RELATIONSHIP OF MEAN PLATELET VOLUME TO SEVERITY AND SHORT-TERM OUTCOME OF ACUTE ISCHEMIC STROKE.

Introduction: Despite the considerable number of clinical studies conducted, questions on the importance of the determinants of outcome after ischaemic stroke still exits. Methodology: Eighty consenting acute ischaemic stroke patients presenting to the emergency unit of Federal Teaching Hospital Gombe, along with 80 age and sex-matched controls were recruited. All the subjects were examined after relevant clinical history and stroke severity was determined using the NIHSS score. A brain imaging computed tomography or magnetic resonance imaging (CT/MRI) was performed for each patient and the stroke outcome of each patient was documented at the end of 30 days. MPV was assayed using the Sysmex KX-21N automated haematology analyser. Result: The mean age of patients 59.74±14.44 years was similar to the mean age of controls 59.80±14.08 years; P=0.947. The gender distribution between the two groups was also similar (p=0.436). Systemic hypertension was the most common modifiable risk factor for stroke accounting for 58.8%. The MPV of stroke patients 10.51 ± 0.88fl was significantly higher than that of controls 9.86±0.88fl p=0.0001 with a reference interval of 9.10-10.62fl using controls. Patients with MPV ≥10.62fl were categorized as high MPV range. The majority of patients in the high MPV category had significantly severe stroke with NIHSS score >16 p=0.001. No significant relationship was observed between the high MPV category and functional outcome based on mRS category p=0.101, The effect of MPV in the prediction of mortality remained significant (OR: 4.58, P= 0.012) in the multivariate regression model after controlling for other factors associated with mortality in acute ischemic stroke. A significant relationship was observed between MPV and infarct volume on the ROC curve and the area under the curve was 0.684 and an MPV value of 9.85fl was determined at 90% sensitivity and specificity of 50%. Conclusion: The study shows that MPV is associated with stroke severity and can be used as a marker to predict mortality in acute ischaemic stroke.

Osmotic demyelination syndrome following acute kidney injury with hypernatremia.

Osmotic demyelination syndrome (ODS) is a life-threatening neurological condition often associated with rapid correction of hyponatremia. While ODS is thought to be rare, with prevalence rates of not more than 0.5% in autopsy series, mortality rates are as high as 90% in some studies. Thus, timely diagnosis and life-saving treatment rest on a high index of suspicion among clinicians. In this report, we discuss the case and literature review of a 45-year-old female with sepsis, acute kidney injury, and spontaneous hypernatremia who developed ODS but responded to therapy with high dose steroids, antibiotics, and supportive care.