Impact of implementing a stroke code on the door to needle time during Hajj at a tertiary center in Makkah, Saudi Arabia.

OBJECTIVES: To assess the impact of a stroke code on the door to needle time during Hajj at a tertiary center in Makkah, Saudi Arabia. Stroke is one of the most common medical problems globally. Tissue plasminogen activator is an effective treatment in patients with acute ischemic stroke. However, its efficacy is time-dependent. METHODS: We conducted a retrospective study on acute ischemic stroke patients who presented within the study window and were eligible for intravenous thrombolysis therapy at King Abdullah Medical City in Makkah between September 1, 2015 and July 2020. RESULTS: Sixty-nine patients received intravenous tissue plasminogen activator and enrolled in this study, 28 patients of which presented during the Hajj period. We found a statistically significant reduction in both the door to needle time and the door to computed tomography time during the Hajj period. In addition, the length of hospital stay reduced significantly in the same period CONCLUSION: We observed a 44% reduction in the door to needle time during the implementation of the stroke code. However, we did not observe a significant difference in clinical outcomes. This study is limited by its small sample size and it lacks a long follow-up for clinical conditions.

Autoimmune epilepsy, retrospective case series of clinical features, management, and outcomes.

OBJECTIVES: To evaluate the clinical and electrographic features of patients with autoimmune epilepsy and assess the influence of early diagnosis and treatment on reducing seizure frequency. METHODS: A retrospective observational case series was conducted utilizing medical records from King Abdullah Medical Hospital between 2017 and 2022. Cases of newly diagnosed seizures were chosen based on laboratory-proven autoimmunity. RESULTS: Five female inpatients were identified, primarily presenting with seizures suggestive of an autoimmune origin. Autoimmune antibodies were detected in all patients as follows: GAD (3), NMDA-R (2). One patient exhibited unilateral temporal lobe onset while three displayed bilateral onset. One patient had an associated malignancy. Rituximab was administered as an immunomodulatory therapy to four patients, resulting in successful seizure reduction post-immunotherapy initiation. CONCLUSION: Autoimmune epilepsy is recognized as a distinct condition. The clinical presentation can be complex and antibody testing may warrant repetition if initial results are negative or if specific antibodies are not detected. Early initiation of immunosuppression, coupled with prompt treatment escalation when required, is vital for achieving optimal patient outcomes.

Efficacy and safety of rituximab in patients with multiple sclerosis: An observational study at a tertiary center in Makkah, Saudi Arabia.

OBJECTIVES: To assess the efficacy and safety of rituximab for multiple sclerosis (MS) treatment in terms of reduction in clinical relapses, magnetic resonance imaging (MRI) activity, Expanded Disability Status Scale (EDSS) score and adverse events. METHODS: This is a retrospective cross-sectional study conducted at King Abdullah Medical City, from January 2017 to August 2021, involving patients with MS given rituximab, with 1-year follow-up. Clinical parameters were noted pre- and post-treatment to determine efficacy; adverse events were noted to analyze safety. A paired samples t-test was used to compare responses pre- and post-treatment. A p-value<0.05 was considered significant. RESULTS: Among 31 patients, 6 (19.4%) had progressive MS, and 25 (80.6%) had relapsing-remitting MS (mean disease duration=8.12±5.65 years). The annual relapse rate reduced from 1.67±0.97 to 0.06±0.25 (p<0.001), the EDSS score from 3.16±2.14 to 2.80±2.28 (p=0.141) and the MRI activity score from 1.84±1.03 to 1.03±0.18 (p<0.001). Only one patient had enhancing lesion activity post-treatment. The commonest side effect was urinary tract infection (25.8%). Only 2 patients discontinued the drug. CONCLUSION: Rituximab is an efficient drug in reducing the annual relapse rate and MRI activity of patients with MS, with few tolerable side effects not leading to drug discontinuation or any lethal outcome.

Acute spasticity secondary to ischemic stroke involving superior frontal gyrus and anterior cingulate gyrus.

Spasticity is a velocity-dependent increase in muscle resistance associated with hypertonia after an acute stroke. Spasticity is expected to appear within a few weeks due to different mechanisms; we are reporting acute spasticity observed at the time of ischemic stroke involving the superior frontal gyrus and anterior cingulate gyrus. A healthy 64-year-old male patient suffered from subarachnoid hemorrhage secondary to aneurysmal rupture of the anterior communicating artery. He was referred to our center and treated with percutaneous transluminal coil embolization. In post-coiling, he developed acute left-sided weakness and spasticity. Magnetic resonance imaging brain showed an acute ischemic stroke involving the superior frontal gyrus and anterior cingulate gyrus. Patient follow-up showed improvement of weakness and spasticity. Therefore, acute spasticity can be related to a stroke involving the superior frontal gyrus and anterior cingulate gyrus.