Search

Abstract Background Virtual Reality (VR) is an emerging technology in post stroke recovery. However, its precise role in stroke rehabilitation is not well defined. The aim of this paper is to conduct an overview of systematic reviews on the role of VR in stroke rehabilitation. Methods A meta-review with results from a search of 7 databases from inception till 5th December 2022 with subsequent quality appraisal was conducted. The primary outcome was to produce a narrative review on the efficacy of VR versus usual or other care in stroke recovery. Data was synthesized in a descriptive fashion and high-quality systematic reviews were emphasized. The AMSTAR-2 tool was used for quality assessment of the included studies. Results Evidence from high-quality systematic reviews suggests that there is benefit from VR in upper limb, lower limb, gait, and balance recovery particularly when additive to conventional therapy. There is also limited evidence to suggest that VR has a positive effect in those with impaired cognition. Conclusion VR is safe and effective as an adjunct to conventional therapy for adults after stroke and should be used routinely for upper and lower limb motor recovery. Further high-quality studies that evaluate its efficacy and explore ways to increase its positive impact in areas such as cognition are required. There is also a scope for the development of stroke-specific virtual environments. (PROSPERO registration # CRD42022372926).

BackgroundPosterior cerebral circulation ischemic stroke (PCS) comprises up to 25% of all strokes. It is characterized by variable presentation, leading to misdiagnosis and morbidity and mortality. We aim to describe PCS in large multiethnic cohorts.MethodsA retrospective review of a large national stroke database from its inception on the 1st of January 2014 till 31 December 2020. Incidence per 100,000 adult population/year, demographics, clinical features, stroke location, and outcomes were retrieved. We divided the cohort into patients from MENA (Middle East and North Africa) and others.ResultsIn total, 1,571 patients were identified. The incidence of PCS was observed to be rising and ranged from 6.3 to 13.2/100,000 adult population over the study period. Men were 82.4% of the total. The mean age was 54.9 ± 12.7 years (median 54 years, IQR 46, 63). MENA patients comprised 616 (39.2%) while others were 954 (60.7%); of these, the majority (80.5%) were from South Asia. Vascular risk factors were prevalent with 1,230 (78.3%) having hypertension, 970 (61.7%) with diabetes, and 872 (55.5%) having dyslipidemia. Weakness (944, 58.8%), dizziness (801, 50.5%), and slurred speech (584, 36.2%) were the most commonly presenting symptoms. The mean National Institute of Health Stroke Score (NIHSS) score was 3.8 ± 4.6 (median 3, IQR 1, 5). The overall most frequent stroke location was the distal location (568, 36.2%). The non-MENA cohort was younger, less vascularly burdened, and had more frequent proximal stroke location (p

Abstract Carotid web has been identified as one of the missed causes of recurrent stroke. The diagnosis and management of such cases impose a challenge to medical practitioners. This etiology should be kept in mind, especially in case of recurrence of stroke in a similar cerebral territory.

Background. Guillain-Barré syndrome (GBS) has many variants with distinct presentations. Ptosis as an initial presentation is rare. Case Report. We describe a young female with bilateral ptosis without ophthalmoplegia as the initial presentation of Guillain-Barré ptosis in an anti-GQ1b IgG antibody negative patient with a favorable outcome to intravenous immunoglobulins. Objectives. Our paper highlights the importance of recognizing GBS as a potential etiology in a patient presenting with isolated ptosis, particularly since the course of GBS can be more dramatic than in the anti-GBQ1b syndromes such as ophthalmoparesis without ataxia and Miller Fisher syndrome or ocular myasthenia. Conclusion. This is the first paper of anti-GBQ1b antibody negative GBS presenting with isolated ptosis without ophthalmoparesis. GBS should be included in the list of differential diagnosis of such presentations.

Background. Extrapontine myelinolysis (EPM) has been well described in the presence of rapid correction of hyponatremia. It is seldom reported with adrenal insufficiency. We report a unique case where a patient developed EPM as a result of adrenal insufficiency where the brain MRI revealed symmetrical lesion in the basal ganglia with pallidal sparing. Case Report. A 30-year-old gentleman with panhypopituitarism developed adrenal crisis, hyponatremia, and hyponatremic encephalopathy. Seven days after the rapid correction of hyponatremia, he developed parkinsonism and neuropsychiatric symptoms. MRI showed extrapontine myelinolysis without central pontine myelinolysis. Conclusion. Extrapontine myelinolysis without central pontine myelinolysis is rare and should raise a concern of associated adrenal insufficiency in the right clinical setting. Rapid correction of hyponatremia particularly in steroid-deficient states should be avoided as it can predispose to extrapontine myelinolysis. Magnetic resonance imaging is very helpful in supporting the diagnosis of EPM.

Invasive group beta-streptococcal arthritis is being increasingly diagnosed as suggested by recent data. We report a case of a middle-aged lady from Sri Lanka who developed septic arthritis of the right shoulder and the left sacroiliac joint as well as an iliopsoas collection caused by Streptococcus agalactiae shortly after labor at Hamad General Hospital in Doha, Qatar. We conclude that Streptococcus agalactiae septic arthritis is rare. It can present with invasive disease in adults. It usually targets older females and immuno compromised patients especially those with risk factors for bacteraemia. Therefore a high index of suspicion is needed. Shoulder and sacroiliac joint affection is not uncommon for unknown reasons. Utilizing imaging modalities such as ultrasonography and magnetic resonance imaging is helpful.

BackgroundStudies assessing the burden of stroke in Qataris are limited. We aim to study stroke in the Qatari population.MethodsA retrospective review was undertaken of all Qatari adults presenting with stroke to Hamad Medical Corporation over a 5-year period. Descriptive statistics were used to summarize demographic and all other clinical characteristics of the patients. The primary outcome was the incidence of stroke in the Qatari patients. Comparison was made between the sexes.Results862 patients were included, with 58.9% being male. The average incidence of stroke over the 5-year period was 92.04 per 100,000 adult Qatari population. The mean age of the cohort was 64.3±14.4 years, (range 19-105 years). The mean age of first ever cerebrovascular event was 63.2±14.5 years. The diagnosis was ischemic stroke in (73.7%), transient ischemic attack in (13.8%), intracerebral hemorrhage (ICH) in (11.6%), subarachnoid hemorrhage in (0.7%) and (0.2%) cerebral venous sinus thrombosis. Small vessel disease was the most common cause of ischemic stroke accounting for (46.5%), followed by large artery atherosclerosis (24.5%). Hypertension (82.7%) and diabetes (71.6%) were particularly prevalent in this cohort. Females were older (65.8±14.1 vs 63.4±14.5 years), had more hypertension and diabetes and more disability or death at 90 days (pConclusionStroke occurs at a significantly lower age in Qataris compared to the western population. This study has uncovered sex differences that need to be studied further.