Akash M Awati

Abstract

Introduction: Generalised Tonic Clonic Convulsions are one of the common presentation to the emergency department. Proper understanding and approach to the same for a practicing doctor and education to the patient and its family helps in avoiding recurrence and the myths associated with it. Not many studies have studied the association of this clinical presentation in relation to neuroimaging and electroencephalography, hence this study. Materials and Methods: Study was conducted over a period of 2 years where in all patients presenting to the out patient and emergency department with first episode of generalized tonic clonic convulsion were taken into consideration. Necessary investigation were performed especially MRI Brain and EEG, the data was analysed across various variables and corelated. Results: In present study it was noted around 34% of patients had no specific cause, 60% had normal MRI, 40% had abnormal EEG, incidence was higher in males and in patients in age group between 18-45 years. Stroke and alcohol withdrawal were other common causes followed by metabolic abnormalities, cerebral venous thrombosis, posterior reversible encephalopathy syndrome and cns infections. Conclusion: A detailed history regarding semiology has to be collected, even though sometimes it is difficult to obtain the same. In such situations neuroimaging like MRI Brain and Electroencephalography should be performed in every patient presenting with first episode of generalized tonic clonic convulsion. This approach helps in preventing the recurrences and identifying the exact cause and management of the patients.   Keywords: Gtcs, Mri Brain, EEG

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Abstract

Introduction: Even with recent advances in the management of ischemic stroke, incidence of recurrence is quite frequent. Identification of risk factors is of prime importance especially during the first episode of ischemic stroke. Imaging in stroke has pivotal role to play in understanding the stroke and also the recurrence risk. Hence we present a study about clinical and radiological profile of recurrent ischemic stroke patients. Materials and Methods: The study was conducted for a period of five consecutive years with a sample size of 100 patients. It is a cross sectional descriptive study where in data was collected and analysed among various variables necessary. Patients with recurrent ischemic stroke were examined and investigated. Continuous variable is expressed as mean +SD or median (Range) if non- normally distributed. Categorical data is expressed in proportions. Results: Recurrence of the ischemic stroke was commonly seen in the patients with uncontrolled blood pressure, hyperglycemia, dyslipidemia, ischemic heart disease and patients with large artery atherosclerosis. Incidence was higher among male patients, patients above 60 years of age and stroke involving MCA and ACA territories. Conclusion: Identification of the risk factors responsible for the recurrence at the first episode of ischemic stroke and appropriate management are of prime importance. Apart from clinical and biochemical parameters, considering the radiological parameters like extent of stenosis and appropriate dosing and choice of medication also is of utmost importance in preventing the recurrence of stroke.   Keywords: Stroke, Recurrence, Risk factors

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Headache is a common presenting symptom in day to day practice, so is epistaxis. Among different types of headaches, migraine is the most common type of headache. Although bleed from other sites are less common presentation compared to epistaxis. Often migraine and epistaxis are managed and evaluated as separate entity. Patients with such bleeds undergo extensive evaluation but do not arrive at definitive diagnosis. Here we present a subgroup of patients with migraine related bleeds from various sites which is less well recognised in day to day clinical practice and hence our study. Aim: To study the clinical profile and outcome in patients with migraine related bleeding. Materials and Methods: Study was conducted in a tertiary care hospital in South India. All patients with history of migraine and bleeding from different sites like nose, eyes, gums etc, presenting to out patient department where chosen for study and were subjected to a detailed questionnaire about same. Treatment was initiated accordingly and patient was followed up to look for treatment response and data was analysed under various variables. Results: These bleeds which was associated with migraine headache lasted only for few seconds to minutes. Beginning of bleeding and peak of severity of headache had no definite correlation. Termination of epistaxis (79%) and other bleeding sites was usually before termination of headache. Side of bleed varied, on side of headache 30%, bilateral or either side 35% and locked to one side in 35% of patients. 79% of patients responded well to Amitryptiline. Conclusion: Bleeds in migraineurs is not uncommon but is a under recognised entity. A detailed questionnaire regarding presence of migraine in patients presenting with epistaxis and bleeding from other sites, helps in avoiding unnecessary extensive evaluation of epistaxis. A significant relief from nose bleeds, gums and eyes is observed with optimum treatment of migraine. This also helps in improving the quality of life of our patients and reduces the apprehension of nose bleeds, social embarassment and syncopal attacks secondary to blood sight. Keywords: Headache, Nose bleed, Migraine, Hemolacria.

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Introduction: Cranial nerve involvement in meningitis is not uncommon and readily treatable if addressed at the earliest. Hospital admissions due to meningitis is quite common in developing countries like India. Here we present a study about clinical profile of meningitis patients with cranial nerve involvement and its significance in day to day practice. This study is conducted from a tertiary care centre of South India. The present study can aid in differentiation of types of meningitis and arrive at proper diagnosis especially in resource limited settings. Materials and Methods: The study was conducted for a period of three consecutive years with a sample size of 150 patients. It is a cross sectional descriptive study where in data was collected and analysed among various variables necessary. Patients with symptoms of meningitis and involvement of either of twelve cranial nerves were taken into consideration. Necessary investigations and examinations were done.  Results: Cranial nerve involvement was most commonly seen in tubercular meningitis as compared to other types of meningitis. 6th cranial nerve was most commonly involved followed by 3rd , 2nd , 8th and 7th respectively. Fever and neck stiffness were seen in considerable number of patients of meningitis with cranial nerve palsy and especially in less than 45 years of age. Conclusion: Tubercular meningitis should be the first differential diagnosis in a patient presenting with symptoms of meningitis (or fever) with cranial nerve palsy. Presence of only papilledema without cranial nerve palsy warrants to exclude other causes. Keywords: Meningitis, Cranial Nerve Palsy.

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