Stroke

ABSTRACTThe third leading cause of death is stroke, mainly occurred in patients with 50 years or more and it is described as a sudden loss of blood flow to the brain that leads to irreversible tissue damage caused by thrombotic, embolic, or hemorrhagic events. While stroke related psychiatric complications have been recognized for over a century, they have never received the same degree of attention as post stroke motor deficits, language difficulties, or intellectual disturbances. Some of these stroke clinical complications, such as depression and whereas anxiety or emotional liability are other complications. Depression after stroke is associated with a lower quality of life and also with a higher risk of dying. After a stroke, approximately one third of patients experience depression. It’s important to correctly test for and diagnosis post stroke depression, as well as determine the seriousness of the disease. PSD is related to a variety of stroke risk factors and it can be fatal if left untreated. There is good evidence that early initiation of antidepressant treatment is associated with a decreased risk of developing and successful prevention of PSD in non depressed stroke patients. PSD requires special care, and consensus on the diagnosis and treatment of PSD should be achieved. Keywords: Antidepressant, depression, Post stroke depression, Stroke

ABSTRACTVascular dementia and cognitive impairment are major problems in stroke which must be diagnosed properly and very less effort is put into management of cognitive decline after stroke. This study is a prospective; questionnaire based observational study conducted for 6 months among stroke patients admitted into in patient setting of a tertiary care teaching hospital done to estimate the prevalence of stroke based on age, sex and educational status and to estimate the prevalence of dementia and cognitive impairment among stroke patients using neuropsychological testing. Data was collected from a total of 181 stroke patients of the age distribution 20 to 85 y with a mean age of 57.68±12.34 y and 75.6% patients were diagnosed with ischemic stroke and 24.3% with hemorrhagic stroke. Majority (76.79%) of patients were from rural population. Diagnostic and Statistical Manual of Mental Disorders-IV, Revised text criteria were used to assess dementia. Mini-mental state examination and short portable mental state questionnaire were used to know the extent of cognitive impairment. Various comorbid conditions like hypertension, diabetes mellitus, coronary artery disease and epilepsy were observed in 69.06% patients. The percentage (45.83%) of people with mild cognitive impairment is high with short portable mental state questionnaire and the percentage (77.69%) of people with moderate dementia is high using mini-mental state examination. 92.81% patients out of 181 were prescribed with neuroprotective drugs. The tools used for screening dementia are not perfect in case of uneducated patients and patients with low education. Current hypotheses and methodologies for the management of post-stroke dementia must be re-evaluated, and new strategies need to be explored. Keywords: Stroke, Dementia, Cognitive impairment, MMSE, SPMSQ

Balint syndrome is an uncommon and incompletely understood triad of neuropsychological impairments. Balint syndrome is characterized by dysmetria secondary to visual perceptive defect and inability to recognize more than one object at a time. Balint’s syndrome most often occurs with an acute onset as a consequence of two or more strokes at more or less the same place in each hemisphere, therefore it occurs rarely. Disorders such as tumours, trauma, near drowning, Eclampsia, drug toxicity, HIV encephalitis, Alzheimer’s can also leads to balint syndrome.  It is a strange combination of optic ataxia, Gaze apraxia, Simultanagnosia. Although it has been generally constructed as a biparietal syndrome causing an inability to see more than one object at a time, other lesions and mechanisms are also possible. Key syndrome components are dissociable and comprise a range of disturbances that overlap the hemineglect syndrome. Balint syndrome usually from large and more or less symmetrical lesions involving the posterior parietal region, including extensively the superior parietal lobe, as well as part of the inferior parietal lobe and the superior part of the occipital lobe. Diagnosis of individual components and of the whole syndrome may remain difficult, particularly when elementary motor, sensory, and visual deficits coexist.  Lack of awareness of this syndrome may lead to misdiagnosis and resulting inappropriate or inadequate treatment, therefore clinicians and other healthcare professionals should be familiar with the balint syndrome.  The goal of this review is to explore a range of anatomical and psychological explanations for this disorder.  

There are chiefly two types of strokes –Ischemic and Hemorrhagic. Apart from these two TIA and subarachnoid forms are taken into consideration in our study. This is a prospective, observational, and interventional study which being focussed on stoke patients. Using standard NIHSS scale a prospective study is being carried out to determine the risk factors in both in-patients and out-patients and using counselling sessions and community services they were interviewed by telephone then visited for noting the therapeutic outcome. A total of 97 cases of stroke were collected of which 66were males and 31 females, average stroke cases are found more in age group of 50yrs and above. Ischemic stroke was reported more in smokers (16), tobacco chewers (7), alcoholics (27), HTN (23), DM (6), and Dyslipidemia (42) patients followed by other types. According to NIHSS severity of score 3% (3)falls into >20 severe category with 3males followed by 21.6%(21) are moderate to severe(16-20) with 12males and 9 females, about 57.7%(56cases) were moderate(5-15) scoring with 40males and15 females, followed by 17.5%(17 cases) of