Neurology Commons^™

Implications Of Female Sex On Stroke Risk Factors, Care, Outcome And Rehabilitation: An Asian Perspective, Prachi Mehndiratta, Mohammad Wasay, Man Mohan Mehndiratta

Section of Neurology

Background:

Stroke affects 16.9 million people annually and the greatest burden of stroke is in low- and middle-income countries, where 69% of all strokes occur. Stroke risk factors, mortality and outcomes differ in developing countries as compared to the developed world. We performed a literature review of 28 articles pertaining to epidemiology of stroke in Asian women, stroke risk factors, gender-related differences, and stroke outcomes.

Summary:

Asian women differ from women worldwide due to differences in stroke awareness, risk factor profile, stroke subtypes, and social issues that impact stroke care. While Asian men have a higher incidence of stroke as …

Determination Of The Factors Leading To Noncompliance With Antiepileptic Drug, Abdul Haz, Naila Naeem Shahbaz, Jai Perkash, Muslim Ali Lakhair

Pakistan Journal of Neurological Sciences (PJNS)

Background:
Epilepsy is a chronic disorder or group of chronic disorder in which the indispensable feature is recurrence of seizures that are typically unprovoked and usually unpredictable. It is well established that non-adherence to antiepileptic drugs may lead to a loss of seizure control. Negative outcomes that may be associated with a loss of seizure control include: injury, increase hospitalizations, and decrease in productivity. All of these contribute to increased direct and indirect healthcare costs related to epilepsy.

Objective:
To determine factors leading to noncompliance with antiepileptic drugs in patients attending a tertiary care hospital.

Methods & Results:
In the …

Psychiatric Diagnosis And Human Emotions, Riffat Moazam Zaman

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Restless Legs Syndrome In Patients With Type 2 Diabetes Mellitus, Shaista A. Siddiqi, Javeria Rauf, Anita Haroon, Bilal Ahmed, Saera Suhail Kidwai, Lubna Nazir

Pakistan Journal of Neurological Sciences (PJNS)

Objective:
To determine the frequency of restless legs syndrome (RLS) and its associated factors in patients with type 2 diabetes mellitus.

Design and Methods:
It was single centered, cross-sectional study done with convenient sampling. The study population comprised 174 subjects (120 diabetics and 54 non-diabetics). Participants were recruited from the Diabetes clinic of Jinnah Medical College Hospital, Karachi. The relevant clinical and laboratory parameters were obtained by clinical history and chart review. Multivariable logistic regression was done to identify the factors of RLS among diabetics.

Results:
Using the International RLS Study Group (IRLSSG) criteria, RLS was identified only in …

Post Stroke Dementia And Its Putative Risk Factors: A Hospital - Based Study, Iranmanesh F, Sheykholeslami Nz, Rahimdel A, Gadari F, Vazirinajad R, Syedyazdi F

Pakistan Journal of Neurological Sciences (PJNS)

Introduction:
Dementia is common after stroke and has a considerable impact on mortality, rehabilitation and quality of life. There are some published articles regarding post stroke dementia but there are many controversies surrounding this topic. Our aim was to identify the prevalence of post stroke dementia 3 months after stroke and evaluation of some its putative risk factors in Iranian population.

Method:
In this cross-sectional study, 151 patients with acute stroke were evaluated. The diagnosis was confirmed by physical examination and neuroimaging. Three months after the stroke, all patients were visited again. The diagnosis of post stroke dementia was made …

The Land Of Opportunities For Research On Rare Genetic Neurological Disorders, Muhammad Ulusyar Khan, Fazal M. Arain

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Journey Over Four Decades To Discover New Definitions Of Stroke And Tia For 21st Century: Are We Ready For The Change?, Muhammad Athar Javed

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Under Recognized Entity: Chronic Inflammatory Demyelinating Polyneuropathy With Lupus, Ali Zohair Nomani, Haris Majid Rajput, Rao Sohail Yasin Khan, Mansoor Iqbal, Zakir Jan, Uzma Jamil, Mazhar Badshah, Muhammad Irshad

Pakistan Journal of Neurological Sciences (PJNS)

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired, autoimmune peripheral neuropathy. It has an insidious disease progression resulting in a debilitating illness. It is a well known neurological disorder. The causative factors are elucidating and it is generally considered idiopathic. However, its’ associations with various systemic disorders is well established albeit under recognized, especially with lupus as evident by few of the case reports/ series published in the recent past. The aim of this report is to highlight this neglected but important aspect of clinical neurology in common practice.

Eight – And - Half Syndrome: A Rare Neuro-Ophthalmic Syndrome “Possible Nine Syndrome”, Muslim Ali Lakhiar, Shaheen Ahmed Mughal

Pakistan Journal of Neurological Sciences (PJNS)

“Eight-and-half” syndrome is “one-and-a-half” syndrome characterized by conjugated horizontal gaze palsy and internuclearopthalmoplegia plus ipsilateral fascicular seventh nerve palsy. We report a case of 50 year old woman who presented with right eight and half syndrome together with contralateral hemiparesis and hemihypesthesia. Non contrast CT scan brain showed hyperdensesignal on right pontine region. MRI brain plain revealed hemorrhagicpontinetegmentuminfarction as well as corticospinal tract and medial meniscus. This spectrum of presentation suggests a possible “Nine syndrome” as a novel neuropthalmicpontine syndrome. The first of its kind ever reported from Pakistan

A 2 ½ Years Old Boy With Squint And Speech Loss, Shaila Ali, Zia Ur Rehman, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Tuberculosis of central nervous system is not uncommon in children of developing countries. Tuberculomaswere initially misdiagnosed due to lack of radiological expertise, un availability of CT scans and MRI. For early diagnosis and treatment, they should be kept in differential of space occupying lesions.We had a 2 ½ years old patient had fever, squint, aphasia and loss of motor milestones. On examination he was a malnourished child with right sided hypertonia and involvement of 9th and 10th cranial nerves with hepatospleenomegaly. His CRP was raised and CXRshowed B/L milliary shadowing which helped us to find out the primary focus leading …

Spectrum Of Neuromuscular Injuries In Victims Of Bomb Blasts, Dureshahwar Kanwar, Ambreen Iqrar, Zaitoon Shivji, Sara Khan

Pakistan Journal of Neurological Sciences (PJNS)

Introduction:
Bomb blast (BB) injuries outside war zones were a rare phenomenon until recently. With the spreading wave of terrorism across the globe, BB related trauma is resurfacing. Explosions can produce unique patterns of neuromuscular injury. No recent data exists categorizing such injuries.

Methods:
Medical records and electrodiagnostic findings of 20 patients with BB related neuromuscular injuries (NMI) were reviewed retrospectively.

Results:
Most common site of injury was the lower extremities (55%) with majority presenting clinically with foot drop (40%) or weakness (30%). 9/17 patients (45%) had associated shrapnel or penetrating trauma. 6/20 patients had associated fractures. The most …

An Ode To Neurology, Marina Wazir

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

National Guidelines For Diagnosis And Management Of Parkinson’S Disease In Pakistan, Nadir A Syed, Farwa Ali, Khalid Sher, Amer Ikram, Bashir Soomro, Naila Shahbaz, Mughis Sheerani, Sarwar Jamil, Ahsan Numan, Manzoor Lakhair, Irshad Awan, Saleem Barech, Haroon Basheer

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Stroke Knowledge And Screening In A High Prevalence, Low Income Community, Maria Khan,, Hasan Rehman,, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Vulnerable Road Users Are At Greater Risk During Ramadan -- Results From Road Traffic Surveillance Data., Amber Mehmood, Anoosh Moin, Irum Qamar Khan, Mohammad Umer Mir, Rashid Jooma

Department of Surgery Docs

Abstract

OBJECTIVE:

To assess how the frequency, nature and outcome of road traffic crashes differ during the fasting month of Ramadan.

METHODS:

The retrospective study was conducted in Karachi and comprised data from the Road Traffic Injury Surveillance Project which entailed information on all road traffic injury victims presenting to Emergency Departments in the city between September 2006 and September 2011. Data was analysed to find the frequency of road traffic crashes according to time of incident, road user group and survival. Ramadan and Non-Ramadan groups were compared with respect to time and frequency of incidents, road user group and …

Factors Affecting Ventriculoperitoneal Shunt Survival In Adult Patients, Farid Khan, Abdul Rehman, Muhammad Shahzad Shamim, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Ventriculoperitoneal (VP) shunt insertion remains the mainstay of treatment for hydrocephalus despite a high rate of complications. The predictors of shunt malfunction have been studied mostly in pediatric patients. In this study, we report our 11-year experience with VP shunts in adult patients with hydrocephalus. We also assess the various factors affecting shunt survival in a developing country setting.
Methods: A retrospective chart analysis was conducted for all adult patients who had undergone shunt placement between the years 2001 and 2011. Kaplan-Meier curves were used to determine the duration from shunt placement to first malfunction and log-rank (Cox-Mantel) tests …

Study Protocol: Asymptomatic Intracranial Atherosclerotic Disease In Pakistanis., Ayeesha Kamran Kamal, Farzin Majeed,, Omrana Pasha, Muhammad Islam, Iqbal Azam Syed, Muhammad Saleem Ilyas, Munawar Hussain, Kamran Masood, Bilal Ahmed, Sumaira Nazir,, Zafar Sajjad, Scott E. . Kasner

Department of Medicine

Background : Intracranial atherosclerotic disease (ICAD) is the most frequent subtype of ischemic stroke globally. It is important to describe the determinants of early ICAD as a strategy to prevent strokes from clinically evident and progressive ICAD. Our objective is to report the determinants of asymptomatic ICAD by linking the presence or absence of ICAD on magnetic resonance angiogram (MRA) with detailed risk assessment in asymptomatic adults.

Methods : This is an observational cross-sectional analytical study. We plan to recruit 200 adult participants from the radiology departments of two tertiary care centers of Karachi, Pakistan. The participants will first be …

Study Protocol: Validation And Adaptation Of Community-Worker-Administered Stroke Symptom Questionnaire In A Periurban Pakistani Community To Determine Disease Burden., Maria Khan, Ayeesha Kamran Kamal, Omrana Pasha, Muhammad Islam, Iqbal Azam Syed, Azam Virk, Alia Nasir, Anita Andani, Muhammad Jan, Anjum Akhtar, Junaid Abdul Razzak

Department of Medicine

Background : Stroke is the second leading cause of mortality and the leading cause of disability in the world today. The disease burden is on the rise in developing nations, but there is scarcity of data from these regions to inform policy decisions. Stroke burden can be determined by clinical diagnosis alone in the public health context and is a far more feasible way to assess disease status in low- to middle-income countries like Pakistan. We aim to translate and adapt a validated stroke symptom questionnaire, train community health workers in its administration, and verify it against assessment by two …

Impacts Of Signal Free Corridors On The Incidence Of Road Traffic Accidents In Karachi, Salman Zubair, Jamil H. Kazm, Syed Shahid Ali, Rashid Jooma, Zeeshan Akhtar

Section of Neurosurgery

Increase in road Traffic Accidents is a global phenomenon and Pakistan is no exception. In Karachi, this problem becomes severe due to rapid growth of population. This menace is ruining the lives of thousands of people and making Karachi a worrisome place to live. Recent road geometrical transitions in the city with insufficient accessories have been reducing the problem of traffic congestion to a limited extent. On the contrary, this has erupted as a problem of Road Traffic Accidents which is reaching out of proportions. Recently, induction of a unique feature named, Signal Free Corridor in Karachi has cost many …

Polio Eradication And Health Systems In Karachi: Vaccine Refusals In Context, Svea Closser, Rashid Jooma, Emma Varley, Naina Qayyum, Sonia Rodrigues, Akasha Sarwar, Patricia Omidian

Section of Neurosurgery

Community and health worker engagement will be key to polio eradication in Karachi, Pakistan. In this study, the authors conducted participant observation, interviews, and a document review in SITE Town, Karachi, an area that in recent years has harbored poliovirus. SITE’s diverse population includes large numbers of internally displaced persons who are disproportionately affected by polio and are more likely than other populations to refuse the polio vaccine. Vaccine acceptance and worker motivation in SITE Town were shaped by the discrepancy in funding and attention for polio eradication campaigns as compared with routine services. Parental vaccine refusals stemmed from a …

Can Trained Field Community Workers Identify Stroke Using A Stroke Symptom Questionnaire As Well As Neurologists? Adaptation And Validation Of A Community Worker Administered Stroke Symptom Questionnaire In A Peri-Urban Pakistani Community., Maria Khan,, Ayeesha Kamran Kamal, Muhammad S. Ilyas, Muhammad Islam, Iqbal Azam Syed, Azam Virk,, Alia Nasir, Hasan Rehman,, Anita Arif,, Muhammad Jan,, Anjum Akhtar,, Minaz Mawani, Junaid Abdul Razzak,, Omrana Pasha

Department of Medicine

Background: Stroke is a leading cause of morbidity and mortality worldwide. There is a paucity of data from South Asia where stroke is highly prevalent. Validated tools administrable by Community Health Workers (CHWs) are required to identify stroke in the community in a resource strapped region such as this.

Methods: The study was conducted in a transitional slum in Karachi, Pakistan. Questionnaire for Verifying Stroke-Free Status (QVSFS) was adapted and translated into Urdu. Two CHWs, trained by a neurologist, selected 322 community dwelling subjects using purposive sampling. Each CHW collected data independently which was validated by a vascular neurologist who …

A Case Report Of Joubert Syndrome In Adult Presenting With Seizures, Ramla Nayaib Hashmi, Umm Ul Kiram

Pakistan Journal of Neurological Sciences (PJNS)

Joubert syndrome (JS) is rare autosomal recessive condition characterized by hypotonia, ataxia, psychomotor delay, and variable occurrence of oculomotor apraxia and neonatal breathing abnormalitie,intellectual disability, and specific mid-hindbrain malformation (“molar tooth sign”, MTS) We reportthe case of Joubert syndrome in a 32 years old female patient presenting with intellectual impairment, breathing abnormal breathing patterns like tachypnea followed by apnea ataxia, and seizures. She was diagnosed on the basis of Magnetic Resonance Imaging (MRI) and clinical features. JoubertSyndrome should be considered in all patients presenting with hypotonia, ataxia, nystagmus, breathing abnormalities and developmental delay. Its neuroimaging hallmarks include molar tooth sign …

Effectiveness Of Stretching Of The Flexor Retinaculum With Ultrasonic Therapy In The Management Of Carpal Tunnel Syndrome, Waqar Ahmed Awan, Muhammad Naveed Babur, Misha Ansari, Maria Liaqat

Pakistan Journal of Neurological Sciences (PJNS)

Aims & Objective: The objective of study was to compare the effectiveness of manual stretching of the flexor retinaculum with or without ultrasonic therapy. Methods: The study was started by selecting the 50 patients from the out patients department of Al-nafees Hospital AlipurFarash and National institute of Rehabilitation Medicine Islamabad with history of carpal tunnel syndrome. The 25 patients in experimental group were treated with manual stretching of flexor retinaculum and ultrasound and 25 patients of control group were treated with manual stretching of flexor retinaculum. Every session was started by assessment of improvement of the symptoms in each patient. …

The Burden Of Dysphagia And Chest Infection In Acute Ischemic Stroke In A Tertiary Care Hospital Of Islamabad Capital Territory, Rao Suhail, Shahzad Ahmed, Sumaira Nabi, Mansoor Iqbal

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is the foremost cause of severe neurologic disability in adults and is associated with a variety of complications. Dysphagia complicates acute ischemic strokes (AIS) in 42% cases and is more evident during the first week after ischemic stroke. Chest infection complicates AIS in 32% of the cases and 89% of these cases are due to dysphagia. Videofluoroscopy is the gold standard for swallowing assessment but due to non availability, bedside swallowing assessment is a more handytool. Methods: From August 2013 to February 2014151 patients were enrolled according to the set criteria.Each patient was assessed for dysphagia according to the …

Diagnostic Issues And Clinical Spectrum Of Childhood Degenerative Brain Diseases, Tipu Sultan, Ashfa Ameer Khan, Muhammad Arshad Khawaja, Zia Ur Rahman, Ahsan Waheed Rathore

Pakistan Journal of Neurological Sciences (PJNS)

To find out the spectrum of clinical presentation and typesof neurodegenerative disorders of childhoodin tertiary care child neurology centre of Pakistan. To find out the role of brain imaging in the diagnosis of degenerative brain disorders in children. Methods: It will bea retrospective, descriptive study conducted at department of paediatric neurology,The Children’s Hospital, Institute of child health, Lahore, Pakistanfrom January 1st,2004 to December 31,2013 (10 years). A total of 22,737 patients were admitted in the Paediatric Neurology department in the above said period. Out of them 366 children fulfilled the inclusion criteria. History, clinical examination and relevant investigations were evaluated …

Stiff Person Syndrome: A Diagnostic And Management Challenge, Zoya Sajjad, Anam Abrar, Zafar Ullah, Aasim Rehman, Wasim Tariq, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

Stiff person syndrome (SPS) is a rare neurological disorder characterized by progressive muscle stiffness and rigidity, mostly involving axial muscles, resulting in functional disability. It is associated with elevated anti- Glutamic acid decarboxylase (GAD) antibody levels. Electromyography findings are often diagnostic. We present a case of a 48 years old male, who presented with progressive stiffness and rigidity of axial muscles and limbs. His EMG was consistent with SPS. Anti GAD antibodies were markedly elevated. He was treated with rituximab and has improved significantly. SPS is a difficult diagnosis, usually under diagnosed due to lack of awareness among medical community. …

Gender Based Differences In Diabetic Peripheral Neuropathy, Athar Javed, Ahmad Furqan, Mohsin Zaheer, Naeem Kasuri

Pakistan Journal of Neurological Sciences (PJNS)

Diabetic peripheral neuropathy (DPN) is one of the common complications of diabetes mellitus. Aim: To find out gender based differences in frequency of DM, age at diagnosis of DM and subsequent onset of DPN, duration of DM and DPN and electrophysiological patterns. Methodology: On the basis of non-probability purposive sampling, a cross sectional study was conducted at Neurology department, Mayo Hospital, Lahore. Patients fulfilling the ADA criteria for DM, and DPN were included in the study. Data was analyzed using SPSS 16 version. Results: A total of 125 patients were included in the study with 57/125 (45.6%) males and 68/125 …

Stroke Rehabilitation In Pakistan: What We Know And What We Need To Do?, Farooq Azam Rathore, Akhtar Waheed

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is one of the leading causes of adult neurological disability all around the globe. There have been some remarkable improvements in the acute management of stroke. These include the use of thrombolysis, development of radiological investigations including computerized tomographic scan and magnetic resonance imaging and establishment of acute stroke units. There have been some promising advances the field of stroke rehabilitation as well in the last three decades.

Prof. Akhtar Ahmed – A Memoir Of Love, Respect, Admiration, And..., Ismail A. Khatri

Pakistan Journal of Neurological Sciences (PJNS)

Prof. Akhtar Ahmed – a majzoob, how can it be. What an unusual analogy! I was kind of surprised when I heard this from one of my revered teachers Prof. Iftekhar Ahmed who happen to be one of the students of Prof. Akhtar Ahmed like me. However, when he explained this analogy it made complete sense. He explained that a majzoob throws stones on the salik and treats the salik harshly until he is confident that the salik can go through and endure the hardships on the path. Once satisfied, the majzoob opens up for the salik and the knowledge …

Pattern And Outcome Of Epilepsy At Department Of Neurology At Cmc Teaching Hospital Larkana, Alam Ibrahim Siddiqui, Badaruddin Junejo, Lal Chander Dhingra, Anila Mumtaz

Pakistan Journal of Neurological Sciences (PJNS)

Epilepsy is third most common chronic neurological disease. Mortality is 2-3% more common in epilepsy patients than in general population. World wide survey have shown that epilepsy responds to treatment in about 70 % of epileptic patients and three fourth of the affected people do not get the treatment they need. So objective of our study was to know the outcome and pattern of epilepsy at Department of Neurology CMC teaching hospital Larkana ,so that in next step we could know which factors could reduce the morbitity and mortality due to epilepsy hence could prevent complications due to epilepsy. Total …