No abstract

The aim of this study is to show the result of aneurysm coiling despite the difficulty in initiating neurointervention in Nepal. It is a retrospective study where only aneurysm that has undergone coiling are taken from 2017 to 2018.A total of eleven patients (male: female = 1: 10) with aneurysm were treated with Endovascular therapy. 9 cases were ruptured aneurysm while 3 were unruptured. 5 aneurysm were located in anterior circulation while 6 were located in posterior circulation. Out of eleven cases 4 were treated by simple coiling technique, while 2 underwent balloon assisted coiling, 3 stent assisted coiling, 1 pConus assisted coiling and 1 simple coiling and stent assisted coiling. Statistical analysis showed significant correlation between fisher grading scale with mRS score (P=0.013) suggesting lower fisher grade, and improved outcome similar to the result of prospective one year follow up of Barrow Ruptured Aneurysm Trial ( BRAT) study. With limited resources aneurysm coiling was performed at ANIAS with similar results to literature.Nepal Journal of Neuroscience, Volume 15, Number 2, 2018, page: 30-35

Stroke is one of the leading causes of mortality and the number one cause of dependency in the world. Endovascular therapy has emerged as promising treatment strategy in the patient with acute ischemic stroke due to large vessel occlusion in anterior circulation. Moreover, the time window for mechanical thrombectomy have also been expanded based on the recent DAWN and DEFUSE-3 trial. It is evident that this trend could dramatically increase the number of potential patients for the treatment. Moreover, advancement in stroke imaging have guided physicians to make wisest decision in identifying suitable patient who can get benefit from the recent treatment strategies. The stroke management is evolving and continues to improve, making better outcome of the patient possible. In context of our country Nepal, it is also necessary to educate and aware medical staffs including physicians, nurses, laboratory/ radiology personnel to design a proper acute stroke team to deliver successful therapy which will eventually make a sound impact in a large number of patients with stroke. Herein, we report a case of a 69-year-old gentleman who presented with right middle cerebral artery territory infarction within 3hours of onset of symptoms and underwent mechanical thrombectomy as a part of the treatment.

No abstract

Introduction and importance Severe acute respiratory distress syndrome coronavirus 2 is the causative agent of COVID-19 (Coronavirus 2019) infection. Although symptoms are usually associated with the respiratory system, its neurological involvement should not be underestimated. The most common cerebrovascular complication following the infection is ischemic stroke however, CVST (Cerebral Venous Sinus Thrombosis) has been reported. Presentation of case We report a unique case of a young patient who had a history of headache and abnormal body movement immediately after COVID-19 infection. His brain Computed tomography scan and Magnetic Resonance Imaging (MRI) showed typical images of CVST. He was admitted and treated with Low Molecular weight heparin. Discussion CVST is a rare form of stroke which may have devastating complications. The diagnosis is clinically challenging due to its non-specific presentation like headache and altered sensorium alone. Inflammatory process and hypoxic state after the virus infection may favor the hypercoagulable state in CVST. Our patient did not have any other predisposing factor for a hypercoagulable state other than the COVID-19 infection.MRI and venography and computed tomographic venography are the preferred modalities. The Patient is generally treated with anticoagulation therapy. Conclusion High index of suspicion of CVST is necessary when a patient presents with unexplained neurological manifestation following a recent COVID-19 infection to prevent from life-threatening complications. Furthermore, clinicians should not underestimate the multisystem involvement of COVID-19.