Neurology Commons^™

Identifying People At High Risk For Developing Sleep Apnea Syndrome (Sas): A Cross-Sectional Study In A Pakistani Population, Fawad Taj, Zarmeneh Aly, Mahwash Kassi, Mansoor Ahmed

Department of Medicine

Background: Obstructive Sleep Apnea (OSA) is associated with many cardiovascular and psychiatric diseases. Day-time sleepiness is a common consequence of sleep apnea and correlates with road-traffic accidents (RTA). Pakistan has a high prevalence of factors which predispose an individual to OSA and death from RTAs are a huge burden. However there is a dearth of prevalence studies in this regard. We aim to understand local relevance of the disease and estimate the prevalence of individuals high-risk for OSA. Methods: This cross-sectional survey was conducted among 450 individuals at Aga Khan University Hospital (AKUH), which is a tertiary care teaching hospital …

Intramedullary Spinal Cord Metastases And Radiation Therapy: A Case Report, Daniel Ikeda, James S. Harrop Md

JHN Journal

Intramedullary spinal cord metastases (ISCM) are a clinically rare, although devastating, complication of disseminated cancer. These lesions have been reported to originate from many types of solid tumors, although primary lung carcinoma, particularly small cell, is the most common etiology. These metastases, which can occur anywhere along the spinal cord, often represent the end-stage of the disease process with limited survival outcomes.

Patients with ISCM may develop a variety of neurological deficits with treatment goals aimed at palliation. Different modalities of treatment have been found to preserve or restore ambulation and neurological function. The options for therapeutic intervention include surgical, …

Cervical Intramedullary Ganglioma, Harminder Singh Md, Ashwini Sharan Md, John K. Ratliff Md

JHN Journal

A 48 year male presented to the ER with severe headaches which were episodic in nature and which had been present for several weeks. Patient had a history of traumatic head injury (TBI) several years prior. Otherwise, he was in good health with no significant past medical or surgical history.

On physical exam, patient was oriented x 3 with an intact cranial nerve exam. He had significant upper and lower extremity spasticity with mild hand intrinsic weakness. His motor exam was otherwise unremarkable. His gait was very spastic. He had sustained lower extremity clonus, upgoing toes, and increased tone in …

Surgeon Opinions On Use Of Epidural Steroids In Treatment Of Lumbar Disk Disease: Results Of An Online Survey, John K. Ratliff Md, Mitchell Maltenfort Phd, Bryan Lebude

JHN Journal

“Standard of care” can vary along regional and specialty lines; it is common to discover that a local “standard” can be different somewhere else. Opinions may differ between pain management specialists, primary care physicians, and spine surgeons with regard to use of conservative treatment modalities.

Opinion within a given group of practitioners, however, should converge. Local differences between hospitals may exist, but conferences, professional journals, and national boards for certification are mechanisms that should act to maintain homogeneity within a professional group. It could be expected that commonly utilized treatment approaches within a well defined group of sub-specialists should converge. …

Case Report: Intramedullary Cervical Spinal Cord Hemangioblastoma With An Evaluation Of Von Hippel-Lindau Disease, Steven Falowski Md, Ashwini Sharan Md, James S. Harrop Md, John K. Ratliff Md

JHN Journal

History of Present Illness

MO is a 49 year old male with a history of multiple sclerosis who presents with a one year history of progressive numbness in his shoulders bilateral and upper back. The patient describes occasional sharp pains that radiate to his first three fingers on his right hand. He denies weakness, clumsiness, difficulty walking, or bladder/bowel dysfunction. He describes no problems with handwriting, or fine motor skills.

Jhn Journal (Download The Full Pdf Of This Issue), Robert H. Rosenwasser Md

JHN Journal

Complete December 2008 issue of JHN Journal

Spinal Cord Stimulators: An Introduction, Steven Falowski Md

JHN Journal

Pain can be divided into two broad categories, nociceptive pain and neuropathic pain. Nociceptive pain is a dull, throbbing pain which results from irritated nerves after physical tissue injury. This is seen commonly in cancer or after a fracture. Nociceptive pain is amenable to treatment with pain medications such as opioids and/or anti-inflammatories. Neuropathic pain is described as burning, shooting, or shocking pain. This type of pain results from nerve damage or abnormal nerve conduction such as pain exhibited with failed back syndrome, post surgical pain, neuromas, shingles, and complex regional pain syndrome (previously called RSD or causalgia). Neuropathic pain …

Minimally Invasive Surgery For Skull Base Tumors, James J. Evans Md, Marc R. Rosen Md

JHN Journal

The Jefferson Center for Minimally Invasive Cranial Base Surgery and Endoscopic Neurosurgery reflects three of the current evolutions in neurological surgery. The first of these is reflected in the name of the Center itself. Surgical Procedures, Minimally Invasive, a Medline Subject Heading since 1998, is defined as:

Procedures that avoid use of open invasive surgery in favor of closed or local surgery. These generally involve use of laparoscopic devices and remote-control manipulation of instruments with indirect observation of the surgical field through an endoscope or similar device. With the reduced trauma associated with minimally invasive surgery, long hospital stays may …

Clinical Guidelines Written By Residents, David W. Andrews Md

JHN Journal

“Variation” is an innocent word that that can represent many levels of frustration to the clinician. Variation among patients is the least of these; the physician expects patients and their individual problems to be as diverse as the human race itself. Variation within a practice should be due to matching the specific needs of the specific patient. Other variations can mean trouble if they represent differences in understanding of the problem among clinicians and other allied health practitioners. These differences could be between institutions or even between shifts within one institution.

Pathological Sub-Types, Risk Factors And Outcome Of Stroke At The Nairobi Hospital, Kenya, James Jowi, Peter Mativo

Internal Medicine, East Africa

Background: Stroke is one of the most common causes of morbidity and mortality the world over. Established risk factors such as arterial hypertension, diabetes mellitus, cigarette smoking, hyper-lipidaemia, micro-vascular rupture, male gender, age and observed co-morbities such as sickle cell disease, HIV/AIDS infection and cerebral malaria are increasingly being encountered in the tropics.

Objectives: To determine pathological sub-types, risk factors, in-hospital period prevalence and in-hospital outcome of stroke.

Design: Hospital-based retrospective study.

Setting: The Nairobi Hospital, Nairobi, Kenya.

Subjects: Patients with recorded diagnosis of stroke/cerebral vascular accident; as per WHO criteria for diagnosis of stroke, …

Vocal Fold Granuloma After Prolonged Neurosurgical Procedure With Wire Reinforced Endotracheal Tube, Muhammad Zubair Tahir, Muhammad Shahzad Shamim, Rashid Jooma

Section of Neurosurgery

No abstract provided.

Young Woman With Chronic Conversion Disorder With Dramatic Improvement In Upper Motor Neuron Type Syndromes Through The Use Of Electromyography (Emg) Triggered Biofeedback, Bruce H. Hsu, Md, Nethra S. Ankam, Md, Ralph J. Marino

Department of Rehabilitation Medicine Faculty Papers

Patient: 31 year old woman chronic flexion contracture of hand, prior history seizure disorder, chronic conversion disorder.

Program Description: Patient presented initially to neurology service with chronic right hand flexion contracture in the context of 3 days of weakness and numbness in lower extremities after exertion. MRI/MRA Brain, Head CT, CT of entire spine were all unrevealing. Patient was transferred to the rehabilitation unit 8 days after initial admission. On rehabilitation admission patient exam was noted to have right hand markedly flexed with pain to passive ranging out of extreme flexion, chronic in nature. Patient initially had her hand ranged …

Follicular Thyroid Carcinoma Presenting As Solitary Skull Metastasis: Report Of Two Cases, Muhammad Shahzad Shamim, Faraz Khursheed, Muhammad Ehsan Bari, Khalid Naseem Chisti, Ather Enam

Section of Neurosurgery

We report two otherwise healthy patients with no prior history of thyroid cancer, who presented to us with a solitary scalp lump. Neuroimaging of both patients showed osteolytic lesions involving the cranium which were subjected to complete excision biopsy and cranioplasty. Histopathological examination revealed metastases from well differentiated follicular thyroid carcinoma (FTC). Subsequent workup confirmed occult primary carcinoma of the thyroid gland in both patients.

Variable Judgments Of Decisional Capacity In Cognitively Impaired Research Subjects, Marion B. Patterson, Peter J. Whitehouse

Faculty Scholarship

OBJECTIVES: To compare assessments of the decisional capacity of cognitively impaired patients by research assistants (RAs) and by family caregiver/proxies and to determine whether either or both groups judge capacity differently depending on the specific (hypothetical) research enrollment decision being made. DESIGN: Cross-sectional. SETTING: Three clinics, one each in Ohio, Kentucky, and Illinois. PARTICIPANTS: One hundred forty-nine patients with established dementia diagnoses and their caregiver/proxies. MEASUREMENTS: As part of a longer interview, patients were asked about future enrollment in five hypothetical research projects with varying risks and benefits. After patients reported each decision and reasons for that decision, RAs (using …

The Trauma Centre: What It Should Mean, Rashid Jooma, Sabeena Jalal Khan, Junaid Razzak

Section of Neurosurgery

No abstract provided.

Sensitivity Of The Human Circadian System To Short Wavelength (420 Nm) Light, George C. Brainard, David Silney, John P. Hanifin, Gena Glickman, Brenda Byrne, Jeffrey M. Greeson, Samar Jasser, Edward Gerner, Mark D. Rollag

Department of Neurology Faculty Papers

The circadian and neurobehavioral effects of light are primarily mediated by a retinal ganglion cell photoreceptor in the mammalian eye containing the photopigment, melanopsin. Nine action spectrum studies using rodents, monkeys, and human for these responses indicate peak sensitivities in the blue region of the visible spectrum ranging from 459 nm to 484 nm, with some disagreement in short wavelength sensitivity of the spectrum. The aim of this work was to quantify the sensitivity of human volunteers to monochromatic 420 nm light for plasma melatonin suppression. Adult female (N=14) and male (N=12) subjects participated in two studies, each employing a …

Changing Patterns And Outcome Of Dengue Infection; Report From A Tertiary Care Hospital In Pakistan, Mohammad Wasay, Roomasa Channa, Maliha Jumani, Afia Zafar

Department of Medicine

Objective: To identify predictors of outcome in patients with Dengue Infections at a tertiary care hospital and to analyze that if pattern of Dengue infection is changing in the past two years.

Methods: We reviewed 225 cases of confirmed dengue virus infection. The diagnosis was confirmed by presence of IgM antibodies against Dengue by ELISA in addition to fever according to WHO criteria.

Results: From years 2000-2004, 30(73%) had Dengue Fever (DF), 10(24%) had Dengue Haemorrhagic Fever (DHF) and 1(2.4%) had Dengue shock syndrome (DSS) while after 2005, 107(58%) had DF, 71(39%) had DHF and 6(3%) had DSS. Six …

Experimental Optic Neuritis Induced By A Demyelinating Strain Of Mouse Hepatitis Virus., Kenneth S. Shindler, Lawrence C. Kenyon, Mahasweta Dutt, Susan T. Hingley, Jayasri Das Sarma

Department of Neurology Faculty Papers

Optic neuritis (ON), an inflammatory demyelinating optic nerve disease, occurs in multiple sclerosis (MS). Pathological mechanisms and potential treatments for ON have been studied via experimental autoimmune MS models. However, evidence suggests that virus-induced inflammation is a likely etiology triggering MS and ON; experimental virus-induced ON models are therefore required. We demonstrate that MHV-A59, a mouse hepatitis virus (MHV) strain that causes brain and spinal cord inflammation and demyelination, induces ON by promoting mixed inflammatory cell infiltration. In contrast, MHV-2, a nondemyelinating MHV strain, does not induce ON. Results reveal a reproducible virus-induced ON model important for the evaluation of …

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 …

Associations Between Performance On The Rey-Osterrieth Complex Figure And Regional Brain Volumes In Children With And Without Velocardiofacial Syndrome, Kevin M. Antshel, Jena Peebles, Nuria Abdulsabur, Anne Marie Higgins, Nancy Roizen, Robert J. Shprintzen, Wanda Fremont, Robert Natasi, Wendy R. Kates

Communication Disorders Faculty Publications

Ninety-two children with velocardiofacial syndrome (VCFS), a genetic disorder caused by a microdeletion of chromosome 22q11.2 and an age, race, and gender-ratio comparable sample of 59 control participants were included in the project. Participants received an MRI as well as a comprehensive neuropsychological battery; the primary outcome measure in the current report is the Rey-Osterrieth Complex Figure (ROCF). Children with VCFS performed less well on the ROCF and have lower whole brain volume compared to controls. After controlling for whole brain volume differences, children with VCFS have bilaterally less parietal lobe gray and white matter yet more frontal lobe white …

Multi-Scale Modeling Of Angiotensin Ii Induced Neuronal Regulatory Mechanisms In The Brain, Rajanikanth Vadigepalli

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Poster Presentation.

Role Of Neurosurgery In The Management Of Stroke, Gohar Javed, Muhammad Zubair Tahir, Ather Enam

Section of Neurosurgery

Stroke is the second leading cause of death worldwide. The aim of treatment in stroke patients is to prevent further neurologic deterioration and prevent recurrence. Despite all advances in medical treatment, morbidity and mortality in stroke patients is still very high. The other alternative is surgical treatment, which still lacks class 1 evidence. However there is recent reconsideration of this form of treatment and ongoing trials are showing some promising results. In this review the recent advances in surgical treatment of stroke will be discussed along with recommendations from the latest randomized trials.

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.

Perfusion Imaging In Ischaemic Stroke, Zafar Sajjad

Department of Radiology

Perfusion imaging allows the blood flow to the tissue to be imaged. It is currently widely applied to the management of acute ischaemic stroke. Using either Computerised Tomography or Magnetic Resonance Imaging techniques, perfusion maps can be created in a short enough time to allow their routine use in clinical practice. Perfusion Imaging enables the physician to directly estimate the tissue at risk which can be salvaged with reperfusion, enabling appropriate patient selection. Perfusion imaging however has its limitations which need to be kept in mind when these studies are interpreted. Although perfusion imaging is widely used, the evidence to …

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 …

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 …

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 …

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 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 …