Neurology Commons^™

Vagal Nerve Stimulation; Current And Future Interventions, Sidra Saleem, Muhammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Vagus Nerve is the 10th and the largest cranial nerve of the parasympathetic system, consist of approximately 20% efferent and 80% afferent. It is a big nerve, providing autonomous, cardiovascular, respiratory, gastrointestinal, immune and endocrine systems.

Perception Of Shisha Smoking & Drug Abuse Among University Students Of Karachi, Farwah Rizvi, Lubna Naz, Nazneen Zehra

Pakistan Journal of Neurological Sciences (PJNS)

Tobacco smoking in the form of cigarettes and shisha hasbecome a sign of modernization and trend among youth for pleasant and relaxing experience. Drug addiction is the most common problem in young ones nowadays causing craving practices and long-term consequences includesdisturbances in physical and mental health.

Prevalence Of Risk Factors Promoting Diabetic Neuropathy ., Aisha Qadir, Sumera Sohail1, Lubna Naz, Ghazala Yasmeen, Nazish Iqbal

Pakistan Journal of Neurological Sciences (PJNS)

Diabetic neuropathy is the worst consequence of diabetes mellitus leading to nerve dysfunction that is the cause of several complications such as pain, loss of sensitivity, damage to body systems, foot ulcers, morbidity and amputations etc. The aim of the present work was to study the prevalence of risk factors and occurrence of diabetic neuropathy in patients with diabetes, and how much diabetic neuropathy complications affect the life of diabetic patients.

Freehand Pedicle Screw Fixation: A Safe Recipe For Dorsal, Lumbar And Sacral Spine, Muhammad Junaid, Ali Afzal, Anisa Kalsoom, Syed Sarmad Bukhari

Section of Neurosurgery

Objective: To determine outcome of freehand pedicle screw fixation for dorsal, lumbar and sacral fractures at a tertiary care centre in the developing world.
Methods: A retrospective review was performed of 150 consecutive patients who underwent pedicle screw fixation from January 1, 2012 to 31^st December 2017. A total of 751 pedicle screws were placed. Incidence and extent of cortical breach by misplaced pedicle screw was determined by review of intra-operative and post-operative radiographs and/or computed tomography.
Results: Among the total 751 free hand placed pedicle screws, four screws (0.53%) were repositioned due to a misdirected trajectory towards the …

Enhanced Recovery After Elective Craniotomy For Brain Tumours, Ummey Hani, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

Enhanced recovery after surgery (ERAS) is aimed at accelerated rehabilitation after surgery, and involves a multidisciplinary approach. Significant work has been published on this concept with regards to abdominal surgeries, however, the idea is relatively new for those undergoing neurosurgical procedures. We have reviewed literature on ERAS in patients undergoing craniotomy for brain tumours.

Need Of Physical And Chemical Restraints: Experiences At Inpatient Psychiatric Ward In A Tertiary Care Hospital In Karachi, Pakistan, Humera Saeed, M. Shameel Khan, Syeda Maheen Batool, Asma Akbar Ladak, Nadia Karim, Rabeeka Aftab

Department of Psychiatry

In psychiatry, agitated / aggressive patients are often treated with de-escalation techniques. If this does not work, physical or chemical restrains are required; but in the event of resistance, seclusion is applied. We report the findings of baseline study of experiences of physical and chemical restraints in a tertiary care hospital in Karachi, where 104 files were evaluated retrospectively. The mean age of patients was 32.5 ±14.3 years with 54.8% men, while the average length of stay was 11.5 ±9.3 days. Agitation, violent behaviour, and aggression were the most common indications for restraints. In total, 94.5% of patients had both …

Dementia In Pakistan; An Unprecedented Challenge And Local Cultural Beliefs, Problems And Actions Required., Qamar Zaman, Maimoona Siddiqui, Zaha Iqbal Malik

Pakistan Journal of Neurological Sciences (PJNS)

Changing cultural and social dynamics has brought a major shift in lifestyles and associated risk factors for various disorders that were previously uncommon in Pakistan. Dementia is among the one of these emerging problems that is going to affect the elderly population worldwide but more so in the developing world. To adequately deal with the problems faced by patients with dementia and their caregivers, several important measures are needed that can help to reduce the morbidity and burden on the families and overall society. Increasing the awareness regarding the risk factors may help to reduce the dementia burden similarly knowledge …

Use Of Novel Oral Anticoagulants For Treatment Of Cerebral Venous Sinus Thrombosis: A Case Series And Follow Up, Rizwana Shahid, Noman Ishaque, Aishah Albakr, Nourah Abdulaziz Alkhaldi, Feras Abdulsalam, Abdullah Alsulaiman

Pakistan Journal of Neurological Sciences (PJNS)

Thrombosis of cerebral venous sinuses and/or cortical veins (CVST) is an infrequent type of stroke for which anticoagulation is considered standard of treatment. However, 40% of CVST patients have evidence of parenchymal changes like edema or haemorrhage on neuroimaging which complicates use of anticoagulation in such cases. Therefore, Novel Oral Anticoagulants (NOACs) are recently being used for treatment of CVST as they are associated with half the risk of intracerebral haemorrhage as caused by vitamin K antagonist. Case reports and case series have reported use of NOACs in CVST with good outcomes both clinically and radiologically. We report use of …

New Oral Anticoagulants Versus Warfarin For Cerebral Venous Thrombosis: A Multi-Center, Observational Study, Mohammad Wasay, Maria Khan, Haris Majid Rajput, Salman Farooq, Mohammed Ibrahim Memon, Suhail Abdulla Alrukn, Abdul Malik, Foad Abd-Allah, Raja Farhat Shoaib, Rizwana Shahid, Sadia Nishat, Safia Awan

Section of Neurology

No abstract provided.

A New Health Care Model For Pakistan, Mohammad Wasay, Ashar Malik

Section of Neurology

No abstract provided.

Diagnostic Accuracy Of Diffusion Weighted Mri In Differentiating Benign And Malignant Meningiomas, Din Muhammad Sohu, Saba Sohail, Rehana Shaikh

Department of Radiology

Objective: To determine the diagnostic accuracy of DWI in differentiating benign and malignant meningiomas keeping histopathology as gold standard.
Methods: This was a descriptive analytical study conducted at Radiology Department, DUHS/Dr. Ruth K. M. Pfau Civil Hospital Karachi, from August 2016 to March 2018.It included152 patients clinically suspected of meningioma on conventional neuroimaging. Imaging features of DWI were compared with histopathology findings. The diagnostic accuracy of DWI was calculated in terms of sensitivity, specificity, accuracy, PPV and NPV using histopathology as gold standard.
Results: There were 59 male and 93 female patients with mean age of 55.38±9.8 years. Mean duration …

Diffuse Low-Grade Glioma - Changing Concepts In Diagnosis And Management: A Review, Rashid Jooma, Muhammad Waqas, Inamullah Khan

Section of Neurosurgery

Though diffuse low-grade gliomas (dLGGs) represent only 15% of gliomas, they have been receiving increasing attention in the past decade. Significant advances in knowledge of the natural history and clinical diversity have been documented, and an improved pathological classification of gliomas that integrates histological features with molecular markers has been issued by the WHO. Advances in the radiological assessment of dLGG, particularly new magnetic resonance imaging scanning sequences, allow improved diagnostic and prognostic information. The management paradigms are evolving from "wait and watch" of the past to more active interventional therapy to obviate the risk of malignant transformation. New surgical …

Role Of Surgery In Spinal Metastases, Altaf Ali Laghari, Humza Faisal Siddiqui, Muhammad Shahzad Shamim

Section of Cardiology

Spinal metastases constitute two-third of all cases of bone metastases. Surgical intervention in these tumours has been recommended in highly selective cases, for confirming diagnosis, stabilizing the spine, and decompressing nerves or spinal cord for alleviation of pain and preservation of function.In this article,the authors have reviewed available evidence on role of surgery in spinal metastases and have presented results of selected papers on this vast topic.

Rare Variant Of Guillain-Barré Syndrome After Chikungunya Viral Fever, Sajid Hameed, Sara Khan

Section of Neurology

Chikungunya (CHIK) viral fever is a self-limiting illness that presents with severe debilitating arthralgia, myalgia, fever and rash. Neurological complications are rare. We present a case of a 36-year-old woman who presented with acute onset progressive difficulty swallowing and left arm weakness. She was diagnosed with CHIK viral fever 4 weeks prior to admission. After investigations, she was diagnosed with a pharyngeal-cervical-brachial variant of Guillain-Barré syndrome. In hospital, she required ventilator support. Her condition improved after five sessions of intravenous immunoglobulin with almost complete resolution within 6 months of symptom onset. With frequent CHIK outbreaks, the neurological complications are increasingly …

Endovascular Coiling Versus Neurosurgical Clipping For Aneurysmal Subarachnoid Hemorrhage: A Systematic Review And Meta-Analysis, Syed Ijlal Ahmed, Gohar Javed, Syeda Beenish Bareeqa, Syeda Sana Samar, Ali Shah, Arwa Giani, Zainab Azam, Abeer Tasleem, Syed Hasham Humayun

Section of Neurosurgery

Background: Aneurysmal subarachnoid hemorrhage is a frequently devastating condition with a reported incidence of between 10 and 15 people per 100,000 in the United States. Currently, according to the best of our knowledge, there are not enough meta-analyses available in the medical literature of the last five years which compare the risks and benefits of endovascular coiling with neurosurgical clipping.
Methods: Twenty-two studies were selected out of the short-listed studies. The studies were selected on the basis of relevance to the topic, sample size, sampling technique, and randomization. Data were analyzed on Revman software.
Results: Mortality was found to be …

Current Situation And Future Recommendations For Neurophysiology Services In Pakistan, Imran Ahmad, Farooq Azam Rathore

Pakistan Journal of Neurological Sciences (PJNS)

Clinical neurophysiology is defined as “a medical specialty that studies the central and peripheral nervous systems through the recording of bioelectrical activity, whether spontaneous or stimulated”.1 There are different models of practice for clinical neurophysiology around the world. In some countries it is considered to be an independent specialty, while in other countries it is integrated with neurology.

Choice Of Therapeutic Anti-Seizure Medication In Patients With Brain Tumour, Altaf Ali Laghari, Syed Ijlal Ahmed, Namra Qadeer, Muhammad Shahzad Shamim

Section of Neurosurgery

Seizures are common in patients with brain tumours, even though prophylactic anti-seizure treatment for all patients with brain tumours is not recommended. Newer anti-epileptic drugs have shown benefits that outweigh the side effects of treatment and can also be given in combination with traditional anti-epileptic drugs. The authors have reviewed the literature on the various combinations of anti-epileptics in patients with seizures and brain tumours.

Management Of Non-Epileptic Seizures Through Hypnosis: A Case Study, Muhammad Rafiq, Sana Zaheer

Pakistan Journal of Neurological Sciences (PJNS)

Conversion disorder is associated with diverse somatic complaints including visual deficiency, psychogenic nonepileptic seizures, lethargy, paralyses etc. Studies have revealed that in addition to pharmacological treatment, psychological intervention including hypnosis has a significant impact in the management of conversion disorder. The current case study was focused to see any effect of unique hypnotic technique, Circle Therapy for the management of conversion disorder. The patient A.J. was referred for the evaluation and psychological management ofnon-epileptic seizures. After a complete physical and psychological observation and interview, stressors were identified a n d the patient underwent brief hypnotic session and it was suggested …

Multiple Sclerosis In Pakistan And Need For Multiple Sclerosis Registry, Haris Majid Rajput, Mohammad Wasay, Mazhar Badshah, Muhammad Hassan

Pakistan Journal of Neurological Sciences (PJNS)

Multiple sclerosis(MS) is an acquired chronic demyelinating disease of central nervous system is a leading cause of non-traumatic disability in young with significant socioeconomic impact. The aim of this study was to provide a comprehensive review of all available data of MS in Pakistan.

Value Of Periodic Transcutaneous Daytime Carbon Dioxide Monitoring In Screening For Respiratory Failure In Patients With Amyotrophic Lateral Sclerosis, Muhammad K Rafiq

Pakistan Journal of Neurological Sciences (PJNS)

There is no single test currently available, which can predict respiratory failure in patients with amyotrophic lateral sclerosis (ALS) with high sensitivity and specificity. This study explores the potential use of transcutaneous carbon dioxide (PtcCO2) monitoring in early detection of respiratory failure in ALS.

Prevalence Of Stress And Depression Among University Students Of Karachi, Nida Naseem, Lubna Naz, Nazneen Zehra

Pakistan Journal of Neurological Sciences (PJNS)

Stress is an all-time concerned issue in undergraduate students. Stress levels are high due to workload, pressure of academic and extra-curricular activities and unhealthy lifestyle. Though stress can be beneficial for academic growth but increased magnitude can be harmful for physiological, psychological and social aspects.

Posterior Reversible Encephalopathy Syndrome (Pres) Presenting As Transient Complete Visual Loss, Nismat Javed, Sohail Naseem, Mohammad Amer Awan, Shahzad Khan Siddique, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Application Of Epley Maneuver In Treating Benign Paroxysmal Positional Vertigo (Bppv), Nasir Yaqoob, Arif Herekar

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Cognitive And Brain Plasticity By Performing Small Scale Brain Activities In Youth, Sonya Arshad, Muhammad Nisar, Mushkbar Fatima, Sadaf Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Is playing video game really a waste of time? No…!!! It’s merely a simple way of making the brain physiology better, smarter and faster. Great quality games, which are testing, enlightening, and retaining, can make learning charming and compelling. Studies have shown that people who are engaged in playing video games have more grey matter in their brains which results in boosting up their cognitive skills.

Antioxidative Activity Of Clove (Syzygium Aromaticum) Oil Administration In Middle Cerebral Artery Occlusion (Mcao) Models Of Acute Focal Cerebral Ischemia, Hira Jawed, Mufzala Shamim, Sumera Sohail, Uzma Firdous, Nazish Iqbal Khan

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is a multifactorial neurological deficit syndrome. Oxidative stress is the principal underlying pathophysiological mechanism of ischemic stroke associated with neuronal damage and neuroinflammation.

Dermoid Cyst With No Intracranial Extension: A Case Report And Literature Review, Asra Tanwir, Noor Malik, Gohar Javed, Romana Idress

Section of Neurosurgery

Background: Dermoid cysts are cystic inclusion tumors. They comprise hair follicles, sweat glands, and sebaceous glands. They have lining of stratified squamous epithelium. The most common areas involved are face, lower back, and ovaries. Congenital cystic dermoid involving the anterior fontanelle with no intracranial extension is a rare scalp swelling. We present a case of dermoid cyst with no intracranial extension.
Case description: We report a case of 4-month-old child presented with a history of a scalp swelling since birth. The swelling increased in size progressively. Magnetic resonance imaging of the brain revealed extracranial cystic lesion over anterior fontanelle with …

Primary Trauma Care: A Training Course For Healthcare Providers In Developing Countries, Saqib Kamran Bakhshi, Rashid Jooma

Section of Neurosurgery

Outcomes of injury in low and middle income countries may be compromised by skill deficiencies of healthcare providers. Short subspecialty training courses can be a useful solution to skill-deficits. We report on the Primary Trauma Care programme, a 2-day course designed to train frontline health workers in resuscitation and early management of the injured with limited resources and equipment. Developed for use in weak health systems and now conducted in over 70 countries, the programme is cost-efficient with built-in design sustainability by way of early transfer of ownership to local partners to effect a cascade of trauma courses in their …

Diffusion-Weighted Magnetic Resonance Imaging May Be Useful In Differentiating Fungal Abscess From Malignant Intracranial Lesion: Case Report, Syeda Maheen Batool, Fatima Mubarak, Ather Enam

Section of Neurosurgery

Background: Diffusion-weighted magnetic resonance has a well-defined role in differentiating between important intracranial lesions. Sometimes, the surgeon is faced with a dilemma of how to diagnose an infectious versus malignant lesion.
Case Description: A 28-year-old male presented to the neurosurgery clinic with complaints of headache and left-sided weakness for 2 weeks. Neurological examination was intact. Magnetic resonance imaging (MRI) scan showed a large infiltrating heterogeneous mass involving the right parietal lobe. On further reviewing, there was homogenous diffusion restriction in the center of lesion. In addition, its aggressive behavior confirmed it to be a fungal abscess.
Conclusions: Correctly identifying an …

Multidisciplinary Care In Motor Neuron Disease, Sara Khan

Pakistan Journal of Neurological Sciences (PJNS)

Motor neuron disease (MND) is a progressive degenerative disorder of the motor neurons, resulting in progressive limb, bulbar and respiratory muscle weakness. No definitive disease modifying treatment is available at this time. The mainstay of management remains multidisciplinary care, which has shown to improve quality of life, prevents complications and may also increase life span. In this review, different medical specialties necessary to offer complete multidisciplinary care are discussed. Symptomatic management of individual symptoms commonly experienced by patients with MND is elaborated on.

Retracted: The Epidemiology Of Stroke In A Developing Country (Pakistan), M Ishaq Khan, Junaid I. Khan, Sheikh I. Ahmed, Sajjad Ali

Pakistan Journal of Neurological Sciences (PJNS)

Retraction Notice

Khan MI, Khan JI, Ahmed SI, Ali S. The epidemiology of stroke in a developing country (Pakistan).

Pak J Neurol Sci. 2018;13(3):30-44.

A reader brought to our attention that the article titled “The epidemiology of stroke in a developing country (Pakistan)”, published in Volume 13, Issue 3, of Pakistan Journal of Neurological Sciences (PJNS) was a redundant (duplicate) publication. We investigated this complaint and found out that prior to its submission to PJNS on February 11 2018, this article had already been published almost verbatim in Journal of Neurology & Stroke on January 23, 2018.

Reference of the …