Background: Vascular dementia is extremely common and contributes to stroke-associated morbidity and mortality. The study of vascular dementia may help to plan preventive interventions.Aims: To study the frequency of cognitive impairment after stroke in a series of consecutive patients with acute stroke, along with factors which influence it.Methods: Fifty adults with acute infarct or hemorrhage (as seen on computed tomography of the brain) were included in the study. The National Institute of Health Stroke Scale (NIHSS) and Barthel’s Index scores were done. Cognitive testing was done by PGI Battery of Brain Dysfunction (PGI-BBD) and Short Form of the Informant Questionnaire on Cognitive Decline in the Elderly (SIQCODE). Statistical analysis was by Student’s t-test, Chi-square test, Fisher’s exact test, and Mann-Whitney U test.Results: Mean age of patients was 61.82 years; males and ischemic strokes predominated. Dementia was seen in 30%, cognitive impairment no dementia (CIND) in 42%, and normal cognition in 28% patients. Factors associated with vascular cognitive impairment included old age, male sex, low education, hemorrhages, recurrent or severe stroke, silent infarcts, severe cortical atrophy, and left hemispheric or subcortical involvement.Conclusions: Up to 72% of patients have some form of cognitive impairment after a stroke. Secondary stroke prevention could reduce the incidence of vascular dementia.

Background: Coronavirus disease 2019 (COVID-19) has placed a tremendous strain on healthcare services. This study, prepared by a large international panel of stroke experts, assesses the rapidly growing research and personal experience with COVID-19 stroke and offers recommendations for stroke management in this challenging new setting: modifications needed for prehospital emergency rescue and hyperacute care; inpatient intensive or stroke units; posthospitalization rehabilitation; follow-up including at-risk family and community; and multispecialty departmental developments in the allied professions. Summary: The severe acute respiratory syndrome coronavirus 2 uses spike proteins binding to tissue angiotensin-converting enzyme (ACE)-2 receptors, most often through the respiratory system by virus inhalation and thence to other susceptible organ systems, leading to COVID-19. Clinicians facing the many etiologies for stroke have been sobered by the unusual incidence of combined etiologies and presentations, prominent among them are vasculitis, cardiomyopathy, hypercoagulable state, and endothelial dysfunction. International standards of acute stroke management remain in force, but COVID-19 adds the burdens of personal protections for the patient, rescue, and hospital staff and for some even into the postdischarge phase. For pending COVID-19 determination and also for those shown to be COVID-19 affected, strict infection control is needed at all times to reduce spread of infection and to protect healthcare staff, using the wealth of well-described methods. For COVID-19 patients with stroke, thrombolysis and thrombectomy should be continued, and the usual early management of hypertension applies, save that recent work suggests continuing ACE inhibitors and ARBs. Prothrombotic states, some acute and severe, encourage prophylactic LMWH unless bleeding risk is high. COVID-19-related cardiomyopathy adds risk of cardioembolic stroke, where heparin or warfarin may be preferable, with experience accumulating with DOACs. As ever, arteritis can prove a difficult diagnosis, especially if not obvious on the acute angiogram done for clot extraction. This field is under rapid development and may generate management recommendations which are as yet unsettled, even undiscovered. Beyond the acute management phase, COVID-19-related stroke also forces rehabilitation services to use protective precautions. As with all stroke patients, health workers should be aware of symptoms of depression, anxiety, insomnia, and/or distress developing in their patients and caregivers. Postdischarge outpatient care currently includes continued secondary prevention measures. Although hoping a COVID-19 stroke patient can be considered cured of the virus, those concerned for contact safety can take comfort in the increasing use of telemedicine, which is itself a growing source of patient-physician contacts. Many online resources are available to patients and physicians. Like prior challenges, stroke care teams will also overcome this one. Key Messages: Evidence-based stroke management should continue to be provided throughout the patient care journey, while strict infection control measures are enforced.

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Background and Purpose: The purpose of this study was to determine the incidence and risk factor of ischemic stroke subtypes by a mechanismbased classifi cation scheme (Trial of ORG 10172 in Acute Stroke Treatment [TOAST]). Materials and Methods: This study was conducted in Indraprastha Apollo Hospital, New Delhi, between 01/01/2004 and 31/12/2006. Out of 361 admitted stroke patients, 244 (67.59%) ischemic stroke patients were analyzed retrospectively for incidence and modifi able risk factors for stroke in our region. The cause of ischemic stroke was classifi ed according to the TOAST criteria. Results: Out of 244 patients 165 (67.6%) were male and 79 (32.4%) were female, the mean age at the time of stroke was 57.1 years, the incidence of different risk factors were as follows: 139 (56.9%, odds ratio 2.71) hypertensive, 85 (34.8%, odds ratio 2.4) diabetics, 95 (38.9%, odds ratio 3.12) smokers, 58 (23.7%, odds ratio 5.34) dyslipidemics, 44 (18.0%, odds ratio 1.43) coronary artery disease (CAD) patients, 14 (5.7%, odds ratio 1.22) patients have the transient ischemic stroke in the past, 13 (5.3%, odds ratio 1.43) were given the history of atrial fi brillation. The incidence rates of ischemic stroke subtypes were as follows: Determined causes; large artery atherosclerosis 141 (57.7%), lacunes 18 (7.7%), cardio-embolism 11 (4.5%), hypercoagulable state 8 (3.2%), un-determined causes; atherosclerosis and/or lacunes 25 (10.2%), embolism and/or two more (hypercoagulable state/CAD) possible causes 7 (2.8%), negative evaluation in 34 (13.9%) patients. Ischemic stroke subtype according to the TOAST criteria was a signifi cant predictor for long-term survival. Conclusions: Our data indicate that large vessel disease is a major cause, and the hypertension, diabetes, smoking, hyperlipidemia are the most common risk factors for Ischemic stroke.Stroke remains the most common life-threatening neurological disease globally and impacts individuals, their families and society. [1,2] It is the leading cause of disability among elderly and the second leading cause of mortality worldwide. [3] Stroke is responsible for millions of deaths in developing countries, [4] and is the major cause of mortality and morbidity in Asian countries. Treatment options are limited to thrombolysis, but only few patients receive this treatment owing to restrictions in application time and indication. [5] Thus, primary prevention remains the most important general strategy for reducing the impact of stroke. [6] Several well-established modifi able risk factors for stroke, that is, hypertension (HTN), smoking, cardiac disease, diabetes, etc. Stroke appears to be a preventable disease to a large extent, [7,8] change in lifestyle is supposed as the major primary prevention strategy. Lifestyle changes are likely to infl uence risk factor prevalence, which in turn may modify the stroke risk. [9] The aim of the present study is to identify the prevalence of common modifi able risk factors (demographic and cardiovascular) for ischemic stroke in India. Abstract ...

By definition, a brain abscess is an intraparenchymal collection of pus. Nocardia shows to have a special tropism for the neural tissue. Solitary abscess represents the most common manifestation in the central nervous system, accounting for 1%–2% of all cerebral abscesses. In this report, we present a case of primary multiple brain abscesses due to Nocardia farcinica in an immune competent patient. Early diagnosis and surgical intervention is significant for the patient.