Prognostic indicators in cerebral venous sinus thrombosis

Cerebral venous sinus thrombosis [CVT] can affect all age groups, particularly women of childbearing age. Overall prognosis for survival and functional independence is better than it was believed. Mortality usually ranges from 6-15% and transtentorial herniation is the major cause of death. Approximately 80% of patients are functionally independent in the long term. Altered mental status and cerebral haemorrhage at presentation are the strongest predictors of death and disability. Patients with CVT related to pregnancy and puerperium generally do better than patients with other causes. Septic CVT carries a worse prognosis than aseptic CVT and of the latter, patients with syndrome of isolated intracranial hypertension have a better prognosis than those with focal deficits or encephalopathy. Anticoagulation is believed to improve outcome in CVT although robust data are lacking. Epilepsy, headaches, visual loss, pyramidal deficits and cognitive impairment are some of the long term sequelae. The risk of recurrence of CVT is low, particularly after the first 12 months of the first episode

Predictors pf ischemic versus hemorrhagic strokes in hypertensive patients

To identify the factors that predispose to ischemic versus hemorrhagic stroke in hypertensive patients. Cohort study. The study was conducted at the Aga Khan University Hospital [AKUH], Karachi, from August 1999 to May 2001. All the hypertensive patients, who were registered in AKUH acute stroke outcome data base, over a period of 22 months, were identified and from this cohort the patients with first ever stroke were selected. The data regarding demographics, stroke type [ischemic vs. hemorrhagic], pre-existing medical problems, laboratory and radiological investigations was recorded and analyzed. Five hundred and nineteen patients with either ischemic stroke or parenchymal hemorrhage were registered over a period of 22 months. Three hundred and forty-eight patients [67%] had hypertension and of these, 250 had first ever stroke at the time of admission. Presence of diabetes mellitus [OR: 3.76; CI: 1.67-8.46] and ischemic heart disease [OR: 6.97; CI: 1.57-30.98] were found to be independent predictors of ischemic strokes. Presence of diabetes mellitus and ischemic heart disease predict ischemic stroke in a patient with hypertension

Prognostic indicators in patients with primary intraventricular haemorrhage

Primary intraventricular haemorrhage [PIVH] is a rare clinical entity. We sought to evaluate risk factors, clinical and radiological features, and outcome of patients with PIVH. Cases of PIVH were identified from cohort of patients with non traumatic intracerebral haemorrhage [ICH] by reviewing the radiological data. Their charts were reviewed and demographic, clinical, radiological and laboratory data was recorded and analyzed. Chi square and t test were used to determine predictors of poor outcome. Fifteen of 677 [2%] patients with ICH had PIVH. Nine [60%] were men. Median age was 56 years. Predisposing factors included hypertension in twelve [80%], coagulopathy in five [33%] and vascular malformations in two [13%] patients. Eleven [73%] patients developed hydrocephalus. Two patients died. Univariate analysis identified diabetes mellitus, blood in all ventricles and coagulopathy as predictors of death during initial hospital stay and hydrocephalus as predictor of poor outcome [death and disability combined] [p<0.05]. Hypertension is most common associated risk factor for primary intraventricular haemorrhage followed by coagulopathy. Hydrocephalus is a common complication, associated with poor outcome. Diabetes mellitus, coagulopathy and panventricular blood predict early mortality