Neurology Commons^™

Plasma Soluble Human Elastin Fragments As An Intra-Aneurysmal Localized Biomarker For Ruptured Intracranial Aneurysm, Daichi Nakagawa, Mario Zanaty, Joseph Hudson, Nahom Teferi, Daizo Ishii, Lauren Allan, Pascal Jabbour, Santiago Ortega-Gutierrez, Edgar A. Samaniego, David M. Hasan

Department of Neurosurgery Faculty Papers

Background—Fragmentation of the tunica media is a hallmark of intracranial aneurysm formation, often leading to aneurysmal progression and subsequent rupture. The objective of this study is to determine the plasma level of elastin fragments in the lumen of ruptured versus unruptured human intracranial aneurysms. Methods and Results—One hundred consecutive patients with/without ruptured saccular intracranial aneurysms undergoing endovascular coiling or stent-assisted coiling were recruited. Blood samples were collected from the lumen of intracranial aneurysm using a microcatheter. The tip of the microcatheter was placed inside the aneurysm’s sac in close proximity to the inner wall of the dome. Plasma levels of …

Role Of Palliative Csf Diversion In Patients With Intracranial Metastatic Disease And Symptomatic Hydrocephalus, Farhan A. Mirza, Muhammad Shahzad Shamim

Section of Neurosurgery

Hydrocephalus, unless treated, is one of the terminal manifestations of intracranial metastatic disease. Single lesions causing obstructive hydrocephalus are amenable to surgical resection, but in the setting of multiple lesions and communicating hydrocephalus from leptomeningeal disease, the approach to treatment is much less defined. The use of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunting (VPS) has been described, but data is limited. In this review, we summarize the sparse data available in literature describing the use of CSF diversion for patients with metastatic disease presenting with hydrocephalus and neurological decline.

Parametric And Nonparametric Tests In Spine Research: Why Do They Matter?, Sarah Hopkins, Joseph R Dettori, Jens R Chapman

Articles, Abstracts, and Reports

No abstract provided.

Procarbazine, Ccnu And Vincristine (Pcv) Versus Temozolomide Chemotherapy For Patients With Low-Grade Glioma: A Systematic Review., Karim Hafazalla, Arjun Sahgal, Blessing Jaja, James R Perry, Sunit Das

Student Papers, Posters & Projects

Low-grade gliomas (LGG) encompass a heterogeneous group of tumors that are clinically, histologically and molecularly diverse. Treatment decisions for patients with LGG are directed toward improving upon the natural history while limiting treatment-associated toxiceffects. Recent evidence has documented a utility for adjuvant chemotherapy with procarbazine, CCNU (lomustine), and vincristine (PCV) or temozolomide (TMZ). We sought to determine the comparative utility of PCV and TMZ for patients with LGG, particularly in context of molecular subtype. A literature search of PubMed was conducted to identify studies reporting patient response to PCV, TMZ, or a combination of chemotherapy and radiation therapy (RT). Eligibility …

Prevention Of Neural Tube Defects By Folic Acid In Pregnancy., Atiq Ahmed Khan, Ruth K.M.

Pakistan Journal of Neurological Sciences (PJNS)

Pakistan is a developing country facing variety of challenges including maternal malnutrition and neonatal mortality. Globally Pakistan has the third highest neonatal mortality rate(1). Maternal malnutrition contributes to low birth weight neonates and birth anomalies. A study conducted in tertiary care hospital of Karachi catering to lower socioeconomic background showed 10.9% of birth defects to be of central nervous system. Maternal factor related to neural tube defects in same study showed 81.3 % mothers had not taken folic acid during pregnancy(

Neurology Advocacy In Pakistan, Abdul Malik

Pakistan Journal of Neurological Sciences (PJNS)

Advocacy is an activity by an individual or group which aims to influence decisions within political, economic, and social systems and institutions. Advocacy can include many activities that a person or organization undertakes including media campaigns, public speaking, commissioning and publishing research or conducting exit poll or the filing of an amicus brief. Lobbying (often by lobby groups) is a form of advocacy where a direct approach is made to legislators on an issue which plays a significant role in modern politics

Hyperglycemia In Acute Subarachnoid Hemorrhage, Maher Bano Malik, Jehangeer Shoro, Haris Majid Rajput

Pakistan Journal of Neurological Sciences (PJNS)

Subarachnoid hemorrhage (SAH) is associated with high inhospital mortality and morbidity. Hyperglycemia occurs frequently in acute medical conditions including SAH and is associated with poor outcome. The aim of the study was to determine the frequency of Hyperglycemia in patients of subarachnoid hemorrhage.

Personality Traits And Mental Health Of University Male Students Viewing Internet Pornography, Komal Razzaq, Muhammad Rafiq, Fatima Sana, Zahid Mahmood

Pakistan Journal of Neurological Sciences (PJNS)

Studies have indicated that viewing internet pornography is like addiction and has been implicated in the development of psychosocial issues leading to mental health. However, in view of Pakistani culture, psychosocial issues and mental health problems associated with viewing internet pornography especially in perspective to personality traits are not studied yet. Objective: Objective of the current study was to investigate any effect of personality traits on mental health of university male students viewing internet pornography.

Chikungunya Virus Associated Guillain-Barre Syndrome With Variable Presentation: A Case Series., Salman Farooq, Muhammad Imran, Ejaz Karim, Dureshahwar Kanwar, Muhammad Bilal Tariq

Pakistan Journal of Neurological Sciences (PJNS)

Chikungunya Virus Is A Mosquito-borne Alpha Virus Which Occasionally Causes Neurologic Complications Including Guillain-barre Syndrome, Myelitis, Myopathies And Encephalitis. Pakistan Experienced Its First Chikungunya Outbreak In The Metropolis Of Karachi Officially Confirmed By World Health Organization In December 2016. During This Outbreak, Over 30,000 People Have Been Reported To Be Infected In Different Parts Of Karachi. We Report Four Cases Of Chikungunya Virus Infection Associated Guillain-barre Syndrome Having An Atypical Clinical Presentation And Variable Outcome. Each Case Presented As A Different Variant Of Gbs Including Acute Inflammatory Demyelinating Polyneuropathy, Acute Motor And Sensory Axonal Neuropathy And Pharyngeal-cervical-brachial.

Stroke Like Migraine Attacks After Radiation Therapy (Smart) Vs Radiation Vasculopathy, Farheen Niazi

Pakistan Journal of Neurological Sciences (PJNS)

Stroke like migraine attacks after radiotherapy (SMART) syndrome is a phenomenon of reversible neurologic dysfunction which occurs rarely years after radiotherapy for brain tumors. We present a 35years old patient who had new onset neurological dysfunction with fits twice in between a symptom free interval of one year. He had radiotherapy for grade 1 astrocytoma about 27 years ago. Tumor recurrence or growth was ruled out both times by neuroimaging. Alternate diagnosis like meningoencephalitis were also ruled out by appropriate workup. Patient was managed on antiepileptics and antiplatelets. Radiation induced vasculopathy was an important differential. The mechanism of both SMART …

Three Siblings With Charcot-Marie-Tooth Disease With No Other Family History, Prem Chand, Pooja Manglani, Faiq Amin, Fazal Manzoor Arain

Pakistan Journal of Neurological Sciences (PJNS)

Charcot-Marie-Tooth (CMT) disease is one of the most common inherited disorders of the peripheral nervous system. Patients diagnosed with CMT disease have axonal degeneration which results in muscle wasting, sensory loss and weakness. These patients have a very characteristic walking gait and shape of hands, along with other changes. Despite many common visible changes, no singular common genetic mutation for this disease or its cure has been identified. Therefore more case series for this disease needs to be identified so that future studies increase our knowledge about this disease. Here, we present a case series of 3 out of 4 …

Neuromyelitis Optica (Nmo); A Case Report, Saad Waheed, Jawad Hussian, Yasir Saood, Aqsa Shehzadi

Pakistan Journal of Neurological Sciences (PJNS)

Devic’s disease or syndrome also known as Neuromyelitis optica (NMO) which is a demyelinating central nervous system (immune-mediated) ailment that predominantly targets the optic nerves and spinal cord. NMO-IgG seropositivity & longitudinally extensive spinal-cord lesions typically represents the Devic’s disease & differentiates it from Multiple Sclerosis (MS).Treatment for NMO is based upon its presentation such as for acute phase(steroids, IVIG etc), prevention of relapse (steroid sparing immunosuppression etc) and symptom based therapy (e.g spasticity etc). Here, we present a case of NMO in a young female (26 years old), married patient who presented to us with total vision loss, urinary …

Behavioral Challenges In Childhood Epilepsy, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Behavioral problems among children with epilepsy is one of the most common problem. Severity of the problem ranges from 16% to 77% as compared to 9% in the general pediatric population. Such a huge variation in the results reflects probable difference in the methodology. Structured interviews that include parents, children and clinician’s reports have identified a higher rate of behavioral problems when compared to self-report instruments. Higher rates are reported in clinical samples recruited from tertiary care medical centers, where they have a lot of referrals from the peripheral small units. Most researchers agree that children with epilepsy have three …

Cerebral Venous Thrombosis At High Altitude, Maryam J Syed, Wasim Alamgir, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Cerebral Venous Thrombosis (CVT) is one of the rarest causes of stroke. It is described as complete or partial occlusion of the sinuses or cortical veins of the brain. A relationship between high altitude (HA) and cerebral venous thrombosis has been long suspected due to various case reports and studies, however, the exact underlying mechanisms and etiologies are highly complex and debatable. In this article review we discuss the incidence etiologies, risk factors, clinical presentations and management of CVT at high altitude. CVT majorly affects young people [2]. It presents with a wide variety of clinical presentations due to the …

Evaluation Of Quality Of Warfarin Therapy By Assessing Patient's Time In Therapeutic Range At A Tertiary Care Hospital In Pakistan, Haris Hakeem, Ammar Zaman Khan, Kashif Aziz, Ayesha Abbasi, Anam Haider, Bushra Moiz, Mohammad Wasay

Section of Neurology

Objective: To assess the time in therapeutic range in patients on warfarin anti-coagulation therapy.

Methods: The retrospective chart review was conducted at Aga Khan University Hospital, Karachi, and comprised data of patients having undergone anti-coagulation with warfarin from January 2013 to April 2015. To determine the mean time in therapeutic range, Rosendaal method was used. Association of time in therapeutic range with the composite outcome, bleeding and thromboembolic events was also assessed. Percentage of patients with time in therapeutic range <60% was calculated.

Results: There were 92 patients whose median time in therapeutic range was 34.9% (interquartile range: 20.0- 55.7). Overall, 71(77.2%) …

Neurological Complications In Patients With Plasmodium Vivax Malaria From Karachi, Pakistan, Mohammad Asim Beg, A Akhlaq, Najia Karim Ghanchi, B Usmani, R Shahzad, A Rahim, Mohammad Wasay

Department of Pathology and Laboratory Medicine

Background: Malaria remains an endemic disease in Pakistan with an estimated healthcare burden of 1.6 million cases annually, with Plasmodium vivax accounting for 67% of reported cases. P. vivax is the most common species causing malaria outside of Africa, with approximately 13.8 million reported cases worldwide.
Method: We report a series of P. vivax cases with cerebral involvement that presented at Aga Khan University Hospital, Karachi, Pakistan.
Results: The majority of the patients presented with high-grade fever accompanied by projectile vomiting and abnormal behaviour, seizures, shock and unconsciousness. Seven of 801 patients with P. vivax monoinfection presented or developed cerebral …

Impact Of Airborne Pollutants On Stroke, Adeel Khoja, Fizzah Kazim

Section of Neurology

No abstract provided.

Distinctive Structural And Molecular Features Of Myelinated Inhibitory Axons In Human Neocortex., Kristina D Micheva, Edward F Chang, Alissa L Nana, William W Seeley, Jonathan T Ting, Charles Cobbs, Ed Lein, Stephen J Smith, Richard J Weinberg, Daniel V Madison

Articles, Abstracts, and Reports

Numerous types of inhibitory neurons sculpt the performance of human neocortical circuits, with each type exhibiting a constellation of subcellular phenotypic features in support of its specialized functions. Axonal myelination has been absent among the characteristics used to distinguish inhibitory neuron types; in fact, very little is known about myelinated inhibitory axons in human neocortex. Here, using array tomography to analyze samples of neurosurgically excised human neocortex, we show that inhibitory myelinated axons originate predominantly from parvalbumin-containing interneurons. Compared to myelinated excitatory axons, they have higher neurofilament and lower microtubule content, shorter nodes of Ranvier, and more myelin basic protein …

Editorial., Jeffrey C Wang, Jens R Chapman, Karsten Wiechert

Articles, Abstracts, and Reports

No abstract provided.

Hypoglycemic, Hypolipidemic And Antioxidant Effects Of Iridoid Glycosides Extracted From: Corni Fructus: Possible Involvement Of The Pi3k-Akt/Pkb Signaling Pathway, Jiefang Kang, Chen Guo, Rodolfo Thome, Ning Yang, Yuan Zhang, Xing Li, Xiaoyan Cao

Department of Neurology Faculty Papers

Iridoid glycosides (CIG) are the major component of Corni fructus. In this work, we researched the antioxidative, hypoglycemic and lowering blood lipids effects of CIG on diabetic mice induced by a high-fat diet (HFD) and streptozotocin (STZ). Furthermore, to investigate the molecular mechanism of action, the phosphorylation and protein expression of phosphoinositide 3-kinase (PI3K) and its downstream proteins, such as insulin receptor (INSR), protein kinase B (Akt/PKB) and glucose transporter 4 (GLUT4) have been detected. The results showed that CIG significantly improved oral glucose tolerance in diabetic mice. Biochemical indices also revealed that CIG had a positive effect on lipid …