Narcolepsy is a sleep disorder characterized by excessive daytime sleepiness. It can be either primary or symptomatic due to other neurologic disorders. Neuromyelitis optica (NMO) is an inflammatory demyelinating disorder in which symptomatic narcolepsy is being described as one of the core clinical features. Here, we report a patient with NMO who presented with narcolepsy. Signal changes on magnetic resonance imaging in hypothalamus and other periventricular regions of high aquaporin-4 expression should prompt considering NMO as diagnosis. Serum anti-aquaporin-4 IgG antibody testing should be done in such cases, and appropriate treatment should be initiated to prevent further neurological worsening and relapses.
Background: The Incidence of Cerebral Venous Thrombosis (CVT) is around 3-4 cases among one million population affecting children and young adults. In India the puerperal CVT is 10-12 times more common than western countries. Even though there is apparent “rarity” of the condition but advances in knowledge and available investigation in terms of imaging (CT scan/MRI) diagnosis can be done early for appropriate treatment and decreasing the morbidity and mortality.Methods: A prospective study was conducted at Karnataka Institute of Medical Sciences, Hubli, Karnataka from December 2014 to November 2015. A total of 36 patients were included in the study.Results: Mean age of females in the study was 27.06±9.033years. 75% had seizures, 47.2% had headache, 19.4% had focal neurological deficit, 13.9% had altered sensorium, 8.3% had cranial nerve deficits 5.6% had speech deficits. 72.22% of patients and were in peripartum period and 27.8% were non-pregnant. 72.2% had superior sagittal sinus involvement, 47.2% had transverse sinus, 47.2% had sigmoid sinus, and 13.9% had internal jugular vein and 5.6% straight sinus. 47.2% had single sinus involvement, and 52.8% had multiple sinus involvement. 94.4% patients were managed conservatively and 5.6% were managed by neurosurgical intervention. 94.4% patients survived and 5.6% had mortality.Conclusions: Cerebral venous sinus thrombosis is most common in young females during peripartum period. Early diagnosis, treatment and if necessary neurosurgical intervention has good outcome.
Introduction: Incidence of stroke is higher in developing countries than in developed countries. India shows prevalence of Cerebrovascular Disease (CVD) in the range of 52 to 843/100,000 population. Stroke causes 9% deaths around the world. The basic principle of managing stroke includes making an accurate diagnosis, choosing the effective drugs and dose for the stroke type. Aim: To analyse the outcomes of pharmacotherapy of stroke based on characteristics and clinical presentation of patients admitted to hospital and to know the adverse effect of drugs used. Materials and Methods: This cohort study was conducted with Department of Medicine and Neurology at Karnataka Institute of Medical Sciences, Hubballi from January 2015 to December 2015. After clearance from Institutional Ethics Committee, 162 cases were selected based on the inclusion and exclusion criteria. The clinical history, in examination modified Rankin score (mRS) at admission, discharge and on follow-up were recorded. The criteria for selecting the drugs, frequency, dosing, duration and change in drug therapy were recorded. The efficacy of drug therapy was assessed by clinical improvement. The adverse events were assessed and recorded. The patients were followed-up at three and six months. The data were entered after defining the variables in SPSS (version 16) from case record form. Descriptive statistics were used to summarise baseline data. Results: Of the 162 patients, 155 completed the six months follow-up. The median age of patients was 60 years for ischaemic and 55 years for haemorrhagic stroke. More males were admitted with strokes {108 (69.67%)} compared to females {47 (30.32%)}; 130 (83.87%) patients had ischaemic strokes, 16 (10.30%) haemorrhagic stroke {15 (9.67%) were intracerebral haemorrhage + 1 (0.63 %) patient had a subarachnoid haemorrhage}, 9 (5.8%) had Transient Ischaemic Attack (TIA). The modified Rankin score calculated for the patients was statistically significant between admission and discharge (1.29, p-value 0.0035), and that between three months and six months (0.9, p-value 0.003) of follow-up.Total 93% of 121 patients with ischaemic stroke received antiplatelet therapy. Amlodipine was the most commonly prescribed antihypertensive. Conclusion: Pharmacotherapy of stroke in the study was evidence-based and satisfactory. However, patients showed reduced compliance to all medications. Clinical presentation and type of stroke were important predictors of morbidity and mortality at the end of six months.
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