Background & Objectives: Stroke mimics are conditions that simulate the signs and symptoms of a stroke. These conditions pose a clinical challenge as they need to be distinguished from actual strokes based on neurologic findings, laboratory tests, and imaging studies in order to minimize the adverse effects of acute stroke therapies as well as hospital costs. The study aims to determine the rate and the most common etiologies of stroke mimics in a private tertiary care hospital in the Philippines and calculate the average cost incurred for diagnostics. Methods: We conducted a retrospective review of medical records of adult patients assessed by the hospital’s Brain Attack Team from 1 January 2014 to 31 December 2017. The diagnosis of stroke mimic was based on negative neuroimaging findings and laboratory results that showed an alternate diagnosis, in consultation with the stroke neurologist on call. Results: A total of 1,485 patient records were analyzed; 448 patients (30.2%) were diagnosed as stroke mimics. The most common etiologies were encephalopathy (83 cases, 18.5%), seizures (77 cases, 17.2%), headache (31 cases, 6.9%), hypertensive emergency (31 cases, 6.9%), and radiculopathy (27 cases, 6.0%). The average cost for diagnostics for each patient diagnosed as a stroke mimic was PHP 24,629.53 (approximately US$500). Conclusion: Stroke mimics are often encountered in the emergency setting. Due to the wide range of medical conditions that mimic stroke, early recognition is important in order to avoid the potential adverse effects of acute stroke therapies and minimize diagnostic costs, particularly in countries with limited resources.

OBJECTIVES

Bickerstaff brainstem encephalitis (BBE) is an uncommon disease characterized by the occurrence of ataxia, ophthalmoplegia, sensorial disturbance, and pyramidal tract signs such as hyperreflexia and toe extensor response. In Asia, preponderance of cases has been reported in Japan. It has not been previously reported in the Philippines. This will describe the clinical symptoms, laboratory features and diagnostic criteria and treatment of this rare disease.

CASE REPORT

A 31- year old Vietnamese-American from Makati City presented with a 3-week history of diarrhea and flu-like symptoms followed by dizziness, gait instability, diplopia, generalized weakness and rapidly progressive sensorial deterioration. Neurologic findings included ataxia, bilateral external ophthalmoplegia, ocular bobbing, hyperreflexia, bilateral toe extensor response and altered sensorium. Cranial MRI, Complete CSF Analysis, EMG-NCV and RNS were unremarkable. Brainstem auditory evoked potential indicated failed conduction between the lower and upper pons. Blink reflex study indicated failed conduction along the medullary interneuronal pathway. Plasmapheresis and intravenous corticosteroid therapy were instituted. Patient's condition improved from a comatose state and was discharged ambulatory with minimal residual neurologic deficits after 38 days of hospitalization. Serum Anti-ganglioside antibody assay were positive for GM1b lgG and GQ 1DG.

CONCLUSION

The clinical characteristics, laboratory features and course of this patient were consistent with Bickerstaff's Brainstem Encephalitis.

Human ; Male ; Adult: 25-44 Yrs Old ; Encephalitis ; ; Antibodies ; ; Amino Acids, Peptides, And Proteins ; ; Blood Proteins ; ; Immunoproteins ; ; Immunoglobulins ; ; Diarrhea ; ; Adrenal Cortex Hormones ; ; Pyramidal Tracts ; ; Ophthalmoplegia ; ; Ataxia ; ; Plasmapheresis

OBJECTIVES

Bickerstaff brainstem encephalitis (BBE) is an uncommon disease characterized by the occurrence of ataxia, ophthalmoplegia, sensorial disturbance, and pyramidal tract signs such as hyperreflexia and toe extensor response. In Asia, preponderance of cases has been reported in Japan. It has not been previously reported in the Philippines. This will describe the clinical symptoms, laboratory features and diagnostic criteria and treatment of this rare disease.

CASE REPORT

A 31- year old Vietnamese-American from Makati City presented with a 3-week history of diarrhea and flu-like symptoms followed by dizziness, gait instability, diplopia, generalized weakness and rapidly progressive sensorial deterioration. Neurologic findings included ataxia, bilateral external ophthalmoplegia, ocular bobbing, hyperreflexia, bilateral toe extensor response and altered sensorium. Cranial MRI, Complete CSF Analysis, EMG-NCV and RNS were unremarkable. Brainstem auditory evoked potential indicated failed conduction between the lower and upper pons. Blink reflex study indicated failed conduction along the medullary interneuronal pathway. Plasmapheresis and intravenous corticosteroid therapy were instituted. Patient's condition improved from a comatose state and was discharged ambulatory with minimal residual neurologic deficits after 38 days of hospitalization. Serum Anti-ganglioside antibody assay were positive for GM1b lgG and GQ 1DG.

CONCLUSION

The clinical characteristics, laboratory features and course of this patient were consistent with Bickerstaff's Brainstem Encephalitis.

Human ; Male ; Adult: 25-44 Yrs Old ; Encephalitis ; ; Antibodies ; ; Amino Acids, Peptides, And Proteins ; ; Blood Proteins ; ; Immunoproteins ; ; Immunoglobulins ; ; Diarrhea ; ; Adrenal Cortex Hormones ; ; Pyramidal Tracts ; ; Ophthalmoplegia ; ; Ataxia ; ; Plasmapheresis

OBJECTIVES: To determine the prevalence, risk factors, etiology, location, and outcome of non-traumatic intracerebral hemorrhage (ICH) in young Filipino patients. To identify factors associated with poor outcome and mortality
METHODOLOGY: Review of charts of patients age /- 45 years admitted for acute non-traumatic intracerebral hemorrhage with neuroimaging evidence of symptomatic ICH was done. Data regarding risk factors, location, etiology and outcome were analyzed using SPSS 9.01 for Windows and Epi 6 for univariate and multiple regression analysis
RESULTS: Seventy subjects were included. 66 percent were males and 34 percent were females. The mean age of the subjects was 37 years old. Prevalence of non-traumatic ICH among stroke in young adults is 17 percent. The most frequent risk factors were hypertension, smoking, alcohol use, and family history of CVD. The common locations in order were basal ganglia/internal capsule (44 percent), thalamus (22 percent), lobar, and brainstem. The common causes of ICH were hypertension (46 percent), vascular malformations (16 percent) and hematologic/coagulation disorders (13 percent). Arteriography was done in 33 percent of cases. Overall in-hospital mortality rate was 8.5 percent in the acute stage of ICH. Factors independently associated with poor outcome and mortality on multivariate regression analysis were posterior circulation (p=0.005), presence of intraventricular extension (p=0.002), ICH volume 30 cc (p= 0.011), and smoking history (p=0.021)
CONCLUSION: Non-traumatic intracerebral hemorrhage in young Filipino adults has a heterogenous etiology. Non-traumatic ICH occurred in 17 percent of young stroke patients. Posterior circulation involvement, presence of intraventricular extension, ICH volume of 30cc and smoking history were significant factors associated with poor outcome.

Human ; Male ; Female ; Adult ; Adolescent ; Smoking ; Cerebral Hemorrhage ; Stroke ; Cerebral Hemorrhage, Traumatic ; Hypertension ; Brain Stem ; Vascular Malformations