Neurology Commons^™

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.

Longitudinally Extensive Transverse Myelitis: A Sub-Saharan Conundrum, Antonina Obayo, Sylvia Mbugua, Sayed Karar

Internal Medicine, East Africa

Spinal cord schistosomiasis is a rare, underdiagnosed manifestation of schistosomiasis. We present the case of a 36-year-old male who presented to our institution with a one-week history of low back pain with rapidly progressive lower limb weakness, loss of sensation, and flaccid paraparesis. An MRI of the spine showed a longitudinally extensive transverse myelitis from T6 to L1, with enhancement at the cauda equina region. Further review of the images and serological tests eventually led to diagnosis of spinal schistosomiasis. He was treated with praziquantel and high-dose steroids, with minimal improvement in his symptoms.

Sleep Deprivation And Neurological Disorders, Muhammed Bishir

Brain and Mind Institute

Sleep plays an important role in maintaining neuronal circuitry, signalling and helps maintain overall health and wellbeing. Sleep deprivation (SD) disturbs the circadian physiology and exerts a negative impact on brain and behavioural functions. SD impairs the cellular clearance of misfolded neurotoxin proteins like α-synuclein, amyloid-β, and tau which are involved in major neurodegenerative diseases like Alzheimer’s disease and Parkinson’s disease. In addition, SD is also shown to affect the glymphatic system, a glial-dependent metabolic waste clearance pathway, causing accumulation of misfolded faulty proteins in synaptic compartments resulting in cognitive decline. Also, SD affects the immunological and …

Can Awake Glioma Surgery Be The New Standard Of Care In Developing Countries?, Syed Sarmad Bukhari, Muhammad Shahzad Shamim

Section of Neurosurgery

No abstract provided.

Understanding The Neuroprotective Effect Of Tranexamic Acid: An Exploratory Analysis Of The Crash-3 Randomised Trial, Amy Brenner, Antonio Belli, Rizwana Chaudhri, Timothy Coats, Lauren Frimley, Sabariah Faizah Jamaluddin, Rashid Jooma, Raoul Mansukhani, Peter Sandercock, Haleema Shakur-Still

Section of Neurosurgery

Background: The CRASH-3 trial hypothesised that timely tranexamic acid (TXA) treatment might reduce deaths from intracranial bleeding after traumatic brain injury (TBI). To explore the mechanism of action of TXA in TBI, we examined the timing of its effect on death.
Methods: The CRASH-3 trial randomised 9202 patients within 3 h of injury with a GCS score ≤ 12 or intracranial bleeding on CT scan and no significant extracranial bleeding to receive TXA or placebo. We conducted an exploratory analysis of the effects of TXA on all-cause mortality within 24 h of injury and within 28 days, excluding patients with …

Intracranial Mesenchymal Tumor With Fet-Creb Fusion - A Unifying Diagnosis For The Spectrum Of Intracranial Myxoid Mesenchymal Tumors And Angiomatoid Fibrous Histiocytoma-Like Neoplasms, Emily A. Sloan, Jason Chiang, Javier E. Villanueva-Meyer, Sanda Alexandrescu, Jennifer M. Eschbacher, Wesley Wang, Manuela Mafra, Nasir Ud Din, Emily Carr-Boy, Michael Watson

Department of Pathology and Laboratory Medicine

Intracranial mesenchymal tumors with FET-CREB fusions are a recently described group of neoplasms in children and young adults characterized by fusion of a FET family gene (usually EWSR1, but rarely FUS) to a CREB family transcription factor (ATF1, CREB1, or CREM), and have been variously termed intracranial angiomatoid fibrous histiocytoma or intracranial myxoid mesenchymal tumor. The clinical outcomes, histologic features, and genomic landscape are not well defined. Here we studied twenty patients with intracranial mesenchymal tumors proven to harbor FET-CREB fusion by next-generation sequencing (NGS). The 16 female and 4 male patients had a median age of 14 years (range …

Quality Of Life In Children Treated For Craniopharyngiomas, Mishal Gillani, Sheza Hassan, Umme Hani Abdullah, Muhammad Waqas Saeed Baqai, Muhammad Shahzad Shamim

Medical College Documents

Craniopharyngiomas are common but complex paediatric brain lesions that present interesting management challenges. Quality of life is an important consideration while choosing management options. In this review, we have discussed the existing literature on various aspects of quality of life in patients treated for craniopharyngioma, assessed by variety of measurement tools.

Anaesthetic Management Of Patients Undergoing Deep Brain Simulation: A Retrospective Review Of 8 Cases From A Tertiary Care Center Of Pakistan, Usama Ahmed, Faraz Shafiq, Dileep Kumar, Khalid Ahsan, Waleed Bin Ghaffar, Muhammad Ehsan Bari

Department of Anaesthesia

Objectives: To review anaesthesia related outcome, perioperative complications and overall length of stay (LOS) in hospital for patients who had deep brain stimulation (DBS).
Methods: The study was retrospective review of patients medical records diagnosed with Parkinson disease (PD) and underwent DBS at The Aga Khan University Hospital, Karachi from 2017-2019. Data was reviewed from file notes and patient chart and recorded on predesigned Performa. Frequency and percentages were used to present the data.
Results: All patients were anaesthetized using Sleep-Awake-Sleep technique (SAS). Dexmedetomidine was mainly used for conscious sedation. Bispectral index monitor (BIS) was used to monitor the depth …

Air Pollution And Non Communicable Diseases, Zafar Fatmi, Shafaq Mahmood, Zainab Samad, Mohammad Wasay

Community Health Sciences

No abstract provided.

Childhood Medulloblastoma, Naureen Mushtaq, Shahzadi Resham, Muhammad Shahzad Shamim, Bilal Mazhar Qureshi, Quratulain Riaz, Eric Bouffet

Section of Haematology/Oncology

Medulloblastoma is the most common malignant brain tumour in children and is a major cause of mortality and morbidity, particularly in low- and middle-income countries. It has been risk-stratified on the basis of clinical (age, metastasis and extent of resection) and histological subtypes (classic, desmoplastic and anaplastic). However, recently medulloblastoma has been sub-grouped by using a variety of different genomic approaches, such as gene expression profiling, micro-ribonucleic acid profiling and methylation array into 4 groups, namely Wingless, Sonic hedgehog, Group 3 and Group 4. This new sub-grouping has important therapeutic and prognostic implications. After acute leukaemia, brain tumour is the …

Consequences Of A Missed History: A Case Of Antidepressant Discontinuation Syndrome, Sajid Hameed, Mukesh Kumar, Piyush Puri, Fnu Sapna, Pal Satyajit Singh Athwal

Section of Neurology

Antidepressant discontinuation syndrome (ADDS) is reported to occur in almost 30-50% of the patients who take antidepressants for a duration of at least four to six weeks and then suddenly discontinue the drug. Since there is an increase in the use of antidepressants for various reasons by general practitioners, patient education about when and how to discontinue a drug is not acknowledged enough. It is reported to occur with the use of different classes of antidepressants - selective serotonin reuptake inhibitor (SSRI), monoamineoxidase inhibitor (MAOI), tricyclic antidepressants (TCAs), and atypical antipsychotics like risperidone, trazodone, clozapine, and venlafaxine. Slow tapering off …

Surgical Outcomes Of Intramedullary Spinal Cord Ependymomas, Ummey Hani, Muhammad Waqas Saeed Baqai, Muhammad Shahzad Shamim

Section of Neurosurgery

Intramedullary Spinal Cord Ependymomas (ISCE) are uncommon pathologies that need to be aggressively managed before clinical deterioration sets in. Novel application of different therapeutic strategies is being assessed for improving long-term outcomes in patients presenting with these rare neoplasms. In this review, we have discussed the existing literature on ISCEs, and the role of surgery in determining outcomes in terms of neurological status, progression-free survival (PFS) and overall survival (OS).

Acute Symptomatic Seizures In Critically Ill Children: Frequency, Etiology And Outcomes, Sanam B. Rajper, Mujtaba Moazzam, Arsheen Zeeshan, Qalab Abbas

Department of Paediatrics and Child Health

Background: Critically ill individuals have an increased risk of acute symptomatic seizures secondary to systemic illnesses; unrecognized or untreated seizures can quickly convert into status epilepticus, which is associated with high morbidity and mortality.
Objective: The aim of this study was to determine frequency, etiology, and outcome of seizures in critical ill children admitted in intensive care unit of a tertiary care hospital.
Materials and methods: Retrospective review of medical records of all children admitted in pediatric intensive care unit (PICU) of the Aga Khan University from January 2016 to December 2018 and who had a new-onset seizure irrespective of …

Cerebellar Mutism Syndrome After Surgical Resection Of Posterior Fossa Neoplastic Lesions, Saqib Kamran Bakhshi, Rida Mitha, Naureen Mushtaq, Muhammad Shahzad Shamim

Section of Neurosurgery

Cerebellar Mutism Syndrome (CMS) is a well-described clinical entity that complicates surgeries for posterior fossa tumours; more so in children than adults. This review focuses on the current understanding of CMS, its incidence and risk factors. Incidence showed a variable range in retrospective studies due to variety of definitions. Risk factors can be classified as either modifiable including surgical technique, or non-modifiable which include tumour related factors. A positive correlation has been associated between tumour pathology, brain stem invasion and size of tumour at time of presentation with development of CMS.

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 …

A Case Of Guillain-Barré Syndrome Presented With Abnormal Pupil Without Ophthalmoplegia, Kiran Abbas, Hassan Haroon, Noorulain Qureshi, Ritesh Pahwani, Suneel Kumar

Pakistan Journal of Neurological Sciences (PJNS)

A 50-year-old man, resident of Balochistan, Pakistan presented with acute progressive tetraparesis associated with a unilateral dilated pupil. He had normal ocular movement, but the right pupil was dilated and unresponsive to light or accommodation reflexes. This is the first case from Pakistan.

A Rare Presentation Of Acute Flaccid Myelitis In Covid-19 Patient: A Case Report, Liaquat Ali, Adnan Khan, Osama Elalamy, Beatriz Canibano, Mohammad Al Hatou, Ghulam Adeli, Islam Ahmed, Ambreen Iqrar, Ahmed Abdussalam, A Saif Ibrahim, Sundus Sardar

Pakistan Journal of Neurological Sciences (PJNS)

SARS-CoV-2 virus enters human cells via ACE-2 receptors and causes multiple organs dysfunction. These ACE-2 receptors are in cells surface of human lung, liver, heart, kidney and blood vessels. The expression of ACE2 receptors in cortical neurons, glial cells and spinal cord cells create nervous system susceptible to SARS-CoV-2 attack and may be a source of different neurological deficits including myelitis in COVID-19 patients.

Parkinson's Disease- "Move Together To End": Theme For World Brain Day 2020, Abdul Malik

Pakistan Journal of Neurological Sciences (PJNS)

World Federation of Neurology (WFN) promoting brain health through its educational, skills development & advocacy activities. Since 2014 WFN had been focused to organized dedicated awareness drive in all the WFN members countries round the globe.