Human ; Research

Multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) is a variant of chronic inflammatory demyelinating polyneuropathy (CIDP). It presents as a chronic, asymmetrical sensory-motor polyneuropathy with features of demyelination on nerve conduction studies. Management options include intravenous immunoglobulin and corticosteroid infusions. Prognosis is generally favorable but there have been reports of variable response to treatment. This condition is rare and local data on CIDP and its variants is limited, hence we report a case of a 64-year-old male presenting with 3 year history of progressive asymmetric numbness and weakness of all limbs. Sensory deficits began on the left hand and had progressed to involve the distal portions of all limbs, eventually developing weakness as well. The patient underwent multiple nerve-conduction studies, all of which showed findings congruent with MADSAM. He was given intravenous high dose methylprednisolone and was maintained on mycophenolate mofetil.

This is a case of a 44 year old single, Filipino, female who presented with dysarthria, left central facial paresis, left hemianopsia and left hemiparesis. Magnetic Resonance Imaging showed an acute infarction of the right posterior cerebral artery territory. 2d echo and transesophageal echocardiography were done and vegetations were observed on the mitral, aortic and tricuspid valves giving a diagnosis of endocarditis. With the absence of fever and negative blood cultures, infective endocarditis was less likely. On further workup, computed tomography scan of the abdomen showed a probable malignant ovarian mass. This finding led to a diagnosis of nonbacterial thrombotic endocarditis as the cause of the stroke. Endocarditis as a cause of an embolic event in the brain is uncommon and nonbacterial thromobotic endocarditis is rare. It commonly affects the left sided heart valves. Multivalvular involvement which includes the right sided heart valves are rarely reported. Nonbacterial thrombotic endocarditis has a high mortality so therefore early detection and management is crucial and can be life-saving.

BACKGROUND

Acute migraine can be treated with rimegepant, an antagonist of the calcitonin gene-related peptide (CGRP) receptor. With a focus on the Asian population as a subgroup, this metaanalysis attempts to investigate the effectiveness and safety of rimegepant for individuals suffering from severe migraines.

PubMed, MEDLINE database and Cochrane Library were used to identify valid randomized controlled trials for this study. The primary endpoint investigated was freedom from pain and freedom from the most bothersome symptom 2 hours post dose. RevMan 5.4.1 software was used to perform a meta-analysis on each outcome measure.

A total of five randomized controlled trials were incorporated, with two of them being conducted on Asian populations and published between 2014 and 2024. There were 2,516 cases in the rimegepant group and 2,668 cases in the placebo group out of the total 5,184 patients that were included. Rimegepant was found to significantly reduce the primary endpoints in acute migraine patients (RR 1.58, 95% CI 1.42-1.75, P-value 0.0001; RR 1.34, 95% CI 1.08-1.66, Pvalue 0.0001), and in the acute migraine Asian patients (RR 1.79, 95% CI 1.47-2.19, P-valueCONCLUSION

The use of rimegepant is effective and safe for acute migraine patients, including the Asian subgroup.

BACKGROUND

Polypharmacy in patients with chronic disease such as Migraine Headache poses potential harm in patients such that psychological distress may come in. In relation to psychological distress, Migraine Headache patients with multiple drug use are at increased risk of anxiety and depression.

The main objective of the study is to determine the association between anxiety and depression to polypharmacy in migraine headache patients by using the data in the PNA One Headache Database.

We utilized the data obtained from the Philippine Neurological Association One (PNA-1) Headache Database from 2021 to 2024 and determine the association between Anxiety and Depression to Polypharmacy in patients with Migraine.

The number of medications taken by patients does not significantly differ across depression and anxiety levels, indicating that polypharmacy has no impact on patient’s depression and anxiety. However, the study found that patients with anxiety have more tendency to report more severe headache.

The study highlights that participants, primarily middle-aged women, experience chronic headaches with high pain severity, often lasting for hours. Educational attainment may influence headache management compliance with a large proportion having only elementary education. Headache onset typically begins in early adulthood, and medication effectiveness often diminishes over time suggesting potential tolerance issues. Anxiety is associated with reporting of increased headache severity while depression does not significantly impact headache characteristics or polypharmacy. The findings emphasize the need for targeted interventions and revised treatment strategies to improve headache management outcomes.

BACKGROUND

There is growing interest in gender differences in acute stroke worldwide. However, no known studies have been published on the differences in prognosis of hyperacute intracerebral hemorrhage between genders among Asians, particularly Filipinos.

Compare gender differences in the prognosis of hyperacute intracerebral hemorrhage in terms of baseline demographic and radiologic profile, as well as, clinical outcomes.

This is a retrospective cohort study involving a chart review of all patients diagnosed with hyperacute Intracerebral Hemorrhage admitted at a tertiary hospital from January 2021 to May 2023. Patients were grouped according to their gender and baseline demographic, radiologic and clinical outcomes were assessed and compared between two groups.

No statistical difference was found between stroke risk factors between the two groups. However, males tend to have higher percentages of intraventricular extension (29.2 %. (n=28) vs 30.6% (n=11) and increased hematoma volume compared to their female counterparts (n=39, 83% vs n=11, 68%). In addition, males had a higher number of ICU admissions (42.7% (n= 41) vs. 33.3% (n= 12) and mortality (46.9%( n=45) vs. 30.6% (n=11), though the results were not statistically significant.

In patients with hyperacute intracerebral hemorrhage, gender does not influence on its radiologic and clinical outcome.

BACKGROUND

Endovascular thrombectomy (EVT) is the gold standard of care for large vessel occlusion strokes, but is underutilized in developing countries.

This single-center retrospective study included patients who underwent EVT during the period of September 2018 to April 2023. Data collected were demographics, underlying co-morbidities, use of anti-thrombotics/coagulants, CT or MR ASPECTS, thrombolysis prior to EVT, technique, timing, TICI score, occlusion site, discharge and 90-day MRS.

Of the 1,595 stroke patients, 57 (3%) cases underwent EVT. The mean age was 65 with a male to female ratio of 6:5. Hypertension, atrial fibrillation, and diabetes were the common comorbidities. Majority of patients (90%, n=54) presented with moderate to severe disability (MRS 3-5). Majority were in the anterior circulation (89%, n=51). Stentriever technique was mostly used (59% n=34) with a 77% (n=44) recanalization rate. Early neurologic improvement (ENI) was seen in 7% (n=4), 2 of which translated to a favorable outcome after 90-days. Mortality occurred in 24% (n=14) of cases, mostly from neurological complications. 24% (n=14) had favorable outcome of MRS 0-2 after 90 days. Among those grouped in the unfavorable outcome, 53% (n=23) were MRS 3, still showing marked improvement of quality of life.

EVT outcomes in this study is aligned with the landmark trials which exhibited a number needed to treat of 2.8-7.4. This local data highlights that EVT is a possible and effective treatment for large vessel strokes despite wide gap in accessibility and use in the country.

Glioblastoma multiforme (GBM) represents the most malignant form of brain tumor and is relatively common, comprising nearly almost 20% of all primary malignancies of the central nervous system1. GBM is a WHO grade IV tumor with several variants, depending primarily on their genetic signature and on the predominant histological architecture. Among the variants of GBM, epithelioid glioblastoma (E-GBM) has been one of the more recently described. This tumor, documented to be highly malignant and clinically aggressive, has been separated from close variants and thus differentials, pleomorphic anaplastic xanthoastrocytoma, rhabdoid GBM, small cell and giant cell GBM, GBM with neuroectodermal differentiation, and gliosarcoma2. Autoimmune diseases have been linked within creased risk of CNS complications, from the constant effects of chronic inflammatory milieu. Systemic lupus erythematosus (SLE) has been associated with several CNS abnormalities, hence the terms CNS lupus or neuropsychiatric lupus. Likewise, SLE has been repeatedly associated with CNS malignancies in several cases and case reports. To date, there is paucity in the reported cases of malignant brain tumors, especially rare variants, in patients with SLE. While it is hypothesized that the inflammatory milieu that bathes the brain in a dynamic microenvironment that influences the incidence of rare variants of GBM, clinicians should be mindful, as treatment is challenging: it may either induce exacerbation of autoimmunity or cause undertreatment of the malignancy. This complex interplay births curiosity into the enigma of autoimmunity and oncology. In this particular report, we highlight the case of a patient with SLE who developed E-GBM. We identify the clinicopathologic features of the tumor present in the patient and explore the known aspects of the crosstalk between SLE and E-GBM.
Lupus Erythematosus, Systemic ; Glioblastoma

Background: Antiplatelet resistance is one factor that contributes to stroke recurrence among patients with noncardioembolic ischemic strokes. Objectives: This paper aims to describe the prevalence of aspirin and clopidogrel resistance, along with frequency of statin, NSAID and proton pump inhibitor use among our cohort of stroke patients. Method. This is a single-center cross-sectional review that included all adult patients with recurrent noncardioembolic ischemic stroke admitted in a tertiary hospital between January 2019 and June 2023. Results: A total of 1,374 patients were admitted for ischemic stroke from January 2019 to June 2023. Among these, 155 (11.28%) were recurrent noncardioembolic ischemic strokes. Prevalence of aspirin and clopidogrel resistance were 25% and 32.7%, respectively. Clinical profiles of those in the resistant group were comparable with those in the nonresistant group. None of the patients taking aspirin had concomitant use of nonsteroidal antiinflammatory drugs. Only 2 of the patients who were resistant to clopidogrel were on proton pump inhibitors. More than half of the patients both in the resistant and the nonresistant groups were on statin. The study had a small sample size and hence it was not enough to establish causal relationship between factors and antiplatelet resistance. Conclusion More patients were resistant to clopidogrel than to aspirin. Further studies with a bigger sample size are recommended to explore factors that contribute to antiplatelet resistance in Filipino patients.
Aspirin ; Clopidogrel ; Ischemic Stroke ; Tertiary Care Centers

Introduction: Acute Ischemic Stroke (AIS) is a medical emergency that affects people globally. In the Philippines, it remains as the third leading cause of mortality. This study aims to determine the use of platelet-lymphocyte ratio (PLR) - a simple, economical, and safe tool - as a predictor of in-hospital outcomes in patients with acute ischemic stroke. Methods: A retrospective cross-sectional study was conducted among AIS patients at the Remedios Trinidad Romualdez Hospital (RTRH) Tacloban City, Leyte, Philippines from January 2020 to December 2022. Clinical demographics, laboratory profile, and hospital outcomes were described. Descriptive statistics, Mann-Whitney test, and T-test were utilized to determine the association between PLR and in-hospital outcomes. Results and Conclusions There were 76 patients enrolled in the study, majority were females (57.9%), and hypertensive (84.2%). Risk factors that are pivotal to the development of AIS were also identified. To note, half of the population presented with unilateral body weakness. Moreover, only 7.9% died due to the disease. Higher PLR levels resulted from an increased platelet count and a decreased lymphocyte count. However, no significant association between PLR levels and AIS outcomes was noted, hence the need for further investigation of these parameters.
Ischemic Stroke ; Tertiary Care Centers