Pseudomelanosis of the upper gastrointestinal tract is a rare diagnosis of undetermined significance, most commonly affecting the duodenum. Endoscopically, it is characterized by dark spickled pigmentation . Its development has been linked to certain conditions and medications. Involvement of the stomach is extremely rare with very few cases reported in the literature to date. We report an 85-year-old male who is known to have type 2 diabetes mellitus, dyslipidemia, iron deficiency anemia, and chronic kidney disease who underwent an esophagogastroduodenoscopy for evaluation of upper gastrointestinal bleeding and was found to have gastric and duodenal pseudomelanosis confirmed by biopsy. It is an extremely rare benign condition, but metastatic melanoma has to be ruled out, as was done in this case.
Background
Intracranial atherosclerotic stenosis (ICAS) is one of the most common causes of stroke worldwide. This study aimed to analyze the demographic and risk factor profiles of ICAS in the Kingdom of Bahrain. The study population included 477 patients who were hospitalized in the Neurology Department from March 1, 2018, to September 1, 2020 because of acute ischemic stroke and underwent arterial brain imaging (CTA or MRA) examination during their hospitalization.
Results
Of 477 patients, 123 (25.7%) had ICAS. A history of stroke/transient ischemic attack was significantly higher in patients with intracranial stenosis (P = 0.012). Patients with ICAS had significant concurrent extracranial arterial stenosis (ECAS) (P = 0.00). In Bahraini patients, dyslipidemia was associated with a higher percentage of developing ICAS, but this was statistically nonsignificant (p = 0.06).
Conclusions
An independent and significant correlation was found between ICAS and stroke recurrence. In addition, a concurrent existence of ECAS and ICAS was noted.
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