Introduction Longitudinally extensive transverse myelitis (LETM) is inflammation of the spinal cord that spans three or more spinal segments. LETM is a rare occurrence on its own and has seldom been reported with tuberculous meningitis (TBM), the rarest and deadliest of tuberculous manifestations. TBM is usually seen in children, the immunocompromised, or those with a previous history of tuberculosis infection. Case presentation A 24-year-old healthy male with no co-morbidities or history of tuberculosis presented with fever and headache for the past 3 months. The patient’s Kernig’s and Brudzinski’s signs were both negative, with bilateral abnormal plantar reflexes. The neurological level of injury was T8 and the patient was classified as AIS grade A. His CSF analysis showed a lymphocytic picture. However, both GeneXpert and Ziehl–Neelsen staining came back negative for Mycobacterium tuberculosis . MRI scans of the brain and thoracic spine revealed enhancing nodules and ring lesions in the brain and spinal cord, along with the rare complication of LETM, extending from T2 to T9. Discussion Although Mycobacterium tuberculosis was never isolated, the patient started recovering as soon as antituberculous therapy was initiated. Hence, more emphasis needs to be placed on radiological imaging in the management of rare medical emergencies like tuberculous meningitis, especially in areas where tuberculosis is rampant and endemic, rather than waiting for a positive culture. This case report also demonstrates the growing evidence that transverse myelitis and/or LETM is associated with TBM.

No abstract

Background: Ischemic stroke is caused by carotid artery stenosis, often known as carotid artery disease. Stroke is thought to be the leading factor of impairment and the most prevalent and severe neurological condition. For the investigation of intracranial carotid artery disease CT angiography should be preferred. Objective: To assess the carotid artery disease in anterior circulation strokes Methodology: This retrospective study was carried out at the department of medicine, Shalamar Hospital Lahore for a period of two years from January 2019 to April 2021. Simple convenient sampling technique was employed. Totally 356 subjects fulfilling the inclusion criteria were enrolled in the current study. Carotid Doppler USG results were entered in the predesigned Performa. SPSS version 20 was used for analysis of data. Results: In the current study, there were 198 (55.62%) males and 158 (44.38%) females. The average age of the subjects was 62.12 years with standard deviation of 13.1. Amongst the 356 subjects, less than 50% stenosis was observed in 296 (83.14%) patients in the right carotid, 50-69% stenosis in 40 (11.24%) subjects and more than 70% stenosis was observed in 20 (5.62%) subjects in the right carotid while in the left carotid, in 303 (85.11%), 35 (9.83%) and 18 (5.06%) patients, less than 50% stenosis, 50-69% stenosis and more than 70% stenosis was observed respectively. Conclusion: Our study concludes that the frequency of carotid artery disease in anterior circulation strokes is high. For high-risk individuals, Doppler examinations are indicated for both primary and secondary prevention of ischemic stroke. For the investigation of intracranial carotid artery disease CT angiography should be preferred. Key words: Carotid artery disease; Anterior circulation strokes; Doppler ultrasound

No abstract

Novel corona virus 2019 also known as severe acute respiratory syndrome coronavirus 2 [SARS COV2] is enveloped non segmented ribonucleic acid (RNA) virus. Acute ischemic stroke remains emergency during covid19 pandemic [1] Here we present a case of a woman with COVID 19 who presented to us with symptoms of altered state of consciousness (ASOC), cough, fever, dysarthria, right sided body weakness and massive bilateral middle cerebral artery (MCA)/ anterior. Our case was unique in the sense that it showed drastic central nervous system (CNS) damage in the presence of coronavirus infection. There are a few cases of patients who develop stroke after COVID 19 infection. Aims: Clinicians need to be aware of possible causes of unconsciousness in coronavirus disease (COVID 19) patients, particularly as delirium appears to be common complications to find out the association between stroke and COVID 19 and its impact and mortality. Case Presentation: A 70 years old lady presented to us with symptoms of stroke like ASOC, right sided body weakness, dysarthria, and symptoms of pneumonia like mild cough and fever later which turned out to be COVID 19. Clinicians need to be aware of possible causes of unconsciousness in coronavirus disease (COVID 19) patients, particularly as delirium appears to be common complications to find out the association between stroke and COVID 19 and its impact and mortality. Discussion: Bilateral ischemic stroke is relatively uncommon presentation in general population and is usually the result of cardio embolic cause such as atrial fibrillation and recent myocardial infarction. While this patient had pre existing risk factors for stroke such as type 2 diabetes mellitus, hypertension and old age and her electrocardiography showed sinus rhythm. Conclusion: COVID-19 may be a risk factor or aggravating factor for stroke.