We present a case of a 25-year-old woman with drowsiness, nystagmus, severe ataxia and areflexia, which developed six weeks after admission to an obstetric clinic for hyperemesis gravidarum. She had been treated with intravenous dextrose and electrolyte solutions and antiemetics. Magnetic resonance imaging (MRI) performed on the fifth day of her neurologic symptoms showed increased intensity in both thalami, periaqueductal grey matter, the floor of the fourth ventricle and superior cerebellar vermis in T2 weighted and FLAIR images. Clinical signs and MRI findings were consistent with the diagnosis of Wernicke's encephalopathy. On the third day of thiamine replacement, neurologic signs improved dramatically In addition to our case, we review 29 previously reported cases of Wernicke's encephalopathy associated with hyperemesis gravidarum, and emphasize the importance of thiamine supplementation to women with prolonged vomiting in pregnancy especially if they are given intravenous or parenteral nutrition.

We report a series of four cases presented with transient ischemic attacks (TIA) or ischemic stroke as the predominant manifestation of neurobrucellosis (NB). Three of the patients were 20–28 years of age, and one patient was 53 years old. They all used to consume unpasteurized milk or its products. Two patients had systemic brucellosis in the past and received antibiotic treatment. Other causes of TIA including cardiac embolism, hypercoagulability, vascular malformations, systemic vasculitis, and infective endocarditis were excluded. NB was diagnosed with serological tests or cultures for Brucella in the cerebrospinal fluid. None of the patients had any further TIA after the initiation of specific treatment. NB should always be sought in young patients with TIA or ischemic stroke, especially if they have no risk factors for stroke and live in an endemic area for brucellosis, even if they do not have other systemic signs of brucellosis.

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Background: Stroke is one of the leading causes of repetitive and disability, affecting the quality of life of the patients negatively, causing depressive symptoms. Aim: The aim of this study was to determine the clinical pharmacist’s contribution on treatment adherence and quality of life (QOL) in patients with stroke, and assessing patient’s satisfaction. Methods: A total of 98 patients with first-ever stroke were included in the study and followed up by for 3 months. This interventional 2-phase study was conducted sequentially at two different university hospitals. Patients in intervention group (IG) was given education by clinical pharmacist and patient in control group (CG) was only given routine care. Medication adherence and QOL was assessed at discharge day, 1st and 3rd month after discharge. Results: The increase in treatment adherence of the patients in IG was significant over time (p<0.001). The scores of the patients in IG from the ‘energy’ and ‘work/productivity’ subscales at 1st and 3rd months after discharge were higher than the patients in CG (p<0.05). The patient’s satisfaction in IG was also higher than the patients in CG (p<0.001). Conclusion: Clinical pharmacist-led education is beneficial to improve treatment adherence and patient’s satisfaction in patients with first ever stroke. Clinical pharmacist should be integrated to improve QOL and treatment adherence multidisciplinary team consisting physician, nurse and physiotherapist. Further studies are needed to assess the impact of clinical pharmacists’ interventions on protection from the second stroke of these patients.