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.

Post partum headache: a case series

Postpartum headache is the complaint of head, neck, or shoulder pain occurring during the first 6 weeks following delivery. Among the women who underwent neuraxial aneasthesia Post Dural puncture headache is one of the most common presentations. However, physicians should be aware that post Dural puncture headache is not the only cause of postpartum headache. Authors present a series of four cases that had varied presentation of post partum headache with varied diagnosis, the first case was of subdural haematoma where CT scan revealed an acute on chronic SDH. The second case was diagnosed as meningitis and the CSF for culture sensitivity grew Streptococcus Pneumoniae .In our third case of cortical vein  thrombosis , NCCT followed by MR venogram  revealed left transverse venous sinus thrombosis and our last case in the series was of posterior reversible encephalopathy syndrome where MRI confirmed the findings of typical findings are symmetric edema involving the white matter of the posterior regions of the cerebral hemispheres. The diagnostic dilemma was resolved by neuroimaging because the clinical presentation was not making us reach a satisfactory diagnosis of the cause of headache. Early resort to neuroimaging and multidisciplinary team effort paved way to early diagnosis and appropriate recovery of the patients.

Isolated cortical vein thrombosis with subdural hematoma: A case report and literature review / 中国脑血管病杂志

Isolated cortical vein thrombosis is rare. It is easy to be missed or misdiagnosed due to variations of cortical vein anatomy, nonspecific clinical presentation, and lack of any imaging gold-standard of diagnosis. Cerebral venous sinus thrombosis with subdural hematoma is rarer. Because of the side effects of anticoagulation, the optimal therapy for such patients is hard to decide. A 34-year-old puerperal woman who suffered from isolated cerebral cortical venous thrombosis with subdural hematoma was reported and relevant literatures were review, aiming to provide some references for the treatment of this disease.

Hemorragia subaracnoídea no traumática con angiografía por tomografía computada inicial "negativa / Non-traumatic subarachnoid hemorrhage with "negative" initial computed tomography angiography

La hemorragia subaracnoidea (HSA) no traumática es un subtipo de ictus hemorrágico que representa aproximadamente el 5% de todos los accidentes vasculares encefálicos (AVE). El 85% de los casos de HSA espontánea (no traumática) son secundarios a un aneurisma intracraneano roto, el 10% a hemorragia perimesencefálica no aneurismática y el otro 5% a otras causas. Entre estas se incluyen malformaciones arterio-venosas, fístulas durales, vasculits, trombosis de vena cortical, síndrome de vasoconstricción reversible, angiopatía amiloidea y síndrome de encefalopatía posterior reversible. La aproximación inicial a una HSA no traumática requiere un estudio angiográfico no invasivo con tomografía computada para la toma de decisiones terapéuticas. Si no se detecta un aneurisma sacular intradural que explique el sangrado, las conductas a seguir dependerán del patrón de distribución de la sangre. En esta revisión sugerimos una aproximación basada en 1) revisar el estudio inicial tomando en cuenta los puntos ciegos para la detección de aneurismas, 2) analizar el patrón de distribución de la sangre y 3) analizar los hallazgos en imágenes de acuerdo a las posibles causas según patrón.

Non-traumatic subarachnoid hemorrhage represents approximately 5% of strokes. From these, 85% of nontraumatic subarachnoid hemorrhage are secondary to a ruptured aneurysm, 10% to nonaneurysmal perimesencephalic hemorrhage and the other 5% to other causes. These include but are not limited to arteriovenous malformations, dural fistulae, vasculitis, cortical vein thrombosis, reversible cerebral vasoconstriction syndrome, amyloid angiopathy and posterior reversible encephalopathy syndrome. Initial workup of nontraumatic subarachnoid hemorrhage requires a non-enhanced CT and CT angiography for decision making and management. If there is no aneurysm as a source of hemorrhage, subsequent imaging studies will depend on blood distribution pattern. In this review we suggest an approach: 1) review blind spots for aneurysm detection in the initial CT angiography, 2) analyze blood distribution pattern and 3) evaluate imaging findings and possible causes according to each pattern.

Isolated Cortical Vein Thrombosis with Long Cord Sign

Isolated cortical vein thrombosis (ICVT) is a rare disease, accounting for less than 1% of strokes. A 46-year-old woman presented with progressive left side weakness. Magnetic resonance (MR) imaging with T2*-gradient echo (T2*-GE) sequence showed long cord sign at the right frontal cortex. The patient was treated with low molecular weight heparin, followed by oral warfarin for 6 months. The 3-month follow-up MR imaging showed recanalization of the previously thrombosed cortical vein. She was completely recovered without neurological deficits after 6 months. This provides that MR imaging with T2*-GE sequence can help to diagnosis the ICVT and outcomes of the ICVT are generally favorable.

A Case of Cortical Vein Thrombosis in Wegener's Granulomatosis

Wegener's granulomatosis is an uncommon disease characterized by variable degrees of disseminated vasculitits involving both small arteries and veins. This disease is rarely associated with thrombosis. Isolated reports of intracranial thromboses of large and small vessels have been described in both adults and children. This report describes the first case of cortical vein thrombosis which was central nervous system manifestation in Wegener's granulomatosis.

A Case of Cortical Vein Thrombosis in Wegener's Granulomatosis

Wegener's granulomatosis is an uncommon disease characterized by variable degrees of disseminated vasculitits involving both small arteries and veins. This disease is rarely associated with thrombosis. Isolated reports of intracranial thromboses of large and small vessels have been described in both adults and children. This report describes the first case of cortical vein thrombosis which was central nervous system manifestation in Wegener's granulomatosis.

Protein S deficiency in a case of superor sagital vein thrombosis.

Cortical vein thrombosis (CVT) is rare and is most common in the third decade of life. Cerebral venous thrombosis may be due to a variety of pathologic conditions like deficiencies of protein S (PS), antithrombin III, protein C, factor V Leiden, prothrombin gene mutations and hyperhomocysteinemia. Protein S is a vitamin K-dependent anticoagulant present in plasma and prevent thrombosis in association with protein C. Lack of it results in venous thromboembolism (VTE) rarely causing thrombosis of cerebral venous sinuses. Our patient is a 35-year-old male who presented with focal seizures. MRI brain showed venous infarcts, and MR venogram showed extensive thrombosis of superior sagittal sinus. Later work up for hypercoagulable state showed significant Protein S deficiency.

Spontaneous Intracranial Hypotension Complicated by Cortical Vein Thrombosis

Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache, diffuse dural thickening, and enhancement in MRI associated with low cerebrospinal fluid pressure. While SIH causes several complications such as subdural hematoma, cranial nerve palsies, and altered consciousness, cerebral venous thrombosis caused by SIH has been rarely described. We report a patient presenting with generalized tonic-clonic seizure that was probably caused by cortical vein thrombosis that had developed after SIH.