Truncal pulsion in acute ischemic stroke – Clinico-anatomical correlation

Context: Truncal pulsion is a compelling sensation of being pulled to one side, in the context of normal motor and sensory functions and normal co-ordination. It is seen in a variety of ischemic strokes. Aims: This article aims at identifying ischemic stroke syndromes associated with truncal pulsion, with review of the neural substrate responsible, to help in recognition and reporting. Settings and Design: This was a prospective study conducted at Department of Neurology, at Pushpagiri institute of medical sciences and research centre, Thiruvalla, Kerala, India, over a period of 5 years, among patients with acute ischemic stroke. Methods and Material: We studied all patients with acute ischemic stroke, who were admitted to our department, over a five-year period. Patients presenting with truncal pulsion were shortlisted and were assessed by investigators independently. All patients underwent MRI brain, which was assessed by investigators 1 and 2, independently. The demographic profile, risk factors, clinical features, neuroimaging findings and outcomes were analysed using SPSSv21. Results: A total of 1456 patients with acute ischemic strokes were identified, of which 27 with truncal pulsion were included in the study. The common sites of infarction resulting in truncal pulsion were lateral medulla, cerebellum, thalamus, pons and midbrain. One patient had infarct involving anterior cingulate. Truncal pulsion was ipsilateral in infarcts involving medulla and cerebellum and contralateral in infarcts involving the pons, midbrain, mesencephalo-diencephalic junction, thalamus and cingulate. Conclusions: Truncal pulsion, a compelling sensation of falling, is a disabling symptom occurring in a variety of strokes and it poses significant challenge in neuro-rehabilitation.

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Clot composition of embolic strokes of undetermined source: a feasibility study

BMC Neurology ◽

10.1186/s12883-020-01969-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Amre Nouh ◽

Tapan Mehta ◽

Mohamed Hussain ◽

Xianyuan Song ◽

Martin Ollenschleger

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

National Institutes Of Health ◽

Carotid Dissection ◽

Stroke Patients ◽

Stroke Etiology ◽

The Mean ◽

Undetermined Etiology ◽

A Prospective Study

Abstract Background A number of emerging studies have evaluated clot composition in acute ischemic stroke. Studies of clot composition of embolic strokes of undetermined strokes are lacking. Objectives We sought to analyze the RBC to platelet ratios in clots and correlated our findings with stroke etiology. Methods This was a prospective study analyzing clots retrieved by mechanical thrombectomy in acute ischemic stroke patients at our institution. All clots were stained and scanned at 200x magnification by using a Scanscope XT digital scanner (Apergio, Vista, California). Image-J software (National Institutes of Health, Bethesda, Maryland) was used for semi quantitative analysis of percentage RBC’s and platelets. Unpaired t-test was used to compare means of RBC to Platelet ratios. Correlation of RBC to Platelet ratios with stroke etiology was performed. Results A total of 33 clots from 33 patients were analyzed. Stroke etiology was undetermined in 6 patients, cardioembolic in 14, large vessel atherosclerosis (LVA) in 9, and carotid dissection in 4. The mean RBC to platelet ratio was 0.78:1 (+/− 0.65) in cardioembolic clots, 1.73:1 (+/− 2.38) in LVA and 1.4:1(+/− 0.70) in carotid dissections. Although patients with undetermined etiology had a similar clot composition to cardioembolic stroke (0.36:1+/− 0.33), (p = 0.19), it differed significantly from LVA and dissections respectively (p = 0.037, p = 0.01). Conclusion In our study, a low RBC to Platelet ratio was found among patients with embolic strokes of undetermined source, however shared similar characteristics with cardioembolic thrombi. Ongoing collection and analysis is needed to confirm these findings and its significance in evaluating stroke etiology.

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An acute ischemic stroke after multiple bee stings in an elderly patient

Asian Journal of Medical Sciences ◽

10.3126/ajms.v4i2.7892 ◽

2013 ◽

Vol 4 (2) ◽

pp. 55-58

Author(s):

Niranjan Mambally Rachaiah ◽

Rajashekar Hirisave Kalegowda ◽

Rashmi Bhadravathy Krishnaswamy

Keyword(s):

Computed Tomography ◽

Elderly Patient ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Neurological Complications ◽

Neurologic Deficit ◽

Allergic Reactions ◽

Medical Sciences ◽

Wasp Stings ◽

Focal Neurologic Deficit

Although bee stings can cause local and systemic allergic reactions, neurological complications are rare. There are few reports of stroke following bee or wasp stings. We report a 70-year-old healthy man developed a focal neurologic deficit 5 hours after multiple bee stings, which was confirmed to be an acute ischemic stroke on computed tomography (CT) scan.DOI: http://dx.doi.org/10.3126/ajms.v4i2.7892Asian Journal of Medical Sciences 4(2013) 55-58

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Clinical analysis of first-ever acute ischemic stroke involving the territory of paramedian mesencephalic arteries

Open Medicine ◽

10.2478/s11536-007-0001-y ◽

2007 ◽

Vol 2 (1) ◽

pp. 37-46 ◽

Cited By ~ 1

Author(s):

Peterus Thajeb ◽

Teguh Thajeb ◽

Dao-Fu Dai

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Age Of Onset ◽

Clinical Analysis ◽

Clinical Triad ◽

One Year ◽

Associated Risk Factors ◽

A Prospective Study ◽

Bilateral Lesions

AbstractTo determine one-year clinical outcome of patients with first-ever acute ischemic stroke involving the territory of paramedian mesencephalic arteries (PMAS), we conducted a prospective study evaluating the cognitive functions of 28 patients with PMAS. Neuropsychological tests were performed during the first month of stroke onset and at the 12th month of follow-up. There were 12 women and 16 men. Mean age of onset for women and men was 70 years and 65 years, respectively. Progressing strokes occurred in 62% of patients and 96% developed a full-blown picture of the clinical triad of akinetic mutism, hypersomnolence, and bilateral blepharoptosis and ophthalmoparesis. Involuntary movements occurred in 6, and focal myoclonus in 4 patients. The top four associated risk factors were hypertension (68%), hyperlipidemia (57%), diabetes mellitus (46%), and atrial fibrillation (36%). Unilateral midbrain infarctions occurred in 12 patients and bilateral lesions in 16. Thalamic infarctions were unilateral in 10 and bilateral in 13 cases. Three of the 28 (11%) patients died of recurrent cerebral infarctions within 1 year of the onset of PMAS. The recurrent infarctions involved the basilar artery territory in two cases and the carotid system in another. One patient died of acute myocardial infarction. Of the 24 patients who had survived the stroke by 1 year, 20 (71%) developed dementia. We conclude that first-ever ischemic stroke with PMAS is not a benign syndrome. Most patients developed dementia by 1 year after the stroke.

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A Prospective Study to Assess the Safety and Effectiveness of Intra-Arterial Reteplase and Intravenous Abciximab in Patients with Acute Ischemic Stroke

Neurosurgery ◽

10.1227/01.neu.0000310215.33872.75 ◽

2006 ◽

Vol 58 (2) ◽

pp. 415

Author(s):

Adnan I. Qureshi ◽

Jawad F. Kirmani ◽

Nazli Janjua ◽

Ammar Alkawi ◽

Pansy Harris-Lane

Keyword(s):

Ischemic Stroke ◽

Prospective Study ◽

Acute Ischemic Stroke ◽

A Prospective Study

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FP18-TU-05 Outcomes of intravenous thrombolytic therapy for acute ischemic stroke with integrated acute stroke referral network at no prior experience hospital: a prospective study

Journal of the Neurological Sciences ◽

10.1016/s0022-510x(09)70360-0 ◽

2009 ◽

Vol 285 ◽

pp. S86

Author(s):

S. Muengtaweepongsa ◽

P. Dhammasaroja ◽

U. Kammark

Keyword(s):

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Prospective Study ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Prior Experience ◽

Referral Network ◽

A Prospective Study

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A Prospective Study of Deteriorating Acute Ischemic Stroke in NonThrombolysed Patients

Scholars Journal of Applied Medical Sciences ◽

10.36347/sjams.2020.v08i01.035 ◽

2020 ◽

Vol 08 (01) ◽

pp. 178-190

Author(s):

Srikumar B ◽

Dileep R ◽

Jayasree L ◽

Ram Mohan ◽

Deepthi S

Keyword(s):

Ischemic Stroke ◽

Prospective Study ◽

Acute Ischemic Stroke ◽

A Prospective Study

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Can High-Sensitivity C-Reactive Protein and Ferritin Predict Functional Outcome in Acute Ischemic Stroke? A Prospective Study

Topics in Stroke Rehabilitation ◽

10.1310/tsr2006-528 ◽

2013 ◽

Vol 20 (6) ◽

pp. 528-536 ◽

Cited By ~ 6

Author(s):

Aslihan Kusvuran Ozkan ◽

Oya Umit Yemisci ◽

Sacide Nur Saracgil Cosar ◽

Pinar Oztop ◽

Nur Turhan

Keyword(s):

Ischemic Stroke ◽

Prospective Study ◽

Acute Ischemic Stroke ◽

Functional Outcome ◽

High Sensitivity ◽

C Reactive Protein ◽

Reactive Protein ◽

A Prospective Study

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A prospective study of maternal and fetal outcome in repeat LSCS mother

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190979 ◽

2019 ◽

Vol 8 (4) ◽

pp. 1327

Author(s):

Pradeep Ganiga ◽

Shanthala Rudrappa

Keyword(s):

Fetal Outcome ◽

Research Centre ◽

Cesarean Sections ◽

Medical Sciences ◽

Singleton Pregnancy ◽

Intraoperative Complication ◽

Abdominal Operations ◽

Nicu Admission ◽

A Prospective Study ◽

Febrile Morbidity

Background: Cesarean section is one of the most commonly performed abdominal operations on women in most countries. The incidence of primary LSCS is increasing all over the world, Consequently, there is a rise in multiple repeat LSCS with associated complications. Previous LSCS is a common indication for repeat LSCS. Primarily, authors aim at studying the influence of repeat LSCS on maternal and fetal outcome in a tertiary centre.Methods: All mothers with one previous LSCS admitted for emergency/elective LSCS at term gestation with singleton pregnancy in A.J. Institute of Medical Sciences and Research centre, Mangalore were recruited in the study from July to December 2018. Detailed history with antenatal risk factors were noted. Intraoperative and postoperative events were noted. Neonatal outcome was also noted correlated.Results: Majority of patients (58%) were in age group of 20-24years. Most of them were between 38 to 39 weeks of gestation. Most common intraoperative complication was bladder adhesion (18% of cases). In postoperative period febrile morbidity (7%) was common followed by urinary tract infection (2%). Most of the neonates (80%) weighed 2.5 to 3kg at birth. The incidence of poor APGAR respiratory distress, NICU admission was not significantly increased. There were 5 morbidly adherent placenta, 1 scar rupture, 4 scar dehiscence, no maternal or perinatal death.Conclusions: Previous caesarean is the most common cause of repeat caesarean and is associated with maternal morbidity. Measures should be taken to reduce primary caesarean sections which indirectly reduces the incidence of repeat cesarean sections.

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