Aneurysmal subarachnoid hemorrhage: presentation and neuroradiological detection

To study the presentation and the results of the different radiological tools; computed tomography [CT] brain scan, magnetic resonance imaging [MRI], magnetic resonance angiography [MRA] and cerebral angiography [CA] in patients with subarachnoid hemorrhage [SAH] resulting from ruptured cerebral aneurysms. Consecutive patients with CT proved diagnosis of SAH were subjected to thorough history taking, general, neurological examination and laboratory investigation. After exclusion and deaths, 13 patients underwent MRA and CA beside CT and MRI. CA detected 11 aneurysms in 11 patients, arterio-venous malformation in one patient and in one patient there was no apparent cause. Among our 11 patients with aneurysmal SAH, females and age group of 31-50 years predominated. Smoking was present in 45.5%, hypertension in 27.3% and history of recurrent headache in 63.6%. With the onset of SAH, headache with neck stiffness was the most common presentation [63.6%]. Disturbed consciousness was found in 45.5%, seizures in 18.2% and focal signs in 9.1%. 36.4% of the patients had grade II and 27.3% had grade III in Hunt and Hess scale. Radiological assessment revealed that 7 patients had pure SAH, 3 patients had intracerebral hemorrhage [ICH] and one patient had intraventricular hemorrhage [IVH] in association with SAH. 63.6% of the aneurysms in our patients were small and no giant aneurysms were found. The most common site of aneurysms was middle cerebral artery [MCA] accounted for 36.4%. Anterior cerebral artery [ACA] and anterior communicating artery [ACoA] accounted for 18.2% each. Internal carotid artery [ICA] and posterior communicating artery [PCoA] accounted for 27.3%. In comparison to the CA, as the golden standard method, MRA detected 10 aneurysms out of 11, and missed one small aneurysm, with a sensitivity of 90.9% in detection of aneurysms. Ruptured intracranial aneurysms accounted for about 85% of causes of SAH. History of recurrent headache, smoking, hypertension and female gender may be predictors of aneurysmal rupture in the 4[th] and 5[th] decades. 36.4% of SAH may be associated with ICH or IVH. Headache is the most common presentation of rupture aneurysm while less than half of the patients presented with altered consciousness. About tow thirds of aneurysms are small sized. Intracranial aneurysms located in the anterior cerebral circulation mostly in MCA. MRA is a rapid, non invasive technique and can be used to detect intracranial aneurysms with high sensitivity of 90.9%, with excellent correlation with the gold standard, invasive, CA

Cerebral infarction in diabetics: patterns and predictors of hospital mortality

Ischemic cerebrovascular disease accounts for substantial proportion of all strokes. Diabetes mellitus is a well established known risk factor for ischemic stroke and this due to the pathophysiological changes affecting blood vessels during the course of the disease. However it's unclear whether stroke features, severity and prognosis differ in diabetic and non-diabetic patients. This work is aiming to study and compare prospectively the characters and patterns of ischemic stroke in both diabetic and non-diabetic patients, with evaluation and predication of causes of hospital mortality. This study included 380 patients presenting with acute ischemic stroke, 120 were diabetic and 260 were non-diabetic. All were subjected to the following: Detailed history taking, complete general and neurological examination, assessment of stroke severity using Glasgow Coma Scale [GCS] and Canadian Stroke Scale [CANS] and Modified Rankin Scale [MRS] was done on the first and tenth day of admission to evaluate functional outcome, laboratory investigations including glycosylated haemoglobin [HbA1C], fasting and postprandial blood sugar, lipid profile, complete blood count and computed tomography of the brain. Our results showed that: The age of our diabetic patients was younger than non diabetic. We found that, hypertension, myocardial infarction, transient ischemic attack, obesity and hyperlipidemia were common in our diabetic patients, while atrial fibrillation and smoking were common in non diabetic patients. There was positive correlation between admission glucose level and HbA1c level and clinical presentation by CANS and MRS. Dysarthria, pure motor, pure sensory and sphincteric disturbance were higher in diabetic group. The size of infarctions were more medium and small size [lacunar] in our diabetic patients. Occipital lobe and thalamic infarctions were significantly higher in our diabetic group, while frontal infarction were higher in non-diabetic group. Outcome using CANS and MRS was more worse in diabetics indicating increasing disability and mortality. Causes of deterioration were hemorrhagic transformation, infarct expansion and stroke recurrence. In our diabetic group infarct expansion and stroke recurrence were higher than non-diabetic one. Mortality was higher in non diabetic group. Causes of mortality varies between infection and cardiac diseases. Diabetes mellitus has a negative effect on cerebral ischemia regarding occurrence and recovery. Furthermore uncontrolled diabetic patients were highly susceptible for stroke recurrence indicating the toxic role of hyperglycemia in cerebral tissues and also affection on blood brain barrier promoting hemorrhagic transformation of cerebral infarction

Silent cerebral infarcts in children with sickle cell anemia

Children with sickle cell anemia [SCA] are at high risk for neurologically overt cerebral infarcts associated with stroke and neurologically silent cerebral infarcts [SCI] correlated with neuropsychometric deficit. The purpose of this study was to determine the incidence of SCI among patients with SCA and to detect the risk factors for its occurrence and to evaluate the effect of SCI on neurocognitive functions. We studied 20 patients with SCA clinically and laboratory, then MR1 brain to detect cerebral infarctions was performed to all patients and neuropsychological evaluation using Wechseler Intelligence Scale-far children, 3[rd]. [WISC-III] was done to all patients. We found that the incidence of SCI was 15% among our patients with SCA and the most common clinical event predicting SCI was seizures as it occured in 2 out of 3 patients with SCI, also decreased hemoglobin concentration and increased leucocytic count were a risk factors for developing SCI. We also found that patients with SCA and SCI had significantly lower full scale intelligence quotient [IQ] than patients with normal MRI although the latter patients also have lower IQ than the normative data supplied by the test. So we concluded that all patients with SCA must undergo careful clinical, radiological and neuropsychological evaluation for early detection of SCI and congnitive impairment in these patients