Neurology Commons^™

Inadvertent Stone Migration During Pneumatic Lithotripsy: Still A Conundrum In The 21st Century, Ali Akbar Zehri, Miten Patel, Philip Adebayo, Authar Ali

General Surgery, East Africa

Currently, an ideal gadget to stop retrograde stone migration remains a holy grail, and the hunt for such a device is still ongoing in the 21st century. The quest for an ideal instrument is driven by the need to reduce cost, minimize ancillary procedure rates, reduce the device's operative time, and improve the stone-free rate. The purpose of the present review is to provide an update on the use of preventive measures that are used to stop retrograde stone migration during pneumatic lithotripsy for ureteric stone management.

Currently, an ideal gadget to stop retrograde stone migration remains a holy grail, …

Postinfectious Cerebellar Syndrome With Paraneoplastic Antibodies: An Association Or Coincidence?, Sajid Hameed, Mukesh Kumar, Pal Satyajit Singh Athwal, Sukhmanii Kahlon, Nimit Dalal

Section of Neurology

Cerebellar ataxia has a very broad differential diagnosis in adults, including paraneoplastic and postinfectious etiologies. We report a case of a 56-year-old male presented with right-sided cerebellar dysfunction preceded by fever and headache. He was diagnosed with subacute postinfectious cerebellar ataxia. Blood serology showed the presence of anti-amphiphysin and anti-Ri (ANNA-2, antineuronal nuclear autoantibody type 2) antibodies, which have a known association with cerebellar syndrome. The patient subsequently improved with the steroids. Although no evidence of an underlying tumor was found in the patient, the presence of the paraneoplastic antibodies remains a mystery. We suggest a probable association of these …

Arteriovenous Malformation With Associated Multiple Flow-Related Distal Anterior Cerebral Artery Aneurysms: A Case Report With Poor Outcomes, Ummey Hani, Muhammad Ehsan Bari, Syed Sarmad Bukhari

Section of Neurosurgery

Background: Low-grade arteriovenous malformations (AVMs) associated with multiple flow-related distal anterior cerebral artery (DACA) aneurysms are rare occurrences. Here, we present a case of a frontal AVM with three associated DACA aneurysms arising from a single feeder.
Case description: A 36-year-old male presented to us in the ER with acute-onset dysphasia and altered mental status. Head computed tomography and angiogram showed a spontaneous intracerebral hemorrhage with intraventricular extension and revealed a Spetzler Martin Grade II AVM, being fed by two feeders, with the major feeder from the DACA bearing three flow-related aneurysms. As the patient awaited digital subtraction angiography, his …

Value Of Achieving A Watertight Dural Closure, And The Use Of Dural Sealants After Supratentorial Cranial Surgery, Ummey Hani, Fatima Aziz, Muhammad Shahzad Shamim

Section of Neurosurgery

Dural closure at the end of cranial surgery is considered an extremely important step to maintain anatomical continuity, separate the intradural space with the extradural one, and to prevent possible complications related to cerebrospinal fluid leak. Wherein its usefulness in posterior fossa craniotomy is established, many surgeons do not perform it routinely in supratentorial craniotomies, citing unnecessary delay and lack of evidence supporting it. Herein, we have reviewed the data to find evidence in support of watertight suture based dural closures compared to other dural closure techniques, in supratentorial craniotomies.

Out-Patient Neurological Disorders In Tanzania: Experience From A Private Institution In Dar Es Salaam, Philip Adebayo, Omar Aziz, Rose E. Mwakabatika, Mandela Makakala, Mugisha Clement, Shabbir Adamjee, Noureen Mushi, Ahmed Jusabani, Eric Aris

Internal Medicine, East Africa

Background and introduction: Low and middle-income countries (LMIC) have a considerable burden of neurological disorders. Available profile of neurological disorders in our environment is biased towards neurological admissions. There is a paucity of data on out-patient neurological conditions in sub-Saharan Africa.

Objective: To determine the frequency and demographic data of neurological illnesses being managed at the adult out-patient neurology clinic of the Aga Khan Hospital, Dar es Salaam (AKHD).

Materials and methods: The electronic medical records of all cases with neurological diseases who presented to the adult neurology clinic of the AKHD between January 2018, and December 2019 were retrospectively …

A Fatal Case Of Primary Amoebic Meningoencephalitis (Pam) Complicated With Diabetes Insipidus (Di): A Case Report And Review Of The Literature, Zain Mushtaq, Saad Bin Zafar Mahmood, Adil Aziz

Section of Internal Medicine

Naegleria fowleri is a highly infective free-living amoeba usually isolated from soil and fresh water and is primarily found to infect the central nervous system (CNS) resulting in primary amoebic meningoencephalitis (PAM). PAM as a cause of meningitis is often overlooked for other, more common causes of meningitis. Despite all the advances in antimicrobial therapy and supportive care systems, the mortality rate of this rare infection remains above 95% with the bulk of the cases being found in developed countries. We are presenting a case of a 44-year-old male with fever, worsening headache, and generalized weakness. Lumbar puncture showed a …

Significance Of Micro-Rna Expression In Patients With Meningioma, Rida Mitha, Muhammad Shahzad Shamim

Section of Neurosurgery

Recent brain tumour research has shown abnormalities in gene expression as key features for almost all common brain tumours investigated. However, there is increasing evidence that epigenetic abnormalities are also crucial for tumorigenesis. Epigenetic abnormalities are heritable alterations affecting gene expression without changing the primary DNA sequence. Epigenetic abnormalities in meningiomas include abnormal microRNA expression, altered DNA methylation and histone and chromatin modifications. In this review we identify the role of altered expression of microRNA in the development and recurrence of meningioma. Based on the review of current literature, extensive knowledge of micro-RNA expression cannot only determine tumour recurrence and …

Post-Vaccination Pharyngeal-Cervical-Brachial Variant Of Guillain-Barré Syndrome, Funmilola T. Taiwo, Daniel E. Ezuduemoih, Philip Adebayo

Internal Medicine, East Africa

The pharyngeal-cervical-brachial (PCB) variant of Guillain-Barré syndrome (GBS) is very rare. It is characterized by weakness of the upper extremities associated with bulbar symptoms and facial diplegia. Documented cases were post-infectious, a post-vaccination occurrence has not been documented in the available literature. Even rarer is the occurrence of any variant of GBS following the mumps measles rubella (MMR) vaccine. The neurophysiological hallmark of PCB variant of GBS is a combination of myelinopathy and axonopathy, hence, its consideration as a subtype of the acute motor axonal neuropathy (AMAN) variant. It should be suspected in any case of acute-onset flaccid symmetrical weakness …

Furrowed Tongue, Fatten Lip And Facial Droop, Philip Adebayo, Hanifa Mbithe

Internal Medicine, East Africa

No abstract provided.

Outcome Of Cranial Firearm Injuries In Civilian Population Based On A Novel Classification System, Farrukh Javeed, Asad Abbas, Lal Rehman, Syed Raza Khairat Rizvi, Ali Afzal, Hafiza Fatima Aziz

Section of Neurosurgery

Background: Cranial firearm injuries (CFAIs) are expected to be frequent during warfare; however, it is becoming increasingly common among civilian population in our part of the world. These injuries are associated with significant morbidity and mortality in addition to financial loss. The objective of our study is to evaluate the pattern of gunshot injuries to cranium and their outcome.
Methods: The study was conducted on 114 patients presenting with CFAIs to Jinnah Postgraduate Medical Centre, Karachi, Pakistan, between June 2015 and January 2019. Patients were evaluated with respect to age, gender, pattern of injury, Glasgow coma scale on arrival, radiological …

Investigation Of Japanese Encephalitis Virus As A Cause Of Acute Encephalitis In Southern Pakistan, April 2015-January 2018, Tazeen Fatima, Abida Rais, Erum Khan, Susan L. Hills, Trudy V. Chambers, Aneeta Hotwani, Shahida Qureshi, Saad Shafqat, Saima Malik, Farah Qamar, Fatima Mir, Anthony A. Marfin, Anita K. M. Zaidi, Asif Raza Khowaja, Sadia Shakoor

Department of Pathology and Laboratory Medicine

Background: Japanese encephalitis (JE) occurs in fewer than 1% of JE virus (JEV) infections, often with catastrophic sequelae including death and neuropsychiatric disability. JEV transmission in Pakistan was documented in 1980s and 1990s, but recent evidence is lacking. Our objective was to investigate JEV as a cause of acute encephalitis in Pakistan.
Methods: Persons aged ≥1 month with possible JE admitted to two acute care hospitals in Karachi, Pakistan from April 2015 to January 2018 were enrolled. Cerebrospinal fluid (CSF) or serum samples were tested for JEV immunoglobulin M (IgM) using the InBios JE DetectTM assay. Positive or equivocal samples …

Association Of Bipolar I Disorder With Conversion Disorder And Syncope- A Retrospective Clinical Study From Pakistan, Qurat Ul Ain Khan, Sana Younus, Hania Hasan, Muhammad Zaman Khan

Pakistan Journal of Neurological Sciences (PJNS)

Bipolar I disorder (BD I) is a chronic mood disorder that begins in early adulthood. Its association with conversion disorder and syncope has not been widely studied, especially in Pakistani population.

Permanent Pre-Operative Cerebrospinal Fluid Diversion In Paediatric Patients With Posterior Fossa Tumours, Ummey Hani, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

Management options for obstructive hydrocephalus in children with posterior fossa tumours have been debated upon throughout the course of neurosurgical practice. Permanent pre-operative CSF diversion via ventricular shunts or endoscopic third ventriculostomy have been employed to prevent the possible persistence of hydrocephalus after tumour removal, but is considered unnecessary and even dangerous amongst a large group of neurosurgeons. In this paper, we have reviewed the literature for the merits and demerits of pre-operative permanent CSF diversion in paediatric patients presenting with posterior fossa tumours.

Cns Tuberculosis And Stroke, Burden, Management Challenges And Future Needs For Care And Research, A H Jokhio, Simon M Bell, Mohammad Wasay, Arshad Majid

Pakistan Journal of Neurological Sciences (PJNS)

An estimated 10 million cases of Tuberculosis (TB) and 1.6 million deaths due to this disease occurred worldwide in 2017 (1). About 1.7 billion people, 23% of the world’s population are estimated to have latent TB infection and are thus at risk of developing active TB disease during their life time. TB is mostly common in developing countries and Pakistan ranks 5th among 30 high-burden countries and 5th for Drug Resistant TB (DRTB). The incidence of TB in Pakistan is 267 per 100,000 (1) with an estimated 525,000 cases in 2017 including 57,000 cases among those who were less than …

Acute Colonic Pseudo Obstruction (Ogilvie Syndrome) In A Patient With Hemorrhagic Stroke: A Case Report., Muhammad Dawood Sohail, Haroon Khan, Zainab Alam, Sardar M Alam

Pakistan Journal of Neurological Sciences (PJNS)

Acute colonic pseudo-obstruction (ACPO) or Ogilvie syndrome is a functional motility disorder of the colonic bowel without any organic or mechanical obstruction. Autonomic disturbance which is one of the underlying factors that can lead to Ogilvie syndrome, is caused by stroke. Acute colonic pseudo- obstruction (ACPO) in the setting of stroke is not often reported in medical literature. Various modalities of treatment strategies are recommended including conservative approaches, medical therapies, endoscopic and surgical procedures. We will discuss a patient suffering from a hemorrhagic stroke in the right basal ganglia that developed Acute Colonic Pseudo Obstruction and improved subsequently with conservative …

Obstructive Sleep Apnea In Middle Age Male Smokers, Muhammad Hassan, Saad Ali Ansari, Farzana Salman, Raafay Kamal Khan, Waleed Shahzad, Ehsan-Ur- Rehman, Omer Hassaan, Aftab Ahmed, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

OBJECTIVE: Obstructive sleep apnea is the most common type of sleep apnea. This was designed to establish the relationship between smoking and obstructive sleep apnea. Methods:This cross-sectional study was conducted at the outpatient department of Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from August 2018 to November 2018 (dates mentioned in methods are different) and comprised of males aged 30-50 years. Participants were divided into two groups of smokers and non-smokers and Berlin questionnaire was used to collect data employing systemic random sampling. SPSS 22 was used for analysis. Results:There were 768 male participants in the study equally split between …

A Review Of Brain Death Protocols Across The Globe And Need For Brain Death Guideline For Pakistan., Mohammad Wasay, Syeda Batool Mujtaba, Mughis Sheerani, Saleem Barech, Rashid Jooma

Pakistan Journal of Neurological Sciences (PJNS)

The concept of brain death was first formally presented in United States of America in 1968 (Ad Hoc Committee of the Harvard Medical School to examine the definition of Brain Death, 1968) in part to facilitate organ donation. It is a widely accepted term in most countries but some like Japan do not consider it as death. According toAAN, brain death is defined as death due to irreversible loss of function of the entire brain — comparable to circulatory death, which is defined as irreversible loss of function of the circulatory system. The purpose of our study is to review …

Factors Influencing Severity In Acute Ischemic Strokes, Inam E Khuda, Intisar Siddiqui, Saad Munzar, Rashid Nazir, Arsalan Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Background: Stroke severity is one of the factors that determines stroke related disability. We explored possible associations between stroke severity and commonly evaluated clinical parameters of stroke patients. Objective: To determine the relationships between clinical features including routine in- hospital investigations done in first 24 hours of admission and variations in the stroke severity. Patients and Methods: This was a retrospective, analytical study performed in the Department of Neurology at Shifa International Hospital, Shifa Tameer-e-Millat University, Islamabad, Pakistan. Adult patients admitted with ischemic stroke, over a period of 39 months, with Middle Cerebral Artery infarctions, were included. National Institute of …

Knowledge And Use Of The International Classification Of Functioning, Disability And Health (Icf) Among Health Professionals In A Developing Country, Sidra K. Jafri, Olaf Kraus De Camargo

Pakistan Journal of Neurological Sciences (PJNS)

The World Health Organization’s (WHO) International Classification of Functioning, Disability, and Health (ICF) provides a biopsychosocial framework for understanding all the factors that should be considered while managing any health condition. The ICF has been employed for clinical, academic, research, and policymaking purposes in developed as well as developing countries. There is a great disparity in the representation in the literature regarding knowledge and potential application of the ICF in professional practice around the world especially from low middle-income countries like Pakistan. This study aims to evaluate the profile and knowledge of health professionals in Pakistan about the application of …

Concussion: A Review Of Epidemiology, Presentation And Treatment., Sidra Saleem, Arsalan Anwar, Fahham Asghar, Muhammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

A direct impact on the head can cause a Mild Traumatic Brain Injury or Concussion. It is a neuronal brain injury with or without loss of consciousness. Each year, approximately 69 million people are estimated to suffer from Concussion. Around 80-90% of these Concussion cases resolve within a week. The most commonly reported post-concussion symptoms include headache, cognitive changes, sleep disturbances, and depression. Essential in the approach to patients with concussion includes a detailed history taking and physical examination. Imaging modalities like Magnetic Resonance Images (MRI) of the brain may not show any significant changes; therefore more sensitive tests, like …

A Rare Presentation Of Pulmonary Sarcomatoid Carcinoma With Left Atrial Involvement And Spinal Metastasis Presenting With An Ischemic Infarct., Hina Imtiaz, Muhammad Dawood Amir Sheikh

Pakistan Journal of Neurological Sciences (PJNS)

Pulmonary Sarcomatoid Carcinoma is a rare, aggressive tumor comprising of both epithelial and mesenchymal cells. It is important to distinguish it from other lung tumors due to its poor prognosis and extensive metastasis. We present a case of a 36 year old female patient who initially presented with right sided weakness and slurred speech due to an ischemic infarct of the left basal ganglia. Further workup revealed a lung mass extending to the left atrium with spinal metastasis. Sarcomatoid Carcinoma remains a diagnostic challenge due to its early recurrence and atypical presentation.

Movement Disorder Associated With Celiac Disease And Thyroid Dysfunction:Case Report, Ramla Nayaib Hashmi, Ummul Kiram, Rabbia Tariq

Pakistan Journal of Neurological Sciences (PJNS)

Autoimmune movement disorders are uncommon yet likely treatable conditions. It is challenging to diagnose and manage these disorders, ultimately leading to a significant morbidity in terms of functional disability of patient. It is troublesome for practicing neurologists to identify whether the antibodies which are detected during the work up of these autoimmune movement disorders are merely incidental or have pathogenic role. This will help them to decide regarding whether to start immunotherapy or not. Here we have discussed two patients of movement disorder who were found to have positive work up for other autoimmune diseases. Available Literature on autoimmune movement …

Effects Of Intermittent Fasting On Taste Modulation And Perception, Sajid Hameed, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

The Neurology Of Covid-19 Revisited: A Proposal From The Environmental Neurology Specialty Group Of The World Federation Of Neurology To Implement International Neurological Registries, Gustavo C. Román, Peter S. Spencer, Jacques Reis, Alain Buguet, Mostafa El Alaoui Faris, Sarosh M. Katrak, Miguel Láinez, Marco Tulio Medina, Chandrashekhar Meshram, Mohammad Wasay

Section of Neurology

A comprehensive review of the neurological disorders reported during the current COVID-19 pandemic demonstrates that infection with SARS-CoV-2 affects the central nervous system (CNS), the peripheral nervous system (PNS) and the muscle. CNS manifestations include: headache and decreased responsiveness considered initial indicators of potential neurological involvement; anosmia, hyposmia, hypogeusia, and dysgeusia are frequent early symptoms of coronavirus infection. Respiratory failure, the lethal manifestation of COVID-19, responsible for 264,679 deaths worldwide, is probably neurogenic in origin and may result from the viral invasion of cranial nerve I, progressing into rhinencephalon and brainstem respiratory centers. Cerebrovascular disease, in particular large-vessel ischemic strokes, …

Steriotactic Radiosurgery For Vestibular Schwannomas, Ummey Hani, Dr Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

The approach to treating vestibular schwannomas ranges from wait-and-scan policies to micro-and radiosurgery. However, in the past few decades, Stereotac tic Radiosurgery (SRS) has emerged as an approved primary treatment option as well. In this review, we have assessed some of the existing literature on the role of SRS in the management of vestibular schwannomas, and to estimate its efficacy in tumour control and conservation of cranial nerve function.

Neurological Manifestations Of Covid-19, Dureshahwar Kanwar, Abdul Mannan Baig, Mohammad Wasay

Section of Neurology

Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) has turned out to be a formidable pandemic. Upcoming evidence from confirmed cases of COVID-19 suggests an anticipated incursion of patients with neurological manifestations in the weeks to come. An expression of the angiotensin-converting enzyme 2 (ACE 2), the cellular receptor for SARS-CoV-2 over the glial cells and neurons have made the brain a potential target. Neurotoxicity may occur as a result of direct, indirect and post-infectious complications. Attention to neurological deficits in COVID-19 is fundamental to ensure appropriate, timely, beneficial management of the affected patients. Most …

Utility Of Tranexamic Acid To Minimize Blood Loss In Brain Tumour Surgery, Syed Sarmad Bukhari, Muhammad Shahzad Shamim

Section of Neurosurgery

Tranexamic acid is emerging as a useful option for a number of clinical indications, by virtue of its anti-fibrinolytic properties that allow better haemostasis and lesser blood loss. Herein, the authors have attempted to summarize the existing evidence on the possible role of tranexamic acid in brain tumour surgeries.

Neurological Involvement In Covid-19 Infections; Pathophysiology, Presentation And Outcome., Dureshahwar Kanwar, Muhammad Imran, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Severe acute respiratory syndrome corona virus 2 (SARS CoV 2) seems to display an increasing affinity for the nervous system. The ongoing pandemic has made evident that diverse neurological manifestations may occur with COVID 19. Headache and dizziness remain the most common symptoms however stroke, seizures, encephalopathy, neuropathy and skeletal muscle injury may be seen. An increasing number of patients report initial anosmia and ageusia. Tendency for serious illness is believed to be in the elderly or people with a history of diabetes, high blood pressure and heart disease. Many patients on immunosuppressive therapies such as multiple sclerosis, myasthenia gravis …

Primary Intracranial Malignant Melanoma, Ummey Hani, Dr Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

Primary intracranial malignant melanoma (PIMM) are rare brain tumours; more infrequent than melanomas metastasizing to the brain or those extending to the brain from adjacent structures such as the orbit. Complete surgical excision with adjuvant chemotherapy and radiation remains the mainstay of treatment. Herein, we have reviewed the literature to find the treatment modalities for PIMMs that can lead to longer overall survivals and better patient outcomes.

Narcolepsy :A Review Amongst Sleep Disorders., Muhammad Umer Ahmed, Manahil Jeoffrey, Omer Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Narcolepsy is a sleep disorder known and studied about from time to time is a sleep disorder characterized by a combination of myriad of symptoms including excessive day time sleepiness with recurrent irresistible sleep attacks , hypnogogic hallucinations ,hypnopompic hallucinations ,sleep paralysis and cataplexy (sudden and bilateral loss of muscle tone.1 Narcolepsy may present it self long with cataplexy or without cataplexy. The pathogenesis behind narcolepsy is found to be due to degeneration of hypocretin/orexin secreting neurones in the central nervous system due to disorder of human leukocyte antigen DQB1*0602.Narcolepsy is a deblitating disorder which causes intense functional impairment and …