Childhood posterior circulation arterial ischemic stroke – An unusual case with a possible COVID-19-related arteriopathy

Viral infections are known to increase predilection to stroke and coronavirus disease 2019 (COVID-19) has proven these concerns true. We are presenting the case of a 6-year-old previously normal male child diagnosed with posterior circulation stroke who had all etiological workups negative except for the COVID antibody. Imaging showed thrombi over the V3 segment of the vertebral artery at C1–C2 level causing near complete occlusion, with embolic infarct in the bilateral posterior inferior cerebellar artery, bilateral posterior cerebral artery, bilateral anterior inferior cerebellar artery, and the left superior cerebellar artery. The child was managed with methylprednisolone, anticoagulation, and supportive care and was able to restore near-normal neurological status within months. This case is unique in terms of the involvement of posterior circulation which is rare in the pediatric population. A possibility of inflammation-related arteriopathy secondary to infection should be considered in the etiological workup of stroke. Anti-inflammatory measures to control cytokine storm along with supportive care will ensure a good outcome.

Cardiac catheterization at civil hospital Karchi three years experience

In this study we have done retrospective analysis of coronary angiographies performed during 3 years at the Cardiology Unit of Civil Hospital, Karachi; from 1st January 1996 to 31st December 1998. The aim was to evaluate incidence of the vessels involved in Pakistani population and to identify the gender pattern with peak age for expression of disease. Total of 233 cases were studied, out of which 200 were males and 33 females [ratio = 6:1], with significant sex difference. Mean age for males was 51 years and for females 55 years. Disease was present in total 200 patients, with 179 males and 23 females [7.8:1]. Single vessel involvement was present in 30 males and 9 females [3.3:1], 2 vessel disease [VD] in 49 males and 8 females [6:1], 3VD in 103 males and 6 females [17:1]. Coronaries were normal in 33 cases of which 23 were males and 10 females [2.3:1]. The overall positivity of test was 85.8%. It is concluded that, there has been gradual increase in yearly test performed, with small but significant increase in percentage of abnormal test. 3VD is seen in 40 to 50% patients each year, followed by 2VD in 21 to 23% and single VD in 14 to 21% cases. Normal coronaries witnessed in 13 to 17% in our study. Thus coronary angiography is a time honoured predictor to detect the number, site and extent of coronary vessels involved