Medical Specialties Commons^™

Spatial And Temporal Homogeneity Of Driver Mutations In Diffuse Intrinsic Pontine Glioma., Hamid Nikbakht, Eshini Panditharatna, Leonie G Mikael, Rui Li, Tenzin Gayden, Alan Siu, Javad Nazarian, + 17 More

Neurological Surgery Faculty Publications

Diffuse Intrinsic Pontine Gliomas (DIPGs) are deadly paediatric brain tumours where needle biopsies help guide diagnosis and targeted therapies. To address spatial heterogeneity, here we analyse 134 specimens from various neuroanatomical structures of whole autopsy brains from nine DIPG patients. Evolutionary reconstruction indicates histone 3 (H3) K27M-including H3.2K27M-mutations potentially arise first and are invariably associated with specific, high-fidelity obligate partners throughout the tumour and its spread, from diagnosis to end-stage disease, suggesting mutual need for tumorigenesis. These H3K27M ubiquitously-associated mutations involve alterations in TP53 cell-cycle (TP53/PPM1D) or specific growth factor pathways (ACVR1/PIK3R1). Later oncogenic alterations arise in sub-clones and often …

Neurosurgery Concepts: Key Perspectives On Intrathecal Fluorescein For Detecting Intraoperative Cerebrospinal Fluid Leak During Endoscopic Endonasal Surgery, Spinal Intraarterial Chemotherapy, Oligoastrocytoma Classification By In Situ Molecular Genetics, And Prenatal Myelomeningocele Closure And The Need For Cerebrospinal Fluid Shunt Placement., Anand V Germanwala, Winward Choy, Jonathan H. Sherman, Sandi Lam, Isaac Yang, Zachary A Smith

Neurological Surgery Faculty Publications

No abstract provided.

Response To The Comments: "Prospective Case Control Evaluation Of Epidural Midazolam For Improving Pain And Ambulation After Microdiscectomy", Muhammad Shahzad Shamim

Section of Neurosurgery

No abstract provided.

Prenatal Nicotine Exposure As A Teratogen In Neurological Pathways, Monica Grover

AUCTUS: The Journal of Undergraduate Research and Creative Scholarship

Attention-deficit/hyperactivity disorder (ADHD) is the most heritable and commonly diagnosed childhood psychiatric disorder with 4% of all children being diagnosed with this disorder. Prenatal smoking has been found to be a risk factor for ADHD, a disorder that has been believed to be linked to the fluctuation of dopamine levels. Prenatal nicotine exposure in the second trimester influences dopaminergic neurological pathways by altering dopamine release levels. The altered dopamine levels make the fetus brain more sensitive to the nicotine, causing the nicotine exposure to be more dangerous in causing ADHD symptoms. Prenatal nicotine exposure alters the neurological pathway of the …

Validity Of Intracerebral Haemorrhge Score In Predicting Prognosis Of Hemorrhagic Stroke, Muhammad Aslam Rind, Muzaffar Sheikh, Manzoor Ali Lakhair, Maria Nazir, Sadia Sheikh

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is a common neurological disorder, leading cause of death and disability worldwide. Intra cerebral hemorrhage comprises of 10-15% of all strokes but associated with high risk of morbidity and mortality than cerebral infraction .The ICH Score is a good prognostic tool calculated very easily, when it is used to predict 30 day morality. Objective:To determine the validity of Intracerebral hemorrhagic score in predicting prognosis (adverse outcome or death) in patients of hemorrhagic stroke.Material&Methods:This case series study was carried out at department of medicine Liaquat medical University Hospital Jamshoro and Hyderabad from June 16th 2012 to December 15th 2012.Eighty nine …

Demographic Profile And Associations Of Dialysis Dependent Chronic Kidney Disease Patients In Federal Capital Of Pakistan., Ali Zohair Nomani, Mansoor Iqbal, Faisal Bacha, Shahzad Mughal, Haris Majid Rajput, Mazhar Badshah, Rao Suhail Yasin Khan

Pakistan Journal of Neurological Sciences (PJNS)

Depression is quite prevalent in patients with chronic kidney disease. Knowing the frequency of depression in such patients and its association with different variables may be helpful in devising strategies for better and timely management of such patients in our setup. Materials and methods: This cross sectional study was conducted by recruiting 315 patients of either gender, ≥ 18 years of age with chronic kidney disease (CKD) and receiving care at Pakistan Institute of Medical Sciences, Islamabad. Patients were divided into two groups; group A: pre-dialysis and group B: dialysis (End Stage Renal Disease). Prevalence of depression in CKD and …

Primary Anaplastic Pleomorphic Xanthoastrocytoma In Adults. Case Report And Review Of Literature, Usama Khalid Choudry, Saad Akhtar Khan, Amjad Qureshi, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Pleomorphic xanthoastrocytoma (PXA) classified as a low Grade (WHO II) astrocytic neoplasm. It is known for its relatively favorable prognosis. It most commonly occurs in young adults. Malignant progression in PXA has been frequently reported since its first description in 1979; however, the presentation of a primary anaplastic PXA tumor with an aggressive clinical course in adults is rare especially in the later age group.
Case description: We present a case of primary anaplastic PXA in a 53 year old male that manifested with an early recurrence pattern at 9 weeks. Treatment performed was surgical excision and external beam …

Cerebral Venous Sinus Thrombosis With Tentorial Haemorrhagic Infarctions In Combined Proteins Deficiency And Hyperhomocysteinemia Treated With Anticoagulation- Limited Evidence With Good Results: A Case Report, Muhammad Waqas, Muhammad Akbar Baig, Shahan Waheed Aga Khan University, Munawar Khursheed

Department of Emergency Medicine

We are presenting a case of a 40-year-old lady who presented with sudden loss of consciousness. Computed Tomography scan of her brain revealed the presence of blood in her sub-arachnoid space on her right hemisphere, cerebral oedema, and cerebral venous sinus thrombosis later magnetic Resonance Imaging revealed extensive cerebral venous sinuses thrombosis formation associated with supra and infra-tentorial haemorrhages. Elevated levels of plasma homocysteine and deficient levels of protein S. Patient was anticoagulated with warfarin and INR was monitored. She recovered successfully with no complication of anticoagulation observed. The use of anticoagulation had a favourable outcome in our …

Application Of Pre-Participation Cardiovascular Screening Guidelines To Novice Older Runners And Endurance Athletes, Justin R. Abbatemarco, Courtney Bennett, Adrian J. Bell, Laura Dunne, Martin E. Matsumura

Neurology Faculty Publications

Objectives: Despite robust growth in participation in marathons and endurance sports among older individuals, guidance regarding pre-participation cardiovascular evaluation of these athletes is lacking. The objective of this study was to assess the utility of currently available pre-participation cardiovascular evaluation guidelines as applied to a cohort of older novice endurance athletes.

Methods: We applied data from 1457 novice runners and endurance athletes aged 35 years and older to two pre-participation screening tools, the American Heart Association/American College of Sports Medicine Pre-Participation Questionnaire and the 2001 Working Group recommendations for pre-participation screening of masters athletes (2001 Masters).

Results: Application of the …

Progression Of Friedreich Ataxia: Quantitative Characterization Over 5 Years, Maya Patel, Charles J. Isaacs, Lauren Seyer, Karlla Brigatti, Sarah Gelbard, Cassandra Strawser, Debbie Foerster, Julianna Shinnick, Kimberly Schadt, Eppie M. Yiu, Martin B. Delatycki, Susan Perlman, George R. Wilmot, Theresa Zesiewicz, Katherine Mathews, Christopher M. Gomez, Grace Yoon, Sub H. Subramony, Alicia Brocht, Jennifer Farmer, David R. Lynch

Neurology Faculty Publications

Objective Friedreich ataxia (FRDA) is a progressive neurodegenerative disorder of adults and children. This study analyzed neurological outcomes and changes to identify predictors of progression and generate power calculations for clinical trials.

Methods Eight hundred and twelve subjects in a natural history study were evaluated annually across 12 sites using the Friedreich Ataxia Rating Scale (FARS), 9-Hole Peg Test, Timed 25-Foot Walk, visual acuity tests, self-reported surveys and disability scales. Cross-sectional outcomes were assessed from recent visits, and longitudinal changes were gaged over 5 years from baseline.

Results Cross-sectional outcomes correlated with measures of disease severity. Age, genetic severity (guanine-adenine-adenine …

Bisphenol-A And Sleep Adequacy Among Adults In The National Health And Nutrition Examination Surveys, Hind A. Beydoun, May A. Beydoun, Hueiwang Anna Jeng, Alan B. Zonderman, Shaker M. Eid

Community & Environmental Health Faculty Publications

Study Objectives: To evaluate bisphenol-A (BPA) level and its relationship to sleep adequacy in a nationally representative sample of U.S. adults.
Methods: A population-based cross-sectional study was conducted using 2005-2010 National Health and Nutrition Examination Survey whereby data were collected using in-person interviews, physical examination and laboratory testing. BPA level was measured in urine samples and analyzed as loge-transformed variable and in quartiles (< 0.9 ng/mL; 0.9 to < 1.9 ng/mL; 1.9 to < 3.7 ng/mL; 3.7+ ng/mL). Sleep adequacy was operationalized with three questions: "How much sleep do you usually get at night on weekdays or workdays?", "Have you ever told a doctor or other health professionals that you have trouble sleeping?" and "Have you ever been told by a doctor or other health professional that you have a sleep disorder?" Sleep duration was further categorized as (< 6 h, ≥ 6 h); (< 7 h, 7-8 h, > 8 h); (< 5 h, 5-6 h, 7-8 h, ≥ 9 h). Linear, binary, and ordinal logistic regression models were constructed.
Results: Loge-transformed BPA level was inversely related to sleep duration defined, in hours, as a continuous variable, a dichotomous variable (≥ 6, < 6), or an ordinal variable (≥ 9, 7-8, 5-6, < 5), after adjustment for confounders. Help-seeking behavior for sleep problems and diagnosis with sleep disorders were not significantly associated with loge-transformed BPA level in fully adjusted models.
Conclusions: Loge-transformed BPA level may be associated with fewer hours of …

Unusual Late Onset Of Parenchymal Neuro-Behçet Disease, Wai Wai Miller, Demetrios Konstas, Chetan Gandhy, Derrick Robertson

Neurology Faculty Publications

Neuro-Behçet disease (NBD) is a multisystem inflammatory disorder characterized by oral lesions, genital lesions, uveitis, and neurological deficits. If left untreated, it may lead to worsening neurological function and can be fatal. Here we present a case of a 52-year-old woman who was diagnosed with Behçet disease (BD) as a teenager and had a relatively mild disease course. Decades later after her initial DB diagnosis, she presented to our hospital with a chief complaint of headache. She did not have focal neurological deficits or any active mucosal lesions. Upon further investigation, the patient was found to have multiple inflammatory changes …

Pharmacological Inhibition Of Cyclophilin Ameliorates Experimental Allergic Encephalomyelitis, Zi L. Huang

Theses and Dissertations

A subset of cyclophilins have been implicated in mechanisms of neuroinflammation and neurodegeneration that contributes to the pathogenesis of Multiple Sclerosis. Mitochondrial dysfunction leading to mitochondrial permeability transition plays a pivotal role in axonal damage and disease progression in Multiple Sclerosis. Cyclophilin D (CypD) is a crucial regulatory component of the mitochondrial permeability transition pore and it was demonstrated that the cyclophilin D knockout animals showed reduced experimental allergic encephalomyelitis (EAE) clinical disease severity and axonal injury. We investigated the effect of N-methyl-4-isoleucine-cyclosporin (NIM811), a non-immunosuppressive and non-selective cyclophilin inhibitor, on the course and severity of EAE. EAE mice treated …

The Role Of Capillaries In The Lesser Ailments Of Old Age And In Alzheimer's Disease And Vascular Dementia: The Potential Of Pro-Therapeutic Angiogenesis, Charles T. Ambrose

Microbiology, Immunology, and Molecular Genetics Faculty Publications

Apart from chronic diseases (arthritis, diabetes, etc.), old age is generally characterized by three lesser ailments: muscle weakness, minor memory lapses, and cold intolerance. This trio of complaints may have a common, underlying cause, namely, the age-associated reduced microcirculation in muscles, brain, skin, and elsewhere in the body. The Angiogenesis Hypothesis proposes that old age is in part a deficiency disease due to the decline in angiogenic (AG) factors, resulting in a reduced capillary density (CD) throughout the body. Over fifty published papers document waning levels of AG factors and/or decreased CD in various organ systems of aged animals and …

Cns Plasticity In Injury And Disease, Brandon A. Miller, John C. Gensel, Michael S. Beattie

Spinal Cord and Brain Injury Research Center Faculty Publications

No abstract provided.

Cerebrovascular Risk Factors, Arteriolar Sclerosis, And Cognitive Decline In The Kentucky Appalachian “Stroke-Belt”, Omar M. Al-Janabi

Theses and Dissertations--Medical Sciences

The relationship between cerebrovascular disease (CVD) risk factors and cognitive impairment or dementia has been widely studied with significant variability in findings between groups. We hypothesized that chronic small vessel injury in the form of arteriolar sclerosis, measured quantitatively using MRI to measure total white matter hyperintensity (WMH) volumes, would identify specific association of CVD risk factors and patterns of cognitive decline, associated with mild cognitive impairment of the cerebrovascular type, that represent the core features of vascular cognitive impairment in our cohort.

A Cross-sectional analysis of clinical and quantitative MRI data on 114 subjects with normal cognitive function (n=52) …

Looking To The Future Of Stroke Treatment: Combining Recanalization And Neuroprotection In Acute Ischemic Stroke, Michael E. Maniskas

Theses and Dissertations--Neuroscience

Stroke is the 5^th leading cause of death in the U.S. with 130,000 deaths and around 800,000 affected annually. Currently, there is a significant disconnect between basic stroke research and clinical stroke therapeutic needs. Few animal models of stroke target the large vessels that produce cortical deficits seen in the clinical setting. Also, current routes of drug administration, intraperitoneal and intravenous, do not mimic the clinical route of intra-arterial drug administration. To bridge this divide, we have retro-engineered a mouse model of stroke from the current standard of care for emergent large vessel occlusion (ELVO) stroke, endovascular thrombectomy, to …

A Culture That Fosters Concussions: Does Increased Education Lead To More Accurate Reporting Of Concussions?, Michael Heptig

PCOM Psychology Dissertations

With over 1.7 million incidents reported annually, concussion has become the most common class of traumatic brain injury (TBI) in the United States (Bazarian, Zhu, Blyth, Borrino, & Zhong, 2012). As staggering a statistic as this may be, many believe it fails to represent the true number of concussions because the non-reporting of symptoms has been commonplace among athletes (Khurana & Kaye, 2012; Williamson & Goodman, 2006). The aim of this study was to determine those factors that influence the reporting of concussion symptoms. Specific variables that were examined include the amount of concussion education provided (determined by requisite amount …

Present And Future Of Neurology In Pakistan, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Neurology started as a department in early nineteen sixties in Dow Medical College and King Edward Medical College and initially having a separate department of neurology was not mandated in medical colleges by Pakistan Medical and Dental Council¹. Some neurology training programs do not give exposure to subspecialties and training is focused on adult neurology². From 2015 to 2016, several conferences were held on neurology including an Annual Meeting in Quetta, movement disorder conference in Lahore.

Acute Childhood Ischemic Stroke: A Pakistani Tertiary Care Hospital Experience, Prem Chand, Shahnaz Ibrahim, Muhammad Matloob Alam, Fazal Arain, Bhojo Khealani

Pakistan Journal of Neurological Sciences (PJNS)

Stroke in pediatric population is increasingly recognized and has diverse clinical presentation and risk factor profile. Majority of patients survive acute stroke but remain disabled. The reported literature on the subject from our part of world is scarce.Methods:A retrospective chart review was carried out for stroke patients between 1 month and 14 years of age, admitted between January 2009 and January 2015. Their demographic, clinical and radiological data was collected and analyzed.Results:Twenty nine patients were admitted with stroke over 5 years. Their mean age was 5.7 ±11.7 and male to female ratio was 3:1. The most common clinical features reported …

Factors Influencing Antiepileptic Drug Non-Compliance In Epileptic Patients Of Pakistan, Safia Bano, Ahsan Numanb

Pakistan Journal of Neurological Sciences (PJNS)

Failure to comply with drug regimes is prevalent amongst patients with epilepsy and the consequence of this is often an increased risk of further seizures and other associated harms including increased health care costs. Contributing factors leading to non-compliance of anti-epileptic drugs has not been examined in Pakistan. We investigated the factors influencing non-compliance to prescribed antiepileptic drugs (AEDs). A cross-sectional study was employed for a total of 53 epileptic patients with non-compliance of anti-epileptic drugs. The data-collection tools were a questionnaire and structured interview for this study. Results showed that males were more liable to non-compliance of AEDs as …

Socio-Demographic Risk Factors For Hemorrhagic And Ischemic Stroke: A Study In Tertiary Care Hospital Of Hyderabad, Tariq Feroz Memon, Manzoor Ali Lakhair, Muzaffar Shaikh, Abeer Raque, Muhammad Saleem Rind

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is a common neurological disorder and major cause of death and disability worldwide. Stroke is a second leading cause of death after cancer and ischemic heart disease. Incidence of stroke has not been well studied in Pakistan but it is estimated that 350,000 cases of stroke occur per year. Objective: To determine the frequencies and Socio-demographic features of Hemorrhagic and Ischemic strokes among stroke patients in tertiary care hospital.Material & method:This cross-sectional study was carried out at department of medicine Liaquat university hospital Hyderabad from June to September 2010, Patients were included in study according to inclusion and exclusion …

Neurocutanoussarcoidosis: A Rare Entity, Muslim Ali Lakhiar, Manzoor Lakhiar, Abdul Hafeez Bughio

Pakistan Journal of Neurological Sciences (PJNS)

Neurosarcoidosis is a granulomatous disorder considered to be a great imitator. We report a case of young lady who presented with gradual onset flexed posturing of fingers of left hand for four years, followed by similar pattern of weakness involving the right hand for three years along with slipping of slippers for one year. Neurologic examination showed distal wasting & weakness in upper limbs with normal jerks and sensory impairment in gloves and stocking distribution. On skin examination there were hypopigmented macules over face, neck and back. Electro diagnostic studies showed sensory motor axonal polyneuropathy, while skin biopsy reported as …

Mental Health Is Not A Luxury In Pakistan, Salma Kerai

Pakistan Journal of Neurological Sciences (PJNS)

A day with a fever is taken serious enough to get off from work in contrast to a day with emotional distress. World health organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. However, mental health is not seen as an integral part of overall well-being in many cultures.

Spontaneous Intracranial Hypotension; Three Case Reports With Similar Clinical Manifestations, Treated Successfully Using Different Management Techniques., Ali Ilyas, Wasim Tariq, Anam Abrar, Muhammad Amjad, Muhammad Azhar Saeed, Inayatullah Khan

Pakistan Journal of Neurological Sciences (PJNS)

Spontaneous Intracranial hypotension (SIH) is a rare neurological disorder, characterized by orthostatic headaches. Due to the complicity of its diagnosis and lack of awareness amongst physicians, SIH remains an under-diagnosed disease and its true prevalence remains unknown. It is a reversible condition, if diagnosed early. Delay in diagnosis can result in life threatening complications.Case Reports:We present a case series of three patients who presented with typical symptoms of SIH. But management course of each patient varied. The first patient responded well to the EBP (epidural blood patch) while the second improved with conventional symptomatic treatment. The third patient needed a …

An Unusual Presentation Of Gbs: Case Report And Literature Review, Sadaf Khattak, Sumaira Nabi, Irfan Khattak, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Guillain-Barre syndrome (GBS), also known as Landry paralysis is an acute idiopathic polyneuritis, believed to be immunologically mediated. It usually presents as a demyelinating neuropathy with ascending weakness, however, many clinical variants have been well documented in the medical literature, and variants involving the cranial nerves or pure motor involvement with axonal injury have also been described. We report a case of a 50 year old patient who initially presented to the ER with hemiparesis and cranial nerve palsies simulating a cerebrovascular event. Based on neurological examination, CSF analysis and needle EMG finding a diagnosis of GBS was made.

From Tip To Tpa, Shaista A Siddiqi, Syed Habibullah Kamran, Abubaker A Almadni

Pakistan Journal of Neurological Sciences (PJNS)

We present the case of a 50 year old lady who presented with sudden onset altered sensorium, anarthria, right hemianopia, ophthalmoplegia, quadriparesis and abnormal posturing of upper limbs for 4 hours. The NIHSS score was 31. The CT brain showed early ischemic changes in left posterior cerebral artery territory. The CT cerebral angiogram showed occlusion of the tip of basilar artery. Intravenous thrombolysis with rtPA resulted in remarkable recovery and NIHSS improved to 3 within 6 hours. In view of expected severe disability associated with tip of basilar artery syndrome, intravenous thrombolysis can be rewarding even in patients with high …

The Arp2/3 Complex Is Essential At Multiple Stages Of Neural Development., Fu-Sheng Chou, Pei-Shan Wang

Manuscripts, Articles, Book Chapters and Other Papers

During development of the nervous system, radial glial cells perform self-renewing asymmetric divisions and give rise to intermediate progenitor cells (IPC) and neurons. The neuronally committed IPC subsequently undergo multiple rounds of transient amplification and migrate outwards to form cortical layers as they continue to differentiate into mature neurons. Maturing neurons extend protrusions on their cell surface to form neurites, a process called neuritogenesis. Neurite formation results in the establishment of dendrites and axons for synapse formation, which is essential for sensory and motor functions and even higher-level functioning including memory formation and cognitive function, as well as shaping of …

Determinants Of Activity Levels In African Americans With Mild Cognitive Impairment., Barry W. Rovner, Md, Robin J. Casten, Phd, Benjamin E. Leiby, Phd

Department of Neurology Faculty Papers

Engaging in cognitive, social, and physical activities may prevent cognitive decline. In a sample of older African Americans with mild cognitive impairment (MCI; N=221), we investigated the cross-sectional relationships between activity levels and participants' demographic, clinical, and neuropsychological characteristics. The average age of participants was 75.4 years (SD, 7.0); 177 (80.1%) were women. Participation in cognitive/social activities was positively associated with education, depression, literacy, mobility, instrumental activities of daily living (IADL), verbal learning, and subcomponents of executive function. A linear regression identified IADLs, education, depression, and verbal learning as independent predictors. Participation in physical activities was positively associated with sex, …

Depression And Anxiety: A Snapshot Of The Situation In Pakistan, Bilaal Ahmed, Syed Faaiz Enam, Zafar Iqbal, Ghulam Murtaza, Shahid Bashir

Medical College Documents

Background: Depression is a great cause of morbidity around the world. Not one person seems to escape the hollow dread that the disease can bring forth.
Aims: Although living in a large extended family which serves as a social support is common in Pakistan, why we still suffer from anxiety and depression just as often if not more than those in other countries?
Method: We checked studies conducted in different localities of Pakistan over the past 10 years to find prevalence values of anxiety and depression. Results: The values of anxiety and depression ranging from 22% to as high as …