Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Acute stroke is a medical emergency. Therefore, early recognition and rapid activation of the medical system are important prerequisites for successful management. We sought to investigate the impact of our new Acute Stroke Team emergency call system (AST) on admission delays from the emergency department (ED) to the stroke care unit (SCU) and on the subsequent length of stay (LOS) and in-hospital mortality. ⋯ The introduction of AST has reduced the time from door to brain CT scan. This is an important finding as the window period for thrombolysis is short and early diagnosis is crucial.
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Chiari I malformation (CM) associated with a cervico-thoracic syrinx due to supracerebellar arachnoid cyst has not been reported in the literature. We report such a case, managed by fenestration of the arachnoid cyst and foramen magnum decompression (FMD), aiming to reduce the inferiorly directed pressure on the cerebellum and eliminate the craniospinal pressure dissociation respectively. Imaging done post-operatively showed upward displacement of the cerebellar tonsils with a decompressed craniovertebral junction and disappearance of the syrinx.
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Charles Bonnet syndrome (CBS) is a widely under-recognised disorder typically characterised by complex visual hallucinations in the visually impaired. The lack of consensus over a uniform definition for CBS has much to do with the unresolved pathophysiology of the disorder. ⋯ While treatment aimed at improving the visual deficit can limit the symptoms of CBS, at present there is no reliably effective pharmacotherapy for the disorder. Once correctly recognised, a key management principle is to reassure the patient that CBS is a well-documented clinical entity that is not a harbinger of psychiatric illness.
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We report a patient with paradoxical brain embolism due to patent foramen ovale (PFO) associated with pulmonary embolism (PE). The number of microembolic signals, as detected by contrast saline transcranial Doppler (c-TCD) exam, drastically decreased with improvement of increased right atrial pressure due to PE. In a patient with paradoxical brain embolism associated with PE, c-TCD may be useful for both diagnosis of the presence of right-to-left shunting and evaluation of cardio-pulmonary circulation.
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Pregnancy and puerperium raise the risk of thrombotic events, and these risks are likely to be increased in women who are carriers of thrombophilic gene polymorphisms. Prothrombin G20210A variant is reported to be the second most frequent prothrombotic polymorphism in Caucasians. Our aim was to determine the prevalence of this variant in south Indian women and examine its association with cerebral venous and sinus thrombosis occurring during puerperium. ⋯ The prothrombin G20210A variant was not detected in either the CVT patients or the healthy control subjects. Our study on a large series of patients with puerperal CVT shows that the prothrombin G20210A variant is not present in south Indian women and is not associated with puerperal CVT. This study also highlights the fact that there are racial differences in the risk factors for thrombosis, which should be considered when investigating these patients.