Open Access Original Article

Introduction Cerebrovascular accident (CVA), also termed as stroke, is the third leading cause of mortality and the most common cause of disability globally. The National Institutes of Health Stroke Scale (NIHSS) is a valid assessment tool utilized to determine the severity of the stroke and can be used to prioritize patients to design treatment plans, rehabilitation, and better clinical outcomes. The primary objective of this study was to determine the validity of the NIHSS to predict mortality among patients presenting with symptoms of a stroke. Material and methods This was a descriptive case-series conducted over a period of six months between September 2019 and February 2020 at a tertiary care hospital in Nawabshah, Pakistan. The sample population included 141 patients admitted within 24 hours of the onset of symptoms of a stroke. A neurological examination of the patients was performed. On admission, stroke severity was evaluated with the NIHSS. After an initial clinical evaluation, patients underwent a non-enhanced computed tomography (CT) scan of the brain. The score of NIHSS and mortality at 72 hours were recorded on the pre-defined proforma by the investigators. All statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23.0 (Armonk, NY: IBM Corp). Results The mean age of the participants was 52.37±8.61 years. 68.1% of patients were hypertensive, 29.1% were diabetic, and 36.9% of patients were found with hyperlipidemia. The mortality rate was 41.1%. The mean NIHSS score was 16.68±6.72 points. The findings of this study demonstrated that the score of 14.9% cases was good (0-6 points), the score of 29.1% cases was moderate (7-15 points), and the score of 56% cases was poor (≥16 points). There was a significant association of NIHSS score with mortality (p<0.001).

Coronavirus disease 2019 (COVID-19) is an active worldwide pandemic with diverse presentations and complications. Most patients present with constitutional and respiratory symptoms. Acute ischemic stroke remains a medical emergency even during the COVID-19 pandemic. Here we present a case of a patient with COVID-19 who presented with acute ischemic stroke in the absence of common risk factors for cerebrovascular accidents. A 70-yearold male patient, with no prior comorbidities, presented to the emergency department (ED) with fever, cough, and shortness of breath for four days, and altered level of consciousness and right-sided weakness with the sensory loss for one day. On examination, the patient had a score of 8/15 on the Glasgow coma scale (GCS). There was a right-sided sensory loss and weakness in both upper and lower limbs with a positive Babinski's sign. The pulmonary examination was remarkable for bilateral crepitation. On blood workup, there was leukocytosis and raised creactive protein (CRP). D-dimer, ferritin, thyroid-stimulating hormone (TSH), vitamin B12, and hypercoagulability workup were normal. Transthoracic echocardiography was also normal. COVID-19 polymerase chain reaction (PCR) detected the virus. Chest x-ray showed infiltrations in the left middle and both lower zones of the lungs in the peripheral distribution. Computed tomography (CT) scan of the chest showed peripheral and mid to basal predominant multilobar ground-glass opacities. CT scan of the head showed a large hypodense area, with a loss of gray and white matter differentiation, in the left middle cerebral artery territory. Magnetic resonance imaging (MRI) of the head showed abnormal signal intensity area in the left parietal region. It appeared isointense on T1 image and hyperintense on T2 image. It also showed diffusion restriction on the diffusion-weighted 1 (DW1) image with corresponding low signals on the apparent diffusion coefficient (ADC) map. These findings were consistent with left middle cerebral artery territory infarct due to COVID-19. The patient was intubated in the ED. He was deemed unfit for thrombolysis and started on aspirin, anti-coagulation, and other supportive measures. Patients with COVID-19 should be evaluated early for neurological signs. Timely workup and interventions should be performed in any patient suspected of having a stroke to reduce morbidity and mortality.

A substantial proportion of patients with chronic liver disease had hyperlipidemia which varied with the severity of disease on Child-Pugh classification. Routine monitoring of the lipid profile of such patients is necessary for timely identification and management of dyslipidemia to improve the outcome of such patients. It also suggests an important role of lipid profile in the risk stratification and treatment of chronic liver disease patients and warrants further studies in this regard.

Objective: To determine the frequency of intracerebral hemorrhage inhypertensive patients. Study design: Cross sectional study. Setting: This study was conductedat Medical department of Peoples Medical College & Hospital Nawabshah, from 01-01-2012 to31-12-2012. Material and methods: Admitted patient through emergency department withhistory of hypertension more than two years, meeting the inclusion criteria taken consent fromattendant. Patient was referred for C.T scan brain presence of hyperdense area was consideredas intracerebral hemorrhage. Inclusive criteria were age >20 years, either sex and patients withhistory of hypertension more than two year with any two or more sign and symptoms like suddenunconsciousness or with hemiplegia, hemiparesis, dysarthria. Aphasia, cranial nerve palsies.Exclusion criteria were age less than 20 years, normotensive patients with cerebral hemorrhageand patients with traumatic hemorrhage. Results: Among 281 patients that had stroke, therewere 147 males and 134 females with a sex ratio males: female 1:1. Mean age of patientsadmitted with intracerebral hemorrhage was 37.89 ± 7.33 years with an average age amongmales and females was same. Duration of hypertension was greater than 20-25 years in most ofthe patients nearly 63.7%. Patients with long duration of diabetes and hypertension presentedwith intracerebral hemorrhage. Nearly all the patients with intracerebral hemorrhage weresmokers 145, only 2 patients were non smokers and nearly all had long history of smoking. The127 patients who presented with intracerebral hemorrhage were obese. All risk factors werestatistically significant and were responsible for intracerebral hemorrhage. Conclusions:Hypertension is a risk factor for intra cerebral hemorrhage. An effort should be made to controlblood pressure and other modifiable risk factors to reduce incidence of intra cerebralhemorrhage and improve patient outcomes.