Neurology Commons^™

Neurotoxicity In A Young Patient With Diffuse Large B-Cell Lymphoma After First Dose Of Intrathecal Triple Therapy., Ali Sajjad, Sajid Hameed, Sara Khan

Pakistan Journal of Neurological Sciences (PJNS)

Intrathecal triple chemotherapy (ITT) including cytarabine arabinoside, methotrexate and glucocorticoids is a standard regimen for prophylaxis and treatment of hematological malignancies, owing to their high proclivity for invasion of the neuraxis. Unfortunately, intrathecal chemotherapy is associated with various neurological adverse effects including seizures, encephalopathy, myelopathy, arachnoiditis and cauda/conus syndrome. We present a case of 33-year-old lady with primary bone diffuse large B-cell lymphoma. She had received 4 cycles of R-CHOP* and later 2 cycles of R-DHAP**. The first dose of ITT was administered along with the last cycle of R-DHAP. On the third day post-ITT, she developed acute bilateral lower …

Extended Window Intravenous Thrombolysis: Is Conventional Window Of 4.5 Hours Coming To An End?, Malik Muhammad Adil, Narmeen Masood

Pakistan Journal of Neurological Sciences (PJNS)

The current standard of care to treat acute stroke patients presenting within 4.5 hours of stroke symptom onset is intravenous (IV) Alteplase.1 Over the past decade, tremendous efforts have been made to challenge the conventional window of 4.5 hours for the administration of Alteplase to expand the patient population which can benefit from thrombolysis. Based on the recent meta-analysis, 2 we have strong evidence supporting the use of IV thrombolysis in patients presenting between 4.5 to 9 hours of symptom onset with favorable perfusion imaging and it appears that the era of the conventional 4.5 hours window may be coming …

Science Of Lifestyle; Strategies For Change, Raza Ur Rahman

Pakistan Journal of Neurological Sciences (PJNS)

Since the start of 21st century the focus of medical treatment is changing from curative to the preventive medicine and now functional recovery and quality of life are the outcome of curative medicine. These new outcomes of modern medicine can be achieved through adopting the strategies that enhance wellness of patient. The methods of enhancing wellness are in practice since centuries and their effectiveness has been handed down through word of mouth and tradition. They continue to evolve and were first documented in 1970s, by Canyon Ranch1, as a strategy to improve health through the principles of a healthy lifestyle. …

Post-Stroke Seizures: A Clinically Oriented Analysis, Sajid Hameed, Haris Hakeem, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is an important cause of secondary epilepsy, especially in the elderly. Not only does this impact morbidity and mortality in an adverse way, it also prolongs the hospitalization. Various risk factors have been described in literature that increase the risk of seizures in a patient with stroke. Post stroke seizures fall on a spectrum of acute symptomatic and unprovoked seizures with varying pathophysiology and risk of subsequent development of epilepsy. Hence, the treatment approaches are also different. However, randomized controlled trials are lacking to guide monitoring and management strategies in post stroke seizures and the approaches remain individualized to …

An Overview Of Autism: Is It Treatable In Pakistan?, Tania Nadeem, Rabeeka Aftab, Nargis Asad

Pakistan Journal of Neurological Sciences (PJNS)

Autism Spectrum Disorder (ASD) is a clinically complex, pervasive neurodevelopmental disorder with early appearing social communication deficits and repetitive sensory–motor behaviors.1 Although affected individuals differ significantly from one another, typically the disorder is characterized by impairment in social reciprocity and communication. Children usually have speech delays or lack of social interaction including: lack of eye contact, limited response to name, decreased interest in peers, and restricted shared attention with parents.1 Autistic individuals also exhibit repetitive behaviors like flapping, lining, or stacking objects and narrowly focused rigid interests such as paying particular attention to spinning objects.1 It usually manifests before 3 …

What, When And For Whom Model Of Nutrition: A Health Management Approach, Muhammad Rafiq

Pakistan Journal of Neurological Sciences (PJNS)

Studies have shown that nutrition plays an important role in the pathophysiology of different health issues either physiological, or psychological. Nutrition is implicated in the development of health issues in different ways. The purpose of this mini review was to suggest a comprehensive model of nutrition, “What, When and for Whom Model of Nutrition”, in the light of existing literature. For this purpose, existing literature was explored to study the role of nutrition on mental health in perspective to, what type of nutrition, when it is consumed and/or who consumes it. Researchers concluded that it is not only what we …

Diagnostic Dilemmas Of Progressive Supranuclear Palsy, Humera Saeed, Qurat Ul Ain Khan, Syeda Masharab Jilani, Syeda Maheen Batool

Pakistan Journal of Neurological Sciences (PJNS)

In this report authors discuss similarities between psychiatric phenomenon i.e. catatonia and neuropsychiatric syndromes such as progressive supranuclear palsy (PSP) in a 51 years old male, known case of hypertension and diabetes, who presented to the psychiatric services with mutism, stereotypical movements of upper limbs, echolalia, anteriorly flexed neck, swallowing difficulty, decreased oral intake, urinary and fecal incontinence for a period of 1 year worsened for 6 months. Patient was initially treated for catatonia with benzodiazepines and electroconvulsive therapy but did not improve. A neuropsychiatric consultation was sought and a diagnosis of possible PSP was made according to the National …

The Natural Predominant Sleeping Positions In Cerebral Palsy; Does It Correlate With The Type Of Cerebral Palsy?, Sarah Razaq, Muhammad Aleem Arshad, Tahira Amjad

Pakistan Journal of Neurological Sciences (PJNS)

To see the natural positions of cerebral palsy subjects during sleep and their correlation with the particular type of cerebral palsy.

Tacrolimus-Associated Posterior Reversible Encephalopathy Syndrome In Allogenic Hematopoietic Stem Cell Transplant, Hina Imtiaz, Maryam Jamil Syed, Dureshahwar Kanwar, Bushra Taimuri, Sajid Hameed

Pakistan Journal of Neurological Sciences (PJNS)

Tacrolimus is an immunosuppressive drug used to lower the risk of transplant rejection in individuals after solid organ or hematopoietic transplantation. Cases of posterior reversible encephalopathy syndrome (PRES) as a complication of tacrolimus therapy are infrequently documented. The pathogenesis of this phenomenon is not well understood. Here, we report a case of an 18-year-old female with a history of acute myeloid leukemia that developed PRES after undergoing an allogeneic stem cell transplant and subsequent immunosuppressive therapy with tacrolimus.

Cross-Sectional Study Of Knowledge Of Stroke Management Amongst Doctors Of A Tertiary Care Hospital; Peshawar, Pakistan, Muhammad Fozan Khan, Farzana Behttani, Omer Nasim, Muhammad Shahid Iqbal, Sohail Khan, Muhammad Khizar Hayat

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is one of the leading causes of mortality and neurological disability worldwide. ‘Time is brain’ and prompt management of stroke is vital to improve the outcomes. Knowledge of stroke management is important for clinicians working in various specialties and this study focused on evaluation of this vital aspect.

Pituitary Adenoma With Calcifications: A Case Report, Yakoot Khan, Noor Malik, Saba Iqbal Awan, Syed Hassan Khalid, Altaf Ali Laghari

Section of Neurosurgery

Pituitary adenomas and Rathke’s cleft cyst with calcification are rarely seen and craniopharyngioma still remains the common sellar suprasellar space occupying lesion with calcification. Presence of calcification is reported in pituitary adenoma in only 0.2% to 8% cases. The pituitary adenoma with calcification is a rare radiological finding and it must be distinguished from other lesions of the pituitary gland as the management and prognosis differs significantly. We report a case of a 29-year-old gentleman presented electively with the complaints of deterioration of vision for four months. CT-scan without contrast examination revealed pituitary adenoma with calcification. The patient underwent transsphenoidal …

Timing Of Postoperative Magnetic Resonance Imaging (Mri) Following Glioma Resection: Shattering The 72 Hour Window, Syed Sarmad Bukhari, Muhammad Shahzad Shamim, Fatima Mubarak

Section of Neurosurgery

Extent of enhancing tumour resection is correlated with progression free survival following glioma surgery. Historically, a contrast enhanced MRI has been recommended within 72 hours following surgery to evaluate for residual disease. This theoretical window was established amidst conflicting evidence to avoid reactive enhancement. Recent studies with better designs and better imaging quality have sought to challenge this window with a more pragmatic method of evaluating residual disease.

Spectrum Of Neurological Disorders In Neurology Outpatients Clinics In Urban And Rural Sindh, Pakistan: A Cross Sectional Study, Safia Awan, Alam Ibrahim Siddiqi, Ahmed Asif, Naveeduddin Ahmed, Hazim Brohi, Sajad Jalban, Mohammad Wasay

Section of Neurology

Background: Neurological disorders are the most common cause of morbidity and mortality in developing countries. Available evidence on urban–rural differences on neurological diseases is scare in such countries. Our study objective was to determine the prevalence of neurological diseases in urban and rural tertiary care hospitals of Sindh, Pakistan.

Methods: This was a cross sectional study conducted in selected urban and rural region of tertiary care hospitals of Sindh, Pakistan. The outpatients medical records of adults (18 years and above) was obtained from January 1st, 2014 to December 31st, 2014.

Results: A total of 10,786 outpatients visit were recorded in …

Emergency Care Surveillance And Emergency Care Registries In Low-Income And Middle-Income Countries: Conceptual Challenges And Future Directions For Research, Hani Mowaf, Christine Ngaruiya, Gerard O'Reilly, Olive Kobusingye, Vikas Kapil, Andres Rubiano, Marcus Ong, Juan Carlos Puyana, Akm Fazlur Rahman, Rashid Jooma, Blythe Beecrof, Junaid Razzak

Section of Neurosurgery

Despite the fact that the 15 leading causes of global deaths and disability-adjusted life years are from conditions amenable to emergency care, and that this burden is highest in low-income and middle-income countries (LMICs), there is a paucity of research on LMIC emergency care to guide policy making, resource allocation and service provision. A literature review of the 550 articles on LMIC emergency care published in the 10-year period from 2007 to 2016 yielded 106 articles for LMIC emergency care surveillance and registry research. Few articles were from established longitudinal surveillance or registries and primarily composed of short-term data collection. …

Endoscopic Transsphenoidal Surgery For Cushing's Disease: A Review, Mirza Zain Baig, Altaf Ali Laghari, Aneela Darbar, Umme E Hani Abdullah, Sumiya Abbasi

Section of Neurosurgery

Ever since the 1960s, transsphenoidal surgery has been the modality of choice for treating Cushing's disease. Subsequent visualization of the pituitary fossa and sphenoid sinus may be done either with the operating microscope or with the relatively new endoscope. The endoscope due to its panoramic view allows greater visualization as compared to the operating microscope. It confers greater access to the cavernous sinus, sella, suprasellar, and parasellar regions and accommodates higher magnifications. It is bi-dimensional, however as opposed to the operating microscope that provides a three-dimensional view and allows greater depth perception. This article provides a comprehensive review of the …

Effect Of Pregnancy On Growth Of Intracranial Meningiomas, Ayesha Quddusi, Muhammad Shahzad Shamim, Quratulain Virani

Section of Neurosurgery

Meningiomas are the most common benign primary intracranial tumours in adults. Their rapid growth during pregnancy has been well reported. Moreover, the relationship of increased progesterone expression during pregnancy and extensive tumour growth has been debated. In this review, we discuss not only the effect of progesterone on meningiomal growth but also other mechanisms involved in gestational meningiomas.

Ossification Of The Cruciform Ligament Of Atlas; A Rare Cause Of Cervical Myelopathy: Case Report And Review Of Literature, Muhammad Waqas Saeed Baqai, Gohar Javed, Mirza Zain Baig

Section of Neurosurgery

We present a case of cervical myelopathy secondary to ossification of the cruciform ligament (also known as cruciate ligament). This is a rare phenomenon that, to the best of our knowledge, has only been reported 16 times previously in literature. We have added a review of literature after our case presentation. We hope that by doing so, we may aid clinicians reach early diagnosis so as to be able to better manage this rare disease.

Perianal Necrotizing Fasciitis With Retroperitoneal Extension: A Case Report From Pakistan, Mirza Zain Baig, Abeer Aziz, Umme E Hani Abdullah, Muhammad Salman Khalil, Sumiya Abbasi

Section of Neurosurgery

Necrotizing fasciitis is a rare but potentially fatal condition. It is defined as a rapidly spreading infection of the subcutaneous soft tissue. Extension into the retroperitoneum may further complicate this deadly condition. We report a case of a 45-year-old gentleman who presented to our institute with perianal necrotizing fasciitis with extension into the retroperitoneum. He was managed with antibiotics and prompt surgical debridement. Our patient had a positive outcome which may be due to the fact that we had a high clinical suspicion, on the basis of which we opted for early operative management rather than delaying definitive treatment by …

Guillain-Barre Syndrome Following A Snakebite: A Case Report And Review Of Literature, Sajid Hameed, Mubashar Memon, Sara Khan

Section of Neurology

Guillain-Barre syndrome (GBS) is preceded by a respiratory or gastrointestinal illness in more than 50% of the patients. A rare association of GBS with a preceding snakebite is reported in the literature in only four previous cases. We present a case report of a patient diagnosed with GBS following the bite of a yellow-bellied sea snake (Hydrophis platurus) and a brief review of the available literature.

Yield Of Muscle Biopsy In Patients With Findings Of Myopathy On Electrodiagnostic Testing, Sarah H. Siddiqui, Raheel Ahmed, Safia Awan, Ambreen Zain, Sara Khan

Section of Neurology

Background: The evaluation of neuromuscular diseases includes detailed clinical assessment, blood testing, electrodiagnostic studies (EDS), biopsy, and genetic tests. EDS alone cannot provide a specific diagnosis. Further testing in the form of genetic tests or muscle biopsy (MB) is required. Objective The objective of the study is to evaluate the yield of MB in patients with findings of myopathy on electrodiagnostic testing and assess the factors affecting an abnormal biopsy outcome.

Methods: Electromyography (EMG)/nerve conduction studies (NCS) performed for suspected myopathy over 5 years from 2011 to 2016, at the neurophysiology department of a tertiary care center in Pakistan, were …

Patent Foramen Ovale Closure In Young Patients With Cryptogenic Stroke: A Case Series And Follow Up From Saudi Population., Aishah Albakr, Noman Ishaque, Rizwana Shahid, Alaa Jamal Al Obaidli, Noora Waleed Alayyaf, Mohammed Almansoori, Sarah Ali Saleh Al Amri

Pakistan Journal of Neurological Sciences (PJNS)

One quarter of cerebral infarctions are cryptogenic and most of these patients are young. Patent Foramen Ovale (PFO) is found to be more prevalent in young persons with cryptogenic stroke and risk of stroke recurrence in such patients ranges from as low as 2% per annum to as high as 12% per annum. Since patients with PFO and cryptogenic stroke are young they need more effective ways to reduce risk of stroke recurrence hence percutaneous closure of PFO seems reasonable approach to deal with this etiology of stroke in such population. We report four cases of cryptogenic stroke in young …

Early Versus Delayed Flow Diversion For Ruptured Intracranial Aneurysms: A Meta-Analysis, Rimal Hanif Dossani, Devi P. Patra, Jennifer Kosty, Fareed Jumah, Okkes Kuybu, Nasser Mohammed, Muhammad Waqas, Muhammad Riaz, Hugo Cuellar

Section of Neurosurgery

Objective: The use and timing of flow diversion for aneurysmal subarachnoid hemorrhage is controversial. The objective of this study is to perform a meta-analysis and systematic review to compare overall complication rate between early versus delayed flow diversion for ruptured aneurysms.
Methods: A literature search for all eligible articles was performed using PubMed, Cochrane, and Web of Science databases. The primary outcome was the overall complication rate (any complication in the perioperative period), and secondary outcomes were 1) hemorrhage and 2) stroke/death (all hemorrhagic/ischemic strokes and/or death).
Results: Thirteen articles including 142 patients met inclusion criteria. Eighty-nine (62.7%) patients underwent …

Serum Biomarkers For Glioblastoma Multiforme, Ayesha Quddusi, Muhammad Shahzad Shamim

Section of Neurosurgery

A number of different serum biomarkers are currently being evaluated for their potential use as diagnostic and prognostic biomarkers in Glioblastoma Multiforme. Amongst these, a vast number of different microRNAs have been studied, that are up-regulated or downregulated in relation to Glioblastoma Multiforme. Different studies have found numerous associations of these different microRNAs with recurrence, Karnofsky Performance Score, Progression Free Survival and Overall Survival. Other than microRNAs, serum Glial Fibrillary Acid Protein, cytokines and YLK-40, as well as a number of other candidate serum biomarkers are being studied.More studies, with larger sample sizes are required before these serum biomarkers can …

Vgkc Antibody (Anti Lg1) Associated Limbic Encephalitis In A Young Adult With Full Recovery., Farheen Niazi, Madeeha Iftikhar, Rizwan Ali, Tahir Aziz

Pakistan Journal of Neurological Sciences (PJNS)

A young boy with no premorbids was admitted with fever, fits and psychosis. His initial investigations including cerebrospinal fluid (CSF) routine examination, electroencephalogram(EEG) and MRI brain with contrast were normal. His autoimmune encephalitis panel revealed positive voltage gated potassium channel(VGKC) antibodies, anti -leucine rich glioma inactivated 1 antibody (LG1) group and was give five doses of methylprednisolone and five sessions of plasmapheresis. Psychiatric symptoms took one month to respond. He had a complete recovery. Autoimmune limbic encephalitis should be diagnosed promptly in young patient with fit, psychosis and a high index of suspicion should be kept as initial work up …

Polyneuropathy Associated With Iga Paraproteinemia: A Case Report And Literature Review., Waleed Shahzad, Sumaira Nabi, Hafiza Faiza Mushtaq, Tehmina Inayat, Muhammad Hassan, Haris Majid Rajput, Zakir Jan, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Paraproteinemia is precipitated by an accumulation of monoclonal plasma cells or B lymphocytes. Idiopathic neuropathies that are associated with paraproteinemia account for only 10% of the neuropathies. Paraprotein acts like an antibody and is targeted against myelin and axons present in the peripheral nerves. Despite being of interest for quite a long time, the caudal relationship between paraproteinemias and peripheral neuropathies still remains a sorcery. We report a case of a middle aged male who presented with pain and parasthesias in both arms and legs. His workup revealed him to be having a paraproteinemic neuropathy consistent with IgA Lambda chains …

Is It Really Transverse Myelitis? Acute Flaccid Myelitis A Rare Entity., Hina Yusuf, Arsalan Ahmad, Ejaz Ahmed Khan

Pakistan Journal of Neurological Sciences (PJNS)

Acute Flaccid Myelitis is a relatively new and rare disease entity which was recognized for the first time in United States in 20121. Usually children below 18 years of age present with sudden onset rapidly progressive flaccid paralysis sometimes following upper respiratory tract infection. To date no cases have been reported from Afghanistan and Pakistan. We are reporting case of a young girl who presented with sudden onset flaccid paralysis and respiratory distress. Her MRI Cervical spine showed longitudinally extensive transverse myelitis. One year after the onset of disease flaccid paraparesis continued despite various treatments. It is important to report …

Spectrum Of Electroencephalogram Finding In Children With Newly Diagnosed Epilepsy –An Experience At A Tertiary Care Hospital., Sanam B. Rajper, Khairunnisa Mukhtiar, Fozia Baloch, Shahnaz H. Ibrahim, Abdul Rashid Memon

Pakistan Journal of Neurological Sciences (PJNS)

Epilepsy is the most common neurological disorders that affect all age groups. It is characterized by at least two unprovoked seizures more than 24 hours apart. The most common investigation used for both diagnosis and management is an Electroencephalogram (EEG), which is relatively cheap and easy to perform. However, EEG requires technical expertise and is prone to misinterpretation. Objective: To determine the frequency of abnormal EEG findings in children with newly diagnosed epilepsy at tertiary care hospital.

Humanism And Mental Health Of Married Female Patients With Systemic Lupus Erythematosus., Hafiza Muzammal Shafiq, Dr. Muhammad Rafiq, Dr. Zahid Mahmood

Pakistan Journal of Neurological Sciences (PJNS)

Autoimmune diseases exert adverse impact on the psychological, social and physical well-being of the individuals who suffer from such diseases. Systemic lupus erythematosus is one of chronic illnesses that disturb the all areas of life especially psychosocial perspective of life. In such conditions, belief and view of patients about their own self is necessary to prognosis of their health. Studies suggest that humanism is one of those protective factors that can lead risky health towards better life.

The Mhgap; Will It Bridge The Mental Health Treatment Gap In Pakistan?, Shireen Najam, Aisha Sanober Chachar, Ayesha Mian

Pakistan Journal of Neurological Sciences (PJNS)

In Pakistan, the treatment gap for mental disorders is significantly high. Pakistan faces a unique problem of sustainable delivery. In 2009, WHO launched a mental health gap action program (mhGap) to provide evidence-based services at the primary and secondary level for the prevention and management of psychiatric and neurological disorders. This article highlights the discrepancies of the systems and issues related to mental health services provision in Pakistan. By discussing two initiatives of mhGap implementation for the Pakistani health system, authors have surveyed core areas where the sustainability of such a model can be compromised. The structural challenges marked by …

Alterations In Human Reaction Time Upon Consumption Of Taurine-Caffeine Based Energy Drink. A Gender Based Study., Asif Abbasi, Amaila Fazal, Faizan Mirza, Sadaf Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Energy drinks contains several potentially psychoactive ingredients including taurine, glucoronolactone, and caffeine that increases the human performances, reaction time and mood with relative differences to visual and auditory stimuli between both the genders.