A Clinical Correlation of EEG Changes in Relation to Ischaemic Stroke on its Prognosis as per Location

Background : Stroke is a common, potentially devastating disease with potential high morbidity and mortality. EEG (Electro-encephalogram), functional representation of electrical activity of brain, changes are closely tied to CBF (Cerebral Blood Flow). Thus EEG is useful to establish the location of Ischaemic CVA (Cerebro-vascular accident). It can also prognosticate Ischaemic stroke. Aims & Objectives : (1) To assess the grade and severity of clinical manifestations in acute ischaemic stroke patients by clinical scoring following admission. (2) To obtain EEG findings of ischaemic stroke patients following admission and after 1 month. (3) To assess the morbidity of ischaemic stroke patients by Modified Rankin Scale after 1 month. (4) To correlate EEG changes according to the clinical outcome and according to the site of involvement of ischaemic stroke. Materials and Methods : 90 Patients were selected during the study period as per the inclusion and exclusion criteria. Clinical scoring was done by NIHSS (National Institute of Health Scoring System). CT (Computed Tomography) scan of brain and MRI (Magnetic Resonance Imaging) Brain with DWI (Diffusion Weighted Image) extension was done. EEG findings on admission of morbidity was done by Modified Rankin Score on follow up after 1 month was noted. EEG findings after 1 month was noted on follow up. Assessment Clinical correlation was compared with EEG changes. All the data were collected and analysed by statistical software SPSS version 20. Results : The mean MRS (Modified Rankin Score) after 1 month for abnormal EEG on admission was 4.50 in comparison to score of 3.36 in case of normal EEG. The p value of this association was 0.003 and was considered significant. Conclusions : Normal EEG and focal slowing of EEG was mostly noted in MCA (Middle Cerebral Artery) and PCA (Posterior Cerebral Artery) infarcts involving the cortical region. Those with normal EEG findings had good clinical outcome in comparison to those with abnormal findings in EEG

An Uncommon Presentation of a Common Etiology : Tubercular Cerebral Abscess in Pulmonary TB

A patient, recently diagnosed with Pulmonary Tuberculosis and on ATT for the last 1 month, was initially admitted in a primary care setup with severe headache and altered consciousness for 5 days and then referred to our institute for further management. Extensive investigations and imaging led to the conclusion that the patient had a massive Tubercular Brain Abscess (TBA) in the background of Pulmonary TB

Intracranial Calcification in a Case of Seizure Disorder

A patient with repeated episodes of Seizures and elevated Blood Pressure for 2 days, was admitted in a primary care set up initially, followed by admission to our Institute where he was thoroughly worked up to find the possible etiology behind the presentation. Extensive investigations and imaging led to the conclusion that the patient had Idiopathic Intracranial Calcification after the possible secondary causes of Intracranial Calcification were ruled out

A study on dyslipidaemia in subclinical hypothyroidism.

Subclinical hypothyroidism is characterised by elevated serum thyroid stimulating hormone (TSH) concentrations in association with normal free thyroid hormones. The aim of the study was to evaluate the prevalence and pattern of serum lipid alterations in patients with stable subclinical hypothyroidism in comparison to age- as well as sex-matched euthyroid group and also subgroup analysis between them in regard to age of presentation, sex, antithyroperoxidase (anti TPO) positivity, and TSH value. In this study, 100 patients of SCH were recruited, age ranged 17-68 years, majority (78%) being females, presenting mainly with non-specific symptoms and compared with 52 euthyroid control regarding lipid parameters. Of the subclinical hypothyroidism patients, only 10% had goitre and anti TPO was positive in 52% cases. Serum lipoprotein (a) above the age of 20 years, and total cholesterol, triglyceride and low density liporpotein cholesterol in the age group of 40-50 years were significantly elevated. In addition, total cholesterol, triglyceride and low density lipoprotein cholesterol levels in anti TPO positive cases and serum triglyceride and low density lipoprotein cholesterol in anti TPO negative patients showed statistically significant higher levels. In males only lipoprotein (a), but in females total cholesterol, triglyceride, low density lipoprotein cholesterol and liproprotein (a)--all were significantly elevated.

Complications of hypertension as encountered by primary care physician.

Hypertension is a common clinical problem with great implications for public health. It is a silent killer and often remains asymptomatic. So regular BP check-up is a must. Complications of untreated hypertension include ventricular hypertrophy, heart failure and accelerated atherosclerosis, cerebrovascular disease and stroke, renal failure and retinopathy. Primary care physicians have immense duty to perform in this regard because they are the first to encounter them in various stages of the disease. Hypertension can present per se or in emergencies (as in crisis) or in disguise of a complication (like anaemia and renal failure). Control of hypertension and delaying the development of complications should be their first goal. Lastly, some hypertensives with complications may require referral to advanced centres.

Rheumatological problems in diabetes mellitus.

Major complications of diabetes mellitus--classified as microvascular and macrovascular, are more or less well understood. But musculoskeletal syndromes of diabetes are not rare and they are a major cause of morbidity. Musculoskeletal pain is a universal experience. Soft tissue rheumatism such as rotator cuff lesion of the shoulder, carpal tunnel syndrome and stenosing tenosynovitis are more common in subjects with diabetes mellitus. Articular musculoskeletal disorders also occur more frequently in diabetes mellitus. Careful history and physical examination are essential in reaching a specific diagnosis. Unnecessary investigations are expensive, may cause anxiety to the patients and if taken out of clinical context, lead to over-diagnosis and over-treatment. This article briefly covers the association between musculoskeletal disorders and diabetes mellitus.