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Re-initiation of oral-anticoagulants in survivors of hemorrhagic stroke
Publication date: Available online 22 May 2017 Source:Apollo Medicine Author(s): Pushpendra Nath Renjen, Dinesh Chaudhari Intra-cerebral hemorrhage (ICH) is the most feared and the deadliest complication of oral anticoagulant therapy, i.e. warfarin (Coumadin). After such an occurrence, clinicians wonder whether their patients should resume anticoagulant therapy. The decisions to reverse and re-initiate anticoagulation hinge on the phase of stroke as the risk of thromboembolism outweighs risk of bleeding in the chronic phase. Hence in the short term, most patients with ICH will benefit from acute reversal of anticoagulatio...
Source: Apollo Medicine - July 21, 2017 Category: General Medicine Source Type: research

Systemic to pulmonary venous collaterals in lung malignancy: Rare acquired right-to-left shunt
We present a case of a 90-year-old female with lung malignancy, who developed such an acquired shunt. A robust knowledge of such an event is critical from the perspective of understanding potential complications and taking timely steps to mitigate them.
Source: Apollo Medicine - December 14, 2016 Category: Journals (General) Source Type: research

A lesion to learn: Stroke mimics
Publication date: Available online 26 March 2016 Source:Apollo Medicine Author(s): Mahir Meman, Pushpendra Nath Renjen, Dinesh M. Chaudhari Acute ischemic stroke with neurological deficit is a very debilitating condition, especially in younger patients. IV thrombolysis is the only effective treatment available in most of the centers across India. But delay in hospitalization and bleeding complications are major limitations. In addition to that, stroke mimics are another big problem. Correct identification of stroke mimics needs clinical expertise and imaging studies. Multiple studies indicate safety of thrombolysis in...
Source: Apollo Medicine - March 25, 2016 Category: Journals (General) Source Type: research

Hormone use and stroke
Publication date: Available online 14 March 2016 Source:Apollo Medicine Author(s): Pushpendra Nath Renjen, Dinesh M. Chaudhari, Mahir Meman Strokes are an important cause of disability and death among older women. Because many women use hormone therapy for the control of perimenopausal symptoms and to prevent osteoporosis after menopause, establishing whether such therapy has other health effects is of considerable clinical importance. Overall, 55% of strokes occur in women, and women account for nearly 60% of all stroke-related deaths. Women appear to be protected from heart disease and stroke before menopause. This ...
Source: Apollo Medicine - March 14, 2016 Category: Journals (General) Source Type: research

Statins and stroke
Publication date: Available online 14 March 2016 Source:Apollo Medicine Author(s): Dinesh M. Chaudhari, Pushpendra Nath Renjen, Mahir Memon Stroke is a heterogeneous condition with a number of possible etiologies. Patients with different underlying stroke pathophysiologies may variably respond to specific preventive treatment strategies. Statin outcome trials in subjects with established coronary artery disease, hypertension, diabetes, or at high vascular risk have shown a consistent 17–21% relative reduction in the risk of incident stroke. The benefits observed with statins appear to be greater than what might be e...
Source: Apollo Medicine - March 14, 2016 Category: Journals (General) Source Type: research

Evidence base for secondary prevention – Antihypertensive therapy in cerebrovascular disease
Publication date: Available online 21 March 2015 Source:Apollo Medicine Author(s): Abha Pandit Antihypertensive therapy for preventing recurrence in survivors of stroke and transient ischemic attack patients requires much caution. Cutting the right balance between benefit and harm calls for the classical individual evidence based considerations. Current understanding to guide practices is briefly reviewed as stroke emerges as huge challenge with increasing longevity and chronic diseases.
Source: Apollo Medicine - March 21, 2015 Category: Journals (General) Source Type: research

Central sleep apnea in a patient with dengue encephalitis
We report for the first time a case of Central sleep apnea in a patient with dengue encephalopathy. This is a case report of a 50 year old male who had presented with fever, body ache, headache and altered mental status. A diagnosis of dengue fever was made on the basis of IgM antibodies in serum and encephalopathy was attributed to dengue encephalitis in the absence of another etiological cause of encephalopathy. Persistent hyper somnolence and desaturation despite resolution of fever led to a polysomnographic evaluation, which revealed significant central sleep apnea. Hypersomnia, a primary complaint of excessive sleepin...
Source: Apollo Medicine - March 5, 2015 Category: Journals (General) Source Type: research

Stroke-sleep disorder breathing
Publication date: Available online 23 February 2015 Source:Apollo Medicine Author(s): Pushpendra N. Renjen , Dinesh Chaudhari , Sudha Kansal , Mahir Meman Obstructive Sleep Apnoea (OSA) and Cerebrovascular Accidents (CVA) are common disorders in general population and share many common risk factors as age, gender, family history and obesity. However some of the strongest pathophysiological triggers for stroke are hypertension, atrial arrhythmias and atherosclerosis. Untreated OSA also contributes to these issues. Untreated sleep disorder breathing (SDB) such as OSA can lead to strokes, and strokes in the absence of prior...
Source: Apollo Medicine - February 23, 2015 Category: Journals (General) Source Type: research

Blunt traumatic injury of the innominate artery resulting in a stroke – A rare presentation
We present a case of traumatic injury of the innominate artery resulting in an ischemic stroke. Case presentation A 20-year-old gentleman ejected from a two wheeler and run over by a truck presented to us with multiple bleeding facial wounds and severe crush injury of his upper torso. Bedside chest X-ray revealed a widened mediastinum and multiple rib fractures with pneumothoraces bilaterally which were drained with intercostal tubes. An hour into his stay in the ED he developed left hemiparesis. CT brain showed infarcts in right temporo-parietal and occipital regions. CT angiogram of neck vessels revealed an avulsion inj...
Source: Apollo Medicine - October 23, 2014 Category: Journals (General) Source Type: research