Browsing by Author "Sathkorala, W."

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Carotid artery stenosis in patients with ischaemic stroke in a tertiary care centre: Prevalence and associated factors
(Ceylon College of Physicians, 2019) Ranawaka, U.K.; Mettananda, K.C.D.; Eshani, M.D.P.; Wettasinghe, L.M.; Somaratne, S.; Premadasa, H.M.S.D.; Sirigampola, C.; Upasena, A.; Sathkorala, W.; Pathmeswaran, A.
OBJECTIVES: Data on the prevalence of carotid artery stenosis (CAS) among Sri Lankan stroke patients is limited. We sought to determine the prevalence and associated factors of significant CAS in patients with ischaemic stroke admitted to a Sri Lankan stroke unit. METHODS: We prospectively studied all stroke patients admitted to a stroke unit in a tertiary care hospital over a five-year period. Presence and degree of CAS was evaluated by doppler ultrasonography (US). Degree of CAS was classified as low {<50%), moderate (50-69%), significant (70-99%) or total occlusion (100%) according to NASCET criteria. Factors associated with significant CAS were identified by stepwise multiple logistic regression analysis. RESULTS: Out of 867 stroke patients studied, 704 (81.2%) had ischaemic strokes (59.7% male, mean age 59.0 ± 10.3 years), and 550 (78.1%) of them had carotid doppler data available. 528 (96.0%) had low degree stenosis, 12 (2.2%) had moderate stenosis, 7 (1.3%) had significant stenosis and 3 (0.5%) had total occlusion. Older age was associated with significant CAS (OR 1.14, p=0.011) on stepwise multiple logistic regression analysis. Sex, smoking, BMI, total cholesterol, LDL cholesterol, history of diabetes mellitus, hypertension, hyperlipidemia or ischemic heart disease, and premorbid aspirin or statin use were not associated with significant CAS. CONCLUSIONS: Significant CAS is seen in only 1.8% of Sri Lankan patients with ischaemic stroke at this tertiary care centre. These figures are much lower compared to Western data. Our findings have implications for the use of management approaches such as thrombectomy and carotid endarterectomy in Sri Lankan patients. ACKNOWLEDGEMENTS: EMDP and WLM were supported by a research grant from the National Stroke Association of Sri Lanka.
A large pericardial cystic lymphangioma presenting as acute-onset respiratory distress in a child: a case report
(BioMed Central, London, 2022) Pathiraja, H.; Rasnayake, D.; Muthukumarana, T.; de Silva, C.; Sathkorala, W.; Gunaratne, S.; Rajindrajith, S.; Mettananda, S.
Background: Lymphangiomas are rare benign malformations of the lymphatics that occur due to blockage of the lymphatic system during fetal development. They commonly occur in the neck and axilla, while involvement of the pericardium is rare. We report herein the case of a 16-month-old Sri Lankan child with a large pericardial cystic lymphangioma presenting with sudden-onset shortness of breath. Case presentation: A 16-month-old Sri Lankan boy presented with sudden-onset dyspnea for 1-day duration following a febrile illness that lasted 2 days. On examination, he was afebrile and had subcostal, intercostal, and suprasternal recessions, with a respiratory rate of 50 breaths per minute. He had a loud expiratory grunt. The chest expansion was reduced on the right side, which was dull to percussion. Auscultation revealed a marked reduction of air entry over the right lower and mid zones. Chest X-ray showed a well-demarcated opacity involving the lower and mid zones of the right hemithorax associated with a tracheal shift to the opposite side. Ultrasound scan of the chest revealed fluid-filled right hemithorax suggesting a septate pleural effusion. A contrast-enhanced computed tomography scan of the thorax showed a large multiloculated extrapulmonary cystic lesion involving the right hemithorax with a mediastinal shift towards the left side associated with displacement of the right-side mediastinal structures. He underwent mini-thoracotomy and surgical excision of the cyst. A large cyst originating from the pericardium was observed and excised during surgery. Histological examination revealed a lesion composed of cysts devoid of a lining epithelium but separated by connective tissue, mature adipose tissue, and lymphoid aggregates. The child showed complete recovery postoperatively with full expansion of the ipsilateral lung. Conclusion: We report the case of a patient with cystic lymphangioma who was perfectly well and asymptomatic until 16 months of age. This case report presents the very rare occurrence of a large cystic lymphangioma originating from the pericardium. It highlights the importance of considering rare possibilities and performing prompt imaging in situations of diagnostic uncertainty to arrive at an accurate diagnosis that can be lifesaving.
Prevalence and correlates of carotid artery stenosis in a cohort of Sri Lankan ischaemic stroke patients
(BioMed Central, 2021) Mettananda, K.C.D.; Eshani, M.D.P.; Wettasinghe, L.M.; Somaratne, S.; Nanayakkkara, Y.P.; Sathkorala, W.; Upasena, A.; Sirigampola, C.; Tilakaratna, P.M.Y.; Pathmeswaran, A.; Ranawaka, U.K.
Background: Large artery atherosclerotic disease is an important cause of stroke, accounting for 15–46% of ischaemic strokes in population-based studies. Therefore, current guidelines from west recommend urgent carotid imaging in all ischaemic strokes or transient ischaemic attacks and referral for carotid endarterectomy. However, the clinical features and epidemiology of stroke in Asians are diferent from those in Caucasians and therefore the applicability of these recommendations to Asians is controversial. Data on the prevalence of carotid artery stenosis (CAS) among South Asian stroke patients is limited. Therefore, we sought to determine the prevalence and associated factors of signifcant CAS in a cohort of Sri Lankan patients with ischaemic stroke. Methods: We prospectively studied all ischaemic stroke patients who underwent carotid doppler ultrasonography admitted to the stroke unit of a Sri Lankan tertiary care hospital over 5 years. We defned carotid stenosis as low (<50%), moderate (50–69%) or severe (70–99%) or total-occlusion (100%) by North American Symptomatic Trial Collaborators (NASCET) criteria. We identifed the factors associated with CAS≥50% and≥70% by stepwise multiple logistic regression analysis. Results: A total of 550 ischaemic stroke patients (326 (59.3%) male, mean age was 58.9±10.2 years) had carotid doppler ultrasonography. Of them, 528 (96.0%) had low-grade, 12 (2.2%) moderate and 7 (1.3%) severe stenosis and 3 (0.5%) had total occlusion. On multivariate logistic regression, age was associated with CAS≥50% (OR 1.12, p=0.001) and CAS≥70% (OR 1.14, p=0.016), but none of the other vascular risk factors studied (sex, hypertension, diabetes mellitus, smoking, past history of TIA, stroke or ischemic heart disease) showed signifcant associations. Conclusions: Carotid stenosis is a minor cause of ischemic stroke in Sri Lankans compared to western populations with only 4.0% having CAS≥50 and 3.5% eligible for carotid endarterectomy. Our fndings have implications for the management of acute strokes in Sri Lanka.