Mala Modi

Postpartum Cerebral Angiopathy in a Patient With Chronic Migraine With Aura

A 25‐year‐old woman with a history of chronic severe migraine with aura presented in an apoplectic state 1 week after the delivery of her third child. She developed a severe headache and within hours lapsed into a coma. A CT scan of the brain showed cerebral edema and an occipital hemorrhage. A four‐vessel angiogram showed diffuse arterial narrowing of all the intracranial vessels with segmental narrowing of the suprasellar portion of the internal carotid arteries bilaterally. She had no risk factors for stroke or vasculitis. Her pregnancy and delivery were uneventful with no preeclampsia or eclampsia. Apart from ergometrine at the time of the delivery, no vasoconstrictor drugs were used.

Stroke and HIV - causal or coincidental co-occurrence? : editorial

Stroke is responsible for a large part of the global burden of disease. Worldwide in 1990 it was the second commonest cause of mortality causing approximately 4.4 million deaths. Two-thirds of these deaths occurred in less developed countries. In South Africa in 2001 it was the fourth leading reported natural cause of mortality. HIV infection has in the wake of our pandemic become a leading cause of death and dread disease with an estimated 15% of the population being infected. A co-occurrence of these two illnesses is therefore expected. The debate rests with regard to whether or not there is a causal relationship. The first suggestion that there is an association between HIV and stroke came from autopsy and case series from the USA. These were followed by population studies to determine the risk of this association. The first of these was a study from KwaZulu-Natal (KZN) that found an HIV prevalence of 16% in a young stroke population. The prevalence of HIV in that region at that time was also 16% suggesting that there was no significant increase in the risk of stroke associated with HIV infection. In another population-based study from Baltimore USA the incidence of stroke in persons with AIDS was 0.2% per year. In this study AIDS was found to confer an adjusted relative risk of 13.7 for ischaemic stroke (IS) and 25.5 for intracerebral haemorrhage (ICH) indicating that AIDS is strongly associated with both IS and ICH. A criticism directed at this study has been that only patients meeting the Centers for Disease Control (CDC) definition of AIDS were included. In a study from Germany on 772 HIV-infected patients a prevalence of 1.2% for stroke and an annual incidence rate for IS of 216/100 000 population was reported. The prevalence was highest in young adult patients with advanced HIV infection. This latter finding has been consistently observed in studies reporting on the association between HIV and stroke. The results in this regard thus appear to be inconclusive but favour an increased stroke risk at least with advanced HIV/AIDS. (excerpt)

Progressive multifocal leucoencephalopathy - a case report

Progressive multifocal leucoencephalopathy (PML) is a demyelinating disease caused by the human neurotropic JC (John Cunningham) virus, a polyomavirus. Following on the worldwide HIV / AIDS pandemic there has been a dramatic increase in the incidence of PML. However, cases of PML, an AIDS-defining illness, have rarely been reported from Africa, an area where HIV-1 clade C infection predominates.

Vascular cause for stridor in infants

The double aortic arch is a form of vascular ring that constitutes a class of congenital anomalies in which the trachea and oesophagus are encircled by connected segments of the aortic arch and its branches. Although it takes various forms, the common defining feature is that both the left and right aortic arches are present.

MRI of a twin pregnancy in a uterus bicornis unicollis.

1At 33 weeks, an emergency caesarean section delivery was performed via two separate classic incisions into each corpus. A spectrum of congenital uterine malformations is attributed to the abnormal fusion of the pair of Mullerian ducts or failure of the absorption of the uterine septum; 2,3 bicornuate uterus is the most common. 3 Spontaneous twin gestation in a case of bicornuate uterus is rare. MRI is a valuable adjunct to sonar, which can be diagnostically limited in the third trimester. MRI assists in delineating external uterine contour, characterising septal composition, endometrial/myometrial ratio and defining the subtype of Mullerian duct anomalies. 3 Deep uterine bifurcation causes myometrial distortion denying each corpus the full complement of musculature,

Fetal magnetic resonance imaging - the new horizon in fetal anomaly screening

Magnetic resonance imaging (MRI) has been used extensively in neonatal imaging to further characterise abnormalities identified on ultrasound (US) or computed tomography (CT) scan.