Risk Factors, subtypes and outcome of ischaemic stroke in Kuwait - A hospital-based study

To report on stroke subtypes, associated risk factors and outcome in Kuwait. The records of 62 patients [30 male, 32 female] admitted with diagnosis of stroke to Kuwait Oil Company Hospital, Kuwait, a tertiary care hospital, during a 5-year period [1995-1999], were retrospectively reviewed. Small artery infarction was the most common subtype and occurred in 37 subjects [59.7%]; less common were atherosclerotic large artery strokes [19 patients, 30.6%] and strokes of cardio-embolic origin [6 patients, 9.7%]. Identifiable risk factors or associated morbidities were hypertension [72.5%], diabetes mellitus [69.4%], ischaemic heart disease [14.5%], history of migraine [8.1%], lone atrial fibrillation [5.0%], and valvular heart disease [1.6%]. The most important determinants of a deleterious 30-day outcome, as indicated by severe disability or death, were female gender, lack of use of anti-platelet drugs, presence of a large artery infarction stroke subtype, and cardio-embolic stroke. Prevalence of hypertension and diabetes is high among patients with stroke in Kuwait, with rates higher than those found in any previous reports from the Gulf region. Two unusual observations were that women had a rather high frequency of stroke, and infarction of the small artery was more common than that of the large artery. Outcome, as indicated by severe disability or death, was worse among women, elderly patients, and those with large artery atherosclerotic and cardio-embolic strokes. There is some evidence that such a deleterious outcome might be ameliorated with use of anti-platelet drugs

Treatment related fluctuation in a case of Guillain Barre Syndrome after plasma exchange

A patient with Guillain-Barre syndrome, who improved after initial treatment with plasma exchange, experienced a relapse of two functional grads 16 days after the completion of treatment. Subsequent treatment with a combination of plasma exchange and intravenous immunoglobulins led to a rapid clinical improvement. The patient experienced complete recovery within 2 months of the treatment