Subacute sclerosing panencephalitis (SSPE) is a well-known childhood disease; however, the adult onset of SSPE cases are also widely recognized where the oldest case reported is 52 years old. We report a 61-year-old woman patient presenting with atypical clinical and EEG features, diagnosed with SSPE. Measles and SSPE have decreased dramatically owing to worldwide immunization programs; however, there are still reasons to consider SSPE in differential diagnosis even in patients presenting with atypical clinical findings and older ages. First, there is a generation who missed the immunization era, constituting a latent disease pool. Second, antivaccination movements have led to a decline in MMR (measles, mumps, rubella) vaccination worldwide, leading to measles outbreaks and potential future SSPE cases. Third, most of the vaccination programs start measles immunization at the age of 12 months, leading to a shift in the incidence below the age of 1 year, when the risk of developing SSPE in adult life is higher. Finally, disruption in vaccination programs, in which fast disease transmission due to close contact living, unhygienic conditions of refugee camps, and limited access to health care in displaced populations have also led to measles outbreaks. In conclusion, we believe that neurologists for adults should consider SSPE in differential diagnosis, even in older patients with atypical presentations.
Öz Çin'in Wuhan eyaletinde Aralık ayında başlayan yeni bir korona virüs salgını (Corona virüs hastalığı-2019, Covid-19) doğrulandı ve virüs tüm Dünya'ya yayılarak güçlü ve ciddi bir pandemi oluşturdu. Covid-19'a bağlı görülen ateş, öksürük, solunum sıkıntısı, ishal, yorgunluk gibi semptomlar tipik klinik bulguları oluşturmaktadır. Bazı hastalarda ise baş ağrısı, dizziness, bilinç bozukluğu, ensefalit, ensefalopati, serebrovasküler hastalıklar, periferik sinir sistemi hasarları gibi nörolojik bulguların saptandığı bilinmektedir. Bu hastaların bir kısmında beyin omurilik sıvısında virüs izole edilmiştir, bir vakanın postmortem beyin biyopsisinde SARS-CoV-2 ile uyumlu olabilecek virus partikülleri saptanmıştır. Bu derlemede Covid-19 ile enfekte hastalarda görülebilecek nörolojik belirti ve bulgular ve virüsün nöronal hasar yapabilme mekanizmaları tartışılacaktır.
Illicit drug use is an important cause of stroke in young adults and poses a serious public health problem. The use of psychostimulants such as cocaine and methamphetamine has been found to be associated with higher rates of stroke, and the risk of hemorrhagic and ischemic strokes increases through different mechanisms. In this report, we discuss the possible pathophysiological pathways of cerebrovascular damage in three patients using cocaine, methamphetamine, and cannabis.
Objective: The term ‘mild stroke’ is used to describe stroke patients
with a NIHSS score of 0 to 6. There is still no clear decision regarding
the application of iv recombinant tissue plasminogen activator (iv-tPA)
to patients who is admitted with an acute ischemic stroke and is in the
mild stroke category. In our study, we aimed to analyze the data of
patients who applied to our stroke center with an acute mild stroke
clinic and received iv-tPA treatment and their three-month follow-up.
Methods: A total of 47 (age 69.1 ± 14.1, 28 female) mild stroke patients
were included out of 350 patients receiving thrombolytic therapy.
Intravenous thrombolysis was initiated with a maximum delay of 4.5 hours
in all patients. Patients had a NIHS score less than 6. NIHSS scores
immediately before starting thrombolytic therapy and scores 24 hours
after treatment were recorded. Modified Rankin Scale scores (mRS) at
admission, 1 and 3 months were recorded. Results: NIHSS scores of the
patients who received tPA decreased significantly after the treatment (p
= 0.001). The patients’ 1st and 3rd month mRS scores were statistically
significantly decreased according to the mRS scores when they entered
the treatment (p = 0.001). Conclusions: This study highlights the
efficacy of iv-tPA in acute ischemic stroke patients with mild symptoms
and demonstrates the low risk profile of this therapy.
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