Neurology Commons^™

Younger Neurosurgoens —Ambitions, Evircilions Or Dilemma?, Amit Agrawal

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Clinical Evaluation 32 Patients With Jme In Southern Khorasan, Hamid Riasi, Fariba Nakhaei, Kavian Ghandehari, Frood Salehi, Zahra Toraby, Mojtaba Teimoori

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Changing Patterns Of Visual Hallucinations, Mubashira Hashmi, Ashfaq A. Sharif, Shaista A. Siddiqui, Muhammad Shahid Mustafa

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Gliosarcoma, Rafael Cincu, Juan F. Martín Lázaro, José Luis Capablo Liesa, Jose Eiras

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Intrathecal Use Of Polyrnyxinb For Multiresistant Acineobacter Meningitis, Atta-Ul Aleem Bhatti, Aslam Khan, Syed Ather Enam, Rashid Jooma

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Cerebral Palsy In Adolescents, Rehan Ali, Shakeel Ahmed, Maqbool Qadir

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Assessment Of Knowledge & Practice Of Contraceptives In Females Of Reproductive Age Group At A Tertiary Care Hospital, Nabeela Fazal Babar, Mahmood Ahmed, Muhammad Babar Khan, Muhammad Wasif Khan

Department of Surgery Docs

Abstract

Objectives: To assess the knowledge & practice of contraceptives in females of reproductive age group.
Study Design: Cross sectional descriptive.
Place and Duration of Study: OPD of Fauji Foundation Hospital from February 2008 – September 2008.
Subjects and Method: 339 Females of age b/w of 15 – 49 years attending OPD of Fauji Foundation Hospital were included in study. A structured questionnaire was used to collect data.
Results: Eighty eight percent of the females in our study sample were familiar with one or more methods of contraception (72.7%were familiar with combined oral contraceptive pill (COCP), 60.7% were aware of …

Asian Cerebral Venous Thrombosis Registry: Study Protocolv, Mohammad Wasay, Ayeesha Kamal, Bhojo Khealani

Department of Medicine

Introduction:

Cerebral venous thrombosis (CVT) is a well known but poorly reported entity. Most of the studies and registries related to CVT are reported from European countries. No large multi-center or multi- national data base or registry has been reported from Asian countries. CVT is not uncommon in Asia especially in south Asian subcontinent including India, Pakistan and Bangladesh. One study reported from India that CVT accounted for half of all strokes in the young and 40% of strokes in women. Review of CVT cases from Asian countries is suggestive of differences in risk factors profile and outcome in these …

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.

Moyamoya Disease: A Clinical Spectrum, Literature Review And Case Series From A Tertiary Care Hospital In Pakistan., Sana Shoukat, Ahmed Itrat, Ather M. Taqui, Moazzam Zaidi, Ayeesha Kamran Kamal

Department of Medicine

Background: Moyamoya is a rare cerebrovascular disease of unknown etiology. The data on moyamoya disease from Pakistan is sparse. We report a case series of 13 patients who presented with moyamoya disease to a tertiary care hospital in Pakistan with a national referral base.

Methods: We conducted a retrospective review of thirteen patients who presented to The Aga Khan University and diagnosed with "Moyamoya Disease" during the period 1988 – 2006. These patients were identified from existing hospital database via ICD-9 codes. A predesigned questionnaire containing information about clinical presentation, management and neuroimaging was administered to all identified patients. Results: …

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 …

A Dissociation Between Perception And Action In The Material‐Weight Illusion, Gavin Buckingham, Jonathan S. Cant, Kai-Ling C. Kao, Melvyn A. Goodale

Psychology Presentations

We examined what forces are applied to objects that elicit this illusion when they are lifted.We predicted that:

(1) Forces on early trials will scale to each participant’s expectations of how much a particular block will weigh ‐ excessive force will be applied to the metal block and insufficient force applied to the polystyrene block.

(2) Forces on later trials will scale to the real weight of each block ‐ identical levels of force applied to all the blocks.

(3) MWI will persist throughout ‐ polystyrene block will feel the heaviest, metal block will feel the lightest.

Grasping And Lifting Different Materials, Gavin Buckingham, Jonathan S. Cant, Melvyn A. Goodale

Psychology Presentations

The material from which an object is made can determine how heavy it feels (Seashore, 1899). Interestingly, a metal block that has been adjusted to have the same size and mass as a polystyrene block will feel lighter than the polystyrene block. We recently showed that participants experiencing this material-weight illusion’ (MWI) do not apply forces that match their perceptual experience of heaviness ‐ just like in the size‐weight illusion ( Flanagan & Beltzner, 2000).

Our previous study showed that forces on early trials were scaled to each participant’s expectations of how much a particular block should weigh ‐ excessive …

A Comparison Of The Observation Of Movement Method And Electromyography Method Of Determining Motor Threshold In Transcranial Magnetic Stimulation, Berry Stephen Anderson

MUSC Theses and Dissertations

Clinicians are using transcranial magnetic stimulation (TMS) as a noninvasive tool to treat depression; however, standards for determining the motor threshold (MT), which often determines the final location of the TMS coil and the intensity of simulation for the depression treatment, are not clear. This study compared the observation of movement (OM) method and electromyography (EMG) method of determining motor threshold in a group of experienced TMS administrators and nurses with no previous MT knowledge. We hypothesized that between methods and groups the MT estimates would vary by ≤ 5% of stimulator output and the ideal motor scalp location between …

A Comparative Analysis Of Structural Brain Mri In The Diagnosis Of Alzheimer’S Disease, Jason Appel, Elizabeth Potter, Qian Shen, Gustavo Pantol, Maria T. Greig, David Loewenstein, Ranjan Duara

Neurology Faculty Publications

Dementia is a debilitating and life-altering disease which leads to both memory impairment and decline of normal executive functioning. While causes of dementia are numerous and varied, the leading cause among patients 60 years and older is Alzheimer’s disease. The gold standard for Alzheimer’s diagnosis remains histological identification of amyloid plaques and neurofibrillary tangles within the medial temporal lobe, more specifically the entorhinal cortex and hippocampus. Although no definitive cure for Alzheimer's disease currently exists, there are treatments targeted at preserving cognition and memory while delaying continued loss of function. Alzheimer's disease exists along a spectrum of cognitive decline and …

Near Fatal Posterior Reversible Encephalopathy Syndrome Complicating Chronic Liver Failure And Treated By Induced Hypothermia And Dialysis: A Case Report., Rashmi Chawla, Daniel Smith, Paul E Marik

Division of Pulmonary, Allergy, and Critical Care Medicine Faculty Papers

INTRODUCTION: Posterior reversible encephalopathy syndrome is a clinico-neuroradiological entity characterized by headache, vomiting, altered mental status, blurred vision and seizures with neuroimaging studies demonstrating white-gray matter edema involving predominantly the posterior region of the brain. CASE PRESENTATION: We report a 47-year-old Caucasian man with liver cirrhosis who developed posterior reversible encephalopathy syndrome following an upper gastrointestinal hemorrhage and who was managed with induced hypothermia for control of intracranial hypertension and continuous veno-venous hemodiafiltration for severe hyperammonemia. CONCLUSION: We believe this is the first documented case report of posterior reversible encephalopathy syndrome associated with cirrhosis as well as the first report …

Resting State Default-Mode Network Connectivity In Early Depression Using A Seed Region-Of-Interest Analysis: Decreased Connectivity With Caudate Nucleus, Robyn Bluhm, Peter Williamson, Ruth Lanius, Jean Théberge, Maria Densmore, Robert Bartha, Richard Neufeld, Elizabeth Osuch

Philosophy Faculty Publications

Aim: Reports on resting brain activity in healthy controls have described a default-mode network (DMN) and important differences in DMN connectivity have emerged for several psychiatric conditions. No study to date, however, has investigated resting-state DMN in relatively early depression before years of medication treatment. The objective of the present study was, therefore, to investigate the DMN in patients seeking help from specialized mental health services for the first time for symptoms of depression.

Methods: Fourteen depressed subjects and 15 matched controls were scanned using 4-T functional magnetic resonance imaging while resting with eyes closed. All but one subject was …

Calpain Inhibition Attenuates Inflammatory And Neurodegenerative Events In Animal Models Of Multiple Sclerosis, Mary Kelly Guyton

MUSC Theses and Dissertations

Multiple sclerosis (MS) is an autoimmune, demyelinating disease of the central nervous system (CNS) that affects approximately 400,000 people in the United States every year and results in fatigue, visual dysfunction, and paralysis. Inflammatory events associated with MS include activation of auto-reactive T cells and migration of these and other immune cells into the CNS, leading to production of cytokines and other mediators and to demyelination. Astrogliosis and microgliosis are also prominent inflammatory features of MS. Neurodegenerative events such as axonal damage and loss of neurons and oligodendrocytes also contribute to clinical disease symptoms. Cell death is thought to occur, …

Influencing T Helper Cell Bias In Autoimmunity, Jonathan Ty Butler

MUSC Theses and Dissertations

Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) that affects approximately 400,000 people in the United States every year and results in neurological deficits. Inflammatory events associated with MS include activation of auto-reactive T cells and migration of these and other immune cells into the CNS, leading to a coordinated attack upon oligodendrocytes and demyelination. Most current therapies only treat the symptoms of disease, not the cause, which is still in large part unknown. Therefore, the identification of the etiology of this complex disease and the development of new therapies is of great importance. Targeting …

Functional Interleukin-17 Receptor A Is Expressed In Central Nervous System Glia And Upregulated In Experimental Autoimmune Encephalomyelitis., Jayasri Das Sarma, Bogoljub Ciric, Ryan Marek, Sanjoy Sadhukhan, Michael L. Caruso, Jasmine Shafagh, Denise C. Fitzgerald, Kenneth S. Shindler, Am Rostami

Department of Neurology Faculty Papers

BACKGROUND: Interleukin-17A (IL-17A) is the founding member of a novel family of inflammatory cytokines that plays a critical role in the pathogenesis of many autoimmune diseases, including multiple sclerosis (MS) and its animal model, experimental autoimmune encephalomyelitis (EAE). IL-17A signals through its receptor, IL-17RA, which is expressed in many peripheral tissues; however, expression of IL-17RA in the central nervous system (CNS) and its role in CNS inflammation are not well understood.

METHODS: EAE was induced in C57Bl/6 mice by immunization with myelin oligodendroglial glycoprotein. IL-17RA expression in the CNS was compared between control and EAE mice using RT-PCR, in situ …

The Efficacy Of Surgical Decompression Before 24 Hours Versus 24 To 72 Hours In Patients With Spinal Cord Injury From T1 To L1--With Specific Consideration On Ethics: A Randomized Controlled Trial., Vafa Rahimi-Movaghar, Soheil Saadat, Alexander R Vaccaro, Seyed Mohammad Ghodsi, Mohammad Samadian, Arya Sheykhmozaffari, Seyed Mohammad Safdari, Bahram Keshmirian

Department of Neurosurgery Faculty Papers

BACKGROUND: There is no clear evidence that early decompression following spinal cord injury (SCI) improves neurologic outcome. Such information must be obtained from randomized controlled trials (RCTs). To date no large scale RCT has been performed evaluating the timing of surgical decompression in the setting of thoracolumbar spinal cord injury. A concern for many is the ethical dilemma that a delay in surgery may adversely effect neurologic recovery although this has never been conclusively proven. The purpose of this study is to compare the efficacy of early (before 24 hours) verse late (24-72 hours) surgical decompression in terms of neurological …

Combined Effects Of Hyperglycemic Conditions And Hiv-1 Nef: A Potential Model For Induced Hiv Neuropathogenesis., Edward A Acheampong, Cassandra Roschel, Muhammad Mukhtar, Alagarsamy Srinivasan, Mohammad Rafi, Roger J Pomerantz, Zahida Parveen

Department of Neurology Faculty Papers

Hyperglycemic conditions associated with diabetes mellitus (DM) or with the use of antiretroviral therapy may increase the risk of central nervous system (CNS) disorders in HIV-1 infected patients. In support of this hypothesis, we investigated the combined effects of hyperglycemic conditions and HIV-1 accessory protein Nef on the CNS using both in vitro and in vivo models. Astrocytes, the most abundant glial cell type required for normal synaptic transmission and other functions were selected for our in vitro study. The results show that in vitro hyperglycemic conditions enhance the expression of proinflammatory cytokines including caspase-3, complement factor 3 (C3), and …

Po10.19 Clinical Spectrum Of Pseudo Seizures At A Tertiary Care Hospital Karachi: A Video Eeg Based Study, Nadeem Ahmed Memon, Bhojo A. Khealani, Fazal Karim, Mustafa Khan, Nadir Ali Syed, Saad Shafqat

Department of Medicine

Background: Nonepileptic seizures are involuntary episodes of movement, sensation, or behaviors (e.g., vocalization, crying and other expressions of emotion), that do not result from abnormal cortical discharges. The events typically occur in teenage patients with anxiety and affective disorders. Psychotherapy, behavioral therapy, drugs, hypnosis and placebo are mainstay of treatment. There is no published data on clinical characteristics of pseudo-seizures from Pakistan. The objective of our study is to describe the clinical characteristics of pseudoseizures in a tertiary care hospital in Karachi, Pakistan. Methods: This is a descriptive study. Patients with pseudo-seizures were identified from departmental Video EEG monitoring …

Treatment Options For Neuropathic Pain, Sara Akre

Honors Program Theses

Neuropathic pain is caused by injury to or disease of the nervous system. It affects many people around the world and is a symptom of several diseases. In the United States, it is estimated that up to 3% of Americans have neuropathic pain, which costs the healthcare system $40 billion annually (Gilron et al. 2006). It is, unfortunately, difficult to ameliorate or eliminate due to the complexity of the nervous system and its plasticity and is, therefore, a chronic condition. Health care professionals continually struggle to treat patients' pain and, since tolerance to painkillers is easily built up, this often …

Po5.53 Critical Illness Polyneuropathy And Myopathy: Experience At A Tertiary Care Center In Pakistan, Ghulam Shabbir, Ali Mehmood Raufi, Mustafa Khan, Nawal Salahuddin, Saad Shafqat

Department of Medicine

Background: Polyneuropathy and Myopathy are frequently encountere in the setting of Critical illness patients. Up to 50% of intensive care unit (ICU) patients show electrophysiological features of either or both conditions. These conditions interfere with functional recovery and delay weaning from mechanical ventilation, resulting in excess morbidity,mortality and cost of care. This study was to define the clinical spectrum of critical illness Polyneuropathy (CIP) and Myopathy (CIM) in a setting of developing country.
Methods: Hospital records spanning the period 2000 through 2005 weresearched with ICD-9 codes to identify patients with CIP and CIM. Functional improvement was judged by (i) …

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 …

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, …

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. …