Clinical Profile of Cerebral Venous Sinus Thrombosis.

BACKGROUND AND OBJECTIVES: Cerebral venous sinus thrombosis (CVT) occurs due to occlusion of the veins and sinuses which drain the brain parenchyma. It is an uncommon form of stroke, predominantly found in young patients1 . Despite advances in the recognition of CVT in recent years, diagnosis and management can be difficult because of the diversity of underlying risk factors, presenting features and the absence of a uniform treatment approach. This study aimed to ascertain the clinical presentation, various aetiologies and prognostic indicators of cerebral venous sinus thrombosis. METHODOLOGY: This hospital-based descriptive study was carried out on 30 eligible patients from December 2013 to July 2015 after approval of Institutional Ethics Committee. Detailed history, clinical findings and required relevant investigations were recorded and analysed. RESULTS: CVT was commonly observed in younger persons, commonly between 21-30 years. Female: Male ratio was 2.33. Altered sensorium at presentation was a poor prognostic indicator. The most common etiology was pregnancy and puerperium, followed by hyperhomocysteinemia. Superior sagittal sinus was found to be the most common site of thrombosis in this study, in 17 (56.7%) of the patients. 17 patients (56.67%) recovered completely without any neurodeficit. 24 ( 80%) and 22 (66%) subjects had cerebral infarction secondary to CVT. 5 (16.67%) patients succumbed to thrombosis or complications, most commonly due to intracerebral haemorrhage and cerebral edema. CONCLUSION: CVT is a disease with multifactorial, gender-related specific causes and has a wide and varied clinical spectrum.

Clinical Profile of Hypertensive Emergencies in an Intensive Care Unit.

AIMS AND OBJECTIVE: To study the prevalence of hypertensive emergencies in an ICU set up and to study the clinical presentation of hypertensive emergencies related to cardiovascular, neurological and renovascular system. METHODS: Type of Study: Cross-sectional, descriptive study. DURATION OF STUDY: Two years from 1st December 2011 till 30th November 2013. SAMPLE SIZE: 50 patients of hypertensive emergencies admitted to the intensive care unit of Dr. V.M. Govt. Medical College, Solapur were studied. Inclusion criteria All patients above 18 years of age. Systolic blood pressure > 180 mmHg Diastolic blood pressure > 120 mm Hg Exclusion criteria Pregnancy Patients with diabetes mellitus We classified as hypertensive emergencies all cases in which the increase in blood pressure was associated with one or more of the following types of acute or ongoing end-organ damage: hypertensive encephalopathy; stroke (cerebral infarction or intracerebral or subarachnoid hemorrhage, transient ischemic attack); acute pulmonary edema, left ventricular failure; acute myocardial infarction or unstable angina, progressive renal insufficiency features suggestive of retinopathy. All these conditions were diagnosed clinically or by approprriate diagnostic tests. CONCLUSIONS: most common presenting complaint in patients was breathlessness seen in 17 patients (34%), followed by neurological deficit in 14 patients (28%). Thirteen patients (26%) had complaints of headache, whereas 12 (24%) patients complained of chest pain on admission. Other symptoms included vomiting, giddiness, psychomotor agitation, and decreased urine output. Out of a total of 4076 admissions during the study period in the intensive care unit we had 50 cases of hypertensive emergencies with prevalence of 1.22% in our intensive care unit. Most common organ involvement was the retina followed by cardiovascular system, renal and then the central nervous system.

Foreign Body in Left Main Bronchus.

Tracheobronchial foreign body (TFB) aspiration is rare in adults, although incidence rates increases with advancing age. We report a case of foreign body in left main bronchus in an adult female who had no risk factor. She was successfully treated with removal of betel nuts by bronchoscopy. Unusual presentation and high index of suspicion can help in proper management.