Aim: Stroke is one of the leading causes of death and disability. The proportion of patients receiving recombinant tissue plasminogen activator is low in our country. Biomarkers to identify patients at risk of severe disease, and guide treatment and prognosis would be valuable. This article aims to identify the factors that can independently prognosticate the acute phase of ischemic stroke. Methods: All patients with the first episode of ischemic stroke admitted to the Neurology Department between 1st December 2017 to 31st March 2018 were included in this pilot study. Stroke severity was evaluated using the National Institute of Health Stroke Scale (NIHSS). Patients being admitted within 4.5 h of onset of symptoms were thrombolysed with injection alteplase. For each patient, 4 serum biomarkers (D-dimer, fibrinogen, C-reactive protein and neuron specific enolase) were evaluated at admission and 24 h later. Discharged patients were assessed on an outpatient basis using the modified Rankin scale. The study primarily aimed to identify the factors predicting the severity and outcome of stroke, and to evaluate the effect of thrombolysis on the outcome. The secondary aim was to evaluate the role of biomarkers to predict the unfavorable outcome and the chance of post thrombolysis hemorrhage. Results: Out of 30 patients included in the study, 10 had NIHSS 0-4, 12 had NIHSS 5-15 and 8 had NIHSS 16-42. Sixteen patients had unfavorable outcome (mRS score ≥ 2), and 5 patients expired. Old age, history of diabetes, CHADS2 score ≥ 2, and total anterior circulation stroke (TACS) independently affected stroke severity, whereas low ejection fraction < 35%, and TACS, independently predicted unfavorable outcome and mortality. High mean arterial blood pressure (MABP) and capillary blood glucose (CBG) at admission were significant predictors of stroke severity, unfavorable outcome, and mortality. Out of 10 thrombolysed patients, two had mRS score ≥ 2 and 3 had the post-thrombolysis hemorrhage. Thrombolysis significantly reduced the incidence of the unfavorable outcome, but did not significantly affect death. All the biomarker levels at admission were significantly higher among patients with severe stroke and those who subsequently had an unfavorable outcome. D-dimer levels significantly increased and fibrinogen level significantly decreased following thrombolysis. Higher MABP, CBG, and fibrinogen levels at admission predicted significantly higher chance to develop hemorrhagic complications post thrombolysis. Conclusion: Low ejection fraction, occurrence of TACS and the higher levels of the biomarkers under study predicted poor outcome. Higher mean CBG and MABP and raised fibrinogen levels predicted higher chance of postthrombolysis hemorrhage.

No abstract

Thromboembolic event is an important and widely regarded risk factor, influencing the outcome and overall survival in post-operative cases with second highest association with gynaecological surgeries. Here we report a 52 years old female who underwent total laparoscopic hysterectomy with bilateral salpingo-oophorectomy (TLH+BSO) presented to our emergency in unconscious and intubated state on her post-operative day-1 with cardiorespiratory failure. Based on the immediate investigations after successful resuscitation, an initial diagnosis of massive pulmonary thromboembolism was made following supportive and conservative management. Interestingly on subsequent days she started to display episodic non-rhythmic symmetric myoclonic jerks persisting for seconds to minutes; resembling ‘post-hypoxic’ or ‘post-anoxic’ status myoclonus due to hypoxic ischemic brain injury. Further neuro-electrophysiological examination revealed rhythmic well-formed delta activity on both sides symmetrically with a transformation into theta activity with forward displacement on subsequent days, bilaterally over the same areas. Later on, magnetic resonance imaging with magnetic resonance-spectroscopic findings also corroborated to hypoxic ischemic brain injury related changes over bilateral basal ganglia mostly in caudate nucleus. Post operative venous thromboembolism is a major clinical challenge and a subject of constant intensive care yet the neurological sequalae of such event is given less priority despite of its major contribution on overall prognostic and survival index.

Background: Hepatic artery pseudoaneurysm (HAP) is an unusually rare vascular complication following laparoscopic procedures with a few yet gradually increasing incidences. Case presentation: We report a case of 63 years old male with distal right HAP mediated massive gastrointestinal bleeding after a successful laparoscopic cholecystectomy. He was treated successfully with selective endovascular coil embolization and percutaneous thrombin administration. Conclusion: Risk of rupture and bleeding from HAP can be a potentially life-threatening scenario and needs prompt diagnosis with emergent intervention. The documentation of this case may be useful for practicing surgeons to be cautious about the possibility of pseudoaneurysmal changes during post-operative period.

The persistence of measles virus infection in childhood and early adolescence can rarely lead to a fatal progressive neurodegenerative disorder known as subacute sclerosing panencephalitis (SSPE), characterized by behavioral disturbances and intellectual disability followed by myoclonic jerks and occasional negative myoclonus. Movement disorders are rarely presenting manifestations in SSPE. We herein report a 63-year-old woman with generalized choreoathetosis as the presenting manifestation of stage-I SSPE. Our case was atypical for the patient's age and clinical presentation with generalized choreoathetosis and bilateral putaminal and caudate nucleus signal hyperintensity. Though highly uncommon, neurologists should keep SSPE as a differential diagnosis among patients with movement disorders. Measles-endemic countries should be more vigilant to the atypical and rare presentations of SSPE, such as generalized choreoathetosis.