Medicine and Health Sciences Commons^™

Improving Stroke Unit Numbers And Care In Pakistan, Abubakar Siddique, Umair Rashid Ch, Ahsan Numan

Pakistan Journal of Neurological Sciences (PJNS)

t is self-evident that stroke remains one of the leading causes of death and disability not only in the world but also in Pakistan. The prevalence of stroke risk factors and epidemiological studies shows that the burden of stroke will not decrease in the next decades and beyond. It poses a huge challenge for the affected and their families, for medical services, governments and the society as a whole. The promising thing about stroke is that it is preventable, treatable and manageable and there is potential to drastically reduce the burden of stroke and the long term consequences.1 However, this …

Artificial Intelligence And Neurology - Opportunities And Challenges In Pakistan, Adeel A. Memon, Junaid S. Kalia

Pakistan Journal of Neurological Sciences (PJNS)

The field of artificial intelligence (AI) has undergone rapid development in neurological disorders over the past few decades. AI relies on large volumes of high-quality data. As a result, their use in low-resource settings has been limited due to the lack of a digitized health care system. This article will address the challenges and opportunities involved in implementing AI for neurological care in Pakistan, as well as discuss the types of digital health care data and the benefits of applying AI in resource-limited countries

The Truth About Brain Cells: Is Adult Neurogenesis Possible?, Ekene Nnagha, Queen-Helen Egbai, Ahtesham Khizar

Pakistan Journal of Neurological Sciences (PJNS)

Brain cells regeneration involves renewal and repair of neurons and other cells in the brain, with restoration of their functions. Although this phenomenon was thought to end in early childhood, research has proven that adult neurogenesis is highly possible with some limitations. Regeneration of axons in the central nervous system is very slow and more complicated than neuronal regeneration, especially regeneration of peripheral nerves. Brain cell regeneration in the adult brain can help in recovery of damaged brain cells and correct cellular and brain tissue dysfunction that are commonly seen in some neurological disorders such as Stroke, Traumatic Brain Injury …

Pseudo-Torch- A Rare Mutation Causing Global Development Delay, Microcephaly And Extensive Band Like Brain Calcification, Javeria Raza Alvi, Saher Gul Ahdi, Mahrukh Sultan, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Pseudo-TORCH 1 syndrome is an inherited autosomal recessive disorder that clinically and radiologically mimic congenital TORCH infection. We report a case of three and half years old child who presented with early infantile seizures, progressive microcephaly, facial dysmorphism and global developmental delay. There were symmetrical band like intra-parenchymal calcification as well as in pons and thalami. Serological testing for infectious agents was negative. His Whole exome sequencing revealed OCLN gene mutation consistent with Pseudo-TORCH syndrome-1.

A Rare Case Of Epilepsia Partialis Continua Secondary To Rasmussen’S Encephalitis, Waleed Shahzad, Muhammad Hassan, Haris Majid Rajput, Tehmina Inayat, Naveed Ullah Khan, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Rasmussen's encephalitis is a rare baffling disorder seen in nearly 1 % to 2 % of epilepsy population and in 7.4% of paediatric population. It is mostly seen in children and in most cases seizures are seen during 14 months to 14 years with peak age 3 to 6 years. Etiology includes viral infections, humoral autoimmunity and T-cell mediated cyto-toxicity of the brain tissue. The main clinical features are intractable epilepsy, hemiparesis, hemidystonia, hemiathetosis, epilepsia-partialis-continua and mental decline. Imaging shows unilateral hemispheric brain atrophy. Here we describe a unique case of a 15-year-old Pakistani girl with severe immune mediated brain …

A Rare Case Of Epilepsia Partialis Continua Secondary To Rasmussen’S Encephalitis, Waleed Shahzad, Muhammad Hassan, Haris Majid Rajput, Tehmina Inayat, Naveed Ullah Khan, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Rasmussen's encephalitis is a rare baffling disorder seen in nearly 1 % to 2 % of epilepsy population and in 7.4% of paediatric population. It is mostly seen in children and in most cases seizures are seen during 14 months to 14 years with peak age 3 to 6 years. Etiology includes viral infections, humoral autoimmunity and T-cell mediated cyto-toxicity of the brain tissue. The main clinical features are intractable epilepsy, hemiparesis, hemidystonia, hemiathetosis, epilepsia-partialis-continua and mental decline. Imaging shows unilateral hemispheric brain atrophy. Here we describe a unique case of a 15-year-old Pakistani girl with severe immune mediated brain …

Guillain–Barré Syndrome In Sars-Cov-2; A Case Report, Naveed Ullah Khan, Muhammad Hassan, Haris Majid Rajput, Waleed Shahzad, Hafsa Mobeen, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Multiple systems have been affected by COVID-19 infection, and neurological symptoms are not uncommon. A 45-year-old male presented to us in the emergency department without focal neurological deficits. He developed ascending paralysis soon after his admission, which was followed by worsening respiratory symptoms. The family of the patient refused a lumbar puncture, and his NCS/EMG showed features of acute motor axonal neuropathy (AMAN), a variant of Guillain-Barré syndrome (GBS). After being admitted on the 4th day, the patient developed type 2 respiratory failure and died on the 5th day of admission before any treatment could be started. Patients with COVID-19 …

The Constellation Of Centronuclear Myopathy And Craniofacial Dysmorphism, Mahnoor Hafeez

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT:

A 20 years old third-year MBBS female student from Dow Medical College in 2008 presented to the Neurology Dept. in Karachi with a short history of rapidly worsening bilateral lower limb weakness for 6 months. There was facial dysmorphism. Motor neuron disease was the suspicion; EMG/NCS study revealed non inflammatory myopathic process involving all limb muscles; Centro nuclear myopathy (CNM) was diagnosed via muscle biopsy. CNM is a group of congenital myopathies, where cell nuclei are abnormally located in skeletal muscle cells. Craniofacial dysmorphism is characterized by abnormal development of facial and skull structures. To the best of the …

Clinical Spectrum And Eeg Findings Of Non-Convulsive Status Epilepticus In Children, Shaila Ali, Natasha Ghani, Ather Khalily, Zia-Ur- Rehman, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT

OBJECTIVE:

To determine the clinical spectrum and EEG findings ofnon-convulsive status epilepticus in children. METHODS: A total of 38 children were included in this prospective cross sectional study, having EEG suggestive of NCSE after taking informed consent from guardians, keeping EEG as gold standard tracings were reviewed according to criteria of non-convulsive status epilepticus. Their clinical features were also noted leading to non- convulsive status epilepticus. Diagnostic workup will be done to find out the underlying cause, according to the suspected etiology of non-convulsive status epilepticus.

RESULTS: There were 26 male and 12 female patients, with ratio of 2:1. …

Neurological Syndromes After Recent Covid-19 Vaccination; A Possible Association, Ayisha Farooq Khan, Sajid Hameed, Sara Khan, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT OBJECTIVE:

Coronavirus disease 2019 (COVID-19) pandemic is one of the deadliest pandemics of our time. Vaccines are our best hope to put an end to this pandemic. An emergency use authorization (EUA) has been given to seven vaccines and more than 4 billion doses have been globally administered. Because of EUA, the large-scale safety trials were not conducted before their use and adverse effects were one of the chief concerns resulting in vaccine hesitancy.

METHODS: This is a retrospective observational study. All the inpatients admitted to the Department of Neurology, Aga Khan University during the period from 1st April …

Frequency And Types Of Cerebral Infarctions On Brain Imaging In 2257 Hospitalized Patients With Covid-19, Raima Kaleemi, Zainab Rauf, Muhammad Azeemuddin, Muhammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT BACKGROUND AND OBJECTIVE:

SARS-COV (COVID-19) virus is not solely a pulmonary disease but affect multiorgan system including the brain. The objective of this study was to see the frequency of neuroimaging findings especially cerebral infarcts in our covid population. METHODS: This study is a retrospective observational study conducted in a large tertiary care hospital which was also a Covid center from March 1, 2020 to December 30, 2020.The frequency of neurological manifestations in COVID19 positive patients admitting in the hospital was observed through charts review. All scans were reviewed by two trained neuroradiologists. RESULTS: Total of 2257 patients enrolled …

Barriers And Challenges To Mental Health Care In Pakistan, Fatima Siddiqui, Qurat Ul Ain Khan

Pakistan Journal of Neurological Sciences (PJNS)

World Health Organization (WHO) defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity"(1). Despite being a global health-related burden, and a major cause of morbidity worldwide including Pakistan, mental health diseases are an overlooked entity in our country. In Pakistan, we have seen a rapid improvement in the treatment of conditions related to physical health over the course of years, but mental health issues are still being given limited priority. Pakistan is the 6th most populated country in the world with a current estimated population of 210 million …

Risk Factors For Stroke In, Bolan Medical Complex Hospital Quetta, Muhammad Essa, Amanullah Kakar, Dr Gulandam, Muhammad Saleem Barech, Hina Imtiaz, Sher Zaman Mandokhail, Muhammad Dawood

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is one of the leading causes of physical impairment and mortality worldwide. Optimizing preventive strategies will help decrease the burden of stroke. The objectives of this study were to determine common stroke risk factors, by analyzing a comprehensive panel of variables in our local population.

200 patients were consecutively enrolled in this prospective observational study at stroke unit (SU) of Bolan Medical Complex Hospital over 6 months from March 2019 to August 2019. Structured questionnaires were prepared History and clinical examination were performed to gather relevant information. CT scan of brain was done to confirm the diagnosis of stroke. …

Self-Concept, Self- Affirmation And Psychological Distress In Women With Polycystic Ovarian Syndrome (Pcos), Zeenash Mazhar Dar, Muhammad Nasar Iqbal, Muhammad Rafiq, Shahyan Qamar, Fatima Javed

Pakistan Journal of Neurological Sciences (PJNS)

To study the relationship among self-concept, self- affirmation and psychological distress in females having Polycystic Ovary Syndrome (PCOS).

In this correlational study one hundred patients with polycystic ovarian syndrome participated with age ranging from 21-40 years. Self-Concept questionnaire, self-Affirmation scale, and Kessler psychological distress scale were used to collect data

The results of this study revealed that negative-self-concept has significantly positive relationship with psychological distress. Multiple regression revealed that positive self-concept negatively predicted psychological distress in females having polycystic ovarian disease. Independent sample t=test revealed that psychological distress is more in married women (M= 32.96, SD=8.60) as compared to single …

Suicide, A Convoluted Challenge In Covid-19 Era, Aisha Noorullah

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Pediatric Neurology In Pakistan: Past, Present And Future, Iram Javed

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Current Status Of Non-Disease Modifying Gene Therapy In Parkinson’S Disease, Muhammad Shariq Shaikh, Syed Ahsan Ali, Dureshahwar Kanwar

Pakistan Journal of Neurological Sciences (PJNS)

Parkinson’s disease (PD) is a chronic progressive neurological disorder characterized by bradykinesia, tremor, muscular rigidity, and postural instability. The world-wide prevalence is expected to rise further with increasing mean age. Theoretically, if all desired elements required for dopamine synthesis are functionally available, need for exogenous L-DOPA administration can be eliminated or markedly reduced. However, lack of effective long-term treatment has led to extensive gene therapy research focusing both on disease modifying as well as non-disease modifying aspects. Since genetic lesions are found in both familial as well as sporadic PD cases, the principle of introducing a normal gene to cure …

Effects Of Intermittent Fasting On Cognition And Neurodegeneration, Dureshahwar Kanwar, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Intermittent fasting (IF) can facilitate neurodegenerative, neuroadaptive and neuroprotective processes leading to profound effects on cognition and dementias. The impact that IF has on the central nervous system is still not fully known. Several factors come into likely effect including changes in energy metabolism, oxidative damage, insulin sensitivity, inflammation, and functional changes related to various neurotransmitters and hormones. During IF ketones are produced in large quantities and the brain consumes these for energy. The presence of ketone bodies increases the expression of the genes for brain derived neurotrophic factor which has a powerful effect on dementia and cognition. Brain derived …

Finding Needle In A Haystack; Neuroleptic Malignant Syndrome Disguising Meningitis In A 2-Years-Old Girl, Raman Kumar, Farah Shams Abbasi, Asma Noreen

Pakistan Journal of Neurological Sciences (PJNS)

Fever with CNS symptoms in children is almost, always considered to be a CNS infection and treated as Meningitis. Central causes of fever are not usually taken in to the account in such cases. We present a case of a 2- year old girl who developed fever and CNS symptoms after she was given anti-emetic medications for her initial presentation of acute gastroenteritis. She developed high grade fever and spasticity and was treated on lines of meningitis empirically without any evidence of infection. She did not improve and once she fulfilled clinical criteria of Neuroleptic malignant syndrome, her condition improved, …

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 …

A Rare Case Of Thiamine Responsive Megaloblastic Anemia Presenting With Seizures, Waleed Shahzad, Tehmina Inayat, Mansoor Iqbal, Muhammad Hassan, Fibhaa Syed, Naveed Ullah Khan, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Thiamine responsive megaloblastic anemia (TRMA) also known as Rogers syndrome is a rare entity inherited as an autosomal recessive disorder. It consists of a pentad of diabetes-mellitus, megaloblastic anemia, thrombocytopenia, leukopenia and sensory-neural hearing loss. The defect occurs due to mutations in SLC19A2 gene resulting in the deficiency of a thiamine transporter proteins which prevents the transport of thiamine in to the cells and tissues. Here we report a 13 year old boy with megaloblastic anemia, sensory-neural deafness and young onset diabetes mellitus who presented with generalized tonic-clonic seizures. Diagnosis was based on clinical features and a rapid response to …

The Midas Score After Memantine In Patients With Migraine At A Tertiary Care Hospital., Ihsan Ul Haq Zarkoon, Wazir Akbar, Noor Ahmed Khosa

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT INTRODUCTION: Memantine has been suggested as a migraine prophylaxis therapy in some observational studies. OBJECTIVE: To determine the mean change in MIDAS score after Memantine in patients having migraine. SAMPLING TECHNIQUE: Non-probability, consecutive sampling.

Gaba-B Encephalitis In Pakistan: A Rare But Treatable Entity, Asfandyar Khan Niazi, Shafain Shaikh, Arsalan Ahmad, Ayesha Zafar, Tahir Aziz Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Autoimmune and paraneoplastic encephalitides are a group of neurologic disorders that present with cognitive decline, neuropsychiatric symptoms, movement disorders, or seizures. These diseases can present before, with, or after the diagnosis of malignancy. We report two cases of GABA-B encephalitis from Pakistan. The first patient was a 67-year-old gentleman presented with cognitive decline and neuropsychiatric symptoms. His CSF analysis showed increased protein levels and GABA-B receptor antibodies. He was treated with pulse steroids, which improved his symptoms. The second patient was a 34-year-old lady with cognitive decline and psychomotor symptoms. Her serum autoimmune antibody panel showed antibodies against GABA-B receptors. …

Optimizing Stroke Care In Baluchistan, Anjum Farooq, Wazir Akbar, Ahmed Wali

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is the second leading cause of death after ischemic heart disease.(1) Pakistan, currently the fifth most populous country of the world, has limited data on prevalence of stroke and its risk factors. Only two small-scale population-based studies conducted in Karachi showed stroke prevalence of 4.8% and 19.1%. (1) One study conducted in KP province of Pakistan showed estimated stroke prevalence of 1.2%. (1) The burden of stroke risk factors in Pakistan is enormous. Diabetes and hypertension are the most common risk factors in Pakistan. (2) Other common risk factors in Pakistan are active smoking, obesity, and family history of …

Anti-Nmda Receptor Encephalitis, Zaid Waqar, Haris Majid Rajput, Muhammad Hassan, Iqra Athar, Neelma Naz Khattak, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Anti N-methyl-D-aspartate receptor (NMDA)receptor encephalitis is one of the most common type of auto immune encephalitis. Its diagnosis is often delayed due to initial clinical presentation with psychiatric clinical features. Initial clinical features resemble those of acute psychosis or depression which later evolve into frank neurological dysfunction. This was first described in association with ovarian teratoma, but it was later also found to exist without neoplastic association and in men as well. It occurs more frequently in younger age group, mostly below 50 years of age. Diagnosis is established with the help of cerebrospinal fluid (CSF) analysis for oligo clonal …

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 …

Association Of Hypomagnesaemia & Hypocalcemia With Intracerebral Hemorrhage And Outcome, Muhammad Hassan, Naveed Ullah Khan, Mansoor Iqbal, Haris Majid Rajput, Ehsan-Ur- Rehman, Waleed Shahzad, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Determine if hypomagnesemia & hypocalcemia on admission was associated with ICH and outcome.

Magnesium is a vascular smooth muscle relaxant and appears to provide protection against cellular injury in experimental stroke models. The implication of low serum magnesium in primary ICH is not well defined.

All patients with a primary ICH presented to PIMS, Islamabad prospectively analyzed in a pilot study. Demographics, initial lab values, ICH location, Mg+2 level, NIHSS & MRS at presentation were recorded. All patients with INR <= 1.5 were included in this study. We took normal serum magnesium in our study was 1.8 - 2.5 mEq/dL. Statistical significance was determined using linear regression adjusting for admission systolic blood pressure (SBP).

We identified 66 patients who met the inclusion criteria. The mean age was 52.76 years with minimum and maximum age …

Criminal Thinking Styles And Criminal Social Identity Among Juvenile Delinquents: Moderating Role Of Parenting Styles, Fatima Sana, Muhammad Rafiq, Muhammad Nasar Iqbal

Pakistan Journal of Neurological Sciences (PJNS)

Parenting is considered imperative in the development of juvenile's cognitions, and beliefs. The parent-child relationship might significantly influence juvenile’s thought patterns and social communications. Different parenting styles perhaps indicate criminal involvement of juveniles, resultantly turns them into delinquent. The present study was done to discover whether parental authority styles moderate the path that links criminal thinking styles to criminal social identity amongst juvenile delinquents. Participants of the study were 211 juvenile delinquents who responded on Juvenile Criminal Thinking Styles’ Inventory (Sana & Rafiq, 2019), Measure of Criminal Social Identity (Boduszek, et al., 2012), Parental Authority Questionnaire (Babree, 1997) and approached …

Valproate Used In Women Of Childbearing Age With Epilepsy, Salman Mansoor, Kevin Murphy, Siobhan Kelly, Shoab Saadat

Pakistan Journal of Neurological Sciences (PJNS)

Valproate is one of the oldest known anti-epileptic drugs (AED) in practice which was discovered in 1881 and later in 1962 was approved for treating epilepsy. It is indicated in most of the seizure types including generalized onset (motor, non-motor and myoclonic), focal onset, unknown onset and unclassified. Valproate has other indications in migraine prophylaxis, and bipolar disorder.

Neurological Associations Of Covid-19 Vaccines, Rija Zehra Ghazanfar, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

It does not come as a surprise that the introduction of an unprecedented treatment for a recently notorious disease will cause concerns and raise some questions. As a race we have become cautious over the centuries about what treatment modalities we accept and reject. With the advent of social media and endless sources of information we find ourselves standing at an intersection of many pathways, thinking meticulously where to go from there? At one point the widely available stats and the complex way in which these vaccines work do not really interest the general population as much as how they …