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Cerebral Venous Sinus Thrombosis With Positive Dengue Serology, Sajid Hameed, Owais Hashmat, Mubashar Memon, Muhammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Dengue fever is a viral febrile illness caused by dengue virus and spread by Aedes mosquito worldwide. It usually manifests as an acute fever associated with body ache, skin rash, and thrombocytopenia. Neurological manifestations are relatively uncommon but well-known. We report a case of a 25-year-old male patient who presented to our hospital with acute febrile illness, headache, and vomiting. Extensive laboratory investigations were done and he was diagnosed with cerebral venous sinus thrombosis. Dengue serology was positive. He was treated with anticoagulation and hydration with complete recovery. The treatment with anticoagulation is challenging due to accompanying thrombocytopenia. Only two …

Can Early Orthotic Support And Physical Therapy Improve The Functional Level And Decrease Rate Of Surgical Interventions In Spastic Cerebral Palsy?, Sarfraz Ahmad, Syeda Rahat, Syeda Bushra

Pakistan Journal of Neurological Sciences (PJNS)

cerebral palsy is a disorder of movement and posture that results from a non progressive lesion of brain within 3 years of age. To determine the role of early orthotics and physical therapy in improving the functional status and in decreasing the rate of surgical interventions in management of spastic diplegic cerebral palsy child.

Outcome In Patients With Myasthenia Gravis Managed With Or Without Thymectomy, Safia Bano, Muhammad Athar Javed, Waqas Arshad

Pakistan Journal of Neurological Sciences (PJNS)

Myasthenia gravis is a chronic acquired autoimmune disorder in which autoantibodies are produced against acetylcholine receptors present on neuromuscular junction. It results in neuromuscular transmission blockage hence muscle weakness occurs. Thymus gland is considered as having crucial role in development of these antibodies. Screening patients for thymoma and removal of the thymus gland with surgery has an important aspect in management of disease.

Empowerment Of Primary Health Care In An Outreach Resource-Limited District In Punjab: A Strategy For Improving Adherence To Antiepileptic Drug Treatment In Children With Epilepsy., Muhammad Akbar Malik, Arshad Rafique, Ahmad Omar Virk

Pakistan Journal of Neurological Sciences (PJNS)

There is wide acknowledgement of the need for community involvement in the optimal management of children with epilepsy (CWE) in outreach financially constrained districts of the developing countries, but there is scarce data on comprehensive community-based childhood epilepsy treatment programs assessment.

Rhabdomyolysis Due To Status Epilepticus Causing Acute Renal Failure, Iqra Athar, Neelma Naz Khattak, Haris Majid Rajput, Anam Anis, Hanin Tanich, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Acute renal failure is one of the most common complications of rhabdomyolysis. Rhabdomyolysis is a serious syndrome and should be suspected in patients presenting after direct or indirect muscle injury, seizures, strenuous exercise, crush injuries and ingestion of drug or toxins. Rhabdomyolysis secondary to status epilepticus is a serious complication, leading to life threatening acute renal failure. Therefore, early recognition of risk of rhamdomylosis in status epilepticus and initiation of treatment is important.

Mr Perfusion Imaging, Techniques And Role In Differentiating Radiation Necrosis And Tumor Recurrence, Raima Zakaria, Fatima Mubarak, Muhammad Shahzad Shamim

Department of Radiology

High grade brain tumours are treated with surgery, chemotherapy and radiation therapy and despite such aggressive treatment, can recur in a short span of time. MRI scan has been the conventional diagnostic modality to diagnose recurrence, although at times it becomes difficult for the neuroradiologists to differentiate between tumour recurrence and radiation necrosis. Herein lies the emergent need to explore the efficacy of functional imaging to assist in this diagnostic challenge. Recent studies have sought to do so with promising implications, which we have attempted to summarize in this review.

Culture Bound Syndromes In Pakistan: Implications And Strategic Vision For Health Management, Lamae Zulfiqar, Nazish Idrees, Muhammad Rafiq

Pakistan Journal of Neurological Sciences (PJNS)

Understanding the culture a person belongs to is crucial as it forms the beliefs, values, perspectives, worries and hopes. It can then be used to assess the problems a person goes through and devise a treatment plan with a focus on belief system of a person. Culture bound syndromes are common in every society but are usually overlooked or given less consideration by professionals. These syndromes are belief systems associated with various diseases and disorders and can be very helpful in treatment, if understood in the perspective of a particular person as every syndrome is perceived differently by an individual …

Neuromyelitis Optica Spectrum Disorder: A Case Report From Rehman Medical Institute, Peshawar., Dr. Muhammad Shahid Iqbal, Zainab Rustam, Omer Nasim

Pakistan Journal of Neurological Sciences (PJNS)

Devic's disease or Neuromyelitis Optica is a serious, rare idiopathic neurological disorder which affects the optic nerve and the spinal cord. A 15-year-old girl was admitted in the neurology was with a previous history of 4 episodes of weakness in both the lower limbs and urinary retention. The patient gradually lost her eyesight in both eyes at the age of 8. Initially, she was diagnosed as a case of Multiple Sclerosis at the age of 11 when she presented with first episode of lower limb weakness. Later, Seropositivity for Aquaporin 4 IgG and clear MRI scan of the brain confirmed …

Rare Presentation Of Cerebral Venous Sinus Thrombosis, Haris Majid Rajput, Anam Anis, Iqra Athar, Neelma Naz Khattak, Hanin Tanich, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

We report case of a 16 year old girl with no known co-morbidities, presented with headache, quadriparesis and sudden vision loss. She had pallor and BMI was 33.09kg/m2. She had left 6th nerve palsy, bilateral papilledema and no perception of light. Motor examination showed power of 4/5 in all four limbs with bilateral extensor plantars. Neuroimaging was suggestive of superior saggital sinus thrombosis. CSF opening pressure was 72 cm of water.20 ml CSF was drained leading to improvement in headache and visual acuity. CVST presenting with quadriparesis and visual loss is a rare entity. Common presentations of CVST include headache, …

Mental Health Of University Male Students Viewing Internet Pornography: A Qualitative Study, Komal Razzaq, Muhammad Rafiq

Pakistan Journal of Neurological Sciences (PJNS)

This research was carried out to explore psychosocial and mental health issues of adults viewing pornography on the internet. Study Design: For this purpose, a qualitative research design was used. Method: In- depth interviews were conducted with twenty five university male students to explore the psychosocial issues in cases of internet pornography. After gathering the data from participants, a software, NVivo11 Plus was used for data management and analysis. This was also used for labelling and themes and categories generation. Results: After data analysis, main three categories generated on psychosocial issues associated with viewing internet pornography which were psychological issues, …

Neurology Training In Pakistan: 2020-2025, Safia Bano, Sarwar Jamil Siddique, Ahsan Numan Numan

Pakistan Journal of Neurological Sciences (PJNS)

As the year 2019 comes to end, many advances in neurology has been occurred over worldwide and is still going on. The emergence of new devices and drugs will help neurologists with additional therapeutic options to optimize the patient care especially in more complex cases. Antibody therapies especially monoclonal antibodies are flooding the landscape in nearly every discipline of neurology is no exception. We watched newer clinical trials, gain FDA approval for use, and many more therapeutic evidence-based interventions enter the pipeline. Neurology in the 20th century has undergone extraordinary changes, particularly in the past few decades. We trace the …

Development And Validation Of Juvenile Criminal Thinking Styles’ Inventory, Fatima Sana, Muhammad Rafiq

Pakistan Journal of Neurological Sciences (PJNS)

The current research explored the styles of criminal thinking among juvenile delinquents in Pakistani cultural context. Initially, 40 juvenile delinquents were interviewed individually to generate an item pool of 34 distinct thought statements. After excluding repetitive items a list of 19 items was piloted on 30 juvenile delinquents as a self-report measure of 5-point rating scale (Juvenile Criminal Thinking Styles’ Inventory). Finally, a sample of 211 juvenile delinquents were given the final list of 19 items, Measure of Criminal Social Identity (Boduszek, Adamson, Shevlin, & Hyland, 2012; Shagufta, 2015), and a demographic form. Principal Component factor analysis determined a three …

Pediatric Brainstem Gliomas: An Institutional Experience, Altaf Ali Laghari, Mirza Zain Baig, Muhammad Ehsan Bari, Aneela Darbar, Naureen Mushtaq, Umme E Hani Abdullah, Daniya Aziz Khan

Section of Neurosurgery

Objective: The aim of this study was to analyze the clinical profiles and outcomes of pediatric brainstem gliomas treated at our institute.
Methodology: We reviewed the files of 18 pediatric age group patients diagnosed with brainstem glioma at our institution. The following variables were recorded: age, sex, duration of symptoms, date of diagnosis, main clinical symptoms, Karnofsky performance status score, magnetic resonance imaging findings, histopathology findings, details of the treatment given, disease progression, and date of mortality/last follow-up. This data were then transferred to SPSS version 23 which was used for further analysis.
Results: The mean age of our cohort …

Utilization And Outcomes With Low Dose Tissue Plasminogen Activator As Intravenous Thrombolytic Therapy For Ischaemic Stroke At Aga Khan University Hospital, Karachi: A Retrospective Analysis, Masood Uz Zaman Babar, Ammar Zaman Khan, Haris Hakeem, Jaleed Gilani, Mohammad Wasay

Section of Neurology

Objective: To determine the utilisation of intravenous tissue plasminogen activator at a certain dose for ischaemic stroke thrombolysis and to compare the outcomes with those of a different dosage mentioned in literature.
Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised medical records from January, 2007, to October, 2016, of all patients having received intravenous tissue plasminogen activator for ischaemic stroke thrombolysis. Primary safety outcome variables included symptomatic intracerebral haemorrhage after the start of treatment (0.6mg/kg) and death within three months as per the modified Rankin scale 6. Secondary efficacy outcome variable was functional …

Current State Of Knowledge Of Basic Life Support In Health Professionals Of The Largest City In Pakistan: A Cross-Sectional Study, Babar Irfan, Ibrahim Zahid, Muhammad Sharjeel Khan, Omar Abdul Aziz Khan, Shayan Zaidi, Safia Awan, Sobia Bilal, Omar Irfan

Section of Neurology

Background: Basic Life Support (BLS) is the recognition of sudden cardiac arrest and activation of the emergency response system, followed by resuscitation, and rapid defibrillation. According to WHO, Pakistan has one of the highest mortality rates from accidental deaths therefore assessment and comparison of BLS knowledge in health professionals is crucial. We thereby aim to assess and compare the knowledge of BLS in doctors, dentists and nurses.

Methods: A multi-centric cross-sectional survey was conducted in Karachi at different institutions belonging to the private as well as government sector from January to March 2018. We used a structured questionnaire which was …

Longitudinally Extensive Transverse Myelitis With Seropositive Chikungunya, Sajid Hameed, Mubashar Memon, Hina Imtiaz, Dureshahwar Kanwar

Section of Neurology

Chikungunya viral (CHIKV) fever is often a self-limiting febrile illness associated with severe debilitating arthralgia. Neurological complications associated with CHIKV, although rare, have been reported in literature; however, longitudinally extensive transverse myelitis (LTEM) is rarely associated with it. We present a case of a middle-aged man with a 1-week history of low-grade fever and arthralgia followed by urinary retention and quadriplegia. A sensory level was noted at T2. On subsequent investigations, he was diagnosed with LETM. Although LETM is commonly seen in patients with neuromyelitis optica, the other possible etiologies are inflammatory and parainfectious. To date, only two cases of …

Burden And Risk Of Neurological And Cognitive Impairment In Pediatric Sickle Cell Anemia In Uganda (Brain Safe): Final Results Of The Cross-Sectional Analysis, Nancy Green, Deogratias Munube, Paul Bangirana, Linda Buluma, Bridget Kebirungi, Robert Opoka, Ezekiel Mupere, Philip Kasirye, Sarah Kiguli, Annet Birabwa

Paediatrics and Child Health, East Africa

Background: Children with sickle cell anemia (SCA) are highly susceptible to stroke and other manifestations of pediatric cerebral vasculopathy. Detailed evaluations in sub-Saharan Africa are limited.

Methods: We aimed to establish the frequency and types of pediatric brain injury in a cross-sectional study at a large SCA clinic in Kampala, Uganda in a randomly selected sample of 265 patients with HbSS ages 1–12 years. Brain injury was defined as one or more abnormality on standardized testing: neurocognitive impairment using an age-appropriate test battery, prior stroke by examination or transcranial Doppler (TCD) velocities associated with stroke risk in children with …

Current Management Of Glioma In Pakistan, Umme E Hani Abdullah, Altaf Ali Laghari, Muhammad Usman Khalid, Huzaifa Bin Rashid, Fatima Ali, Adnan Jabbar, Asim Hafiz, Muhammad Shahzad Shamim, Ather Enam

Section of Neurosurgery

To date, information on the management of specific neurosurgical tumors, such as glioma, in Pakistan remains scattered and scarce. Our review synthesizes the predicaments of glioma management routinely presented to the neurosurgery, medical oncology, radiation oncology, and radiology departments in Pakistan. Expert opinions were integrated from each of the relevant fields in the form of personal citations. The data presented in our review were collected from various PubMed and non-PubMed indexed articles, coupled with various health reports from the Government of Pakistan along with the World Health Organization. Through these data, it was postulated that the utilization of innovative and …

What, When And For Whom Model Of Nutrition: A Health Management Approach, Muhammad Rafiq

Pakistan Journal of Neurological Sciences (PJNS)

Studies have shown that nutrition plays an important role in the pathophysiology of different health issues either physiological, or psychological. Nutrition is implicated in the development of health issues in different ways. The purpose of this mini review was to suggest a comprehensive model of nutrition, “What, When and for Whom Model of Nutrition”, in the light of existing literature. For this purpose, existing literature was explored to study the role of nutrition on mental health in perspective to, what type of nutrition, when it is consumed and/or who consumes it. Researchers concluded that it is not only what we …

Gbs With Non-Hodgkin Lymphoma, A Rarity, Javaria Munir, Umer Aziz Qazi

Pakistan Journal of Neurological Sciences (PJNS)

Patients of Non-Hodgkin’s lymphomas may develop neurological signs and symptoms. This case is of a 76 year old male recently diagnosed with Non-Hodgkin’s lymphoma and on chemotherapy who presented with sudden bilateral leg weakness and inability to walk. The signs and symptoms, neurological examinations and Nerve conduction studies revealed a polyneuropathy which was consistent with Guillain-Barré syndrome (GBS). This has been seen in patients with Hodgkin's lymphoma but is rare in NHL.

Neurotoxicity In A Young Patient With Diffuse Large B-Cell Lymphoma After First Dose Of Intrathecal Triple Therapy., Ali Sajjad, Sajid Hameed, Sara Khan

Pakistan Journal of Neurological Sciences (PJNS)

Intrathecal triple chemotherapy (ITT) including cytarabine arabinoside, methotrexate and glucocorticoids is a standard regimen for prophylaxis and treatment of hematological malignancies, owing to their high proclivity for invasion of the neuraxis. Unfortunately, intrathecal chemotherapy is associated with various neurological adverse effects including seizures, encephalopathy, myelopathy, arachnoiditis and cauda/conus syndrome. We present a case of 33-year-old lady with primary bone diffuse large B-cell lymphoma. She had received 4 cycles of R-CHOP* and later 2 cycles of R-DHAP**. The first dose of ITT was administered along with the last cycle of R-DHAP. On the third day post-ITT, she developed acute bilateral lower …

The Natural Predominant Sleeping Positions In Cerebral Palsy; Does It Correlate With The Type Of Cerebral Palsy?, Sarah Razaq, Muhammad Aleem Arshad, Tahira Amjad

Pakistan Journal of Neurological Sciences (PJNS)

To see the natural positions of cerebral palsy subjects during sleep and their correlation with the particular type of cerebral palsy.

Science Of Lifestyle; Strategies For Change, Raza Ur Rahman

Pakistan Journal of Neurological Sciences (PJNS)

Since the start of 21st century the focus of medical treatment is changing from curative to the preventive medicine and now functional recovery and quality of life are the outcome of curative medicine. These new outcomes of modern medicine can be achieved through adopting the strategies that enhance wellness of patient. The methods of enhancing wellness are in practice since centuries and their effectiveness has been handed down through word of mouth and tradition. They continue to evolve and were first documented in 1970s, by Canyon Ranch1, as a strategy to improve health through the principles of a healthy lifestyle. …

Diagnostic Dilemmas Of Progressive Supranuclear Palsy, Humera Saeed, Qurat Ul Ain Khan, Syeda Masharab Jilani, Syeda Maheen Batool

Pakistan Journal of Neurological Sciences (PJNS)

In this report authors discuss similarities between psychiatric phenomenon i.e. catatonia and neuropsychiatric syndromes such as progressive supranuclear palsy (PSP) in a 51 years old male, known case of hypertension and diabetes, who presented to the psychiatric services with mutism, stereotypical movements of upper limbs, echolalia, anteriorly flexed neck, swallowing difficulty, decreased oral intake, urinary and fecal incontinence for a period of 1 year worsened for 6 months. Patient was initially treated for catatonia with benzodiazepines and electroconvulsive therapy but did not improve. A neuropsychiatric consultation was sought and a diagnosis of possible PSP was made according to the National …

Post-Stroke Seizures: A Clinically Oriented Analysis, Sajid Hameed, Haris Hakeem, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is an important cause of secondary epilepsy, especially in the elderly. Not only does this impact morbidity and mortality in an adverse way, it also prolongs the hospitalization. Various risk factors have been described in literature that increase the risk of seizures in a patient with stroke. Post stroke seizures fall on a spectrum of acute symptomatic and unprovoked seizures with varying pathophysiology and risk of subsequent development of epilepsy. Hence, the treatment approaches are also different. However, randomized controlled trials are lacking to guide monitoring and management strategies in post stroke seizures and the approaches remain individualized to …

Tacrolimus-Associated Posterior Reversible Encephalopathy Syndrome In Allogenic Hematopoietic Stem Cell Transplant, Hina Imtiaz, Maryam Jamil Syed, Dureshahwar Kanwar, Bushra Taimuri, Sajid Hameed

Pakistan Journal of Neurological Sciences (PJNS)

Tacrolimus is an immunosuppressive drug used to lower the risk of transplant rejection in individuals after solid organ or hematopoietic transplantation. Cases of posterior reversible encephalopathy syndrome (PRES) as a complication of tacrolimus therapy are infrequently documented. The pathogenesis of this phenomenon is not well understood. Here, we report a case of an 18-year-old female with a history of acute myeloid leukemia that developed PRES after undergoing an allogeneic stem cell transplant and subsequent immunosuppressive therapy with tacrolimus.

Cross-Sectional Study Of Knowledge Of Stroke Management Amongst Doctors Of A Tertiary Care Hospital; Peshawar, Pakistan, Muhammad Fozan Khan, Farzana Behttani, Omer Nasim, Muhammad Shahid Iqbal, Sohail Khan, Muhammad Khizar Hayat

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is one of the leading causes of mortality and neurological disability worldwide. ‘Time is brain’ and prompt management of stroke is vital to improve the outcomes. Knowledge of stroke management is important for clinicians working in various specialties and this study focused on evaluation of this vital aspect.

An Overview Of Autism: Is It Treatable In Pakistan?, Tania Nadeem, Rabeeka Aftab, Nargis Asad

Pakistan Journal of Neurological Sciences (PJNS)

Autism Spectrum Disorder (ASD) is a clinically complex, pervasive neurodevelopmental disorder with early appearing social communication deficits and repetitive sensory–motor behaviors.1 Although affected individuals differ significantly from one another, typically the disorder is characterized by impairment in social reciprocity and communication. Children usually have speech delays or lack of social interaction including: lack of eye contact, limited response to name, decreased interest in peers, and restricted shared attention with parents.1 Autistic individuals also exhibit repetitive behaviors like flapping, lining, or stacking objects and narrowly focused rigid interests such as paying particular attention to spinning objects.1 It usually manifests before 3 …

Extended Window Intravenous Thrombolysis: Is Conventional Window Of 4.5 Hours Coming To An End?, Malik Muhammad Adil, Narmeen Masood

Pakistan Journal of Neurological Sciences (PJNS)

The current standard of care to treat acute stroke patients presenting within 4.5 hours of stroke symptom onset is intravenous (IV) Alteplase.1 Over the past decade, tremendous efforts have been made to challenge the conventional window of 4.5 hours for the administration of Alteplase to expand the patient population which can benefit from thrombolysis. Based on the recent meta-analysis, 2 we have strong evidence supporting the use of IV thrombolysis in patients presenting between 4.5 to 9 hours of symptom onset with favorable perfusion imaging and it appears that the era of the conventional 4.5 hours window may be coming …

Pituitary Adenoma With Calcifications: A Case Report, Yakoot Khan, Noor Malik, Saba Iqbal Awan, Syed Hassan Khalid, Altaf Ali Laghari

Section of Neurosurgery

Pituitary adenomas and Rathke’s cleft cyst with calcification are rarely seen and craniopharyngioma still remains the common sellar suprasellar space occupying lesion with calcification. Presence of calcification is reported in pituitary adenoma in only 0.2% to 8% cases. The pituitary adenoma with calcification is a rare radiological finding and it must be distinguished from other lesions of the pituitary gland as the management and prognosis differs significantly. We report a case of a 29-year-old gentleman presented electively with the complaints of deterioration of vision for four months. CT-scan without contrast examination revealed pituitary adenoma with calcification. The patient underwent transsphenoidal …