Background: Stroke is considered as a lethal condition associated with significant mortality and morbidity. After stroke, complications are common and cause devastating effects on rehabilitation. The present study was designed to study the frequency of complications in acute stroke patients in Peshavar, Pakistan.Methods: This prospective observational study was conducted from March 2006 to February 2007 in the General Surgery and Neurosurgery Postgraduate Medical Institute, Lady Reading Hospital and Department of General Medicine of Hayatabad Medical Complex in Peshawar, Pakistan in a tertiary health care facility. The study was conducted on 100 consecutive patients of acute stroke, presenting within 7 days of the onset of stroke. All patients fulfilling WHO definition of acute stroke were admitted. The patients with subarachnoid hemorrhage were excluded from study. After initial assessment for the degree of neurological defect and functional disabilities, the patients were investigated for stroke types and cause. Daily assessment of all patients for occurrence of complications was done till discharge from hospital or death of the patient.Results: Fift-eight (58%) patients were male and 42 (42%) were female with a mean age of 59.98 (±11.95) years. The patients with intra-cerebral bleeding were 32 while those with cerebral infarction were 64 and cases with lacunar infarction were 4. The median hospital stay was 6 days. The main complications were aspiration pneumonia in 28 (28%), constipation in 28 (28%), chest infection in 27 (27%), dehydration in 21 (21%) and urinary tract infection (UTI) in 12 (12%). 16 patients (16%) had no complications and seven patients died. Aspiration pneumonia was the cause of death in four patients (57%) during their hospital stay.Conclusion: Post-stroke complications are very common and these can alter the outcome of stroke patients. Multidisciplinary stroke management is needed to decrease the complications of acute stroke.

Background & Aim: Preeclampsia is the major cause of maternal and perinatal morbidity and mortality. Transcranial Doppler (TCD) as a noninvasive procedure is used to assess hemodynamic changes in middle cerebral artery (MCA). Knowing the influence of normal pregnancy and preeclampsia on brain hemodynamics is essential for proper management of anesthesia, labor and vasoactive drug usage in these patients. The aim of the present study is to evaluate and compare vasomotor reactivity in normal pregnancy and preeclampsia.Patients and Method: In this case-control study, transcranial Doppler ultrasound was used to measure peak systolic velocity (PSV), end-diastolic velocity (EDV), mean flow velocity (MV), and pulsatility index (PI) in the middle cerebral artery(MCA) of 16 preeclamptic and 15 normotensive pregnant women in the third trimester. Cerebral vasomotor reactivity (VMR) was measured as percentage of changes in peak flow velocity after inhaling 5% co2 for 1-2 minutes. Statistical analysis was done using independent t-test and Fisher Exact test. Results: There was no significant difference in terms of maternal age, gestational age and gravidity between the two groups. Preeclamptic women had higher baseline peak (113.3 compared with 76.31 cm/s, P<0.001), end diastolic (59.1 compared with 38.4cm/s, P<0.001) and mean velocity (73.8 compared with 46.1 cm/s, P<0.001). In comparison to normotensive group, preeclamptic women showed a significant decrease in vasomotor reactivity (4.41% compared with 8.51%, P<0.001).Conclusion: Preeclamptic patients had elevated baseline peak, end-diastolic and mean velocity in the MCAs and decreased VMR in reaction to 5% co2 inhalation. These findings are consistent with a state of vasoconstriction in preeclamptic women which is unresponsive to stimuli that under normal circumstances result in vasodilation. Cerebral edema, hemorrhage, ischemia, and convulsion are all considered as complications developing in preeclampsia or eclampsia. The precise etiology of these complications is unknown but they might be seen due to vascular disturbance. Under normal circumstances, autoregulation maintains the blood flow of the brain subject to a wide range of changes in systemic blood pressure. It seems that autoregulation malfunctions in preeclampsia. Abnormal response given to cerebral perfusion pressure by cerebral vessels might have a role in pathophysiology of cerebral dysfunction which is seen in preeclampsia.

Introduction: Mitral valve prolapse (MVP) is a known benign entity. However, in certain instances it may ensue cerebrovascular complication with ominous prognosis. This study was under taken in the past 9 years and 12 cases with mitral valve prolapse and cerebrovascular complications were diagnosed and their medical data were recorded. The main goals of this study were to try ana detect the possible risk factors and predisposing symptoms of stroke (including vertigo amorosis fugax faint and convulsion) in those patients, and to explore the possibility of prevention.Methods: MVP was diagnosed by physical examination and echocardiographic findings. The cases were divided clinically into two groups; group one which was hospitalized with cerebrovascular accident (CVA) as well paralysis. They include 6 cases aged between 18 and 42 years (average 33.5 years) with a male over female ratio was 2/4. Five out of 6 cases having had mitral regurgitation. Group 2 as the control group with 6 cases who were followed for 10-66 months at the cardiac clinic. Their age range was between 17 to 30 years (average age 22.5 years) one out of 6 had mitral regurgitation. The male to female ratio was 1/5. These cases with symptoms of risk factors as mentioned above were placed on Propranolol dipyridamol and aspirin with follow up of 10-66months (averaging 31 months).Results: In group 1 CT and MRI revealed embolic stroke in 4 cases and hemorrhage CVA in 2 cases, whereas in group 2 MRI and CT revealed ischemic changes without necrosis in 4 cases and normal pattern in 2 cases.Discussion: The conclusion of this study points to the fact that cases of MVP and true stroke as well as paralysis are older and patients with high risk symptoms such as faint, vertigo, convulsion, amorosis fugax, in combination with MVP which warrant the administration of anti thrombotic agents including aspirin dipyridamol while they are on Propranolol. The same is in cases with MVP associated with mitral insufficiency P.F.O. and migraine headache.

Background and Importance: Vascular lesions are rare pathologies that affect the blood vessels in the brains of newborns, infants, and growing children. Their symptoms tend to appear rather abruptly, and the condition can be alarming and potentially life-threatening.Unfortunately many of them do not have clear treatment. We here present 3 cases that presented with unusual and challenging vascular le sion.Case presentation Case 1: A 2-year-old girl that refered to our clinic with complained of large head circumference. She had mild developmental delay and a head size more than average normal age. In her brain sonography she had an external hydrocephalus. After several examinations, we detected an unusual form of occipital areriovenous malformation and an abnormal connection to galenic venous system, which caused venous hypertension.Unfortunately we were not able to treat the patient because of complexity of the lesi on.Case 2: A 5-year-old girl presented with intermittent claudication. She had the history of progressive neurological symptoms from 5 months ago. Brain MRI revealed a frontoparietal vascular lesion, which was angiographicaly occult. The lesion had widely extended to the corpus callosum and deep cerebral structures. After several investigations and consultation with neurovascular surgeons, podiatrists and oncologists, we started high dose of intravenous corticosteroid for her with good clinical response.Case3: The parents of a 2-day-old boy consulted with us about because of high cardiac output heart failure. In his brain sonography, a vascular lesion with the proximity to the galenic structure was detected. After vascular workup, a high flow lesion with multiple arterial flow to aneurysmal galenic venous system was found. The patient was treated with endovascular approach successfully.Conclusion: Intracranial vascular lesions of pediatric age group are rare, but they usually emerge abruptly and need careful diagnosis and treatment. For treatment of these lesions, the case should be decided individually.