Neurology Commons^™

Extensive And Persistent Disruption Of Neurovascular Coupling By A Single Cerebral Microinfarct, Philipp Mcconnell Summers

MUSC Theses and Dissertations

Cerebral microinfarcts (CMI), microscopic brain lesions caused by blockade of small blood vessels, have recently emerged as a potential determinant of cognitive decline. Though small in size, our recent work demonstrated that a single, strategically placed CMI was sufficient to disrupt sensory input in a behavioral task. However, the means by which such small lesions disrupt brain function remain poorly understood. We imaged vascular function in awake, head-fixed mice using two-photon microscopy to examine the impact of CMI on neurovascular coupling. CMI were generated in cortex by photothrombotic occlusion of single penetrating vessels through a thinned-skull cranial window. Vibrissa-evoked dilation …

Non Communicable Diseases In Pakistan: Burden, Challenges And Way Forward For Health Care Authorities, Mohammad Wasay, Shehla Zaidi, Maria Khan, Rashid Jooma

Section of Neurology

No abstract provided.

Current Pathophysiological Concepts In Cerebral Small Vessel Disease., Fred Rincon, Clinton B Wright

Department of Neurology Faculty Papers

The association between cerebral small vessel disease (SVD) - in the form of white matter lesions, infarctions, and hemorrhages - with vascular cognitive impairment (VCI), has mostly been deduced from observational studies. Pathological conditions affecting the small vessels of the brain and leading to SVD have suggested plausible molecular mechanisms involved in vascular damage and their impact on brain function. However, much still needs to be clarified in understanding the pathophysiology of VCI, the role of neurodegenerative processes such as Alzheimer's disease, and the impact of aging itself. In addition, both genetic predispositions and environmental exposures may potentiate the development …

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 …

Diagnostic Potential Of The Nmda Receptor Peptide Assay For Acute Ischemic Stroke, Svetlana A. Dambinova, Kerstin Bettermann, Theodore Glynn, Matthew Tews, David Olsen, Joseph D. Weissman, Richard K. Sowell

Faculty Articles

Background

The acute assessment of patients with suspected ischemic stroke remains challenging. The use of brain biomarker assays may improve the early diagnosis of ischemic stroke. The main goal of the study was to evaluate whether the NR2 peptide, a product of the proteolytic degradation of N-methyl-D-aspartate (NMDA) receptors, can differentiate acute ischemic stroke (IS) from stroke mimics and persons with vascular risk factors/healthy controls. A possible correlation between biomarker values and lesion sizes was investigated as the secondary objective.

Methods and Findings

A total of 192 patients with suspected stroke who presented within 72 h of symptom onset …

Hdl Cholesterol--How Do I Raise My Patients Good Cholesterol?, Quratulain Shaikh, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Hdl Cholesterol--How Do I Raise My Patients Good Cholesterol?, Quratulain Shaikh, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

What Is The Role Of Free Radical Scavengers In Acute Stroke?, Muhammad Faisal Wadiwala, Ambreen Sonawalla, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

My Patient Has A Lot Of Variability In His Blood Pressure Measurements? Should I Be Worried? What Can I Do Which May Be Better, Quratulain Shaikh, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Can Selective Serotonin Reuptake Inhibitors (Ssri) Improve Motor Recovery After Stroke? What Is The Role Of Neuroplasticity?, Farzin Majeed, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

My Patient Just Had A Transient Ischaemic Attack. Can I Predict His Risk For Stroke? Is Stroke Inevitable Or Preventable?, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

What Are The Emerging Therapeutic Alternatives To Warfarin In Stroke Patients? How Would The Results Of Re-Ly Benefit Pakistanis, Maria Khan, Emmon Raza, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Can We Stop The Stroke Epidemic In Pakistan?, Ismail A. Khatri, Mohammad Wasay

Department of Medicine

No abstract provided.

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.

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.

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.

Ischemic Stroke Care - Official Guidelines From The Pakistan Society Of Neurology, Ayeesha Kamran Kamal, Ahmed Itrat, Imama Naqvi, Maria Khan, Roomasa Channa, Ismail Khatri, Mohammad Wasay

Department of Medicine

No abstract provided.

Does Admission Hyperglycemia Predict Intracranial And Extracranial Vasculopathy?, Ather Mohammed Taqui, Ayeesha Kamran Kamal, Saqib Ali Gowani, Bhojo A Khealani, Shafquat Rozi

Community Health Sciences

Objective: To study the association between admission hyperglycaemia and the presence and pattern of intracranial and extracranial vascular disease.
Methods: This retrospective study was conducted at a major tertiary care hospital in Karachi, Pakistan. Patients who had presented with acute stroke and had undergone a carotid ultrasound doppler of the carotids and/or Magnetic Resonance Angiography (MRA) of the brain were included in the study. A multiple logistic regression analysis of variables was done for an abnormal finding on each investigation.
Results: Out of the total of 216 patients, the age of majority of the patients (83.3%) was >50 years …

Does Admission Hyperglycemia Predict Intracranial And Extracranial Vasculopathy?, Ather Mohammed Taqui, Ayeesha Kamran Kamal, Saqib Ali Gowani, Bhojo A. Khealani, Shafquat Rozi

Department of Medicine

Objective: To study the association between admission hyperglycaemia and the presence and pattern of intracranial and extracranial vascular disease.
Methods: This retrospective study was conducted at a major tertiary care hospital in Karachi, Pakistan. Patients who had presented with acute stroke and had undergone a carotid ultrasound doppler of the carotids and/or Magnetic Resonance Angiography (MRA) of the brain were included in the study. A multiple logistic regression analysis of variables was done for an abnormal finding on each investigation.
Results: Out of the total of 216 patients, the age of majority of the patients (83.3%) was >50 years …

Fight Against Chronic Diseases (High Blood Pressure, Stroke, Diabetes And Cancer) In Pakistan; Cost-Effective Interventions, Mohammad Wasay, Abdul Jabbar

Department of Medicine

No abstract provided.

Early Ischemic Stroke Presentation In Pakistan, Ayeesha Kamran Kamal, Bhojo A Khealani, Sajjad Ahmed Ansari, Maria Afridi, Nadir Ali Syed

Department of Medicine

Introduction: There are no studies from Pakistan that describe stroke presentation rates or factors associated with early or delayed presentation. This is important to know because current clinical protocols limit the use of recombinant tissue plasminogen activator (rtPA), the only available therapy for acute ischemic stroke, to a three-hour window from symptom onset.
Methods: All patients aged 14 years or above with acute ischemic stroke of < or = 48 hours duration were prospectively identified from the Aga Khan University Stroke Data Bank over a 22-month period ending May 2001.
Results: 269 ischemic stroke patients presented within 48 hours of stroke onset. 55 out of 269 (21%) presented within first three hours and 110 out of 269 (41%) within first six hours. Unawareness of …

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, …

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.

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 …

Racial Disparities Of Post Stroke Physical Therapy In South Carolina, Aaron E. Embry

MUSC Theses and Dissertations

Background and Purpose: Stroke is a devastating event that drastically changes the lives of many people worldwide. Stroke statistics vary across the United States with the highest rates in the southeast. Physical therapy is often required to return to normal function. Appropriateness for physical therapy is based on individual impairments, thus access to and amount of physical therapy should not differ between races. Methods: Using a South Carolina UB-92 data subset for 2002, univariate analysis is performed against physical therapy and race for ischemic stroke victims. Logistic regression is used to test for differences in access to physical therapy. Multiple …

Acute Stroke Secondary To Internal Carotid Artery Pseudoaneurysm: Mri Findingsand Treatment With Endovascularcoiling, Mohammad Wasay, Alper Dai, Neeraj Dubey, Saadat Kamran

Department of Medicine

Internal carotid artery pseudoaneurysms are uncommon. We report a young man with history of trivialtrauma who presented with middle cerebral artery stroke.Head CT scan revealed a right parapharyngeal mass. MRI confirmed the diagnosis of internal carotidpseudoaneurysm. Cerebral angiogram showed dissection of internal carotid artery with a large pseudoaneurysm and almost complete occlusion of vessel distal to aneurysm.Vessel was obliterated by fibercoiling and gluing byendovascular technique to diminish risk of furthere mbolization. MRI characteristics of carotid pseudoaneurysms and role of endovascular treatment arediscussed.

Wernekink Comissure Syndrome: A Rare Midbrain Syndrome Secondary To Stroke, Alper I. Dai, Mohammad Wasay

Department of Medicine

Wernekink commissure involves the decussation of superior cerebellar peduncle (SCP) in midbrain. We report an elderly hypertensive, diabetic man who developed slurred speech, ataxia, and internuclear ophthalmoplegia. MRI examination revealed an unusual ischemic stroke involving Wernekink commissure. This rare stroke pattern involving decussation of SCP occurs in the setting of small arterial disease. The association between the anatomic location of the stroke and clinical findings is noteworthy.