Digital subtraction angiography (DSA) is the gold standard investigation to assess the extracranial stenosis of carotid vessels. But this is an invasive diagnostic tool. So it is still a controversial issue whether duplex ultrasound is an alternative to DSA for measurement of stenosis of carotid vessels. This prospective crossectional observational study was conducted in the department of Neurology, BSMMU, Dhaka from May 2012 to April 2013 to assess the diagnostic accuracy of duplex ultrasound and its potential to replace DSA before performing carotid endarterectomy (CEA) and carotid stenting. Total of 38 patients, 33 patients of nondisabling ischaemic stroke and 5 patients with history of TIAs whose extracranial carotid stenosis was >50% on duplex ultrasound were selected for DSA. DSA was done on these vessels and stenosis was measured using NASCET criteria. Results of USD and DSA were compared to determine the sensitivity, specificity and accuracy of duplex ultrasound (USD). At 70% stenosis of right internal carotid artery and left internal carotid artery the sensitivity, specificity and accuracy were 93.8%, 63.7%, 89.5% and 93.3%, 75%, 89.5% respectively. This level of diagnostic efficiency of USD is less than that of DSA of carotid arteries. It was found in this study that, USD underestimates or overestimates the degree of carotid stenosis. DSA was safe and effective in determining stenosis in this study & there was no 67 complication. So before taking any decision for carotid endarterectomy or carotid artery stenting, digital subtraction angiography of carotid vessels should be done. DOI: http://dx.doi.org/10.3329/bmj.v43i2.21385 Bangladesh Med J. 2014 May; 43 (2): 67-71
Background: Anton’s syndrome is a rare syndrome characterised by denial of blindness by a patient who obviously cannot see. Visual anosognosia and usually caused by bilateral occipital infarct. Rarely caused by demyelination or haemorrhage.
Objective: The aim was to report a case of Anton’s syndrome due to bilateral occipito-parietal lobar haemorrhage following percutaneous coronary intervention due to myocardial infarction.
Methods: The case was thoroughly evaluated clinically then diagnosis was confirmed by CT scan of head showing bilateral occipito-parietal haemorrhage.
Result: The possible cause of bilateral lobar haemorrhage was due to use of Heparin during procedure and duel antiplatelet after percutaneous coronary intervention.
Conclusion: A suspicion of cortical blindness and Anton’s syndrome should be raised in patients with atypical visual loss and evidence of bilateral occipital lobe injury. Though infarction is the common cause but any other cause that leads to bilateral occipital damage like haemorrhage in this patient may cause this syndrome. Drug induced extensive intracerabral haemorrhage is difficult to manage in the setting of myocardial infarction.
Bangladesh Med Res Counc Bull 2021; 47(1): 98-100
Background: The extent of damage by ischaemic stroke and the course of illness depend largely on the presence of collateral vessels around the affected area. The Circle of Willis (CoW), which serves as an important potential collateral pathway in maintaining adequate blood flow around the brain, is known to have variable patency. So the completeness of CoW is expected to influence the severity of ischaemic stroke.
Objective: The objective of the study was to determine the association of completeness of Circle of Willis with severity of acute ischaemic stroke.
Methods: It was a cross-sectional study done in Bangabandhu Sheikh Mujib Medical University, Dhaka from March, 2015 to August, 2017. A total of 42 patients of acute ischaemic stroke who were undergoing Digital Subtraction Angiography (DSA) for different reasons were selected by purposive sampling method. Data regarding completeness of Circle of Willis were obtained from DSA. National Institutes of Health Stroke Scale (NIHSS) score were measured to assess the severity of stroke. Then the severities of stroke between the complete and incomplete Circle of Willis groups were compared.
Results: A total of 27 male and 15 female patients were enrolled. Among them, 47.6% (20) had complete CoW and it was incomplete in rest 52.4% (22). Median (range) of NIHSS scores of complete and incomplete CoW group was 4.5 (0-17) and 9.5 (3-21) respectively. Mean NIHSS (±SD) for the complete and incomplete CoW was
6.60 (±4.97) and 9.95 (±5.10) respectively. The difference of mean between the two groups was found to be statistically significant (p=0.037). Odd’s Ratio (OR) for development of more severe stroke in patients with incomplete CoW was 4.5, 95% Confidence Interval (CI) 1.18-18.13 which was statistically significant (p=0.029).
Conclusion: It was concluded that incomplete Circle of Willis is associated with more severe stroke in acute ischaemic stroke patients.
Bangladesh Med Res Counc Bull 2021; 47(2): 181-191
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