Neurology Commons^™

Neurofibromatosis Type 2 Patient Presenting With Medulloblastoma, Jan Kalimullah, Abdul Malik Amir Humza Sohail, Rai Shahjehan, Sabeehuddin Siddique, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Neurofibromatosis type 2 (NF2) is an autosomal dominant syndrome with a frequency of 1 in 25,000 live births and a penetrance of almost 100% by the sixth decade of life. The main tumors occurring in NF2 patients are bilateral vestibular schwannomas, other peripheral, cranial and spinal nerve schwannomas, intracranial and intraspinal meningiomas, ependymomas, and gliomas.
Case description: We report the case of a 6-year-old boy who presented with a 1-month history of nausea and recurrent vomiting. Physical examination was positive for ataxic gait and left-sided facial nerve palsy. Family history was positive for NF2 in the patient's father and …

Deadly Heat Wave In Karachi, July 2015: Negligence Or Mismanagement?, Adnan Salim, A. Ahmed, N. Ashraf, M. Asher

Section of Neurosurgery

No abstract provided.

Epilepsy In Pakistan: National Guidelines For Clinicians (Part 2), Fowzia Siddiqui, Shaukat Ali, Mughis Sheerani, Tipu Sultan, Shahid Mustafa, Saleem Barech, Haris Majid, Sarwar Jamil Siddiqui, Abdul Malik, Mohsin Zaheer, Wasim Akhter, Rashid Jooma

Section of Neurology

No abstract provided.

A Randomized Controlled Behavioral Intervention Trial To Improve Medication Adherence In Adult Stroke Patients With Prescription Tailored Short Messaging Service (Sms)-Sms4stroke Study., Ayeesha Kamran Kamal, Quratulain Shaikh,, Omrana Pasha, Iqbal Azam Syed, Muhammad Islam,, Adeel Ali Memon, Hasan Rehman, Masood Ahmed Akram,, Muhammad Affan, Sumaira Nazir, Salman Aziz, Muhammad Jan, Anita Andani, Abdul Muqeet, Bilal Ahmed, Shariq Khoja

Department of Medicine

Background: The effectiveness of mobile technology to improve medication adherence via customized Short Messaging Service (SMS) reminders for stroke has not been tested in resource poor areas. We designed a randomized controlled trial to test the effectiveness of SMS on improving medication adherence in stroke survivors in Pakistan.

Methods: This was a parallel group, assessor-blinded, randomized, controlled, superiority trial. Participants were centrally randomized in fixed block sizes. Adult participants on multiple medications with access to a cell phone and stroke at least 4 weeks from onset (Onset as defined by last seen normal) were eligible. The intervention group, in addition …

Hereditary Sensory Autonomic Neuropathy Ii, A Rare Disease In A Large Pakistani Family, Fazal M. Arain, Prem Chand

Department of Paediatrics and Child Health

Hereditary Sensory Autonomic Neuropathy II (HSAN II) is a rare genetic disorder, characterized by severe loss of pain, temperature and touch sensation. Injuries in these patients can progress to necrosis and shedding of digits and limbs. Here we report two cases of HSAN II belonging to a Pakistani family. Individual 1, a forty five year old man, had complete loss of pain sensation since birth. Self-mutilation and complication of injuries resulted in the shedding of all the digits and right foot and surgical amputation of left leg. Individual 2, a five year old girl,had delay in healing of wounds and …

Stroke Manifesto - What Must Be Done For Stroke Care In Pakistan, Abdul Malik, Ismail Khatri, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Modifiable Risk Factors In Patients With Cerebrovascular Accident, Sher Ali Khan, Mir Jalal-Ud-Din, Raheel Ahangir Jadoon, Shawana Asad, Rashid Ali, Muhammad Saqib Saeed

Pakistan Journal of Neurological Sciences (PJNS)

To determine the frequency of modifiable risk factors of stroke. Study Design: Descriptive Case series. Place and duration of study: Ayub Teaching Hospital, Abbottabad from March to December 2012. Methodology: 106 cases of cerebrovascular accident (CVA) above 20 years of age and of either sex admitted in medical units of Ayub Teaching Hospital, Abbottabad were included in this study. The patients below 20 years of age, those with recurrent history of CVA, patients not fulfilling the required criteria of risk factors set in operational definitions and patients having intracranial space occupying lesion such as tumors or brain abscess or neurological …

Fasting Headache, A Cross-Sectional Study, Adnan Salim, Muhammad Ahmed Ilyas, Mehwish Rizvi, Arzlan Ullaha Baig, Syed Hassaan Ahmed, Zuha Pandit, Muhammad Saleem Ilyas

Section of Neurosurgery

Headache is a predominant disorder in general population and is classified into primary and secondary forms by the International Headache Society. Fasting headache is currently classified in Group 10 of ICHD-III as “Headache attributed to disorders of homeostasis”. In spite of continuing research, there is still indistinctness regarding the exact cause of fasting headache. Hypoglycaemia, previous history of headache, stress, caffeine withdrawal, lack of sleep and female gender have been speculated as causative factors. Our rationale for this study is to find out what percentage of the population experiences fasting headache and to find out any link between the occurrence …

Improving Medication Adherence In Stroke Patients Through Short Text Messages (Sms4stroke)-Study Protocol For A Randomized, Controlled Trial., Ayeesha Kamran Kamal, Quratulain Nauman Shaikh,, Omrana Pasha, Iqbal Azam Syed, Muhammad Islam, Adeel Ali Memon,, Hasan Rehman,, Muhammad Affan,, Sumaira Nazir, Salman Aziz,, Muhammad Jan, Anita Andani, Abdul Muqeet, Bilal Ahmed,, Shariq Khoja

Department of Medicine

Background: Stroke is a major cause of morbidity and mortality, especially in low and middle income countries. Medical management is the mainstay of therapy to prevent recurrence of stroke. Current estimates are that only 1 in 6 patients have perfect adherence to medication schedules. Using SMS (Short Messaging Service) as reminders to take medicines have been used previously for diseases such as diabetes and HIV with moderate success. We aim to explore the effectiveness and acceptability of SMS in increasing adherence to medications in patients with stroke.

Methods: This will be a randomized, controlled, assessor blinded single center superiority trial. …

Diagnostic Tcd For Intracranial Stenosis In Acute Stroke Patients: Experience From A Tertiary Care Stroke Center In Karachi, Pakistan., Ayeesha Kamran Kamal, Hasan Rehman, Nasir Mustafa, Bilal Ahmed, Mohammad Jan, Faisal Wadivalla, Syed Kamran

Department of Medicine

Background: Stroke is a common cause of morbidity and mortality around the world. Intracranial large artery atherosclerosis (ICAD) is a frequent etiology of stroke in the South Asian population. There is a need for widely available screening tools to identify patients that are at high risk of stroke due to ICAD for aggressive risk management. This study describes the experience of using the transcranial Doppler (TCD) as a screening tool for this purpose at a tertiary care hospital in a developing country.

Methods: 86 Patients admitted with stroke due to ICAD underwent TCD for six arteries (Right and left …

The Mouse That Trolled: The Long And Tortuous History Of A Gene Mutation Patent That Became An Expensive Impediment To Alzheimer's Research, Tania M. Bubela, Saurabh Vishnubhakat, Robert Cook-Deegan

Office of the Provost

This case study presents the tale of the academic discovery of a rare mutation for early-onset Alzheimer's disease that was patented by a sole inventor and licensed to a non-practicing entity (NPE), the Alzheimer's Institute of America (AIA). Our aims are (1) to relate this story about patents, research tools, and impediments to medical progress, and (2) to inform ongoing debates about how patents affect research, disposition of university inventions, and the distribution of benefits from publicly funded research. We present an account of the hunt for Alzheimer's genes, their patenting, assignment, and enforcement based on literature, litigation records and …

Multiple Cerebral Hydatid Cysts In 8-Year-Old Boy: A Case Report And Literature Review Of A Rare Presentation, Muhammad Baba Khan, Muhammad Riaz, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Multiple cerebral hydatid cysts are very rare with only a few reports in the literature detailing diagnostic workup, medical management, surgical techniques, possible complications, and outcomes.
Case description: We present the case of an 8-year-old boy who presented with progressively worsening headaches, vomiting, and intermittent fever since 20 days. Diagnostic workup was performed, and magnetic resonance imaging revealed multiple intracranial cysts predominantly in the right frontal region with significant mass effect. A total of 19 intracranial cysts were removed surgically, and the child recovered uneventfully.
Conclusions: Neurosurgeons should keep hydatidosis in the list of differentials when evaluating patients with …

Epilepsy In Pakistan: National Guidelines For Clinicians, Fowzia Siddiqui, Tipu Sultan, Shahid Mustafa, Sarwar Jamil Siddiqui, Shaukat Ali, Abdul Malik, Zafar Sajjad, Saleem Barech, Rashid Jooma

Section of Neurology

Introduction: Epilepsy is one of the most common chronic neurological disorders requiring prolonged treatments and drugs. According to The World Health Organization (WHO), epilepsy is one of those serious brain disorders that affect not only the individual but has a deep impact on the family and society in general. Approximately 50 million people are affected with epilepsy around the world36, though proper epidemiological studies do not exist for Pakistan it is estimated that the prevalence of epilepsy is 9.99/1000. Highest prevalence is seen in people younger than 30 years of age, i.e. about 2 million people and 1/10th of the …

Computed Tomography-Guided Biopsy For Potts Disease: An Institutional Experience From An Endemic Developing Country, Muhammad Waqas, Mohsin Qadeer, Faizuddin Faiz, Mohammad Ali Alvi, Muhammad Ehsan Bari

Section of Neurosurgery

Study design: A retrospective chart review.
Purpose: In endemic resource poor countries like Pakistan, most patients are diagnosed and treated for Potts disease on clinical and radiological grounds without a routine biopsy. The purpose of this study was to evaluate the use and effect of computed tomography (CT)-guided biopsy in the management of Potts disease since the technique is becoming increasingly available.
Overview of literature: CT-guided biopsy of spinal lesions is routinely performed. Literature on the utility of the technique in endemic resource poor countries is little.
Methods: This study was conducted at the Neurosurgery section of Aga Khan University …

Hyperhomocysteinemia - An Unidentified Risk Factor For Stroke In Our Population, Sabaa Asif, Bashir A Soomro, Kanwal Sartaj, Shafaq Alvi

Pakistan Journal of Neurological Sciences (PJNS)

Introduction:
Various studies show that moderate elevation of plasma homocysteine level has been associated with increased risk for cardiovascular and cerebrovascular disease.

Objective:
To observe the frequency of increased homocysteine level in ischemic stroke patients; and its association with other risk factors.

Methodology:
Observational pilot study was conducted on a sample of 75 ischemic stroke patients, enrolled regardless of their age, gender and comorbidities, at Ziauddin university hospital, Karachi. Fasting serum homocysteine, folate and vitamin B12 levels were measured. Results were interpreted using spss 20.0.

Results and Discussion:
Mean homocysteine level in our population was 19.51 (SD: 11.47)micromol/l. …

Stress Induced Hyperglycemia In Stroke Patients, Aziz U Rehman, Ajeet Kumar, Salma Razzaque, Ashok Kumar, M. Ishaq Ghauri

Pakistan Journal of Neurological Sciences (PJNS)

Background:
Stroke is the third most common cause of death in developed countries and second most common cause of death worldwide. High proportion of patients may develop hyperglycemia after an acute stress such as stroke or myocardial infarction even in the absence of preexisting diagnosis of diabetes mellitus. Prolonged stress hyperglycemia in ischemic stroke increases the risk of in-hospital 28- day mortality, especially in non-diabetic patients.

Aims and objectives:
To determine the frequency of stress-induced hyperglycemia in non-diabetic patients with ischemic or hemorrhagic stroke.

Subjects and methods:
A total of 255 patients admitted with acute stroke, fulfilling the inclusion …

Efficacy Of Memantine In Treating Patients With Migraine And Tension-Type Headache, Sameen Khalid, Bashir A Soomro, Samreen Mahmood, Aamer Abbass

Pakistan Journal of Neurological Sciences (PJNS)

Objective:
To assess the efficacy of Memantine as a preventive and therapeutic intervention for migraine and tension-type headache.

Methods:
This clinical trial was conducted over a period of 3 months. A total of 44 subjects, with diagnosed migraine and/or tension-type headache, presenting to a private neurology clinic in Karachi, Pakistan were selected through purposive sampling technique. Patients were treated with incremental doses of Memantine. Adult patients belonging to both genders were included in the study. Data was analyzed using SPSS version 16.0 and associations were made using Chi square test with p-value of less than 0.05 taken as significant. …

Marburg Variant Of Multiple Sclerosis; A Diagnostic And Therapeutic Challenge, Sadia Imtiaz, Maimoona Siddiqui, Arsalan Ahmad Md

Pakistan Journal of Neurological Sciences (PJNS)

Marburg variant of multiple sclerosis (MS) is a highly aggressive, fulminant demyelinating disease with very high morbidity and mortality. Early diagnosis and aggressive management is vital to limit severe disability and improve the outcome. We present a case of 35 years old male who presented with rapidly progressive demyelinating illness, leading to bed bound status over the course of a month. He was treated aggressively with intravenous (IV) steroids, plasma exchange (PLEX) and Mitoxantrone (MTX), leading to a remarkable recovery.

Encephalopathy With Behavioral And Psychiatric Features–Firstantibody Proven Case Of Anti-Nmda Receptor Encephalitis From Pakistan, Rabel Khalid Memon, Maimoona Siddiqui, Rizwanullah Khan

Pakistan Journal of Neurological Sciences (PJNS)

Background:
Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is associated with psychiatric symptoms, memory disturbances, seizures, dyskinesia, and catatonia along with other constellation of symptoms. It is more common in females and usually associated with underlying ovarian teratoma. Treatment involves immunosuppression. This is the first antibody proven case from Pakistan.

Case Report:
A 16 year old girl with a short history of sore throat and no other prior illness, presented with 12 day history of behavioral changes (can you please describe some behavioral changes?) and seizures, followed by decreased responsiveness, involuntary limb movements and facial grimacing. She also had intermittent high grade fever …

9th Annual Neurology Research Day 2015 Abstracts Shifa International Hospital, Islamabad

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Relationship Between Fear, Fall & Balance In Cummunity Dwelling Older Adults, Ayesha Afridi, Sadia Maqbool, Arshad Nawaz Malik

Pakistan Journal of Neurological Sciences (PJNS)

Background:
In older population the risk of fall is always at high risk and there are many contributing factor which increase the prevalence of fall. The impaired balance leads to limited daily activities and confidence level.

Purpose of the study:
The main purpose of this study was to determine the relationship between fall, fear and balance in older population.

Method & methodology:
The descriptive cross sectional study design was used and a sample of 271 older adult were recruited through purpose sampling technique. The detail demographic was noted, history of fall and other related co-morbidities were mention in performa. The …

A Rare Case Of Simple Hereditary Recessive Optic Atrophy, Fazal M. Arain, Prem Chand, Tanveer A. Choudary

Pakistan Journal of Neurological Sciences (PJNS)

Simple Autosomal Recessive Optic Atrophy (AROA) is a rare hereditary disorder that belongs to a group of disorders called Hereditary Optic Atrophy. Patients diagnosed with simple AROA have complete blindness since birth or from first few months of life. This blindness does not improve with age. However, no other organ or system is affected in this disorder. There is no known cause or gene mutation associated with it. Here we report a case of a two year old child diagnosed with simple AROA. Family history of the patient revealed that an older deceased relative also suffered from similar symptoms. Identification …

Challenges In Certification And Credentialing Of Pakistani Physicians In Middle East, Abdul Malik

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

The Need And Roadmap For Stroke Rehabilitation Guidelines In Pakistan, Farooq Azam Rathore

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Frequency Of Cerebrovascular Accidents And Brain Abscess In Childrens With Tetralogy Of Fallot Dr., Sommayya Aftab, Amir Usman, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

OBJECTIVE:
To determine the frequency of cerebrovascular accidents and brain abscess in children of Tetralogy of Fallot presented with neurological manifestations.

PATIENTS AND METHODS:
It was a cross-sectional descriptive observational study done at the Pediatric Cardiology and Pediatric Neurology departments of The Children’s Hospital & Institute of Child Health, Lahore from Dec 2009 to Nov 2010. A total 75 patients of Tetralogy of Fallot (TOF) up to the age of 15 years with neurological manifestation meeting the inclusion criteria were enrolled in this study. CT brain with contrast was conducted in all patients to look for evidence of cerebrovascular accident …

Association Of Vitamin D With Statin Induced Myalgia, Ayla K. Zubair, Imran N Ahmad, Arsalan Ahmad Md

Pakistan Journal of Neurological Sciences (PJNS)

Objective:
To determine the association of serum 25-hydroxy vitamin D (25(OH) Vitamin D) deficiency with the occurrence of myalgia in patients on statin therapy.

Methods:
The pathology laboratory database was reviewed to identify patients tested for serum 25(OH) Vitamin D and creatine kinase. A retrospective chart review was then conducted to ascertain statin use and reporting of myalgia for patients tested concurrently for serum 25(OH) vitamin D and creatinekinase levels between January 1, 2013 and December 31, 2013.

Results:
Of the 825 patients tested for creatine kinase and 25 (OH) Vitamin D in 2013, 49 met the study criteria.The …

Validation Study Of The Mini-Mental State Examination In Urdu Language For Pakistani Population, Safia Awan, Naila Shahbaz,, Syed Wasim Akhtar, Arsalan Ahmad, Sadaf Iqba, Sellal Ahmed, Haider Naqvi, Mohammad Wasay

Section of Neurology

Validation study of the Mini-Mental State Examination in Urdu language for Pakistani population. Objective: This study was conducted primarily to validate and determine the optimal cutoff score in the diagnosis of dementia among Pakistani’s and study the effects of gender and education on the MMSE performance in our population. Methods: Four hundred participants took part in the study. Patient with dementia recruited from five major hospitals from Pakistan. The MMSE was translated into Urdu. Results: There were 61 men and 39 women in dementia group and 225 men and 75 women in the control group. The mean score of Urdu …

Astrocyte Morphology, Heterogeneity, And Density In The Developing African Giant Rat (Cricetomys Gambianus), Matthew A. Olude, Oluwaseun A. Mustapha, Oluwatunde A. Aderounmu, James O. Olopade, Amadi O. Ihunwo

Brain and Mind Institute

Astrocyte morphologies and heterogeneity were described in male African giant rats (AGR; Cricetomys gambianus, Waterhouse) across three age groups (five neonates, five juveniles, and five adults) using Silver impregnation method and immunohistochemistry against glial fibrillary acidic protein. Immunopositive cell signaling, cell size and population were least in neonates, followed by adults and juveniles, respectively. In neonates, astrocyte processes were mostly detected within the glia limitans of the mid and hind brain; their cell bodies measuring 32 ± 4.8 μm in diameter against 91 ± 5.4 μm and 75 ± 1.9 μm in juveniles and adults, respectively. Astrocyte heterogeneity in …

Clinical Outcome And Cost Effectiveness Of Early Tracheostomy In Isolated Severe Head Injury Patients, Usman Tariq Siddiqui, Muhammad Zubair Tahir, Muhammad Shahzad Shamim, S. Ather Enam

Section of Neurosurgery

Background: Early tracheostomy (ET) has been shown to be effective in reducing complications associated with prolong mechanical ventilation. The study was carried out to evaluate the role of ET in reducing the duration of mechanical ventilation, duration of intensive care unit (ICU) stay, ICU-related morbidities, and its overall effect on outcome, in patients with isolated severe traumatic brain injury (TBI).
Methods: This 7-year review included 100 ICU patients with isolated severe TBI requiring mechanical ventilation. ET was defined as tracheostomy within 7 days of TBI, and prolonged endotracheal intubation (EI) as EI exceeding 7 days of TBI. Of 100 patients, …

Clinoidal Meningioma Associated With An Internal Carotid Artery Aneurysm, Muhammad Waqas, Yousuf Bashir Hadi, Badar Uddin Ujjan, Gohar Javed

Section of Neurosurgery

Coexistence of primary brain neoplasms with intracranial aneurysms is rare but presents a diagnostic and therapeutic challenge to healthcare providers. We describe the case of a 60-year-old woman who had a left internal carotid artery aneurysm with a small ipsilateral clinoidal meningioma. The meningioma was an unexpected finding encountered during the surgery for aneurysmal clipping. Both the lesions were dealt with simultaneously.