Chicken pox (Varicella) infection is generally present in children and caused by Varicella Zoster Virus (VZV). There are quite a number of case reports of hypercoagulable state leading to deep venous thrombosis (DVT) and other thromboembolic sequelae following varicella induced auto antibodies to natural anticoagulants in children. But such a clinical entity is rarely seen in adults. Here we report a rare case of CVST in an adult due to low protein S levels following varicella zoster infection.

INTRODUCTIONICH is the second most common subtype of stroke after ischemic stroke and accounts for approximately 10% to 20% of all strokes and is characterized by high mortality and morbidity.1 Dyslipidemia is an important risk factor for ischemic stroke and statins use significantly decrease risk of recurrence of ischemic stroke. However the association between lipid levels, statins use and risk of ICH is controversial and not clear.Most research studies have shown that lower total cholesterol, lower LDL cholesterol, and higher HDL were associated with increased risk of ICH.2 However the association between TG and VLDL and risk of ICH is not clear.In the present study we prospectively recruited patients with symptomatic ICH in a case control design to know the relationship between individual lipid fractions and risk of ICH. ABSTRACTBackground: Intracerebral hemorrhage (ICH) is characterized by high mortality and morbidity. A little is known about the association between blood lipids, statin use and risk of ICH. Objective of the study was to investigate the relation between blood lipid levels and risk of hemorrhagic stroke. Methods: Prospectively compared the lipid levels of primary ICH patients (case) with ischemic group (control) patients, i.e. age and sex matched individuals admitted from January 2014 to January 2015 and outcome analyzed. Results: Of the 678 acute stroke patients, 78 (11.5%) had ICH who was enrolled. Mean age was 53±14.4. ICH was frequent in older age (57.6%) with male gender predominance (73%). Most frequent location of bleed was in thalamus (30.7%). Low density lipoprotein (LDL), triglyceride (TG) and very low density lipoprotein (VLDL) cholesterol were significantly low in ICH patients compared to controls. There was no significant difference in the high density lipoprotein (HDL) levels in both groups. Mean total cholesterol was significantly low in a subset of study group that included male gender, younger onset stroke (<50 years) and with prior history of hypertension. Subgroup analysis in ICH group showed significantly low mean total cholesterol, LDL and TG cholesterol in statin group compared to non-statin group. Conclusions: Lower blood lipid levels are associated with an increased risk of ICH. The reduction of blood lipids due to statin therapy might increase the risk of ICH, especially in hypertensive individuals and those with alcohol use; hence there should be a cautious use of statins.

INTRODUCTIONRibes et al first discovered CSVT in 1825 on autopsy cases. CSVT affects predominantly younger people with female gender predominance.1 CSVT is considered to be a multifactorial condition associated with inherited and acquired risk factors. Inherited risk factors include hyperhomocystenemia, factor V Leiden mutation, protein C, protein S and antithrombin III deficiency and positive anti-cardiolipin and antiphospholipid antibodies. 1,2Acquired risk factors include central nervous system infections, head trauma, brain tumor, systemic vasculitis, hematological conditions, nephrotic syndrome, pregnancy and puerperium and dehydration. The purpose of present study is to investigate the prevalence, pattern and risk ABSTRACT Background: Intracranial Sino venous occlusive disease is an infrequent condition and accounts only 0.5-1% of all strokes. Objective of the study was to know the prevalence, pattern and risk factors involved in patients of cerebral sinus venous thrombosis (CSVT). Methods: Hospital databases were searched retrospectively and patients diagnosed with CSVT from December 2014 to February 2016 were identified. Data on clinical presentation, risk factor, cerebral sinus involved, hospital stay and outcome were analyzed. Results: Fifteen patients (3.4%) were identified as CSVT out of a total acute stroke case of 430. Mean age of patients was 31 years and 11 (73.3%) were males. The presenting symptoms included headache (n=14), altered sensorium (n=1) and seizures (n=5); signs included hemi paresis (n=4), papilledema (n=8) and bilateral VI nerve palsy (n=3). Majority had aseptic CSVT (n=14), and one patient had septic CSVT associated with tuberculous meningitis (TBM). Radiological findings included brain parenchyma involvement (n=8), subdural hematoma (SDH) (n=1), subarachnoid haemorrhage (SAH) (n=1) and normal brain parenchyma (n=5). Multiple cerebral sinuses were involved in seven patients. Most common site of CSVT was observed in sigmoid sinus. Risk factors included hyperhomocystenemia (n=3), protein S deficiency (n=8), protein C deficiency (n=6) and antithrombin III deficiency (n=3) as primary hypercoagulable state. ANA positive was observed in one patient and four had history of alcohol use. All fifteen patients received low molecular weight heparin (LMWH) for 1 week along with bridging oral anticoagulant. None of the patients required intrasinus thrombolysis and decompression surgery. Average hospital stay was 9 days. All had modified Rankin scale (MRS) ≤ 2 at 6 months follow up. Conclusions: Prevalence of CSVT is higher than that reported from Asian studies. Younger age and male predominance was observed. Protein S deficiency was the major risk factor for CSVT.