Patient was admitted to the emergency room due to traumatic brain injury, with altered state of consciousness. Physical examination revealed hypotension, tachycardia, bilateral periorbital ecchymosis, left ptosis, mydriasis, and abnormal reflexes by cranial nerves II, III, IV, VI, and VIII. Non-contrasted computed tomography was performed on the patient's head, revealing only an incidental sellar lesion with hemorrhagic infarct. Supportive measures to ensure hemodynamic stability and hydrocortisone replacement were initiated. There was evidence of hypocortisolism, central hypothyroidism, hypogonadotropic hypogonadism, and hyperprolactinemia evidenced by a prolactin level of 6,213 ng/dL. Levothyroxine replacement was established after corticosteroid medication. Cranial magnetic resonance imaging revealed a sellar lesion of 21 × 42 × 52 mm, with hemorrhagic infarction. We diagnosed PPA in a macroprolactinoma, however it was not possible perform neurosurgery so cabergoline treatment (1.5 mg/week) was initiated. Patient had a successfully clinical evolution; only decreased visual acuity of the left eye resulted as a sequela (visual acuity 20/400). At follow-up, adequate hypopituitarism replacement, normogonadism, normalization of prolactin, and shrinking of the tumor were observed.Conclusion: This is the first case report of a patient with PPA concurrent with a prolactinoma. PPA can result in a life-threatening event that requires prompt resuscitation and corticosteroid replacement. Surgical intervention should be considered in patients with severely reduced visual acuity, severe and persistent visual field defects, and deteriorating level of consciousness.Abbreviations: CN cranial nerve; PA pituitary apoplexy; PPA posttraumatic pituitary apoplexy

Dengue virus, a RNA virus of family Flaviviradae is considered non-neurotropic. Increasing studies and case reports reveal neurological manifestations of dengue virus. In our case series, we have evaluated magnetic resonance imaging (MRI) findings of 3 patients with dengue fever diagnosed by positive dengue NS1 antigen with neurological symptoms, which revealed nonspecific imaging features of dengue encephalitis in two cases and dengue meningoencephalitis in one case. Autopsy findings are also correlated in 2 patients who succumbed to their disease. This case series underlines the consideration of dengue encephalitis in patients of dengue fever with neurological symptoms and relevant imaging findings.

BACKGROUND AND PURPOSE: Although most cervical dissections are managed medically, emergent endovascular treatment may become necessary in the presence of intracranial large-vessel occlusions, flow-limiting and long-segment dissections with impending occlusion, and/or hypoperfusion-related ischemia at risk of infarction. We investigated the role of emergent endovascular stenting of long-segment carotid dissections in the acute ischemic stroke setting. MATERIALS AND METHODS: We retrospectively studied long-segment carotid dissections requiring stent reconstruction with multiple tandem stents (≥3 stents) and presenting with acute (70% flow limiting stenosis and involved the distal cervical ICA with a minimum length of 3.5 cm. Carotid stent reconstruction was successful in all patients with no residual stenosis or flow limitation. Nine patients (60%) harbored intracranial occlusions, and 6 patients (40%) required intra-arterial thrombolysis/thrombectomy, achieving 100% TICI 2b–3 reperfusion. Two procedural complications were limited to thromboembolic infarcts from in-stent thrombus and asymptomatic hemorrhagic infarct transformation (7% morbidity, 0% mortality). Angiographic and ultrasound follow-up confirmed normal carotid caliber and stent patency, with 2 cases of

A 51-year-old woman with history of hypertension presented with left-sided weakness and diplopia. Imaging revealed a large hemorrhagic infarct involving the right thalamus and rostral midbrain with intraventricular extension (figure). Neuro-ophthalmic examination demonstrated bilateral upgaze palsy with limitation of infraduction on the right (video 1), overcome with a doll's head maneuver (video 2). Bilateral lid retraction was present with markedly reduced convergence along with convergence-retraction nystagmus. Vertical one-and-a half syndrome is an uncommon presentation resulting from a unilateral thalamomesencephalic stroke with involvement of the rostral interstitial nucleus of the medial longitudinal fasciculus and posterior commissure1 and was accompanied here by dorsal midbrain syndrome.

Stroke is defined as the rapid onset of focal neurological deficit resulting from diseases of the cerebral vasculature and its contents. Stroke represents the third most common cause of death in developed nations. The prevalence of stroke in India is approximately 200 per 100,000 persons and 9.94% of total deaths.The present article deals with a diagnosed case of hemorrhagic stroke presenting with left sided hemiplegia with right Middle cerebral artery hemorrhagic infarct. The Ayurvedic diagnosis of Vama pakshaghata was made and managed with Parisheka (Pouring of medicated liquids), Shiropichu (Applying oil to vertex using cotton pad), Pradhamananasya (Administration of powdered medicine through nasal route), Shastika Shali Masha Pinda Sweda (Full body massage with bolus prepared by rice and black gram ) and Matrabasti (Administration of medicated ghee through rectum). Two assessments were made before and after treatment using the National Institute of Health Stroke Scale (NIH-SS) and Stroke Specific Quality of Life Scale (SS-QOL). Maximum improvement was noticed in the symptoms of facialpalsy, aphasia and dysarthria. There were also improvement in left lower and upper extremity functions. At the end of the treatment he could walk without support. Assessment using SS-QOL showed considerable recovery in language ability, mobility, energy, mood, self-care and vision. Panchakarma plays a key role in the management of stroke/Pakshaghata. The recovery was promising and worth documenting.

Background: Cerebral venous thrombosis (CVT) is an uncommon and sometimes critical disease, especially in untreated patients. CVT is an elusive diagnosis because of its nonspecific presentation and its numerous predisposing causes. Accurate diagnosis is difficult but important because effective therapies, including anticoagulants and intrasinus thrombolysis are available. Patients with cerebral venous thrombosis often make dramatic recoveries after anticoagulation. For this reason, accurate diagnosis is important and critical. The aim was to study the extent of venous sinus involvement and associated cerebral parenchymal changes on magnetic resonance venogram (MRV); to study the pattern of diffusion weighted images and ADC (apparent diffusion coefficient) mapping in patients with cerebral venous thrombosis; to study the role of susceptibility weighted images in patients with cerebral venous thrombosis. Methods: Study was conducted on 34 patients diagnosed to have cerebral venous thrombosis on imaging. Results: Imaging analyses of 34 patients (19 females, 15 males, and age range 19-75 years) were done. Thrombus on MRV was seen as loss of high flow signal from the sinus in cases of complete occlusion of the sinus and frayed or patchy flow signal in the cases of non-occlusive thrombus. 16 patients with hemorrhagic infarct showed heterogeneous signal intensity on DWI (diffusion weighted imaging) and blooming on SWI (suseptibility weighted imaging) sequence. 13 patients with non-hemorrhagic infarct showed multifocal high signal intensities in DWI with variable ADC values and no blooming on SWI. 5 patients with intracerebral hematoma showed areas of heterogeneous signals on DWI with blooming on SWI, corresponding ADC values were variable. Conclusions: MRV, diffusion and susceptibility weighted imaging can be used to evaluate the extent of thrombus, discriminate between different types of edema, detect intracerebral hematoma, hemorrhagic and non-hemorrhagic infarcts, and deliver time-saving information for early diagnosis of CVT.

Sagittal venous thrombosis (SVT) is most commonly seen in hypercoagulable conditions, whereas infection-related thrombosis is very rare. Infections due to viruses, fungi, and bacteria can cause SVT. Disseminated tuberculosis (TB) causing SVT is rarely reported. Here, we report the case of a 38-year-old male who presented with the complaints of numbness and weakness to the right side of the body, cough with mucopurulent expectoration, and breathlessness. The patient was examined, which showed signs of cerebral inflammation and right-sided hemiparesis. Respiratory examination was suggestive of pulmonary TB. Chest X-ray was done which was suggestive of bilateral nodular opacities, and sputum Cartridge based nucleic acid amplification test (CBNAAT) was positive for Mycobacterium TB. Cerebrospinal fluid analysis was suggestive of tubercular meningitis. Magnetic resonance imaging brain was also done which revealed sagittal sinus thrombosis and bilateral frontoparietal cortical vein thrombosis and associated hemorrhagic infarct in the left parietal lobe. The patient was treated with antitubercular drugs along with anticoagulants.

The chapter describes the epidemiology of cerebrovascular diseases, anatomy of the cerebral blood vessels, pathophysiology of ischemia, hypoxia, hypoxemia, anemic hypoxia, histotoxic hypoxia, carbon monoxide damage, hyperoxid brain damage and decompression sickness, and selective cell and regional vulnerability; diseases of the blood vessels including atherosclerosis, hypertensive angiopathy, small vessel disease, inflammatory vascular diseases, cerebral amyloid angiopathies, CADASIL, CARASIL and other diseases that can lead to cerebrovascular occlusion; intracranial and intraspinal aneurysms and vascular malformations; hematologic disorders that can cause cerebral infarct or hemorrhage; brain ischemic damage; and spontaneous intracranial bleeding. Within ischemic brain damage, focal cerebral ischemia, hemorrhagic infarct, brain edema, penumbra, global cerebral ischemia, venous thrombosis, lacunas and lacunar state, status cribosus, granular atrophy of the cerebral cortex, hippocampal sclerosis, vascular leukoencephalopathy Binswanger type and multi-infarct encephalopathy are discussed in detail. Cognitive impairment of vascular origin deserves an individual section.