Nervous System Diseases Commons^™

Polio To The Rescue; New Frontiers In Glioblastoma Treatment, Syed Sarmad Bukhari, Aneela Darbar, Muhammad Shahzad Shamim

Section of Neurosurgery

Lack of substantial progress in effective treatment of glioblastomamultiforme has led investigators to explore unconventional treatment options including the use of tumour treating fields and oncolyticvirotherapy. Herein the authors have reviewed some of the recent literature on oncolyticvirotherapy for the treatment of glioblastomamultiforme.

Using A Tailored Health Information Technology- Driven Intervention To Improve Health Literacy And Medication Adherence In A Pakistani Population With Vascular Disease (Talking Rx) - Study Protocol For A Randomized Controlled Trial, Ayeesha Kamran Kamal, Abdul Muqeet, Kashfa Farhat, Wardah Khalid, Anum Jamil, Ambreen Gowani, Aliya Amin Muhammad, Fabiha Zaidi, Danyal Khan, Touseef Elahi, Shahrukh Sharif, Syedah Saira Bokhari, Nasir Rahman, Fateh Ali Tipoo Sultan, Saleem Sayani, Salim S. Virani

Section of Internal Medicine

Background: Vascular disease, manifesting as myocardial infarction and stroke, is a major cause of morbidity and mortality, especially in low- and middle-income countries. Current estimates are that only one in six patients have good adherence to medications and very few have sufficient health literacy. Our aim is to explore the effectiveness and acceptability of Prescription Interactive Voice Response (IVR) Talking Prescriptions (Talking Rx) and SMS reminders in increasing medication adherence and health literacy in Pakistani patients with vascular disease.
Methods: This is a randomized, controlled, single center trial. Adult participants, with access to a cell phone and a history of …

Implications Of Female Sex On Stroke Risk Factors, Care, Outcome And Rehabilitation: An Asian Perspective, Prachi Mehndiratta, Mohammad Wasay, Man Mohan Mehndiratta

Section of Neurology

Background:

Stroke affects 16.9 million people annually and the greatest burden of stroke is in low- and middle-income countries, where 69% of all strokes occur. Stroke risk factors, mortality and outcomes differ in developing countries as compared to the developed world. We performed a literature review of 28 articles pertaining to epidemiology of stroke in Asian women, stroke risk factors, gender-related differences, and stroke outcomes.

Summary:

Asian women differ from women worldwide due to differences in stroke awareness, risk factor profile, stroke subtypes, and social issues that impact stroke care. While Asian men have a higher incidence of stroke as …

Cloned Microglias With Novel Delivery System In Multiple Sclerosis, Abdul Mannan Baig Dr.

Department of Biological & Biomedical Sciences

Multiple Sclerosis (MS) is a chronic inflammatory neurological disease of the Central Nervous System (CNS), characterized by demyelination and activation of microglia. Mitochondrial mutations and dysfunctions in microglial cells are thought to contribute to the detrimental effects of neuroinflammation seen in MS. The Somatic Nuclear Transfer (SCNT) technology offers a more practical mode of therapy in MS, this method would attempt to dilute and/or progressively replace the mutated and activated microglia with cloned Olfactory Ensheathing Cells (OEC) with remyelinating and scavenging properties which would attempt to limit the progression of MS. Applying SCNTderived Embryonic Stem (ES) cells based therapy by …

Diagnosis, Treatment And Follow-Up In Four Children With Biotinidase Deficiency From Pakistan, Bushra Afroze, Mohammad Wasay

Department of Medicine

Biotinidase deficiency is an inherited disorder in which the vitamin biotin is not recycled. If untreated, affected individuals develop neurological and cutaneous symptoms. Untreated individuals with biotinidase deficiency either succumb to disease or are left with significant morbidity. We describe clinical course and follow-up of 4 children from Pakistan. All 4 presented with classical symptoms of biotinidase deficiency and responded dramatically to oral biotin within days to weeks. Biotinidase deficiency is reported in Pakistani children from different part of world, however; there is no such report from Pakistan. This highlights lack of awareness of biotinidase deficiency among physicians in Pakistan

A Descriptive Study To Find Possible Correlation Between Mri Findings Of Pituitary Gland And Serum Prolactin Level, Muhammad Azeemuddin, Rohana Naqi, Mohammad Wasay

Department of Medicine

Objective: To explore equation, if any, between findings of magnetic resonance imaging of pituitary gland and serum prolactin level.

Methods: The retrospective, descriptive study was conducted at the Department of Radiology, Aga Khan University Hospital, Karachi, and related to patients\' records from April 19, 2006 to April 23, 2009. Seventy patients underwent magnetic resonance imaging of brain for pituitary gland. Inclusion criteria were all patients referred with relevant clinical symptoms or deranged serum prolactin level. Patients who were claustrophobic or had a pacemaker, aneurysm clip, metallic foreign body in the orbit or with no laboratory investigation were excluded from the …

Biotinidase Deficiency In Pakistani Children; What Needs To Be Known And Done, Bushra Afroze, Mohammad Wasay

Department of Medicine

No abstract provided.

Can We Stop The Stroke Epidemic In Pakistan?, Ismail A. Khatri, Mohammad Wasay

Department of Medicine

No abstract provided.

What Modifiable Risk Factors Lead To Strokes In Our Part Of The World, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

A Simple Method To Reduce Infection Of Ventriculoperitoneal Shunts Clinical Article, Atiq-Ur Rehman, Tausif-Ur Rehman, Hassaan H. Bashir, Vikas Gupta

Department of Medicine

Object: Postoperative shunt infection is the most common and feared complication of ventriculoperitoneal (VP) shunt placement for treatment of hydrocephalus. The rate of shunt infection is highest in the 1st postoperative month. The most common organisms responsible for shunt infection include coagulase-negative Staphylococcus and Staphylococcus aureus. This suggests a transfer of Patient's skin flora via the surgeons' glove as a possible means of infection. The authors conducted a study to determine if the rate of postoperative shunt infections could be reduced simply by changing gloves before handling the shunt catheter. Methods: A total of 111 neonates born with congenital hydrocephalus …

Hyperprolactinaemia Induced By Proton Pump Inhibitor, Abdul Jabbar, Rabbia Khan, Syed Nadir Farrukh

Section of Internal Medicine

A case of a 13 year old girl who manifested hyperprolactinaemia and galactorrhea induced by Omeprazole, a commonly used proton pump inhibitor is presented.

Band Heterotopia, M. S. Alam, N Naila

Section of Internal Medicine

Band heterotopias are one of the rarest groups of congenital disorder that result in variable degree of structural abnormality of brain parenchyma. Band of heterotopic neurons result from a congenital or acquired deficiency of the neuronal migration. MRI is the examination of choice for demonstrating these abnormalities because of the superb gray vs. white matter differentiation, detail of cortical anatomy and ease of multiplanar imaging. We report a case of band heterotopia that showed a bilateral band of gray matter in deep white matter best demonstrated on T2 Wt. and FLAIR images.

Growing Burden Of Neurological Diseases In Pakistan � Need For A National Health Survey, Mohammad Wasay, Shaukat Ali

Department of Medicine

No abstract provided.

Ischemic Stroke Care - Official Guidelines From The Pakistan Society Of Neurology, Ayeesha Kamran Kamal, Ahmed Itrat, Imama Naqvi, Maria Khan, Roomasa Channa, Ismail Khatri, Mohammad Wasay

Department of Medicine

No abstract provided.

Fight Against Chronic Diseases (High Blood Pressure, Stroke, Diabetes And Cancer) In Pakistan; Cost-Effective Interventions, Mohammad Wasay, Abdul Jabbar

Department of Medicine

No abstract provided.

Asian Cerebral Venous Thrombosis Registry: Study Protocolv, Mohammad Wasay, Ayeesha Kamal, Bhojo Khealani

Department of Medicine

Introduction:

Cerebral venous thrombosis (CVT) is a well known but poorly reported entity. Most of the studies and registries related to CVT are reported from European countries. No large multi-center or multi- national data base or registry has been reported from Asian countries. CVT is not uncommon in Asia especially in south Asian subcontinent including India, Pakistan and Bangladesh. One study reported from India that CVT accounted for half of all strokes in the young and 40% of strokes in women. Review of CVT cases from Asian countries is suggestive of differences in risk factors profile and outcome in these …

A Non-Randomized Study Of Safety And Efficacy Of Heparin For Dvt Prophylaxis In Intracerebral Haemorrhage, Mohammad Wasay, Saqibuddin Khan, Khawaja S. Zaki, Bhojo A. Khealani, Ayeesha Kamal, Iqbal Azam, Ismail A. Khatri

Department of Medicine

Objective: To evaluate the safety and efficacy of subcutaneous heparin for deep venous thrombosis (DVT) prophylaxis in patients with intracerebral haemorrhage (ICH) during acute phase in comparison to elastic stockings.

Methods: The diagnosis of ICH was based on imaging (CT or MRI) and DVT was based on Doppler ultrasound.

Results: A total of 458 patients were identified over a period of 5 years (1997-2001). Median age was 59 years (range:12-99 years). Two hundred (44%) patients received heparin (heparin group) in addition to elastic stockings and 258 (56%) patients were only given elastic stockings (stockings group). These two groups were not …

Idiopathic Epilepsy Of Childhood And Potassium Ion Channels, Alper I. Dai, Mohammad Wasay

Department of Medicine

Potassium can affect the development of common seizure type and can be defined seizure susceptibility allele. The existence of inward-rectifying potassium (Kir) channels was first recognized half a century ago. The biophysical fingerprint of Kir channels is inward rectification in the current-voltage relationship , which limits potassium efflux at depolarizing membrane potentials. Kir channels are essential in the control of resting membrane potential, coupling of the metabolic cellular state with membrane excitability, and maintenance of potassium homeostasis. The critical interval contains several candidate genes, one of which, KCNJ10, exhibits a potentially important polymorphism with regard to fundamental aspects of seizure …

Acute Stroke Secondary To Internal Carotid Artery Pseudoaneurysm: Mri Findingsand Treatment With Endovascularcoiling, Mohammad Wasay, Alper Dai, Neeraj Dubey, Saadat Kamran

Department of Medicine

Internal carotid artery pseudoaneurysms are uncommon. We report a young man with history of trivialtrauma who presented with middle cerebral artery stroke.Head CT scan revealed a right parapharyngeal mass. MRI confirmed the diagnosis of internal carotidpseudoaneurysm. Cerebral angiogram showed dissection of internal carotid artery with a large pseudoaneurysm and almost complete occlusion of vessel distal to aneurysm.Vessel was obliterated by fibercoiling and gluing byendovascular technique to diminish risk of furthere mbolization. MRI characteristics of carotid pseudoaneurysms and role of endovascular treatment arediscussed.

Cerebral Venous Thrombosis: Recent Advances And Need For An Asian Registry, Mohammad Wasay, Ayeesha K. Kamal

Department of Medicine

No abstract provided.

Mechanism Of Neuronal Injury In Cerebral Venous Thrombosis, Uzma Usman, Mohammad Wasay

Department of Medicine

The impact of CVT on the brain is wide spectrum, ranging from completely normal parenchyma to brain oedema and/or haemorrhage. Multiple factors relate to neuronal injury in CVT including; dural sinus pressure, increased venous flow velocities, collateralization of venous channels, rate of occlusion, development of cytotoxic and vasogenic oedema, recanalization and accelerated myelination. It is suggested that recanalization of occluded vein, as well as, the presence or absence and the efficiency of intracranial venous collaterals, may have an impact on the extent of brain tissue damage and hence the prognosis of acute CVT.

Botulinum Toxin Type-A In The Management Of Cerebral Palsy: Low Or High Dose?, Alper I. Dai, Mohammad Wasay

Department of Medicine

Cerebral palsy is the most common cause of severe physical disability in childhood. Spasticity is a common and disabling symptom for many patients with cerebral palsy. Therapy for spasticity is symptomatic with the aim of increasing functional capacity and relieving discomfort. Spasticity treatment by orally administered drugs and intramuscular chemodenervation agents has become more frequent. Most oral medications to treat spasticity have been inadequately studied in children, especially those with cerebral palsy. Since its first use in pediatric patients, reported in 1993, botulinum toxin (BTX-A), a relatively recent addition to the available medical interventions for children with cerebral palsy, has …

Central Nervous System Involvement In Dengue Viral Infection, Romasa Channa, Mohammad Wasay

Department of Medicine

Neurological manifestations of dengue infection are rare. This review includes data regarding the epidemiology of the disease, neurological manifestations,pathogenesis, diagnosis and prognosis. It is based on 9 original articles and 10 case reports, adding up to 200 cases of dengue fever with neurological manifestations. Relevant cases have been reported from Asia, the Pacific rim, the Americas, the Mediterranean region, and Africa. A wide range of neurological manifestations has been reported. Altered consciousness and seizure are among the more common manifestations. The exact pathogenesis of this disease has not yet been established. However, recent studies hypothesize that the virus is neurotropic. …

Wernekink Comissure Syndrome: A Rare Midbrain Syndrome Secondary To Stroke, Alper I. Dai, Mohammad Wasay

Department of Medicine

Wernekink commissure involves the decussation of superior cerebellar peduncle (SCP) in midbrain. We report an elderly hypertensive, diabetic man who developed slurred speech, ataxia, and internuclear ophthalmoplegia. MRI examination revealed an unusual ischemic stroke involving Wernekink commissure. This rare stroke pattern involving decussation of SCP occurs in the setting of small arterial disease. The association between the anatomic location of the stroke and clinical findings is noteworthy.

Abdominal Pain With Rigidity Secondary To The Anti-Emetic Drug Metoclopramide, Nadeem Ullah Khan, Junaid A. Razzak

Department of Emergency Medicine

We report a case of abdominal pain with rigidity, mimicking an acute abdomen, caused by metoclopramide, a common anti-emetic drug. Extrapyramidal symptoms are commonly reported side-effects of this medication. They generally include involuntary movements of limbs, torticollis, oculogyric crisis, rhythmic protrusion of tongue, trismus, or dystonic reactions resembling tetanus, etc. Abdominal rigidity due to this medication, resembling an acute abdomen, has not been reported previously. This case report illustrates the importance of considering medication side-effects when evaluating a patient with abdominal pain and rigidity.

Neuroleptic Malignant Syndrome: Need For Early Diagnosis And Therapy, Humaira M. Khan, Nadir A. Syed, Mughis Sheerani, Bhojo Khealani, Ayeesha Kamal, Mohammad Wasay

Department of Medicine

Background: Neuroleptic Malignant Syndrome (NMS) is a medical entity that has received little attention in the clinical settings in Pakistan. The aim of our study was to review the predisposing factors, outcomes and characteristics of in-patients diagnosed with NMS.

Methods: We performed a retrospective chart review of all cases (age > 15 years) at a tertiary care center in Karachi between January 01, 1990 and November 30, 2001, diagnosed using ICD 10 coding. Data was collected using a standardized data entry form and statistical analysis was performed using Epi Info 6, Version 6.02.

Results: There were a total of 20 patients …

Prognostic Indicators In Patients With Primary Intraventricular Haemorrhage, Bilal Hameed, Bhojo A. Khealani, Tahseen Mozzafar, Mohammad Wasay

Department of Medicine

Objectives: Primary intraventricular haemorrhage (PIVH) is a rare clinical entity. We sought to evaluate risk factors, clinical and radiological features, and outcome of patients with PIVH.

Materials and Methods: Cases of PIVH were identified from cohort of patients with non traumatic intracerebral haemorrhage (ICH) by reviewing the radiological data. Their charts were reviewed and demographic, clinical, radiological and laboratory data was recorded and analyzed. Chi square and t test were used to determine predictors of poor outcome.

Results: Fifteen of 677 (2%) patients with ICH had PIVH. Nine (60%) were men. Median age was 56 years. Predisposing factors included hypertension …

Rapidly Developing Optic Neuritis Secondary To Ethambutol: Possible Mechanism Of Injury, Sajjad Ali, Uzma Usman, Mohammad Wasay

Department of Medicine

Optic neuritis has been described among the toxic effects of Ethambutol. This side effect is dose related. The mean duration of Ethambutol induced optic neuritis (EON) is three months. We report a case of EON after few days of exposure to Ethambutol and the symptoms resolved after discontinuation of Ethambutol. This most likely represents an idiosyncratic reaction which is different as compared to dose related optic neuritis.

Autonomic Nervous System Dysfunction Predicts Poor Prognosis In Patients With Mild To Moderate Tetanus, Mohammad Wasay, Bhojo A. Khealani, Naasha Talati, Rohmah Shamsi, Nadir Ali Syed, Naseem Salahuddin

Department of Medicine

Background

Autonomic nervous system (ANS) dysfunction is present in up to one third of patients with tetanus. The prognostic value of ANS dysfunction is known in severe tetanus but its value is not well established in mild to moderate tetanus.

Methods

Medical records of all patients admitted with tetanus at two academic tertiary care centers in Karachi, Pakistan were reviewed. The demographic, clinical and laboratory data was recorded and analyzed. ANS dysfunction was defined as presence of labile or persistent hypertension or hypotension and sinus tachycardia, tachyarrythmia or bradycardia on EKG. Patients were divided into two groups based on presence …

Neurology In The 21st Century: Contemporary State Of Diagnostics And Therapeutics, Saad Shafqat, Mohammad Wasay

Department of Medicine

Although neurological disease has been recognized since antiquity, neurology as a systematic clinical discipline is less than 130 years old. Neurological practice has traditionally been constrained by the complexity of the human nervous system, which has been slow to yield its secrets. Over the last three decades, however, clinical neurology has been transformed in terms of both diagnostics and therapeutics and now marches in lockstep with the cutting edge of medicine. Efficacious treatments are now available for the majority of neurological diseases, including epilepsy, migraine, Guillain-Barre syndrome, Parkinson's disease, multiple sclerosis, and ischemic stroke. This neurological revolution has been enabled …