Neurology Commons^™

What Are The Therapeutic Options For Strokes Secondary To Intracranial Large Artery Stenosis?, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Cilostazol Versus Aspirin For Secondary Prevention Of Vascular Events After Stroke Of Arterial Origin, Ayeesha Kamran Kamal, Imama Naqvi, Muhammad R Husain, Bhojo A Khealani

Section of Neurology

Background:Aspirin is widely used for secondary prevention after stroke. Cilostazol has shown promise as an alternative to aspirin in Asian people with stroke. ObjectiveS: To determine the relative effectiveness and safety of cilostazol compared directly with aspirin in the prevention of stroke and other serious vascular events in Patients at high vascular risk for subsequent stroke, those with previous transient ischaemic attack (TIA) or ischaemic stroke of arterial origin. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched September 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 4), MEDLINE (1950 …

What Modifiable Risk Factors Lead To Strokes In Our Part Of The World, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Predictors Of The Intracerebral Hemorrhage Volume In Hypertensive Patients, Mohammad Wasay, Adnan Yousuf, Darshan Lal, Safia Awan

Section of Neurology

Background: Hemorrhage volume is an important predictor of outcome in Patients with intracerebral hemorrhage (ICH). It is not clear why in some Patients ICH volume is larger than in others. Identification of modifiable factors responsible for large-volume hemorrhage in hypertensive Patients may help to reduce ICH-related morbidity and mortality. Objective: The objective of this study was to identify predictors of large-volume ICH in hypertensive Patients. Methods:At a tertiary care center in Karachi (Pakistan), 157 hypertensive Patients with ICH were prospectively analyzed in 2008-2009, and hemorrhage volumes were determined using CT or MRI and various factors, including duration of hypertension, …

Viewpoint: My Journey From The Us Back To Pakistan: What Keeps Me Here, Saad Shafqat

Section of Neurology

No abstract provided.

What Are The Current Therapeutic Options For Haemorrhagic Strokes?, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Acute Administration Of Rt-Pa For Acute Stroke In Pakistani Patients--What Does The Available Evidence Teach Us?, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

What Is The Best First Agent To Give To A Patient With Acute Ischaemic Stroke? Aspirin, Heparin, Clopidogrel, Cilostazol Or Dipyridamole?, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

What Is The Best Antiplatelet Agent For Prevention Of Recurrent Stroke In Pakistani Patients? Do Combinations Offer Significant Advantages In The South Asian Context?, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

How Should Physicians Practically Approach Symptomatic And Asymptomatic Carotid Stenosis?, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Effects Of A Perindopril-Based Blood-Pressure-Lowering Regimen In Patients With Previous Stroke Or Transient Ischaemic Attack (Progress). How Do The Results Affect Practice In Pakistan, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Spontaneous Dural Tear Leading To Intracranial Hypotension And Tonsillar Herniation In Marfan Syndrome: A Case Report, Aqueel H. Pabaney, Farhan A. Mirza, Nadir A. Syed, Humera Ahsan

Section of Neurology

Background:We describe the case of a 38 year old male with Marfan syndrome who presented with orthostatic headaches and seizures. Case Presentation: The Patient was diagnosed with Spontaneous Intracranial Hypotension secondary to CSF leaks, objectively demonstrated by MR Myelogram with intrathecal contrast. Epidural autologus blood patch was administered at the leakage site leading to significant improvement.

Conclusion:

Our literature search shows that this is the second reported case of a Marfan Patient presenting with symptomatic spontaneous CSF leaks along with tonsillar herniation.

High Dose Atorvastatin After Stroke Or Transient Ischaemic Attack (Sparcl)--Does Every Stroke Patient In Pakistan Deserve A Statin, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Stroke Registry: A Developing Country's Perspective., Farrukh S. Khan, Maimoona Siddiqui, Hazim Brohi, Khurram A. Siddiqui

Section of Neurology

No abstract provided.

Surgical Interventions For Malignant Middle Cerebral Infarction--Saving Lives And Functionality Or Increasing Disabled Survivors?, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Headache In Cerebral Venous Thrombosis: Incidence, Pattern And Location In 200 Consecutive Patients., Mohammad Wasay, Suleman Kojan, Alper I Dai, George Bobustuc, Zubair Sheikh

Section of Neurology

We analyzed the incidence, pattern and location of headache in consecutive 200 Patients with proven diagnosis of CVT to identify an association between localization of headache and site of sinus involvement. Headache was present in 136 (68%) Patients. The duration of headache (reported in 128 Patients) was reported as acute (1-3 days), 81 Patients (60%), sub-acute (4-14 days), 33 Patients (24%), and chronic (more than 14 days), 14 Patients (10%). The quality of headache (reported in 72 Patients) was reported as throbbing 12 (9%), band like 27 (20%), thunderclap 7 (5%), and other (pounding, exploding, stabbing, etc.) 26 (20%). The …

The International Surgical Trial In Intracerebral Haemorrhage (Stich)--What Are Its Implications In A Resource Limited Health System Like Pakistan, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Role Of Levetiracetam In Refractory Seizures Due To A Rare Progressive Myoclonic Epilepsy: Lafora Body Disease, Mubashira Hashmi, Feroza Saleem, Muhammad Shahid Mustafa, Mughis Sheerani, Zeeshan Ehtesham, Khurram Siddiqui

Section of Neurology

Lafora disease is one of the rare, most fatal progressive myoclonic epilepsies reported. We present a case of a teenager with intractable seizures and progressive mental decline, diagnosed as Lafora body disease on axillary skin biopsy. He was admitted with status epilepticus with refractory myoclonic and generalised tonic clonic seizures. Despite on maximum doses of multiple antiepileptic drugs and infusions of propofol and midazolam, his seizures were refractory to all forms of medical therapy tried. Levetiracetam (LEV), a pyrrolidine derivative, was introduced; he showed a prompt response and was weaned off successfully from infusions of anticonvulsants and mechanical ventilation within …

The Burden Of Stroke And Transient Ischemic Attack In Pakistan: A Community-Based Prevalence Study, Ayeesha Kamran Kamal, Ahmed Itrat, Muhammed Murtaza, Maria Khan, Asif Rasheed, Amin Ali, Amna Akber, Zainab Akber, Naved Iqbal, Sana Shoukat, Farzin Majeed, Danish Saleheen

Section of Neurology

Background: The burden of cerebrovascular disease in developing countries is rising sharply. The prevalence of established risk factors of stroke is exceptionally high in Pakistan. However, there is limited data on the burden of stroke and transient ischemic attack (TIA) in South Asia. We report the first such study conducted in an urban slum of Karachi, Pakistan. Methods:Individuals 35 years of age or older were invited for participation in this investigation through simple random sampling. A structured face-to-face interview was conducted using a pretested stroke symptom questionnaire in each participant to screen for past stroke or TIA followed by …

Relating Visual To Verbal Semantic Knowledge: The Evaluation Of Object Recognition In Prosopagnosia, Jason J. S. Barton, Hashim-M Hanif, Sohi Ashraf

Section of Neurology

Assessment of face specificity in prosopagnosia is hampered by difficulty in gauging pre-morbid expertise for non-face object categories, for which humans vary widely in interest and experience. In this study, we examined the correlation between visual and verbal semantic knowledge for cars to determine if visual recognition accuracy could be predicted from verbal semantic scores. We had 33 healthy subjects and six prosopagnosic Patients first rated their own knowledge of cars. They were then given a test of verbal semantic knowledge that presented them with the names of car models, to which they were to match the manufacturer. Lastly, they …

Characteristics Of Tia And Its Management In A Tertiary Care Hospital In Pakistan, Ayeesha Kamal, Farhad Khimani, Rushna Raza, Sahar Zafar, Salman Bandeali, Sayeedullah Jan

Section of Neurology

Background:Transient ischemic attack (TIA) is described as a brief episode of neurological dysfunction caused by focal brain ischemia, with clinical symptoms typically lasting less than an hour, and without evidence of acute infarction. Recent studies depict TIA as a particularly unstable condition. Risk of stroke is greater than 10% in the first 90 days after an index TIA. The presentation, prognosis and intervention for TIA have not been reported in South-Asians in a developing country. Method: A retrospective chart review was done for 158 Patients who were admitted with the diagnosis of TIA, as defined by ICD 9 code …

Brain Death: Concepts And Knowledge Amongst Health Professionals In Province Of Sindh, Pakistan, Mughis Sheerani, Mian Zainul Sajadeen Urfy, Bhojo A Khealani, Junaid Patel, Qamarunnisa, Suresh Rath

Section of Neurology

OBJECTIVE: Last few decades have seen improved resuscitative measures and use of life saving machines like ventilators. Due to these dramatic interventions, end of life decisions, including brain death and organ transplantation, have become more complex and a major problem in our clinical practice. This study was done to find the opinion and awareness of physicians regarding issues surrounding brain death in this region.

METHODS: A total of 259 questionnaires were analyzed that encompassed physicians at different level of training and students in the final year of their training, from five major tertiary care centres, located at Karachi and Hyderabad …

Helicobacter Pylori Gastritis And Risk Of Ischaemic Stroke, Mohammad Wasay, Wasim Jafri, Bhojo Khealani, Iqbal Azam, Akber Hussaini

Section of Neurology

OBJECTIVE: To identify the association between H. Pylori gastritis and stroke.

METHOD: Patients with biopsy proven H. Pylori gastritis and non H. Pylori gastritis were enrolled. Patients were followed for a period of two years.

RESULTS: A total of 326 patients were included in the study. 162 patients were with H. Pylori gastritis. There was no significance difference in age, sex and duration of symptoms in the two groups. Three patients in H. Pylori group had stroke or TIA as compared to one in non H. Pylori group. Patients with H. Pylori gastritis were more likely to die or have …

Hypotension At Presentation Is An Indicator Of Poor Prognosis In Acute Intracerebral Haemorrhage, Mohammad Wasay, Bhojo A Khealani, Saad Shafqat, Ayesha Kamal, Nadir Ali Syed

Section of Neurology

OBJECTIVE: To identify frequency of hypotension in a large cohort of patients with intracerebral haemorrhage and its prognostic significance.

METHODS: We retrospectively reviewed medical records of 920 patients with spontaneous intracerebral haemorrhage (ICH). Patients were divided in three groups based on Diastolic blood pressure (DBP); hypotensive group (DBP < 70 mmHg), normotensive group (DBP; 71-90 mmHg) and hypertensive group (DBP > 90 mmHg).

RESULTS: Of the total patients with ICH, 7% (64) presented with hypotension, 13% (120) were normotensive and 80% (736) were hypertensive. In the hypotensive group, 37% (24) patients died as compared to 25%(30) in normotensive group and 25% (182) in hypertensive group (p = 0.03). Hypotension at presentation, thalamic and …

Post Stroke Seizures: Descriptive Study From A Tertiary Care Centre In Pakistan, Bhojo A Khealani, Sajjad Ali, Shahid M Baig

Section of Neurology

OBJECTIVE: To determine the frequency, mode of onset and outcome of post stroke seizures in a local setting.

METHODS: The retrospective (Aug 1999 to July 2001) and prospective (August 2001 to July 2002) data of patients aged 14 years and above, with post stroke seizures was collected from a tertiary care centre in a metropolitan city. The demographic, clinical, radiological, laboratory, neurophysiologic and outcome data was recorded and analyzed.

RESULTS: During the three year period 1548 patients with stroke were admitted to the hospital. Four hundred thirty one (28%) had intracerebral haemorrhage (ICH) and 1117 (72%) had ischaemic stroke. One …

Diagnostic Yield Of Transthoracic Echocardiography For Stroke Patients In A Developing Country, Muhib Alam Khan, Bhojo A Khealani, Bilal Hameed, Ayeesha Kamal, Mohammad Wasay, Nadir Ali Syed

Section of Neurology

OBJECTIVE: To assess the utility and cost effectiveness of transthoracic echocardiography (TTE) as part of stroke workup in a developing country.

METHODS: All patients over the age of 14 years with acute stroke were prospectively enrolled in Aga Khan University stroke databank from August 1999 to May 2001 (22 month period). All patients were evaluated by a consultant neurologist and underwent standard stroke work up such as neuroimaging, TTE, carotid doppler sonography and blood tests e.g. serum glucose, lipid profile, blood urea nitrogen and serum creatinine. For the purpose of this study, patients with ischemic stroke were identified and their …

Stroke In Pakistan, Bhojo A Khealani, Bilal Hameed, Uzma U Mapari

Section of Neurology

Stroke is the most common cause of disability and a leading cause of mortality world wide. Though the incidence is falling in West but probably is rising in Asia. The burden of stroke risk factors in Pakistan is enormous e.g. by 2020 Pakistan will be 4th most populous country in terms of diabetic patients. Similarly every 3rd person above age of 45 years has hypertension. Ironically a great majority of these patients are unaware of their diagnosis. This is further complicated by the fact that most of diagnosed patients have uncontrolled hypertension, as a result of poor compliance on patients …

Post-Infarct Cerebellar Cognitive Affective Syndrome: A Case Report, Ali Jawaid, Muhammad Ameen Rauf, Uzma Usman, Bhojo A Khealani

Section of Neurology

Post Infarct cerebellar cognitive affective syndrome is a rare disorder, characterized by cognitive impairment in the domains of memory, language, visuo-spatial functioning and affect after cerebellar stroke. We report a case of young female who developed mood alteration and cognitive disturbance following isolated cerebellar infarct. We, therefore, advocate a potential role of cerebellum in regulation of cognition and behaviour in humans.

Pakistani Physicians And The Repatriation Equation, Saad Shafqat, Anita K. M. Zaidi

Section of Neurology

In Pakistan, students who are accepted into medical school are congratulated — only half-jokingly — on three counts: that they will become doctors, that they will become certified by the American Board of Medical Specialties, and that they will soon be living in the United States.

Local Thrombolytic Treatment Of Cerebral Venous Thrombosis In Three Paediatric Patients, Mohammad Wasay, Rohit Bakshi, Alper Dai, Steve Roach

Section of Neurology

There is increasing evidence that local thrombolysis can be used with relative safety and efficacy in adults with superior sagittal sinus thrombosis (SSST). However, little data is available on the use of local thrombolysis in children with SSST. We report three patients who received local thrombolysis for dural sinus thrombosis. Two patients received urokinase and one patient received urokinase followed by local TPA infusion. Recanalization was achieved in two patients.