73,74 Recently, in a local population in Egypt, it was reported that CNS involvement (vascular stroke, meningeoencephalitis, and dementia) was recorded in nine patients out of 27 patients (33.3%) with brucellosis.75 Treatment is a special problem, and there are different protocols. A combination of doxycycline with rifampin and/or co-trimaxazole for six weeks or

more has been recommended.71,73 Other infectious and non-infectious diseases associated with stroke are summarized in table 1. Table Inhibitors,research,lifescience,medical 1: Tropical diseases associated with stroke Crimean-Congo Hemorrhagic Fever Crimean-Congo Hemorrhagic Fever (CCHF) is thought to be an old disease first described in the former Soviet Union. Since 1999 Iranian Ministry of Health reported a cluster of Inhibitors,research,lifescience,medical viral hemorrhagic fever in Sistan-Balouchestan, Isfahan and Golestan provinces in Iran. Fever, myalgia, petechia, purpura, bleeding, thrombocytopenia, anemia and leukopenia

are the main signs, symptoms and laboratory findings.36 Intracerebral hemorrhage due to severe thrombocytopenia may cause hemiparesis or hemiplegia.36 Hemorrhage in the arm compress median or ulnar nerves, and present itself as motor deficit.36 Management of Stroke Management consists of drug therapy, physical rehabilitation, control of risk factors and good nursing care. Antiplatelet drugs are the mainstay of drug treatment.76 They consist of aspirin, dipyridamole, Inhibitors,research,lifescience,medical ticlopidine Inhibitors,research,lifescience,medical and clopidogrel. The two last drugs are platelet surface glycoprotein inhibitors.77 For patients with embolic diseases due to cardiac problems or vascular atherothrombotic plaques anticoagulant drugs such as heparin or warfarin could be used. Aspirin is the most frequently used drug in all countries for acute therapy and secondary prevention. Main benefits of aspirin consist of low price and known adverse effects. The most important adverse effect is peptic ulcer and GI bleeding. In those cases ticlopidine and clopidogrel could Inhibitors,research,lifescience,medical be useful, but both are expensive. Dipyridamole has an additive pharmacologic effect when used with aspirin. Thrombolysis, carotid this website endarterctomy and vascular stenting are new procedures

which are not available in most countries located in tropical regions. Nursing care include early rehydration, prevention of bedsores, protecting from aspiration pneumonia and rehabilitation. The latter is a combination of physical, occupational and speech therapy. It should however be mentioned that in some situations such as intracranial hemorrhage secondary to CCHF or cerebral malaria antiplatelet drugs and heparin are contraindicated. Treatment of the risk factors such as hypertension, diabetes mellitus, and hypercholesterolemia, and smoking cessation are important features of the stroke management. Decreasing salt intake as well as weight and increase in physical activity also are the other important aspects of stroke management.