Neurology Commons^™

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 …

Commentary On: "Facilitating Transparency In Spinal Cord Injury Studies Using Data Standards And Ontologies", Diane M. Snow

Spinal Cord and Brain Injury Research Center Faculty Publications

No abstract provided.

Spinocerebellar Ataxia 7: A Report Of Unaffected Siblings Who Married Into Different Sca 7 Families, Fariha Zaheer, Dominic B. Fee

Neurology Faculty Publications

Two families with spinocerebellar ataxia type 7 are presented. Although there are affected cousins, it is not the sibling parents that transmitted the mutation. It is assumed that the affected families share a common ancestor.

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.

Immunotherapy In Combination With Behavioral Enrichment In A Canine Model Of Aging, Paulina R. Davis

Theses and Dissertations--Pharmacology and Nutritional Sciences

Alzheimer’s disease (AD) is characterized by cognitive decline and hallmark neuropathology, including β-amyloid (Aβ). Therapeutic strategies for AD are focusing on reducing Aβ. Canines develop Aβ neuropathology and cognitive decline with age similar to AD patients. In previous studies, immunization with Aβ1-42 (VAC) in aged canines decreased brain Aβ but did not improve cognition. Behavioral enrichment (ENR) improved cognition without reducing brain Aβ. We hypothesized that VAC combined with ENR would provide cognitive benefits and reduce Aβ neuropathology, as compared individual VAC and ENR treatments. Aged beagles were placed into groups: control, VAC with fibrillar Aβ1-42, ENR, and combination treatment …

The Role Of Gamma-Secretase Impairment And Amyloid Beta Degradation In Alzheimer's Disease Pathogenesis, Robert J. Baranello Jr.

MUSC Theses and Dissertations

Accumulation of the amyloid β (Aβ) protein in the brain as senile plaques is a signature lesion of Alzheimer's disease (AD). The mechanisms of Aβγ accumulation that foster its deposition is a subject of intense study and represent the primary targets for most drug development efforts in the field. As one of the most important neurodegenerative diseases in the world, it is imperative that we continue to move toward efficacious treatment strategies. A number of y-secretase inhibitors (GSIs), such as N-[N-(3,5-Difluorophenacetyl-L-alanyl)]-S-phenylglycine t-butyl ester (DAPT), have been developed with the goal of reducing Aβ to treat AD. Although most studies show …

Direct Classification Of All American English Phonemes Using Signals From Functional Speech Motor Cortex, Emily M. Mugler, James L. Patton, Robert D. Flint, Zachary A. Wright, Stephan U. Schuele, Joshua Rosenow, Jerry J. Shih, Dean J. Krusienski, Marc W. Slutzky

Electrical & Computer Engineering Faculty Publications

Although brain-computer interfaces (BCIs) can be used in several different ways to restore communication, communicative BCI has not approached the rate or efficiency of natural human speech. Electrocorticography (ECoG) has precise spatiotemporal resolution that enables recording of brain activity distributed over a wide area of cortex, such as during speech production. In this study, we investigated words that span the entire set of phonemes in the General American accent using ECoG with 4 subjects. We classified phonemes with up to 36% accuracy when classifying all phonemes and up to 63% accuracy for a single phoneme. Further, misclassified phonemes follow articulation …

Empirical Models Of Scalp-Eeg Responses Using Non-Concurrent Intracranial Responses, Komalpreet Kaur, Jerry J. Shih, Dean J. Krusienski

Electrical & Computer Engineering Faculty Publications

Objective- This study presents inter-subject models of scalp-recorded electroencephalographic (sEEG) event-related potentials (ERPs) using intracranially recorded ERPs from electrocorticography and stereotactic depth electrodes in the hippocampus, generally termed as intracranial EEG (iEEG).

Approach- The participants were six patients with medically-intractable epilepsy that underwent temporary placement of intracranial electrode arrays to localize seizure foci. Participants performed one experimental session using a brain-computer interface matrix spelling paradigm controlled by sEEG prior to the iEEG electrode implantation, and one or more identical sessions controlled by iEEG after implantation. All participants were able to achieve excellent spelling accuracy using sEEG, four of the participants …

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 …

Educators' Knowledge Of And Attitudes Toward Concussions And The New Jersey Concussion Law, Einat Katz-Delong

PCOM Psychology Dissertations

Recent media attention, lawsuits from retiring athletes, and the early retirement of famous athletes have increased public awareness of sports-related head injuries. High school student athletes are more susceptible to concussions than older athletes. Athletes suffering from concussions may experience long-lasting effects on their lives, particularly in cognitive, emotional, and school functioning. Given the increased rates of concussions and their ramifications, state governments and the federal government have taken action. Beginning with the start of the 2011–2012 school year, the state of New Jersey has implemented legislation that requires all school districts with interscholastic sports programs to develop a written …

Parkinson's Diagnosis From The Caregiver's Perspective, Helen Maree Bradley

Theses : Honours

Parkinson’s disease (Parkinson’s) is a progressive neurodegenerative disorder. The irreversible and accumulating disability experienced means that people with Parkinson’s progressively lose their autonomy, eventually requiring complete care. Consequently, Parkinson’s significantly impacts sufferers and the people who care for them. Informal care, predominantly provided by female spouses becomes exceptionally demanding over time, and caregivers experience significant morbidity. Stress manifests across all stages of the caregiving trajectory, with diagnosis reported as a particularly stressful period for caregivers; however, few attempts have been made to understand what makes it stressful. The current study explored female spousal caregivers’ subjective experience of the Parkinson’s diagnosis, …

Three‐Dimensional Brain Mri For Dbs Patients Within Ultra‐Low Radiofrequency Power Limits, Subhendra N. Sarkar, Efstathios Papavassiliou, David Hackney, David Alsop, Ananth Madhuranthakam, Ludy Shih, Reed Busse, Susan Laruche, Rafeeque Bhadelia

Publications and Research

Background: For patients with deep brain stimulators (DBS), local absorbed radiofrequency (RF) power is unknown and is much higher than what the system estimates. We developed a comprehensive, highquality brain magnetic resonance imaging (MRI) protocol for DBS patients utilizing three-dimensional (3D) magnetic resonance sequences at very low RF power. Methods: Six patients with DBS were imaged (10 sessions) using a transmit/receive head coil at 1.5 Tesla with modified 3D sequences within ultra-low specific absorption rate (SAR) limits (0.1 W/kg) using T2, fast fluid-attenuated inversion recovery (FLAIR) and T1- weighted image contrast. Tissue signal and tissue contrast from the low-SAR images …

Differential Effects Of Fatigue On Movement Variability, N. Cortes, J. Onate, S. Morrison

Rehabilitation Sciences Faculty Publications

When individuals perform purposeful actions to fatigue, there is typically a general decline in their movement performance. This study was designed to investigate the effects exercise-induced fatigue has on lower limb kinetics and kinematics during a side-step cutting task. In particular, it was of interest to determine what changes could be seen in mean amplitude and all metrics of signal variability with fatigue. The results of the study revealed that post-fatigue there was an overall decrease in absolute force production as reflected by a decline in mean amplitude and variability (SD) of the ground reaction forces (GRF_V and GRF …

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 …

Pulmonary Function In Patients With Huntington's Disease, Alvaro Reyes, Travis Cruickshank, Mel Ziman, Ken Nosaka

Research outputs 2014 to 2021

Background: Huntington's disease (HD) is a neurodegenerative disorder characterized by progressive motor, cognitive and psychiatric disturbances. Chest muscle rigidity, respiratory muscle weakness, difficulty in clearing airway secretions and swallowing abnormalities have been described in patients with neurodegenerative disorders including HD. However limited information is available regarding respiratory function in HD patients. The purpose of this study was to investigate pulmonary function of patients with HD in comparison to healthy volunteers, and its association with motor severity.Methods: Pulmonary function measures were taken from 18 (11 male, 7 female) manifest HD patients (53 ± 10 years), and 18 (10 male, 8 female) …

Update On Intra-Arterial Chemotherapy For Retinoblastoma., Mario Zanaty, Guilherme Barros, Nohra Chalouhi, Md, Robert M Starke, Philip Manasseh, Stavropoula I. Tjoumakaris, Carol L Shields, David Hasan, Ketan Bulsara, Robert H. Rosenwasswer Md, Pascal Jabbour Md

Department of Neurosurgery Faculty Papers

The tools for managing retinoblastoma have been increasing in the past decade. While globe-salvage still relies heavily on intravenous chemotherapy, tumors in advanced stage that failed chemotherapy are now referred for intra-arterial chemotherapy (IAC) to avoid enucleation. However, IAC still has many obstacles to overcome. We present an update on the indications, complications, limitations, success, and technical aspects of IAC. Given its safety and high efficacy, it is expected that IAC will replace conventional strategies and will become a first-line option even for tumors that are amenable for other strategies.

Novel Partial Anomalous Pulmonary Venous Connection Associated With Brain Abscess., Anish Koka, Md, Amit Sachdev, Md, Moussa F Yazbeck, Md, Rodney Bell, Md, Christopher Farrellc, Md

Department of Neurology Faculty Papers

BACKGROUND: Right-to-left vascular shunts are associated with brain abscess.

CASE REPORT: We present a 47-year-old female with a cryptogenic left thalamic abscess on which Streptococcus mitis grew upon aspiration. Computed tomography of the chest with contrast agent revealed an anomalous connection between the left superior pulmonary and brachiocephalic veins. A right-to-left shunt was confirmed in a transthoracic echocardiogram study in which bubbles were injected into the left arm; this shunt had not previously been noted upon right-arm injection.

CONCLUSIONS: We recommend aggressive evaluation for right-to-left shunts in patients who present with cryptogenic brain abscesses. In addition to imaging, this should …

Perception And Use Of Complementary And Alternative Medicine Among Children And Adults With Epilepsy: The Importance Of The Decision Makers., Ali A Asadi-Pooya, Mehrdad Emami

Department of Neurology Faculty Papers

The aim of the current study was to assess the extent to which complementary and alternative medicine (CAM) has been used in children and adults to treat seizures and to compare the perceptions and usage of CAM between adult patients who decides for themselves and adults who decide for their sick children.In this cross-sectional study, patients who have been treated for epilepsy for at least one year at the outpatient epilepsy clinic at the Shiraz University of Medical Sciences were interviewed from January 2012 through March 2012. The questionnaire collected specific information of CAM perceptions and usage among patients. Pearson …