Sternal Cleft With Coarctation of Aorta and Vascular Anomalies - Learning Point in Young Stroke

@#Sternal cleft is a rare congenital anomaly that is known to be associated with other congenital abnormalities in particular coarctation of aorta and vascular anomalies. We present a case of a young teacher who presented with recurrent episodes of ischemic stroke. During the workup to look for the cause of stroke, it was discovered that this patient had complete midline sternal cleft with underlying coarctation of aorta and left subclavian artery aneurysm. We wish to highlight the relation between the presence of sternal cleft and coarctation of aorta as well as vascular anomalies as one of the rare cause of young stroke.

Clinical and Etiological Profile of Cerebral Venous Sinus Thrombosis

Introduction: Cerebral Venous Thrombosis is an importantcause of stroke in the young. The importance of recognisingthis condition is that it carries a good prognosis if recognisedand treated early. Study objective was to analyse the clinicaland etiological profile of Cerebral Venous Sinus Thrombosis.Material and Methods: Prospective cross sectional studyin patients attending OPD or emergency at a tertiary referralcentre in eastern Tamilnadu with history suggestive of CVTand in whom the diagnosis of CVT confirmed by imagingof brain (MRI and MRV) were included in the study aftermeeting the inclusion criteriaResult: Among the 33 patients included in the study, majorityaffected were young males, most common clinical presentationwas headache and most common sinus involved was superiorsagittal sinus. Pro thrombotic state was observed in 27% ofcases and alcohol addiction was found to highly prevalent inthe study population.Conclusion: Cerebral Venous Thrombois is found to besignificantly high in males and alcoholics. Compared to otherIndian studies there was not much disparity in clinical profileand risk factors.

Clinical profile and serum homocysteine level in young patients with stroke: a prospective, observational study

Background: According to the WHO, stroke is the second most important cause of death in elderly people with age >60 years and fifth leading cause in the age group of 15 to 59 years. Hyperhomocysteinemia has been linked to increased incidence of ischemic strokes. Thus, the aim of the present study was to assess serum homocysteine levels as an individual risk factor of stroke in young patients.Methods: This was a prospective, cross-sectional, single center study performed in 50 patients admitted in the Department of Medicine, Thanjavur Medical College and Hospital, Thanjavur, over a period of 7 months (i.e., from December 2013 to June 2014). Young patients, aged 1545 years, and diagnosed with stroke were included in the study. Serum homocysteine was measured by fluorescein polarization immunoassay (FPIA). Significant difference between the patients with normal and elevated mean serum homocysteine levels was identified by using unpaired t-test. P value ?0.05 was considered as statistically significant.Results: Majority of the stroke patients were male (78%). Similarly, male patients dominated the total number of patients with elevated serum homocysteine levels (75%). Thirty-two (64%) patients had an elevated serum homocysteine level. There was a significant difference between the patients with increased homocysteine levels as compared to patients with normal homocysteine levels (p value <0.05). Out of 32 patients with hyperhomocysteinemia, 27 (84.38%) patients had ischemic stroke, 4 (12.50%) had cortical vein thrombosis and 1 (3.12%) had hemorrhagic stroke.Conclusions: Findings of the present study confirm that hyperhomocysteinemia is associated with an increased incidence of stroke in young patients. As healthcare providers, we must stress on prevention of stroke, especially by identifying treatable risk factors.

Clinical profile, risk factors and aetiology of young stroke: a tertiary care hospital based study from the Sub-Himalayan region in North India.

Background: Rapid urbanisation of rural areas is predicted to increase the incidence of risk factors for vascular events like stroke. There is scarcity of literature addressing issue of stroke from Sub-Himalayan region in North India. Methods: The study was conducted in the department of medicine, R. P. govt. medical college, Kangra, Himachal Pradesh. Consecutive patients between the age of 15-45 years presenting with signs and symptoms of stroke in a duration of one year were included in the study. CT scan-head and lipid profile was done in all patients. Other relevant investigations to rule out aetiology were undertaken. Results: Thirty two patients with the mean age of 41.1 ± 5.41 years were recruited. The incidence of stroke in young forming 8.55% of the total stroke patients (374). There were larger proportion of male patients with a ratio of 3:1.16 patients (50%) presented between 6 am and 12 pm in the morning hours of day. Maximum patients presented in winter months from November to January. Average delay of presentation to hospital was 30.8 hours. 19 patients (59.3%) presented with infarct. Most common symptom reported was weakness in 18 (56.2%). Predominant traditional risk factors observed was hypertension in 18 (53.1%). Hyperhomocysteinemia was seen in 4 patients (12.5%). Primary antiphospholipid antibody syndrome was seen in 2 (6.25%). Conclusion: This study demonstrated predominant presence of conventional risk factors in young strokes. There was substantial time delay of presentation. Majority of patients presented in winter months. Prevention of vascular risk factors as well as issue of factors leading to delay in presentation needs to be addressed.