The ‘Ivy Sign’ of Moyamoya disease Karadan, Ummer; Manappallil, Robin George
Asian Journal of Medical Sciences,
05/2019, Letnik:
10, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Stroke is uncommon in pediatric age group. Moyamoya is a rare idiopathic disease characterized by progressive vaso-occlusion of the main blood vessels to the brain. We report a case of 13 year old ...female who presented with recurrent headache and transient left hemiparesis and was diagnosed to have Moyamoya disease. The ‘ivy sign’ is a characteristic magnetic resonance image finding seen in patients with Moyamoya disease.
Exercise has been associated with several systemic reactions. These reactions can vary from mild symptoms to life threatening situations like anaphylaxis. In many of these cases, a predisposing ...factor in the form of food has been noticed. People may develop anaphylaxis on exercising after consumption of a nonspecific or specific food item. The patient being described developed anaphylaxis with seizure on exercising after having his meal. Nonspecific food dependant exercise-induced anaphylaxis is a rare scenario. Proper history taking is essential, as it can be lifesaving.
Parainfectious vasculitis is a rare life threatening complication of Streptococcus pneumoniae (S.pneumoniae) meningitis. There is a 19% risk of developing meningitis in the patients with ...cerebrospinal fluid (CSF) rhinorrhoea. The patient being reported developed CSF rhinorrhoea due to traumatic fracture of cribriform plate, followed by pneumococcal meningitis and parainfectious vasculitis resulting in cerebellar infarction.
Background: An outbreak of Nipah virus infection was confirmed in Kerala, India in May 2018. Five out of 23 cases including the first laboratory-confirmed case were treated at Baby Memorial Hospital ...(BMH), Kozhikode. The study describes the clinical characteristics and epidemiology of the Nipah virus outbreak at Kozhikode during May 2018. Objective: To study the clinical and epidemiological profile of Nipah virus epidemic that occurred in Kerala in May 2018. Methods: A collaborative team of physicians and epidemiologists from BMH, Medical College Hospital (MCH) Kozhikode and from the Indian Medical Association (IMA) conducted this study. The clinical and exposure history and the data on outbreak response were gathered from hospital medical records and through interviewing patient relatives and health workers using questionnaires. Results: It was identified that out of the 23 patients with Nipah virus infection, 21 (91.3%) expired. Out of the 21 patients, 18 tested positive for Nipah virus by Real Time polymerase chain reaction (RT-PCR). It has been found that only the index case was infected in the community from fruit bats. Rest of the cases were due to transmission of the virus at three public hospitals. Median age was 45 years. 65% of them were males. Median incubation period was 9.5 days. Fever (100%), altered sensorium (84.2%), tachycardia (63.1%), hypertension (36.8%), segmental myoclonus (15.7%), segmental sweating (15.7%) and shortness of breath (73.6%) were common features. Mean duration of illness was 6.4 days. Conclusion: The rapid spread of infection uncovered the miserable state of health care system in implementing infection control measures. The case fatality and the socio-economic burden warrant developing appropriate treatments, vaccines and diagnostics.
Hashimoto’s thyroiditis (HT) or chronic lymphocytic thyroiditis is the most common form of primary hypothyroidism. Muscular manifestations like weakness, pain, stiffness and elevated muscle enzymes ...have been noticed in hypothyroidism. Statins are also known to cause myositis and rhabdomyolysis. This is a case of a middle-aged man, on statin therapy, who presented with severe muscle aches and pain and was found to have rhabdomyolysis. Further evaluation revealed an underlying HT as the culprit for his condition. He was managed with intravenous fluids and levothyroxine along with cessation of statins, following which he improved.
Time to revascularization is critical in improving outcomes in stroke thrombolysis. We studied the effectiveness of a mobile app based strategy to improve door-to-needle time (DNT) in treatment of ...acute ischemic stroke.
Consecutive patients presenting with acute ischemic stroke to the emergency department at a tertiary care hospital in Southern India between April 2017 - September 2018 were included. The app enabled rapid entry of patient parameters, the NIH stroke scale (NIHSS), thrombolysis checklist and dose calculation along with team synchronization, notifying all on-call members and team leaders of the patient movement, and sharing of radiological images. DNT captured from the app was compared to previous values from our center using one-way Analysis of Variance (ANOVA) after adjusting for differences in baseline variables.
A total of 76 patients were thrombolysed during the study period, while using the mobile app. The mean DNT was 41 min, with 89% being thrombolysed within 60 min and 57% being thrombolysed within 45 min. Compared to 100 consecutive patients thrombolysed in the months prior to April 2017 where the mean DNT was 57 min, with 67% thrombolysed within 60 min and 47% being thrombolysed within 45 min, there was a mean DNT decrease of 16 min with 1.3x increase in DNT < 60 min. This difference was statistically significant after adjusting for age, sex and NIHSS Score (p=0.005, One-Way ANOVA).
We have been able to demonstrate a significant improvement in DNT using mobile app as a tool to improve team performance.
Pontine hemorrhages are relatively uncommon. Various atypical manifestations of pontine stroke like eight-and-a-half syndrome, fifteen-and-a-half syndrome, and sixteen syndrome have been described in ...the past. We came across a case of pontine bleed that presented with bilateral facial palsy, bilateral horizontal gaze palsy, and contralateral sensorineural hearing loss accounting to the hitherto not described “twenty-four syndrome” with Horner's syndrome and left hemiparesis.
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