RESUMO
Background: Cerebrovascular accident also called as stroke is defined as the sudden onset of neurological deficit that can be attributable to a focal vascular cause. Many studies in the past have demonstrated the fact that neurological abnormalities produce Electrocardiographic changes without any underlying cardiac lesions. Present study is done to analyze different changes in Electrocardiogram and echocardiographic patterns in the cases of cerebrovascular accidents and to assess whether these different changes have got any prognostic significance in these patients.Methods: In this study 100 patients of acute stroke admitted between May 2011 to August 2012 in Vydehi institute of medical sciences and research centre were considered and subjected to CT scan of brain, Electrocardiogram and 2D echocardiography within 24 hours of admission. Follow-up was done within the hospital to know the prognosis of all the patients.Results: Out of 100 patients majority of them had ischemic stroke accounting for 80% and remaining 20% of patients had haemorrhagic stroke. Abnormal Electrocardiographic changes were seen in 64% patients and 58% patients showed abnormal Echocardiography. ECG changes seen are Tachycardia, QTc prolongation, T wave inversion, ST depression, U waves and Bradycardia. Commonly seen echocardiographic changes were LV dysfunction, mitral valve abnormality, aortic valve abnormality. Overall mortality in patients with abnormal ECG was 28.12% compared to 11.11% in patients with normal ECG and it was statistically not significant. Overall mortality in patients with abnormal 2D echocardiography was 31.03% compared to patients with normal 2D Echocardiography which was 4.76% and it was statistically significant.Conclusions: From this study we conclude that ECG abnormalities in stroke patients do not have any prognostic significance. But LV dysfunction has prognostic significance in predicting mortality in cerebrovascular accident.
RESUMO
Various risk factors have been implicated in causation of stroke but hypertension remains the single most important treatable risk factor in all age groups, and it is the one which seems to have a direct relation to incidence. Furthermore antihypertensive therapy has been observed to be effective in reducing the incidence of CVD (cerebrovascular disease). The interaction between hypertension, antihypertensive treatment and stroke is a complex one. Nevertheless the conclusion is that antihypertensive treatment has definite beneficial effects on stroke. Limited data are available to guide the choice of a target for the systolic blood-pressure level when treating acute hypertensive response in patients with intra cerebral hemorrhage. In this study, a total of 55 patients who presented with CVD and with hypertension (stage 1 and 2 of JNC 7) were included in this study. Out of 55, 37 (67%) cases are ischemic and 18 (33%) cases were due to cerebral hemorrhage. In ischemic stroke 35 (63.5%) cases are thrombotic, 2 (3.5%) are embolic strokes. All patients were given treatment with oral Nifedipine retard preparation 10-20mg q 8th hourly or Angiotensin converting enzyme inhibitors (which also stabilizes endothelium of the vasculature), along with other conservative treatment and physiotherapy. Patients with intra cerebral haemorrhage were treated with Nimodipine 60 mg q 8th hourly along with antihypertensive treatment. In our study, the reduction of blood pressure improved the outcome, and their Blood Pressure normalized without any complications. Blood pressure reduction in acute stroke, irrespective of the etiology improved the outcome. In our study, we reduced the BP in all acute CVA patients with E. A. Ashok Kumar, P. Jijiya Bai. Role of blood pressure control in all acute cerebrovascular accidents with hypertension. IAIM, 2016; 3(8): 111-125. Page 112 hypertension to normal within 24-48 hours. This study suggested BP control improves the outcome, when compared to fatalities in other studies, where BP is not reduced acutely.
RESUMO
A seizure (Latin word which means “to take possession of”) is a paroxysmal event due to abnormal excessive or synchronous neuronal activity in the brain. Seizure is a medical emergency and about 1 in 10 persons will experience a seizure in their lifetime. Etiological contribution to seizures in developing countries is different from developed countries. Epilepsies related to malaria, neuroinfections, tuberculosis, HIV, meningitis, trauma and perinatal difficulties more prevalent in India and other developing countries. Neurocysticercosis is the most common cause of seizures/epilepsy in the developing countries and designated as a “biological marker” of the social and economic development of a community. In India, Single Small Enhancing CT Lesions (SSECTL) being the most common radiological finding and dying cysticercus larva in histopathological studies. Aim: To study the etiological profile in new onset seizures. Methods: This was an observational and prospective study. The present study enrolled 100 patients above 15 years of age with new onset seizures. All the patients and their relatives were interviewed regarding history and thorough clinical examination was done. Routine blood investigations, blood urea, serum creatinine, blood sugar, liver function tests, serum electrolyte were done. Special investigations like electroencephalography (EEG), CT scan brain, MRI, and lumbar puncture were done in selected cases. Results: Out of 100 patients included in the study, neuroinfection is leading cause of seizure in 36%, Cerebrovascular accidents (25%) and metabolic in (12%). Majority of seizures in neuroinfections were due to neurocysticercosis in 15 patients (42%) followed by meningoencephalitis in 14 patients (38%). Among Cerebrovascular accidents, stroke accounted for 84% (21) (Infarct-12, Haemorrhage-9), followed by cerebral venous thrombosis 12% (3). Out of 12 patients with metabolic seizures, hypoglycaemia and hyponatremia constituted 33% each. Conclusions: Etiological spectrum of seizures includes neuroinfection, CVA, tumour, metabolic, poisoning and alcohol withdrawal. Neuroinfection accounted for significant number of seizures in all the age groups. Neurocysticercosis is the most common etiology among neuroinfections. Cerebrovascular accidents common in 4th & 5th decades. Limitation: Patients <15 years with new onset seizures were not included in the study.
RESUMO
Objective To explore the effects of walking training assisted by electromyographic biofeedback (EMGBF) on the lower limb function of subacute stroke patients with foot drop. Methods Forty subacute stroke patients with foot drop were randomly divided into an EMGBF training group (n =20 ) and a routine rehabilitation training group ( n =20 ).Both groups received routine rehabilitation training.The EMGBF training group also received walking training assisted by three stages of EMGBF.The subjects were treated for 40 min twice per day,5 days a week for 6 weeks.Clinical and functional evaluations such as surface electromyogram (sEMG) signals from the anterior tibial muscle,active ankle dorsiflexion range of motion ( AROM ),scores on the modified Ashworth scale (MAS),results of the modified Lovett manual muscle test (mMMT),pace and step length,Berg balance scale (BBS) scores,Fugl-Meyer movement function scale (FMA) assessments,modified Barthel index (MBI) scores and Holden walking function test results were observed before treatment,after 6 weeks of treatment and at follow-up 6 weeks after the end of treatment. Results Before treatment there was no significant difference between the two groups.There were significant differences in all of the assessment results in the EMGBF training group after treatment compared with before treatment and compared with the routine rehabilitation training group after treatment.At followup 6 weeks after training,average pace (69.75 ± 35.09 m/min),step length (60.98 ± 14.09 cm),FMA score (32.5 ± 6.34 ) and MBI score (88.65 ± 14.13 ) in the EMGBF training group were all significantly better than in the routine rehabilitation group.At follow up,5 patients in the EMGBF training group achieved grade 5 in the Holden walking function test versus only 1 patient in the routine rehabilitation group. Conclusion Walking training assisted by EMGBF is effective in improving lower limb motor function in subacute stroke patients with foot drop.
RESUMO
Objective Electric stimulation functional observation statistics (FES) were collected for elderly patients with cerebral apoplexy in search of any curative effect. Methods A total of 40 patients with cerebral apoplexy were divided randomly into a FES group of 20 cases and a control group of 20 cases. Both groups received the same routine rehabilitation training and basic drugs. The FES group was also treated using FES therapeutic apparatus for 30 min daily over 3 weeks (15 sessions). The control group received no electrical stimulation. Upper limb motor function, lower limb motor function, balanceand Barthel's index were evaluated. Results In the FES group, upper limb motor function was significantly improved after treatment, and significantly better compared with the control group. Lower limb motor function showed the same significant differences. Balance was also significantly better after treatment and significantly better than in the control group. Similar significant improvements were seen in terms of Barthel's index. Conclusions FES can improve the functional capacity of elderly patients with cerebral apoplexy hemiplegia and improve their ability in daily activities.
RESUMO
@#ObjectiveTo describe 64 cases of cerebrovascular accidents temporally associated with cervical vertebra manipulation therapy in terms of patients' characteristics, potential risk factors, nature of complication, and neurologic sequelae.MethodsThree researchers using a uniform data abstraction instrument performed an independent review of 64 previously medicine records describing cerebrovascular ischemia after cervical vertebra manipulation. Descriptive statistics were calculated for characteristics of the patients and the complications. Means and standard deviations were computed for continuous variables. Frequencies were computed for continuous variables. Frequencies and proportions were calculated for categorical variables.ResultsProposed risk factors include age, gender, migraine headaches, hypertension, diabetes, birth control pills, cervical spondylosis, and smoking. It was unable to identify factors from the clinical history and physical examination of the patient that would assist a physician attempting to isolate the patient at risk of cerebral ischemia after cervical manipulation.ConclusionsCerebrovascular accident after manipulation appear to be unpredictable and should be considered an inherent, idiosyncratic, and rare complication of this treatment approach.
RESUMO
A comparative study of the incidence of CVA and myocardial infarction was done. CVA was found to be 10 times more common than myocardial infarction. Thrombosis was the most common type of CVA. The male sex is more frequently affected. These diseases are prevalent after the age of 40. Hypertension, diabetes mellitus, and obesity are predisposing factors in their production. The prognosis is more serious in cerebral hemorrhage than in thrombosis. Myocardial infarction has a mortality rate of 10-20% depending on the number of infarctsAtherosclerosis, the underlying pathology, is a widespread disorder of the whole world in general. However, coronary disease has a slightly lower incidence in the East. Some data are given regarding the incidence CVA and myocardial infarction in other countries. Therapy of predisposing factors may help in some way in the prevention of some of these conditions.(Summary)
RESUMO
This study was done to investigate the blood pressure, BMI and serum lipids of cerebrovascular accident patients in Seoul. The subjects were 195 Korean urban cerebrovascular accident patients who were hospitalized at Dong Seo Oriental Hospital in Seoul from June, 1997 to December, 1997. There were more cerebral infarction patients(164) than cerebral hemorrhage patients(31). Cerebral infraction patients were prevalent for subjects in their sixties, but cerebral hemorrhage patients were most commonly in their fifties. The BMI of cerebral infarction accidents was significantly higher than that of cerebral hemorrhage patients(p<0.05). Mean diastolic blood pressure of cerebral hemorrhage patients was significantly higher than that of the cerebral infarction patients(p<0.05). The mean systolic blood pressure of the cerebral hemorrhage patients was higher than that of the cerebral infarction patients, not statistically significant. The serum total cholesterol and glucose levels of the cerebral infarction patients was significantly higher than those of the cerebral hemorrhage patients(p<0.05). Serum total cholesterol(p<0.01), triglyceride(p<0.05) and LDH(p<0.01) levels of female subjects were significantly higher than those of male subjects. Serum total cholesterol has a negative correlation with serum GOT and GPT, but has a positive correlation with triglyceride. Serum triglyceride has a negative correlation with diastolic blood pressure but has a positive compellation with serum glucose.