Camel-Hump T-Wave, Tee-Pee Sign, and Wavy Triple Sign (Yasser’s Sign) with Hypocalcemia and Hyperkalemia in Covid-19 Pneumonia with Lacunar Infarction

Rationale: A novel COVID-19 is a multi-systemic critical worldwide pandemic infection. Certainly, associated multiple electrolytes imbalance in COVID-19 pneumonia is a remarkable decisive event. Camel-hump T-wave, Tee-Pee sign, and Wavy triple sign (Yasser’s sign)are novel highly significant descriptive electrocardiographic signs that are seen in calcium and potassium disturbance. There is an established and strong relationship between and electrocardiographic abnormalities and electrolytes imbalance. COVID-19 pneumonia and cerebrovascular stroke are commonly seen in a patient with Coronavirus infection. Patient concerns: A 69-year-old married worker Egyptian male patient was presented to the emergency department with COVID-19 pneumonia and cerebrovascular stroke. Diagnosis: COVID-19 pneumonia with lacunar infarction, hypocalcemia, and hyperkalemia. Interventions: Chest CT scan, brain CT scan, electrocardiography, oxygenation, and echocardiography. Outcomes: Initial bad and deterioration outcome but, the dramatic outcome had happened after later management. Lessons: The understanding of electrocardiographic signs regarding metabolic disorders such as electrolytes imbalance and other associated systemic diseases is very important. Elderly male sex, heavy smoker, COVID-19 pneumonia, cerebrovascular stroke, chronic renal impairment, ischemic heart disease, hypokalemia, hypocalcemia, and hypernatremia represent bad prognostic points and is indicating a high-risk condition.

Pontine demyelination as a late complication of resolved mild COVID-19 infection

Previous case reports have demonstrated COVID-19 related neurotropism. Neural infection may result from trans-lamina cribrosa invasion that allows COVID-19 to reach the brain through the olfactory tract. A wide range of symptoms from headaches, anosmia, dysgeusia to neuropathy, encephalitis, cerebrovascular stroke, and rarely demyelination has been reported. Here, we report a case of pontine demyelination causing generalized weakness as a rare neurological complication in a COVID-19 survivor. Our case highlights that even mild and moderate COVID-19 infection can have late neurological sequelae. Keywords: COVID-19, demyelination, neurological complications, corticosteroids

Prevalence of paroxysmal atrial fibrillation in patients with cerebrovascular stroke of undetermined etiology

Background cerebrovascular stroke is major cause of morbidity and disability. Many causes may contribute to its presence, however. Some patients have none of the identified risk factors, yet face the consequences of stroke or transit ischemic attack. This type of stroke known to be stroke of undetermined source or etiology. It has a high rate of recurrence due to the persistence of the unknown etiology. Paroxysmal atrial fibrillation remains the hidden bottom of an iceberg representing a major part of the causes of ischemic cerebrovascular stroke of undetermined etiology . Aim and Objectives: to determine the prevalence of subclinical atrial fibrillation in patients with ischemic cerebrovascular stroke of undetermined etiology in a population in Egypt by 48h holter monitoring. Patients and Methods Patients diagnosed with acute cerebrovascular stroke of undetermined etiology at the neurology department of Ain Shams university hospitals underwent 48 hours holter monitoring within the first week of the insulting event. Results This study included 50 patients with cryptogenic stroke (CS) who underwent 48 hours holter monitoring. The patients' ages ranged between 22 and 77 years old (mean age 48.46 ± 12.74years). This study included 34 males and 16 females. Their body mass index BMI ranges from 21-35 kg/m2, with mean BMI of 24.78 ± 2.99 kg/m2. Their left atrial diameter ranges from 26-47mm, with mean diameter of 36.08 ± 5.23mm .Eight out of fifty patients newly diagnosed with subclinical atrial fibrillation with prevalence of 16%. There was statistically significant association between the atrial fibrillation (AF) and both age (p value, 009) and left atrial (LA) diameter (p value, 001) .There was an associated finding that need further investigation about the significant association between the ventricular ectopic beat VEB burden and the presence of AF or stroke. Conclusion The prevalence of paroxysmal atrial fibrillation among the population of ischemic stroke of undetermined etiology in a population in Egypt is close to worldwide percentage and the recent met analysis studies of 11%.

Structural Magnetic Resonance Imaging Correlated with Motor Function of Upper Extremity in Patients with Chronic Stroke

Background Ischemic cerebrovascular stroke is defined as an acute neurological dysfunction caused by focal cerebral infarction after decrease in the blood supply of the brain either by stenosis or occlusion leading to gross physical impairment or disability lasting more than 24 hours. Objective To assess correlation between site of infarction and upper extremity ( UE) function in chronic stroke patients. Methodology A cross sectional study with (30) Patients with chronic ischemic stroke ( >3 months) suffering from persistent UE motor function impairment, MRI brain done to assess the site of infarction. UE motor function assessment using the Fugl Meyer Assessment (FMA-UE) Scale. Results The current study found that no significant correlation between the site of infarction and UE motor function. Conclusion We concluded that the site of infarction not correlated with UE motor function in chronic stroke patients.

Correlation of C-reactive protein with stroke severity in patients with acute ischemic cerebrovascular stroke.

Objective: To determine the correlation of mean serum C - reactive protein with frequency of stroke severity in patients with acute ischemic cerebrovascular stroke. Study Design: Descriptive Cross Sectional study. Setting: Department of Medicine, Allied Hospital Punjab Medical College Faisalabad. Period: March 2016 to September 2016 Material & Methods: Patients fulfilling the selection criteria were enrolled in the study. Besides routine laboratory tests, plasma CRP levels on admission were measured in all patients through hospital pathology laboratory. CRP levels were correlated with the results of NIHSS (National institute of health stroke scale) score based assessment of ischemic stroke severity at admission. Results: In our study, out of 50 cases of acute stroke, 62%(n=31) were male and 38%(n=19) were females, mean±sd for age was calculated as 46.82+8.65 years, mean CRP levels was calculated as 8.04+2.15mg/dL, mean NIHSS levels were calculated as 10.08+3. Correlation of mean serum C-reactive protein with frequency of stroke severity in patients with acute ischemic cerebrovascular stroke was calculated where r value was 0.9183 showing a strong positive correlation, which means that high CRP goes with high NIHSS (and vice versa). Conclusion: We concluded that CRP levels are positively correlated with the frequency of stroke severity in patients with acute ischemic cerebrovascular stroke.

CORRELATION AND CLINICAL SIGNIFICANCE OF CAROTID INTIMA MEDIA THICKNESS, HSCRP IN CEREBROVASCULAR STROKE

OBJECTIVE: CIMT and hsCRP are strongly related with cerebrovascular stroke.This study was done to evaluate patients with cerebrovascular stroke, correlation of hsCRP, carotid intima media thickness with outcome. METHOD:This study was an observational cross-sectional study. The study was conducted in the Department of Medicine, MLN Medical College and SRN Hospital, Allahabad .All individuals aged ≥18 years . Ethical Committee approval was taken from Institutional Ethics Committee. Patient of CVA with symptoms lasting for more than 24 hours and admitted within 72 hours after the onset of stroke were included in the study. Routine blood parameter including CBC, LFT, KFT, electrolyte, lipid prole was done. HbA1c, hsCRP, CT Head/ MRI brain, Carotid Doppler to assess intima media thickness. RESULT: Total number of CVAcases selected for study was 100,out of which 77patients (77%) had ischaemia and 23 (23%)patients had haemorrhage.Mean age of ischaemic patient was (60.69±13.05) and mean age of haemorrhagic group was 67.74±13.79.In haemorrhagic group CIMT>0.5 mm was present in 21 % cases and CIMT <0.5mm was seen in only 2 cases.This was statistically signicant.In ischaemic group CIMT>0.5mm was present in 73 % cases and CIMT<0.5mm was 4% cases. This was also statistically signicant .CIMT was signicantly higher in haemorrhagic group. In haemorrhagic group hsCRP>3 was present in 20 cases (20%) as compared to only 3 patients with hsCRP <3. This was statistically signicant. Mean hsCRP level was higher in haemorrhagic group as compared to ischaemic group this correlate with increased risk of stroke in cases with hsCRPIn ischaemic group GCS<8 had higher hsCRPlevel as compared to cases of ischaemic stroke with GCS >8.In haemorrhagic group GCS<8 had lower hsCRPlevel as compared to cases of haemorrhagic stroke with GCS >8. CONCLUSION: Carotid intima media thickness was higher in haemorrhagic group as compared to ischaemic group. Haemorrhagic group (82.6%) had low GCS compare to ischaemic group (35.05%) while cases with haemorrhage have more left ventricular diastolic dysfunction in comparison to ischaemic cases. Carotid intima media thickness, triglyceride and more left ventricular diastolic dysfunction was higher in haemorrhagic group

Predictors of the functional outcome after thrombolysis in an Egyptian patients’ sample

Background About 6.2 million individuals worldwide and approximately 200 Egyptians/100,000 citizens have cerebrovascular stroke annually, and only less than 1% of stroke patients received intravenous (IV) thrombolysis in 2014. Outcome of the ischemic stroke after IV thrombolysis varies, and there is lack of data about the predicting factors that contributes to the outcome of ischemic strokes after IV thrombolysis in Egypt. Objective The aim of this work is to study the predictors of the functional outcome of ischemic cerebrovascular stroke after IV thrombolysis in Egyptian patients. Patients and methods This is a prospective study that includes acute ischemic stroke patients who received IV thrombolysis at the Alexandria University Hospital during the year from February 2017 to February 2018, and they were evaluated initially by Rapid Arterial Occlusion Evaluation (RACE) scale and followed-up serially for 6 months after thrombolysis using the National Institutes of Health Stroke Scale (NIHSS) and modified ranking score (mRS). Results Forty-five patients are included; 56% had favorable functional outcome (mRS 0–2) after 6 months, 68% had ≥ 4 points improvement in NIHSS after 6 months, and 13% had hemorrhagic conversion with 18% mortality rate. High initial RACE scale and long hospital stay are associated with poor functional outcome 6 months after thrombolysis. Conclusion Stroke severity demonstrated by high initial RACE and the duration of hospital stay are the two most significant predictors with an impact on the functional outcome of ischemic cerebrovascular stroke after thrombolysis.