Browsing by Author "Sylaja, P. N."

Now showing 1 - 3 of 3
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    Incidence, Types, Risk Factors, and Outcome of Stroke in a Developing Country The Trivandrum Stroke Registry
    (STROKE, 2009)
    Background and Purpose-Despite increasing burden of stroke in developing countries, population-based data are rare. Through the Trivandrum Stroke Registry, we intend to assess incidence, types, risk factors, and outcome of stroke among urban and rural dwellers of a South Indian community.Methods-We ascertained all first-ever strokes occurring among 741000 urban and 185 000 rural inhabitants of Trivandrum, Kerala. In addition to Steps I and 2 of World Health Organization STEPS Stroke Manual, we used multiple supplementary methods to maximize ascertainment of nonfatal and nonhospitalized fatal stroke events in the community.Results-During a 6-month period, 541 strokes were registered, 431 in the urban and 110 in the rural communities. Stroke occurred at a median age of 67 years; only 3.8% of patients were aged <= 40 years. Adjusted annual incidence rates per 100 000 were 135 (95% confidence interval 123 to 146) for total, 135 (122-148) for urban, and 138 (112-164) for rural populations, and 74.8 (66.3 to 83.2), 10.1 (7.0 to 13.2), and 4.2 (2.2 to 6.1) for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, respectively. There was more stroke of undetermined type in the rural community. One or more modifiable risk factors were identified in 90% patients. More rural male patients smoked tobacco. The 28th day case fatality rate was 24.5% for urban and 37.1% for rural populations (P=0.011).Conclusions-There are more similarities than differences between developing and developed countries in the epidemiology of stroke. Compared to urban stroke patients, rural ones are less likely to be optimally investigated and treated. (Stroke. 2009;40:1212-1218.)
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    Intracranial hypertension with polyradiculopathy - early CSF diversion to optimize neurological recovery
    (BRITISH JOURNAL OF NEUROSURGERY, 2012)
    Cerebral venous sinus thrombosis (CVST) and idiopathic intracranial hypertension (IIH) are common considerations in young patients presenting with isolated intracranial hypertension. We report two patients with progressive visual failure and polyradiculopathy with arefl exic quadriparesis, secondary to raised intracranial pressure (ICP). Both underwent cerebrospinal fl uid diversion with complete recovery. Such a fulminant presentation of raised ICP with an excellent outcome has rarely been reported in the literature.
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    'Susceptibility sign' on susceptibility-weighted imaging in acute ischemic stroke
    (NEUROLOGY INDIA, 2012)
    Background and Aim: Acute intra-arterial thrombus produces susceptibility artifact on gradient echo images (susceptibility sign). Our aim was to study the sensitivity and specificity of the susceptibility sign in various major intracranial arteries on susceptibility-weighted imaging (SWI) in patients with acute stroke. We also compared it with the 'hyperintensity sign' on fluid-attenuated inversion recovery (FLAIR) and 'hyperdense artery sign' on computed tomography (CT) for middle cerebral artery (MCA) occlusion. Materials and Methods: We have retrospectively studied 48 patients with ischemic stroke in various stages, due to intracranial arterial occlusions, for presence of 'hyperdense artery sign' (CT), 'hyperintense arterial sign' (FLAIR sequence) and 'susceptibility sign' (SWI). The sensitivity and specificity of each sign to detect intracranial arterial occlusion were calculated using the contrast-enhanced magnetic resonance (MR) angiogram as reference standard. Results: The sensitivity and specificity of the 'susceptibility sign' for detecting the MCA occlusion were 77% and 100% respectively (10 of 13). The sensitivity of the 'susceptibility sign' for detecting anterior cerebral artery (ACA) occlusion was 50% (1 of 2), 66.6% for posterior cerebral artery (2 of 3) and 75% for basilar artery (3 of 4). All the vertebral artery occlusions showed 'susceptibility sign' (6 of 6). Overall sensitivity and specificity of the 'susceptibility sign' for all acute major intracranial arterial occlusions were 82% and 100% respectively. Only one of the two cases of subacute infarcts studied showed a positive susceptibility sign. None of the 11 chronic intracranial occlusions and seven internal carotid occlusions showed the sign intracranially. Conclusion: 'Susceptibility sign' is more sensitive in detecting the acute MCA thrombus as compared to 'hyperdense MCA sign' on CT and 'hyperintense artery' sign on FLAIR images. It also has high sensitivity and specificity for other intracranial acute arterial occlusions.