Shorog Althubait

Acute hemorrhagic leukoencephalitis (AHLE) is a rare, hyperacute inflammatory disorder of the central nervous system that is usually diagnosed on clinical and radiological grounds when tissue is unavailable. We report a previously healthy, unvaccinated 19-year-old woman with a 5-day febrile respiratory illness and a nasopharyngeal real-time reverse transcription polymerase chain reaction test positive for influenza A. Within approximately 12 h of admission, she progressed from full consciousness to coma with signs of brainstem dysfunction and developed shock requiring vasopressors. Brain magnetic resonance imaging showed bilateral confluent white-matter lesions with vasogenic edema, symmetric thalamic restricted diffusion, midbrain and pontine involvement, and petechial hemorrhages within the pons on susceptibility-weighted imaging. Cerebrospinal fluid showed elevated protein and mild lymphocytic pleocytosis. Despite intravenous methylprednisolone, intravenous immunoglobulin, oseltamivir, and intensive care, she died approximately 36 h after admission. The diagnosis of AHLE was clinicoradiological because neuropathological examination was not performed, and the symmetric thalamic and brainstem involvement overlapped with influenza-associated acute necrotizing encephalopathy (ANE). This case illustrates the fulminant course that influenza A-associated hemorrhagic encephalopathy can take in young adults, the value of early multisequence imaging, and the difficulty of distinguishing AHLE from ANE without neuropathological confirmation.

Background: Ischemic stroke is a leading cause of morbidity and mortality worldwide. Despite established prevention strategies, many patients present with previously undiagnosed vascular risk factors (URFs) at the time of their first-ever ischemic stroke, suggesting missed opportunities for early detection. In Canada, particularly in Quebec, access to primary care is inconsistent, and a substantial proportion of the population lacks attachment to a family doctor (FD). Objective: This study aimed to determine the prevalence of URFs among patients with first-ever ischemic stroke and to evaluate the relationship between URFs, geographic region, and access to primary care in Quebec, Canada. We hypothesized that patients without an FD would have a higher prevalence of URFs. Methods: We conducted a retrospective chart review of 610 patients admitted with first-ever ischemic stroke to the McGill University Health Center (MUHC) between 2014 and 2017. Data collected included demographics; known and undiagnosed stroke risk factors such as hypertension (HTN), diabetes mellitus (DM), hyperlipidemia (HLD), and atrial fibrillation (AF); FD status; and geographic location based on postal code. Results: Among the 610 patients, 136 (22.3%) had at least one URF. The most common URF was HLD (14.3%), followed by HTN (6.2%), AF (1.6%), and DM (0.1%). Of 609 patients with available data, 146 (23.97%) lacked an FD. Patients without an FD were significantly more likely to have undiagnosed HTN (7.6% vs. 2.1%, p = 0.008). No significant differences were observed for the other URFs. Geographic variation was noted in both URF prevalence and FD access, but regional differences were not statistically significant. Conclusions: Our findings support the hypothesis that a lack of an FD is associated with a higher prevalence of undiagnosed HTN in ischemic stroke patients. Targeted screening and improved access to primary care, particularly in underserved regions, may help to reduce the burden of preventable stroke by facilitating the earlier identification and management of modifiable risk factors.