Medicine and Health Sciences Commons^™

Sarcoidosis Presenting As Vocal Cord Palsy: An Unusual Presentation And Literature Review, Mohummad Hassan Raza Raja, Muhammad Abdullah Javed, Ali Bin Sarwar Zubairi

Medical College Documents

We report the case of a 60-year-old woman, presenting with left vocal cord paralysis (VCP). Diagnostic evaluation revealed sarcoidosis to be the underlying pathology. Computed tomography (CT) scans exhibited enlarged subcarinal, pretracheal, and prevascular lymph nodes as the possible mechanism of left VCP through compression of the left recurrent laryngeal nerve. Initial treatment with oral prednisolone and azathioprine led to remission of symptoms; however, tapering of dosage led to relapse of cough without any signs of VCP. The dosage of prednisolone was further boosted, leading to complete remission. A review of literature reveals 20 cases have been reported to date, …

Current Role Of Laser Interstitial Thermal Therapy In The Treatment Of Intracranial Tumors, Farhan A. Mirza, Rida Mitha, Muhammad Shahzad Shamim

Section of Neurosurgery

Laser interstitial thermal therapy (LITT) is gaining popularity in the treatment of both primary and secondary intracranial tumors. The goal of LITT is to deliver thermal energy in a predictable, controlled, and minimally invasive fashion. It can be particularly valuable in patients with recurrent tumors who, due to previous radiation or surgery, may have a potentially higher risk of wound breakdown or infection with repeat craniotomy. Deep-seated lesions that are often inaccessible through open approaches (thalamus, hypothalamus, mesial basal temporal lobe, brainstem) may also be suitable targets. The experience and data published thus far on this modality is limited but …

The Use Of Life-Like Robotic Animals In The Acute Care Setting To Assist In The Care Of Patients With Dementia, Abby Denby

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The purpose of this pilot project was to describe the effect of life-like robotic animals on the nurses’ ability to provide care, patients’ level of agitation, use of antipsychotic medications, restraint and sitter use for patients with dementia in an acute care setting. Nurses report challenges and feelings of helplessness while caring for patients with dementia. Dementia may cause depression, agitation, aggression (physical or verbal) and a decrease quality of life. Animal Assisted Therapy (ATT) is a growing therapy in many healthcare settings but there is a lack of literature specifically related to the use of AAT in the acute …

Evaluation Of Hyperhomocysteinemia In The Progression Of Parkinson's Disease, Marisa A. Ducach, Pritpal S. Saggu

Physician Assistant Capstones, 2020-current

Abstract:

Objective:To assess the prevalence of hyperhomocysteinemia in Parkinson’s Disease (PD) and if this elevated serum level can be used as a predictive biomarker in risk assessment for the progression of cognitive decline in PD.

Design:Systematic Literature Review

Methods:A literature search was conducted through Google Scholar and Pubmed using phrases such as, “Parkinson's Disease”, and “homocysteine”, “Parkinson’s progression. Three articles, measuring serum homocysteine levels and cognitive functioning in PD patients, were selected, analyzed, and compared to assess for a relationship between homocysteine levels and cognitive decline in PD.

Results: Elevated homocysteine levels are associated with worse cognitive …

Induction Of Hypothermia In Patients With Traumatic Brain Injury, Frank Hadden, Courtney Lennix

Physician Assistant Capstones, 2020-current

Common Abbreviations:

TBI = Traumatic Brain Injury

Glasgow Outcome Scale = GOS

Glasgow Outcome Scale Extended = GOSE

Objective: To determine whether hypothermia induction improves long-term morbidity and mortality in patients with severe traumatic brain injury

Methods: A search was conducted using PubMed database and the search terms “induced hypothermia” and “traumatic brain injury”. Studies were excluded if the publication dates were over 10 years old, children were the population being studied, and the researchers were looking at other independent variables.

Results: The results from all three randomized control trials showed that the induction of hypothermia did not show effectiveness …

Beyond Low-Earth Orbit: Characterizing Immune And Microrna Differentials Following Simulated Deep Spaceflight Conditions In Mice, Amber M. Paul, Margareth Cheng-Campbell, Elizabeth A. Blaber, Sulekha Anand, Sharmila Bhattacharya

Publications

Spaceflight missions can cause immune system dysfunction in astronauts with little understanding of immune outcomes in deep space. This study assessed immune responses in mice following ground-based, simulated deep spaceflight conditions, compared with data from astronauts on International Space Station missions. For ground studies, we simulated microgravity using the hindlimb unloaded mouse model alone or in combination with acute simulated galactic cosmic rays or solar particle events irradiation. Immune profiling results revealed unique immune diversity following each experimental condition, suggesting each stressor results in distinct circulating immune responses, with clear consequences for deep spaceflight. Circulating plasma microRNA sequence analysis revealed …

Deep Brain Stimulation Of The Subcallosal Cingulate Gyrus In The Treatment Of Treatment Resistant Depression, Megan Caravas, Melanie Sov

Physician Assistant Capstones, 2020-current

Objective: a systematic review to determine the efficacy of deep brain stimulation (DBS) targeting the subcallosal cingulate gyrus (SCG) for the treatment of treatment resistant depression (TRD). Methods: PubMed database was utilized in a search for clinical randomized control trials that were completed after the year 2000, using the terms deep brain stimulation, treatment resistant depression, and subcallosal cingulate gyrus. Results: Three clinical trials were chosen based on specific inclusion criteria as noted in the PRISMA flow chart (Chart 1). The results of the three articles showed various discrepancies. Two of the three studies demonstrated some statistical significance in reduction …

Antibodies Against Lysophosphatidic Acid Protect Against Blast-Induced Ocular Injuries, Peethambaran Arun, Franco Rossetti, James C. Demar, Ying Wang, Andrew B. Batuure, Donna M. Wilder, Irene D. Gist, Andrew J. Morris, Roger A. Sabbadini, Joseph B. Long

Internal Medicine Faculty Publications

Exposure to blast overpressure waves is implicated as the major cause of ocular injuries and resultant visual dysfunction in veterans involved in recent combat operations. No effective therapeutic strategies have been developed so far for blast-induced ocular dysfunction. Lysophosphatidic acid (LPA) is a bioactive phospholipid generated by activated platelets, astrocytes, choroidal plexus cells, and microglia and is reported to play major roles in stimulating inflammatory processes. The levels of LPA in the cerebrospinal fluid have been reported to increase acutely in patients with traumatic brain injury (TBI) as well as in a controlled cortical impact (CCI) TBI model in mice. …

Treating Ms After Surviving Pml: Discrete Strategies For Rescue, Remission, And Recovery Patient 1: From The National Multiple Sclerosis Society Case Conference Proceedings, Nidhiben Anadani, Megan Hyland, Roberto A. Cruz, Robert Lisak, Kathleen Costello, Eugene O. Major, Yasir Jassam, Ethan Meltzer, Thomas C. Varkey, Matthew S. Parsons

School of Medicine Publications and Presentations

A 38-year-old woman with MS receiving natalizumab presented to the neurology clinic with the complaint of a new neurologic symptom.

Addressing The Unspoken Adl: A Professional Development Training, Cadence Starr, Angela Blackwell

Fall 2020 Virtual OTD Capstone Symposium

Sexual activity is the most neglected and unspoken about Activity of Daily Living (ADL) in occupational therapy clinical practice due to lack training on how to address it with clients. Addressing the Unspoken ADL is a professional development training, created to train occupational therapist on how to talk about and include sexuality into evaluations and intervention strategies when working with individuals with spinal cord injury. This poster presentation outlines the completed literature review and development and implementation of Addressing the Unspoken ADL: A Professional Development Training.

Enhancing Quality Of Life For Individuals With Dementia Through A Virtual Ot Based Equine-Assisted Activities Program, Lauren Fearn, Becki Cohill, Karen Park, Martha Gipson

Fall 2020 Virtual OTD Capstone Symposium

Individuals living with dementia typically experience progressive, cognitive, and functional decline which limits their ability to communicate and fully perform activities (Pimouguet el al., 2019). Horses have been shown to benefit individuals with dementia by improving well-being, physical health, functional capacity, and social relationships (Fields et. al., 2019). A 6-week OT based virtual equine-assisted activities program was conducted to determine if participation in equine-assisted activities could improve the quality of life of individuals with dementia. Outcomes of the program resulted in improvements in mood, energy level, engagement, communication, memory, socialization, and overall quality of life.

FromSubjectReceivedSizeCategoriesLauren FearnAbstract for Poster7:11 PM26 …

The Poststroke Peripheral Immune Response Is Differentially Regulated By Leukemia Inhibitory Factor In Aged Male And Female Rodents, Stephanie M. Davis, Lisa A. Collier, Sarah J. Messmer, Keith R. Pennypacker

Neurology Faculty Publications

Background. The goal of this study was to determine whether leukemia inhibitory factor (LIF) promotes anti-inflammatory activity after stroke in a sex-dependent manner. Methods. Aged (18-month-old) Sprague-Dawley rats of both sexes underwent sham surgery or permanent middle cerebral artery occlusion (MCAO). Animals received three doses of intravenous LIF (125 μg/kg) or PBS at 6, 24, and 48 h before euthanization at 72 h. Spleen weights were measured immediately following euthanization. Western blot was used to measure protein levels of CCL8, CD11b, CXCL9, CXCL10, IL-12 p40, IL-3, and the LIF receptor (LIFR) in spleen tissue. ELISA was used …

Manf Is Neuroprotective Against Ethanol-Induced Neurodegeneration Through Ameliorating Er Stress, Yongchao Wang, Wen Wen, Hui Li, Marco Clementino, Hong Xu, Mei Xu, Murong Ma, Jacqueline A. Frank, Jia Luo

Pharmacology and Nutritional Sciences Faculty Publications

Fetal alcohol spectrum disorders (FASD) are a spectrum of developmental disorders caused by prenatal alcohol exposure. Neuronal loss or neurodegeneration in the central nervous system (CNS) is one of the most devastating features in FASD. It is imperative to delineate the underlying mechanisms to facilitate the treatment of FASD. Endoplasmic reticulum (ER) stress is a hallmark and an underlying mechanism of many neurodegenerative diseases, including ethanol-induced neurodegeneration. Mesencephalic astrocyte-derived neurotrophic factor (MANF) responds to ER stress and has been identified as a protein upregulated in response to ethanol exposure during the brain development. To investigate the role of MANF in …

Risk Of Mechanical Thrombectomy Recanalization Failure: Intraoperative Nuances And The Role Of Intracranial Atherosclerotic Disease, Joshua H. Weinberg, Ahmad Sweid, Ashlee Asada, Rawad Abbas, Keenan Piper, Daniel Joffe, Michael Reid Gooch, Stavropoula Tjoumakaris, Pascal Jabbour, Robert H. Rosenwasswer, Hekmat Zarzour

Department of Neurosurgery Faculty Papers

Objective: To present intraoperative observations that when recognized may facilitate the identification of patients at high risk of MT recanalization failure. We illustrate 4 cases of successful recanalization via rescue treatment with balloon angioplasty and/or stenting when such observations were noted. We also discuss the role of intracranial atherosclerotic disease in recanalization failure.

Patients and methods: We conducted a retrospective review of a prospectively maintained database for 450 stroke patients and identified 122 patients who underwent MT that failed to achieve recanalization. Operative notes were reviewed, and intraoperative nuances were discussed amongst neurointerventionalists.

Results: Intraoperative observations that may suggest a …

Focal Cortical Dysplasia With Prolonged Ictal Asystole, A Case Report, Ahmad Wali, Fowzia Siddiqui

Section of Neurology

Introduction: Cortical dysplasia carries significant morbidities such as seizures and delayed milestones. Focal cortical dysplasia (FCD) causes refractory epilepsy with various seizure types depending on the location and extent of the dysplasia. FCD in the temporal region and the insular cortex may cause ictal bradycardia (IB) and ictal asystole (IA). Video EEG (VEEG) with simultaneous EKG recording can better diagnose these cardiac abnormalities in FCD. We describe a case of refractory epilepsy. The patient's clinical seizures were usually followed by syncope. VEEG revealed frequent seizures some of which were associated with prolonged ictal asystole.
Results: A 15 years old female …

Network-Level Mechanisms Underlying Effects Of Transcranial Direct Current Stimulation (Tdcs) On Visuomotor Learning, Pejman Sehatpour, Clément Dondé, Matthew J. Hoptman, Johanna Kreither, Devin Adair, Elisa Dias, Blair Vail, Stephanie Rohrig, Gail Silipo, Javier Lopez-Calderon, Antigona Martinez, Daniel C. Javitt

Publications and Research

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation approach in which low level currents are administered over the scalp to influence underlying brain function. Prevailing theories of tDCS focus on modulation of excitation-inhibition balance at the local stimulation location. However, network level effects are reported as well, and appear to depend upon differential underlying mechanisms. Here, we evaluated potential network-level effects of tDCS during the Serial Reaction Time Task (SRTT) using convergent EEG- and fMRI-based connectivity approaches. Motor learning manifested as a significant (p <.0001) shift from slow to fast responses and corresponded to a significant increase in beta-coherence (p <.0001) and fMRI connectivity (p <.01) particularly within the visual-motor pathway. Differential patterns of tDCS effect were observed within different parametric task versions, consistent with network models. Overall, these findings demonstrate objective physiological effects of tDCS at the network level that result in effective behavioral modulation when tDCS parameters are matched to network-level requirements of the underlying task.

A Narrative Review Of Targeted Therapy In Meningioma, Pituitary Adenoma, And Craniopharyngioma Of The Skull Base., Nina L. Martinez, Omaditya Khanna, Christopher J. Farrell

Department of Neurosurgery Faculty Papers

Management of solid tumors involving the skull base are primarily managed with surgery and radiation, though proximity to important vascular and neuroanatomic structures often limit the extent of resection and permissible radiation dose. Meningiomas are the most common primary brain tumor in adults, and although the majority of skull base meningiomas are low-grade, their location in proximity to critical anatomical structures precludes aggressive surgical resection, and larger tumors are often resistant to radiation treatment. In patients with clinically aggressive, unresectable meningiomas, several molecular biomarkers of angiogenesis, as well as genetic mutations (SMO, AKT1, PIK3CA, KLF4, POLR2, SMARCE1, and TRAF7), have …

Molybdenum Cofactor Deficiency Causing Neonatal Seizures And Global Developmental Delay, Sundal Aziz, Javeria Raza Alvi, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT: Molybdenum cofactor deficiency is a rare degenerative brain disorder with autosomal recessive inheritance. It presents early in neonatal life with seizures, feeding difficulty and spasticity, sometimes misdiagnosed as neonatal hypoxic ischemic encephalopathy. Neuroimaging findings are consistent with loss of white matter and volume along with cystic encephalomalacic changes. Most of the patients have mutations in the MOCS1 and MOCS2 genes causing imbalance in the sulfur-containing amino acid metabolism leading to progressive neurological damage and early childhood death in majority of cases. We report a case of a 7 months old child, product of non-consanguineous marriage with history of neonatal …

Challenges For Dementia Care And Research In Pakistan, Fatima Siddiqui, Qurat Khan, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Dementia is a syndrome characterized by a decline in cognition and memory severe enough to interfere with daily life activities and is one of the major causes of disability and dependency in elderly worldwide with Alzheimer’s disease being the most common cause of dementia (1). 703 million individuals (9% of the world’s population) are more than 65 years of age and this number will double by the end of 2050 reaching 1.5 billion (16% of the world’s population) (2). Ageing has been the fastest in Eastern and South Eastern countries (3). Despite being a global health priority, with significant social …

Acute Ischemic Stroke Treatment Barriers In Pakistan, Saima Ahmad, Umair Rashid, Ossama Mansour, Sohail Akhtar

Pakistan Journal of Neurological Sciences (PJNS)

Worldwide stroke is the second most common cause of death and the third most common cause of disability (1). No large-scale epidemiological studies are available to determine the true incidence of stroke in Pakistan. There is only one published stroke prevalence study which was conducted in a community residing in Karachi, the prevalence was 4.8%, however the results of the study should be interpreted with caution as a non-validated questionnaire was used. (2). Another community-based survey suggested as estimated 21.8% prevalence of stroke in an urban slum of Karachi (3). These studies although published in local journals but do not …

Spectrum Of Fugitive Diagnosis Of Neurological Disorders In Elderly, Safia Bano, Ayesha Aslam, Adnan Tariq, Adnan Mahmood, Rashid Imran, Ahsan Numan

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT BACKGROUND Fugitive diagnosis “escape from true diagnosis” of neurological disorders is very common in elderly patients. It’s not always an underlying disease symptom or progression in old age. Aim of this study is to determine the frequency and nature of fugitive diagnosis of neurodegenerative brain disorders in old age. MATERIAL AND METHODS STUDY DESIGN A study was conducted in private Neuro-clinic in Lahore. Study duration is 3 years from to 1st January, 2017 to 31th December, 2019. It was a prospective, cross sectional study. Inclusion criteria: 1) Age >60years 2) Neurodegenerative brain disorders including vascular dementia 3) with or …

Prevalence Of Depression In Patients With Migraine, A Cross-Sectional Study From A Tertiary Care Hospital, Zuhaib Ahmed, Umar Farooque, Aijaz Ali, Syeda Urooj Riaz, Muhammad Ramzan, Vijaya Chaitanya Bollampally, Ehtesham Zahoor, Omer Cheema, Mujeeb Ur Rehman, Rizwan Farooque, Muhammad Daim Bin Zafar

Pakistan Journal of Neurological Sciences (PJNS)

BACKGROUND Headache is one of the most common presenting complaints in patients attending primary care centers and the majority of them have primary headache syndromes. Depressive disorders are among the leading causes of disability globally and can further complicate the clinical manifestation if coupled with other comorbidities. Therefore, the primary objective of our study was to determine the prevalence of depression in migraine patients presenting at a tertiary care hospital to better understand the leading causes of the disease. METHODS A cross-sectional study was carried out between December 2019 and June 2020 (six months) including 66 migraine patients between 18 …

Factors Affecting Treatment Compliance In Psychiatric Setting, Yasirah Gohar, Uroosa Talib, Nasir Mehmood

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Evaluation Of Post Therapy Functional Status And Residual Weakness Of Patients With Guillain-Barre Syndrome, Iqra Athar, Anam Anis, Mansoor Iqbal, Sumaira Nabi, Mazhar Badshah, Syeda Rida

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT: Introduction: The annual global incidence of Guillain-Barre Syndrome is approximately 1–2 per 100,000 person-years. Data on Guillain-Barre Syndrome is very rare from Pakistan, we conducted a retrospective study to assess the clinical presentation, and treatment response of these patients.

Obturator Nerve Block With Aqueous Phenol Reduces Hip Adductor Spasticity – A Single Centre Experience, Sarah Razaq, Fahim Anwar, Muhammad Aleem Arshad

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT

Aim: Spasticity is a cardinal symptom of upper motor neuron disorders. It affects different individuals differently.

Spasticity in the hip adductor muscles can be very painful and may result in postural abnormalities and hip deformities

that interfere with walking, transferring and perineal hygiene. The study aimed to assess the effectiveness of phenol

obturator nerve block on hip adductor spasticity caused by the upper motor neuron lesions.

Materials and methods: This is a single-centre retrospective study of all patients with known spasticity in the hip

adductors who were assessed suitable for phenol nerve block of the obturator nerve. All patients …

Longitudinally Extensive Transverse Myelitis And Neuromyelitis Optica Spectrum Disorder: A Tertiary Care Centre Experience, Safia Bano, Muhammad Athar Javed, Ahsan Numan

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT OBJECTIVE: To determine the frequency of longitudinally extensive transverse myelitis and Causes of longitudinally extensive transverse myelitis METHODOLOGY: A Cross-Sectional, retrospective study was conducted at Neurology Department, Mayo Hospital, Lahore from 1st January 2015 to 31st December 2015. Patients were included from inpatient with history of weakness of lower limbs/all four limbs with or without visual disturbances. History and clinical examination was consistent with transverse myelitis. Neuroimaging (MRI brain, (orbit in case of optic neuritis) and spinal cord) was done followed by LP/CSF, Vasculitis screening.

Assessment Of Dementia Caregiver Burden In Karachi, Pakistan Using 10/66 Protocol, Qurat Ul Ain Khan

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT INTRODUCTION: Care arrangements and caregiver burden of people with dementia (PWD) are different in low and middle income countries (LMICs) than in developed countries. This is the first study in Pakistan assessing caregiver burden using the 10/66 protocol. METHOD: PWD were recruited from outpatient clinics and from the community in Karachi and were diagnosed according to DSM-IV TR. Three scales were used: 1. Zarit Burden Interview (ZBI) to assess caregiver burden. 2. Caregiver Activity Survey (CAS) to assess activities that the caregiver engaged in the last 24 hours to care for PWD and 3. General Health Questionnaire- 12 (GHQ …

A Case Of Heroin Induced Toxic Leukoencephalopathy, Sidra Sattar, Saba Zaidi

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT: Heroin-induced leukoencephalopathy comes under the category of Toxic leukoencephalopathies. We report the case of middle-aged gentleman with the history of polysubstance abuse who presented with recurrent falls, difficulty in walking and drowsiness. Diffuse white matter changes were appreciated on MRI Brain with sparing of cerebellum. In context of his history of inhalational heroin abuse with extensive symmetrical white matter changes in cerebrum, a diagnosis of heroin induced toxic leukoencephalopathy was made.

Hemichorea Associated With Type 2 Diabetes: A Rare Neurological Complication, Waleed Shahzad, Tehmina Inayat, Fibhaa Syed, Mohammad Ali Arif, Muhammad Hassan, Haris Majid Rajput, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Diabetic hemichorea/hemiballism is a spectrum of hyper kinetic, involuntary, irregular, purposeless, non-rhythmic, rapid and unsustained movements flowing from one part of the body to another. It involves contra lateral basal-ganglia and often striatum of the brain. Here we are reporting an un-usual case of choreiform movement disorder which was sudden in onset. It was accompanied with abnormally high values of blood glucose. Our patient had a complete remission of symptoms after an adequate control of blood glucose was achieved. This case illustrates the importance and rarity of hyperglycemia as a rare cause of hemichorea. It recovers rapidly and has a …

Longitudinally Extensive Transverse Myelitis: A Sub-Saharan Conundrum, Antonina Obayo, Sylvia Mbugua, Sayed Karar

Internal Medicine, East Africa

Spinal cord schistosomiasis is a rare, underdiagnosed manifestation of schistosomiasis. We present the case of a 36-year-old male who presented to our institution with a one-week history of low back pain with rapidly progressive lower limb weakness, loss of sensation, and flaccid paraparesis. An MRI of the spine showed a longitudinally extensive transverse myelitis from T6 to L1, with enhancement at the cauda equina region. Further review of the images and serological tests eventually led to diagnosis of spinal schistosomiasis. He was treated with praziquantel and high-dose steroids, with minimal improvement in his symptoms.