Hypoglycemic Hemiparesis Masquerading As Ischemic Stroke: When Guideline Fails

2020 ◽  
Vol 15 (4) ◽  
pp. 420-422
Author(s):  
Dhruvkumar M. Patel ◽  
Mukundkumar V. Patel ◽  
Jayanti K. Gurumukhani ◽  
Maitri M. Patel ◽  
Himal J. Mahadevia ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Neurological Deficit ◽  
Clinical Case ◽  
Complete Recovery ◽  
Acute Onset ◽  
Diabetic Patients ◽  
Focal Neurological Deficit ◽  
Random Blood Sugar ◽  
Resident Doctor

Background: Hypoglycemia may rarely present as hemiparesis and sometimes it is difficult to differentiate from ischemic stroke. When random blood sugar (RBS) value is between 50 and 80 mg % in patients presenting with focal neurological deficit, no guideline exists to consider the possibility of hypoglycemia before initiating thrombolytic therapy. Clinical Case: A 58-year-old male, who was a known case of diabetes and hypertension, was brought to the emergency room with acute onset of right hemiparesis and dysarthria of 90 minutes duration. His NIHSS Score was 9, blood pressure was 150/90 mm of Hg and RBS was 79 mg% on admission. His CT scan brain was normal and was considered for thrombolysis. Resident doctor not aware of previous sugar repeated RBS before thrombolysis which was surprisingly 60 mg% 60 minutes after the first RBS. Even though he was a candidate for thrombolysis, intravenous 25 % dextrose was administered considering the possibility of hypoglycemia. He made a complete recovery within 20 minutes and thrombolytic therapy was withheld. : In Diabetic patients with focal neurological deficit and RBS less than 80 mg% on admission, RBS should be rechecked and in appropriate cases should be challenged with IV dextrose considering the possibility of hypoglycemia before commencing thrombolytic therapy.

scholarly journals Clinical Features, Risk Factors and Hospital Mortality of Acute Stroke Patients

2020 ◽  
pp. 9-14
Author(s):  
Mahfuj-Ul Anwar ◽  
Sajeda Afrin ◽  
ASM Rahenur Mondol ◽  
Mohammad Nurul Islam Khan ◽  
Narayan Chandra Sarkar ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Patient ◽  
Neurological Deficit ◽  
Hemorrhagic Stroke ◽  
Acute Onset ◽  
Stroke Patients ◽  
Focal Neurological Deficit ◽  
Alteration Of Consciousness ◽  
Acute Hemorrhagic Stroke

Background: Stroke is a leading cause of mortality and disability worldwide. To prevent complications and permanent defects, early diagnosis, distinguishing the type and risk factor of stroke is crucial. Methodology: It was a hospital based cross sectional study, purposive sampling method was used, and a total of 469 stroke patients admitted into Department of Medicine, Rangpur medical college hospital, Bangladesh were included in this study. Results: In this study we have studied of 469 acute stroke patients. Among them 81% (380) were ischemic stroke patients and 19% (89) were hemorrhagic stroke. Overall male were more than female 308 (65.7%) vs 161(34.4%). The mean age for the ischemic stroke group was 64.1 ± 10.9 years, which was significantly higher than that of the hemorrhagic group (59.8 ± 9.60years) (P<0.05). Acute hemorrhagic stroke patients presented with acute onset of focal neurological deficit 61.8%, headache 64%, vomiting 59.6%, alteration of consciousness 48.3% and convulsion 27%. On the other hand, acute ischemic stroke patient presented with alteration of consciousness 65.5%, acute onset of focal neurological deficit 39.5%, paralysis 41%, deficit after awakening 32.4% and aphasia 34.7%. Among the risk factors of stroke in acute ischemic stroke patients hypertension was 59.2%, diabetes mellitus 20%, history of previous stroke 16.1%, ischemic heart disease 14.5% and atrial fibrillation 10.3% were present, on the other hand in acute hemorrhagic stroke patients hypertension 76.4%, smoking 70.8% and diabetes mellitus 6.7% were present. 26.97% of the acute hemorrhagic stroke and 13.9% of the acute ischemic stroke patients died in hospital. Conclusion: Common presentation of stroke was acute onset of focal neurological deficit; headache and vomiting were more in hemorrhagic stroke patient; alteration of consciousness, paralysis was predominant in ischemic stroke patient.

scholarly journals Effect of mexidol on the efficiency of intravenous thrombolytic therapy for ischemic stroke during the therapeutic window

2018 ◽  
Vol 10 (3) ◽  
pp. 86-90 ◽  
Author(s):  
K. S. Knni ◽  
T. V. Dyomin ◽  
L. B. Adeeva
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Neurological Deficit ◽  
Time Course ◽  
Neurological Status ◽  
Therapeutic Window ◽  
X Ray Computed ◽  
The Republic ◽  
Severity Of The Disease ◽  
Positive Effect

Objective: to evaluate the effect of intravenous mexidol on the efficiency of intravenous thrombolytic therapy (TLT) during the therapeutic window. Patients and methods. The retrospective study enrolled 123 patients with ischemic stroke (IS) who had undergone intravenous TLT in the vascular centers of the Republic of Tatarstan. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the time course of changes in their neurological status. According to the baseline severity of a neurological deficit, all the patients were divided into three subgroups: 1) mild IS (<8 NIHSS scores at admission); 2) moderate IS (>8 scores); and 3) severe IS (<16 scores). All the patients underwent X-ray computed tomography at admission, at 24 hours after TLT, and in case of worsening of their health status. Results. The prehospital use of mexidol followed by TLT in patients with IS had a positive effect on the regression of neurological deficit regardless of the severity of the disease. There were significant differences in the degree of regression of neurological deficit according to NIHSS at 24 hours and 10 days after hospital admission in patients with severe IS, who received intravenous mexidol at the prehospital stage and who did not take this drug before TLT. The pre-TLT use of mexidol contributed to higher regression of neurological deficit. There was a lower frequency of hemorrhagic transformations in the patients who used mexidol at the prehospital stage versus those who did not. Conclusion. The findings demonstrate the positive effect of mexidol on the efficiency and safety of TLT in patients with IS.

scholarly journals Be-Fast Faster and Fastest

2019 ◽  
Vol 1 (1) ◽  
pp. 7-10
Author(s):  
Karuna Tamrakar
Keyword(s):  
Ischemic Stroke ◽  
Neurological Deficit ◽  
Critical Time ◽  
Recombinant Tissue Plasminogen Activator ◽  
Reperfusion Therapy ◽  
Time Frame ◽  
Large Artery ◽  
Vessel Occlusion ◽  
Focal Neurological Deficit ◽  
Undetermined Etiology

Annual incidence of stroke is 2.5%/1000 people or 200000 stroke /year. Every 5 seconds undergo stroke all over the world. 15-20 % die in first month of brain attack and 75% lives with focal neurological deficit. Ischemic stroke is the most common (85%) after hemorrhagic stroke and subarachnoid hemorrhage (15%). Among all 5 subtypes, large artery atherosclerosis, cardio embolism, small vessel occlusion, stroke of other determined etiology, undetermined etiology, ischemic stroke carries poor prognosis of increasing morbidity and mortality. Window of opportunity is a critical time that need to be addressed to reverse neurological stroke symptoms either partially or completely through active interventional approaches either noninvasive or invasive methods. Thrombolysis has radically changed the prognosis of acute ischemic stroke. Intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) is effective in reducing the neurological deficit. Time is brain, either you be fast or faster and fastest, early or timely reperfusion therapy within a time frame of 4.5 hours helps to restore normal neurological function.

scholarly journals Neurocysticercosis presenting as a ‘Stroke Mimic’

2016 ◽  
Vol 15 (2) ◽  
pp. 79-83
Author(s):  
Aimee Rowe ◽  
◽  
Reza Ghasemi ◽  
Rajiv Shah ◽  
Pradhib Venkatesan ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Neurological Deficit ◽  
Ct Scanning ◽  
Complete Recovery ◽  
Sensory Loss ◽  
Mri Scan ◽  
Focal Neurological Deficit ◽  
Brain Ct ◽  
Acute Infarction ◽  
Stroke Mimic

A 62 year old Nepalese gentleman presented with left sided weakness and sensory loss. Initial brain CT scanning was suggestive of acute infarction but a subsequent MRI scan showed cysts with oedema. Cysticercosis serology was positive and a diagnosis of neurocysticercosis was made. The patient made almost a complete recovery after treatment with albendazole, praziquantel and steroids. Neurocysticercosis should be considered in the differential diagnosis when patients originating from endemic areas present with focal neurological deficit.

scholarly journals THE EFFICACY OF COMBINED NEUROPROTECTION IN MOTOR AND COGNITIVE RECOVERY FOLLOWING THE ACUTE PHASE OF ISCHEMIC STROKE

2019 ◽  
Vol 33 (4) ◽  
pp. 131-135
Author(s):  
A. E. Shoboev ◽  
I. M. Balkhayev
Keyword(s):  
Ischemic Stroke ◽  
Retrospective Analysis ◽  
Acute Phase ◽  
Functional Recovery ◽  
Neurological Deficit ◽  
Cognitive Status ◽  
Modified Rankin Scale ◽  
Focal Neurological Deficit ◽  
Clinical Indicators ◽  
Acute Period

The clinical efficacy of combined neuroprotection with citicoline and cortexin in the acute period of ischemic stroke is discussed in the paper. A retrospective analysis of 127 cases with a primary ischemic stroke was carried out. For unbiased evaluation of the severity of the condition, extent of the focal neurological deficit and the assessment of the dynamics in clinical indicators, the National Institute of Health Stroke Scale was used; the degree of functional recovery was assessed by the modified Rankin Scale; the cognitive status score was measured by the MMSE scale. The obtained data suggest the effectiveness of combined neuroprotection with cortexin and citicoline in the acute period of ischemic stroke in comparison with monotherapy.

Effect of age on outcome in patients with cerebral stroke

2020 ◽  
pp. 41-45
Author(s):  
G. R. Kuchava ◽  
E. V. Eliseev ◽  
B. V. Silaev ◽  
D. A. Doroshenko ◽  
Yu. N. Fedulaev
Keyword(s):  
Ischemic Stroke ◽  
Neurological Deficit ◽  
Neurological Status ◽  
Statistical Correlation ◽  
Multiple Organ ◽  
The Body ◽  
Social Adaptation ◽  
Cerebral Stroke ◽  
Septic Complications ◽  
Risk Of Death

The aim of the study was to assess the course and outcome of cerebral infarction, depending on the age factor and duration of stay in the neuroblock. Materials and methods: a dynamic observation of 494 patients, men and women, aged 38–84 years with acute ischemic stroke of hemispheric localization, which were divided into the three groups depending on age, was performed. Group 1 – younger than 60 years old, group 2–60–70 years old, group 3 – older than 60 years. All patients underwent standard therapy, according to the recommendations for the treatment of ischemic stroke. The patients underwent comprehensive clinical and instrumental monitoring, which included assessment of somatic and neurological status according to the NIH‑NINDS scales at 1st, 3rd, 10th days and at discharge or death; assessment of the level of social adaptation according to the Bartel scale on 1st, 3rd, 10th days and at discharge, clinical and biochemical blood tests, computed tomography of the brain. Assessment of the quality of therapy was carried out according to specially developed maps using methods of statistical correlation analysis. Results: the most pronounced positive dynamics of neurological status was in the 1st group of patients. The regression of neurological deficit in the 2nd group was worse. The minimal dynamics of neurological deficit was in the 3rd group of patients with cerebral stroke. Most often, the death of patients with cerebral stroke occurred from the development of multiple organ disorders. Conclusions: patients over 70 years of age have the greatest risk of death, due to: a decrease in the reactivity of the body, the presence of initially severe concomitant somatic pathology in patients with admission to hospital; accession of secondary somatic and purulent‑septic complications.

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