Effect of Admission Hyperglycaemia on Infarct Size and Clinical Outcome in Black Patients with Acute ISCHAEMIC Stroke, Northeast Nigeria.

Aims: To determine the relationship between admission blood glucose level, infarct size and stroke outcome in black African patients with acute ischaemic stroke. Study Design: The study was cross-sectional. Place and Duration of Study: University of Maiduguri Teaching Hospital, Northeast Nigeria, from January 2006 to January 2009. Methodology: Sixty-two patients were recruited and clinical characteristics recorded. Stroke severity was assessed using the National Institutes of Health Stroke Score(NIHSS); disability assessed using Modified Rankin score (mRS) and Barthel Activity of Daily Living (ADL) index (BI). Infarct volume was calculated from CT scan using the ‘method of measurements of the largest diameters’. Random blood glucose (RBG) was measured on admission, and dichotomised into those with hyperglycaemia > 7mmol/L those without < 7 mmol/L. Bivariate statistics were used to compare characteristics and outcome. Kaplan-Meier Statistic was used to compare mortality rates. The influence of hyperglycaemia on infarct volume and outcome was determined using logistic regression. Results: Fourteen (22.6%) patients had hyperglycaemia on admission. Those with hyperglycaemia had a larger infarct volume (P < .0001) and higher NIHSS (P = .003) on presentation. They had worse stroke outcome (Discharge BI: P = .001; NIHSS: P < 0.0001; mRS: P = .001) and higher 30-day mortality (P = .005). Admission RBG positively correlated with infarct size (P < .001), NIHSS (P = .01), mRS (P = .02) and negatively with BI (P = .02). Survival time is significant with Log Rank (P = .009) and Wilcoxon test statistics (P = .006). Hyperglycaemia predicted a larger infarct (OR = 4.46, P = < .0001), poorer NIHSS on discharge (OR = 3.44, P = .001), poorer mRS (OR = 2.53, P = .02) and 30 – day mortality (OR = 2.04, P = .046). Conclusion: Hyperglycaemia is associated with a larger infarct size, severe stroke at presentation and a worse stroke outcome.

Antiphospholipids Antibodies and Migraine

Background: Antiphospholipids antibodies has been associated with non-thrombotic neurological conditions such as migraine. We set out to estimate the concentration of antiphospholipids antibody among patients with migraine and normal population. Methods: This is prospective case-control study of 158 subjects including 82 migraine patients who fulfilled the International Headache Society criteria for the diagnosis of migraine headache and 76 age and sex-matched controls who were mostly hospital staff and medical students. Blood samples were taken for quantification of antiphospholipids antibodies. Results: There were 28 males and 54 females among the migraine patients and 30 males and 46 females among the controls. Their mean ages were 28.8 + 8.4 years and 26.4 + 3.9 years; respectively. Migraine patients had increased level of aPL (lgG anti Beta2GP1) 27.76 + 14.47IU/ml compared to the normal healthy adults (21.43 + 9.4IU/ml) (p0.05). Similarly; antiphospholipid antibodies was significantly elevated in migraine patients with aura compared to those without aura; (?2

Subarachnoid haemorrhage - changing trends

Bleeding into the subarachnoid space (Subarachnoid Haemorrhage - SAH) is a dramatic and potentially fatal event that should not be missed. Modern trends have seen a decline in morbidity and mortality mainly due to advancements in neuroradiology and neurosurgical techniques coupled with early intervention. The review presents the problems faced in the past and highlights the developments in various aspects of this catastrophic disease whose morbidity and mortality remain unacceptably high despite the improvements