Neurology Commons^™

A Rare Case Of Myasthenia Gravis With Coexisting Muscular Dystrophy, Sommayya Aftab, M Haroon Hamid, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Myasthenia gravis (MG) is an autoimmune disease in which antibodies are directed against postsynaptic membrane of neuromuscular junction, resulting in muscle weakness and fatigability. We report a rare case of an 11 years old boy who was a known case of myasthenia gravis presented with progressive weakness and wasting of facial and limb musculature and was found to have coexisting muscular dystrophy most like facioscapulohumeral muscular dystrophy (FSHD).

Hallervorden Spatz Disease – A Rare Clinicoradiological Diagnosis, Anam Abrar, Arsalan Ahmad, Ejaz A Khan

Pakistan Journal of Neurological Sciences (PJNS)

Hallervorden Spatz disease, also known as pantothenate kinase associated neuro-degeneration, is a rare, progressive neurological disorder usually seen in first decade of life. It is associated with extrapyramidal effects, dysarthria and dementia. Hallervorden Spatz Disease is also associated with psychiatric symptoms, depression and behavioral changes. Affected patients are disabled predominantly by dystonia. MRI, in later stage of the disease, shows “eye of the tiger’ appearance which is fairly diagnostic of Hallervorden Spatz Disease. Response to drugs is often poor and of limited value to these patients. This report highlights a classical case of Hallervorden Spatz disease that presented as an …

Stroke In Women: Burden, Challenges And Future For Pakistan, Maria Khan, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

The burden of stroke is increasing around the world in both men and women. South Asia is home to 20% of the world’s population but harbors almost 80% of world strokes. Previously sex specific data on stroke incidence, prevalence, severity and mortality was not available. Now over recent years this aspect has received attention. A systematic review in 2009 concluded that although stroke in women is less common compared to men, it has a greater severity and case fatality. Although this kind of data is not available from Pakistan, some preliminary reports suggest that this might be the case in …

Clinical Predictors Of Mechanical Ventilation In Guillain-Barré Syndrome (Gbs), Sumaira Nabi, Sadaf Khattak, Muhammad Irshad Awan

Pakistan Journal of Neurological Sciences (PJNS)

Guillain-Barre’ Syndrome is the most common cause of acute flaccid paralysis worldwide. One of the most serious complications is respiratory failure warranting mechanical ventilation which is required in about 30% of the patients. Various studies have been carried out to identify clinical factors which could help identify patients with impending respiratory failure and facilitate elective mechanical ventilation in these patients to reduce the associated mortality. Material and methods: 92 patients diagnosed with GBS were enrolled from February 6, 2013 to August 5, 2013 in department of Neurology, PIMS, Islamabad. Each patient was then be managed accordingly and monitored for therequirement …

Impact Of Guillain Barre Syndrome On Psychosocial Functionings Of Patients In Islamabad, Muhammad Naveed Babur, Farrukh Shahzad, Waqar Ahmed Awan

Pakistan Journal of Neurological Sciences (PJNS)

GuillainBarre Syndrome (GBS) is a rare autoimmune disease of unknown causes that affects peripheral nervous system. Objectives: To review the impacts of the GuillainBarre Syndrome on the psychosocial functioning of the patients and to assess the relationship between GuillainBarre Syndrome and the psychosocial functioning Methodology: Comparative cross sectional survey was conducted on 100 participants (50 GBS patients from Shifa International Hospitals and 50 normal participants from Islamabad in 6 months time from February to July 2013. Data collected through Structured Questionnaire in hospital settings for GBS patients and normal persons from Islamabad through Psychosocial functioning scale and social functioning scale …

Variants And Variations Among Gullian Barre Syndrome Presenting As Acute Flaccid Paralysis, Alam Ibrahim Siddiqui, Ghulam Rasool Bouk, Lal Chand, Sarfraz Ahmed Mahesar, Ghulam Mustafa Tunio

Pakistan Journal of Neurological Sciences (PJNS)

Acute flaccid paralysis (AFP) is a clinical syndrome characterized by rapid onset of weakness that frequently includes respiratory and bulbar weakness. An accurate and early diagnosis of the cause has important bearing on the management and prognosis. Guillian Barre Syndrome (GBS) is a post infectious polyradiculoneuropathy involving mainly motor but sometimes sensory and autonomic nerves.

Neuroradiological Manifestations Of Tuberculous Meningitis, Sumaira Nabi, Sadaf Khattak, Mazhar Badshah, Haris Majid Rajput

Pakistan Journal of Neurological Sciences (PJNS)

Tuberculous meningitis (TBM) represents the most severe form of extra pulmonarytuberculosis (1).The early and exact diagnosis of TBM is important but difficult due to time consuming definitive microbiological procedures (2).Neuroimaging is an important initial investigation in tuberculous meningitis(3).This study was conducted to evaluate the neuroradiological findings in patients with tuberculous meningitis, as a useful modality for itsearly diagnoses and prompt treatment.

Spontaneous Intracranial Hypotension, Mehwish Sayed, Ahmed Asif, Bushra Reha, Amanullah Khan

Pakistan Journal of Neurological Sciences (PJNS)

Spontaneous intracranial hypotension (SIH) is uncommon and usually undiagnosed entity which present most commonly with postural headache. The diagnosis is difficult because of the nonspecific symptoms and lack of awareness about the disease .It is important to recognize SIH as if the disease goes undiagnosed it can cause a significant delay in initiation of the treatment and exposing patient to the risks associated with the treatment for the disorders mimicking intracranial hypotension . We describe a patient with SIH and outline the important clinical and radiological features of this syndrome. The aim of presenting this case report is to emphasize …

Radiosurgery: Current Recommendations For Intracranial Lesions And Practices In Pakistan, Hussain Shallwani, Sohaib Tariq, Muhammad E Bari

Pakistan Journal of Neurological Sciences (PJNS)

Radiosurgery is defined as the use of high-dose ionizing radiation for precise and total destruction of a chosen target, avoiding concomitant or delayed harm to adjacent tissues. The three types of radiations include gamma rays (GammaKnife) by Cobalt-60, X8 rays using linear accelerator (LINAC) system, and charged-particles generated from synchocyclotron. Recommendations: Based on current evidence, radiosurgery has proven benefits as the treatment of certain brain metastases, vestibular schwannomas, meningiomas, and some skull base tumors. Conclusion: This review describes the current recommendations for use of radiosurgery for intracranial pathologies. Radiosurgery is a relatively newer modality in the developing country of Pakistan. …

Isoflavones And Alzheimer’S Disease: The Effects Of Soy In Diet, Sara Habib, Asad Ali Khan Afridi, Mohammad Wasay, Romaina Iqbal

Pakistan Journal of Neurological Sciences (PJNS)

Pathologically, Alzheimer’s disease is a result of aggregation of amyloid peptides and protein tau in the brain forming neurofibrillary tangles which are highly toxic to neuronal circuits in the brain. Recent evidences report that apart from aging, estrogen deficiency is one of the risk factors predisposing to the development of Alzheimer’s disease. Isoflavones, also known as phytoestrogens, are metabolized by the body forming compounds that are known to interfere with neurotoxic pathways and through their anti-fibrillization effects they play a role in reducing apoptosis of neurons and glial cells and promote axonal regeneration. Experimental studies on transgenic models with Alzheimer’s …

Novel Anticancer Agents In Clinical And Preclinical Trials, Adnan Salim

Section of Neurosurgery

No abstract provided.

Distribution, Severity And Radiologic Features Of Intracranial Stenosis In Asymptomatic Pakistanis., Ayeesha Kamran Kamal, Farzin Majeed, Muhammad S. Ilyas, Munawar Hussain, Kamran Masood, Bilal Ahmed, Hasan Rehman,, Zafar Sajjad, Scott E. Kasner8

Department of Medicine

Background: Intracranial atherosclerotic disease (ICAD) is the most common ischemic stroke subtype globally. It accounts for 30–50% of all ischemic strokes in Asians. Aims—The aim of the study is to report the frequency of asymptomatic ICAD and its associated Magnetic Resonance Imaging (MRI) findings.

Methods: 200 adult participants were recruited from the Radiology Departments of two major diagnostic centers in Karachi. Eligible participants were confirmed for the absence of stroke symptoms via the Questionnaire for Verifying Stroke Free Status (QVSFS). QVSFS negative subjects underwent MRI on a 1.5 Tesla scanner. Images were centrally reviewed on Di com Viewer 3.0 with …

Is Surgical Spinal Decompression For Supratentorial Gbm Symptomatic Drop Down Metastasis Warranted? A Case Report And Review Of Literature, Muhammad Babar Khan, Muhammad Riaz, Muhammad Ehsan Bari

Medical College Documents

Background: Symptomatic spinal metastasis from an intracranial primary
glioblastoma multiforme (GBM) is very rare. Our literature search identified a total
of 42 such patients of which 11 were treated with surgical decompression for spinal metastasis with only one such report from the pediatric age group. Previous studies have reported variable outcomes after surgical management.

Case Description: We report the case of a 16‑year‑old boy who underwent
surgical spinal decompression for spinal metastasis after intracranial GBM. The
patient regained motor and autonomic function following surgery and reported
improvement in pain. We also present findings from a literature review using …

Spectrum Of Acquired Demyelinating Disorders Of The Central Nervous System In Adults In A Tertiary Care Hospital, Muhammad Athar Javed, Dr Qamar Zaman, Dr Naveed Alam, Ather Enam

Pakistan Journal of Neurological Sciences (PJNS)

Acquired demyelinating disorders of the central nervous system are diverse group of conditions characterized by destruction or disturbance of myelin sheath in the central nervous system i.e. brain and spinal cord. These vary in their causes, clinical presentations, and prognosis.

Understanding And Managing Complications In Neurosurgery, Raza Sayyed, M Shahzad Shamim

Pakistan Journal of Neurological Sciences (PJNS)

It is a well-known surgical maxim that only two types of surgeons do not have surgical complications; those who do not operate, and those who lie. Surgical complications in other words, are unwanted but undeniable part of surgery. There is not one operation with a 0% complication rate and therefore statistically, if a surgeon does not have complications, he probably has not operated enough. Despite their inevitability, complications convey a sense of gravity to the public, health professionals, and the policy makers alike.

Delay In Diagnosis Of Motor Neuron Disease. A Tertiary Care Experience, Hazim Brohi, Naveed Uddin Ahmed, Rajesh Khatri, Ishaq Asghar

Pakistan Journal of Neurological Sciences (PJNS)

Motor Neuron Disease is a progressive neurological disorder with poor prognosis. Inability to correctly recognize the disease, leads to undue agony and diagnostic dilemma. Studies have been done to look at the average duration taken to diagnose the disease from the onset of symptoms. The literature shows that latency from symptom onset to diagnosis range from 10.6–17.5 months. No such study has been conducted in our region. We reviewed 62 patients referred to the neurophysiology lab from year 2009 to 2013 with quarry of MND. Only 40 patients were identified to fulfill the El Escorial criteria for MND. The median …

Assessing Interprofessional Continuing Education And Planning Ahead, Farhan Vakani, Mughis Sheerani

Pakistan Journal of Neurological Sciences (PJNS)

The purpose of this survey is to check the concept of Interprofessional education (IPE) to continuing education among working physicians.It assessed 150 randomly selected working physicians of the Aga Khan University Hospital. One -best type questionnaire was designed and piloted to check its completion within 90 seconds.Four quick questions were dedicated at C1 & C2 level focused to check the knowledge and understanding of the physicians to IPE. The results showed 100% response rate. Majority (i.e. > 80%) of the respondents were familiar with the term IPE.The next three items tested physicians understanding regarding the IPE ability to improve communication, teamwork, …

Crossed Cerebellar Diaschisis In Partial Status Epilepticus, Sahrish Aieshah Kazi, Rehmani Aniqah Jawad, Rashed Nazir, Shahid Ahmed Shah, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

Crossed cerebellar diaschisis is a phenomena described as decrease in metabolism in the cerebellar hemisphere contralateral to the supratentorial lesion. A 61 year old man presented with status epilepticus. CT Brain showed small acute hemorrhage in left parietal lobe.MRI revealed diffusion restriction in right cerebral and left cerebellar hemispheres with hyperintensities on T2WI and FLAIR. However, CT perfusion was suggestive of increased perfusion in these areas. Periictal EEG showed frequent bursts of higher voltage spike and wave discharges over the right hemisphere. He was treated with IV antiepileptics. But he continued to deteriorate, and expired at 10th day of admission.

Neurostimulation For Refractory Primary Chronic Headache Disorders: A Review, Bindu Yoga, Modar Khalil, Hassan Zafar, Fayyaz Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Headache is the commonest symptom seen in both primary and secondary care. Vast majority are primary i.e. for which no underlying cause has been detected. Tension Headaches, Migraine and Cluster Headaches are the most common primary headache disorders in the population. Although most of the primary headache disorders can be satisfactorily treated with both acute and preventive medications, those that are refractory to conventional treatment pose a great challenge to the headache physician. Moreover some patients are not able to use traditional treatment due to intolerance and co-morbidities. Neurostimulation is a treatment modality that has been used in other neurological …

Can Prophylactic Antibiotics For Aspiration Improve Stroke Outcomes? The Pantheris Trial., Ayeesha Kamran Kamal, Quratulain Shaikh

Department of Medicine

No abstract provided.

Toward The Development Of The International Classification Of Functioning Core Sets For Children With Cerebral Palsy: A Global Expert Survey, Veronica Schiariti, Louise C. Masse, Alarcos Cieza, Anne F. Klassen, Karen Sauve, Robert Armstrong, Maureen O’Donnell

Paediatrics and Child Health, East Africa

The goal of the International Classification of Functioning is to standardize the classification of health and function of children around the world. To facilitate the application of this classification, International Classification of Functioning-based tools like the "Core Sets" are being developed. We conducted an international survey of professional experts to identify the most relevant areas of functioning in children with cerebral palsy. The questionnaire covered each component of the classification. In total, 193 professionals completed the survey (response rate 78%). Overall, 9706 answers were linked to the classification (pediatric version) by 2 professionals. From the experts' perspective, movement-related areas and …

Neurosurgery Literature Highlights & Psychiatry Literature Highlights, Muhammad Waqas Shaiq, Muhammad Shahzad Shamim

Pakistan Journal of Neurological Sciences (PJNS)

Today, a great challenge of our profession is to envision how we will deliver exemplary neurosurgical care in the future. To accomplish this requires anticipating how economic, political, and societal influences will affect our ability to provide the highest quality of patient care in an arena that will look increasingly different from today's world of medicine. Already, our profession is battling a relentless assault as numerous sectors implement change that impacts us and our community every day. Surviving this requires an effective strategy that will involve significant cultural change.

Using Management Information System To Evaluate Quality Of Care At Tertiary Care Hospital’S Stroke Centre, Abdul Malik, A. Zafar, F. S. Khan

Pakistan Journal of Neurological Sciences (PJNS)

To find out the average length of stay, the rate of I/V catheter cellulites, the rate of bed sores among patients in stroke centre and determine the mortality rates. Methodology: This is a descriptive study, carried out at a tertiary care hospital over the period of six months. Data was analyzed by SPSS version 15.0. Result: Total numbers of patients were 36 from January 1 to June 30, 2007 at Stroke Center Liaquat National Hospital. The mean length of stay was 8.17 ±5.81 days. Patients had cellulitis (intravenous) 97.2%, only 2.8% of patients did not develop. The rate of bed …

Task-Based Learning Versus Problem-Oriented Lecture In Neurology Continuing Medical Education., Farhan Vakani, Wasim Jafri, Amina Ahmad, Aziz Sonawalla, Mughis Sheerani

Department of Medicine

Objective: To determine whether general practitioners learned better with task-based learning or problem-oriented lecture in a Continuing Medical Education (CME) set-up.

Study Design: Quasi-experimental study.

Place and Duration of Study: The Aga Khan University, Karachi campus, from April to June 2012.

Methodology: Fifty-nine physicians were given a choice to opt for either Task-based Learning (TBL) or Problem Oriented Lecture (PBL) in a continuing medical education set-up about headaches. The TBL group had 30 participants divided into 10 small groups, and were assigned case-based tasks. The lecture group had 29 participants. Both groups were given a pre and a post-test. Pre/post …

Mentoring Ethics In Postgraduate Surgical Training: A Developing Country Perspective From Pakistan, Mohsin Azam, Saleha Anwar, Muhammad Shahzad Shamim, Muhammad Waqas

Section of Neurosurgery

No abstract provided.

Postgraduate Training In Neurosciences - Role Of The Specialty Societies, Junaid Ashraf

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Frequency Of Raised Plasma Homocysteine Levels In Patients Of Ischemic Stroke, Mohsin Zaheer, Muhammad Naeem

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

The Effectiveness Of Botlinum Toxin In The Management Of Benign Essential Blepharospasm And Hemifacial Spasm, Amanullah Khan Sarangzal, Noor Ahmed Khosa, Wazir Akbar

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Acute Disseminated Encephalomyelitis (Adem) Presenting As A Multiphasic Encephalopathy: A Case Report, Tehreem Zahra, Zarmast Khan, Ejaz Ahmed Khan, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

13th Annual International Neurology Update Meeting & 6th Biennial Stroke Conference, 13th Annual International Neurology Update Meeting & 6th Biennial Stroke Conference

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.