Background:Symptomatic Intracerebral hemorrhage (sICH) is a serious complication of recombinant tissue-plasminogen activator (rt-PA) therapy for acute ischemic stroke (AIS).Objective:To estimate the prevalence and predictors of sICH in patients after receiving IV rt-PA for AIS.Material and Methods:Consecutive patients of AIS thrombolysed between January 2010 and June 2016 in a University hospital in Hyderabad (India) were studied prospectively for sICH and it's various variables compared with the control group without sICH to determine any sigificantant difference.Results:Out of 113 patients , sICH was detected in 12 (10.61%) whose mean age(58±12.0 years) and gender ratio ( 2:1 ) was not statistically significant from controls. In s ICH group mean NIHSS score was 16.53± 5.81 vs 10.19± 5.06 in controls (p<0.001), gap between stroke onset and thrombolysis was 227.50±46.15 min vs 178.50± 69.20 min in controls(p=0.018). At presentation mean blood sugar was 208.75±90.97 mg/dl in sICH group vs 146.83±70.21 mg/dl in controls (p=0.002). Prior diabetes was in 7(53.30%) vs 23 (22.8%) in controls (p= 0.014)and hypertension in 11 (91.7%) vs (56(55.4%) in controls (p= 0.026) The mortality in sICH was 7 (58.30%)vs 4 (4.94%) in controls (p<.0.001). At 3 months mean mRS ofsICH patients was 5.57± 0.54 vs 2.17± 1.69 in controls (p<.05).Conclusion:High NIHSS score, increased stroke onset to thrombolysis time , high blood sugar at presentation ,prior diabetes and hypertension increase the chances of sICH. None of these contraindicate thrombolysing strokes but should caution the physician.
Background:Intrasinus thrombolysis (IST) is believed to improve outcome in patients of cerebral venous sinus thrombosis (CVST) unresponsive to heparin.Purpose:The purpose of this article is to describe our experience with IST in patients of CVST unresponsive to heparin.Materials and Methods:Hospital databases were searched, and patients with CVST who underwent IST from May 2011 to March 2014 were identified. Data on clinical presentation, duration of symptoms, and indications and dosage of IST were retrieved and outcomes analyzed.Results:Twenty-four patients received IST. The presenting symptoms included headache (n = 19), seizures (n = 16), and altered sensorium (n = 14); signs included papilledema (n = 20) and hemiparesis (n = 15). Nineteen patients received unfractionated heparin (UFH), four received low-molecular-weight heparin (LMWH), and one received both. In one patient, microcatheter could not be passed, two patients bled intracranially, and three had nonintracranial bleeds. Among four deaths, none was due to iatrogenic bleeding. On discharge, 10 patients (43.5%) had good improvement with the modified Rankin Scale (score; mRS) ≤2 and eight (34.8%) had partial improvement with mRS = 3, 4. Seventeen patients (73.9%) had mRS ≤2 at 6 months follow-up. Bleeding complications of urokinase were less than those of alteplase. Recanalization of the involved sinuses was achieved in all. Early intervention led to successful recanalization. Functional recanalization decreased intracranial bleeding.Conclusion:Till date, our study is the largest series of IST in CVST reported from India. IST may be more effective than systemic heparin anticoagulation in moribund and unresponsive patients despite the potential for bleeding manifestations. Functional recanalization is adequate for good results. However, a randomized prospective study comparing heparin anticoagulation with IST is warranted.
We report an HIV patient aged 38 years with acute inflammatory demyelinating polyradiculoneuropathy subtype of Guillain-Barré syndrome (GBS) as the only manifestation of seroconversion and worsening of GBS being the harbinger of immune reconstitution inflammatory syndrome (IRIS). To date, only 5 cases of GBS during IRIS are reported. They manifested either during the third week or later after starting highly active antiretroviral therapy (HAART). Our patient witnessed worsening weakness by fifth day after starting HAART, even before the occurrence of pneumonia, cautioning one of the impending serious complications of IRIS and helped us initiate steroids at an early date.
Background: Scoliosis refers to deviation of spinal alignment in three dimensional planes. In response to functional demands Muscle fibers change in motor unit function. Knowledge of difference in muscle fiber activity in functional situations allows us to plan curve specific effective physical therapy.
Methodology: All study subjects were categorised based on Rigo Classification and assessed for para spinal muscle activity by Surface Electro Myography at cervical, thoracic, lumbar, concave- convex sides of apex and lumbar /lumbo sacral regions of spine in general sequence and curve specific sequence.
Results: Total number of subjects were 25 (16 female and 9 male). Age ranging from 12 to 39 years and Risser from 1-5. Overall maximum amplitudes recorded in antigravity positions. Amplitudes of as low as (M±σ = mean± standard deviation) M±σ: 0.92±0.79µv to M± σ: 1411.6±734.9µv were found.
Conclusion: Differences in right and left paraspinal activity was observed in general and specific sequences, but this difference was not consistent in general and specific sequence surface electro myography. Maximum amplitudes found at lumbar and lumbo sacral regions on antigravity positions than other positions. Convex side has more activity than concave sides at apex regions. Differences were not similar in all positions, this difference in left and right side was varying with curve type and type of movement. Results of paraspinal activity may be used for planning of suitable exercises after achieving best possible correction in sagittal and frontal planes.
Key words: Paraspinal muscle activity differences, idiopathic scoliosis, deviation of spinal alignment.
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