Síndrome metabólico en pacientes hospitalizados en Servicio de Geriatría / Metabolic syndrome in patients hospitalized in Geriatric Services

RESUMEN Introducción: la prevalencia del síndrome metabólico, a nivel mundial, es muy elevada y continúa en aumento vertiginosamente en los últimos años. Por lo que se puede considerar una pandemia de la época contemporánea, se estima que el 25 % de la población adulta la padece. Objetivo: determinar la prevalencia del síndrome metabólico e identificar otras formas clínicas de enfermedad vascular ateroesclerótica, en gerontes hospitalizados en Servicios de Geriatría del Hospital Provincial Clínico Quirúrgico Docente "Celia Sánchez Manduley", Manzanillo, Granma; en el período comprendido entre junio 2015 a junio 2016. Materiales y métodos: se realizó estudio observacional, descriptivo, de corte transversal. Se incluyeron los 120 senescentes que ingresaron en los Servicios de Geriatría. Resultados: se estableció el diagnóstico de síndrome metabólico en 105 individuos de 120 sujetos estudiados. El grupo de 70-79 años de edad y el sexo masculino fueron los más afectados por la endocrinopatía. Las otras formas clínicas de enfermedad vascular ateroesclerótica que se identificaron en los senescentes estudiados, fueron: cardiopatía isquémica, enfermedad cerebrovascular y cardiopatía hipertensiva. Conclusiones: existe una alta prevalencia del síndrome metabólico en los adultos mayores estudiados.

ABSTRACT Introduction: the prevalence of the metabolic syndrome is very high around the world and is still vertiginously increasing in the last years. Therefore, it can be considered a pandemic of the current times. It is thought that 25 % of the adult population suffers it. Objective: to determine the prevalence of the metabolic syndrome and to identify other clinical forms of the atherosclerotic vascular disease in elder people who entered the Service of Geriatrics of the Provincial Teaching Clinical Surgical Hospital "Celia Sanchez Manduley", of Manzanillo, Granma, in the period from June 2015 to June 2016. Materials and methods: a cross-sectional, observational, descriptive study was carried out with the inclusion of the 120 elder people who the Service of Geriatrics. Results: 105 individuals of 129 studied were diagnosed with metabolic syndrome. The 79-79 age group and male sex were the most affected by endocrinopathy. Other clinical forms of the arteriosclerotic vascular disease identified in the studied elder people were ischemic heart disease, cerebrovascular disease and hypertensive heart disease. Conclusions: there is a high prevalence of the metabolic syndrome among the studied elder people.

Analyzing the neuropsychological characteristics and changes in serum markers of patients with chronic cerebral circulation insufficiency

Summary Objective: To investigate the neuropsychological characteristics and changes in CRP, S100B, MBP, HSP-7, and NSE in serum. Method: Sixty-six (66) patients treated in our hospital as CCCI group were chosen for our study, and 90 patients with depression were selected as the depression group. The patients in both groups were examined with CT perfusion, depression, anxiety and cognition evaluation. Their serum CRP, S100B, MBP, HSP-70 and NSE levels were detected. Neuropsychological and serum markers characteristics were compared. Results: The CBF and CBV in bilateral basal ganglia, frontal lobes, greater oval center, brain stem, and left and right regions of occipital lobes of the patients in CCCI group were significantly lower than in the depression group. The HAMD and HAMA scores of CCCI group patients were significantly lower than in the depression group; CCCI group performed better regarding attention, memory, abstract terms and delayed recall. CCCI also had significantly higher total scores than the depression group. Serum CRP, S100B, MBP, HSP-70 and NSE levels in CCCI group were significantly higher than in the depression group. The differences reach statistical significance (p<0.05). Conclusion: CCCI patients who are accompanied by minor depressive disorder have different degrees of cognitive impairment and experience a significant rise in serum CRP, S100B, MBP, HSP-70 and NSE.

Predictive value of CHADS2 score for cardiovascular events in patients with acute coronary syndrome and documented coronary artery disease

BACKGROUND/AIMS: The CHADS2 score, used to predict the risk of ischemic stroke in atrial fibrillation (AF) patients, has been reported recently to predict ischemic stroke in patients with coronary heart disease, regardless of the presence of AF. However, little data are available regarding the relationship between the CHADS2 score and cardiovascular outcomes. METHODS: This was a retrospective study on 104 patients admitted for acute coronary syndrome (ACS) who underwent coronary angiography, carotid ultrasound, and transthoracic echocardiography. RESULTS: The mean age of the subjects was 60.1 +/- 12.6 years. The CHADS2 score was as follows: 0 in 46 patients (44.2%), 1 in 31 (29.8%), 2 in 18 (17.3%), and > or = 3 in 9 patients (8.7%). The left atrial volume index (LAVi) showed a positive correlation with the CHADS2 score (20.8 +/- 5.9 for 0; 23.2 +/- 6.7 for 1; 26.6 +/- 10.8 for 2; and 30.3 +/- 8.3 mL/m2 for > or =3; p = 0.001). The average carotid total plaque area was significantly increased with CHADS2 scores > or = 2 (4.97 +/- 7.17 mm2 vs. 15.52 +/- 14.61 mm2; p = 0.002). Eight patients experienced cardiovascular or cerebrovascular (CCV) events during a mean evaluation period of 662 days. A CHADS2 score > or = 3 was related to an increase in the risk of CCV events (hazard ratio, 14.31; 95% confidence interval, 3.53 to 58.06). Furthermore, LAVi and the severity of coronary artery obstructive disease were also associated with an increased risk of CCV events. CONCLUSIONS: The CHADS2 score may be a useful prognostic tool for predicting CCV events in ACS patients with documented coronary artery disease.

Enfermedades mitocondriales: diagnóstico diferencial de enfermedad cerebrovascular en adulto joven a propósito de un caso / Mitochondrial diseases: differential diagnosis of cerebrovascular disease in young adults: case report

Introduction: Mitochondrial diseases are a heterogeneous group of disorders characterized by impaired oxidative phosphorylation. Clinical manifestations are varied, depending on the nature of the mutation, phenotype of the mitochondria, degree of competition with normal mitochondrial DNA and affected tissues. The diagnosis is challenging and requires a high clinical suspicion with the corroboration of ragged red fibers on the muscle biopsy. Case report: We present the case of 41 years-old woman, with history of insulin dependent diabetes, bilateral sensorineural deafness, exercise intolerance and muscle weakness, which suffered a pseudovascular event with an increase of lactic acid in blood and cerebrospinal fluid. Brain magnetic resonance imaging showed a right temporo-parietal ischemic lesion. Muscle biopsy confirmed a mitochondrial myopathy. We emphasize the relevance of differential diagnosis of cerebrovascular disease in young adults...

Las enfermedades mitocondriales son un grupo heterogéneo de trastornos en la fosforilación oxidativa, que se expresan según la naturaleza de la mutación, el fenotipo de las mitocondrias, el grado de complementación con el mtDNA normal y tejidos afectados. El diagnóstico se basa en la sospecha clínica y en la corroboración de fibras rojo rasgadas en la biopsia muscular con tricrómico de Gomori, entre otras técnicas. Presentamos un caso de una mujer de 41 años, con antecedentes de diabetes mellitus insulinodependiente, hipoacusia neurosensorial bilateral, intolerancia al ejercicio y debilidad muscular, que sufre un cuadro pseudovascular, con aumento del ácido láctico en sangre y LCR. TC y RM cerebral indican lesión isquémica temporoparietal derecha, y biopsia evidencia miopatía mitocondrial. Destacamos la importancia del diagnóstico diferencial de enfermedad cerebrovascular en adulto joven...

Application of Magnetic Resonance Imaging and Magnetic Resonance Angiography as Diagnostic Measures for the First Attack of Suspected Cerebrovascular Diseases in Korea

PURPOSE: No precise data are available showing how magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) can be applied to diagnosis for the first attack of a suspected cerebrovascular disease in Korea. The purpose of this study was to evaluate the application level of MRI and MRA as diagnostic tools and the related factors to the use of these techniques. MATERIALS AND METHODS: This study used the health benefit claim data of 89,890 patients who were hospitalized for the first time due to suspected cerebrovascular disease in 2007 without having visited medical institutions as an outpatient or inpatient from 2003 to 2006. RESULTS: Of the 89,890 cases, 28.4% took both MRI and MRA, 10.7% took only MRI and 6.9% took only MRA. The related factors identified in the multivariate logistic regression analysis were gender, type of insurance, type of medical institution, type of department, duration of hospitalization, and type of disease. CONCLUSION: This study showed that the application level of MRI and MRA as diagnostic measures for the first attack of a suspected cerebrovascular diseases varied depending on several factors. It is necessary to study more accurate levels of computerized tomography (CT), computerized tomography angiography (CTA), MRI or MRA as measures to diagnose a first attack of suspected cerebrovascular disease.

Clinico-pathological discrepancies in a general university hospital in São Paulo, Brazil

INTRODUCTION: The autopsy rate has continuously diminished over the past few decades, reducing the quality of medical care and the accuracy of statistical health data. OBJECTIVE: To assess the accuracy of clinical diagnoses by comparing pre- and postmortem findings, and to identify potential risk factors for misdiagnoses. METHODS: Retrospective evaluations performed between June 2001 and June 2003 in a 2500-bed tertiary university hospital in São Paulo, Brazil, including 288 patients who died at that institution and had a postmortem examination. RESULTS: Clinical and autopsy records were reviewed and compared for categorization using the adapted Goldman criteria. The overall major and minor discrepancy rates were 16.3 percent and 28.1 percent, respectively. The most common missed diagnoses were pulmonary embolism, pneumonia, and myocardial infarction, and the most prevalent underlying diseases were infectious diseases, cerebro-cardiovascular conditions, and malignancies. Patients age 60 or older had an increased risk of diagnostic disagreement, as did female patients. The period of hospitalization, last admission unit at the hospital and underlying disease were not significantly related to the pre-mortem diagnostic accuracy. DISCUSSION: The discrepancy rate found in this study is similar to those reported globally. The factors influencing diagnostic accuracy as well as the most commonly missed diagnoses are also consistent with the literature. CONCLUSION: Autopsy remains a crucial tool for improving medical care, and effort must be focused on increasing its practice worldwide.

Reproductive history and health screening for women and mortality in the Japan Collaborative Cohort Study for Evaluation of Cancer (JACC).

Reproductive history and participation in health screening for women were surveyed among female subjects, and interesting results were obtained in the present analyses. Women who had never experienced pregnancy had significantly increased risks of death from all causes and cerebrovascular disorders compared with those who had experienced 1 or 2 pregnancies. In contrast, women who had experienced 3 or 4 pregnancies had significantly decreased risks of death from all causes, all cancers, rectal cancer, and breast cancer. Among women who had ever undergone mass screening examination for uterine cervical cancer, there were significantly lower risks of death from all causes, all cancers, stomach cancer, uterine cervical cancer, urinary tract cancer, and ischemic heart diseases compared with those who had not had such experience.

Magnetic resonance venography in intracranial veno-occlusive disease.

OBJECTIVE: To identify the common MR Vfindings in the patient diagnosed intracranial veno-occlusive disease at Ramathibodi Hospital and to identify the underlying conditions that probably predisposed the patient to the intracranial veno-occlusive disease. MATERIAL AND METHOD: Sixty-four patients with clinically suggestive intracranial veno-occlusive disease who underwent MRV were reviewed in terms of signs and symptoms, MRV methods, MRV findings, and clinical diagnosis after report MRV In cases diagnosed to have intracranial veno-occlusive disease, the patients' records were reviewed to identify predisposing conditions. RESULTS: Thirty-four patients were diagnosed to have intracranial veno-occlusive disease. The common findings were lack of typical high flow signal from a sinus that did not appear aplastic or hypoplastic, frayed appearance of flow signal from a sinus at a later stage of the thrombus, and collateral vessels and cerebral hemorrhage. The common sites were superior sagittal sinus, and left and right transverse sinuses. Hypoplasia, a normal variation, was incidentally found in eight patients (12.5%). The most common hypoplastic site was the left transverse sinus. Contributing factors in patients diagnosed to have intracranial veno-occlusive disease in the present series were birth control pill in take, tumor (meningioma, and malignant schwannoma of the scalp), blood dyscrasia, AVM, hypotension, and abscess. The causes of intracranial venous thrombosis could not be identified in seven patients (21%). CONCLUSION: The common MR Vfinding in acute intracranial veno-occlusive disease was lack of typical high flow signal from a sinus while frayed appearance of flow signal from a sinus was the common direct sign in chronic condition. In the present series, birth control pill intake was the most common contributing factor

Antiphospholipid Syndrome and Vascular Ischemic (Occlusive) Diseases: An Overview

Antiphospholipid syndrome (APS) is primarily considered to be an autoimmune pathological condition that is also referred to as "Hughes syndrome". It is characterized by arterial and/or venous thrombosis and pregnancy pathologies in the presence of anticardiolipin antibodies and/or lupus anticoagulant. APS can occur either as a primary disease or secondary to a connective tissue disorder, most frequently systemic lupus erythematosus (SLE). Damage to the nervous system is one of the most prominent clinical constellations of sequelae in APS and includes (i) arterial/ venous thrombotic events, (ii) psychiatric features and (iii) other non- thrombotic neurological syndromes. In this overview we compare the most important vascular ischemic (occlusive) disturbances (VIOD) with neuro-psychiatric symptomatics, together with complete, updated classifications and hypotheses for the etio-pathogenesis of APS with underlying clinical and laboratory criteria for optimal diagnosis and disease management.

Renal and extrarenal manifestations of autosomal dominant polycystic kidney disease

The objective of the present study was to determine the frequency of the most common clinical features in patients with autosomal dominant polycystic kidney disease in a sample of the Brazilian population. The medical records of 92 patients with autosomal dominant polycystic kidney disease attended during the period from 1985 to 2003 were reviewed. The following data were recorded: age at diagnosis, gender, associated clinical manifestations, occurrence of stroke, age at loss of renal function (beginning of dialysis), and presence of a family history. The involvement of abdominal viscera was investigated by ultrasonography. Intracranial alterations were prospectively investigated by magnetic resonance angiography in 42 asymptomatic patients, and complemented with digital subtraction arteriography when indicated. Mean age at diagnosis was 35.1 ± 14.9 years, and mean serum creatinine at referral was 2.4 ± 2.8 mg/dL. The most frequent clinical manifestations during the disease were arterial hypertension (63.3 percent), lumbar pain (55.4 percent), an abdominal mass (47.8 percent), and urinary infection (35.8 percent). Loss of renal function occurred in 27 patients (mean age: 45.4 ± 9.5 years). The liver was the second organ most frequently affected (39.1 percent). Stroke occurred in 7.6 percent of the patients. Asymptomatic intracranial aneurysm was detected in 3 patients and arachnoid cysts in 3 other patients. In conclusion, the most common clinical features were lumbar pain, arterial hypertension, abdominal mass, and urinary infection, and the most serious complications were chronic renal failure and stroke. Both intracranial aneurysms and arachnoid cysts occurred in asymptomatic patients at a frequency of 7.14 percent.

Efeitos da compressão de dados JPEG na avaliação de lesões vasculares cerebrais isquêmicas de pequenos vasos em ressonância magnética / Effects of JPEG data compression on magnetic resonance imaging evaluation of small vessels ischemic lesions of the brain

OBJETIVO: Estabelecer o limite máximo de compactação JPEG na qual não há comprometimento na análise quantitativa de lesões vasculares cerebrais isquêmicas de pequenos vasos em ressonância magnética. MATERIAL E MÉTODO: Quinze imagens em DICOM foram convertidas para JPEG a taxas de compressão de 1:10 a 1:60 e avaliadas juntamente com as originais por três neurorradiologistas, que identificaram as lesões, tipo de contorno, morfologia e intensidade do sinal. RESULTADOS: As lesões foram bem identificadas até a taxa de 1:30. Foram identificadas mais lesôes na taxa de 1:10 do que nas imagens originais. Morfologia e contornos foram bem avaliados até a taxa de 1:40. A compactação não alterou o sinal. CONCLUSÃO: Foram avaliadas lesôes pequenas (até 2mm) e notamos que em todas as taxas de compactação o algoritmo gerou ruídos na imagem, que levaram os avaliadores a identificarem mais lesões nas imagens JPEG do que nas imagens originais DICOM, criando falso-positivos.

OBJECTIVE: To establish the maximum achievable JPEG compression ratio without affecting quantitative and qualitative magnetic resonance imaging analysis of isquemic lesions in small vessels of the brain. MATERIAL AND METHOD: Fifteen DICOM images were converted to JPEG with a compression ratio of 1:10 to 1:60 and were assessed together with the original images by three neuroradiologists. The number, morphology, edges and signal intensity of the lesions were analyzed. RESULTS: Lesions were properly identified up to a 1:30 ratio. More lesions were identified with a 1:10 ratio then in the original images. Morphology and edges were properly evaluated up to a 1:40 ratio. Compression did not affect signal. CONCLUSION: Small lesions were identified (<2mm) and in all compression ratios JPEG algorithm generated image noise that misled observers to identify more lesions in JPEG images then in DICOM images, thus generating false-positive results.

Síndrome Herns (hereditaeria endoteliopatía con retinopatía, nefropatía y accidente cerebrovascular): reporte de un caso clínico / Herns syndrome (hereditary endotheliopathy with retinopathy, nephropathy and stroke): report of a clinic case

El Síndrome HERNS es una Vasculopatía de afectación multisistémica hereditaria autosómica dominante, cuya mutación se encuentra en el Cromosoma 3p21, se caracteriza por la afectación progresiva del endotelio, retina, riñón y accidente cerebrovascular, ha sido descrito en familias de origen caucásico principalmente y otras de origen oriental, el tratamiento y pronostico de estos pacientes no está del todo claro han habido reportes de mejoría en los síntomas y la progresión radiológica mediante el uso de corticoides, sin embargo la evidencia disponible no permite realizar conclusiones basadas en la evidencia debido al escaso numero de pacientes que se han reportado en la literatura. El diagnóstico se puede confirmar mediante estudio genético. Se presenta un caso de un paciente de 43 años que ingresa al Servicio de Urgencia con Síndrome Convulsivo, el primer estudio imagenológico reveló un probable Glioblastoma Multiforme su evolución y estudio evidenciaron compromiso multisistémico que comparte similitud clínica e imagenológicas en el test de Fuoresceína de Retina y la Resonancia Nuclear Magnética Cerebral con el Síndrome HERNS. El estudio molecular y genético no fue posible realizar quedando pendiente la confirmación diagnóstica.

The HERNS Syndrome is a Vasculopathy of affectation multisistemic hereditary autosomal dominant, whose mutation is in the Cromosoma 3p21, is characterized by the progressive affectation of the endotely, retinal, kidney and stroke, has been described in families of caucasian origin principally and others of oriental origin, the treatment and I predict of these patients it is not completely clear there have been reports of improvement in the symptoms and the radiological progression by means of the use of corticoides, nevertheless the available evidence does not allow to realize conclusions based on the evidence due to the patients' scanty number that has been reported in the literature. The diagnosis can be confirmed by means of genetic study. There appears a case of a patient of 43 years old who enters to the Service of Urgency with Convulsive Syndrome, the first radiological study revealed a probable Glioblastoma Multiforme his evolution and study they demonstrated commitment multisistemic that shares clinical similarity and imagenological in Fluoresceína's test of Retina and the Nuclear Magnetic Cerebral Resonance with the Syndrome HERNS. The molecular and genetic study was not possible to realize remaining hanging the diagnostic confirmation.

Cerebral venous thrombosis presented as subarachnoid hemorrhage and treated with anticoagulants

A 45-year-old woman was brought into the emergency room of Al-Zahra hospital, Isfahan, after her first generalized tonic-clonic seizure and a history of thunderclap occipital headache ten days before the first seizure. Examination revealed mild confusion and slight left hemiparesis with facial weakness and no meningeal irritation signs. CT scan showed subarachnoid hemorrhage [SAH] and MRI demanstrated left lateral, sigmoid and sagittal sinus thromboses. Angiography was normal. She was treated by anticoagulants in spite of hemorraghic parenchymal lesion

Validação e adaptação cultural para a língua portuguesa de escalas de avaliação funcional em doenças cerebrovasculares: uma tentativa de padronização e melhora da qualidade de vida / Brazilian versions of stroke scales and clinical assessment tools: a standardization attempt plus improvement of the quality of life

O presente estudo objetivou a tradução e validação para a língua portuguesa de escalas de avaliação funcional de portadores de doenças cerebrovasculares (DCV); buscando padronização científica, redução na morbimortalidade e incapacidade; e principalmente melhora na qualidade de vida pós-DCV. A tradução das escalas envolveu os seguintes passos: Elaboração de versão em português; tradução reversa para língua original; teste piloto com portadores de DCV. As escalas consideradas foram: NIH Stroke Scale (NIHSS), Glasgow Outcome Scale (GOS), Modified Rankin Scale (MRS), Barthel Index e Functional Independence Measure (FIM). Os pacientes avaliados (n=20) foram do serviço de neurologia do Hospital Universitário da UFJF. Os dados obtidos foram analisados através do teste de Kappa e do coeficiente de correlação de Spearman. Todas as versões brasileiras dos instrumentos para avaliação dos pacientes portadores de DCV apresentaram boa aceitabilidade e compreensão pelos entrevistados. A finalidade, critérios avaliados, tempo de administração, pontos negativos e positivos foram expostos para cada escala. Acreditamos ser praticável e segura a utilização destas versões brasileiras. Sugerimos uso rotineiro destas para triagem, direcionamento das condutas clínicas e de reabilitação; padronizando o atendimento e reduzindo a morbimortalidade/incapacidade em qualquer serviço que atue em DCV.

Cerebrovascular lesions in sickle cell pediatric patients: Transcranial color duplex doppler sonography amd diffusion weighted MRI study with clinical correlation

Sickle cell disease [SCD] s a common inherited hemoglobin disorder. Cerebral infraction secondary to occlusive vasculopathy is a major complication in children with SCD, with a prevalence of 5.5% to 17%. Recent MRI studies have also reported a high incidence of silent infarcts [11-16%]. Trans cranial color duplex Doppler [TCD] study can reliably predict which children with SCD are at great risk for developing a stroke. Aim of the work: Is to correlate the TCD and MRI findings with clinical and hematological criteria of children with SCD to identify patients at high risk for developing stroke. This study was conducted 30 children with SCD [16 SS and 14 S-beta T]. Their ages ranged from 2.5 to 19 years [mean age. 9.1 years +/- 4.3]. All were subjected to full history taking thorough clinical examination and laboratory investigations, complete blood picture, hemoglobin electrophoresis, reticulocytic count and liver function tests. The were all subjected to TCD mainly middle cerebral artery [MCA] on both sides and MRI using standard T-2 weighted images and diffusion-weighted imaging technique. Six children had a history of seizures and all were neurologically free except one with left sided hemiprses. The mean velocities [Vmean] of the right and left MCA were significantly higher in SS than S-BT. Four children [13.3%] had abnormal TCD findings with significantly high peak systolic velocities [PSV] of MCA. Three ofthem had abnormal MRI [one had old infract, another one had silent small recent infracts and one showed ischemic foci], the fourth showed no MRI abnormality. Regular TCD screening is useful in detecting the abnormal cerebral vessels and its recommended that cerebrovascular disease with TCD. Screening every 6 months for sikle cell disease pediatric patients may help to select high risk children for [DWI]. This will help determine candidates for regular transfusion therapy in an attempt to prevent the occurrence of stroke

Anesthesia for neurovascular embolisation from 1997-1999 in Prasat Neurological Institute.

BACKGROUND: Embolisation is another treatment of choice in neurovascular abnormalities. We reported anesthetic data as a basis for further research. METHOD: A descriptive retrospective study was performed to evaluate the techniques, drug usage and complications associated with anesthesia in patients who underwent embolisation in the Prasat Neurological Institute within 3 years. RESULTS: There were 108 cases and 213 procedures. The diagnoses were mainly arteriovenous malformation (56.34%) and carotid cavernous sinus fistula (23%). 74.65 per cent received general anesthesia with endotracheal tube, 11.74 per cent received inhalation anesthesia with laryngeal mask airway, 7.04 per cent received inhalation anesthesia with endotracheal tube and 6.57 per cent received total intravenous anesthesia with laryngeal mask airway. The patients were given anesthesia with thiopental (73.24%), propofol (26.76%) intubated with succinyl choline (69.01%), nondepolarizing muscle relaxant (21.13%) and without any muscle relaxant (9.86%) maintained with oxygen and halothane (63.85%), isoflurane (4.23%) and sevoflurane (25.35%). Fentanyl (87.79%), morphine (1.88%), nalbunorphine (0.47%) were given as narcotics and if a muscle relaxant was required, atracurium (64.79%), pancuronium (5.63%), vecuronium (4.23%) were used. The complications were hypotension (7.04%), anaphylaxis (1.88%), arterial vasospasm (0.47%) and hyperglycemia (1.41%). However, there was no significant statistical difference among the anesthetic techniques and those complications. Post-anesthetic complications within 30 minutes included shivering (3.76%) which was statistically related to the duration of the procedure. CONCLUSION: It was concluded that in neurovascular embolisation, there was no need for special techniques or drugs in anesthesia but anesthetic personnel had to optimize the patient's condition for the safety and convenience of neuroradiologists and there should be an awareness of complications eventhough these were not related to anesthetic techniques; further improvement in prevention should be established.

Snake bite presenting as acute myocardial infarction, ischaemic cerebrovascular accident, acute renal failure and disseminated intravascular coagulopathy.

An unusual presentation of a viperine snake bite presenting with ischaemic damage to the major organs like brain and heart leading to cerebrovascular accident and acute myocardial infarction along with acute renal failure and disseminated intravascular coagulopathy (DIC) is described in this report.