52-year-old man • intermittent fevers • recently received second dose of COVID-19 vaccine • tremors in all 4 extremities • Dx?

► intermittent fevers ► recently received second dose of COVID-19 vaccine ► tremors in all 4 extremities.

Long-Term Sequela of Intrathecal Gadolinium Extravasation: Symptoms Mimicking Post-concussive Syndrome.

Gadolinium contrast administration, usually with magnetic resonance imaging, is an important diagnostic modality in the investigation of neurological pathologies. There is little evidence in the literature suggesting repeated exposure to intrathecal gadolinium results in symptoms mimicking post-concussive syndrome (PCS). We studied one patient who received intrathecal gadolinium to investigate a pain pump malfunction and presented with encephalopathic symptoms of confusion and aphasia with imaging consistent with intracranial gadolinium extravasation.

COVID-19 Disease and Hypercoagulability Leading to Acute Ischemic Stroke.

Introduction: SARS-Coronavirus-2 infection leading to COVID-19 disease presents most often with respiratory failure. The systemic inflammatory response of SARS-CoV-2 along with the hypercoagulable state that the infection elicits can lead to acute thrombotic complications including ischemic stroke. We present 3 cases of patients with COVID-19 disease who presented with varying degrees of vascular thrombosis.

Use of Intravenous Thrombolysis in Acute Ischemic Stroke Management in Patients with Active Malignancies: A Topical Review.

Objectives: Our review aims to present existing data on the safety of Intravenous thrombolysis (IVT) use in acute ischemic stroke (AIS) patients with concomitant central nervous system or systemic malignancies, with attention to special circumstances pertaining to specific cancer subtypes to help in acute decision making, especially for neurologists and emergency medicine physicians.

Methods: A literature search was conducted on electronic databases inclusive of Medline, EMBASE and CINAHL for articles published or available in English between January 1, 2000 to June 1, 2020 using the following search terms: "acute ischemic stroke," "cerebrovascular disease," "Intravenous thrombolysis," "tissue plasminogen activator," "cancer patients," and "neoplasm".

Conclusion: Recognition of stroke symptoms in patients with active cancer, in particularly those involving the brain, requires astute clinical judgement.

Safe Readministration of Intravenous Thrombolysis in Recurrent Basilar Thrombosis.

We report a patient who had recurrence of stroke in the basilar artery territory because of repeat thrombosis, and was administered intravenous recombinant tissue plasminogen activator (IV-rtPA) twice within a span of 3 weeks without any adverse events, with radiological evidence of successful thrombolysis. Because of minor and improving stroke symptoms with IV-rtPA, endovascular therapy was not performed and there was radiological evidence of recanalization with IV-rtPA alone. This report adds to the very limited literature on the topic demonstrating safe and successful use of repeat IV thrombolysis following a previous recent stroke.

Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis.

Objective: To compare the times to evaluation and thrombolytic treatment of patients treated with a telemedicine-enabled mobile stroke treatment unit (MSTU) vs those among patients brought to the emergency department (ED) via a traditional ambulance.

Methods: We implemented a MSTU with telemedicine at our institution starting July 18, 2014. A vascular neurologist evaluated each patient via telemedicine and a neuroradiologist and vascular neurologist remotely assessed images obtained by the MSTU CT.

The role of very high high-sensitivity C-reactive protein levels on mortality after stroke.

Unlabelled: High-sensitivity C-reaction protein (hsCRP) levels are correlated with risk of vascular disease. The clinical implications of markedly elevated hsCRP levels in the setting of acute stroke are less understood.

Objective: To determine the association of very high admission hsCRP levels (≥10mg/L) on all-cause mortality in patients with acute stroke.

Telemedicine in Prehospital Stroke Evaluation and Thrombolysis: Taking Stroke Treatment to the Doorstep.

Importance: Mobile stroke treatment units (MSTUs) with on-site treatment teams that include a vascular neurologist can provide thrombolysis in the prehospital setting faster than treatment in the hospital. These units can be made more resource efficient if the need for an on-site neurologist can be eliminated by relying solely on telemedicine for physician presence.

Objective: To test whether telemedicine is reliable and remote physician presence is adequate for acute stroke treatment using an MSTU.

A Mobile Stroke Treatment Unit for Field Triage of Patients for Intraarterial Revascularization Therapy.

Introduction: Favorable outcomes in intraarterial therapy (IAT) for acute ischemic stroke (AIS) are related to early vessel recanalization. The mobile stroke treatment unit (MSTU) is an on-site, prehospital, treatment team, laboratory, and CT scanner that reduces time to treatment for intravenous thrombolysis and may also shorten time to IAT.

Methods: Using our MSTU database, we identified patients that underwent IAT for AIS.

Fluorescent In-situ Hybridization Study of Non-papillary Oncocytic/Eosinophilic Renal Cell Carcinoma.

Aims: Papillary renal cell carcinoma (PRCC) and clear cell RCC (CRCC) can display extensive areas with oncocytic/eosinophilic changes and may be associated with either minimal papillary architecture. These nonpapillary oncocytic/eosinophilic RCC often mimic renal oncocytoma (RO). We investigated numeric changes of chromosomes 7, 17, and Y and loss of the small arm of chromosome 3 in the above-mentioned oncocytic RCC by using the florescent in-situ hybridization (FISH).

The burden of stroke and transient ischemic attack in Pakistan: a community-based prevalence study.

Background: The burden of cerebrovascular disease in developing countries is rising sharply. The prevalence of established risk factors of stroke is exceptionally high in Pakistan. However, there is limited data on the burden of stroke and transient ischemic attack (TIA) in South Asia.

Moyamoya disease: a clinical spectrum, literature review and case series from a tertiary care hospital in Pakistan.

Background: Moyamoya is a rare cerebrovascular disease of unknown etiology. The data on moyamoya disease from Pakistan is sparse. We report a case series of 13 patients who presented with moyamoya disease to a tertiary care hospital in Pakistan with a national referral base.

Awareness of cancer risk factors among patients and attendants presenting to a tertiary care hospital in Karachi, Pakistan.

Objective: To determine awareness of cancer risk factors in the patients and attendants of Out-patient Clinics at a University Hospital in Karachi, Pakistan.

Methods: A cross-sectional survey was conducted on 315 respondents reporting to a tertiary care hospital in Karachi, Pakistan, to assess their level of awareness regarding risk factors of cancer.

Results: The respondents belonged to an urban population with the mean time spent in Karachi of 29.

Immunocytochemical study of urine cytological preparations from secondary prostatic adenocarcinoma involving the urinary bladder.

Involvement of the urinary bladder by prostatic adenocarcinoma (PCA) occasionally occurs. In this study, we analyzed urine cytological findings in patients with secondary involvement of the urinary bladder by PCA with the help of the immunocytochemistry. The cases were divided into two groups: (1) prospective study group: three cases; and (2) retrospective study group: 12 cases which were retrieved from our cytopathological files.

Knowledge, awareness and practices regarding dengue fever among the adult population of dengue hit cosmopolitan.

Background: The World health Organization (WHO) declares dengue and dengue hemorrhagic fever to be endemic in South Asia. Despite the magnitude of problem, no documented evidence exists in Pakistan which reveals the awareness and practices of the country's adult population regarding dengue fever, its spread, symptoms, treatment and prevention. This study was conducted to assess the level of knowledge, attitudes and practices regarding dengue fever in people visiting tertiary care hospitals in Karachi, Pakistan.

Prevalence and demographics of anxiety disorders: a snapshot from a community health centre in Pakistan.

Background: The developing world is faced with a high burden of anxiety disorders. The exact prevalence of anxiety disorders in Pakistan is not known. There is a need to develop an evidence base to aid policy development on tackling anxiety and depressive disorders in the country.

Depression in the elderly: does family system play a role? A cross-sectional study.

Background: The most common geriatric psychiatric disorder is depression. The role of family systems in depression among the elderly has not been studied extensively. It has been suggested that urbanization promotes nucleation of family systems and a decrease in care and support for the elderly.

Family systems: perceptions of elderly patients and their attendents presenting at a university hospital in Karachi, Pakistan.

Objective: To know the present status of family systems in Pakistan, changes they are undergoing and implications of such trends on health of the elderly population.

Methods: A cross-sectional study was carried out at the out-patient clinics, AgaKhan University Hospital, using convenience sampling method. Verbal informed consent was taken from the participants.

Isolated deep venous thrombosis--case series, literature review and long term follow up.

Cerebral Venous Sinus thrombosis may rarely be isolated to a cortical vein or to the deep venous system. When the deep venous system is involved, prognosis is generally poor. In addition, long term follow up is not reported.

Pathophysiology of cerebral venous thrombosis--an overview.

Cerebral venous sinus thrombosis is a disorder with a unique pathophysiology which needs to be described. A Medline search of all articles detailing pathophysiology of CVST was done, using keywords: cerebral venous thrombosis and pathophysiology. In addition, major texts were reviewed for additional references.