Risk factors, mortality and recovery of stroke: a prospective study on 1000 patients

To determine whether a single or multiple risk factors have a relative significance on the mortality and morbidity of stroke and whether previous treatment of major risk factors like hypertension and diabetes mellitus had any positive influence on the clinical outcome. One thousand consecutive cases of acute stroke were included in this prospective descriptive study conducted at the Dept. of Neurology, Jinnah Postgraduate Medical Centre, Karachi from Dec. 1985 to July 1988. A special proforma was designed to collect all the relevant clinical information. Functional status was assessed by using the Barthel Index activity score. Scores obtained at admission were compared with the scores obtained at six weeks follow-up. The results were then analyzed in the background of various risk factors present. Similar observations were made in assessing the mortality. The pre-stroke treatment status of major risk factors like hypertension and diabetes mellitus was also studied. Of the 1000 cases, 61% were male and 39% female. Majority of the cases were in the age group 60-69 years. Hypertension [HTN] alone was present in 58.3% followed by diabetes mellitus [DM] 5%, ischemic heart disease [IHD] 1.3%, whereas in 19.8% HTN, DM, IHD were present in various combinations, 1.5% had Valvular Heart Disease [VHD] while 14.1% had none of the above risk factors. Six-weeks follow-up was available on [673/1000] 67% cases. Gross mortality was 59% [396/673]. Higher mortality was seen in cases with Glasgow Coma Scale [GCS] range 3-9/15. Risk factor profile in fatal cases showed that 221/379 [58%] had HTN, 21/ 32 [65%] had DM, 6/12 [50%] had IHD and 6/10 [60%] had Valvular heart disease [VHD]. Some patients had multiple risk factors, among those 60/95 [63%] had HTN + DM, 19/41 [46%] had HTN + IHD, 5/7 [71%] had DM+ IHD, 11/16 [68%] had HTN + DM + IHD while 47/81 [58%] had none of the above risk factors. Relative influence of individual risk factor or in combination was not statistically significant. The functional recovery showed no significant relative difference among patients with different risk factors. There was no significant difference in the outcome among treated and untreated hypertensive and diabetic patients. Individual or multiple risk factors do not have a relative influence on the higher morbidity and mortality in stroke. For poor prognosis severity of stoke at onset is more important than the type of risk factors. Furthermore, there was no difference in outcome in patients who got pre-stroke treatment compared to those who had no treatment

Migraine: Comorbidity with depression

To identify and see impact of coexisting depression in diagnosed cases of migraine. Hospital-based case-control study. Department of Neurology, Jinnah Postgraduate Medical Centre Karachi. Patients of all ages and both sexes attending neurology OPD at JPMC between October 1998 to October 1999 were included. International Headache Society criteria for diagnosis of migraine and Urdu version of Hospital Anxiety and Depression Scale for diagnosis of depression was used. Migraine with Depression cases [MWD] were compared with Migraine without depression as controls [MC]. Duration and frequency of migraine, co-morbidity with depression. Out of 100 migraineurs, 40 were MWD and 40 MC were taken from the remaining 60 migraineurs. Among MWD and MC females were common: 72%[29] and 78%[31] respectively. Of the females MWD, most of the patients belonged to the age group 31-40years; 52%[15] patients, compared to MC where age group 21-30 years; 58%[18] was common. Among the males, maximum number of migraineurs belonged to the age groups of 22-30 years for both MWD and MC i.e. 46%[05] and 56%[05] respectively. Fifty percent of MWD reported having migraine attacks for 10 or more years, whereas only 18% of MC had the similar duration. [P-value =<0.01]. Ninety percent [n=36] of MWD reported maximal disability during the headache as compared to the 62.5%[25] of MC. 62.5%[25] of MWD had an average frequency of 4 or more attacks per month compare to 55%[22] of MC having once per month or less. [P-value =0.001]. Migraineurs with long history and high frequency might benefit from psychiatric evaluation and addition of antidepressant drugs to their therapeutic regimen

Influence of steroid hormones in women with mild catamenial Epilepsy

In view of considerable differences of opinion regarding the reproductive steroid hormonal pathogenesis in catamenial epilepsy, hormonal analysis of estrogen and progesterone in catamenial epileptics for a precise correlation is of significant importance. Clinical, neurological and physiological assessments, and radioimmunoassay of plasma estradiol-17b and progesterone a day prior to the onset of menstruation were carried out in noncatamenial and mild catamenial epileptics having multiple frequency tonic-clonic [primary and secondary generalized] seizures. Highly significant rise [p > 0.0001] of estradiol-17b was obtained for catamenial epileptics compared to normal subjects as well as noncatamenial epileptics [p > 0.02]. However, nonsignificant fluctuations of progesterone were found for both catamenial and noncatamenial epileptics against normal subjects as well as catamenial versus noncatamenial epileptics. The present report suggests that estradiol have a precise role in the mild premenstrual exacerbation of seizures. However, no significant change in progesterone levels might have been due to mild exacerbation of seizures in these patients. Furthermore, we suggest the importance of how we collect and categorize the data and which pathophysiologic process/ clinicobiological mechanism is involved in patients with catamenial epilepsy. Contradictory results in literature may be related to differential levels of excitation/inhibition equilibrium during various cycle phases. More precise studies including the determination of the blood levels of antiepileptic drugs, however, are required

Stroke recovery and outcome in diabetes

To compare the outcome in stroke among the diabetics and non-diabetics patients. Design: A comparative study. Place and Duration of Study: Jinnah postgraduate medical centre during the period of eight months. Subjects and Acute stroke patients with diabetes and hypertension were included, hypertensives comprised the non-diabetic group, along with other risk factors. There was no significant difference in the outcome in the two groups according to the Katz scale. Our study did not show much difference in the outcome in the diabetics versus the non-diabetics

Prevalence of epilepsy in children [a population survey report]

A population based epidemiologic study carried out in a lower socioeconomic suburb of Karachi, identified 23 children with epilepsy among 994 children [3-9 year old] surveyed for childhood disabilities. Ninteen had major epilepsy, 2 petitmal and one each had focal motor and myoclonic attacks. The high frequency of epilepsy may be due to consanguinity, central nervous system, infections and birth and accidental trauma