Background. Stroke is an important morbidity for low and middle income countries like Bangladesh. We established the first stroke registry in Bangladesh. Methods. Data was collected from stroke patients who were admitted in Department of Neurology of BIRDEM with first ever stroke, aged between 30 and 90 years. Patients with intracerebral hemorrhage, subarachnoid and subdural hemorrhage, and posttrauma features were excluded. Results. Data was gathered from 679 stroke patients. Mean age was 60.6 years. Almost 68% of patients were male. Small vessel strokes were the most common accounting for 45.4% of all the patients followed by large vessel getting affected in 32.5% of the cases. Only 16 (2.4%) died during treatment, and 436 (64.2%) patients had their mRS score of 3 to 5. Age greater than 70 years was associated with poor outcome on discharge [OR 1.79 (95% CI: 1.05 to 3.06)] adjusting for gender, duration of hospital stay, HDL, and pneumonia. Age, mRS, systolic blood pressure, urinary tract infection, pneumonia, and stroke severity explained the Barthel score. Conclusion. Mortality was low but most of patient had moderate to severe disability at discharge. Age, mRS, systolic blood pressure, urinary tract infection, pneumonia, and stroke severity influenced the Barthel score.

The Epidural blood patch is considered the gold standard for managing postdural puncture headache when supportive measures fail. However, it is a procedure which can lead to another inadvertent dural puncture. Other potential adverse events that could occur during a blood patch are meningitis, neurological deficits, and unconsciousness. The bilateral greater occipital nerve block has been used for treating chronic headaches in patients with PDPH with a single injection. This minimally invasive, simple procedure can be considered for patients early, along with other supportive treatment, and an epidural blood patch can be avoided.

No abstract

Aims: The study was aimed to evaluate vascular territories of infarcts involved in patients with stroke for the first time with diabetes on CT and/ or MRI of brain. Methodology: This cross sectional descriptive study was carried on a total of 100 adult patients with first ever stroke consecutively reported in the Department of Neurology, BIRDEM General Hospital, Dhaka, over a period of six months. Results: The mean age was 61.45 years and majority (35%) belongs to age group of 50-59. Ten (10%) subjects had age above 80 years. Male were 68% and 32% were female. Majority (89%) of the subjects had hemiplegia following acute stroke. Aphasia (71%), headache (39%), convulsion (23%), vomiting (18%) and cranial nerve palsy (17%) were also found. Additional preexisting risk factors were hypertension (72%), dyslipidaemia (59%), smoking (56%) and alcohol abuse (2%). Among the study subjects the diabetic complications were peripheral vascular disease (4% ), neuropathy (8%), nephropathy( 9%)and retinopathy(25%). CT scan and/ or MRI brain showed parietal lobe lesion in 57% cases. Majority (76%) had infarcts in middle cerebral artery territory. Involvement of anterior and posterior cerebral artery territory was found in 7% and 5% subjects respectively. Vertebro-basilar arterial system involvement was observed in 6% cases. 4% subjects had involvement of both middle and posterior cerebral arteries. Both anterior and posterior arterial territory infarcts were found in 2% cases. Conclusions: In conclusion most of the diabetic subjects with first ever ischemic stroke had involvement of middle cerebral artery. DOI: http://dx.doi.org/10.3329/bccj.v2i1.19951 Bangladesh Crit Care J March 2014; 2 (1): 16-20

Malignant Ascites (MA) poses significant symptom burden in patients with peritoneal malignancies at the end of life. Various treatment options are available and Indwelling Tunneled Catheters (ITC) have the advantage of increased patient comfort being soft on abdomen, less painful, easy to tap fluid, and less chances of infection etc. A total of 5 patients underwent insertion of ITC after proper counseling and assessment. Insertion was done in operation theatre under combined ultrasonogram and fluoroscopy guidance. Results: 4 out of 5 patients had favorable outcomes in terms of symptom free days spent at home at end of life. ITC’s are a suitable option to manage symptoms in patients with terminal malignant ascites. Careful patient selection and proper education of the caregivers will increase the success rates of procedures.