Medical Specialties Commons^™

Anterior Cervical Infection: Presentation And Incidence Of An Uncommon Postoperative Complication., George M. Ghobrial, James S. Harrop, Rick C. Sasso, Chadi A. Tannoury, Tony Tannoury, Zachary A. Smith, Wellington K. Hsu, Paul M. Arnold, Michael G. Fehlings, Thomas E. Mroz, Anthony F. De Giacomo, Bruce C. Jobse, Ra'kerry K. Rahman, Sara E. Thompson, K Daniel Riew

Department of Neurosurgery Faculty Papers

STUDY DESIGN: Retrospective multi-institutional case series.

OBJECTIVE: The anterior cervical discectomy and fusion (ACDF) affords the surgeon the flexibility to treat a variety of cervical pathologies, with the majority being for degenerative and traumatic indications. Limited data in the literature describe the presentation and true incidence of postoperative surgical site infections.

METHODS: A retrospective multicenter case series study was conducted involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network, selected for their excellence in spine care and clinical research infrastructure and experience. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 …

Using Mobile Health (Mhealth) Technology In The Management Of Diabetes Mellitus, Physical Inactivity, And Smoking, Hasan Rehman, Ayeesha Kamran Kamal, Saleem Sayani, Pamela B. Morris, Anwar T. Merchant, Salim S. Virani

Department of Medicine

Purpose of Review: Cardiovascular mortality remains high due to insufficient progress made in managing cardiovascular risk factors such as diabetes mellitus, physical inactivity, and smoking. Healthy lifestyle choices play an important role in the management of these modifiable risk factors. Mobile health or mHealth is defined as the use of mobile computing and communication technologies (i.e., mobile phones, wearable sensors) for the delivery of health services and healthrelated information. In this review, we examine some recent studies that utilized mHealth tools to improve management of these risk factors, with examples from developing countries where available.
Recent Findings: The mHealth …

GabaB Receptor Attenuation Of GabaA Currents In Neurons Of The Mammalian Central Nervous System, Wen Shen, Changlong Nan, Peter T. Nelson, Harris Ripps, Malcolm M. Slaughter

Pathology and Laboratory Medicine Faculty Publications

Ionotropic receptors are tightly regulated by second messenger systems and are often present along with their metabotropic counterparts on a neuron's plasma membrane. This leads to the hypothesis that the two receptor subtypes can interact, and indeed this has been observed in excitatory glutamate and inhibitory GABA receptors. In both systems the metabotropic pathway augments the ionotropic receptor response. However, we have found that the metabotropic GABA_B receptor can suppress the ionotropic GABA_A receptor current, in both the in vitro mouse retina and in human amygdala membrane fractions. Expression of amygdala membrane microdomains in Xenopus oocytes by microtransplantation …

A Normative Spatiotemporal Mri Atlas Of The Fetal Brain For Automatic Segmentation And Analysis Of Early Brain Growth., Ali Gholipour, Caitlin K Rollins, Clemente Velasco-Annis, Abdelhakim Ouaalam, Alireza Akhondi-Asl, Onur Afacan, Cynthia M Ortinau, Sean Clancy, Catherine Limperopoulos, Edward Yang, Judy A Estroff, Simon K Warfield

Pediatrics Faculty Publications

Longitudinal characterization of early brain growth in-utero has been limited by a number of challenges in fetal imaging, the rapid change in size, shape and volume of the developing brain, and the consequent lack of suitable algorithms for fetal brain image analysis. There is a need for an improved digital brain atlas of the spatiotemporal maturation of the fetal brain extending over the key developmental periods. We have developed an algorithm for construction of an unbiased four-dimensional atlas of the developing fetal brain by integrating symmetric diffeomorphic deformable registration in space with kernel regression in age. We applied this new …

Neurofeedback Or Neuroplacebo?, Robert T. Thibault, Michael Lifshitz, Amir Raz

Psychology Faculty Articles and Research

This scientific commentary refers to ‘Better than sham? A double-blind placebo-controlled neurofeedback study in primary insomnia’, by Schabus et al.. (doi:10.1093/brain/awx011).

Efficient Remyelination Requires Dna Methylation, Sarah Moyon, Dan Ma, Jimmy L. Huynh, David J.C. Coutts, Chao Zhao, Patrizia Casaccia, Robin J. M. Franklin

Advanced Science Research Center

Oligodendrocyte progenitor cells (OPCs) are the principal source of new myelin in the central nervous system. A better understanding of how they mature into myelin-forming cells is of high relevance for remyelination. It has recently been demonstrated that during developmental myelination, the DNA methyltransferase 1 (DNMT1), but not DNMT3A, is critical for regulating proliferation and differentiation of OPCs into myelinating oligodendrocytes (OLs). However, it remains to be determined whether DNA methylation is also critical for the differentiation of adult OPCs during remyelination. After lysolecithin-induced demyelination in the ventrolateral spinal cord white matter of adult mice of either sex, we detected …

Neurologic Correlates Of Gait Abnormalities In Cerebral Palsy: Implications For Treatment, Joanne Zhou, Erin E. Butler, Jessica Rose

Dartmouth Scholarship

Cerebral palsy (CP) is the most common movement disorder in children. A diagnosis of CP is often made based on abnormal muscle tone or posture, a delay in reaching motor milestones, or the presence of gait abnormalities in young children. Neuroimaging of high-risk neonates and of children diagnosed with CP have identified patterns of neurologic injury associated with CP, however, the neural underpinnings of common gait abnormalities remain largely uncharacterized. Here, we review the nature of the brain injury in CP, as well as the neuromuscular deficits and subsequent gait abnormalities common among children with CP. We first discuss brain …

Low Cost Quality Initiatives For Management Of Neurosurgical Patients In Developing Nations: Perspective From A Tertiary Care Centre In Pakistan, Hamid Hussain Rai, Muhammad Waqas, Muhammad Shahzad Shamim

Section of Neurosurgery

Background: Targeting resources on cost-effective care strategies is pertinent for developing nations, specifically for already burdened specialties such as neurosurgery, where without state support and insurance companies, expenses are borne by the patient themselves.
Methods: This was a descriptive review of literary work published by the section of neurosurgery at Aga Khan University Hospital, Pakistan. We searched PubMed and CiNAHL databases to identify articles, which were then critically analyzed and discussed from a perspective of low-cost quality care.
Results: We demonstrate the cost effectiveness of three initiatives, namely, blood ordering protocol for elective spine arthrodesis, nonoperative management being superior to …

Relationship Of The Median And Radial Nerves At The Elbow: Application To Avoiding Injury During Venipuncture Or Other Invasive Procedures Of The Cubital Fossa., Vlad Voin, Joe Iwanaga, Juan P Sardi, Christian Fisahn, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

INTRODUCTION: The median and radial nerves are two important neural structures found in the cubital fossa. The trajectory and landmarks used to identify their location are important when procedures are done in this area.

METHODS AND MATERIALS: Ten fresh-frozen cadavers were dissected (20 upper limbs) and measurements were taken from the medial epicondyle to the median and radial nerves as well as to the lateral epicondyle of each limb.

RESULTS: The distance between the medial epicondyle and the median nerve was found to be three centimeters with a range of 2.1 to four centimeters and the distance from the medial …

The Role Of Adenosine Signaling In Headache: A Review., Nathan T. Fried, Melanie B. Elliott, Michael L. Oshinsky

Department of Neurology Faculty Papers

Migraine is the third most prevalent disease on the planet, yet our understanding of its mechanisms and pathophysiology is surprisingly incomplete. Recent studies have built upon decades of evidence that adenosine, a purine nucleoside that can act as a neuromodulator, is involved in pain transmission and sensitization. Clinical evidence and rodent studies have suggested that adenosine signaling also plays a critical role in migraine headache. This is further supported by the widespread use of caffeine, an adenosine receptor antagonist, in several headache treatments. In this review, we highlight evidence that supports the involvement of adenosine signaling in different forms of …

A Murine Model To Study Epilepsy And Sudep Induced By Malaria Infection., Paddy Ssentongo, Anna E Robuccio, Godfrey Thuku, Derek G Sim, Ali Nabi, Fatemeh Bahari, Balaji Shanmugasundaram, Myles W Billard, Andrew Geronimo, Kurt W Short, Patrick J Drew, Jennifer Baccon, Steven L Weinstein, Frank G Gilliam, José A Stoute, Vernon M Chinchilli, Andrew F Read, Bruce J Gluckman, Steven J Schiff

Neurology Faculty Publications

One of the largest single sources of epilepsy in the world is produced as a neurological sequela in survivors of cerebral malaria. Nevertheless, the pathophysiological mechanisms of such epileptogenesis remain unknown and no adjunctive therapy during cerebral malaria has been shown to reduce the rate of subsequent epilepsy. There is no existing animal model of postmalarial epilepsy. In this technical report we demonstrate the first such animal models. These models were created from multiple mouse and parasite strain combinations, so that the epilepsy observed retained universality with respect to genetic background. We also discovered spontaneous sudden unexpected death in epilepsy …

Beta Oscillatory Changes And Retention Of Motor Skills During Practice In Healthy Subjects And In Patients With Parkinson’S Disease, Aaron B. Nelson, Clara Moisello, Jing Lin, Priya Panday, Serena Ricci, Andrea Canessa, Alessandro Di Rocco, Angelo Quartarone, Giuseppe Frazzitta, Ioannis U. Isaias, Giulio Tononi, Chiara Cirelli, M. Felice Ghilardi

Publications and Research

Recently we found that modulation depth of beta power during movement increases with practice over sensory-motor areas in normal subjects but not in patients with Parkinson’s disease (PD). As such changesmight reflect use-dependentmodifications, we concluded that reduction of beta enhancement in PD represents saturation of cortical plasticity. A few questions remained open: What is the relation between these EEG changes and retention of motor skills? Would a second task exposure restore beta modulation enhancement in PD? Do practice-induced increases of beta modulation occur within each block? We thus recorded EEG in patients with PD and age-matched controls in two consecutive …

Osborne's Ligament: A Review Of Its History, Anatomy, And Surgical Importance., Andre Granger, Juan P Sardi, Joe Iwanaga, Thomas J Wilson, Lynda Yang, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

When discussing the pathophysiology of ulnar neuropathy, Geoffrey Vaughan Osborne described a fibrous band that can be responsible for the symptoms seen in this disorder. In this paper, we take a glimpse at the life of Osborne and review the anatomy and surgical significance of Osborne's ligament. This band of tissue connects the two heads of the flexor carpi ulnaris and thus forms the roof of the cubital tunnel. To our knowledge, no prior publication has reviewed the history of this ligament, and very few authors have studied its anatomy in any detail. Therefore, the aim of the present paper …

Role Of Corpus Callosum Integrity In Arm Function Differs Based On Motor Severity After Stroke, Jill Campbell Stewart, Pritha Dewanjee, George Tran, Erin Burke Quinlan, Lucy Dodakian, Alison Mckenzie, Jill See, Steven C. Cramer

Physical Therapy Faculty Articles and Research

While the corpus callosum (CC) is important to normal sensorimotor function, its role in motor function after stroke is less well understood. This study examined the relationship between structural integrity of the motor and sensory sections of the CC, as reflected by fractional anisotropy (FA), and motor function in individuals with a range of motor impairment level due to stroke. Fifty-five individuals with chronic stroke (Fugl-Meyer motor score range 14 to 61) and 18 healthy controls underwent diffusion tensor imaging and a set of motor behavior tests. Mean FA from the motor and sensory regions of the CC and from …

What Is The Contribution Of Ia-Afference For Regulating Motor Output Variability During Standing?, Niklas König Ignasiak

Physical Therapy Faculty Articles and Research

Motor variability is an inherent feature of all human movements, and describes the system‘s stability and rigidity during the performance of functional motor tasks such as balancing. In order to ensure successful task execution, the nervous system is thought to be able to flexibly select the appropriate level of variability. However, it remains unknown which neurophysiological pathways are utilized for the control of motor output variability. In responding to natural variability (in this example sway), it is plausible that the neuro-physiological response to muscular elongation contributes to restoring a balanced upright posture. In this study, the postural sway of 18 …

Gullain Barré Syndrome: Complications, Commonly Acquired Nosocomial Infections And Antibiotic Susceptibilities At Pakistan Institute Of Medical Sciences, Islamabad, Ali Zohair Nomani, Uzma Jamil, Mansoor Iqbal, Sumaira Nabi, Haris Majid Rajput, Misbah Ahmed, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Introduction: The cause of demise in GBS may be related to the sequelae of complications associated with the disease or its treatment. The primary objective of this study was to enumerate the prevalence of complications associated with treatment of patients with GBS at a tertiary care setup in Islamabad. The secondary objective was to determine the antibiotic susceptibility patterns of commonly encountered infections in GBS during hospital stay in our setup. Materials and methods: The study was carried out between Jan 2014 and June 2015 on one hundred patients of GBS aged ≥ 12 years. Baseline characteristics, complications and antibiotic …

Frequency Of Non-Motor Symptoms In Parkinson Disease: Experience From Pakistan, Saira Saad, Ali Zohair Nomani, Mazhar Badshah, Aamir Afzal

Pakistan Journal of Neurological Sciences (PJNS)

The objective of this study was to determine the frequency of non-motor symptoms (NMS) in patients with Parkinson's disease (PD) and to compare frequency in mild and severe disease. Materials and methods: This descriptive observational study was done from January 2015 to June 2015 at Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad. We used Non-Motor Symptom Questionnaire (NMS-Q); a validated scale using 30 questions related to 9 different domains of symptoms. Results: 62 patients were enrolled in the final data set of study (male 46, Female 16) with average age of 62.4 years (range=33-80). Non-motor symptoms were reported …

Establishment Of Site Specific Multi-Disciplinary Tumour Boards In Pakistan: Sharing Experience Of Neuro Oncology Team Based At A Tertiary Care University Hospital, Muhammad Waqas, Ahmed Nadeem Abbasi

Section of Neurosurgery

No abstract provided.

Giant Arachnoid Granulation Associated With Anomalous Draining Vein: A Case Report., Randle Umeh, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

Giant arachnoid granulations (AG) can mimic intracranial lesions. Knowledge of these structures can help avoid misdiagnosis when interpreting imaging. Here, we report a child who presented with a mass within the superior sagittal sinus and an anomalous draining vein. Herein, the diagnosis of a giant AG was made. Clinicians who view or interpret imaging of the head should be aware of these anatomical variants and though when very large, apparently, do not necessarily result in pathology. Based on our case report, giant AG might also demonstrate anomalous draining veins.

Bone Morphogenic Proteins Are A Good Choice For Select Spinal Surgeries And Merit Further Research., Doniel Drazin, Eric Choi, Alfredo Garcia, Tarush Rustagi

Articles, Abstracts, and Reports

No abstract provided.

Recent Advances In Epilepsy, Mughis Sheerani

Pakistan Journal of Neurological Sciences (PJNS)

Listening to Dr Sarosh Irani in a recent Epilepsy conference about Fascio Brachial dystonic seizures associated with voltage gated potassium channel (VGKC complex/LG1 antibodies)(1) and then reading reports published in Neurology about continued recent use of trephination ‘expelling the demons’ in India(2), I was wondering how far we are in Southeast Asia in the understanding and treatment of this fascinating illness.

Open-Label Phase I Clinical Study To Assess The Safety And Efficacy Of Cilostazol In Patients Undergoing Internal Carotid Artery Stent Placement, A E. Hassan, H Zacharatos, M Grigoryan, Muhammed Suri, Adnan Qureshi

Articles

BACKGROUND:

One-month dual antiplatelet treatment, with aspirin and clopidogrel, following internal carotid artery stent placement is the current standard of care to prevent in-stent thrombosis. Cilostazol, an antiplatelet drug, has been demonstrated to have a safety profile comparable to aspirin and clopidogrel.

OBJECTIVE:

To evaluate the safety and clinical efficacy of cilostazol and aspirin therapy following internal carotid artery stent placement up to 1 month postprocedure.

METHODS:

A phase I open-label, nonrandomized two-center prospective study was conducted. All subjects received aspirin (325 mg/day) and cilostazol (200 mg/day) 3 days before extracranial stent placement. Two antiplatelet agents were continued for 1 …

High Resolution Time-Course Mapping Of Early Transcriptomic, Molecular And Cellular Phenotypes In Huntington's Disease Cag Knock-In Mice Across Multiple Genetic Backgrounds., Seth A Ament, Jocelynn R Pearl, Andrea Grindeland, Jason St Claire, John C Earls, Marina Kovalenko, Tammy Gillis, Jayalakshmi Mysore, James F Gusella, Jong-Min Lee, Seung Kwak, David Howland, Min Young Lee, David Baxter, Kelsey Scherler, Kai Wang, Donald Geman, Jeffrey B Carroll, Marcy E Macdonald, George Carlson, Vanessa C Wheeler, Nathan D Price, Leroy Hood

Articles, Abstracts, and Reports

Huntington's disease is a dominantly inherited neurodegenerative disease caused by the expansion of a CAG repeat in the HTT gene. In addition to the length of the CAG expansion, factors such as genetic background have been shown to contribute to the age at onset of neurological symptoms. A central challenge in understanding the disease progression that leads from the HD mutation to massive cell death in the striatum is the ability to characterize the subtle and early functional consequences of the CAG expansion longitudinally. We used dense time course sampling between 4 and 20 postnatal weeks to characterize early transcriptomic, …

A Case Of Hashimoto’S Encephalopathy In A Patient With Lithium Toxicity, Saba Zaidi, Bashir A. Soomro, Dr Imran Chaudary, Fasiha Sohail

Pakistan Journal of Neurological Sciences (PJNS)

Hashimoto’s encephalopathy is a rare neurological disorder of unknown etiology. We presented, a case of middle aged male with bipolar disorder on Lithium carbonate for 30 years, admitted with altered behavior for 2 weeks and high Lithium levels. He was admitted with the suspicion of Lithium toxicity. EEG showed generalized epileptiform discharges. MRI brain revealed frontal cortical atrophy. CSF detailed report was normal. Further workup showed a high TSH level and positive anti-TPO (anti thyroid peroxidase) antibodies. Based on clinical picture, raised antibodies and no discernible cause, diagnosis of probable Hashimoto’s encephalopathy was made. He received pulse of methylprednisolone for …

Role Of Neuroradiology In Predicting Outome In Spontaneous Intracerebral Hemorrhage, Sumaira Nabi, Mazhar Badshah, Shahzad Ahmed, Ali Zohair Nomani

Pakistan Journal of Neurological Sciences (PJNS)

Spontaneous intracerebral hemorrhage (ICH) accounts for 8-13% of all strokes and is associated with a high mortality and morbidity. Western studies have identified various clinical and radiological factors which help in predicting outcome in patients with spontaneous ICH. Materials and methods: A consecutive series of 100 patients diagnosed with spontaneous ICH admitted to the neurology department were enrolled from 1stJanuary to 30th June, 2014.Radiological parameters on CT brain (plain) were recorded. In-hospital outcome was measured at the end of 7 days of hospital stay in terms of survival or mortality. Different radiological parameters and their effect on outcome were compared …

Frequency Of Miller Fisher Variant Of Guillain Barré Syndrome At A Tertiary Care Hospital, Karachi, Kiran Waqar, Sadaf Nasir, Khalid Sher, Meraj Fatima, Abdul Malik

Pakistan Journal of Neurological Sciences (PJNS)

Miller fisher syndrome is generally considered a rare but important variant of Guillain Barré Syndrome (GBS) having geographically variable incidence. Patients with this clinical syndrome are often misdiagnosed and mismanaged due to lack of awareness on the part of physician. Objective: To determine frequency of Miller fisher syndrome (MFS), variant of GBS in patients presenting to a tertiary care hospital in Karachi. Methods: This descriptive cross sectional study was conducted in the Department of Neurology, Jinnah Postgraduate Medical Centre (JPMC), Karachi. The duration was from April, 2014 to April, 2016 (two years). A total of 100 patients were included in …

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 …

Spectrum Of Gullian Barre Syndrome In Children, Dr. Shaila Ali, Dr. M. Zia Ur Rehman, Dr. Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

GBS is a post-infectious poly-neuropathy involving mainly motor but sometimes also sensory and autonomic nerves. This is an epidemiological report on seasonal & monthly distribution of GBS & differences in GBS incidence between male & female in Punjab, Pakistan. Objective: To determine the seasonal variation, age and gender differentiation in children with GBS along with EMG/NCS findings. Study Design: Retrospective, observational,cross sectional study. Place and duration of study: Department of Neurology, Childrens Hospital & The Institute of Child Health, Lahore from January 2014 to December 2014. METHODS: We extracted data from multi centers retrospectively in a 1 year period (January …

A Giant Right Subclavian- Axillary Artery Aneurysm Presenting As Brachial Plexopathy, Mahnoor Hafeez,, Ateeque Ahmed Khan

Pakistan Journal of Neurological Sciences (PJNS)

We present a rare case of 60 years old lady with diabetes and uncontrolled systemic hypertension, who was referred to the Surgical Department of Civil Hospital Karachi in September 2016 with rapidly progressive mass at right shoulder region and acute onset of ipsilateral limb sensory and motor deficit for last 3 weeks. The nerve conduction studies (NCS) revealed right brachial plexopathy. Computed Tomography demonstrated an 8.2x8.7cm (width x length) fusiform giant aneurysm of right subclavian-axillary artery with reactive axillary lymphadenitis. Early Aneurysmectomy and arterial reconstruction with saphenous vein graft interposition was planned. Unfortunately, she succumbed to death due to spontaneous …

Intracranial Hypertension And Optic Nerve Sheath Fenestration, Irfan Jeeva

Pakistan Journal of Neurological Sciences (PJNS)

Intracranial Hypertension is a neurological condition secondary to raised intracranial pressure in the absence of identifiable intracranial pathology and with normal cerebrospinal fluid composition. It can be a challenging condition to manage. One of the treatment modalities, optic nerve sheath fenestration is an important, yet under utilized mode of treatment, particularly in patients with visual symptoms.