Neurology Commons^™

Brief Report On 16th International Neurology Update And Joint Phs, Pss & Mdsp Conference, Abdul Malik

Pakistan Journal of Neurological Sciences (PJNS)

Keeping up to date with new developments in medicine is a real challenge. But it's a challenge all neurologists must take if they are to do justice to their patients and aim for superior clinical expertise. Although neurology specialty is in growing stage & by the Grace of Almighty in last decade neurology bodies showed remarkable development to strengthen and continuing the training & development for the undergraduates, graduates & postgraduates in Pakistan. This year it was also unique precedence that in Karachi, national neurology body jointly organized four days conference with three sub-specialties national organizations.

Sleep Medicine: A Deserted Field In Pakistan, Bhojo A. Khealani

Pakistan Journal of Neurological Sciences (PJNS)

Sleep is an important and essential aspect of life and we spend about one third of our lives sleeping. Sleep disorders often manifest with insomnia and excessive daytime sleepiness. Large population based studies have shown that people who sleep longer and lesser have shorter life span1,2. Other symptoms of the slep disorders include snoring, abnormal motor behaviors etc.

Clinical Profiles, Management And Outcome Of Myasthenic Crisis In A Tertiary Care Center In Karachi, Pakistan, Sara , Khan, Dureshahwar Kanwar, Sadia Nishat

Pakistan Journal of Neurological Sciences (PJNS)

To determine the clinical profiles, management and outcome of myasthenic crisis (MC) in patients presenting to a tertiary care hospital in Karachi, Pakistan. This was a retrospective study of forty patients with Myasthenic crisis(MC) admitted at the Aga Khan University Hospital, Karachi between 1999 and 2014.Demographics, clinical presentation, hospital course, management and outcomes were reviewed. Ventilatory support for respiratory muscle or bulbar weakness was taken as crisis identification at arrival. Out of the total 40 patients with MC; generalized onset was seen in 28 (70%) and isolated bulbar symptoms in 12 (30%) patients. Fifteen patients (37.5%) had MC as a …

Epidemiology And Prevalence Of Deep Venous Thrombosis In Patients With Spinal Cord Injury, Aatik Arsh, Haider Darain, Syed Muhammad Ilyas

Pakistan Journal of Neurological Sciences (PJNS)

Pressure ulcers in patients with spinal cord injury (SCI) are associated with incredible financial cost and human sufferings. The aim of this retrospective study was to determine prevalence of pressure ulcers amongst patients with different levels of SCI.

Attitude And Perception Of Physical Therapists Towards Multidisciplinary Team Aproach In Stroke Rehabilitation, Muhammad Naveed Babur, Shiasta Habibullah, Anam Aftab

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is a long term disability in developing countries which is considered as major economic burden on part of Health care system. In developing countries multidisciplinary team approach for stroke rehabilitation is emerging in tertiary care hospitals and has considerably increased the chance of early independence, fast recovery and maximum outcome in daily activities of life. Objective: Objective of the study was to evaluate the attitude and perception of physical therapists towards multidisciplinary team approach working in stroke rehabilitation.

Concurrent Intracranial Chloromas And Leukemia Cutis In Chronic Myeloid Leukemia, Ateeque Ahmed Khan, Mahnoor Hafeez

Pakistan Journal of Neurological Sciences (PJNS)

Granulocytic sarcoma (chloroma) is an extramedullary solid tumor composed of immature white blood cells. Most common involvement sites are bone, periostium, soft tissue, lymph nodes and skin. Intracranial granulocytic sarcoma rarely occurs in meningeal or parenchymal form1. We report the of concurrent occurrence of intracranial chloromas and leukemia cutis in 26 years old male patient, known case of Chronic Myeloid Leukemia for 3 years [+ve Philadelphia (Ph) chromosome in bone marrow cells] who now presented to the Civil Hospital Karachi with continuous headache and multiple cutaneous nodules all over the body for last 2 months. The CT exam of the …

Nmda Encephalitis In An Elderly With Poor Prognosis, Farheen Niazi, Abdul Hameed, Tariq Hussain, Sarah Faiz, Hassan Atique

Pakistan Journal of Neurological Sciences (PJNS)

We present a case of a 65 years old man from Islamabad who presented with six months history of psychiatric and behavioural symptoms, significant weight loss. Later on he developed difficulty swallowing and altered sensorium. This was followed by an episode of shortness of breath leading to respiratory arrest, followed by ICU stay on ventilator support, then developed focal deficit in form of left sided weakness, dysautonomia, bradycardia leading to cardiac arrest and another cardiopulmonary resuscitation, myoclonic jerks, orofacial dyskinesias, status epilepticus, coma ultimately resulting in death of the patient. Patient was found to be NMDA receptor antibody positive. CT …

Rescue-Icp Trial, Muhammad Waqas, Muhammad Shahzad Shamim

Pakistan Journal of Neurological Sciences (PJNS)

Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension Peter J. Hutchinson, Angelos G. Kolias, Ivan S. Timofeev, Elizabeth A. Corteen, Marek Czosnyka, and other RESCUEicp Trial Collaborators N Engl J Med 2016; 375:1119-1130September 22, 2016DOI: 10.1056/NEJMoa1605215

Neurological Health Profile In Pakistan – A Health Systems Based Needs Assessment, Tauhid Awan, Arsalan Ahmad, Ather Javed, Mohammad Wasay, Muhammad Babar Khan, Haroon Awan

Pakistan Journal of Neurological Sciences (PJNS)

The aims of our study were to develop a neurological health profile in Pakistan from a health systems perspective, ascertain the readiness of neurology with regards to Sustainable Development Goals, and proffer recommendations for policy advocacy and planning in neurology.

Quality Of Life After Stroke In Pakistan, Wardah Khalid, Shafquat Rozi, Tazeen S. Ali, Iqbal Azam Syed, Michael Mullen, Saleem Illyas, Qamarunnisa, Nabila Soomro, Ayeesha Kamran Kamal

Department of Medicine

Background: There is very little information about the quality of life (QOL) of stroke survivors in LMIC countries with underdeveloped non communicable health infrastructures, who bear two thirds of the global stroke burden.

Methodology: We used a sequential mix methods approach. First, a quantitative analytical cross-sectional study was conducted on 700 participants, who constituted 350 stroke survivor and their caregiver dyads. QOL of stroke survivor was assessed via Stroke Specific Quality of Life Scale (SSQOLS) whereas QOL of caregivers was assessed through RAND-36. In addition; we assessed complications, psychosocial and functional disability of stroke survivors. Following this quantitative survey, …

Secretory Paraspinal Paraganglioma Of Thoracolumar Spine: Case Report And Review Of Literature, Saad Akhtar, Sidra Sattar, Muhammad Ehsan Bari, Naila Kayani, Sarosh Moeen

Section of Neurosurgery

Background: Pheochromocytomas are catecholamine secreting tumors of the adrenal medulla chromaffin cells, however, when present extra-adrenally they are called paragangliomas. Paragangliomas rarely produce catecholamine in excess, which is evident by clinical symptoms, urine, and blood biochemistry. Total resection of these tumors can lead to complete clinical and biochemical resolution. This case report presents the clinical features, radiological findings, and neurological outcome in a middle-aged female with a secretory paraganglioma.
Case description: We present the case of a 34-year-old female who presented with a 2-year history of dizziness, flushing, headache, palpitations, and hypertension. Her blood workup showed raised urinary catecholamine levels. …

Awake Craniotomy For Brain Tumours In Pakistan: An Initial Case Series From A Developing Country, Saad Akhtar Khan, Karim Rizwan Nathani, Badar Uddin Ujjan, Muhammad Danish Barakzai, Ather Enam, Faraz Shafiq

Section of Neurosurgery

Awake craniotomy offers safe resection of brain tumours in eloquent area. Aga Khan University Hospital, Karachi, recently started the programme in Pakistan, and the current study was planned to assess our experience of the first 16 procedures. The retrospective study comprised all such procedures done from November 2015 to May 2016. Pre-operative and post-operative variables were analysed. Of the 16 patients, 11(68.75%) were males and 5(31.25%) were females. The overall median age was 37 years (interquartile range[IQR]: 23-62 years). The most common presenting complaint was seizures 8(50%), followed by headache6(38%). The common pathologies operated include oligodendroglioma and glioblastoma. Pre-operative mean …

Paediatric Traumatic Brain Injury: Presentation, Prognostic Indicators And Outcome Analysis From A Tertiary Care Center In A Developing Country, Badar Uddin Ujjan, Muhammad Waqas, Muhammad Babar Khan, Dr Saqib Kamran Bakhshi, Muhammad Ehsan Bari

Section of Neurosurgery

Traumatic brain injury (TBI) is the leading cause of morbidity and mortality in children worldwide. This study was conducted to report the presentation, management, outcomes and prognostic indicators in a large series of patients from a tertiary care centre in a developing country. It is a review of prospectively collected data of paediatric patients with TBI admitted at our centre between July 2010 and December 2013. A total of 291 patients with a mean age of 7.2±5.0 years were dichotomised into survivors and non-survivors, and variables were compared between the two groups. The mean post-resuscitation Glasgow coma scale (GCS) score …

Co-Existing Spinal Intradural Ependymal Cyst And Sacral Tarlov Cyst In Adult-Onset Tethered Cord Syndrome With Syringomyelia: Case Report And Literature Review, Hamid H. Rai, Muhammad F. Khan, Ather Enam, Imtiaz Hashmi

Section of Neurosurgery

Background: Synchronous spinal intradural ependymal cysts and sacral Tarlov cysts in adult onset tethered cord syndrome are extremely rare.
Case description: A 23-year-old male presented with back pain radiating into both lower extremities, accompanied by acute onset of gait difficulty and sphincter dysfunction. Magnetic resonance imaging identified a low lying conus medullaris, syringomyelia with septations extending from T12 to S1, a tethered cord, and a thickened filum terminale with a sacral Tarlov cyst. The patient underwent a L3-4 laminectomy for decompression of syringomyelia and excision/biopsy of a space occupying lesion along with S1-2 laminectomy for cord untethering and Tarlov cyst …

Brainstem Tuberculoma As A Manifestation Of Paradoxical Reaction In A Patient With Tuberculous Meningitis., Farheen Niazi, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Tuberculosis commonly involves the CNS, During drug treatment of CNS tuberculosis paradoxical response (PR) may occasionally occur. The term “paradoxicalresponse”refers to the development of previously nonexistent tuberculosis lesions or worsening of preexisting lesions during antituberculosis treatment( ATT). Etiology is still not clear but delayed type hypersensitivity and alteration in immune system is thought to be a cause. Continued treatment improves PR without severe sequelae. We report a 41 year-old female patient with tuberculous meningitis(TBM) who developed brainstem tuberculomaduring the course of ATT, after about 9 months of treatment as a paradoxical response to ATT. Early identification, continuation of ATT with …

In-Hospital Outcome In Patients With Spontaneous Intracerebral Hemorrhage (Ich), Faraz Ahmed, Mazhar Badshah, Sumaira Nabi

Pakistan Journal of Neurological Sciences (PJNS)

Spontaneous intracerebral hemorrhage (ICH) is associated with a high in-hospital mortality and morbidity. One radiological parameter which was found significant in predicting mortality was the presence of hydrocephalus on CT brain (plain). The aim of this study was to determine the frequency of hydrocephalus in patients with spontaneous ICH and to determine the in-hospital outcome in patients of spontaneous ICH with hydrocephalus.MATERIALS AND METHODS: This was a descriptive case series carried out in Department of Neurology, Pakistan institute of Medical Sciences, Islamabad from December 30, 2013 to June 29, 2014. All patients who meet the inclusion criteria were selected for …

The Rise And Rise Of Neurosurgery: Academic Journey Of A Young Department In A Developing Country, Muhammad Shahzad Shamim, Hamid Hussain Rai Hussain Rai

Pakistan Journal of Neurological Sciences (PJNS)

The Section of Neurosurgery, part of the Department of Surgery, and the Mind and Brain Service Line at the Aga Khan University Hospital Karachi, has come a long way since its recognition in mid-90s. Although the program itself was recognized in late 90’s and the first resident graduated in 2004, it wasn't until 2008 that it assumed its current shape of a formal, structured training program. Currently it has six full-time faculty members, one part-time faculty member, two instructors, and a team of 12 residents. Following are few of the innovations introduced within the program over the last few years.

Awareness About The Signs, Symptoms And The Risk Factors Of Stroke In Patients With Stroke: A Multicentre Study, Nausheen Farooq, Haider Darain

Pakistan Journal of Neurological Sciences (PJNS)

The aim of this survey was to determine the levels of awareness regarding symptoms, warning signs and risk factors of stroke in patients with stroke. For the latter purpose, a total of 500 participants who had stroke were recruited from four different hospitals of Rawalpindi and Islamabad. Patients who were already diagnosed by physicians with either type of stroke (haemorrhagic and ischemic) were included in this trial. Data was collected through a questionnaire and was analysed in SPSS version 20. Both male and female population were included in this study. The minimum age for the patients to be included was …

Subarachnoid Hemorrhage:Unusual Situations Leading To Sah And Underlying Principles Of Physics Behind Its Complications, Ali Zohair Nomani, Sumaira Nabi

Pakistan Journal of Neurological Sciences (PJNS)

Multiple authors have identified the most unusual novel associations as precipitant factors of subarachnoid hemorrhage and the knowledge of these and pathogenesis in background is necessary to suspect and therefore timely diagnose subarachnoid bleed and understand the mechanism of its subsequent complications. Objective: We herein describe unusual causes of subarachnoid bleed reported in various case reports with a comprehensive but elaborative review describing underlying pathogenesis and physiological mechanisms behind these precipitants and complications. Evidence Review: We sorted unusual causes of subarachnoid hemorrhage from literature review. By conducting meticulous scrutinization on search engines likePubmed®, Medline ®, Medline Plus ®, PubMed Central …

Adem, Diagnostic Dilemma, A Tertiary Care Hospital Experience:, Rajesh Kumar, Hazim Brohi

Pakistan Journal of Neurological Sciences (PJNS)

Acute disseminated encephalomyelitis (ADEM) is an uncommon inflammatory demyelinating disease of the central nervous system that usually occurs following a viral infection or vaccination, bacterial or parasitic infection, or even spontaneously. ADEM is a monophasic; poly symptomatic disorder but it may present with various combinations of motor, sensory, visual and cognitive symptoms. Some case reports of ADEM presented as psychiatric disorders primarily as confusion psychosis and at times dissociative disorder. At times, the diagnosis becomes a dilemma due to multifaceted picture. Due to confusion physician may go to extreme range of tests with no specific conclusion. Debates regarding exact diagnosis …

Management And Outcomes Of Intramedullary Spinal Cord Tumors: A Single Center Experience From A Developing Country, Dr Saqib Kamran Bakhshi, Muhammad Waqas, Baila Shakaib, Ather Enam

Section of Neurosurgery

Background: Intraoperative neurophysiology, high magnification microscopes, and ultrasonic aspirators are considered essential aid for the safe resection of intramedullary spinal cord tumors (IMSCTs). Most centers in developing countries such as Pakistan still lack these facilities. The purpose of this study was to review the management of IMSCTs at our hospital and to determine factors associated with the outcomes of surgery.
Methods: This was a retrospective review of medical records of adult patients undergoing surgery for IMSCT over 12 years. The institutional ethical review committee approved this study. Data were collected regarding demographics, clinical and radiological features, and surgical details. Modified …

Association Of Iron Deficiency Anemia In Children With Febrile Convulsions, Vikash Lal, Haresh Kumar, Shahina Hanif, Om Parkash, Suneel Arwani

Pakistan Journal of Neurological Sciences (PJNS)

:To determine the association of iron deficiency anemia in children presented with febrile convulsion. Study Design: Case control study Setting: The pediatric unit III,Civil Hospital,Karachi. Duration: Six months from 30th April 2013 to 1st November 2013 Material and Methods: History regarding age, sex, developmental milestones, family history of febrile seizures or epilepsy, mean of the temperature peak at admission, and the underlying illness were recorded for all cases and controls, as well as details of seizure history, duration and frequency. Blood samples were collected in the Paediatric wardsfor measurements of hemoglobin, serum ferritin, MCV, MCH and MCHC, serum electrolytes, serum …

Magnetic Resonance Imaging Of Intracranial Extramedullary Haematopoiesis In Β-Thalassemia: A Case Report, Mahnoor Hafeez, Ateeque Ahmed Khan

Pakistan Journal of Neurological Sciences (PJNS)

We report the Magnetic Resonance Imaging of intracranial extramedullaryhematopoiesis in 21 years old β-thalassemic patient who presented to the Neurology Department of Civil Hospital Karachi with seizures. The MR exam revealed multiple intracranialextra-axial masses;isointense on T1W sequence and hypointenseon T1W, T2W, FLAIR, DWI sequence and ADC (b value= 1000 sec/mm2) with avid post contrast enhancement. Plain CT of the Head documented the presence of multiple hyperdenseextra-axial masses with mean value of 45 HU. Extramedullary hematopoiesis is the formation and development of blood cells in tissues outside of the medulla of the bone. The most common sites of involvement are the …

“More Than Meets The Eye” Non Secretory Myeloma Presenting As Cidp In A Patient With Longstanding Diabetic Polyneuropathy. A Diagnostic And Therapeutic Challenge., Farheen Niazi, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

Diagnosing chronic inflammatory polyradiculopathy in patients with pre-existing diabetic sensorimotor polyneuropathy is a diagnostic challenge. We present a case of a 69 years old who presented with weakness of legs for two months,he was diagnosed as having CIDP on the background of diabetic sensorimotor polyneuropathy, further and extensive workup revealed the final diagnosis of nonsecretory myeloma. Diagnosing non secretory myeloma is itself a diagnostic challenge and usually first line investigations for the workup of myeloma are negative as was the case in our patient. Our patient with CIDP had raised free light chains of kappa which made the final diagnosis …

An Overview Of Pathophysiology, Assessment And Management Strategies Of Post Stroke Shoulder Subluxation, Sarah Razaq, Farooq Azam Rathore

Pakistan Journal of Neurological Sciences (PJNS)

Shoulder subluxation is a common complication after stroke. It can result in soft tissue damage, stretching of the joint capsule, rotator cuff injury, and in some cases pain. An estimated 17-81 % of stroke patients have shoulder subluxation. It limits the use of affected extremity in addition to the weakness resulting from stroke itself. It can delay the neurological recovery in hemiplegic stroke patients. The etiology is multifactorial and the underlying mechanisms alongwith its association with shoulder pain are not clearly understood. This makes management of post stroke shoulder- subluxation a challenge for stroke management team. This review provides an …

Knowledge, Attitude And Practice Of Epilepsy Among Schoolteachers In Pakistan, Syed Wasim Akhtar Wasim Akhtar, Zarine Mogal

Pakistan Journal of Neurological Sciences (PJNS)

Assessment of Knowledge, Attitude and Practice (KAP) concerning epilepsy among schoolteachers in Pakistan. No such study has previously been conducted in this country and results would help formulate a comprehensive plan of action to address this important issue.

World Brain Day 2016: Celebrating Brain Health In An Ageing Population, Mohammad Wasay, Wolfgang Grisold, William Carroll, Raad Shakir

Section of Neurology

No abstract provided.

Ischemic Strokes: Observations From A Hospital Based Stroke Registry In Bangladesh., Nirmalenduk Bikash Bhowmik, Aamir Abbas, Mohammad Saifuddin, Md. Rashedul Islam, Rumana Habib, Aminur Rahman, Md. Amirul Haque,, Zahid Hassan, Mohammad Wasay

Department of Medicine

Background. Stroke is an important morbidity for low and middle income countries like Bangladesh. We established the first stroke registry in Bangladesh. Methods. Data was collected from stroke patients who were admitted in Department of Neurology of BIRDEM with first ever stroke, aged between 30 and 90 years. Patients with intracerebral hemorrhage, subarachnoid and subdural hemorrhage, and posttrauma features were excluded. Results. Data was gathered from 679 stroke patients. Mean age was 60.6 years. Almost 68% of patients were male. Small vessel strokes were the most common accounting for 45.4% of all the patients followed by large vessel getting affected …

Neuromyelitis Optica (Devic’S Disease) In A 10 Years Old Boy., Dr.Farida Jan, Amber Shabir, Shahnaz Ibrahim

Pakistan Journal of Neurological Sciences (PJNS)

Neuromyelitis optica (NMO) also known as Devic’s disease is an acute demyelinating disorder combined with optic neuritis and transverse myelitis.A 10 years old boy presented in the ER with the complaints of fever and back pain for past 10 days and inability to walk for 6-7 days. He had developed urinary retention and constipation for the past 5 days along with abdominal distension. There was also blurring of vision in the left eye with only light perception and rapid afferent papillary defect was present while the right eye was normal. The provisional diagnosis was Transverse myelitis vsNeuromyelitisoptica (NMO). CSF revealed …

10-Year Pattern Of Admissions In Psychiatric Unit At A Tertiary Care Hospital In Pakistan., Raza Ur Rahman, Abdul Ghani Khan, Naila Naerm Shahbaz

Pakistan Journal of Neurological Sciences (PJNS)

To identify the pattern of psychiatric morbidity in hospitalized patients of a tertiary care unit.Design; Details of patient’s admissions from the case register of psychiatric unit were recorded retrospectively.The study was conducted in Dept. of Psychiatry Jinnah Postgraduate Medical Centre JPMC Karachi and included data of ten years. RESULTS;- TA total of 5527 patients were hospitalized during period of ten years (1995 – 2004). Among them 62.612% (n = 3461) were males and 37.38 (n = 2066) were females. The majority of patients were in the age range of 15 – 44 years. On the basis of ICD classification, mood …