Neurology Commons^™

Radiological Findings In Peri-Partum Neurological Emergencies: Experience From A Tertiary Care Hospital, Pari Gul, Bushra Rehan, Saleha Anwar, Muhammad Usman Aziz

Pakistan Journal of Neurological Sciences (PJNS)

Acute neurological diseases requiring hospitalization are unusual in young women. Some of these diseases are unique to pregnancy and the post-partum period including pre-ecclampsia. Others such as cerebral venous thrombosis, ischemic stroke, intracranial hemorrhage, etc. are indirectly related to pregnancy and seen less frequently. To explore the causes of neurological emergencies in this specific patient population, we performed a radiological audit of young women in pregnancy and postpartum period presenting with neurological emergencies. Material and methods: This was a retrospective study carried in the Department of Radiology, Liaquat National Hospital over one year from January 2013 till January 2014, after …

Frequency Of Peripheral Neuropathy In Newly Diagnosed Patients Of Diabetes Mellitus Iion Clinical And Electrophysiological Basis, Muslim Ali Lakhiar, Naila Naeem Shahbaz, Abdul Hafeez Bughio, Jai Prakash

Pakistan Journal of Neurological Sciences (PJNS)

To determine the frequency of peripheral neuropathy in newly diagnosed patients of Diabetes Mellitus type II on clinical and electrophysiological basis. Methods: This is Hospital based descriptive cross sectional study conducted at department of Neurology Civil Hospital Karachi/ Dow University of Health Sciences from 20th December 2011 to 20th June 2012. Data was collected from Neurology OPD, Medicine OPD and Diabetic Clinic Civil Hospital Karachi. Results: Total no of patients were 107 who were already diagnosed as type 2 Diabetes Mellitus. Out of these, there were 57 (53.3%) male patients and 50 (46.7%) female patients, with ratio of males to …

Endovascular Treatment Of Spontaneous Indirect High Flow Carotid Cavernous Fistula With A Covered Stent., Qasim Bashir, Hina Nabi Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

The treatment of symptomatic carotid-cavernous fistulas [CCF] has been historically treated in the developed world through the endovascular route. We report our first case of using a covered stent in a patient with spontaneous CCF. Method: Single patient with spontaneous indirect high flow CCF treated with a covered stent. We present retrospective analysis of technical success, initial and 6-month follow-up angiography and clinical outcome. Result: The stent was successfully navigated and deployed covering the CCF orifice. Immediate post stent deployment angiography showed marked reduction in flow and complete occlusion at 6-months. Clinically, patient showed near-complete recovery at 6 months. Conclusion: …

A Clinical Approach To Disorders Of Speech, Apoorva Pauranik

Pakistan Journal of Neurological Sciences (PJNS)

Disorders of speech and communication, including Aphasia (mainly post stroke) are a major community health burden in terms of DALY (Disability Adjusted Life Years). Unfortunately they are relatively neglected with huge treatment gap. Traditionally aphasia related lesion sites have been grouped with reference to Rolandic & Sylvian fissures. However the theoretical models of language and speech organization in brain have undergone major conceptual shifts due to advances in cognitive neuropsychology, linguistics and functional neuro-imaging. Much more widely distributed overlapping neural networks are understood to be actively involved in various communication activities. The notion of speech centers or areas is somewhat …

First International Neuro Rehabilitation & 3rd National Rehabilitation Conference (31st October To 2nd November, 2014), Naveed Babur

Pakistan Journal of Neurological Sciences (PJNS)

The First International Neuro Rehabilitation & 3rd National Rehabilitation Conference was held at Isra Institute of Rehabilitation Sciences, Islamabad Campus Capital City of Pakistan from 31stOct to 2nd Nov, 2014.

Brief Report On 14th International Neurology Update & 7th National Stroke Conference, Muhammad Malik

Pakistan Journal of Neurological Sciences (PJNS)

Learning is an enduring burden for neurologists aiming to maintain a high standard of clinical practice and education. 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. The colossal burden of neurological disorders in Pakistan often overwhelms neurologists and trainees leaving them little time for professional self development.

The Impact Of Polio Eradication On Routine Immunization And Primary Health Care: A Mixed-Methods Study, Svea Closser, Kelly Cox, Thomas M. Parris, R Matthew Landis, Judith Justice, Ranjani Gopinath, Kenneth Maes, Hailom Banteyerga Amaha, Ismaila Zango Mohammed, Rashid Jooma

Section of Neurosurgery

Background: After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC).
Methods: Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review.
Results: Our quantitative analysis did not find compelling evidence of widespread and …

Adult Neurogenesis In The Four-Striped Mice (Rhabdomys Pumilio), Olatunbosun O. Olaleye, Amadi O. Ihunwo

Brain and Mind Institute

In this study, we investigated non-captive four-striped mice (Rhabdomys pumilio) for evidence that adult neurogenesis occurs in the adult brain of animal models in natural environment. Ki-67 (a marker for cell proliferation) and doublecortin (a marker for immature neurons) immunostaining confirmed that adult neurogenesis occurs in the active sites of subventricular zone of the lateral ventricle with the migratory stream to the olfactory bulb, and the subgranular zone of the dentate gyrus of the hippocampus. No Ki-67 proliferating cells were observed in the striatum substantia nigra, amygdala, cerebral cortex or dorsal vagal complex. Doublecortin-immunoreactive cells were observed in …

Non Communicable Diseases In Pakistan: Burden, Challenges And Way Forward For Health Care Authorities, Mohammad Wasay, Shehla Zaidi, Maria Khan, Rashid Jooma

Section of Neurology

No abstract provided.

Magnetic Resonance Spectroscopy Of Enhancing Cerebral Lesions: Analysis Of 78 Histopathology Proven Cases, Muhammad Shahbaz Alam, Humera Ahsan, Zafar Sajjad, Madiha Beg, Umer Bhatti, Ather Enam, Mohammad Wasay

Department of Radiology

Objectives: To investigate the efficacy of magnetic resonance spectroscopy in differentiating various types of neoplastic and non-neoplastic enhancing cerebral lesions.
Methods: The prospective study was conducted from January 2007 to December 2009 at the Department of Radiology, Aga Khan University Hospital, Karachi. All patients with enhancing brain lesions on magnetic resonance imaging who underwent magnetic resonance spectroscopy and a biopsy with histopathological analysis were included in study. The lesions were categorised into neoplastic and non-neoplastic lesions on the basis of spectroscopy findings. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of magnetic resonance spectroscopy were calculated. …

Prospective Validation Of A Blood Ordering Protocol For Elective Spine Arthrodesis And Its Impact On Cost Reduction, Muhammad Waqas, Muhammad Shahzad Shamim, Badar Uddin Ujjan, Saqib Kamran Bakhshi

Section of Neurosurgery

Background: On the basis of an institutional audit, the authors published an individual patient-based protocol for preoperative arrangement of blood products in patients undergoing elective spine arthrodesis. The present study was conducted for the prospective validation of the proposed protocol in reducing cross match to transfusion ratio, and its implications on overall cost.
Methods: This cross-sectional study was conducted over 1 year (2012). All adult patients who underwent elective spinal arthrodesis were included and prospectively observed. The actual transfusion index was calculated for individual patients with the formula C1/T, where C1 is the number of units of packed RBCs cross …

Lumbar Morphometry: A Study Of Lumbar Vertebrae From A Pakistani Population Using Computed Tomography Scans, Muhammad M. Alam, Muhammad Waqas, Hussain Shallwani, Gohar Javed

Section of Neurosurgery

Study design: A cross-sectional study.
Purpose: To describe the characteristics of lumbar vertebrae of Pakistani patients reporting at a tertiary care hospital and compare with studies from other populations.
Overview of literature: Several studies have been conducted to determine morphometry of lumbar vertebrae. Most of the studies involve Caucasian populations, still data on other populations still sparse. This is the first study describing lumbar morphometry of a Pakistani population.
Methods: An observational study was conducted based on a review of thin-cut (3 mm) computed topographic images of lumbar vertebrae. Two-hundred and twenty vertebrae from forty-nine patients were studied, and various …

Gestational Headaches: Characteristics And Influencing Factors In South-Western Nigeria, Philip Adebayo, Aramide Mikhail Tijani, Olukayode Abayom, Adeseye Abiodun Akintunde

Internal Medicine, East Africa

Background: factor s Headache is one of the common neurological diseases in pregnancy but its pattern and influencing are yet to be determined in our environment in Nigeria. The aim of this study was to determine the prevalence and characteristics, as well as the modifying factors for gestational headaches in Ogbomoşo, Nigeria.

Methods: This study was a biinsti pregnant women attending the antetutional crosssectional descriptive study. Three hundred and eight (308) eligible natal care of the Ladoke Akintola University of T local government hospitals in Ogbomoso were recruited consecu 2013. Using an interviewer administered questionnaire, sociodemographic, obstetrics and headache related …

Risk And Impact Of Inter-Ictal Depression On Quality Of Life Of Nigerian Women With Epilepsy Of Childbearing Age, Philip Adebayo, Olukayode Abayomi, Shamsideen Abayomi Ogun

Internal Medicine, East Africa

Background: Depression, the most common psychiatry comorbidity in patients with epilepsy is common among women, especially those of reproductive age. Although it could be said that the female gender is a risk factor for depression, the risk of inter-ictal depression and its impact on the quality of life (QoL) of women with epilepsy (WWE) has not been sufficiently studied among Nigerians.

Materials and Methods: In this cross-sectional case–control study, data were collected from 70 women (29 WWE and 41 women without epilepsy) within the age range ≥18 and ≤55 between July 2010 and March 2011. A questionnaire that includes items-related …

Polio Travel Restrictions: A Sledgehammer To Crack A Nut?, Rashid Jooma

Section of Neurosurgery

Imposition by WHO of mandatory vaccination for international travelers from Pakistan has caused confusion and panic amongst travelers besides the adverse effect on the country's image from the widely reported statement. It is felt that the announced measure is not primarily supported by science but is rather a response to disillusionment in the donors about the repeatedly missed eradication targets set by WHO. In the past few years, exportation of poliovirus from Pakistan has caused outbreaks in China, Iraq and Syria besides the ongoing two way transmission with Afghanistan, but the carriers in these spreads are mainly land route travelers. …

Prevalence Of Anxiety And Depression Among Medical Students Of Shifa College Of Medicine, Anam Abrar, Mehrunissa Kazim, Madiha Hanif, Shafaq Mansoor, Sadaf Tahir, Neil Makken, Wahab Yousufzai

Pakistan Journal of Neurological Sciences (PJNS)

To yield information regarding the prevalence of anxiety and depression among medical students in Islamabad and to emphasize on the need of psychological and mental well being of medical students.Methods: This is a cross-sectional study done at Shifa College of Medicine. A questionnaire was administered to 361 students who were present at the time of distribution and were consented. The instrument used to assess anxiety and depression level was the Aga khan University Anxiety and Depression Scale (AKUADS). The data collected was tabulated and analyzed using SPS v. 16.Results: Out of a total of 500 students in a five year …

Epidemiology Of Cerebral Venous Thrombosis In Asian Countries, Aleena Zia, Mohammad Wasay, Subash Kaul

Pakistan Journal of Neurological Sciences (PJNS)

ECerebral venous thrombosis (CVT) is a rare form of venous thromboembolism (VTE). CVT represents almost 0.5% -3% of all the types of stroke, affecting predominantly younger people, with an estimated incidence for adults of 3-4 per million, and for children 7 per million. In the pre-antibiotics era, the leading cause of CVT were septic processes, currently, the aseptic form of CVT predominates. (1) About 75% of all adult patients are women, over the past decade, advances in neuroimaging and treatments have significantly improved the disease’s prognosis with 80% of sufferers having a good neurological outcome. (2) The largest source of …

Analytic Study Of Clinical Presentation Of Intracranial Space-Occupying Lesions In Adult Patients, Bashir A. Soomro, Sameen Khalid, Shafaq Alvi

Pakistan Journal of Neurological Sciences (PJNS)

Intracranial space-occupying lesions can be caused by a variety of disease processes, ranging from neoplasms to non-neoplastic lesions including hematomas, abscesses and vascular malformations. This article provides an overview of varied clinical presentations of patients with intracranial space-occupying lesions.Methods:A total of 200 cases of intracranial space-occupying lesions presenting at Neuro Clinic and Care were retrospectively analyzed. Adult patients from all age groups and both genders were included in this study. Results: 165 patients (82.5%) had neoplastic lesions while 35 (17.5%) had non-neoplastic lesions. Metastatic lesions from primary tumor elsewhere in the body comprised the most common group with81 cases (40.5%), …

Knowledge, Attitude And Perceptions About Tetanus And Rabies Among Family Physicians; Results Of A Survey At A Teaching Hospital In Karachi, Pakistan, Siddiqui Sj, Jehan F, Awan S S, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

To assess the knowledge, attitude and perception among family physicians about tetanus and rabies. Setting: This study was conducted at the International Family Physicians Conference held at the Aga Khan University. Method: It was a cross sectional study of convenient sampling. The participants were asked to fill a pre-tested questionnaire comprising of 26 questions. Both open and close ended questions were included. A total of 111 doctors fulfilling the inclusion criteria filled in the questionnaire.Result: Out of 111 doctors who participated in this study, vast majority were working in the urban area (86.5%). 59.5% had not seen a case of …

Management Of Multiple, Late Onset Complications In A 33-Year-Old Female, With A Ventriculoperitoneal Shunt And Crohn's Disease, C Gkolemis, P Zogopoulos, P Kokkalis, G Stamatopoulos, N Syrmos, T.S. Paleologos

Pakistan Journal of Neurological Sciences (PJNS)

Numerous complications can occur after the placement of a venticuloperitoneal shunt. The late onset of an autoimmune disease such as Crohn's disease can be the disruptive factor for a previously well functioning shunt. A 33-year-old female with a ventriculo-peritoneal shunt since the age of 7, as well as Crohn's disease since the age of 25, presented in the ER with dysuria, long-lasting fever and intermittent severe headache. The patient underwent a CT scan of the chest, abdomen and brain. An enlargement of the ventricular system was revealed, suggesting malfunction of the shunt. Simultaneously, the abdominal scan revealed an abnormal course …

Cramp Fasciculation Syndrome: A Peripheral Nerve Hyperexcitability Disorder, Bhojo A. Khealani

Pakistan Journal of Neurological Sciences (PJNS)

Cramp fasciculation syndrome is mildest among all the peripheral nerve hyperexcitability disorders, which typically presents with cramps, body ache and fasciculations. The diagnosis is based on clinical grounds supported by electrodiagnostic study. We report a case of young male with two months’ history of body ache, rippling, movements over calves and other body parts, and occasional cramps. His metabolic workup was suggestive of impaired fasting glucose, radiologic work up (chest X-ray and ultrasound abdomen) was normal, and electrodiagnostic study was significant for fasciculation and myokymic discharges. He was started on pregablin and analgesics. To the best of our knowledge this …

Cost-Effective Practice Of Neurology: An Idea Whose Time Has Come, Rashid Jooma

Pakistan Journal of Neurological Sciences (PJNS)

Pakistanis spent $ 7.2 billion on healthcare in 2013 (3.1% of our Gross Domestic Product), representing a per capita expenditure of $ 39.4. The government contribution to this was no more than 31.4% ($ 12.4 per capita). The public allocations to health thus represent a paltry 4.7% of total government expenditure and are just shy of 1% of our GDP.

To Determine The Frequency Of Depression In Patients With Primary Epilepsy, Wazir Akber, Noor Ahmed Khosa, Amanullah Sarangzai

Pakistan Journal of Neurological Sciences (PJNS)

Depression is well known common co-morbid psychiatric condition associated with primary epilepsy. This study showed that frequency of depression was 62% in primary epilepsy patient presenting to the Neurology outpatient clinic of a tertiary care hospital. Female gender, high seizures frequency, polytherapy with AEDs and long duration of primary epilepsy were found to be the factors leading to frequent occurrence of depression in primary epilepsy patients Objective: To determine the frequency of depression in patients with primary epilepsy presenting to the Neurology outpatient clinic of Aga Khan University Hospital Karachi.Study Design: Cross-sectional study. Study Setting: Neurology outpatient department at Aga …

Coil Embolization Of Wide Neck Cerebral Aneurysms Using Balloon Remodeling Technique-Initial Experience In Pakistan, Qasim Bashir, Hina Nabi Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

The balloon remodeling technique [BRT] was developed for neuroendovascular treatment of wide-necked cerebral aneurysms. Herein, we describe our initial experience of aneurysm embolization using BRT in Pakistan with the new double-lumen balloon catheters (Sceptor C and Ascent) and Hyperform balloon micro catheter and discuss its benefits.

Clippers (Chronic Lymphocytic Inflammation With Pontine Perivascular Enhancement Responsive To Steroids)–Case Report With Neuroimaging, Abdul Salam, Farah Sana, Rashed Nazir, M. Azhar Saeed, Yasir Iqbal, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

Background: CLIPPERS syndrome (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids) is an inflammatory disease process primarily involving the pons and adjacent structures. Clinically, the patient may present with cerebellar signs such as dysarthria, gait ataxia and with cranial nerve palsies. It shows good response to steroids / immunosuppressive therapy. Pathologically, there is infiltration of T lymphocytes into the perivascular spaces of brainstem. The disease follows a relapsing and a remitting course and the earlier the treatment is started with high dose steroids and the more prolonged it is, the better the clinical outcome will be.

Sporadic Cjd And Retinitis Punctata Albescansa Case Report And Literature Review, Quratulain Khan, Yusra Hanif Khan

Pakistan Journal of Neurological Sciences (PJNS)

Introduction Sporadic Creutzfeldt-Jakob disease (sCJD) is the most common form of CJD causing 85% of all cases. Various phenotypes of sCJD have been identified including Heidenhain variant which has early and predominant visual symptoms with most pronounced neuropathological changes in occipital lobe. Methodology. We are reporting a case of sCJD with Retinitis Punctata Albescens (RPA), a variant of Retinitis Pigmentosa (RP), which to our knowledge has not been reported before. A 51 year old, married, right handed, Pakistani woman presented with dementia and gait problems for 3 months and visual hallucinations for 2 months. Ophthalmological examination 3 years prior to …

Endovascular Treatment Of Intracranial Aneurysms Using Balloon Remodeling Technique, Wasey Jilani, Tanveer Ul Haq

Pakistan Journal of Neurological Sciences (PJNS)

Endovascular treatment with coils is widely used in the management of intracranial aneurysms. However, this type of treatment can be technically challenging for anatomic reasons, particularly when the neck of the aneurysm is wide or when the dome-to-neck ratio is not favorable. Previous studies described the remodeling technique for extending the indications and feasibility of the endovascular treatment to wide-neck intracranial aneurysms. In remodeling technique, a non-detachable balloon is temporarily inflated in front of the neck of the aneurysm during each coil placement. At the end of the procedure, the remodeling balloon is removed and no device is left in …

Autism- Towards Comprehensive Assessment And Management, Ayesha Mian

Pakistan Journal of Neurological Sciences (PJNS)

Autism is a pervasive, neurodevelopmental disorder characterized by stereotyped movements and impairment in social skills and communication patterns. Prevalence patterns show an increasing burden of about 1 in 150 children affected by the disorder. Most affected individuals have symptoms that interfere greatly with quality of life. Although a burgeoning concern, research on the prevalence, etiological factors and presentation patterns is limited in LAMI countries, leading to a minimal understanding of the disorder at individual, professional and societal level. There is an urgent need to enhance awareness and education to decrease stigma that maybe associated with autism.

Psychiatric Disorders In Neurology, Rizwan Taj, Mamoona Manzoor

Pakistan Journal of Neurological Sciences (PJNS)

Psychiatric disorders (PDs) are very frequent in neurological illnesses. Depression, anxiety and cognitive impairment are frequently seen in many neurological disorders such as stroke, Parkinson disease (PD), epilepsy and multiple sclerosis (MS). In addition, hallucinations, delusions, obsessive-compulsive disorder, sleep disorders, Impulse control disorders (ICDs), somatization, bipolar disorder, behavior problems and psychological problem are also seen. Depression in stroke and epilepsy has bidirectional relationship. Lesion location affects both frequency and severity of depression in stroke patients.

Thoracic And Lumbar Spinal Surgery Under Local Anesthesia For Patients With Multiple Comorbidities: A Consecutive Case Series, Muhammad Babar Khan, Rajesh Kumar, Ather Enam

Section of Neurosurgery

Background: Although some patients with symptomatic spinal disease may benefit greatly from surgery, their multiple attendant comorbidities may make general anesthesia risky or contraindicated. However, there is scarce literature describing the efficacy and safety of local anesthesia to perform these operations. Here we report seven patients who successfully underwent spinal surgery utilizing local anesthesia to limit the risks and complications of general anesthesia.
Methods: Seven patients for whom general anesthesia was contraindicated were prospectively followed for a minimum of 3 months following spinal surgery performed under local anesthesia. Pain and functional improvement were assessed utilizing the Visual Analog Scores (VAS) …