Neurology Ward Research Articles

Conversion Reaction after a Traumatic Brain Injury

KLS, also called recurrent hypersomnia, is a sleep disorder characterized by recurrent episodes of hypersomnia associated with cognitive and behavioral disturbances such as confusion, derealisation, apathy, compulsive eating, and hypersexuality. In this article, we aim to present a case with a history of traumatic brain injury who had been suffering from memory disturbance and came in an unresponsive state. He met several therapists and hospitalized several times. Through reviewing his history, we point out some diagnosis and discuss the probable effect of stressful life events on such patients with impaired memory system. The patient has received these medications during hospitalization in neurology ward pantoprazole 40mg po Qd, amantadine 100mg po BID, modafinil 100mg po TID in addition to diazepam and heparin in bedside. In this case, combination therapy and using hypnosis with family support and cooperation in several medical visits seems to be effective for early treatment.

Large disparities in 28-day case fatality by stroke subtype: data from a French stroke registry between 2008 and 2017.

Background and purposeThe objectives of the present analysis were to assess 28‐day stroke case fatality according to the stroke aetiology and to identify associated factors.MethodsAll stroke events in adults aged ≥35 years between 2008 and 2017 were collected in a population‐based stroke registry in northern France.ResultsOut of a total of 2933 strokes, there were 479 (16%) haemorrhagic strokes and 2454 (84%) ischaemic strokes; the 28‐day case fatality rates were 48% and 15%, respectively. Three‐quarters of the 28‐day case fatalities occurred within 6 days of the event for haemorrhagic strokes and within 16.5 days for ischaemic strokes. After an ischaemic stroke, the case fatality rate was higher for women (18%) than for men (12%, p < 0.0001); however, this difference disappeared after adjustment for age. Cardioembolic strokes (34%) and strokes of undetermined cause (33%) were the most common ischaemic subtypes, with case fatality rates of 16% and 18%, respectively. Large artery atherosclerosis (11%) and lacunar strokes (10%) were less common, and both types had a case fatality rate of 3%. Age at the time of the event and stroke severity were both significantly associated with case fatality. For some types of stroke, a history of cardiovascular events and residence in a nursing home were associated with a poor prognosis. Medical care in a neurology ward was inversely associated with case fatality, for all stroke subtypes.ConclusionsIn northern France, post‐stroke case fatality remains high, especially for haemorrhagic stroke. Being treated in a neurology ward improved survival by around 80%.

Preparedness and impact of COVID 19 infection at tertiary care neurology centers in Pakistan

ObjectiveWe aimed to assess the response and impact of covid 19 pandemic at tertiary care centers in Pakistan especially pertaining to neurological care, facilities and training. MethodsA pre-tested survey form was sent to 40 neurology tertiary care centers in all the provinces in the country in the first week of July 2020. 33 filled forms were received, out of which 18 were public (government) and 15 were private hospitals. ResultsEstimated 1300 HCW (faculty, medical officers, trainees and nurses) work at these 33 participating centers. There were 17 deaths among HCW (1.3%) at ten centers. Sufficient personal protective equipment (PPE) were provided to 158 HCW (12%). 129 (10%)HCW tested positive for COVID 19 at 31 centers including trainees/medical officers (39), consultants (29) and nursing and other staff (61). Due to low neurology admissions, 23/33 hospitals (70%) posted neurology trainees in COVID 19 units to contribute to covid care. Less than 50% hospitals did covid screening PCR before admission to neurology wards. Only 10% hospitals provide training and regular update to HCW. Neurology tele-health services were started for clinically stable patients at 15 (45%) centers. Only 60% neurology training programs were able to start online training. Ongoing research studies and trials focusing neurological manifestations of COVID-19 were done at 10 (30%) centers. Modification of facilities for COVID patients showed that 24(72%) hospitals strictly reduced the number of attendants accompanying patients. Only 10 (30%) centers had neurophysiological tests being conducted on COVID-19 patients. Mental health support services to HCW were provided at 12 (36%) centers. ConclusionsAmong HCW 10% tested positive for covid and 1.3% died. Mental health support services offered for HCW were available in 36% institutions. Neurology training was substantially affected due to low admissions, limited ward rounds and limited availability of online training.

Improvements in Education of Surrogate Decision-makers in the Neurology Wards and Neuroscience ICU are Needed (4831)

Improvements in Education of Surrogate Decision-makers in the Neurology Wards and Neuroscience ICU are Needed (4831)

Efficacy of Thiamine in Patients with Clinically Suspected Dry Beriberi: An Open Labeled Hospital Based Study

Background: Thiamine deficiency-related disorders are increasingly being reported in countries where polished rice is the main dietary constituent and diet is not balanced in calorie, protein, and micronutrient contents. Thiamine deficiency often associated with sensory-motor neuropathy (dry beriberi) without Wernicke’s encephalopathy and cardiac dysfunction. Objectives: The objective of our study is to evaluate the efficacy of thiamine in patients with suspected dry beriberi. Methods: This study was a prospective, open-labeled, self-controlled clinical trial (quasi-experimental study) carried out in the Neurology and Medicine Ward of Chittagong Medical College Hospital from May 2018 to April 2019. Fifty-five (55) patients of suspected dry beriberi were recruited as per inclusion and exclusion criteria. All patients were given 200mg IV Thiamine HCl per day for 1 week, then oral Tab. Thiamine 100mg twice daily for the remaining 11week. They were evaluated clinically before treatment and followed up at the end of 1 week, 6 weeks, and 12 weeks after treatment. Results: There is a significant improvement of leg swelling (p&lt;0.001), muscle cramp (p&lt;0.001), muscle power (p&lt;0.001), the total score of the Overall Neuropathy Limitation Scale (ONLS) (p&lt;0.001) within 1 week of thiamine replacement. The treatment also successfully reduced individual components of sensory impairment (i.e., pain, touch, position, vibration) from baseline to 12 weeks (p&lt;0.001). Only deep tendon reflexes did not return to normal in all patients within 12 weeks. Long-time follow-up is needed for this. Conclusion: Thiamine deficiency should be actively considered as a possible cause of peripheral neuropathy and variability of its clinical features should be taken into consideration. Thiamine is highly effective in reversing most of the clinical features of its deficiency-related peripheral neuropathy. Creating public health awareness about this disease in the community will lead to early diagnosis and treatment.

The Level of Knowledge about Dysphagia Among Neurological and Internal Medicine Nurses

Introduction. Dysphagia is defined as swallowing disorders which causes malnourished, aspiration pneumonia andincreased number of deaths. The best method to diagnose dysphagia are screening tests. Due to the tests it is possibleto introduce an accurate therapy and make a team of therapists to participate in. According to the information theknowledge about this kind of dysfunction is important among nurses.Aim. The main goal of my diploma project was to measure the level of knowledge about dysphagia among thenurses from neurological and internal wards.Material and Methods. The scientific method, which has been used to make the research was diagnosis soundingincluding the surveys. Research tool which has been used while the research was especially made and dedicated formy project own questionnaire of surveys.Results. In the research have taken a part 70 nurses in the age over 22 year-old, who are active in their jobs andwork at neurological and internal wards in the hospitals of Gdańsk. The research has proved higher knowledge levelof the nurses working at neurological wards. All the surveyed people showed the knowledge about the definitionof dysphagia as well as about the food which every sick person should consume and avoid.Conclusions. Own research has shown that the garden of respondents does not affect the level of knowledge aboutdysphagia. The age of the respondents shows no relation to the level of nurses’ knowledge about dysphagia. In turn,seniority affect the knowledge of nurses in this area. The greater the seniority, the higher the level of knowledge ofthe topic in the field of dysphagia. Similarly the workplace. Neurological nurses were characterized by a higher levelof knowledge about dysphagia than nurses from internal medicine departments, while the level of knowledge aboutdysphagia does not depend on the education of the nurses surveyed. (JNNN 2021;10(1):10–17)

Diastolic Blood Pressure as a Predictor of Mortality in Intracerebral Hemorrhage Stroke Patients with Hypertension

Background: Intracerebral hemorrhage (ICH) stroke contributes to a considerable number of deaths, ranging between 30% and 40% of the overall stroke mortality. The incidence of stroke increases with higher blood pressure. High blood pressure at the onset of ICH stroke is a strong predictor for mortality and morbidity. This study aimed to explore the role of diastolic blood pressure as a predictor of death in ICH stroke patients.Methods: Data on 113 ICH stroke patients with chronic hypertension were collected from the medical records of patients treated in the Neurology ward of Dr. Hasan Sadikin General Hospital Bandung, Indonesia, in 2019. Data collected were patient characteristics, hypertension status, systolic and diastolic blood pressures, and patient outcome. Analysis was then performed using the Mann-Whitney test.Results: This study revealed a positive correlation (p=0.031) between diastolic blood pressure and death in ICH stroke patients with chronic hypertension.Conclusion: High diastolic blood pressure is associated with mortality in ICH stroke patients with chronic hypertension.

Microsomic and macrosomic body structure in children and adolescents affected by syndromes or diseases associated with neurodysfunction

In Poland the issue of microsomic body structure (micro-SBS) and macrosomic body structure (macro-SBS) has so far been overlooked. Up until now only a small amount of data have been published, most often as an overview of the problem. The current study was designed to investigate the co-occurrence of microsomic/macrosomic body structure (micro/macro-SBS) and congenital nervous system disorders or neurological syndromes with symptoms visible from infancy, based on essential data acquired during admission procedures at a neurological rehabilitation ward for children and adolescents. The study applied a retrospective analysis of data collected during hospitalization of 327 children and adolescents, aged 4–18 years who had been affected since infancy by congenital disorders of the nervous system and/or neurological syndromes associated with a minimum of one neurodysfunction. To identify subjects with microsomic or macrosomic body structure in the group of children and adolescents, the adopted criteria took into account z-score values for body height (z-score Ht), body weight (z-score Wt), head circumference (z-score HC), BMI (z-score BMI) and head circumference index (z-score HCI). The rates of micro/macro-SBS in the study group amounted to 7.3% and 0.6%, respectively. The findings show a more frequent co-occurrence of, as well as statistically significant correlations between, micro/macro-SBS and type of spasticity (cerebral palsy) (p = 0.024) as well as hydrocephalus not treated surgically (p < 0.001). Macro-SBS was found to more frequently co-occur with hemiplegia and hydrocephalus not treated surgically.

Effect of Shaker Exercise on Dysphagia Level among Patients with Cerebral Vascular Stroke

Background: Dysphagia is one of the major post-stroke complications that can severely damage patient's quality of life and even endangers patients’ lives. Shaker exercise is one of the indirect methods, behavioral swallowing techniques, may increase the swallowing speed and sensitivity. The aim of the study was to evaluate the effect of Shaker exercise on dysphagia level among patients with cerebral vascular stroke. Study design: A quasi-experimental design was utilized to achieve this aim. Setting: This study was conducted at Neurology Ward, Stroke ICU and Intermediate Neurological ICU affiliated to Ain Shams University Hospital, Cairo. Sample: A purposive sample included 68 patients. Tools of data collection: Data were collected using three tools: 1- Structured Interviewing Questionnaire, 2- Clinical data tool, 3- Gugging Swallowing Screening (GUSS) scale. Results: There was a highly statistical significance difference in GUSS score of dysphagia level among patients pre and post implementation of Shaker exercise (P<0.001). The Conclusion: Dysphagia exercise therapy as Shaker exercise was an effective measure in enhancing the swallowing ability among stroke-induced dysphagia patients. Recommendation: Replicate the study on a larger group; selected from different geographical areas in Egypt to obtain more generalized findings in relation to current study

Teaching Video NeuroImages: Multisystemic Erdheim-Chester Disease Presenting as a Cerebellar Ataxia.

A 41-year-old man was admitted to the neurology ward due to progressive vertigo and unsteadiness for the previous 2 months. Neurologic examination was remarkable for a global cerebellar syndrome. Investigation with brain MRI led to the hypothesis of a histiocytosis due to infiltrative lesions of the pons, cerebellar peduncles, and pituitary. Therefore, investigation progressed with chest/abdomen/pelvis CT, bone scintigraphy, and a tibial biopsy that confirmed the diagnosis of Erdheim-Chester disease (figures 1 and 2, video).

A Neurodisparity Index of Nationwide Access to Neurological Health Care in Northern Ireland

Nationwide disparities in managing neurological patients have rarely been reported. We compared neurological health care between the population who reside in a Health and Social Care Trust with a tertiary neuroscience center and those living in the four non-tertiary center Trusts in Northern Ireland. Using the tertiary center Trust population as reference, neurodisparity indices (NDIs) defined as the number of treated patients resident in each Trust per 100,000 residents compared to the same ratio in the tertiary center Trust for a fixed time period. NDIs were calculated for four neurological pathways—intravenous thrombolysis (iv-tPA) and mechanical thrombectomy (MT) for acute ischemic stroke (AIS), disease modifying treatment (DMT) in multiple sclerosis (MS) and admissions to a tertiary neurology ward. Neurological management was recorded in 3,026 patients. Patients resident in the tertiary center Trust were more likely to receive AIS treatments (iv-tPA and MT) and access to the neurology ward (p < 0.001) than patients residing in other Trusts. DMT use for patients with MS was higher in two non-tertiary center Trusts than in the tertiary center Trust. There was a geographical gradient for MT for AIS patients and ward admissions. Averaged NDIs for non-tertiary center Trusts were: 0.48 (95%CI 0.32–0.71) for patient admissions to the tertiary neurology ward, 0.50 (95%CI 0.38–0.66) for MT in AIS patients, 0.78 (95%CI 0.67–0.92) for iv-tPA in AIS patients, and 1.11 (95%CI 0.99–1.26) for DMT use in MS patients. There are important neurodisparities in Northern Ireland, particularly for MT and tertiary ward admissions. Neurologists and health service planners should be aware that geography and time-dependent management of neurological patients worsen neurodisparities.

Randomized Controlled Trial of a Decision Support Intervention About Cardiopulmonary Resuscitation for Hospitalized Patients Who Have a High Risk of Death.

Many seriously ill hospitalized patients have cardiopulmonary resuscitation (CPR) as part of their care plan, but CPR is unlikely to achieve the goals of many seriously ill hospitalized patients. To determine if a multicomponent decision support intervention changes documented orders for CPR in the medical record, compared to usual care. Open-label randomized controlled trial. Patients on internal medicine and neurology wards at two tertiary care teaching hospitals who had a 1-year mortality greater than 10% as predicted with a validated model and whose care plan included CPR, if needed. Both the control and intervention groups received usual communication about CPR at the discretion of their care team. The intervention group participated in a values clarification exercise and watched a CPR video decision aid. The primary outcome was the proportion of patients who had a no-CPR order at 14days after enrollment. We recruited 200 patients between October 2017 and October 2018. Mean age was 77years. There was no difference between the groups in no-CPR orders 14days after enrollment (17/100 (17%) intervention vs 17/99 (17%) control, risk difference, - 0.2%) (95% confidence interval - 11 to 10%; p= 0.98). In addition, there were no differences between groups in decisional conflict summary score or satisfaction with decision-making. Patients in the intervention group had less conflict about understanding treatment options (decisional conflict knowledge subscale score mean (SD), 17.5 (26.5) intervention arm vs 40.4 (38.1) control; scale range 0-100 with lower scores reflecting less conflict). Among seriously ill hospitalized patients who had CPR as part of their care plan, this decision support intervention did not increase the likelihood of no-CPR orders compared to usual care. Canadian Frailty Network, The Ottawa Hospital Academic Medical Organization.

Performance of the Hendrich Fall Risk Model II in Patients Discharged from Rehabilitation Wards. A Preliminary Study of Predictive Ability.

(1) Background: Falls are a dangerous adverse event in patients discharged from rehabilitation units, with the risk of falling being higher in the first weeks after discharge. In this study, we assessed the predictive performance of the Hendrich Fall Risk Model II tool (HIIFRM) when administered before discharging patients to their home from rehabilitative units in orthopedic (OR), neurologic (NR) and pulmonary (PR) rehabilitation wards. (2) Methods: Over a 6-month period, all adult patients who returned home after discharge were assessed by HIIFRM. At six months from discharge the occurrence of falls was obtained by performing a structured survey. The HIIFRM predictive performance was determined by the area under the ROC curve (AUC), sensitivity (Se) and specificity (Sp) for the whole sample and split by ward. (3) Results: 85 of 141 discharged patients were living at home and agreed to take part in the survey. Of these, 19 subjects fell, 6 suffered fractures or head traumas and 5 were hospitalized. The AUC was 0.809 (95% CI: 0.656–0.963), Se was 0.67 (0.30–0.93) and Sp was 0.79 (0.63–0.90) for OR patients. (4) Conclusions: Our preliminary results support the use of HIIFRM as a tool to be administered to OR patients at discharge and provides data for the design of a large study of predictive ability.

Agreement and reliability of repeated bedside respiratory muscle strength measurements in acute and subacute stroke.

Many stroke trials include maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and sniff nasal inspiratory pressure (SNIP) outcome measurements. However, data on agreement and reliability of repeated MIP, MEP, and SNIP measurements in acute and subacute stroke patients are scarce. This study employed a test-retest design. Eighteen patients (seven female) with mean (SD) age 59 (14.5) years were recruited from neurological wards. Median (range) time since first stroke was 50.5 (21-128) days. MIP, MEP, and SNIP were measured repeatedly in three testing sessions (S1-3) conducted within 24h and following international standards. Intra-rater agreement between testing sessions was analyzed using the Bland-Altman method. Test-retest reliability was analyzed using intra-class correlation coefficient (ICC). Association between individual measurement variability, time poststroke, and level of stroke impairment was analyzed using Spearman's rho. Mean difference and 95% limits of agreement for MIP were -0.40 (-23.02, 22.22) cmH2 O between S1 and S2, and 2.14 (-12.79, 16.99) cmH2 O between S2 and S3; for MEP, -4.56 (-29.01, 19.90) cmH2 O between S1 and S2, and 0.29 (-24.28, 24.87) cmH2 O between S2 and S3; and for SNIP, -10.56 (-38.48, 17.37) cmH2 O between S1 and S2, and -6.06 (-27.32, 15.20) cmH2 O between S2 and S3. ICCs for MIP, MEP, and SNIP were ≥0.9 throughout. There were no strong correlations between individual measurement variability and time poststroke or level of stroke impairment. MIP, MEP, and SNIP in acute and subacute stroke patients show good test-retest reliability for group averages; however, absolute agreement can vary considerably for some individuals.

Usability of the head impulse test in routine clinical practice in the emergency department to differentiate vestibular neuritis from stroke.

The bedside head impulse test (bHIT) is used to differentiate vestibular neuritis (VN) from posterior circulation stroke (PCS) in patients presenting with acute vestibular syndrome (AVS). If assessed by neuro-otological experts, diagnostic accuracy is high. We report on its diagnostic accuracy when applied by nonexperts during routine clinical practice in the emergency department (ED), its impact on patient management, and the potential diagnostic yield of the video-oculography-supported head impulse test (vHIT). Medical chart review of 38 AVS patients presenting to our university medical center's ED, assessed by neurology residents. We collected bHIT results (abnormal/peripheral or normal/central) and whether patients were admitted to the stroke unit or general neurological ward. Final diagnosis (VN, n=24; PCS, n=14) was determined by clinical course, magnetic resonance imaging, and vHIT. The bHIT's accuracy was only 58%. Its sensitivity for VN was high (88%), but due to many false-abnormal bHITs in PCS (36%), the specificity was low (64%). The vHIT yielded excellent specificity (100%) and moderate sensitivity (67%). The decision on the patient's further care was almost arbitrary and independent from the bHIT: 58% of VN and 57% of PCS patients were admitted to the stroke unit. The bHIT, applied by nonexperts during routine practice in the ED, has low accuracy, is too often mistaken as abnormal/peripheral, and is not consistently used for patients' in-hospital triage. As false-abnormal bHITs can lead to misdiagnosis/mistreatment of stroke patients, we recommend that bHIT applied by nonexperts should be reassessed by a neuro-otological expert or preferably quantitative vHIT in the ED.

Stroke units in the Philippines: An observational study.

In high-income countries, the management of stroke has changed substantially over the years with the advent of thrombolysis and endovascular treatment. However, in low-income countries, such interventions may not be available, or patients may come to the hospital outside the time window no longer qualified for this therapy. Most studies on stroke units were conducted in high-income countries. Unfortunately, there has been no local multicenter data with large patient numbers showing the effectiveness of stroke units in the Southeast Asian region. To compare the outcomes of patients allocated to stroke units (based on accepted criteria) to those allocated to general neurology wards in the Philippines. This is an open, prospective, parallel, observational comparative study of patients from 11 institutions in the Philippines. Patients were allocated either to the stroke unit or to the general neurology ward by the admitting physician based on the criteria suggested by the Stroke Trialist Collaboration Group. The primary outcome was to determine in-hospital mortality at three- and six months in both stroke units and general neurology wards. The secondary outcomes were determined by a dichotomized modified Rankin scale: (0-2) independent and (3-5) dependent. A total of 1025 patients were included in the study. In the primary outcome, a higher mortality rate (8.4% vs 1.0%) in the general neurology ward (p = 0.000) was seen. The six-month mortality rate was statistically significant and higher among patients admitted to the general neurology ward (3.1% vs 0.8%) (p = 0.009). Patients admitted to the stroke unit attained an independent functional outcome (mRS 0-2) as compared to the general neurology ward (73% vs 61.5%) (p = 0.000). Analysis of functionality at six months favored patients admitted in the stroke unit (88.5% vs 81.4%) as compared to the general neurology ward. Patients specifically admitted to stroke units in the Philippines based on established criteria have better outcomes than those admitted to general neurology wards.

Ethical considerations in neurology during the COVID-19 pandemic.

Coronavirus disease 2019 (COVID-19) pandemic has struck many countries and caused a great number of infected cases and death. Healthcare system across all countries is dealing with the increasing medical, social, and legal issues caused by the COVID-19 pandemic, and the standards of care are being altered. Admittedly, neurology units have been influenced greatly since the first days, as aggressive policies adopted by many hospitals caused eventual shut down of numerous neurologic wards. Considering these drastic alterations, traditional ethical principles have to be integrated with state-of-the-art ethical considerations. This review will consider different ethical aspects of care in neurologic patients during COVID-19 and how this challenging situation has affected standards of care in these patients.

Neurofeedback therapy for the management of multiple sclerosis symptoms: current knowledge and future perspectives.

Fatigue is a frequent and debilitating symptom in patients with multiple sclerosis (MS). Affective manifestations are also of high prevalence in this population and can drastically impact the patients' functioning. A considerable proportion of patients with MS suffer from cognitive deficits affecting general and social cognitive domains. In addition, pain in MS is commonly observed in neurology wards, could be of different types, and may result from or be exacerbated by other MS comorbidities. These complaints tend to cluster together in some patients and seem to have a complex pathophysiology and a challenging management. Exploring the effects of new interventions could improve these outcomes and ameliorate the patients' quality of life. Neurofeedback (NFB) might have its place in this context by enhancing or reducing the activity of some regions in specific electroencephalographic bands (i.e., theta, alpha, beta, sensorimotor rhythm). This work briefly revisits the principles of NFB and its application. The published data are scarce and heterogeneous yet suggest preliminary evidence on the potential utility of NFB in patients with MS (i.e., depression, fatigue, cognitive deficits and pain). NFB is simple to adapt and easy to coach, and its place in the management of MS symptoms merits further investigations. Comparing different NFB protocols (i.e., cortical target, specific rhythm, session duration and number) and performing a comprehensive evaluation could help developing and optimizing interventions targeting specific symptoms. These aspects could also open the way for the association of this technique with other approaches (i.e., brain stimulation, cognitive rehabilitation, exercise training, psychotherapies) that have proved their worth in some MS domains.

An observational study to analyze the risk factors associated with stroke in West Rajasthan, India

Background: The recent years have witnessed a surge in the incidence of stroke cases worldwide. Stroke is the most common neurological emergency. It is the second most known common cause of death and one among the major cause of disability worldwide. Aim and Objectives: The main aim of this study is to analyze the major associated risk factors in stroke and assess the awareness among the survivors for the same. Material and Methods: This was a prospective, cross-sectional, observational study, conducted among 100 patients in both sexes in the age group of 25–75 years admitted in Neurology and General Medicine ward at Mathura Das Mathur Hospital, Dr. Sampurnanand Medical College, Jodhpur. The information was collected by previously designed questionnaire. The data were collected and analyzed using appropriate statistical tests. Results: In our study, 100 patients with stroke were included. Out of these 100 patients, 72% of patients suffered an ischemic stroke and 28% a hemorrhagic stroke. The incidence of stroke was predominant in male with 55% followed by females (45%). With increasing age, the number of stroke patients also increased. Among the 100 selected, 37 patients were below 50 years of age and out of these, 26 showed ischemic and 11 showed hemorrhagic type of stroke. In patients above 50 years, 63 patients were found, in them, 46 showed ischemic and 17 showed hemorrhagic type of stroke. About 63% of stroke patients were found >50 years age group. It was found that the most common comorbid condition in stroke patients was hypertension (47%) followed by diabetes (21%). Family history of stroke was seen in 18% and dyslipidemia in 17%. Fourteen patients have IHD and 10% of patients have a family history of cardiovascular disease. Conclusion: This study concluded that with increasing age, the number of stroke patients also increases and hypertension is the most common cause or risk factor for disease.

Short Term Hospital Outcome of Ischemic Stroke Patient Presenting with Hyponatremia

This observational prospective study was performed in the Department of Neurology and Medicine wards at Mymensingh Medical College Hospital, Bangladesh over the period of one year to assess the short term hospital outcome of ischemic stroke patients presenting with hyponatremia. Patients diagnosed as ischaemic stroke were primarily enrolled as study population in this study. Of them 50 patients were selected whose serum sodium was less than 135 meq/L as hyponatremic and another fifty patients were selected whose serum sodium was normal level (135-145) meq/L as normonatremic. The patients were followed up at admission and at the time of discharge. Disability was assessed by the mRS score. Mean age of hyponatremia patients and normonatremia patients were 64.8 ± 12.3 years and 60.9 ± 13.1 years respectively. Male were predominant in both groups. Mean Na+ level in hyponatremia patients was significantly lower than normonatremia patients (127.6 ± 5.7 mg/dl vs 139.3 ± 3.5 mg/dl). Even mortality rate was higher in hyponatremia group (12.0%) than that of normonatremia group (4.0%) the difference was not statistically significant (p&gt;0.05). No significant difference was observed in disability rate between hyponatremia group and normonatremia group (81.8% vs 72.9%). The mean mRS scores at the time of admission (4.16 ± 1.03 vs 3.74 ± 0.75) and at the time of discharge (3.56 ± 1.21 vs 3.04 ± 0.98) were significantly higher in hyponatremia than normonatremia patients. This study result shows that mRS score is higher in hyponatremic stroke patients than that of normonatrimic stroke patients.