Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Department of General Medicine,
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On 30 Nov 2018




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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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On Aug 2018




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MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2011 | Month : April | Volume : 5 | Issue : 2 | Page : 217 - 221

Clinical Profile Of Posterior Circulation Stroke In A Tertiary Care Centre In Southern India Key Words

KORA.S.A, DODDAMANI.G.B, PRAMILA DEVI, GOORANNAVAR S.M, BIRADAR SATISH

1. Department of Medicine, S. Nijalingappa Medical College and H.S.K.Hospital & Research Center, Bagalkot

Correspondence Address :
Dr. Kora.S.A
‘Shailaja Nilaya’, Mahaveer Road
BAGALKOT- 587 101
(Karnataka-India)
E-mail: shreeramkora@yahoo.co.in

Abstract

The present study has been undertaken in a tertiary care centre in southern India to known the clinical profile of posterior circulation stroke as there are few studies for the same in that mainly the New England Medical Center – Posterior Circulation Stroke Registry. To the best of our knowledge there are no studies available in literature regarding posterior circulation hemorrhagic strokes in India. A total number of 25 cases were studied during the period from Jan 2010 to Dec 2010 who were admitted to department of Medicine and Neurology in S.Nijalingappa Medical College and HSK Hospital & Research Center. Detailed clinical history was taken in all patients with general physical examination. CBC, urine analysis, random blood sugar, blood urea, serum electrolytes, lipid profile, ECG, CXR, and CT scan were done. In some selected cases CSF analysis, EEG and ECHO were done. Incidence of posterior circulation strokes was 12.31 % and male to female ratio was 3.1:1. Amongst posterior circulation strokes, ischaemic were far commoner than haemorrhagic (76% vs. 24%). The common manifestations were motor disturbances, altered sensorium, headache, speech and visual disturbances in ischaemic strokes. Altered sensorium was present in all cases of haemorrhagic strokes. The commonest predisposing factors were tobacco abuse and hypertension. The commonest neurological findings were altered sensorium, motor disturbances, cranial nerve involvement and cerebellar signs. Infratentorial infarcts were seen more frequently than supratentorial infarcts, in this study. Incidence of mortality was higher in haemorrhagic strokes than ischaemic strokes (50% vs. 26.3%)

Keywords

Posterior circulation strokes, haemorrhagic strokes, ischaemic strokes

How to cite this article :

KORA.S.A, DODDAMANI.G.B, PRAMILA DEVI, GOORANNAVAR S.M, BIRADAR SATISH. CLINICAL PROFILE OF POSTERIOR CIRCULATION STROKE IN A TERTIARY CARE CENTRE IN SOUTHERN INDIA KEY WORDS. Journal of Clinical and Diagnostic Research [serial online] 2011 April [cited: 2019 Aug 21 ]; 5:217-221. Available from
http://www.jcdr.net/back_issues.asp?issn=0973-709x&year=2011&month=April&volume=5&issue=2&page=217-221&id=1267

INTRODUCTION
Cerebrovascular accidents have been known since ancient times because of the characteristic clinical picture they produce. Hippocrates (470 – 370 B.C.) described stroke as ‘APOPLEXY’, which means astonishment. Leoniceno described syphilitic hemiplegia in 1497. (1) In 1911 Margurg first reviewed the topic of brain stem infarction & described clinical examples of basilar territory syndromes. In 1932 Pines & Gilinsky published detailed report that included serial section of brain stem in a patient with thrombosis of basilar artery. (2) The World Health Organization (WHO) defines stroke as ‘rapidly developing clinical signs of focal (or global) disturbance of cerebral function, with symptoms lasting 24 hours or longer or leading to death, with no apparent cause other than vascular origin”. (3) The National Institute of Neurological Disorders and Stroke (NINDS) apply the term stroke to “any one or all of a group of disorders including cerebral infraction, intracerebral haemorrhage or subarachnoid haemorrhage”. (4)Posterior circulation strokes account for 10 to 15% (5) of all strokes. The area includes brainstem, cerebellum, occipital lobes and thalamus and is supplied by 2 vertebral arteries, 1 basilar artery and 2 posterior cerebral arteries (6). Posterior circulation ischaemia ranges from fluctuating brainstem symptom caused by intermittent insufficiency to many syndromes like lateral medullary, medial medullary, locked in to top of basilar syndrome (7). There are no data available to reflect the true incidence of cerebrovascular disease in Indian population. There are no hospital statistics available for posterior circulation strokes in India, because there is no study conducted in India about the epidemiological incidence. Hence we have decided to study the clinical profile of posterior circulation stroke, as there are very few studies available in literature.

Material and Methods

This study was conducted during the period from Jan 2010 to Dec 2010. During this period all posterior circulation strokes admitted to Neurology and Medicine departments of S.Nijalingappa Medical College and HSK Hospital & Research Centre were studied. This study consisted of total 25 posterior circulation strokes.

INCLUSION CRITERIA:-
All posterior circulation strokes were included during the study period. The diagnosis of posterior circulation was made when the patient had a clinical stroke syndrome compatible with involvement of posterior circulation territory with the help of clinical signs and symptoms and by means of classical syndromes like Claude’s, Weber’s, Balint’s, Lateral medullary, Medial medullary, Locked in & top of basilar syndromes.
(7) EXCLUSION CRITERIA:-
If CT scan showed recent infarction, haemorrhage in the anterior circulation and other non-vascular lesions, and then they were excluded from the study sample.
CLINICAL STUDY:-
A detailed history was obtained from the patient or a close relative regarding the onset of stroke, risk factors and family history. A detailed physical examination was done according to the proforma including vital signs & detailed examination of other systems. Optic fundus was examined in all the cases.
INVESTIGATION:-
All the patients were investigated for CBC, ESR, urine analysis, random blood sugar, blood urea, serum electrolytes, lipid profile, RA factor, VDRL, ECG & chest radiography. CT scan was done, in all patients in the study whenever needed CSF, EEG & ECHO was done.

Results

During the study period the total number of strokes were 203 and percentage of posterior circulation stroke was 12.31% of all strokes. Stroke was more common in the middle aged and elderly. Ischaemic stroke was more common in age group 41 to 50 and haemorrhagic stroke in age group 71 to 80.The male to female ratio of stroke was 3.1:1 and both ischaemic and haemorrhagic strokes were more common in males. 76% of the patients had ischaemic strokes and 24% had haemorrhagic strokes. Infratentorial stroke was common in both ischaemic and haemorrhagic stroke. The entire haemorrhagic stroke presented with acute completed stroke and where as only 52.63% of ischaemic stroke patients had acute completed stroke and 47.36% had stepwise progression.Table 2 shows frequency of clinical manifestations at the time of admission to hospital. The most frequent manifestation was motor dysfunction in 63% of ischaemic strokes and history of altered sensorium was 100% in haemorrhagic strokes.In ischaemic stroke the commonest risk factor was tobacco abuse (52%) and the next was hypertension (37%). But in the haemorrhagic strokes the commonest risk factor were hypertension, tobacco abuse and alcohol (All were 66%) The most common neurological findings in ischaemic stroke were altered sensorium and motor dysfunction (Both 63%). The next finding was cranial nerve involvement (53%). In haemorrhagic strokes all patients had altered sensorium. The incidence of infratentorial lesion was more (83%) compared to supratentorial lesion (16%) in haemorrhagic strokes but both are equal incidence (40% each) in case of ischaemic strokes Mortality in ischaemic stroke was 26.3% and in haemorrhagic stroke it was 50%. Improvement was seen in 47.4% of ischaemic and 50% of haemorrhagic strokes.

Discussion

Twenty five cases of posterior circulation strokes admitted to Medicine and Neurology wards of HSK Hospital & Research Center during period of 12 months (From Jan 2010 to Dec 2010) were studied for incidence, mode of presentation, pattern, clinical manifestations and neurological findings. To the best of our knowledge there are no studies available in posterior circulation haemorrhagic strokes in India in literature, hence we could not compare clinical profile, risks factor and various other parameters of haemorrhagic posterior circulation strokes. The incidence of posterior circulation stroke was 12.3% in the study, which was comparable with other studies conducted by Jones.et al (8) (17%) and Richard et al (5) (14.8%). In the present study the incidence of posterior circulation ischaemic strokes in below 60 years age group was 56% which was more compared to Jones.et al 8 study (22%), this can be explained on the basis that the incidence of stroke in young is more in India compared to western countries. Incidence was more in males compared to females was in accordance with other studies like Ma.Cristina L et al (9) study and R.B.Libman et al (10) study. In the present study incidence of ischaemic strokes was more (76%) compared to haemorrhagic stroke (24%) was in accordance with other studies like Uma Sundar et al (11)(77% ischaemic strokes). Incidence of infratentorial ischaemic strokes was high (63%) compared to other sites in the present study. But the incidence of infratentorial strokes was less compared to Bogousslavsky et al study (12) (70%), this can be explained on the basis that in our study we used only CT scan to identify infratentorial lesion which is a poor diagnostic tool compared to MRI scan. Incidence of acute completed stroke was 53% and step wise in 47% in the present study, which was in accordance with Patrick et al 13 study. In his study incidence was 44% and 56% respectively.Majority of clinical manifestations were comparable to the Patrick et al (13) study. The incidence of visual disturbance was high in present study (47%) compared to Patrick et al study (13) (13%). This was due to presence of more number of occipital infarcts in the present study. (32% Vs. 8%) Incidence of risk factors like hypertension was comparable with the studies by E.Ratnavalli et al (14), Capalan et al (15) , and Uma et al (11). Incidence of alcohol and IHD were same as of E.Ratnavalli et al (14),because study from the same geographic area. Incidence of high tobacco abuse can be explained on the basis that the tobacco abuse is more than this part of state. Majority of neurological findings of present study correlates well with Patrick et al (13) study. Incidence of mortality correlates well with other studies like Patrick et al 13 study (25.6%), Uma et al (11) study (17%) and Jones et al 8 study (27.5%). Incidence of improvement in this study was 47% where as in Jones et al (8)study it was 35%.

Acknowledgement

The authors wish to thank Dr. C.S. Patil, Principal, S.Nijalingappa
Medical College for his guidance during this study.

References

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Fielding H. Garrison; An introduction to History of Medicine, with medical chronology, suggestions for study & bibliographic data; 4th Edition, W.B.Sounder’s company 1967;775-889.
2.
. Louis. R. Caplan, Michael. S. Pessin and J.P.Mohr; vertebrobasilar occlusive disease in: Bernett H.J. M., J.P. Mohr, Bennett M. Stein, and Frank. M. Yastu (editors) Stroke. Pathophysiology, diagnosis and management, 2nd Edition, New York, Churchill Livingstone 1992, 443-516.
3.
. M.Gold stein (Chairman) USA, HJM Barnett Canada, J.M.Orgogozo France et al Stroke, Recommendations on stroke prevention, diagnosis and therapy: Report WHO task force on stroke and other Cerebrovascular disorders. Stroke 1989, 20(10): 1407-1431.
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. Jack P Whisnant Chairman, Jeffery R.B, Eugene F.B, Edward S.C. et al; Special report from National Institute of Neurological Disorders & Stroke; A classification and out line of cerebrovascular disease III, Stroke, 1990, 21(4): 637-676.
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. Richard A.L., Macdonell, Renate. M. Kalnins et al: cerebellar infarction:Natural history, prognosis and pathology, Stroke, 1987, 18(5): 849-855.
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. Peter. L. Williams, Roger Warwick, M.Dyson, L.H.Bannister (Eds); Gray’s Anatomy, 37th edition, Edinburg Churchill Livingstone, 1989, 735-750.
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. Louis R. Caplan; Top of the basilar syndrome, Neurology, Jan 1980, 30: 72-79.
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. Ma. Cristina L., Isagani Jodi G. de los Santos; posterior circulation stroke, Philippine heart center, 2001,4 (http://www.phc.gov.ph/cgi-bin/ res_complete.cgi)
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. R.B. Libman, T.G.Kwiatkowski, M.D.Hansen et al; Differences between Anterior and Posterior Circulation Stroke in TOAST, Cerebrovascular Diseases, 2001; 11: 311-316
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. Uma Sundar, R Mehetre, Etiopathogenesis and Predictors of In-hospital Morbidity and Mortality in Posterior Circulation Strokes – A 2 Year Registry with Concordant comparison with Anterior Circulation Strokes, JAPI, 2007, 55, 846-849.
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. Bogousslavsky. J, F. Regli, Maeder, R. Meuli et al; The etiology of posterior circulation infarcts; Neurology, 1993, 43: 1528-1533
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. Patrick. K.B., Manuel Ramirez and Bruce. D.Snyder; Temporal profile of vertebrobasilar territory infarction, Stroke, 1980,11(6): 643-648.
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. E Ratnavalli, D. Nagaraja, M. Veerendrakumar et al: stroke in the posterior circulation territory – A clinical and radiological study, JAPI – 1995, 43(12), 910.
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. L.R.Caplan, R.J. Wityk, L.Pazdera et al; New England Medical Center Posterior Circulation Stroke registry II, Vascular Lesions, Journal of clinical Neurology, 2005, 1(1), 31-49.

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JCDR/2011/1267

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com