Medical Specialties Commons^™

Finger Drop Sign In Guillain-Barre Syndrome, Iqra Athar, Neelma Naz Khattak, Haris Majid Rajput, Mazhar Badshah, Zukhruf Zayian, Tashfain Shifa

Pakistan Journal of Neurological Sciences (PJNS)

Guillain-Barre syndrome (GBS) is a post-infectious, immune-mediated disease that causes a rapidly progressing poly-radiculoneuropathy resulting in weakness and areflexia. It has several variant forms like AIDP, AMAN and AMSAN,

Common Peroneal Neuropathy In Harvesting Farmers, Harwindar Kumar, Syed Muhammad Anwar Shah, Jamita Kor, Sadaf Qazi, Jasvindar Kumar

Pakistan Journal of Neurological Sciences (PJNS)

In Pakistan harvesting season occurs from April to May and again from October to December. Thirteen farmers with a history of foot drop were studied in neurophysiology laboratory of Lady Reading Hospital (LRH) during the period from March 2019 to December 2019. All the patients had nerve conduction study (NCS) while in some of the patients, electromyography (EMG) was also done to determine the duration of injury and to rule out other differential diagnoses.

A Case Of Acute Psychosis Following Dengue Fever, Waleed Shahzad, Omer Ismail Khalid, Neelam Sarwar, Muhammad Hassan, Tehmina Inayat, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Dengue fever has been infecting millions of people all around the world specially the rural areas of South East Asia according to World Health Organization. It is caused by an Arbovirus and transmitted by the bite of an infected female Aedes aegyptii mosquito. Dengue commonly presents with fever and thrombocytopenia; rare presentations include acute pancreatitis, dengue hemorrhagic stroke and encephalopathy. Common psychiatric complications of dengue fever include anxiety, depression, manic episodes and catatonia. We present a rare case of a 51 year old man who presented with an acute episode of psychosis including over talkativeness, irritability, authoritative and disinhibited behavior, …

Intra-Carpal Tunnel Steroid Injections Are Superior To Nsaids In Management Of Carpal Tunnel Syndrome, Saba Zaidi, Shafaq Abbas

Pakistan Journal of Neurological Sciences (PJNS)

Carpal tunnel syndrome (CTS) is caused by the compression of median nerve in carpal tunnel. Carpal bones make the floor of the carpal tunnel and the transverse carpal ligament forms the roof. Components include median nerve and the flexor tendons. The pain may be localized to the wrist or may radiate to forearm, arm or rarely shoulder. Effectiveness of treatment by intracarpal corticosteroid injection in comparison with NSAID has never been investigated. The objective of this study was to determine if corticosteroid injections for carpal tunnel syndrome are effective compared to NSAID.

Post Herpes Nmdar Encephalitis In A 8 Month Old Girl, Farida Jan, Shahnaz H Ibrahim

Pakistan Journal of Neurological Sciences (PJNS)

Patients with Herpes Simplex virus Encephalitis are seen to have a relapse of symptoms namely seizures and choreoathetoid movements along with impairment of consciousness1. Though infective relapse is a possibility requiring extended antiviral therapy2, immune mediated mechanism is most probable.3 Although there is a similarity of symptoms between relapsing HSVE and N-methyl-D-aspartate receptor (NMDAR) antibody encephalitis, the most likely culprit is the latter.

Guillain‐Barre Syndrome In Covid-19: A Literature Review, Imran Ahmad, Farooq Azam Rathore

Pakistan Journal of Neurological Sciences (PJNS)

The novel coronavirus (COVID-19) can result in several neurological complications including Guillain-Barré Syndrome (GBS). It is an acute parainfectious paralytic neuropathy. This review summarizes the demographic features, clinical presentation, diagnostics workup, and management strategies of COVID-19 associated GBS reported in the literature. We searched Medline, PubMed Central, SCOPUS, and Google Scholar using pre-defined keywords. We included all kinds of manuscripts in the English language only. Demographics, clinical features, diagnostic workup, management, and outcomes were documented in the datasheet. We identified 24 cases of COVID-19 associated GBS. Most were reported from Italy, followed by the USA. The majority were males (18/24) …

Effectiveness Of Cidofovir In Treating Natalizumab-Associated Progressive Multifocal Leukoencephalopathy (Pml), Salman Mansoor

Pakistan Journal of Neurological Sciences (PJNS)

Natalizumab (Nz) a monoclonal antibody has been in medicinal use for treatment of Relapsing Remitting Multiple Sclerosis (RRMS) since 2004. Progressive Multifocal Leukoencephalopathy (PML) is one of its serious risks which is a demyelinating disorder of brain associated with John Cunningham Virus (JCV). There have been 801 cases up till December 2018 which were reported with its use1. Lack of prospective trials and retrospective studies due to small number of these cases there is no consensus on Nz-associated PML treatment. To date there is no cure for this condition and there is a debate on effectiveness of different modalities2. Cidofovir …

Effect Of Listening To A Relaxing Water Sound For Fifteen Minutes On Traumatic Stress Subjects’ Immediate Stress Levels And Electroencephalograms, S. Farah Jafri, S. Farah Batool, Shamoon Noushad

Pakistan Journal of Neurological Sciences (PJNS)

BACKGROUND: Music and calmness are noteworthy stimulators that significantly affect mental health. Listening to relaxing sounds activates the feeling of wellbeing. The present study aimed to analyze the effect of closed eyes brief exposure to a relaxing water sound on Electroencephalogram (EEG) in pre and post-test states. METHODOLOGY: A total of 20 traumatic stress subjects were included to participate in this study. The subjects were requested to be seated with eyes closed while the sound of water flowing was played for 15 min in between (before and after) the EEG recordings. A subsection of the Sadaf Stress Scale (SSS) i.e. …

Covid-19 Vaccines And Cerebral Venous Thrombosis, Sajid Hameed, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Molybdenum Cofactor Deficiency Causing Neonatal Seizures And Global Developmental Delay, Sundal Aziz, Javeria Raza Alvi, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT: Molybdenum cofactor deficiency is a rare degenerative brain disorder with autosomal recessive inheritance. It presents early in neonatal life with seizures, feeding difficulty and spasticity, sometimes misdiagnosed as neonatal hypoxic ischemic encephalopathy. Neuroimaging findings are consistent with loss of white matter and volume along with cystic encephalomalacic changes. Most of the patients have mutations in the MOCS1 and MOCS2 genes causing imbalance in the sulfur-containing amino acid metabolism leading to progressive neurological damage and early childhood death in majority of cases. We report a case of a 7 months old child, product of non-consanguineous marriage with history of neonatal …

Challenges For Dementia Care And Research In Pakistan, Fatima Siddiqui, Qurat Khan, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Dementia is a syndrome characterized by a decline in cognition and memory severe enough to interfere with daily life activities and is one of the major causes of disability and dependency in elderly worldwide with Alzheimer’s disease being the most common cause of dementia (1). 703 million individuals (9% of the world’s population) are more than 65 years of age and this number will double by the end of 2050 reaching 1.5 billion (16% of the world’s population) (2). Ageing has been the fastest in Eastern and South Eastern countries (3). Despite being a global health priority, with significant social …

Acute Ischemic Stroke Treatment Barriers In Pakistan, Saima Ahmad, Umair Rashid, Ossama Mansour, Sohail Akhtar

Pakistan Journal of Neurological Sciences (PJNS)

Worldwide stroke is the second most common cause of death and the third most common cause of disability (1). No large-scale epidemiological studies are available to determine the true incidence of stroke in Pakistan. There is only one published stroke prevalence study which was conducted in a community residing in Karachi, the prevalence was 4.8%, however the results of the study should be interpreted with caution as a non-validated questionnaire was used. (2). Another community-based survey suggested as estimated 21.8% prevalence of stroke in an urban slum of Karachi (3). These studies although published in local journals but do not …

Spectrum Of Fugitive Diagnosis Of Neurological Disorders In Elderly, Safia Bano, Ayesha Aslam, Adnan Tariq, Adnan Mahmood, Rashid Imran, Ahsan Numan

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT BACKGROUND Fugitive diagnosis “escape from true diagnosis” of neurological disorders is very common in elderly patients. It’s not always an underlying disease symptom or progression in old age. Aim of this study is to determine the frequency and nature of fugitive diagnosis of neurodegenerative brain disorders in old age. MATERIAL AND METHODS STUDY DESIGN A study was conducted in private Neuro-clinic in Lahore. Study duration is 3 years from to 1st January, 2017 to 31th December, 2019. It was a prospective, cross sectional study. Inclusion criteria: 1) Age >60years 2) Neurodegenerative brain disorders including vascular dementia 3) with or …

Prevalence Of Depression In Patients With Migraine, A Cross-Sectional Study From A Tertiary Care Hospital, Zuhaib Ahmed, Umar Farooque, Aijaz Ali, Syeda Urooj Riaz, Muhammad Ramzan, Vijaya Chaitanya Bollampally, Ehtesham Zahoor, Omer Cheema, Mujeeb Ur Rehman, Rizwan Farooque, Muhammad Daim Bin Zafar

Pakistan Journal of Neurological Sciences (PJNS)

BACKGROUND Headache is one of the most common presenting complaints in patients attending primary care centers and the majority of them have primary headache syndromes. Depressive disorders are among the leading causes of disability globally and can further complicate the clinical manifestation if coupled with other comorbidities. Therefore, the primary objective of our study was to determine the prevalence of depression in migraine patients presenting at a tertiary care hospital to better understand the leading causes of the disease. METHODS A cross-sectional study was carried out between December 2019 and June 2020 (six months) including 66 migraine patients between 18 …

Factors Affecting Treatment Compliance In Psychiatric Setting, Yasirah Gohar, Uroosa Talib, Nasir Mehmood

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Evaluation Of Post Therapy Functional Status And Residual Weakness Of Patients With Guillain-Barre Syndrome, Iqra Athar, Anam Anis, Mansoor Iqbal, Sumaira Nabi, Mazhar Badshah, Syeda Rida

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT: Introduction: The annual global incidence of Guillain-Barre Syndrome is approximately 1–2 per 100,000 person-years. Data on Guillain-Barre Syndrome is very rare from Pakistan, we conducted a retrospective study to assess the clinical presentation, and treatment response of these patients.

Obturator Nerve Block With Aqueous Phenol Reduces Hip Adductor Spasticity – A Single Centre Experience, Sarah Razaq, Fahim Anwar, Muhammad Aleem Arshad

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT

Aim: Spasticity is a cardinal symptom of upper motor neuron disorders. It affects different individuals differently.

Spasticity in the hip adductor muscles can be very painful and may result in postural abnormalities and hip deformities

that interfere with walking, transferring and perineal hygiene. The study aimed to assess the effectiveness of phenol

obturator nerve block on hip adductor spasticity caused by the upper motor neuron lesions.

Materials and methods: This is a single-centre retrospective study of all patients with known spasticity in the hip

adductors who were assessed suitable for phenol nerve block of the obturator nerve. All patients …

Assessment Of Dementia Caregiver Burden In Karachi, Pakistan Using 10/66 Protocol, Qurat Ul Ain Khan

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT INTRODUCTION: Care arrangements and caregiver burden of people with dementia (PWD) are different in low and middle income countries (LMICs) than in developed countries. This is the first study in Pakistan assessing caregiver burden using the 10/66 protocol. METHOD: PWD were recruited from outpatient clinics and from the community in Karachi and were diagnosed according to DSM-IV TR. Three scales were used: 1. Zarit Burden Interview (ZBI) to assess caregiver burden. 2. Caregiver Activity Survey (CAS) to assess activities that the caregiver engaged in the last 24 hours to care for PWD and 3. General Health Questionnaire- 12 (GHQ …

A Case Of Heroin Induced Toxic Leukoencephalopathy, Sidra Sattar, Saba Zaidi

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT: Heroin-induced leukoencephalopathy comes under the category of Toxic leukoencephalopathies. We report the case of middle-aged gentleman with the history of polysubstance abuse who presented with recurrent falls, difficulty in walking and drowsiness. Diffuse white matter changes were appreciated on MRI Brain with sparing of cerebellum. In context of his history of inhalational heroin abuse with extensive symmetrical white matter changes in cerebrum, a diagnosis of heroin induced toxic leukoencephalopathy was made.

Hemichorea Associated With Type 2 Diabetes: A Rare Neurological Complication, Waleed Shahzad, Tehmina Inayat, Fibhaa Syed, Mohammad Ali Arif, Muhammad Hassan, Haris Majid Rajput, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Diabetic hemichorea/hemiballism is a spectrum of hyper kinetic, involuntary, irregular, purposeless, non-rhythmic, rapid and unsustained movements flowing from one part of the body to another. It involves contra lateral basal-ganglia and often striatum of the brain. Here we are reporting an un-usual case of choreiform movement disorder which was sudden in onset. It was accompanied with abnormally high values of blood glucose. Our patient had a complete remission of symptoms after an adequate control of blood glucose was achieved. This case illustrates the importance and rarity of hyperglycemia as a rare cause of hemichorea. It recovers rapidly and has a …

Longitudinally Extensive Transverse Myelitis And Neuromyelitis Optica Spectrum Disorder: A Tertiary Care Centre Experience, Safia Bano, Muhammad Athar Javed, Ahsan Numan

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT OBJECTIVE: To determine the frequency of longitudinally extensive transverse myelitis and Causes of longitudinally extensive transverse myelitis METHODOLOGY: A Cross-Sectional, retrospective study was conducted at Neurology Department, Mayo Hospital, Lahore from 1st January 2015 to 31st December 2015. Patients were included from inpatient with history of weakness of lower limbs/all four limbs with or without visual disturbances. History and clinical examination was consistent with transverse myelitis. Neuroimaging (MRI brain, (orbit in case of optic neuritis) and spinal cord) was done followed by LP/CSF, Vasculitis screening.

Medicolegal Issues In Neurology Practice In Pakistan, Ismail A Khatri, Maimoona Siddiqui

Pakistan Journal of Neurological Sciences (PJNS)

Neurology despite its challenges have made tremendous improvement in past few decades. At the same time, the rapid advancement of media and internet has changed the traditional doctor-patient relationship into one of a service provider-consumer relationship1. The health service is now considered a commodity, and has become prone to lack of trust and litigation. Medical professionalism is challenged by increasing commercialism and influence of legal system

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

Pakistan Journal of Neurological Sciences (PJNS)

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

Venous Stroke Secondary To Varicella Zoster Virus Infection, Asma Akbar Ladak, Salman Farooq

Pakistan Journal of Neurological Sciences (PJNS)

This is a case of cerebral venous sinus thrombosis (CVST) as a rare complication of varicella Zoster infection. A young male with no significant medical history presented with generalized tonic clonic seizures preceded by vesicular rash on the face diagnosed as Varicella zoster infection. The MRI showed bilaterial superficial hemorrhagic infarcts involving frontal and temporal lobes and MR Venogram was consistent with extensive CVST involving superioir sagittal, right transverse and superficial veins. After initial treatment with antiepileptic and anticoagulant, he showed marked improvement in symptomatology and made complete recovery subsequently with recanalization of sinuses seen on a follow up MRV …

Hepetatis C Virus A Rare Cause Of Cereberal Venous Sinus Thrombosis, Haris Majid Rajput, Iqra Athar, Neelma Naz Khattak, Anam Anis, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Cerebral venous sinus thrombosis is challenging condition because of its variability of underlying pathological causes. Numerous conditions can cause cerebral venous sinus thrombosis (CVST), and often more than one cause can be found in an individual patient. The causes leading to CVST can be classified into two broad categories; infective and non-infective. Among infective causes, chronic hepatitis C infection is considered as one of the extremely rare causes of cerebral venous sinus thrombosis.

Disease Modification Trials In Parkinsons Disease: A Review, Ramla Nayaib Hashmi, Ummul Kiram

Pakistan Journal of Neurological Sciences (PJNS)

Among the common neurological disorders worldwide, Parkinson’s disease has a major share. Currently, only symptomatic therapies are available for it without any approved neuromodulation drugs as all the previously done disease modification trials have failed. There is a dire need for such therapies. Disease modification trials include all types of intervention targeting the degeneration process which underlies the disease process and thus slows it down or the treatment aim to regenerate or replace the neurons which are lost. There are many reasons for the failure of trials. This review emphasize the need for disease modification trials, causes of failure of …

Cerebral Venous Sinus Thrombosis Associated With Coronavirus Infection (Covid-19), Sajid Hameed, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Coronavirus disease 2019 (COVID-19) is a severe acute respiratory syndrome (SARS) caused by the SARS-CoV-2 coronavirus. Despite its primarily respiratory involvement, an increased propensity for systemic inflammation, neuroinvasion, and thromboembolic events has been reported. This systemic prothrombotic state may predispose to cerebral venous sinus thrombosis (CVST), which is an uncommon cerebrovascular disease with hypercoagulability as one of its important risk factors. We conducted a literature search using the PubMed electronic database and reviewed the published literature for a possible association of CVST with the COVID-19 disease.

Cerebral Cavernous Malformation Presenting As Seizures, Hazim Brohi, Ayisha Farooq, Bushra Rehan, Muhammad Mairaj Khan

Pakistan Journal of Neurological Sciences (PJNS)

Cerebral cavernous malformations (CCMs) is one of the rare vascular malformation. It is diagnosed by characteristic lesions on magnetic resonance imaging (MRI). CCMs typically appears as a “popcorn-like” masses on T2-weighted images on MRI studies.And clinically can lead to headaches, seizures,focal neurological deficits or intracerebral hemorrhages. . A familial form is suggested if lesions are multiple, and a sporadic form, if single

Prevalence Of Paternal Postpartum Depression, Aisha Noorullah, Zehra Mohsin, Taliha Munir, Rida Nasir, Misbah Malik

Pakistan Journal of Neurological Sciences (PJNS)

Background: Postpartum Depression is a type of mood disorder associated with childbirth, which can occur in both parents. It is a major public health concern because it produces insidious effects on the well-being of new born as well as on the whole family. Objective: This study aims to determine the prevalence of postpartum depression among fathers in Karachi, Pakistan. Methods: This cross sectional survey was conducted among fathers, purposive convenient and snowball sampling was used to approach 120 participants after obtaining permission from Al-Khidmat Hospital and Combined Military Hospital (CMH).Participants were aged between 20-50 years, had a newly born child …

Referral Patterns And Diagnoses At A Single Neurophysiology Center In Quetta, Pakistan: An Audit Of 1600 Cases, Ahmad Wali, Ehtisham Khalid2, Hazar Khan, Abdul Nasir, Mr Abdullah

Pakistan Journal of Neurological Sciences (PJNS)

Neurophysiologic tests such as EEG, video EEG, Polysomnography (PSG), Nerve conduction studies (NCS) and electromyography (EMG) are the next steps after neurological examinations. These tests play a significantly important role in the decision-making and management of various neurological diseases. Data regarding the availability and frequency of these tests are not being compiled in Pakistan eventually resulting in a lack of awareness about these tests among physicians as well as patients. This motivated us to conduct a medical audit to assess frequencies, mode of referral, and final conclusion of these tests in detail. A total of 1600 tests were included. Among …