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Stroke is a major health concern worldwide. Published meta-analyses showed significant higher risk of ischemic and hemorrhagic stroke in patients with rheumatoid arthritis (RA) compared to the general population. Major etiopathogenesis of ischemic stroke in RA is non-atherosclerotic vasculopathy. Here the authors described varied aetiopathogensis of ischemic stroke in patients with RA which had been seldom reported in the literature. It was one of the first case series which threw light in this genre. Observational, prospective case series study was conducted over a period of one year. Amongst four cases presenting as an ischemic stroke with co-existing RA; each patient had a medium or small vessel vasculopathy, which had never been described earlier. Case 1 had cardio embolic source plus large vessel vasculopathy, case 2 had intracranial non-atherosclerosis vasculopathy; case 3 had secondary Moya-Moya disease; case 4 had both intracranial and extra cranial vasculopathy. Underlying aetiopathogensis of stroke in patients with RA can be attributed to insufficient cardiovascular treatment (well described in the literature) and vasculopathy of extracranial and intracranial vessels and secondary Moyamoya disease due to RA. Thorough evaluation is needed to prevent recurrence of stroke. The treatment strategy in these patients are immunotherapy apart from the conventional therapy with antiplatelet and statins.

Stroke is the second leading cause of death and disability worldwide. The incidence of stroke in India has increased to hundred percent in past few decades. It was the Framingham heart study trial in 2001 which has first identified the role of dietary habits for prevention of atherosclerotic cardiovascular disease. Majority of secondary prevention strategies for Ischemic stroke are directed towards pharmacotherapy with antiplatelet and statins, while dietary modifications are not projected. However dietary and lifestyle modification can reduce stroke risk by 60%. Hence Diet and nutrition play an active role in prevention of stroke. This review summarizes the dietary intake, dietary patterns and risk of stroke among Indians and provides clinicians with pragmatic guidance to their management. We searched Pub Med, MEDLINE, for articles about diet and stroke in India published in English till May 2021. Diet plays a major role in pathophysiology of stroke. Modification of dietary pattern is the major non pharmacological treatment for the primary and secondary prevention of stroke. Indian traditional diet should be modified according to dietary pattern followed in each region. As a whole reduction of rice consumption, higher protein consumption and lower fat consumption should be encouraged at macronutrient level, while higher intake of fruits and vegetables are advised at micronutrient level. Dietary guidelines should be customized and tailor made based on the regional customs and annual income in various subsections of the society.

Moyamoya disease is a chronic progressive, non-atherosclerotic, occlusive intracranial vasculopathy involving major cerebral arteries around the circle of Willis. MMD occurs frequently in East Asian populations but the disease can affect the American and European ethnicities as well. Knowledge of clinical aspects of Moyamoya disease (MMD) is important in view of distinctive clinical presentation observed in children and adults. MMD has bimodal age of distribution, with peaks in the first and last decades of life. Childhood MMD is characterised by Ischemic manifestation (Transient ischemic attack, Cerebral Infarction), whereas adult MMD presents with hemorrhagic manifestations (Intracerebral haemorrhage, Intraventricular bleed). Refractory headache, seizure and ophthalmological abnormalities are other clinical presentations of MMD. A high index of clinical suspicion and an eye to recognise the common as well as unusual manifestations of the disease and inciting events may prevent delay in the diagnosis. A thorough knowledge about the varied clinical presentation would aid clinician for early diagnosis and management of this rare entity. The present article provides extensive review on the clinical aspects of MMD amongst adults and paediatric population, on the basis of previous articles and research studies.