ABSTRACT
The author names "Dr. Pablo Garcia Bermejo" and "Dr. Muhammad Faisal Wadiwala" needed to be added as the 6th and 7th authors, respectively. The authors regret this error.
ABSTRACT
Asymptomatic small vessel disease (SVD), including white matter hyperintensities (WMHIs), periventricular hyperintensities (PVHIs), silent stroke (SS), and cerebral microbleeds (CMBs), increases the risk of stroke. There are limited studies of SVD in subjects from the Middle East and Southeast Asia (SA). All patients admitted to stroke service between 2014 and 2015 were reviewed for presence of "pre-existing" SVD. Stroke mimics with no previous history of stroke were used as controls. There were 1727 patients admitted with stroke. Analysis was done on 988 subjects (914 strokes and 74 controls) who had MRI scan done. Pre-existing SVD was seen in 642 (64.9%) patients (WMHIs 19.6%, PVHIs 33.2%, SS 51.4%, and CMBs 22%). Silent strokes were significantly more common with ischemic stroke (IS) compared to intracranial hemorrhage (ICH) (62.0 vs 34.3%, p < 0.001). CMBs were more in ICH compared to IS (42.9 vs 23.1%, p < 0.001). The risk of developing CMBs among Far Eastern (FE) patients was 1.58 times more (p = 0.07), while 1.48 times more in Arabs (AR) (p = 0.026) compared to SA after adjusting for age. The risk of developing PVHIs was significantly higher in Arab compared to SA (odds ratio (OR) 1.43; p value = 0.021). Similarly, the risk of developing WMHIs was also significantly higher in AR patients (OR 1.6; p value = 0.009) compared to SA. The majority of ethnic AR, SA, and FE populations show pre-existing SVD on MRI. The advanced changes at a young age may be related to high prevalence of untreated risk factors and possibly as yet defined genetic and environmental factors.
Subject(s)
Brain Ischemia/epidemiology , Cerebral Small Vessel Diseases/epidemiology , Intracranial Hemorrhages/epidemiology , Leukoencephalopathies/epidemiology , Stroke/epidemiology , Adult , Aged , Asia, Southeastern/epidemiology , Brain Ischemia/diagnostic imaging , Cerebral Small Vessel Diseases/diagnostic imaging , Asia, Eastern/epidemiology , Female , Humans , Intracranial Hemorrhages/diagnostic imaging , Leukoencephalopathies/diagnostic imaging , Magnetic Resonance Imaging , Male , Middle Aged , Middle East/epidemiology , Philippines/epidemiology , Stroke/diagnostic imagingABSTRACT
It is important to consider several differential diagnoses in a patient presenting with altered sensorium following surgery. Fat embolism syndrome (FES) is a serious condition that needs to be excluded. Although criteria for diagnosis of FES are available, all patients may not satisfy them. We discuss a patient who presented with an incomplete triad of the FES, where the diagnosis was supported by transcranial doppler monitoring of microembolic signals and magnetic resonance imaging.
