Journal/Magazine Articles
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This collection contains original research articles, review articles and case reports published in local and international peer reviewed journals by the staff members of the Faculty of Medicine
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Item Bites and stings: Exotic causes of stroke in Asia(Karger, 2024) Ranawaka, U.K.BACKGROUND Many unusual and fascinating causes of stroke are seen in Asia. Although rarely encountered in the Western world, such cases are seen not so infrequently by neurologists, physicians, and other healthcare workers in Asian countries. This article highlights some of these intriguing causes of stroke such as snakebite, scorpion stings, and bee and wasp stings.SUMMARY Snakebite is a neglected tropical disease of global importance affecting over 5 million people each year, and scorpion stings and bee and wasp stings affect over a million people worldwide every year. Strokes due to these uncommon causes predominantly affect young males in their most productive years, and many victims die or remain with residual disability with significant socioeconomic consequences to the affected families and society. Both ischaemic and haemorrhagic strokes are seen, with ischaemic strokes being more common. Many unanswered questions remain regarding the pathophysiological mechanisms, clinical spectrum, and the natural history of stroke due to these causes. Antivenom is effective in snake envenoming, antivenom and prazosin are effective in scorpion envenoming, and treatment of anaphylaxis and allergy is recommended in systemic reactions due to bee or wasp stings. However, there are no treatment guidelines or expert recommendations to guide the management of stroke in these patients, and there are no data on the safety and efficacy of stroke-specific treatments such as antiplatelet therapy, thrombolysis or endovascular treatment.KEY MESSAGES More research is clearly needed to unravel the complexities related to stroke following snakebite, scorpion envenoming, and bee and wasp stings, and to guide the development of optimal stroke treatment strategies in these unusual situations. Awareness of these exotic stroke aetiologies is important in early recognition and appropriate management of patients presenting with stroke symptoms in Asian countries, and in global travellers from the region. International collaborations would go a long way in improving our understanding of these rare but fascinating causes of stroke.Item Cerebral microbleeds and stroke: more questions than answers(Association of Sri Lankan Neurologists, 2021) Ranawaka, U.K.With the widespread availability of MRI scanning, cerebral microbleeds (CMBs) are being increasingly recognized in patients with stroke and in healthy individuals. As CMBs are commonly viewed as markers of increased risk of intracerebral haemorrhage (ICH), there are concerns regarding the use of antithrombotic agents (antiplatelets, and especially anticoagulants) in the presence of CMBs, even in patients at high risk of ischaemic events. The use of antiplatelet or anticoagulant therapy in the presence of CMBs, balancing the risk of possible intracranial bleeding, is one of the most contentious contemporary issues in stroke medicine.Item Stroke in Sri Lanka: How can we minimise the burden?(Basel : Karger, 2021) Ranawaka, U.K.; Venketasubramanian, N.ABSTRACT: The burden of stroke in Sri Lanka is high and steadily increasing. Accurate estimation of the burden is hampered by a paucity of epidemiological data. More neurologists, stroke units, facilities for modern treatments and multi-disciplinary rehabilitation services are urgently needed. Essential drugs for risk factor control and secondary prevention are available in many hospitals. Aggressive preventive strategies and promoting stroke awareness are the best ways to minimise the stroke burden in Sri Lanka. KEYWORDS: Burden; South Asia; Sri Lanka; Stroke; Stroke care.Item Stroke awareness in a Sri Lankan community introduction(Ceylon College of Physicians, 2016) Ranawaka, U.K.; de Silva, H.; Balasuriya, J.; Puvanendiran, S.; Jayasekara, B.; Wijesekera, J.C.OBJECTIVE: Knowledge regarding stroke is likely to influence treatment seeking and preventive behaviour. We sought to assess stroke awareness in a Sri Lankan community. METHODS: Adults and schoolchildren in 750 households in the Kelaniya Medical Officer of Health area selected by cluster sampling formed the study population. Knowledge about stroke was assessed using a pre-tested, structured, interviewer administered questionnaire. Level of knowledge was categorised into five groups using a composite score. RESULTS: 711 adults and 155 schoolchildren were studied. Only 36.8% recognised the brain as the organ involved in a stroke. Main presenting symptoms identified were unilateral weakness (93.9%) or sensory symptoms (88%), and speech difficulty (88%). Stroke was considered a cause of sudden death by 58.4%. Many recognised hypertension (74.3%) as a risk factor, but awareness was inadequate regarding diabetes (60.5%), heart disease (60.9%), hypercholesterolaemia (62.5%) and smoking (61.3%). Of the respondents, 60.1% considered stroke was preventable, 74% were aware that stroke could recur, 91.3% believed early treatment would improve outcome and 88.8% considered stroke an emergency. 43.3%, and ‘very good’ in only 0.7%. Majority were graded as average (46.8%), ‘poor’ (5.9%) or ‘very poor’ (3.4%). There was no significant difference in knowledge between adults and schoolchildren. Having a friend or a relative with a stroke was the commonest source of knowledge (61.5%). Doctors (32.2%) and other health workers (9.1%) were poor sources of information. CONCLUSIONS: Knowledge about stroke is deficient in many aspects. Health professionals need to play a greater role in improving awareness.Item Stroke management in the new millennium(Ceylon College of Physicians, 2006) Ranawaka, U.K.No Abstract AvailableItem Living with a stroke : advice to patients and carers(State Pharmaceuticals Corporation, 2005) Ranawaka, U.K.No Abstract AvailableItem Prevention and treatment of Stroke(State Pharmaceuticals Corporation, 2005) Ranawaka, U.K.No Abstract AvailableItem What is Stroke?(State Pharmaceuticals Corporation, 2004) Ranawaka, U.K.