A rare case of central post-stroke pain in a patient with migraine and lacunar infarcts in the medulla oblongata

Studies about headaches associated with acute ischemic stroke in patients suffering from migraine were limited, and therefore we present a clinical case of central post-stroke pain (CPSP) in a 47-year-old woman with migraine and lacunar infarcts in the medulla oblongata and also possible mechanisms of CPSP in patients with migraine. Magnetic resonance imaging of the brain revealed lacunar infarction in the medulla oblongata on the right (vertebral artery basin) and a single focus of gliosis in the parietal lobe on the right. Magnetic resonance angiography of cerebral vessels showed the fetal type of structure of both posterior cerebral arteries. This clinical case is a complex clinical situation of a combination of secondary headaches (post-stroke) in a patient with a primary headache (migraine), which was successfully treated by the combined administration of first-line drugs for the treatment of neuropathic pain in a patient with lacunar infarcts in the medulla oblongata. The treatment of CPSP is a difficult task due to the insufficiently unexplored mechanisms of development, the most effective approaches are those aimed at reducing the increased excitability of neurons.Copyright © 2023, Indian Association of Biomedical Scientists. All rights reserved.

Clinical features of acute ischemic stroke in moderately and severely ill patients with coronavirus disease 2019 (Covid-19)

Introduction and Aim: Although coronavirus disease 2019 (COVID-19) causes respiratory illness, it can even develop hypercoagulation and thrombotic complications. The main objective is to study the clinical features of acute ischemic stroke (AIS) with COVID-19 in moderately and severely ill patients. Materials and Methods: A retrospective analysis of thirty-four (34) patients who were infected with COVID-19 and even diagnosed with AIS in September 2020 was assessed. The main clinical and neurological characteristics of stroke, the results of clinical, laboratory, biochemical, coagulation, lipid metabolism, and clinical examination studies of COVID-19 were assessed. Results: The stroke severity, severity of brain damage, and degree of disability were reported more in the severely ill patients than in the moderately ill patients (p < 0.001, p = 0.002, and p = 0.7). Data from clinical-laboratory and biochemical parameters in moderately and severely ill patients showed that a more significant parameters are C-reactive protein (0.93 ± 0.03) and (5.79 ± 0.1), D-dimer (0.39 ± 0.11) and (0.76 ± 0.14), leukocytes (4.2 ± 1.69) and (3.6 ± 1.32), respectively (p < 0.001) and slightly altered values for fasting blood glucose levels (8.61 ± 2.41) and (7.21 ± 3.15). After clinical and pathomorphological analysis, acute respiratory distress syndrome signs were observed only in severely ill patients in 14 (41.1%). Conclusion: Among all the parameters characterizing clinical-laboratory and biochemical differences, inflammatory and infectious markers, and fasting glucose were higher. In moderately and severely ill patients with AIS and COVID-19 has a significantly favorable outcome with a longer hospital stay.