Articles

Clinical Spectrum of Neurological Emergencies: A Retrospective Analysis from a Tertiary Care Center in Mizoram

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Background: Neurological emergencies are a major cause of morbidity and mortality worldwide. In resource-limited settings, trauma, stroke, and infectious causes remain leading contributors.
Objective: This study aims to analyze the distribution of neurological emergency cases by category, age, and gender in a hospital-based cohort.

Methods: A retrospective analysis of 61 patients admitted with neurological emergencies was conducted. Data were categorized into trauma-related, cerebrovascular accidents (CVA), seizures, fever-related, post-surgical, and other causes. Demographic patterns were also assessed.

Results: Trauma-related emergencies constituted 50% of cases, followed by cerebrovascular accidents (25%) and seizures (13%). The majority of patients were males (64%) and young adults aged 11–40 years (33%). Elderly patients (61+) contributed to 26% of cases, largely due to stroke.
Conclusion: Trauma and stroke remain the leading causes of neurological emergencies. Preventive strategies targeting road traffic accidents, stroke awareness, and timely intervention are essential to reduce disease burden in resource-limited regions.

Prevalence and Determinants of Thromboembolic Events among Adult Rheumatic Heart Disease Patients with Atrial Fibrillation at Tikur Anbessa Hospital Addis Ababa Ethiopia

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Background: Rheumatic heart disease (RHD) combined with atrial fibrillation (AF) significantly contributes to thromboembolic complications, including ischemic stroke. The coexistence of these conditions increases the risk of cardiovascular issues, underscoring the need for targeted management strategies.

Objective: This study aims to assess the prevalence and determinants of thromboembolic events among patients with RHD and AF at the Tikur Anbessa Specialized Hospital adult cardiac outpatient clinic in Addis Ababa, Ethiopia.

Methods: An institution-based retrospective chart review of adult patients with RHD and AF was conducted. Data were gathered from electronic medical records using structured data extraction check list. Descriptive analysis using frequency with percentage and mean with standard deviation was conducted. Binary logistic regression was employed to analyze the relationship between predictor variables and thromboembolic events.

Results: A total of 182 participants were included in this study. The mean age of participants was 40.37 (SD± 13.01) and majority of participants were female participants (70.9%). The overall rate of cardioembolic events was 19.78% (95% CI: 14.3-6.3), with stroke occurring in 18.1% (33) of the participants. Disease duration (AOR: 1.07, 95% CI: 1.03–1.13), left atrial size (AOR: 1.14, 95% CI: 1.07–1.24), presence of left atrial thrombus (AOR: 9.83, 95% CI: 1.53–63.21), mitral stenosis (AOR: 1.88, 95% CI: 1.21–17.14), and Subtheraputic INR levels (<2) (AOR: 4.27, 95% CI: 1.15–15.94) were significantly associated with cardioembolic events.

Conclusion and recommendation:  This study highlights the high prevalence of cardioembolic events in patients with RHD and AF, identifying both modifiable and non-modifiable factors that contribute to increased risk. Monitoring left atrial size and INR levels could help reduce the risk of thromboembolic complications. Further research is needed to develop preventive strategies and optimize management to improve patient outcomes.

Puff of Smoke’ In A Young Brain: A Classic Imaging Sign of Moyamoya Disease – Case Report

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Moyamoya disease is a rare and progressive cerebrovascular disorder marked by the occlusion or blockage of the distal internal carotid arteries and their main branches. In response, the brain develops a network of fragile collateral vessels, which appear as a “puff of smoke” on angiographic imaging—a characteristic feature that inspired the disease’s name. The condition primarily affects children and young adults, often presenting with transient ischemic attacks, strokes, seizures, or cerebral haemorrhage. Although the underlying mechanisms are not fully understood, genetic factors, particularly mutations in the RNF213 gene, have been closely associated with disease susceptibility, The major susceptibility gene for moyamoya disease in people investigation into the mechanisms of disease and potential treatment targets. The Arg4810Lys variant of the gene is most strongly associated with moyamoya disease, but the penetrance is lower than 1%, suggesting a synergistic relationship with additional environmental and genetic risk factors. A 11-year-old female patient presented with the complaints of sudden onset of left upper limb and lower limb transient weakness associated with bowel incontinence patient has  a past medical history of seizures since 10 months with multiple seizure episodes Diagnostic evaluation typically involves magnetic resonance imaging, magnetic resonance angiography, and digital subtraction angiography, the latter of which remains the gold standard. Treatment strategies are primarily surgical, with revascularization procedures—either direct, indirect, or combined approaches—aimed at improving cerebral blood flow and reducing the risk of ischemic events . Based on laboratory investigations and radiological reports case was diagnosed as MOYAMOYA DISEASE preoperative and anaesthesia clearance patient was taken up for STA-MCA bypass (Superficial Temporal Artery to Middle Cerebral Artery Bypass) associated  treatment with perivascular sympathectomy and superior cervical ganglionectomy may be useful but more investigation needs to be carried out into the pathogenesis of the disease before more definitive therapy is realized.

This review outlines the latest developments in the understanding, diagnosis, and management of Moyamoya disease, with attention to its genetic background and surgical outcomes.

Productivity in a Stroke Survivor: Development and Initial Testing of a Stroke-Specific Return to Work Instrument

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Background: Stroke is a leading cause of sudden loss of work and productivity in adults. With no existing instrument to assess or predict a return to work for stroke survivors. There is a growing need as more survivors are discharged with expectations to return to productive life. This study focused on developing a new instrument called the Stroke-Specific Return to Work Instrument (SSRTWI) to assess and predict when stroke survivors can return to work. Given the increasing incidence of stroke and its impact on productivity, this is an important area of study.

Methods: This study used a mixed-method approach using qualitative exploratory in-depth semi-structured interviews. Fifty-three stroke survivors within productive age participated. Twenty survivors and fourteen experts were involved in the initial development through focus group discussions. Thematic analysis was used to analyze focus group data. There was a four-stage testing process to ensure internal consistency. 33 participants were involved in initial instrument testing. Content validity, internal consistency, and test-retest reliability were assessed.

Results: Participants were aged 26-55 years (mean age = 48.4 ± 5.5 years). Seventy-six items initially generated through focus group discussions were reviewed. Eighteen items were eliminated while twenty-two items were reworded. The Content validity index was 0.93, Internal consistency (Cronbach’s α) was 0.89, and the Intraclass correlation coefficient was 0.91.

Conclusion: This study addresses an important gap in stroke rehabilitation by providing a validated instrument to assess return-to-work readiness for stroke survivors. The mixed-method approach and involvement of survivors and experts in the development process strengthened the instrument’s relevance and validity.

Genetic and Molecular Aspects of Ischemic Stroke

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Stroke remains a leading cause of disability and death worldwide, with significant public health implications. Ischemic stroke is classified into various subtypes based on etiology, including large-artery atherosclerosis, small-vessel occlusion, and cardioembolism. The middle cerebral artery is often the most affected. The concept of the ischemic core and penumbra is crucial in understanding stroke pathology, where the core suffers irreversible damage, and the penumbra is at high risk if reperfusion is not timely. Genetic predispositions play a significant role in ischemic stroke, with heritability estimates around 37.9%. Monogenic causes account for 1-5% of cases, while polygenic factors are more prevalent. Genome-wide association studies (GWAS) have identified numerous genetic loci associated with ischemic stroke, revealing the complex genetic architecture of the disease. Molecular pathways such as neuroinflammation, excitotoxicity, oxidative stress, apoptosis, and autophagy are involved in the pathophysiology of ischemic stroke. Understanding these pathways offers potential therapeutic targets. This review aims to synthesise recent genetic studies and provide insights into future directions for research and clinical practice in ischemic stroke, emphasising the importance of personalised medicine and targeted therapies.

Yoga as an Integrated Therapy for Stroke Rehabilitation – A Case Study

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Background and Purpose: A stroke (cerebrovascular accident) is damage to the brain cells from an interruption of their blood supply due to blockage or rupture of an artery to the brain. It is the second-leading cause of death and long-term disability worldwide. The present study is a case report investigating the effect of yoga therapy in addition to acupressure and physiotherapy on activities of daily living and the quality of life of patients after stroke.  

Subject and method:  It is a single case study of 38-year-old women diagnosed with acute ischemic stroke who have chief complaints of loss of function of the left upper and lower limbs, and hypertension. For better management of stroke and recovery, she was undergoing yoga, physiotherapy, and acupuncture treatment in the CAM department at DSVV. The primary outcome measures were activities of daily living by the Barthel index and quality of life by the stroke-specific quality of life scale. The subject received integrated treatment for 12 weeks consisting of 45-minute, 1-hour yoga sessions 6 days a week, regular physiotherapy in the subject’s home, and acupuncture every 2 weeks. The primary outcome data were collected before and after the treatment intervention phase. 

Result: The subject had improved Barthel’s activity and quality of life score. 

Discussion and Conclusion: The results suggest that yoga integrated with other complementary therapies may be beneficial to stroke survivors in rehabilitation.

Quality of Life and Lifestyle Factors among Stroke Survivors and People Living With Osteoarthritis in Port Harcourt Metropolis, Rivers State

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Background: Quality of life (QoL) and Lifestyle factors (LFs) are key determinants of health. Poor QoL and unhealthy lifestyles are global concerns and have been linked to stroke and osteoarthritis (OA).

Aim of the Study: This study determined and compared QoL between stroke survivors and People living with osteoarthritis (PLWOA), and also established association between selected LFs and QoL of the stroke survivors and PLWOA in Port Harcourt Metropolis, Rivers State.

Materials and Methods: The study adopted a comparative cross-sectional design. A multistage sampling technique was used to select 78 stroke survivors and 186 People Living with Osteoarthritis (PLWOA) from the two strata making up Port Harcourt Metropolis – Port Harcourt City Local Government Area (PHALGA) and Obio-Akpor Local Government Area (OBALGA). The World Health Organization Quality of Life Bref (WHOQoL-BREF) Scale was used to measure their current QoL while LFs (Smoking, Alcohol consumption, Physical activity, and Balanced Diet) were selected in line with WHO STEPS instrument for non-communicable diseases (NCDs) from June 2019 to January, 2000. Data were analyzed using the IBM SPSS version 24. Chi-square test statistic was used to compare the proportion of stroke survivors with very poor, poor and good QoL and that of PLWOA. Chi-square test of independence was used to determine association between LFs and QoL of the two groups, and where appropriate Fisher’s exact test. P-value ≤ 0.05 was considered statistically significant.

Results: Results revealed that the proportion of stroke survivors with very poor, poor and good QoL was 18 (23.16%), 53 (67.9%), and 7 (9.0%) compared to 16 (8.6%), 53 (67.9%), and 7 (9.0%) respectively of those of PLWOA. The difference observed between these proportions was statistically significant (Chi-square = 67.097, p-value <0.0001). For association between LFs and QoL, Smoking (Chi-square = 40.678, Fisher’s p-values <0.0001, <0.0001), Alcohol consumption (Chi-square = 26.541, Fisher’s p-values <0.0001, <0.0001), Physical activity (Chi-square = 13.679, Fisher’s p-values 0.001, 0.022), Balanced diet (Chi-square = 39.691, Fisher’s p-values < 0.0001, 0.002) were all associated for stroke survivors and PLWOA respectively.

Conclusion: Majority of stroke survivors and PLWOA had poor QoL. Association exists between LFs and QoL of stroke survivors and PLWOA in the study. There is need for government to collaborate and set up specialized healthcare facilities for stroke survivors and PLWOA in our communities.