Neurology Commons^™

Management Of Penetrating Brain Injury, Syed Faraz Kazim, Muhammad Shahzad Shamim, Muhammad Zubair Tahir, Ather Enam, Shahan Waheed

Section of Neurosurgery

Penetrating brain injury (PBI), though less prevalent than closed head trauma, carries a worse prognosis. The publication of Guidelines for the Management of Penetrating Brain Injury in 2001, attempted to standardize the management of PBI. This paper provides a precise and updated account of the medical and surgical management of these unique injuries which still present a significant challenge to practicing neurosurgeons worldwide. The management algorithms presented in this document are based on Guidelines for the Management of Penetrating Brain Injury and the recommendations are from literature published after 2001. Optimum management of PBI requires adequate comprehension of mechanism and …

Cranial Reconstruction After Decompressive Craniectomy: Prediction Of Complications Using Fuzzy Logic, Saniya Siraj Godil, Muhammad Shahzad Shamim, Ather Enam, Uvais Qidwai, Mohsin Qadeer, Zain A. Sobani

Section of Neurosurgery

Introduction: Cranial reconstruction after decompressive craniectomy (DC) has been shown to be associated with a relatively high complication rate (16.4%-34%) compared with standard neurosurgical procedures (2%-5%). Most studies that have previously attempted to formulate a multivariate model for identifying factors predictive of postoperative complications of cranioplasty either were unsuccessful or yielded conflicting results. Therefore, fuzzy logic-based fuzzy inference system (FIS), which has proven to be a useful tool for risk prediction in medical and surgical conditions, was used in this study to identify predictors of complications of cranioplasty.
Methods: A retrospective chart review of all the patients who underwent DC …

Non-Traumatic Coma In Paediatric Patients: Etiology And Predictors Of Outcome, Saba Ahmed, Kiran Ejaz, Muhammad Shahzad Shamim, Maimoona Azhar Salim, Muhammad Umer Rais Khan

Department of Emergency Medicine

Objective: To determine the common etiological features of non-traumatic coma in children and evaluate possible predictors of morbidity and mortality in these patients.
Method: A cross sectional study was carried out at the Paediatric Department of Civil Hospital Karachi from February 2008 to February 2009. In total 100 children, up to 14 years of age having history of non-traumatic coma were included. At the time of enrolment demographic data, clinical features, laboratory parameters and radiological workup were recorded. Data was entered and analyzed with SPSS version 16. Descriptive statistics were generated for all variables. Relationships between categorical variables were evaluated …

18 Years Old – Time For National Identification, I.A. Khatri

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Pre- And Post-Radiotherapy Predictors Of Functional Outcome And Survival In Metastatic Spinal Cord Compression, Mutahir A. Tunio, Altaf Hashmi

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Pakistan Society Of Neurosurgeons Neurotrauma Karachi 2011

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Pakistan Society For Neurology Conference Abstracts

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

A Rare Case Of Candidal Meningitis In Immuna Competent Host, M. Mittal, Deepak Goel, Garima Mittal, Krishan K. Bansal

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Psychological And Cognitive Determinants Of Vision Function In Age-Related Macular Degeneration., Barry W. Rovner, Robin J Casten, Robert W Massof, Benjamin E Leiby, William S Tasman

Department of Neurology Faculty Papers

OBJECTIVE: To investigate the effect of coping strategies, depression, physical health, and cognition on National Eye Institute Visual Function Questionnaire scores obtained at baseline in a sample of older patients with age-related macular degeneration (AMD) enrolled in the Improving Function in AMD Trial, a randomized controlled clinical trial that compares the efficacy of problem-solving therapy with that of supportive therapy to improve vision function in patients with AMD.

METHODS: Baseline evaluation of 241 older outpatients with advanced AMD who were enrolled in a clinical trial testing the efficacy of a behavioral intervention to improve vision function. Vision function was characterized …

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.

Brain Abscess Complicating Hemorrhagic Contusion In A Case Of Closed Head Injury, A.A. Wani, Altaf U Ramzan, Nayil K Malik, Furqan A Nizami, Anil Dhar, Ashish Kumar, M A Wani

Pakistan Journal of Neurological Sciences (PJNS)

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

Department of Medicine

No abstract provided.

Traumatic Retroclival Epidural Hematoma In Pediatric Patient- Case Report And Review Of Literature, Muhammad Zubair Tahir, S. A. Quadri, Sonia Hanif, Gohar Javed

Section of Neurosurgery

Background: Retroclival epidural hematoma (REDH) is a very rare entity in the practical field of neurosurgery. Only a few cases have been reported in literature. The authors present to you case of a 12-year-old female, a victim of road traffic accident (RTA), who had presented to us with loss of consciousness and seizures.
Case description: Magnetic resonance imaging revealed retroclival hematoma. She was managed on conservative grounds and discharged with assurance of multiple follow-up visits.
Conclusion: Very few cases of REDH have been reported in pediatric population to date. It should be suspected in children with head and neck injuries …

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.

Magnetic Resonance Spectroscopy In Focal Brain Lesions, Muhammad Shahbaz Alam, Zafar Sajjad, Saima Hafeez, Waseem Akhter

Department of Radiology

OBJECTIVE: To describe the spectrum of Magnetic Resonance spectroscopy in focal brain lesions and determine its diagnostic accuracy using histopathology as gold standard in differentiating neoplastic and non-neoplastic focal brain lesions.

METHODS: The study was conducted in Department of Radiology, Aga Khan University Hospital, Karachi from Dec 2006 till Jan 2009. Fifty three patients found to have focal brain lesions on magnetic resonance imaging (MRI) were included in the study. Magnetic Resonance spectroscopy (MRS) was performed in these focal lesions. These lesions were deemed neoplastic and non-neoplastic on MR Spectrum findings. Correlation of all these findings was done with histopathology …

Acute Effects Of A Selective Cannabinoid-2 Receptor Agonist On Neuroinflammation In A Model Of Traumatic Brain Injury., Melanie B Elliott, Ronald F Tuma, Peter S Amenta, Mary F Barbe, Jack I Jallo

Department of Neurosurgery Faculty Papers

Proposed therapeutic strategies for attenuating secondary traumatic brain injury (TBI) include modulation of acute neuroimmune responses. The goal of this study was to examine the acute effects of cannabinoid-2 receptor (CB(2)R) modulation on behavioral deficits, cerebral edema, perivascular substance P, and macrophage/microglial activation in a murine model of TBI. Thirty male C57BL/6 mice underwent sham surgery, or cortical contusion impact injury (CCI). CCI mice received vehicle or the CB(2)R agonist 0-1966 at 1 and 24 h after injury. Performance on the rotarod, forelimb cylinder, and open-field tests were evaluated before and at 48 h after sham or CCI surgery. Cerebral …

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

Department of Medicine

No abstract provided.

Ct Scanning Is Sufficient To Clear The Cervical Spine Of Elderly Falls Less Than 5 Feet., Douglas Lehman Md, Rovinder S. Sandhu Md, Leslie Baga Bsn, Farheen Hussain Ms, John J. Hong Md

Administration & Leadership

No abstract provided.

Multiple Courses Of Stereotactic Re-Irradiation In Recurrent Oligodendroglioma: A Case Report., Shannon Fogh, Charles Glass, David W Andrews, Maria Werner-Wasik

Department of Radiation Oncology Faculty Papers

INTRODUCTION: High grade gliomas are an insidious disease associated with an extremely poor prognosis. The role of re-irradiation for recurrent gliomas is unclear but several retrospective studies have indicated mild toxicity and modest outcomes with this regimen. With subsequent progression, it is unclear what options remain and more radiotherapy is rarely offered for fear of surpassing normal central nervous system tissue tolerance and causing significant side effects without significant benefit.

CASE PRESENTATION: In this report, we describe a 37-year-old Caucasian male initially diagnosed with a grade IV oligodendroglioma, who received multiple courses of re-irradiation and experienced a survival of 10 …

Establishment Of A Comprehensive Epilepsy Center In Pakistan: Initial Experiences, Results, And Reflections, Muhammad Z Tahir, Z A. Sobani, S. A. Quadri, S. Nizam Ahmed, Fowzia Siddiqui, Syed Enam Enam

Department of Surgery Docs

Background. Developing countries, home to 80% of epilepsy patients, do not have comprehensive epilepsy surgery programs. Considering these needs we set up first epilepsy surgery center in Pakistan. Methods. Seventeen teleconferences focused on setting up an epilepsy center at the Aga Khan University (AKU), Karachi, Pakistan were arranged with experts from the University of Alberta Hospital, Alberta, Canada and the University of West Virginia, USA over a two-year period. Subsequently, the experts visited the proposed center to provide hands on training. During this period several interactive teaching sessions, a nationwide workshop, and various public awareness events were organized. …

Pediatric Traumatic Putamenal Strokes: Mechanisms And Prognosis, Zain A. Sobani, Arshad Ali

Section of Neurosurgery

Background: Studies have shown that nearly 3% of closed head injuries result in basal ganglia hemorrhages and that this may be a more frequent occurrence in pediatric patients. Various mechanisms based on shearing forces have been implicated in the injury; however, the underlying mechanism leading to the increased incidence in pediatric patients has not been well described. Angiographic data suggest that putamenal perforators in children are more severely stretched at acute angles compared to those in adults, which may be a contributing factor to the increased incidence.
Case description: We discuss a series of five relatively benign cases of traumatic …

Hormonal Consequences Of Epilepsy And Its Treatment In Men., Kartik Sivaraaman, Scott Mintzer

Department of Neurology Faculty Papers

PURPOSE OF REVIEW: Epilepsy and anticonvulsant medications may substantially alter endocrine homeostasis, including the male reproductive hormonal system.

RECENT FINDINGS: Seizures in medial temporal lobe structures, through their connectivity to the hypothalamus, alter the secretion of gonadotropins. Levels of circulating bioavailable testosterone are affected by changes in the level of binding proteins, which in turn may be affected by seizure medications. The use of older generation medications that induce the cytochrome P450 system is associated with an increase in sex hormone-binding globulin and lower bioactive testosterone. Sexual dysfunction, including decreased libido and decreased potency, and infertility, is seen commonly in …

Effects Of Exercise On Brain Activation In Response To Visual Food Cues, Laura Hackett

Kinesiology and Public Health

No abstract provided.

Characteristics Of An Adult Photosensitive Cohort, Mubashira Hashmi, Mazhar Mobin, Khurram A Siddiqui

Section of Neurology

Intermittent Photic Stimulation (IPS) is a well recognized provocation maneuver during EEG recording which helps in identifying underlying photosensitivity. The frequency and characteristics of various responses to photosensitivity among our adult patients was determine. EEGs of subjects > or =15 years from 2003-2006, were reviewed. Two main photosensitive responses were observed: Photoparoxysmal (PPR) and Photic-driving response (PDR). Demographic and clinical data was also collected. Out of 5950 EEG's performed, response to IPS were detected in 1.2% (n=73) of EEGs. Out of which 49 (67%) had PDR and 24 (33%) had PPR. Mean age of PPR group was 25.7 +/- 12 years …

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

Department of Medicine

No abstract provided.

Microsurgical Excisions Of Vestibular Schwannomas: A Tumor-Size-Based Analysis Of Neurological Outcomes And Surgical Complications, Syed Faraz Kazim, Muhammad Shahzad Shamim, Ather Enam, Muhammad Ehsan Bari

Section of Neurosurgery

Introduction: Vestibular schwannomas (VS) are benign tumors originating from Schwann cells in vestibulocochlear nerve. This study aimed at evaluating outcomes of microsurgical resections of VS based on tumor sizes in a South Asian country.
Methods: The chart notes of 71 Patients who underwent microsurgical resections of VS at a single academic center over a 20-year period (1990-2009) were reviewed, and relevant information was extracted. For analyzing outcomes, Patients were divided into two groups based on tumor size at initial presentation: (1) Group A (tumor size ≤ 4 cm) and (2) Group B (tumor size > 4 cm). Pearson's chi-square and Fisher's …

Diagnostic Accuracy Of Clinical Examination In Cervical Spine Injuries In Awake And Alert Blunt Trauma Patients, Manzar Hussain, Gohar Javed

Section of Neurosurgery

Study design: Observational, case series.
Purpose: To determine the sensitivity and specificity of clinical judgment as compared to the use of X-ray images in detecting cervical spine injuries in trauma patients presenting in the emergency department of Aga Khan University Hospital, Karachi.
Overview of literature: Cross-table cervical spine views are important in patients with signs and symptoms relating to cervical spine, but asymptomatic patients constitute a different subgroup. Accuracy of clinical examination in these patients has not been subjected to scrutiny.
Methods: All patients with blunt trauma who presented to the emergency department and underwent cross-table X-rays as part of …

Intracerebral Migration Of Stray Bullet Leading To Sudden And Fatal Worsening, Manzar Hussain, Muhammad Ehsan Bari

Section of Neurosurgery

Gunshot wounds to the cranium are one of the leading cause of death and disability in young adults. Stray bullets are also being increasingly seen in clinical setting. We report a case of a 14-year-old boy who sustained a stray bullet to the cranium during election festivities. He arrived at the health care facility institution nearly 24 hours after the event in good neurological condition. He remained neurologically stable for about 8 hours after his presentation and later on deteriorated due to intracranial bullet migration. This required immediate bifrontal decompressive craniotomy along with right frontal lobectomy. However, the patient could …

Improving Function In Age-Related Macular Degeneration: Design And Methods Of A Randomized Clinical Trial., Barry W Rovner, Robin J Casten, Mark T Hegel, Robert W Massof, Benjamin E Leiby, William S Tasman

Department of Psychiatry and Human Behavior Faculty Papers

Age-Related Macular Degeneration (AMD) is the leading cause of severe vision loss in older adults and impairs the ability to read, drive, and live independently and increases the risk for depression, falls, and earlier mortality. Although new medical treatments have improved AMD's prognosis, vision-related disability remains a major public health problem. Improving Function in AMD (IF-AMD) is a two-group randomized, parallel design, controlled clinical trial that compares the efficacy of Problem-Solving Therapy (PST) with Supportive Therapy (ST) (an attention control treatment) to improve vision function in 240 patients with AMD. PST and ST therapists deliver 6 one-hour respective treatment sessions …

Atrial Fibrillation, Is Warfarin The Only Option For Stroke Prevention?, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.