Medicine and Health Sciences Commons^™

Neuro-Palliative Medicine, Shazia Faiz

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Ataxic Variant Of Guillain Barre Syndrome: A Case Report, Haris Majid Rajput, Malik Muhammad Adil, Maryam Khalil, Nayab Aslam, Zaid Waqar

Pakistan Journal of Neurological Sciences (PJNS)

A 17-year-old girl was admitted after acute onset of unsteady gait succeeding acute gastroenteritis. Neurological examination reported normal power in all four limbs, impaired finger-nose, heel-shin tests, areflexia and ataxic gait. We eliminated other diseases with cerebellar symptoms; for example, Wernicke encephalopathy, multiple sclerosis, cerebellar vascular disease , encephalitis in the brain stem and cerebellum. Blood serum collected from the patient during the acute phase showed no anti-ganglioside antibodies. As the patient presented with evident cerebellar ataxia without muscle weakness, ophthalmoplegia or proprioceptive sensory disruption a diagnosis of ataxic form of Guillain-Barré syndrome (GBS) after nerve conduction studies. Though ataxic …

National Guidelines For The Treatment Of Common Headaches Disorders In Pakistan, Abdul Malik, Sabrina Khan, Mohammad Wasay, Aziz Sonawalla, Samaira Younis, Faisal Mohammad Amin

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Impairment-Based Multidisciplinary Rehabilitation Management In Multiple Sclerosis In Pakistan, Sarah Razaq, Fahim Anwar, Wasim Wali

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Pediatric Stroke: A Review, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Background and objectives: Pediatric Stroke is a neurological disorder in which the patient suffers with two or more Pediatric stroke is a focal neurological deficit lasting more than 24 hours because of stenosis, occlusion or rupture of cerebral blood vessels. Variable etiological factors are involved ranging from cardiac, haematological, infectious, immune mediated to arteriopathies which is emerging as most important cause of arterial ischemic stroke in children. In this review article we will discuss paediatric stroke with its epidemiology, etiological factors in particular arteriopathies, diagnostic modalities, management protocols and outcome.

Methods: We searched stroke in Pubmed and found 15315 articles, …

Clinical Spectrum, Risk Factors And Electrophysiologic Aspect Of Radial Nerve Injury, Arfah Kanwal, Safia Bano, Ubaid Ullah, Ahsan Numan

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT

Background and objective: Radial nerve is injured due to a variety of reasons. The objective of this study was to determine the clinical spectrum, risk factors and electrophysiologic aspect of radial nerve injury presenting to a tertiary care hospital in Lahore.

Methods: This descriptive prospective cross-sectional study was conducted at department of Neurology, Mayo hospital Lahore from July 2022 to December 2022 and comprised patients with isolated radial nerve injury on the basis of history and clinical examination regardless of their gender, above 15 years of age. NCS/EMG was done on a Japanese machine Nihon Kohden by an expert …

A Rare Case Of X-Linked Bulbo-Spinal Muscular Atrophy With Sensory Neuropathy And Tremors, Waleed Shahzad, Muhammad Hassan, Mansoor Iqbal, Zakir Jan, Tehmina Inayat, Mazhar Badshah, Muhammad Irshad

Pakistan Journal of Neurological Sciences (PJNS)

Kennedy disease (KD) is also known as spino bulbar muscular atrophy caused by a tandem C-A-G tri-nucleotide repeat. It is an adult-onset X-linked recessive inherited neurodegenerative disease involving lower motor neuron damage with predominance of facial muscles. It is often accompanied with androgen sensitivity, sensory nerve damage and endocrinal involvement. It has similar confusing symptoms and is often mis-diagnosed with most of the neuromuscular diseases like POEMS syndrome, myasthenia gravis, mitochondrial myopathy and amyotrophic lateral sclerosis. Hence clinical differentiation is important to prevent adverse outcomes and un-necessary treatment. Here we describe a rare case of a 46 year old Pakistani …

Pregabalin Induced Hypersensitivity Reaction And Joint Pains In Patient With Lumbosacral Radiculopathy, Ramla Nayaib Hashmi, Iqra Khan, Ummul Kiram, Soobia .S Siddiqui, Tamaniat .

Pakistan Journal of Neurological Sciences (PJNS)

Pregabalin is an antiepileptic medication commonly used for other purposes. It is also approved for neuropathic pain. Reported adverse effects are not severe, short lasting and are usually well tolerated1. The most common side effects comprise of lightheadedness , sedation , double vision ,increase in bodyweight and imbalance whereas decrease in neutrophil count and hypersensitivity are the uncommon adverse effects. In the literature till date, few case reports are available on the drug reactions to pregabalin. We report a case of young female who developed hypersensitivity reaction with pregabalin including body rashes, hives peripheral edema, and joint pains. Using the …

Juvenile Dermatomyositis And Posterior Reversible Encephalopathy Syndrome: A Rare Association., Shazma Shamim

Pakistan Journal of Neurological Sciences (PJNS)

Juvenile dermatomyositis or JDM is a rare but debilitating pediatric disease that affects the proximal muscles and skin, as implied by its name. Although rare, it is the most common childhood idiopathic inflammatory myopathy (1). The estimated incidence is 3.2 cases per million children (2). The diagnosis is based on clinical signs and symptoms supported by investigations including, but not limited to, muscle biopsy, muscle enzymes and EMG studies. Bohan and Peter’s criterion is most widely used for diagnosis. It includes the presence of Gottron’s rash, raised muscle enzymes, proximal muscle weakness and suggestive findings on muscle biopsy (3). Treatment …

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 …

Neurological Care And Training In The Times Of Covid-19: A Tertiary Care Center Experience, Lubna Ashraf Jafri, Maryam Javed, Ali Sajjad, Dureshahwar Kanwar, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Resilience in these challenging times of COVID-19 at a professional and personal level is cardinal. Trainees and faculty have had to adapt to this adversity with striking limitations on formal neurological, neurovascular and neurophysiological residencies and fellowships. The revision of schedules and reallocation of assignments to cope with the practical aspects in a teaching tertiary care hospital have been overbearing. Novel structural innovation, testing, communications and supervision to assure a modified yet impactful training educational programme is mandatory and the need of the hour. Healthcare service providers remain at the highest risk of acquiring COVID-19 worldwide. Urgent measures to educate …

Knowledge And Use Of The International Classification Of Functioning, Disability And Health (Icf) Among Health Professionals In A Developing Country, Sidra K. Jafri, Olaf Kraus De Camargo

Pakistan Journal of Neurological Sciences (PJNS)

The World Health Organization’s (WHO) International Classification of Functioning, Disability, and Health (ICF) provides a biopsychosocial framework for understanding all the factors that should be considered while managing any health condition. The ICF has been employed for clinical, academic, research, and policymaking purposes in developed as well as developing countries. There is a great disparity in the representation in the literature regarding knowledge and potential application of the ICF in professional practice around the world especially from low middle-income countries like Pakistan. This study aims to evaluate the profile and knowledge of health professionals in Pakistan about the application of …

Myotonic Dystrophy In A Pakistani Family: A Case Series And Literature Review, Waleed Shahzad, Muhammad Hassan, Mazhar Badshah, Haris Majid Rajput, Zakir Jan, Tehmina Inayat

Pakistan Journal of Neurological Sciences (PJNS)

Myotonic dystrophy also known as (Steinert's disease) is a clinically and genetically heterogeneous multisystem disorder with a prevalence of 1 in 8000 in the general population. It is inherited as an autosomal dominant trait. It is characterized by myotonia, myopathy of voluntary and involuntary muscles, frontal baldness in men, cardiac conduction abnormalities, cataracts, intellectual deterioration and endocrinopathies. Affected men may have gonadal atrophy and infertility. On the other hand women are generally fertile. We report a case series of three individuals belonging to the same family presenting with characteristic features of myotonic dystrophy. The presentation of these cases depicts that …

Memory And Cognitive Flexibility In Physical Therapy Students Of Karachi, Sonya Arshad, Muhammad Faisal Qureshi, Syed Hasan Abbas Rizvi, Javeria Rizvi, Kanza Imtiaz, Kisa Hussain Rizvi, Khushbakht Ahmed, Khola Noman, Vishal Kumar

Pakistan Journal of Neurological Sciences (PJNS)

Memory allows us to remember the skills that we have learnt and retrieve valuable information stored in the brain. Physical therapy is a multidimensional profession which demands efficient cognitive flexibility and decision-making skills with an excellent memory to help the therapist to multi-task.

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.

Polyneuropathy Associated With Iga Paraproteinemia: A Case Report And Literature Review., Waleed Shahzad, Sumaira Nabi, Hafiza Faiza Mushtaq, Tehmina Inayat, Muhammad Hassan, Haris Majid Rajput, Zakir Jan, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Paraproteinemia is precipitated by an accumulation of monoclonal plasma cells or B lymphocytes. Idiopathic neuropathies that are associated with paraproteinemia account for only 10% of the neuropathies. Paraprotein acts like an antibody and is targeted against myelin and axons present in the peripheral nerves. Despite being of interest for quite a long time, the caudal relationship between paraproteinemias and peripheral neuropathies still remains a sorcery. We report a case of a middle aged male who presented with pain and parasthesias in both arms and legs. His workup revealed him to be having a paraproteinemic neuropathy consistent with IgA Lambda chains …

Cultural Assessment: A Study Of Midwives’ Knowledge, Attitude And Self-Reported Practice In Uganda, Mercy Muwema, Karen Drake, Pamela Friesen, Grace Edwards

Journal of Asian Midwives (JAM)

Background: Cultural assessment is critical due to the increased movement and resettlement of people across the globe, and diverse cultural groups in Uganda. This is putting the health care delivery systems serving the communities under pressure to recognize the different attitudes of people towards health and to develop care systems that are effective in meeting diverse needs. However, despite the importance of cultural assessment in nursing literature, little is known about the cultural assessment competence of Ugandan midwives. This study assessed the knowledge, attitude, and practice of midwives in this assessment process.

Methods: A descriptive correlational design was used to …

Dementia In Pakistan; An Unprecedented Challenge And Local Cultural Beliefs, Problems And Actions Required., Qamar Zaman, Maimoona Siddiqui, Zaha Iqbal Malik

Pakistan Journal of Neurological Sciences (PJNS)

Changing cultural and social dynamics has brought a major shift in lifestyles and associated risk factors for various disorders that were previously uncommon in Pakistan. Dementia is among the one of these emerging problems that is going to affect the elderly population worldwide but more so in the developing world. To adequately deal with the problems faced by patients with dementia and their caregivers, several important measures are needed that can help to reduce the morbidity and burden on the families and overall society. Increasing the awareness regarding the risk factors may help to reduce the dementia burden similarly knowledge …

Cognitive And Brain Plasticity By Performing Small Scale Brain Activities In Youth, Sonya Arshad, Muhammad Nisar, Mushkbar Fatima, Sadaf Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Is playing video game really a waste of time? No…!!! It’s merely a simple way of making the brain physiology better, smarter and faster. Great quality games, which are testing, enlightening, and retaining, can make learning charming and compelling. Studies have shown that people who are engaged in playing video games have more grey matter in their brains which results in boosting up their cognitive skills.

Azygos Anterior Cerebral Artery Causing Bifrontal Infarcts: A Case Report, Abdul Khaliq, Palwasha Gul, Pari Gul

Pakistan Journal of Neurological Sciences (PJNS)

The azygos anterior cerebral artery (AACA) is an uncommon anatomical variant. There is absence of the anterior communicating artery (ACom) and bilateral anterior cerebral arteries (ACA) form a common trunk and travels superiorly in the interhemispheric fissure. It can result in bilateral frontal infarcts in case of thromboembolism. Therefore its correct diagnosis is of grave importance for better patient clinical outcome. Cerebrovascular infarction is a common condition, however simultaneous symmetrical bilateral infarction secondary to arterial occlusion is a rare entity. We report a case of a 50 years male with thromboembolic event in azygos anterior cerebral artery resulting in bifrontal …

Challenges & Barriers For Neuro Rehabilitation In Developing Countries, Muhammad Naveed Babur, Maria Liaqat

Pakistan Journal of Neurological Sciences (PJNS)

People with disabilities especially neurological disabilities have many unmet health and rehabilitation needs, face barriers in accessing mainstream health-care services, and consequently have poor health. There are not sufficient epidemiological studies from Pakistan which assess barriers to neurorehabilitation and ways to counter it.

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 …

The Loose End: Neurology Without Rehabilitation, Ahmad Zaheer Qureshi, Farooq Azam Rathore

Pakistan Journal of Neurological Sciences (PJNS)

In recent years, successive therapies for previously untreatable neurological conditions have been introduced in clinical practice and these advance interventions have remarkably changed the landscape of neurosciences1,2 .But, rehabilitation of the functional impairments caused by neurological diseases is often overlooked or sometimes even neglected. In other words, the role of a comprehensive and early multidisciplinary rehabilitation in neurological disease is unrecognized and poorly understood even among neurologists and neurosurgeons. Usually, lifesaving neurosurgical management or solving a diagnostic riddle in neurology is attributed to successful patient management; however in reality, this is the first step in establishing a care plan for …

Acute Disseminated Encephalomyelitis In A Middle Age Female, Hina Mushtaq, Maria Qureshi, Irfan Ahsan

Pakistan Journal of Neurological Sciences (PJNS)

Acute disseminated encephalomyelitis (ADEM) is an autoimmune condition that predominately involve demyelination of the white matter of the brain and spinal cord. It resembles other acute demyelinating syndromes like multiple sclerosis and most often presents in childhood.This is a case of a 52-year woman, presented with lower limb weakness, confusion and spasticity throughout the body with no preceding illness. CSF showed increased proteins with no oligoclonal bands. MRI Brain showed abnormal high intensity areas in bilateral parietal, periventricular region, with no contrast enhancement. She was given 1gram iv methylprednisolone based on the diagnosis of ADEM and responded well.

A Rare Case Of Becker Disease In A 7 Year Old Boy, Prem Chand, Rozmeen Badruddin Husein, Fazal M. Arain

Pakistan Journal of Neurological Sciences (PJNS)

Becker Disease is an autosomal recessive version of the rare congenital disorder called Myotonia Congenita. Due to the rarity of Becker Disease, the genetic and pathological basis of this disease have not been studied well and possible diagnostic methods and techniques are yet to be explored. The existing method of diagnosis of such a case is predominantly dependent on the clinical examination. More work and studies need to be done on the diagnostic aspect of this disease to discover newer diagnostic methods for this disease, which are more reliable and specific. In order to develop better diagnostic methods for the …

Factors Affecting Compliances With Physiotherapy Among Stroke Patients: Physiotherapist's Perspective: A Study From Peshawar Pakistan., Rabia Basri, Maryam Naseen, Aatika Naz

Pakistan Journal of Neurological Sciences (PJNS)

Non-compliances to physiotherapy are common. Outside the Western nations, little is known to the factors responsible for non-compliances with physiotherapy. This study aimed to evaluate the factors affecting non-compliances with physiotherapy among stroke patients, in Peshawar, Pakistan. METHOD: Seven in practice physiotherapists from Peshawar, Pakistan, were invited to focus group discussion to discuss their opinions about factors affecting stroke patient's non-compliances and the strategies to manage with these factors. The dialogues were transcribed and analyzed. Significant words and statements describing noncompliances were identified. The cluster of meanings developed and used to write a combined description presenting the real meaning of …

Transcranial Direct Current Stimulation And Stroke Recovery: Opportunities And Challenges, Murtaza G, Hussain F, Iqbal M, Shahid Bashir

Pakistan Journal of Neurological Sciences (PJNS)

Transcranial direct current stimulation (tDCS) is one type of neuromodulation, which is an emerging technology that holds promise for the future studies on therapeutic and diagnosis applications in treatment of neurological and psychiatric diseases. However, there is a serious question among developing countries with limited financial and human resources, about the potential returns of an investment in this field and regarding the best time to transfer this technology from controlled experimental settings to health systems in the public and private sectors. This article reviews the tDCS as tools of neuromodulation for stroke and discusses the opportunities and challenges available for …

Awareness About The Signs, Symptoms And The Risk Factors Of Stroke In Patients With Stroke: A Multicentre Study, Nausheen Farooq, Haider Darain

Pakistan Journal of Neurological Sciences (PJNS)

The aim of this survey was to determine the levels of awareness regarding symptoms, warning signs and risk factors of stroke in patients with stroke. For the latter purpose, a total of 500 participants who had stroke were recruited from four different hospitals of Rawalpindi and Islamabad. Patients who were already diagnosed by physicians with either type of stroke (haemorrhagic and ischemic) were included in this trial. Data was collected through a questionnaire and was analysed in SPSS version 20. Both male and female population were included in this study. The minimum age for the patients to be included was …

Neuromyelitis Optica (Devic’S Disease) In A 10 Years Old Boy., Dr.Farida Jan, Amber Shabir, Shahnaz Ibrahim

Pakistan Journal of Neurological Sciences (PJNS)

Neuromyelitis optica (NMO) also known as Devic’s disease is an acute demyelinating disorder combined with optic neuritis and transverse myelitis.A 10 years old boy presented in the ER with the complaints of fever and back pain for past 10 days and inability to walk for 6-7 days. He had developed urinary retention and constipation for the past 5 days along with abdominal distension. There was also blurring of vision in the left eye with only light perception and rapid afferent papillary defect was present while the right eye was normal. The provisional diagnosis was Transverse myelitis vsNeuromyelitisoptica (NMO). CSF revealed …

10-Year Pattern Of Admissions In Psychiatric Unit At A Tertiary Care Hospital In Pakistan., Raza Ur Rahman, Abdul Ghani Khan, Naila Naerm Shahbaz

Pakistan Journal of Neurological Sciences (PJNS)

To identify the pattern of psychiatric morbidity in hospitalized patients of a tertiary care unit.Design; Details of patient’s admissions from the case register of psychiatric unit were recorded retrospectively.The study was conducted in Dept. of Psychiatry Jinnah Postgraduate Medical Centre JPMC Karachi and included data of ten years. RESULTS;- TA total of 5527 patients were hospitalized during period of ten years (1995 – 2004). Among them 62.612% (n = 3461) were males and 37.38 (n = 2066) were females. The majority of patients were in the age range of 15 – 44 years. On the basis of ICD classification, mood …