Sudden Loss Of Consciousness Research Articles

Hirtelen szívhalál

A hirtelen szívhalál (HSZH) klinikai szind-róma, amely a legáltalánosabban elfogadott definíció szerint: szívbetegen vagy ismert szívbetegség nélküli személyen cardiogenok miatt bekövetkező, váratlan, idő előtti, természetes halál, amelyet az öntudat hirtelen elvesztése előz meg és az akut tünetek kialakulásától számított egy órán belül bekövetkezik. (3). A hirtelen szívhalál incidenciája a publikált irodalom szerint igen széles tartományban mozog (15-48%), mely függ a földrajzi és demográfi ai mutatóktól.

Classification of orthostatic intolerance through data analytics.

Imbalance in the autonomic nervous system can lead to orthostatic intolerance manifested by dizziness, lightheadedness, and a sudden loss of consciousness (syncope); these are common conditions, but they are challenging to diagnose correctly. Uncertainties about the triggering mechanisms and the underlying pathophysiology have led to variations in their classification. This study uses machine learning to categorize patients with orthostatic intolerance. We use random forest classification trees to identify a small number of markers in blood pressure, and heart rate time-series data measured during head-up tilt to (a) distinguish patients with a single pathology and (b) examine data from patients with a mixed pathophysiology. Next, we use Kmeans to cluster the markers representing the time-series data. We apply the proposed method analyzing clinical data from 186 subjects identified as control or suffering from one of four conditions: postural orthostatic tachycardia (POTS), cardioinhibition, vasodepression, and mixed cardioinhibition and vasodepression. Classification results confirm the use of supervised machine learning. We were able to categorize more than 95% of patients with a single condition and were able to subgroup all patients with mixed cardioinhibitory and vasodepressor syncope. Clustering results confirm the disease groups and identify two distinct subgroups within the control and mixed groups. The proposed study demonstrates how to use machine learning to discover structure in blood pressure and heart rate time-series data. The methodology is used in classification of patients with orthostatic intolerance. Diagnosing orthostatic intolerance is challenging, and full characterization of the pathophysiological mechanisms remains a topic of ongoing research. This study provides a step toward leveraging machine learning to assist clinicians and researchers in addressing these challenges. Graphical abstract Machine learning tools utilized to analyze heart rate (HR) and blood pressure (BP) time-series data from syncope and control patients. Results show that machine learning can provide accurate classification of disease groups for 98% of patients and we identified two subgroups within the control patients differentiated by their BP response.

Multifocal glioblastoma\u2014two case reports and literature review

BackgroundMultifocal glioblastoma is a rare type of glioblastoma with worse prognosis. In this article, we aimed to report two cases of classical multifocal glioblastoma.Case presentationIn case 1, a 47-year-old male presented with dizziness, and once had a sudden loss of consciousness accompanied by convulsion of limbs. Contrast-enhanced MRI showed multiple lesions with heterogeneously ring-enhanced characters in the left hemisphere, diagnosed as multifocal glioblastoma. He underwent a craniotomy of all lesions, concurrent radiotherapy and chemotherapy as well as additional chemotherapy of temozolomide. After 2 cycles, repeat MRI showed that the new lesions already occurred and progressed. Eventually, he abandoned the chemotherapy after the 2 cycles and died 1 year later. In case 2, a 71-year-old male presented with a history of headache, left limb weakness, and numbness. Discontinuous convulsion of limbs once occurred. Contrast-enhanced MRI showed multiple lesions located in the right hemisphere, diagnosed as multifocal glioblastoma. He underwent a right frontoparietal craniotomy of the main lesion. Hemorrhage of the residual tumor and pulmonary artery embolism occurred synchronously. Eventually, his family decided not to pursue any further treatment and opted for hospice care and he passed away within 11 days of surgery.ConclusionsWe reported two cases of typical multifocal glioblastoma. Valid diagnosis is crucial; then, resection of multiple lesions and canonical radio-chemotherapy probably bring survival benefits.

A BUBBLING HEART

SESSION TITLE: Medical Student/Resident Critical Care Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Air embolism is a rare but devastating event that occurs as a consequence of the entry of air into the vasculature. It mostly results from surgical procedures, barotrauma from mechanical ventilation or scuba diving. It can either be arterial or venous with varied implications. Venous air embolism from a routine blood draw is a rare entity not reported much in the literature. CASE PRESENTATION: 62 years old female with past medical history of congestive heart failure with preserved ejection fraction and Sjogren's syndrome presented with complains of sudden onset midsternal chest pain for 5 hours. She rated her pain 7/10 in intensity, radiating to back and pressure-like in sensation, aggravated by inspiration and coughing with no relieving factors. This was also associated with shortness of breath at rest for the same duration. Review of systems was also positive for one episode of lightheadedness and blurry vision on her way to the hospital. She denied any such symptoms in the past. She was a non-smoker. On presentation, she was found to be hypoxic and hypotensive. Her initial labs including workup for acute coronary syndrome was unremarkable, but her CT chest revealed moderate amount of air within the visualized portion of the right and left internal jugular veins, brachiocephalic veins and the right ventricle. She was subsequently admitted to the intensive care unit. The only triggering factor identified for her venous air embolism was a recent regular blood workup done at her rheumatologist’s office one day prior to the onset of her symptoms. She was placed on high-flow nasal oxygen and was also recommended to stay in a left lateral position. These conservative measures led to complete resolution of her symptoms as well as the air embolism on the repeat CT chest within 24 hours. DISCUSSION: Venous air embolism is a catastrophic entity which if not identified and managed on time can lead to life threatening complications. The spectrum of clinical findings ranges from minimal or no symptoms to dyspnea, chest pain, dizziness, sudden loss of consciousness, hemodynamic instability and cardiac arrest. One of the most dangerous complications is the acute right heart failure leading to obstructive shock due to dislodgement of air bubble from the right ventricle into the pulmonary vasculature. It is therefore, managed conservatively with keeping the patient in left lateral (Durant's maneuver) or trendelenburg position that helps in preventing the air lock. Other supportive measures include adequate hydration, high flow nasal oxygen or hyperbaric oxygen in patients with concerns for end organ damage for 12-24 hours. Use of inhalers or mechanical ventilation is contraindicated to prevent barotrauma. CONCLUSIONS: Venous air embolism if not recognized timely can prove to be fatal. Supportive treatment is the key to resolution in majority of the cases. Reference #1: Black, Michael, James Calvin, Kwan L. Chan, and Virginia M. Walley. "Paradoxic air embolism in the absence of an intracardiac defect." Chest 99, no. 3 (1991): 754-755. Reference #2: Cushman, Mary. "Epidemiology and risk factors for venous thrombosis." In Seminars in hematology, vol. 44, no. 2, pp. 62-69. WB Saunders, 2007. Reference #3: Bhatia, Sameer. "Systemic air embolism following CT-guided lung biopsy." Journal of Vascular and Interventional Radiology 6, no. 20 (2009): 709-711. DISCLOSURES: No relevant relationships by Fatima Ayub, source=Web Response No relevant relationships by Vishesh Paul, source=Web Response

Mobitz Type II Second-Degree Atrioventricular Block in a Pilot : To Pace or Not to Pace?

Background: Atrioventricular (AV) block is a threatening condition that caused sudden loss of consciousness and death, notably if happened to aircraft pilot will compromise the reliability of flight operations and safety. Cardiac arrhythmia is well known as one of the main disqualifier for loss of flying license, and discriminating between benign and potentially significant rhythm abnormalities remains a challenge. The present case describes the electrophysiological feature of a high-grade AV block in an aircraft pilot.
 Case illustration: A 60-year-old male worked as commercial aircraft pilot presented with asymptomatic high-grade AV block during inflight Holter monitoring. He had never experienced any remarkable symptoms nor history of near syncope, but had a history of percutaneous coronary intervention (PCI) with one stent at left circumflex (LCx) coronary artery. Electrophysiology (EP) study revealed AH interval of 105 ms, HV interval of 50 ms, AV node effective refractory period of 280 ms and Weckenbach point of 330 ms, suggesting a normal EP study. Stimulation with atrial pacing and ATP showed prolongation of AH interval without changes in HV interval, showing the presence of a supra-Hisian AV node dysfunction. The highly demanding physiological environment in aircraft elucidate the likelihood of vagotonic cause of his condition and pacemaker implantation was not warranted.
 Conclusion: Atrioventricular (AV) block is an AV conduction disorder that can manifests in various symptoms and severity. Electrophysiology study is considered as a modality to locate the site of block that allows the avoidance of unnecessary permanent pacing and the appropriate prophylactic pacing.

Brain death following ingestion of E‐cigarette liquid nicotine refill solution

BackgroundThe use of electronic cigarettes (e‐cigarettes) is very common worldwide. To date, an increase of nicotine intoxication following an accidental or intentional ingestion/injection of refill solution (e‐liquid) has been detected.CaseA 23‐year‐old man presented with sudden loss of consciousness, bradycardia, and respiratory muscle paralysis after intentional ingestion of e‐liquid. Early clinical data, brain computed tomography, and neurophysiological tests (electroencephalogram [EEG] and somatosensory evoked potentials [SEPs]) did not show features with a poor neurological prognostic meaning of an hypoxic encephalopathy. After 4 days, the patient showed bilateral loss of the pupillary reflex, and severe and cytotoxic edema was detected on brain magnetic resonance imaging. SEPs showed a bilateral loss of cortical responses and EEG a suppressed pattern. Nine days after the onset of coma, the patient evolved toward brain death (BD).DiscussionBecause nicotine intoxication might cause respiratory muscle paralysis, without cardiac arrest (CA), it would be important to understand the mechanisms underlying brain damage and to take into account that the current neurological prognostic evidence for hypoxic–ischemic encephalopathy, based on data from patients who all experienced CA may not be reliable. Reporting cases of nicotine intoxication through e‐liquid is relevant in order to improve regulatory parameters for e‐liquid sale.

Sudden onset of syncope and disseminated intravascular coagulation at 14 weeks of pregnancy: a case report

BackgroundAmniotic fluid embolism (AFE), also known as anaphylactoid syndrome of pregnancy (ASP), typically occurs during labor and may result in cardiorespiratory collapse and disseminated intravascular coagulation (DIC). There are reports describing less typical presentations of AFE/ASP in which patients do not necessarily have the classic triad of hypoxia, hypotension, and coagulopathy. AFE/ASP rarely occurs in the absence of labor, but such cases may involve medical or surgical abortion, spontaneous miscarriage, or obstetrical procedures including amniocentesis and amnioinfusion. There are, however, no previously reported cases of AFE/ASP with sudden loss of consciousness and disseminated intravascular coagulation occurring during early pregnancy, in the absence of any intervention or obstetric event.Case presentationA 32-year-old G3P2 Japanese woman had sudden-onset syncope at 14 weeks’ gestation. On arrival at our hospital, her level of consciousness was severely disturbed as determined by the Glasgow Coma Scale. Although her vital signs were initially stable, blood samples collected intravenously and by femoral artery puncture did not coagulate. A subchorionic hematoma with active extravasation of blood was apparent on contrast-enhanced computed tomography. Two hours after her arrival, she developed hypovolemic shock with progression of DIC, presumably due to intrauterine and retroperitoneal bleeding. After transfusion of blood products; treatments for DIC including the use of recombinant human soluble thrombomodulin, ulinastatin, and corticosteroids; and hysterectomy, her level of consciousness and physical condition improved remarkably. Later investigation of preoperative blood samples revealed that serum levels of AFE/ASP-associated markers were elevated. Immunohistochemical studies on the excised, unruptured uterus showed that amniotic fluid components were present inside a uterine blood vessel.ConclusionsThis is the first reported patient with sudden-onset syncope and DIC, but without apparent cardiorespiratory collapse, with the highly likely etiology of AFE/ASP occurring at the beginning of the second trimester of pregnancy and in the absence of intervention or delivery. Maternal collapse with DIC during any stage of pregnancy should be considered an AFE/ASP-associated event, even in the absence of labor or obstetric procedures. This event may occur in the presence of subchorionic hematoma alone.

Approach to the pre-school child with sudden loss of consciousness

Abstract There are several causes for sudden loss of consciousness in pre-school children. These include Transient Loss of Consciousness (T-LOC), which encompasses a group of disorders with the following characteristics: abnormal motor control, loss of responsiveness, amnesia for the period of unconsciousness, and a short duration. There are three main categories of T-LOC in pre-school children: syncope, resulting from a sudden and reversible lack of oxygenated blood supplied to the brain, often caused by transient impairment of cardiac output or systemic arterial hypotension. Secondly, epileptic seizures due to excessive and hypersynchronous cortico-neuronal electrical activity in the brain, and thirdly, “unexplained T-LOC,” which includes cases not yet diagnosed fully, and those for which a pathophysiological mechanism has not yet been identified, despite thorough investigations. Reflex Anoxic Seizures (RAS) are important in the differential diagnosis of non-epileptic paroxysmal events in infants and pre-school children. Parents and carers who witness these episodes are understandably anxious, and the mainstay of management is ensuring that the correct diagnosis is made, reassurance is given, and both the patient and parents are educated about the condition. Diagnosis can be made based off a detailed history, including an eyewitness account of the episode, as well as clinical examinations. This review aims to describe an approach to the diagnosis and management of T-LOC in pre-school children.

The Role and Importance of the Tilt Table Test in Pediatrics

Introduction: The head-up tilt table test is noninvasive diagnostic procedure, which is used in the diagnosis of syncope. Syncope presents a benign short-term disorder of cerebral circulation with the sudden loss of consciousness and muscle tone. Aim: The aim is to present not only the role and importance of orthostatic tests in the daily clinical practice of pediatric cardiology, neuropediatrics but also pediatrics in general. Patients and Methods: This study has retrospective descriptive character and included the period from April 1997 to June 2020, during which the registration and analysis of orthostatic stability tests (head-up/tilt table test, tilt table test) was performed. Medical documentation of outpatient and hospitalized patients on the Paediatric Clinic of Clinical Center University of Sarajevo (Register of Tilt Table Test) was used. Results: During this period, 1029 tests were registered and analyzed. Modification test (head-up) was performed in 132 (12.8%) patients, and since 2008, classic tilt table test was performed in 897 (87.1%) patients. Patients were 6.5–19 years old, with a predominance of female patients 611 (59.4%). There were 519 (50.4%) patients who were 15–19 years old and 510 (49.6%) patients who were under 15 years of age. Indications were syncope or suspected syncope in 671 (65.2%) patients, cardiovascular etiology (arrhythmias, chest pain, congenital heart defects [CHDs], surgically corrected CHDs, hypotension, and hypertension) in 195 (19%) patients, neuropediatric pathology (epilepsia, suspected epilepsia, headache, vertigo) in 101 (9.8%) patients, and other indications in 62 (6.03%) patients. From the total number of tests, 862 were first tests (83.4%) and 167 were control tests (16.3%). The positive test was found in 538 (52.3%) patients, most often vasovagal syncope (473 patients or 87.9%). Conclusion: Tilt table test is a reliable diagnostic tool in examining the etiology of syncope, primarily vasovagal, and is an extremely important method primarily in cardiopediatric and neuropediatric daily diagnostics.

Fahr´s disease presenting with epileptic seizures: a case report

Fahr is a rare neurological disorder that leads to abnormal, symmetrical, and bilateral calcification of the basal ganglia and other brain regions, seizures are one of many symptoms to lead to the diagnosis of this disease. We here report a 45-year-old male diagnosed as Fahr´s disease presenting with loss of consciousness and multiples seizures. A 45-year-old male with a history of an untreated depressive syndrome, smoking, and active alcoholism, admitted to the emergency department with a sudden loss of consciousness and multiples seizures. The Computed tomography scan showed a bilateral and symmetric deposit of calcifications in basal ganglia, the blood tests excluded any other anomaly that may lead to secondary intracranial calcification, the patient denied any similar cases in the family, the clinical, biological and radiological findings were compatible with a sporadic form of Fahr´s disease. Seizures are ones of the rarest symptoms that can reveal a Fahr´s disease, the finding of bilateral and symmetrical calcification of basal ganglia in a patient presenting with seizures should be reminiscent of this illness after excluding any other pathological processes leading to secondary intracranial calcification.

High-grade Atrioventricular Block in Pilot

Background: Atrioventricular (AV) block is a threatening condition that caused sudden loss of consciousness and death, notably if happened to aircraft pilot will compromise the reliability of flight operations and safety. Cardiac arrhythmia is well known as one of the main disqualifier for loss of flying license, and discriminating between benign and potentially significant rhythm abnormalities remains a challenge. The present case describes the electrophysiological feature of a high-grade AV block in an aircraft pilot.
 Case illustration: A 60-year-old male worked as commercial aircraft pilot presented with asymptomatic high-grade AV block during inflight Holter monitoring. He had never experienced any remarkable symptoms nor history of near syncope, but had a history of percutaneous coronary intervention (PCI) with one stent at left circumflex (LCx) coronary artery. Electrophysiology (EP) study revealed AH interval of 105 ms, HV interval of 50 ms, AV node effective refractory period of 280 ms and Weckenbach point of 330 ms, suggesting a normal EP study. Stimulation with atrial pacing and ATP showed prolongation of AH interval without changes in HV interval, showing the presence of a supra-Hisian AV node dysfunction. The highly demanding physiological environment in aircraft elucidate the likelihood of vagotonic cause of his condition and pacemaker implantation was not warranted.
 Conclusion: Atrioventricular (AV) block is an AV conduction disorder that can manifests in various symptoms and severity. Electrophysiology study is considered as a modality to locate the site of block that allows the avoidance of unnecessary permanent pacing and the appropriate prophylactic pacing.

Early total gastrectomy in emphysematous gastritis

AbstractEmphysematous gastritis is a rare form of lethal infection caused by gas‐forming organisms arising from local spread through the gastric mucosa or hematogenous dissemination from a distal focus. It is the counterpart of ischemic bowel disease happening in the stomach. No definitive mode of treatment has been advocated despite its high mortality. Thus far, only 41 cases have been reported in the literature since Dr. Frankel first reported it in 1889. To further understand the disease, we present a case of emphysematous gastritis in a 74‐year‐old female uremic patient, further afflicted with diabetes mellitus, chronic decubitus ulcers, and peripheral occlusive arterial disease, manifesting with fever and sudden loss of consciousness without physical signs of peritonitis. She was diagnosed via computed tomography scan, which showed pneumatosis around the stomach wall, pneumoporta, and pneumoperitoneum. She underwent total gastrectomy within 24 hours, revealing edematous gastric wall and hemorrhagic necroses over the fundus and antrum. Postoperatively, she gradually improved with respirator support, total parenteral nutrition, and broad‐spectrum antibiotics, and she was discharged after 33 days of hospitalization without anastomotic leaks. Further follow‐up revealed that she survived for one and a half years following her surgery without developing a new intra‐abdominal incident, albeit with frequent hospitalizations due to her continuing chronic medical problems. Early aggressive total gastrectomy may be tried to reverse the morbid course of the disease.

CADASIL and Cavernomas: A Common Mechanism.

CADASIL and Cavernomas: A Common Mechanism.

Epithelioid hemangioendothelioma of the liver—case report

Epithelioid hemangioendothelioma of the liver (EHL) is a rare vascular tumor of unknown etiology and unpredictable biological outcome. We describe the case of a 59-year-old Caucasian male patient admitted to University Hospital Merkur for diagnostic work-up and liver transplantation (LT). The patient was presented with sudden loss of consciousness, fatigue and right upper abdominal pain. The only laboratory abnormality was mild increase of transaminases. The MSCT of the abdomen and pelvis showed multiple hypervascular lesions throughout the liver, and the ultrasound-guided biopsy confirmed the pathohistological diagnosis. An orthotopic LT was performed, and the patient was clinically well, without any signs of hepatic transplant dysfunction or tumor recurrence a year after. Multifocality is a common feature of EHL, therefore LT was the treatment of choice. As the multislice computed tomography (MSCT) or magnetic resonance (MR) presentation is frequently inconclusive, the final diagnosis of the tumor has to be confirmed histologically to avoid misdiagnosis of a metastasis or other liver tumors.

Acute Presentation of Metastatic Testicular Seminoma as Chronic Subdural Hematoma with Extra-axial Brain Lesion with Severe Mass Effect: A Case Report and Brief Review of Literature

We present an unusual case of a 33-year-old male, who has been diagnosed with seminoma testes with retroperitoneal lymph nodes involvement 1 year back, the patient had undergone four cycles of the chemotherapy and had undergone left orchidectomy for the same. Past 1 year was uneventful and the patient was living a normal healthy life, with no evidence of any diseases and no symptoms. For the last 1 month, the patient complained of headache with no other symptoms, and on 1 day, the patient had sudden loss of consciousness. Noncontrast computed tomography (CT) head was done, which revealed a large chronic subdural collection with an extra-axial mass attached with the dura on the right parasagittal region. The patient at the time of presentation had a Glasgow Coma Scale of 5/15 with irregular respiration, and the right pupil was fixed nonreacting to the light. Urgent surgery was done, and the patient recovered fully with no deficit and was discharged. The patient will be considered for chemotherapy.

Aortocaval compression resulting in sudden loss of consciousness and severe bradycardia and hypotension during cesarean section in a patient with subvalvular aortic stenosis

BackgroundMaternal cardiac arrest during cesarean section (CS) is an extremely rare but devastating complication. Preventing emergency events from developing into maternal cardiac arrest is one of the most challenging clinical scenarios.Case presentationA 35-year-old pregnant woman with subvalvular aortic stenosis who was scheduled for elective CS under epidural anesthesia, and experienced devastating supine hypotensive syndrome, but was successfully resuscitated after delivery.ConclusionsThe performance of tilt position strictly or high-quality continue manual left uterine displacement (LUD) should be performed until the fetus is delivered, otherwise timely delivery of the fetus may be the best way to optimize the deadly condition.

A Seven-Year retrospective review of stroke admissions in Benin-City, Southern Nigeria

Background: Stroke is a significant cause of hospital admissions, disability and mortality, but there is a lack of information on stroke in parts of the southern region of Nigeria. Objective: To analyze the frequency of stroke admissions, clinical presentations, risk factors, stroke types and outcomes over seven years, in a secondary level hospital in southern Nigeria. Methods: This was a retrospective study. The hospital record of patients hospitalized between January 2006 and December 2012 at the Central Hospital, Benin-City with the diagnosis of stroke based on the World Health Organization (WHO)-clinical criteria, were studied. Results: Four hundred and nineteen patients with stroke were hospitalized during the study period; this accounted for 3.1% of all the medical admissions. The mean age was 62.4 ± 13.6 years. There were 222 (53%) males and 197(47.0%) females. Ischaemic stroke occurred among 71% of cases; others included intra-cerebral haemorrhage (26%) and subarachnoid haemorrhage (3.1%). The main presenting features included hemiparesis (69%) and sudden loss of consciousness (27.2%). The risk factors included hypertension (84%) and diabetes mellitus (12.2%). The 7, 14 and 30 days case fatality rates were 21.2%, 25.5% and 30.8% respectively. A higher case fatality rate was recorded in haemorrhagic stroke compared to ischaemic stroke (68.8% vs 24%, p = 0.0001). Conclusion: Stroke was a significant cause of mortality amongst medical admissions and hypertension was the most common risk factor. Closer attention to the risk factors for stroke may likely help to reduce the burden of stroke.

Computed tomographic evaluation of intracerebral hemorrhage

Context: Computed tomography (CT) has been the standard imaging modality for the initial evaluation of patients presenting with acute stroke symptoms. The primary diagnostic advantage of CT in the hyperacute phase is its ability to rule out the presence of hemorrhage. The accurate early detection of blood is crucial since a history of intracerebral hemorrhage is a contraindication to the use of thrombolytic agents. Aims: The aim of this study is to study the role of CT in the evaluation of intracerebral hemorrhage. Settings and Design: Prospesctive cross sectional observational study. Subjects and Methods: This was a prospective study of 110 patients irrespective of age group with a clinical suspicion of intracerebral hemorrhage done in the Department of Radiodiagnosis, AVBRH, DMIMS (DU), Sawangi (Meghe), Wardha, Maharashtra, India. Results: Out of 110 patients diagnosed with intracerebral hemorrhage, 67 (61%) patients were male and 43 (39%) were female. The main clinical presentation was abrupt onset severe headache, vomiting, difficulty in speech, seizures, weakness in limbs, altered mental sensorium, and sudden loss of consciousness. Among risk factors, the most common was hypertension present in 70 (63.6%) patients followed by diabetes in 62 (56.3%) patients. The putamen is the most common site of intracerebral hemorrhage involved in 47 (42.7%) patients followed by the thalamus in 24 (21.8%) patients. Conclusions: In the present day, CT is the initial modality of choice and is found to be very helpful in diagnosing intracerebral hemorrhage; it plays a crucial role in patient care by determining which course of treatment is called for.

Color doppler assessment of extra cranial carotid arteries in carotid artery disease with correlation of risk factors in predicting cerebro vascular accident in patients with carotid atheromatous disease

Background: Stroke is a clinical syndrome, which describes a sudden neurological deficit of presumed vascular origin. The risk factors for stroke are diabetes mellitus, smoking, alcohol and hypertension. Colour doppler ultrasound is one of the important tool for the evaluation of exracranial insufficiency of the carotid arteries. This study was performed to assess the carotid arteries with the help of color doppler in carotid artery disease.Methods: Of the 100 patients who had come to our department during the study period with symptoms of cerebrovascular disease such as transient episodes of neurological dysfunction, sudden weakness or numbness, hemiparesis, focal neurological deficits, sudden loss of consciousness, altered sensorium, aphasia, slurring of speech, diminution or loss of vision were included into the study. CT scan of brain and color doppler evaluation for the extracranial carotid arteries was done for all the patients to assess the atheromatous disease of extracranial carotid arteries and comparison with brain changes in cerebrovascular disease patients.Results: Of the 100 patients included into the study, 51% were males and 49% were females. 59% of the patients were above 61 years of age, 24% of them were between 51-60 years and 12% were between 41-50 years. 82% of the patients had the presence of atherosclerotic plaque while 18% had increased intima-media thickness without the plaque. Among the patients with atherosclerotic plaque, 63.4% had diabetes and 68.3% had hypertension. <50% stenosis was seen among 45.1% of the patients while 36.6% had between 50-70%. Near total occlusion was seen in 6.1% of the patients.Conclusions: The color Doppler sonography is a useful tool in evaluation of extra cranial course of carotid vessels. It is a non-invasive, cheap, faster modality without any side effects. Therefore, it could be used in predicting CVA in patients with carotid atheromatous disease.

A 69-year-old Man with Sudden Loss of Consciousness, Non-reactive Pupils, and a Bilateral Positive Babinski Sign.

A 69-year-old Man with Sudden Loss of Consciousness, Non-reactive Pupils, and a Bilateral Positive Babinski Sign.