BackgroundThe early hours after an acute stroke are crucial; early accurate prediction of outcome in stroke patients can help health system providers and families to choose appropriate lines of management and plan for the future. The aim of this work is to assess the role of hemorheological parameters (such as blood viscosity, hematocrit, platelet aggregation, and leukocyte count), protein C, protein S, antithrombin III, and serum albumin as predictors of stroke outcome.MethodsThirty subjects, 20 patients with acute ischemic stroke within 24 h from the onset and 10 normal subjects, were included in this case control study. Clinical, functional, and radiological evaluation was done for the patients, and all patients and control were subjected to routine laboratory tests and assessment of blood viscosity, hematocrit level, platelet aggregation, protein C, protein S, and antithrombin III.ResultsPlatelet aggregation was significantly higher and serum albumin was significantly lower in stroke patients compared to control (p value = 0.000 and 0.039) respectively. On comparing between patient with good and poor outcome, good outcome was associated with increased serum albumin level at admission (p value = 0.03) respectively. A significant negative correlation was found between total leukocyte count, hematocrit value, and stroke outcome (p value = 0.015 and 0.013) respectively. Only albumin was found to be a significant predictor for outcome by linear regression analysis.ConclusionSerum albumin, hematocrit level, and total leukocyte count at the time of presentation of ischemic stroke are useful markers for stroke outcome.
Non-convulsive Status Epilepticus (NCSE) is an under reported, treatable cause of coma and has variety of clinical and EEG presentations. It is defined as a mental status with changes from base line of at least 30 -60 minutes duration associated with continuous or near continuous ictal discharges on EEG [1].Stroke is known to be a common risk factor for status epilepticus (SE) in adults [2,3] and has been reported in 22-32% of cases in different studies [4,5]. Recent studies have found slightly higher rates such as 14-27% in patients with cerebrovascular disease [6][7][8] and 17% in patients with intracerebral hemorrhage [9]. Nonconvulsive Status Epilepticus (NCSE) was originally described in patients with chronic epilepsy, but it's now recognized with increased frequency in other patient populations, especially the critically ill. The International League Against Epilepsy (ILAE) defines status epilepticus as a condition resulting either from the failure of the mechanisms responsible for seizure termination or from the initiation of mechanisms that lead to abnormally prolonged seizures [10].Nonconvulsive status epilepticus is surprisingly common, occurring in 8-10% of comatose patients in intensive care units [1,11] and in 37% of patients with unexplained alteration of consciousness [12]. Other studies showed that in the Neurologic Intensive Care Unit, up to 34% of patients undergoing EEG monitoring have nonconvulsive seizures (NCS), and 76% of these cases are nonconvulsive SE [13]. Even after excluding all patients
Neurological and psychiatric symptoms are common presentations, but are often ignored in fresh salted gray Mullet fish intoxication. We report 2 patients with chronic renal failure at a predialyzed stage who developed refractory status epilepticus after ingestion of putrid salted gray Mullet. We warn consultant neurologists that fresh salted gray Mullet fish intoxication must be considered when patients with chronic kidney disease present with seizures or other unexplained neurological or psychiatric symptoms.
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