Neurology Commons^™

Optimization Of Biomathematical Model Predictions For Cognitive Performance Impairment In Individuals: Accounting For Unknown Traits And Uncertain States In Homeostatic And Circadian Processes, Hans P. A. Van Dongen, Christopher G. Mott, Jen-Kuang Huang, Daniel J. Mollicone, Frederic D. Mckenzie, David F. Dinges

Mechanical & Aerospace Engineering Faculty Publications

Current biomathematical models of fatigue and performance do not accurately predict cognitive performance for individuals with a priori unknown degrees of trait vulnerability to sleep loss, do not predict performance reliably when initial conditions are uncertain, and do not yield statistically valid estimates of prediction accuracy, These limitations diminish their usefulness for predicting the performance of individuals in operational environments. To overcome these 3 limitations, a novel modeling approach was developed, based on the expansion of a statistical technique called Bayesian forecasting. The expanded Bayesian forecasting procedure was implemented in the two-process model of sleep regulation, which has been used …

Confidence Intervals For Individualized Performance Models, Hans P. A. Van Dongen, Christopher G. Mott, Jen-Kuang Huang, Daniel J. Millicone, Frederic D. Mckenzie, David F. Dinges

Mechanical & Aerospace Engineering Faculty Publications

Commentary on Reifman J; Rajaraman S; Gribok AV. Moving Towards Individualized Performance Models. Sleep 2007;30(9):1081-82.

Hemicrania Continua-Like Headache Associated With Carotid Dissection May Respond To Indomethacin, Avi Ashkenazi, Muhammad A. Abbas, Dinesh K. Sharma, Stephen D. Silberstein

Department of Neurology Faculty Papers

Hemicrania continua (HC) is an idiopathic, chronic disorder characterized by a continuous, strictly unilateral headache associated with ipsilateral cranial autonomic symptoms. The symptoms of HC typically respond dramatically to indomethacin therapy. We describe a patient with traumatic internal carotid artery (ICA) dissection, who presented with a clinical picture mimicking HC that initially responded to indomethacin. Patients with a clinical picture similar to HC should be managed with a high index of suspicion for a possible cervical arterial dissection.

Reduction Of Astrogliosis And Microgliosis By Cerebrospinal Fluid Shunting In Experimental Hydrocephalus, Janet M. Miller, James P. Mcallister Ii

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Reactive gliosis has the potential to alter biomechanical properties of the brain, impede neuronal regeneration and affect plasticity. Determining the onset and progression of reactive astrogliosis and microgliosis due to hydrocephalus is important for designing better clinical treatments.

Methods

Reactive astrogliosis and microgliosis were evaluated as the severity of hydrocephalus increased with age in hydrocephalic H-Tx rats and control littermates. Previous studies have suggested that gliosis may persist after short-term drainage (shunt treatment) of the cerebrospinal fluid. Therefore shunts were placed in 15d hydrocephalic rats that were sacrificed after 6d (21d of age) or after 21d (36d of …

Self-Consistent Analyses For Potential Conduction Block In Nerves By An Ultrashort High-Intensity Electric Pulse, R. P. Joshi, A. Mishra, Q. Hu, K. H. Schoenbach, A. Pakhomov

Bioelectrics Publications

Simulation studies are presented that probe the possibility of using high-field (>100kV ∕ cm), short-duration (∼50ns) electrical pulses for nonthermal and reversible cessation of biological electrical signaling pathways. This would have obvious applications in neurophysiology, clinical research, neuromuscular stimulation therapies, and even nonlethal bioweapons development. The concept is based on the creation of a sufficiently high density of pores on the nerve membrane by an electric pulse. This modulates membrane conductance and presents an effective "electrical short" to an incident voltage wave traveling across a nerve. Net blocking of action potential propagation can then result. A continuum approach based …

Towards A Cure For Traumatic Paraplegia - Is There Cause For Hope?, Rashid Jooma

Section of Neurosurgery

In the past decade, great strides have been made in the field of CNS tissue repair and expectations have been raised that a cure of spinal paralysis is at hand. The two broad categories of investigational approaches to spinal regeneration are: (1) Enhancing the Regenerative Milieu of the Cord and (2) Cellular and Tissue Transplantation. Amongst the latter approaches, the early use of foetal cord tissue has given way to the more sophisticated studies on stem cell therapy and the implants of olfactory ensheating cells. These have engendered considerable public interest and are being offered as commercially available therapies in …

Narcotic Analgesics For Acute Migraine In The Emergency Room: Are We Meeting Headache Societies' Guidelines?, Mohammad Wasay, Khawaja Slaman Zaki, Saqib Uddin Khan, Rifat Rehmani

Department of Emergency Medicine

We analysed 161 patients with acute migraine in our emergency room (ER) to identify the use of narcotic analgesics as first-line treatment. Twenty-four percent of patients were treated with opioid analgesics and 76% patients were treated with non-opioid analgesics. Pain was completely relieved in 100 (62%) patients, partially relieved in 50 (31%) patients and was not relieved in 11 (7%) patients at the time of discharge. Pain relief was not related to the use of opioids vs. non-opioids. The treatment of acute migraine in our ER is in line with the guidelines of the Headache Societies and needs further improvement.

Neuroradiology, Zafar Sajjad

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Presentation And Features Of Conversion Disorder At A Tertiary Care Hospital In Karachi, Sameer Khan, Abdullah Ladha, Sarah Khalid Khan, Sana Farooq Khan, Awais Amjad Malik, Zehra Memon, Samiullah Ghulam Nabi, Hafiz Yasir Adnan, Haider Ali Naqvi

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Hyperhomocysteinemia And Cerebralvenoussinus Thrombosis, Mughis Sheerani, Bhojo A. Khealani

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Current Approach To Primary Central Nervous System Lymphoma, Amar Lal, Nehal Masood

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Psychiatry, Syed Ahmer

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Treatment Of Spinal Tuberculosis: Role Of Surgical Intervention, Syed Ather Enam, Ahmed Ali Shah

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

The Future Of National Medical Journals, Kamran Abbasi

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Epilepsy And Crohn's Disease, Muhammad Shazam Hussain, S. Nizam Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Liver Transplant Recipient With Calcineurin-Inhibitor Induced Pain Syndrome: A Case Report, Nethra S. Ankam, Md, Stanley R. Jacobs, Md

Department of Rehabilitation Medicine Faculty Papers

Setting: University Hospital

Patient: 65-year-old female status-post liver transplant secondary to cirrhosis.

Case Description: Prior to the rehabilitation consult on post-operative day 42, she had an episode of acute rejection requiring rapid escalation of cyclosporine dosage, later changed to high dose tacrolimus for immunosuppression, resulting in high blood levels of both calcineurin inhibitors. She then complained of paroxysms of 10/10 pain over her entire body not relieved by opioids despite escalation in medication by the acute pain service. She was not participating in a rehabilitation program because of pain. Examination revealed an anxious woman for whom any tactile stimulation …

Rehabilitation Of A Patient With Diabetic Myonecrosis: A Case Report, Nethra S. Ankam, Md, Vishal Kancherla, Do, Stanley R. Jacobs, Md

Department of Rehabilitation Medicine Faculty Papers

Setting: Inpatient rehabilitation unit at a university hospital

Patient: 37-year-old male with diabetic myonecrosis.

Case Description: The patient had a long-standing history of uncontrolled diabetes mellitus with multiple comorbidities, including end-stage renal disease on dialysis and diabetic myonecrosis of the left biceps femoris diagnosed by biopsy and magnetic resonance imaging (MRI.) On this admission, he presented with right leg pain and swelling, found to be a reoccurrence of diabetic myonecrosis in the vastus lateralis, medialis, and intermedius, diagnosed by MRI only. Prior to admission, he lived alone in a wheelchair inaccessible duplex and required minimal assistance with housekeeping.

Assessment/Results: …

Prognostic Indicators In Cerebral Venous Sinus Thrombosis, Bilal Hameed, Nadir Ali Syed

Section of Neurology

Cerebral venous sinus thrombosis (CVT) can affect all age groups, particularly women of childbearing age. Overall prognosis for survival and functional independence is better than it was believed. Mortality usually ranges from 6-15% and transtentorial herniation is the major cause of death. Approximately 80% of patients are functionally independent in the long term. Altered mental status and cerebral haemorrhage at presentation are the strongest predictors of death and disability. Patients with CVT related to pregnancy and puerperium generally do better than patients with other causes. Septic CVT carries a worse prognosis than aseptic CVT and of the latter, patients with …

Oral Contraceptives And Cerebral Venous Thrombosis: Case Report And A Brief Review Of Literature, Mughis Sheerani, Mian Zainul Sajadeen Urfy

Section of Neurology

Cerebral venous thrombosis remains an important and sometimes an elusive cause of strokes. Oral contraceptives seem to have a strong causative association with this entity. We describe a case that highlights the importance of asking specific questions about oral contraceptive use in patients with strokes due to cerebral venous sinus thrombosis, especially, where the cause remains cryptic.

Local Thrombolytic Treatment Of Cerebral Venous Thrombosis In Three Paediatric Patients, Mohammad Wasay, Rohit Bakshi, Alper Dai, Steve Roach

Section of Neurology

There is increasing evidence that local thrombolysis can be used with relative safety and efficacy in adults with superior sagittal sinus thrombosis (SSST). However, little data is available on the use of local thrombolysis in children with SSST. We report three patients who received local thrombolysis for dural sinus thrombosis. Two patients received urokinase and one patient received urokinase followed by local TPA infusion. Recanalization was achieved in two patients.

Thrombolytic Therapy In Cerebral Venous Sinus Thrombosis., Ayeesha Kamran Kamal

Department of Medicine

The use of thrombolytic agents to rapidly lyse the clot has emerged as a therapeutic modality, in concert with interventional neuroradiologic approaches to deliver the agent locally at the site of thrombosis. There are no randomized, double blind, placebo, controlled trials to support thrombolysis as a first line therapy in patients with cerebral venous sinus thrombosis compared to standard therapy using anticoagulation with weight based dose adjusted unfractionated Heparin. Numerous case reports and a single non randomized trial have shown that it is comparatively safe and may rescue patients who are deteriorating despite anticoagulation with unfractionated Heparin. Consideration must be …

Isolated Deep Venous Thrombosis--Case Series, Literature Review And Long Term Follow Up., Ayeesha Kamran Kamal, Ahmed Itrat, Sana Shoukat, Asumal Khealani, Kamran Kamal

Department of Medicine

Cerebral Venous Sinus thrombosis may rarely be isolated to a cortical vein or to the deep venous system. When the deep venous system is involved, prognosis is generally poor. In addition, long term follow up is not reported. We conducted a retrospective review of all patients admitted to a major tertiary care center, with the diagnosis of isolated deep venous thrombosis. Two patients were identified with isolated involvement of the deep venous system, they are reviewed in detail with long term follow up. Two young South Asian women in their thirties with rapid onset of neurologic signs and symptoms are …

Role Of Surgery In Cerebral Venous Sinus Thrombosis, S. Ather Enam

Department of Surgery Docs

Cerebral venous sinus thrombosis (CVST) usually is taken care of by medical management or neuro-interventional vascular techniques. Some cases of CVST may take a malignant course if the intracranial pressure increases excessively. This increase in pressure is because of oedema in brain tissue due to impediment in venous return and/or intracerebral haemorrhage. Neurosurgical experience has shown remarkable recovery in these moribund patients if appropriate surgical intervention is done within reasonable time. Emergent decompressive craniotomy or other neurosurgical interventions are the only appropriate treatment in these malignant forms of CVST to prevent mortality and severe morbidity.

Cerebral Venous Thrombosis: Recent Advances And Need For An Asian Registry, Mohammad Wasay, Ayeesha K. Kamal

Department of Medicine

No abstract provided.

Mechanism Of Neuronal Injury In Cerebral Venous Thrombosis, Uzma Usman, Mohammad Wasay

Department of Medicine

The impact of CVT on the brain is wide spectrum, ranging from completely normal parenchyma to brain oedema and/or haemorrhage. Multiple factors relate to neuronal injury in CVT including; dural sinus pressure, increased venous flow velocities, collateralization of venous channels, rate of occlusion, development of cytotoxic and vasogenic oedema, recanalization and accelerated myelination. It is suggested that recanalization of occluded vein, as well as, the presence or absence and the efficiency of intracranial venous collaterals, may have an impact on the extent of brain tissue damage and hence the prognosis of acute CVT.

Complications Associated With Cerebral Venous Thrombosis., Fazeel Mukhtar Siddiqui,, Ayeesha Kamran Kamal

Department of Medicine

Although CVT is associated with a good outcome in the majority of cases, it may be complicated by numerous unique and sometimes rare complications. The purpose of this review is to discuss the acute and chronic complications of CVT in greater detail. Awareness may lead to a more aggressive approach in those in which these complications are anticipated and perhaps avoided.
The complications of CVT may be temporally divided into those unique to the acute stage and those that are associated with the chronic stage of CVT. They are venous infarction and haemorrhage, subarachnoid haemorrhage, a rapid progression and pulmonary …

Heparin In The Treatment Of Cerebral Venous Thrombosis., Saad Shafqat, Ayeesha Kamran Kamal, Mohammad Wasay

Department of Medicine

Cerebral venous thrombosis (CVT) is a potentially life-threatening condition requiring rapid diagnosis and urgent treatment. Heparin anticoagulation is the time-honoured treatment, and is advocated in all cases of CVT, irrespective of etiology or presence of haemorrhage. The supportive evidence is largely observational; data from randomized placebo-controlled trials shows a nonsignificant trend favouring heparin. Current practice is to begin heparin (unfractionated or low-molecular weight) immediately on confirmation of the diagnosis. Newer antithrombotic agents such as ximelagatran may offer advantages over heparin and need to be investigated in the treatment of CVT.

Pathophysiology Of Cerebral Venous Thrombosis--An Overview., Ahmed Itrat, Sana Shoukat, Ayeesha Kamran Kamal

Department of Medicine

Cerebral venous sinus thrombosis is a disorder with a unique pathophysiology which needs to be described. A Medline search of all articles detailing pathophysiology of CVST was done, using keywords: cerebral venous thrombosis and pathophysiology. In addition, major texts were reviewed for additional references. The pathophysiology of CVST depends on two interconnected events, local signs due to venous infarct, e.g., hemiparesis and global signs due to raised ICP from an obstructed venous system--papilloedema and isolated intracranial hypertension being one of them. Pathophysiology of CVST is diverse and makes it easier to understand the diversity of clinical presentations.

Incidence And Epidemiology Of Cerebral Venous Thrombosis., Fazeel Mukhtar Siddiqui, Ayeesha Kamran Kamal

Department of Medicine

Cerebral venous sinus thrombosis is a disorder whose epidemiology has changed over the past few decades. It is no longer regarded as a uniformly fatal disease. CVST is not a rare disorder. It may have a differential geographic distribution with a higher incidence in the Asian world. It is a disease of neonates, younger women and men, often a hypercoagulable state, either acquired (e.g., cancer) or a genetic prothrombotic condition may be present. Outcome is not uniformly dismal and prognostic criteria that detect patients with a poor outcome have become available from prospective studies. There is a paucity of well …

Treatment Of Spinal Tuberculosis: Role Of Surgical Intervention, Ather Enam, Ahmed Ali Shah

Section of Neurosurgery

The treatment of tuberculosis of the spine (Pott's disease) is essentially conservative and a vast majority of patients can be successfully managed on antituberculo us therapy (ATT) alone.1 Surgery is indicated in a few specific cases where deformity of spine, pain, or neurological compromise is becoming a serious issue. In cases where surgery is indicated the benefits are almost immediate and excellent. Tuberculosis (TB) is one of the leading causes of infectious disease-related deaths in under-developed countries and it has had a resurgence in developed countries as well. The most common site of bony dissemination of this disease is in …