The coronavirus disease 2019 (COVID-19) pandemic has caused millions of deaths worldwide. Acute ischemic stroke is a life-threatening risk factor for COVID-19 infection. Neutrophil-to-lymphocyte ratio (NLR) is one of the predictors of poor prognosis in acute ischemic stroke. The aim of this study was to assess the correlation between NLR values and the clinical outcome of acute thrombotic stroke patients with COVID-19 that was measured using the National Institutes of Health Stroke Scale (NIHSS). A cross-sectional hospital-based study was conducted in Dr. Soetomo General Hospital Surabaya, Indonesia. Patients with acute thrombotic stroke and COVID-19 admitted between 1 March 2020 and 31 May 2021 were recruited. The NLR values and the NIHSS scores were assessed during the admission and the correlation between NLR and NIHSS scores was calculated. This study included 21 patients with acute thrombotic stroke and COVID-19, consisting of 12 males and 9 females. The mean age was 57.6 years old. The mean NLR values was 8.33±6.7 and the NIHSS scores ranging from 1 to 33. Our data suggested a positive correlation between NLR values and NIHSS scores, r=0.45 with p=0.041. In conclusion, the NLR value is potentially to be used as a predictor of the clinical outcome in acute thrombotic stroke patients with COVID-19. However, further study is warranted to validate this finding.
Background: Intracerebral hemorrhage is one of the deadliest acute conditions. The volume of bleeding and its location are factors that alter consciousness level, leading to death. This study aimed to explore the association between bleeding volume, blood pressure, and consciousness level with the mortality rate among patients with intracerebral hemorrhage, so proper treatment and diagnosis can be conducted efficiently. Methods: This was an observational retrospective study conducted from October 2018-July 2019. Bleeding volume, blood pressure, consciousness level, and mortality as the outcomes of the patients with intracerebral hemorrhage were evaluated. Consciousness level was determined by using the Glasgow Coma Scale score. Data were collected from the medical record of intracerebral hemorrhage patients of the Neurologic Department in Dr. Soetomo General Academic Hospital Surabaya in the period of 2016. The Chi-square analysis method was used to determine the correlation between variables. Results: In total, 51 medical records were retrieved, and the majority of the patients were in the 45-60 years old group (54.9%). The mortality during hospitalization was 17.6% with most of them (82.4%) had bleeding volume less than 30 cc. Interestingly, the bleeding volume correlated with the consciousness level (p=0.001) and the outcome of the patients (p=0.02). The blood pressure shows a correlation with the volume of bleeding (p=0.009). Conclusions: Bleeding volume and consciousness level as determined by the Glasgow Coma Scale score show significant correlations with the mortality rate in patients with intracerebral hemorrhage.
Introduction: Tolosa-Hunt syndrome (THS) is an inflammatory disease with painful ophthalmoplegia and unilateral periorbital headache as detailed by the International Classification of Headache Disorders, 3rd edition (ICHD-3). Azathioprine has been suggested as a second-line treatment in refractory THS when oral corticosteroid only gives a partial response. Case: Two cases of THS, 45-year-old and 41-year-old women with unilateral headache, drooping of the left upper eyelid, and diplopia. They presented with complete ophthalmoplegia and ophthalmic division of trigeminal nerve disturbance. Magnetic resonance imaging (MRI) showed thickening of the left cavernous sinus, suggesting THS, while the other was normal. Corticosteroid (prednisone 1-1,5 mg/day) was given orally for the first two weeks, and according to the Numeric Pain Rating Scale (NPRS), pain intensity was reduced from severe to moderate. As a second-line treatment, azathioprine (2 mg/kg/day) was given afterward, with a significant reduction in pain intensity and remission of ophthalmoplegia within seven days. Azathioprine was used as an immunosuppressive agent and was continued for another three months without any deterioration in neurological deficits. The levels of complement 3, 4 (C3, C4), and C-reactive protein (CRP) were normal in both patients, with a slight increase in erythrocyte sedimentation rate (ESR) and equivocal values on antinuclear antibody (ANA) results. Other differentials of THS were eliminated from history-taking, physical examination, and proper investigations. Conclusion: Azathioprine as a second-line treatment can be used instead of an oral corticosteroid for refractory cases of THS with fewer side effects. Complete remission of ophthalmoplegia and a significant reduction in pain intensity was obtained.
Background: Stroke is the second leading cause of death and the third leading cause of morbidity. Therefore, it is important to know which risk factor that most patients have. Stroke can be divided according to its severity using NIHSS, NIHSS itself has strong ability to predict outcomes after stroke Objective: This study’s aim to learn about profile of characteristic, risk factor, and stroke severity on infarction stroke patients in ward Seruni A RSUD Dr. Soetomo from July 2018 – June 2019. Methods: This descriptive observational study’s samples are patients with infarction stroke in ward Seruni A RSUD Dr. Soetomo from July 2018 – June 2019. The observed profile include age, sex, ethnic, family history of vascular disease, history of hypertension, diabetes, heart disease, dyslipidemia, obesity, smoking, alcohol consumption, physical inactivity, and stroke severity. Results: From 200 patiens, 55% (110) are 56-70 years old. 61% (122) patients are male. 81 out of 96 are Javanese. 25 out of 135 have family history of vascular disease, 140 out of 194 have hypertension, 69 out of 190 have diabetes, 27 out of 183 have heart disease, 101 out of 174 have dyslipidemia, 62 out of 162 have obesity, 33 out of 82 smoke, 4 out of 63 consume alcohol, and 50 out of 55 are inactive physically. On admission, out of 60 patients, 27 have moderate stroke, 25 minor, and 8 moderate to severe. On discharge, out of 49 patients, 23 have moderate stroke, 20 minor, 3 moderate to severe, and 3 severe. Conclusion: Infarction stroke patients were mostly male and the peak incidence occur between 56-70 years old. Most patients have histories of hypertension, dyslipidemia, and diabetes. On admission and discharge, most patients have moderate stroke, followed by mild stroke.
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