Neurology Commons^™

Discover The Ibn-E-Sina Within You' Annual Neurology Research Day, May 2017 Shifa International Hospital, Islamabad, Faaraea Haroon

Pakistan Journal of Neurological Sciences (PJNS)

Headaches are the most prevalent neurological disorders and the most frequent symptom seen in general practice. The need to know further of such disorders in medical students is essential to ensure a healthier studying environment, which will ultimately yield better, more capable, health care professionals.

Neurosarcoidosis Presenting As Psychiatric Symptoms: A Diagnostic Challenge, Farheen Niazi, Tariq Hussain

Pakistan Journal of Neurological Sciences (PJNS)

Among patients having neurosarcoidosis, psychiatric manifestations can be seen in 20% of the patients.Sarcoidosis is extremely rare in Asia, being almost unknown in some countries like China and Southeast Asia.Neurosarcoidosis occurs in approximately 5% of patients with sarcoidosis. Neurosarcoidosis presenting as psychiatric manifestations has rarely been reported. We report a case of a young male who presented with psychiatric symptoms,was diagnosed with neurosarcoidosisand responded well to oral steroids.His symptoms were diffuseheadaches, and feelings of movement of fluid on top of headand certain other vague somatic complaints like body aches, vertigo etc. Such patients are difficult to diagnose as sarcoidosis is …

Prognostic Significance Of Idh 1 Mutation In Patients With Glioblastoma Multiforme, Inamullah Khan, Muhammad Waqas, Muhammad Shahzad Shamim

Section of Neurosurgery

Focus of brain tumour research is shifting towards tumour genesis and genetics, and possible development of individualized treatment plans. Genetic analysis shows recurrent mutation in isocitrate dehydrogenase (IDH1) gene in most Glioblastoma multiforme (GBM) cells. In this review we evaluated the prognostic significance of IDH 1 mutation on the basis of published evidence. Multiple retrospective clinical analyses correlate the presence of IDH1 mutation in GBM with good prognostic outcomes compared to wild-type IDH1. A systematic review reported similar results. Based on the review of current literature IDH1 mutation is an independent factor for longer overall survival (OS) and progression free …

Quality Of Life In Individuals Surgically Treated For Congenital Hydrocephalus During Infancy: A Single-Institution Experience, Saad Akhtar Khan, Muhammad Faheem Khan, Saqib Kamran Bakhshi, Omar Irfan, Hamza Abdur Rahim Khan, Asad Abbas, Safia Awan, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Congenital hydrocephalus (CH) is a frequently encountered birth anomaly that can hinder long-term neurologic maturity and social well-being of affected children. This study was undertaken to assess quality of life (QOL) 10-15 years after surgical treatment for primary CH during infancy at a tertiary care hospital in a developing country.
Methods: This retrospective cohort study included individuals who presented to Aga Khan University Hospital, Karachi, Pakistan, between 1995 and 2005 at QOL.
Results: Of 118 patients, 90 patients participated in the study. Mean age at first admission was 6.2 months. Mean length of follow-up was 5.4 years. Of these, …

Adaptation Of The Recent Life Changes Questionnaire (Rlcq) To Measure Stressful Life Events In Adults Residing In An Urban Megapolis In Pakistan, Azmina Artani, Shireen Shehzad, Iqbal Azam Syed, Moiz Abdul Sultan, Adeel Khoja, Ayeesha Kamran Kamal

Section of Neurology

Background: Contextually relevant stressful life events are integral to the quantification of stress. None such measures have been adapted for the Pakistani population.

Methods: The RLCQ developed by Richard Rahe measures stress of an individual through recording the experience of life changing events. We used qualitative methodology in order to identify contextually relevant stressors in an open ended format, using serial in-depth interviews until thematic saturation of reported stressful life events was achieved. In our next phase of adaptation, our objective was to scale each item on the questionnaire, so as to weigh each of these identified events, in terms …

Unmet Need For Surgery In South Asia, Sanjay Nagral, Maharra Hussain, Sarder A. Nayeem, Ranjan Dias, S. Ather Enam, Samiran Nundy

Section of Neurosurgery

No abstract provided.

Noninvasive Monitoring Intracranial Pressure - A Review Of Available Modalities, Marium Naveed Khan, Hussain Shallwani, Muhammad Ulusyar Khan, Muhammad Shahzad Shamim

Section of Neurosurgery

Background: Intracranial pressure (ICP) monitoring is important in many neurosurgical and neurological patients. The gold standard for monitoring ICP, however, is via an invasive procedure resulting in the placement of an intraventricular catheter, which is associated with many risks. Several noninvasive ICP monitoring techniques have been examined with the hope to replace the invasive techniques. The goal of this paper is to provide an overview of all modalities that have been used for noninvasive ICP monitoring to date.
Methods: A thorough literature search was conducted on PubMed, selected articles were reviewed in completion, and pertinent data was included in the …

Perioperative Steroids For Lumbar Disc Surgery: A Meta-Analysis Of Randomized Controlled Trials, Muhammad Waqas, Hussain Shallwani, Muhammad Shahzad Shamim, Khabir Ahmed

Department of Surgery Docs

Background: Our review question was "Does perioperative steroids administration, in comparison with other treatments or placebo, improve either postoperative pain control, length of hospital stay, or return to work in patients undergoing lumbar disc surgery?"
Methods: We searched PubMed, CINAHL PLUS, and Cochrane databases for randomized control trials (RCTs) studying the role of steroids for lumbar disc surgery. Studies that compared perioperative steroids with other treatments or placebo were included. Study outcomes included postoperative back pain, leg pain, length of hospital stay, and return to work. Data was extracted through a proforma. Means and mean differences were calculated for continuous …

Using Mobile Health (Mhealth) Technology In The Management Of Diabetes Mellitus, Physical Inactivity, And Smoking, Hasan Rehman, Ayeesha Kamran Kamal, Saleem Sayani, Pamela B. Morris, Anwar T. Merchant, Salim S. Virani

Department of Medicine

Purpose of Review: Cardiovascular mortality remains high due to insufficient progress made in managing cardiovascular risk factors such as diabetes mellitus, physical inactivity, and smoking. Healthy lifestyle choices play an important role in the management of these modifiable risk factors. Mobile health or mHealth is defined as the use of mobile computing and communication technologies (i.e., mobile phones, wearable sensors) for the delivery of health services and healthrelated information. In this review, we examine some recent studies that utilized mHealth tools to improve management of these risk factors, with examples from developing countries where available.
Recent Findings: The mHealth …

Low Cost Quality Initiatives For Management Of Neurosurgical Patients In Developing Nations: Perspective From A Tertiary Care Centre In Pakistan, Hamid Hussain Rai, Muhammad Waqas, Muhammad Shahzad Shamim

Section of Neurosurgery

Background: Targeting resources on cost-effective care strategies is pertinent for developing nations, specifically for already burdened specialties such as neurosurgery, where without state support and insurance companies, expenses are borne by the patient themselves.
Methods: This was a descriptive review of literary work published by the section of neurosurgery at Aga Khan University Hospital, Pakistan. We searched PubMed and CiNAHL databases to identify articles, which were then critically analyzed and discussed from a perspective of low-cost quality care.
Results: We demonstrate the cost effectiveness of three initiatives, namely, blood ordering protocol for elective spine arthrodesis, nonoperative management being superior to …

Gullain Barré Syndrome: Complications, Commonly Acquired Nosocomial Infections And Antibiotic Susceptibilities At Pakistan Institute Of Medical Sciences, Islamabad, Ali Zohair Nomani, Uzma Jamil, Mansoor Iqbal, Sumaira Nabi, Haris Majid Rajput, Misbah Ahmed, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Introduction: The cause of demise in GBS may be related to the sequelae of complications associated with the disease or its treatment. The primary objective of this study was to enumerate the prevalence of complications associated with treatment of patients with GBS at a tertiary care setup in Islamabad. The secondary objective was to determine the antibiotic susceptibility patterns of commonly encountered infections in GBS during hospital stay in our setup. Materials and methods: The study was carried out between Jan 2014 and June 2015 on one hundred patients of GBS aged ≥ 12 years. Baseline characteristics, complications and antibiotic …

Frequency Of Non-Motor Symptoms In Parkinson Disease: Experience From Pakistan, Saira Saad, Ali Zohair Nomani, Mazhar Badshah, Aamir Afzal

Pakistan Journal of Neurological Sciences (PJNS)

The objective of this study was to determine the frequency of non-motor symptoms (NMS) in patients with Parkinson's disease (PD) and to compare frequency in mild and severe disease. Materials and methods: This descriptive observational study was done from January 2015 to June 2015 at Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad. We used Non-Motor Symptom Questionnaire (NMS-Q); a validated scale using 30 questions related to 9 different domains of symptoms. Results: 62 patients were enrolled in the final data set of study (male 46, Female 16) with average age of 62.4 years (range=33-80). Non-motor symptoms were reported …

Establishment Of Site Specific Multi-Disciplinary Tumour Boards In Pakistan: Sharing Experience Of Neuro Oncology Team Based At A Tertiary Care University Hospital, Muhammad Waqas, Ahmed Nadeem Abbasi

Section of Neurosurgery

No abstract provided.

Recent Advances In Epilepsy, Mughis Sheerani

Pakistan Journal of Neurological Sciences (PJNS)

Listening to Dr Sarosh Irani in a recent Epilepsy conference about Fascio Brachial dystonic seizures associated with voltage gated potassium channel (VGKC complex/LG1 antibodies)(1) and then reading reports published in Neurology about continued recent use of trephination ‘expelling the demons’ in India(2), I was wondering how far we are in Southeast Asia in the understanding and treatment of this fascinating illness.

A Case Of Hashimoto’S Encephalopathy In A Patient With Lithium Toxicity, Saba Zaidi, Bashir A. Soomro, Dr Imran Chaudary, Fasiha Sohail

Pakistan Journal of Neurological Sciences (PJNS)

Hashimoto’s encephalopathy is a rare neurological disorder of unknown etiology. We presented, a case of middle aged male with bipolar disorder on Lithium carbonate for 30 years, admitted with altered behavior for 2 weeks and high Lithium levels. He was admitted with the suspicion of Lithium toxicity. EEG showed generalized epileptiform discharges. MRI brain revealed frontal cortical atrophy. CSF detailed report was normal. Further workup showed a high TSH level and positive anti-TPO (anti thyroid peroxidase) antibodies. Based on clinical picture, raised antibodies and no discernible cause, diagnosis of probable Hashimoto’s encephalopathy was made. He received pulse of methylprednisolone for …

Role Of Neuroradiology In Predicting Outome In Spontaneous Intracerebral Hemorrhage, Sumaira Nabi, Mazhar Badshah, Shahzad Ahmed, Ali Zohair Nomani

Pakistan Journal of Neurological Sciences (PJNS)

Spontaneous intracerebral hemorrhage (ICH) accounts for 8-13% of all strokes and is associated with a high mortality and morbidity. Western studies have identified various clinical and radiological factors which help in predicting outcome in patients with spontaneous ICH. Materials and methods: A consecutive series of 100 patients diagnosed with spontaneous ICH admitted to the neurology department were enrolled from 1stJanuary to 30th June, 2014.Radiological parameters on CT brain (plain) were recorded. In-hospital outcome was measured at the end of 7 days of hospital stay in terms of survival or mortality. Different radiological parameters and their effect on outcome were compared …

Frequency Of Miller Fisher Variant Of Guillain Barré Syndrome At A Tertiary Care Hospital, Karachi, Kiran Waqar, Sadaf Nasir, Khalid Sher, Meraj Fatima, Abdul Malik

Pakistan Journal of Neurological Sciences (PJNS)

Miller fisher syndrome is generally considered a rare but important variant of Guillain Barré Syndrome (GBS) having geographically variable incidence. Patients with this clinical syndrome are often misdiagnosed and mismanaged due to lack of awareness on the part of physician. Objective: To determine frequency of Miller fisher syndrome (MFS), variant of GBS in patients presenting to a tertiary care hospital in Karachi. Methods: This descriptive cross sectional study was conducted in the Department of Neurology, Jinnah Postgraduate Medical Centre (JPMC), Karachi. The duration was from April, 2014 to April, 2016 (two years). A total of 100 patients were included in …

Transcranial Direct Current Stimulation And Stroke Recovery: Opportunities And Challenges, Murtaza G, Hussain F, Iqbal M, Shahid Bashir

Pakistan Journal of Neurological Sciences (PJNS)

Transcranial direct current stimulation (tDCS) is one type of neuromodulation, which is an emerging technology that holds promise for the future studies on therapeutic and diagnosis applications in treatment of neurological and psychiatric diseases. However, there is a serious question among developing countries with limited financial and human resources, about the potential returns of an investment in this field and regarding the best time to transfer this technology from controlled experimental settings to health systems in the public and private sectors. This article reviews the tDCS as tools of neuromodulation for stroke and discusses the opportunities and challenges available for …

Spectrum Of Gullian Barre Syndrome In Children, Dr. Shaila Ali, Dr. M. Zia Ur Rehman, Dr. Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

GBS is a post-infectious poly-neuropathy involving mainly motor but sometimes also sensory and autonomic nerves. This is an epidemiological report on seasonal & monthly distribution of GBS & differences in GBS incidence between male & female in Punjab, Pakistan. Objective: To determine the seasonal variation, age and gender differentiation in children with GBS along with EMG/NCS findings. Study Design: Retrospective, observational,cross sectional study. Place and duration of study: Department of Neurology, Childrens Hospital & The Institute of Child Health, Lahore from January 2014 to December 2014. METHODS: We extracted data from multi centers retrospectively in a 1 year period (January …

A Giant Right Subclavian- Axillary Artery Aneurysm Presenting As Brachial Plexopathy, Mahnoor Hafeez,, Ateeque Ahmed Khan

Pakistan Journal of Neurological Sciences (PJNS)

We present a rare case of 60 years old lady with diabetes and uncontrolled systemic hypertension, who was referred to the Surgical Department of Civil Hospital Karachi in September 2016 with rapidly progressive mass at right shoulder region and acute onset of ipsilateral limb sensory and motor deficit for last 3 weeks. The nerve conduction studies (NCS) revealed right brachial plexopathy. Computed Tomography demonstrated an 8.2x8.7cm (width x length) fusiform giant aneurysm of right subclavian-axillary artery with reactive axillary lymphadenitis. Early Aneurysmectomy and arterial reconstruction with saphenous vein graft interposition was planned. Unfortunately, she succumbed to death due to spontaneous …

Intracranial Hypertension And Optic Nerve Sheath Fenestration, Irfan Jeeva

Pakistan Journal of Neurological Sciences (PJNS)

Intracranial Hypertension is a neurological condition secondary to raised intracranial pressure in the absence of identifiable intracranial pathology and with normal cerebrospinal fluid composition. It can be a challenging condition to manage. One of the treatment modalities, optic nerve sheath fenestration is an important, yet under utilized mode of treatment, particularly in patients with visual symptoms.

Central Nervous System Tuberculosis In Children, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Brain and spinal cord tuberculosis are one of the commonest neurological infection in developing countries. Its associated with high morbidity and mortality. Diagnosis is based on clinical features, cerebrospinal fluid and brain imaging. Combination of antituberculous drugs should be started as early as possible to prevent the complications. The patient's clinical stage at presentation is the most important prognostic factor. Surgical procedures are directed at management of the hydrocephalus. Focal lesions, intracranial tuberculomas, and tuberculous abscesses, are usually located in cerebral or cerebellar hemispheres, uncommonly in brainstem and very rarely in spinal cord. They do not usually require surgical intervention …

Preventive Gabapentin Versus Pregabalin To Decrease Postoperative Pain After Lumbar Microdiscectomy: A Randomized Controlled Trial, Mohsin Qadeer, Muhammad Waqas, Muhammad Jawad Rashid, Ather Enam, Salman Sharif, Ghulam Murtaza

Section of Neurosurgery

Study design: Randomized controlled trial.
Purpose: The purpose of this study was to compare pregabalin and gabapentin for mean postoperative visual analog score (VAS) for pain in patients undergoing single-level lumbar microdiscectomy for intervertebral disc prolapse at a tertiary care hospital.
Overview of literature: Pregabalin has a superior pharmacokinetic profile and analgesic effect at lower doses than gabapentin; however, analgesic efficacy must be established during the perioperative period after lumbar spine surgery.
Methods: This randomized controlled trial was carried out at our institute from February to October 2011 on 78 patients, with 39 participants in each study group. Patients undergoing …

Neurorobotics In Pakistan, Ather Enam, Muhammad Waqas

Section of Neurosurgery

No abstract provided.

Complications Of In-Patient Cerebral Angiography: Comparison Between Patients With And Without Sub Arachnoid Haemorrhage, Yaseen Rauf, Usman Tariq Siddiqui, Gohar Javed

Section of Neurosurgery

Objective: To compare complications of cerebral angiography among patients with and without subarachnoid haemorrhage.
Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients undergoing inpatient therapeutic and diagnostic cerebral angiographies from 2001 to 2010. The patients were divided into subarachnoid and non-subarachnoid haemorrhage groups. During the study period no modifications were made to the operational protocol and all patients were subjected to the same procedure and prophylactic care.
Results: Of the 93 patients, 42(45.2%) were women and 51(54.8%) were men. The overall mean age was 45.27±16.15 years (range: 4-80 years). The …

Practical Neurology Linked To The Curriculum: An Online Resource, Dilraj Sokhi, Alice Brockington, Christine Lo

Internal Medicine, East Africa

Navigating the online galaxy for up-to-date evidence-based knowledge in clinical neurology can be a challenge. Practical Neurology is a noted and popular online clinical resource,1 which according to its website is "…practical in the sense of being useful for everyone who sees neurological patients and who want to keep up to date, and safe, in managing them." As UK-based neurology trainees, we have been fortunate to have automatic access to Practical Neurology during our training. We found that the articles adequately covered most elements in our syllabus and were ideal reference material for our department. This accords with the …

The Dynamics Of Adult Neurogenesis In Human Hippocampus, Amadi O. Ihunwo, Lackson H. Tembo, Charles Dzamalala

Brain and Mind Institute

The phenomenon of adult neurogenesis is now an accepted occurrence in mammals and also in humans. At least two discrete places house stem cells for generation of neurons in adult brain. These are olfactory system and the hippocampus. In animals, newly generated neurons have been directly or indirectly demonstrated to generate a significant amount of new neurons to have a functional role. However, the data in humans on the extent of this process is still scanty and such as difficult to comprehend its functional role in humans. This paper explores the available data on as extent of adult hippocampal neurogenesis …

South Asian Contributions To The International Rehabilitation Literature: An Online Literature Survey Of 10 Years, Sermad Ahmad Mangat, Farooq Azam Rathore, Shahbaz Ali Nasir, Mubasshar Shahid, Hassaan Altaf

Pakistan Journal of Neurological Sciences (PJNS)

Physical medicine and rehabilitation (PM & R) deals with management, rehabilitation and community reintegration persons with disabilities. It is an emerging medical specialty in the South-Asian region (Pakistan, India, Bangladesh, Nepal, Srilanka ,Afghanistan, Bhutan and Maldives,). The region comprises 24% of the world population with a huge burden of disability. The contributions of South Asian authors to the international rehabilitation medicine literature are unknown. The aim of this study was to document the contributions of south Asian authors in the international rehabilitation literature in the last decade.

Stroke As A First Presentation Of Malignancy, Farheen Niazi, Puneet Kakar, Ratneshwari Jha, Reena Dhami, Farook Edoo

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is a frequent complication in patients with cancer occurring in nearly 15% of the cases. However cerebrovascular disease as the first presentation of malignancy has rarely been reported. We report two such cases who were admitted with acute stroke but were later on found to be having malignancy. Routine workup was unrewarding in both patients. Both patients developed pulmonary embolism as well during hospital stay suggesting hypercoagulable state as likely etiology. Reaching to the final diagnosis was an arduous journey but can help guide other clinicians facing similar cases. Non Hodgkins B cell lymphoma and Carcinoma Gall bladder were …

Spectrum Of Acute Flaccid Paralysis In Children, Shaila Ali, M. Zia Ur Rehman, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Acute flaccid paralysis (AFP) is a clinical syndrome characterized by rapid onset of weakness in a child aged less than 15 years due to any cause when polio is suspected(1). Exact cause of AFP with its incidence is needed for proper management.