Neurology Commons^™

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.

Is Phonophobia Associated With Cutaneous Allodynia In Migraine?, Avi Ashkenazi, Irene Yang, Aamir Mushtaq, Michael L. Oshinsky

Department of Neurology Faculty Papers

ABSTRACT

Objective

To determine whether phonophobia and dynamic mechanical (brush) allodynia are associated in episodic migraine (EM).

Methods

Adult patients with EM were prospectively recruited. A structured questionnaire was used to obtain demographic and migraine related data. Phonophobia was tested quantitatively using a real time sound processor and psychoacoustic software. Sound stimuli were pure tones at frequencies of 1000 Hz, 4000 Hz and 8000 Hz, delivered to both ears at increasing intensities, until an aversive level was reached. Allodynia was assessed by brushing the patient’s skin with a gauze pad at different areas. Patients were tested both between and during …

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

Section of Neurology

No abstract provided.

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.

Multiport Minimally Invasive Skull Base Surgery: How Many Ports Are Too Many?, Yaron A. Moshel, Theodore H. Schwartz

Department of Neurosurgery Faculty Papers

Surgical access to the ventral skull base has evolved considerably over the past several years with the introduction of minimally invasive endoscopic and endoscope-assisted approaches. The accompanying manuscript by Ciporen et al. demonstrates an addition to this growing body of literature in their description of the feasibility of multiportal endoscopic approaches to the skull base, particularly the precaruncular transorbital approach, in a series of cadaver dissections. Similar to laparoscopic abdominal surgery, which utilizes multiple small ports to improve visualization and manipulation, they envision a modular combination of approaches that allows an endoscope to be placed in one port and surgery …

The Significance Of Percutaneous Aspiration Of The Zygapophysial Facet Joint Synovial Cyst: A Case Series, S. Kamal Fetouh, Nicholas Kaffl, Linqiu Zhou

Department of Rehabilitation Medicine Faculty Papers

Cysts that are clearly associated with threat of progressive neurological loss or intractable, unremitting symptoms should be released by a decompression procedure.

In our case series, percutaneous aspiration has been successfully used for 3 of 4 PTs with marked decrease in size of cyst on imaging and clinical improvement.

Obstructing pathology and ultimately the location of the cyst can be major factors in determining the success of the procedure.

Our study demonstrated that a minimally invasive aspiration of a ZP SC can often achieve clinical improvement.

This may save the PT from undergoing an invasive surgical decompression.

The Significance Of A Triple Flexion Reflex In The Acute Spinal Cord Injured Patient: A Case Report And Review Of The Literature, S. K. Fetouh, S. Kolli, R. J. Marino, N. D. Martin, A. L. Schreiber

Department of Rehabilitation Medicine Faculty Papers

The TFR is a sign of upper motor neuron impairment. It does not typically appear for several days after an injury but in patients with pre-existing myelopathy, an early onset exaggerated Babinski response exhibited as a TFR may occur. It is important not to misinterpret such responses as volitional movements, particularly in patients with cognitive dysfunction where the history and physical examination may be limited. Failure to immobilize the spine and to administer adjunct steroid therapy may be detrimental to the patient. Education of initial response physicians may prevent overlooking an acute SCI.

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

Department of Medicine

No abstract provided.

Posterior Reversible Encephalopathy Syndrome: A Case Series In Patients With Eclampsia, Rohana Naqi, Humera Ahsan, Muhammad Azeemuddin

Department of Radiology

Posterior Reversible Encephalopathy Syndrome (PRES) refers to a clinicoradiologic entity with characteristic features on neuro-imaging and non-specific symptoms comprising headache, confusion, visual disturbances and seizures. The lesions in PRES are thought to be due to vasogenic oedema, predominantly in the posterior cerebral hemispheres, and are reversible with appropriate management. We report 3 cases of acute PRES who had eclampsia and presented with recurrent episodes of seizures and hypertension. Their MRI scan showed diffuse abnormal signal intensities involving predominantly deep white matter of the occipital lobes. Based on the findings the most probable diagnosis of PRES was suggested. They were started …

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.

Brain Research To Ameliorate Impaired Neurodevelopment - Home-Based Intervention Trial (Brain-Hit), Jan L. Wallander, Elizabeth Mcclure, Fred Biasini, Shivaprasad S. Goudar, Omrana Pasha, Elwyn Chomba, Darlene Shearer, Linda Wright, Vanessa Thorsten, Hrishikesh Chakraborty, Sangappa M. Dhaded, Niranjana S. Mahantshetti, Roopa M. Bellad, Zahid Abbasi, Waldemar Carlo

Community Health Sciences

Background: This randomized controlled trial aims to evaluate the effects of an early developmental intervention program on the development of young children in low-and low-middle-income countries who are at risk for neurodevelopmental disability because of birth asphyxia. A group of children without perinatal complications are evaluated in the same protocol to compare the effects of early developmental intervention in healthy infants in the same communities. Birth asphyxia is the leading specific cause of neonatal mortality in low-and low-middle-income countries and is also the main cause of neonatal and long-term morbidity including mental retardation, cerebral palsy, and other neurodevelopmental disorders. Mortality …

Impact Of Insurance Status On Migraine Care In The United States, Andrew Wilper, Steffie Woolhandler, David U. Himmelstein, Rachel Nardin

Publications and Research

Objective
To determine whether insurance status is associated with differential outpatient treatment of migraine in the United States.

Methods
We analyzed 11 years of data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (1997–2007), which survey patient visits to doctors’ offices, hospital outpatient departments, and emergency departments (EDs) in the United States. We used logistic regression to determine whether insurance status was associated with the prescription of standard migraine therapy, defined as 1) a triptan or dihydroergotamine and 2) a prophylactic agent.

Results
We identified 6,814 individual patient visits for migraine, representing 68.6 million …

Future Of Neurology In Pakistan, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Risk Factors For Ischemic Stroke In Patients Attending Tertiary Hospital In Quetta, Ms. Barech, Sm Sadiq, Ak Zarkoon, M Gulandam, Kaleem Ullah

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Early Outcome Of Subthalamic Nucleus – Deep Brain Stimulation (Stn-Dbs) In The Advanced Stage Of Parkinson Disease – A Trial Of Iranian Patients, G.A. Shahidi, Mohammad Rohani, Bahram H, Javad M

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Pediatrics Neurolgy, Shamshad Gulab

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Neurosurgery, Mohsin Qadeer

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Spectrum Of Chronic Acquired Immune Neuropathies, K. Sher, H Firdaus, S Ali

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Post Cardiac Surgery Opthalamoplegia Due To Pitutary Apolexy, M. Khan, M Shahzad Shamim, Aa Siddiqui

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Approach To Symptomatic Migraine - A Reviewof Literature, Ayesha Kk, Rushna Raza, Sahar Zafar

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Fatal Primary Intraventricular Hemorrhage In 3rd Trimester Of Pregnancy With Rescue Of Baby, S. Tamizuddin, M Hashmi, Ismail A. Khatri

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Overview Of Surgical Management Of Infectious Non Suppurative Brain Lesions (Part Ii), M.S. Shamim, Sa Enam, S.F Ali, R.P Ali, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

17th Annual Psn Meeting, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Walk On, Australia: An Exceptional Approach To Spinal Cord Injury, Amanda Randall

Inquiry Journal 2010

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.

Valproate Semisodium Er For Migraine And Cluster Headache Prophylaxis., Brigitte V. Lovell, Michael J. Marmura

Department of Neurology Faculty Papers

IMPORTANCE OF THE FIELD: Migraine and cluster headache (CH) are disabling syndromes that often require prophylactic treatment. Valproate semisodium ER (VPS ER) is FDA-approved for the treatment of epilepsy, acute mania in bipolar disorder and migraine prophylaxis.

AREAS COVERED IN THIS REVIEW: We reviewed literature regarding VPS ER pharmacokinetics and its use in migraine and CH prophylaxis.

WHAT THE READER WILL GAIN: VPS ER is well studied and effective in the preventive treatment of migraine and CH. This article reviews the evidence for its use, describes how to administer and dose this medication, and reviews important safety precautions.

TAKE HOME …

Metabolic Consequences Of Antiepileptic Drugs, Scott Mintzer

Department of Neurology Faculty Papers

Purpose of Review: Chemical properties of the widely used older generation antiepileptic drugs (AEDs) suggest that they might be responsible for a number of medical comorbidities. Recent Findings: AEDs which induce the cytochrome P450 system adversely affect bone, lipid, and gonadal steroid metabolism. Specifically, phenytoin causes loss of bone mass in women, and both phenytoin and carbamazepine produce increases in serum lipids and C-reactive protein, as well as decreases in bioactive testosterone in men. Patients treated with inducing AEDs are at increased risk of fracture. Some contradictory data raise the question of whether bone mass is truly related to enzyme …

Molecular Cross Talk Between Misfolded Proteins In Animal Models Of Alzheimer's And Prion Diseases, Rodrigo Morales, Lisbell D Estrada, Rodrigo Diaz-Espinoza, Diego Morales-Scheihing, Maria C Jara, Joaquin Castilla, Claudio Soto

Faculty, Staff and Student Publications

The central event in protein misfolding disorders (PMDs) is the accumulation of a misfolded form of a naturally expressed protein. Despite the diversity of clinical symptoms associated with different PMDs, many similarities in their mechanism suggest that distinct pathologies may cross talk at the molecular level. The main goal of this study was to analyze the interaction of the protein misfolding processes implicated in Alzheimer's and prion diseases. For this purpose, we inoculated prions in an Alzheimer's transgenic mouse model that develop typical amyloid plaques and followed the progression of pathological changes over time. Our findings show a dramatic acceleration …

Electronic Medical Records As A Research Tool: Evaluating Topiramate Use At A Headache Center., Michael J. Marmura, Md, Mary Hopkins, Rn, Msn, Jocelyn Andrel, Msph, William B. Young, Md, David M. Biondi, Do, Marcia F.T. Rupnow, Phd, Robert B. Armstrong, Md

Department of Neurology Faculty Papers

Background.—Electronic medical records (EMRs) are used in large healthcare centers to increase efficiency and accuracy of documentation. These databases may be utilized for clinical research or to describe clinical practices such as medication usage.

Methods.—We conducted a retrospective analysis of EMR data from a headache clinic to evaluate clinician prescription use and dosing patterns of topiramate. The study cohort comprised 4833 unique de-identified records, which were used to determine topiramate dose and persistence of treatment.

Results.—Within the cohort, migraine was the most common headache diagnosis (n = 3753, 77.7%), followed by tension-type headache (n = 338, 7.0%) and cluster or …