Malignant middle cerebral artery syndrome with thrombotic thrombocytopenia following vaccination against SARS-CoV-2

Cases of thromboses at unusual sites with thrombocytopenia have been reported following vaccination against Sars-CoV-2. This new syndrome, christened vaccine-induced thrombotic thrombocytopenia (VITT), mainly results in venous thromboses. We report the case of a young woman with a right middle cerebral artery stroke following vaccination with ChAdOx1 nCoV-19. A diagnosis of VITT was made and platelet counts began to recover shortly after commencing treatment with argatroban, intravenous immunoglobulins and corticosteroids. On day 6 following admission, the patient deteriorated neurologically and decision made to proceed with decompressive hemicraniectomy. There were no perioperative complications and anticoagulation with argatroban was reinitiated on the first postoperative day. VITT is a rare condition resembling auto-immune heparin-induced thrombocytopenia. All critical care staff should be aware of the rare link between vaccination against SARS-CoV-2 and VITT and the need to rapidly commence both anticoagulation, using heparin alternatives, and immunomodulation.

EFFECT OF COMBINING TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION WITH EXERCISE REGIME ON SPASTICITY AND UPPER EXTREMITY FUNCTION FOLLOWING CHRONIC MIDDLE CEREBRAL ARTERY STROKE

Background: Post stoke hemiparesis limit the upper extremity function due to development of spasticity and synergy patterns, therefore rendering the patient impaired in activities of daily living. Transcutaneous electrical nerve stimulation (TENS) has recently been used to reduce spasticity. The purpose of this study was to evaluate the effects of TENS on spasticity and upper extremity function following chronic middle cerebral artery stroke (MCA). Study design and setting: interventional study conducted on patients from clinical and hospital setting in Ahmedabad. Methods: A total of 30 patients between the age group of 35-75 years of age. Group A received TENS for 30 minutes in addition to conventional exercise therapy regime where as group B received only exercise therapy regime. The intervention was given for 5 days a week for 4 weeks. The outcome measures were Modified Ashworth scale (MAS) and Fugl Meyer assessment for upper extremity (FMA-UE). The data collected was statistically analysed by using Wilcoxon’s signed rank test for within group analysis and Mann Whitney U test for between the group analysis. Results and conclusion: Group A showed a statically (P <0.05) as well as clinically significant improvement in both the outcome measures. There-fore it was concluded that TENS prove to be effective in reducing spasticity and improving upper extremity function in chronic MCA stroke. KEY WORDS: Stroke, Spasticity, TENS, Modified Ashworth scale (MAS), Fugl Meyer assessment for upper extremity (FMA-UE).