Neurology Commons^™

Outcomes Of Rescue Endovascular Treatment Of Emergent Large Vessel Occlusion In Patients With Underlying Intracranial Atherosclerosis: Insights From Star., Sami Al Kasab, Eyad Almallouhi, Ali Alawieh, Stacey Wolfe, Kyle M. Fargen, Adam S. Arthur, Nitin Goyal, Travis Dumont, Peter Kan, Joon-Tae Kim, Reade De Leacy, Ilko Maier, Joshua Osbun, Ansaar Rai, Pascal Jabbour, Jonathan A. Grossberg, Min S. Park, Robert M. Starke, Roberto Crosa, Alejandro M. Spiotta

Department of Neurosurgery Faculty Papers

Background: Some emergent large vessel occlusions (ELVOs) are refractory to reperfusion because of underlying intracranial atherosclerosis (ICAS), often requiring rescue therapy (RT) with balloon angioplasty, stenting, or both. In this study, we investigate the safety, efficacy, and long-term outcomes of RT in the setting of mechanical thrombectomy for ICAS-related ELVO.

Methods and Results: We queried the databases of 10 thrombectomy‐capable centers in North America and Europe included in STAR (Stroke Thrombectomy and Aneurysm Registry). Patients with ELVO who underwent ICAS‐related RT were included. A matched sample was produced for variables of age, admission National Institute of Health Stroke …

Are Guidelines Important? Results Of A Prospective Quality Improvement Lumbar Fusion Project., James Harrop, Alexandra Emes, Ameet Chitale, Chengyuan Wu, Fadi Al-Saiegh, Geoffrey Stricsek, Glenn A. Gonzalez, Jack Jallo, Joshua Heller, Kevin Hines, Lucas Philipp, Sara Thalheimer, Srinivas K. Prasad, Thiago Montenegro, Umma Fatema, Ashwini Sharan

Department of Neurosurgery Faculty Papers

BACKGROUND: United States (U.S.) healthcare is a volume-based inefficient delivery system. Value requires the consideration of quality, which is lacking in most healthcare disciplines.

OBJECTIVE: To assess whether patients who met specific evidence-based medicine (EBM)-based criteria preoperatively for lumbar fusion would achieve higher rates of achieving the minimal clinical important difference (MCID) than those who did not meet the EBM indications.

METHODS: All elective lumbar fusion cases, March 2018 to August 2019, were prospectively evaluated and categorized based on EBM guidelines for surgical indications. The MCID was defined as a reduction of ≥5 points in Oswestry Disability Index (ODI). Multiple …

Deciphering An Agrp-Serotoninergic Neural Circuit In Distinct Control Of Energy Metabolism From Feeding, Yong Han, Guobin Xia, Dollada Srisai, Fantao Meng, Yanlin He, Yali Ran, Yang He, Monica Farias, Giang Hoang, István Tóth, Marcelo O Dietrich, Miao-Hsueh Chen, Yong Xu, Qi Wu

Children’s Nutrition Research Center Staff Publications

Contrasting to the established role of the hypothalamic agouti-related protein (AgRP) neurons in feeding regulation, the neural circuit and signaling mechanisms by which they control energy expenditure remains unclear. Here, we report that energy expenditure is regulated by a subgroup of AgRP neurons that send non-collateral projections to neurons within the dorsal lateral part of dorsal raphe nucleus (dlDRN) expressing the melanocortin 4 receptor (MC4R), which in turn innervate nearby serotonergic (5-HT) neurons. Genetic manipulations reveal a bi-directional control of energy expenditure by this circuit without affecting food intake. Fiber photometry and electrophysiological results indicate that the thermo-sensing MC4RdlDRN neurons …

Lesion Loci Of Impaired Affective Prosody: A Systematic Review Of Evidence From Stroke, Alexandra Zezinka Durfee, Shannon M. Sheppard, Margaret L. Blake, Argye E. Hillis

Communication Sciences and Disorders Faculty Articles and Research

Affective prosody, or the changes in rate, rhythm, pitch, and loudness that convey emotion, has long been implicated as a function of the right hemisphere (RH), yet there is a dearth of literature identifying the specific neural regions associated with its processing. The current systematic review aimed to evaluate the evidence on affective prosody localization in the RH. One hundred and ninety articles from 1970 to February 2020 investigating affective prosody comprehension and production in patients with focal brain damage were identified via database searches. Eleven articles met inclusion criteria, passed quality reviews, and were analyzed for affective prosody localization. …

Emergency Use Of Targeted Osmotic Lysis For The Treatment Of A Patient With Aggressive Late-Stage Squamous Cell Carcinoma Of The Cervix, Harry J. Gould, Paige R. Miller, Samantha Edenfield, Kelly Jean Sherman, Chad K. Brady, Dennis Paul

School of Medicine Faculty Publications

Upregulation of voltage-gated sodium channels (VGSCs) and Na+/K+-ATPase (sodium pumps) is common across most malignant carcinomas. Targeted osmotic lysis (TOL) is a developing technology in which the concomitant stimulation of VGSCs and pharmacological blockade of sodium pumps causes rapid selective osmotic lysis of carcinoma cells. This treatment of cervical carcinoma is evidence that TOL is a safe, well-tolerated and effective treatment for aggressive advanced carcinomas that has the potential to extend life without compromising its quality. TOL is likely to have broad application for the treatment of advanced-stage carcinomas.

Post-Operative Seizure Control In Patients With Glioblastoma, Ummey Hani, Muhammad Ammar Haider, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

While the median survival in patients with glioblastoma has not improved significantly over the past decade, aggressive attempts have been made on palliation and improving quality of life in these patients. A confluence of two debilitating pathologies which massively distorts the normal day-to-day functioning of the patients who experience it, seizures in glioblastoma patients portends a poor prognosis. There exists a paucity of reported seizure outcomes after glioblastoma treatment in neurosurgical literature. Herein we present a review examining post-operative seizure control in patients with glioblastoma.

Pregabalin Induced Hypersensitivity Reaction And Joint Pains In Patient With Lumbosacral Radiculopathy, Ramla Nayaib Hashmi, Iqra Khan, Ummul Kiram, Soobia .S Siddiqui, Tamaniat .

Pakistan Journal of Neurological Sciences (PJNS)

Pregabalin is an antiepileptic medication commonly used for other purposes. It is also approved for neuropathic pain. Reported adverse effects are not severe, short lasting and are usually well tolerated1. The most common side effects comprise of lightheadedness , sedation , double vision ,increase in bodyweight and imbalance whereas decrease in neutrophil count and hypersensitivity are the uncommon adverse effects. In the literature till date, few case reports are available on the drug reactions to pregabalin. We report a case of young female who developed hypersensitivity reaction with pregabalin including body rashes, hives peripheral edema, and joint pains. Using the …

Neurological Associations Of Covid-19 Vaccines, Rija Zehra Ghazanfar, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

It does not come as a surprise that the introduction of an unprecedented treatment for a recently notorious disease will cause concerns and raise some questions. As a race we have become cautious over the centuries about what treatment modalities we accept and reject. With the advent of social media and endless sources of information we find ourselves standing at an intersection of many pathways, thinking meticulously where to go from there? At one point the widely available stats and the complex way in which these vaccines work do not really interest the general population as much as how they …

Optimizing Stroke Care In Baluchistan, Anjum Farooq, Wazir Akbar, Ahmed Wali

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is the second leading cause of death after ischemic heart disease.(1) Pakistan, currently the fifth most populous country of the world, has limited data on prevalence of stroke and its risk factors. Only two small-scale population-based studies conducted in Karachi showed stroke prevalence of 4.8% and 19.1%. (1) One study conducted in KP province of Pakistan showed estimated stroke prevalence of 1.2%. (1) The burden of stroke risk factors in Pakistan is enormous. Diabetes and hypertension are the most common risk factors in Pakistan. (2) Other common risk factors in Pakistan are active smoking, obesity, and family history of …

Anti-Nmda Receptor Encephalitis, Zaid Waqar, Haris Majid Rajput, Muhammad Hassan, Iqra Athar, Neelma Naz Khattak, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Anti N-methyl-D-aspartate receptor (NMDA)receptor encephalitis is one of the most common type of auto immune encephalitis. Its diagnosis is often delayed due to initial clinical presentation with psychiatric clinical features. Initial clinical features resemble those of acute psychosis or depression which later evolve into frank neurological dysfunction. This was first described in association with ovarian teratoma, but it was later also found to exist without neoplastic association and in men as well. It occurs more frequently in younger age group, mostly below 50 years of age. Diagnosis is established with the help of cerebrospinal fluid (CSF) analysis for oligo clonal …

Gaba-B Encephalitis In Pakistan: A Rare But Treatable Entity, Asfandyar Khan Niazi, Shafain Shaikh, Arsalan Ahmad, Ayesha Zafar, Tahir Aziz Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Autoimmune and paraneoplastic encephalitides are a group of neurologic disorders that present with cognitive decline, neuropsychiatric symptoms, movement disorders, or seizures. These diseases can present before, with, or after the diagnosis of malignancy. We report two cases of GABA-B encephalitis from Pakistan. The first patient was a 67-year-old gentleman presented with cognitive decline and neuropsychiatric symptoms. His CSF analysis showed increased protein levels and GABA-B receptor antibodies. He was treated with pulse steroids, which improved his symptoms. The second patient was a 34-year-old lady with cognitive decline and psychomotor symptoms. Her serum autoimmune antibody panel showed antibodies against GABA-B receptors. …

Association Of Hypomagnesaemia & Hypocalcemia With Intracerebral Hemorrhage And Outcome, Muhammad Hassan, Naveed Ullah Khan, Mansoor Iqbal, Haris Majid Rajput, Ehsan-Ur- Rehman, Waleed Shahzad, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Determine if hypomagnesemia & hypocalcemia on admission was associated with ICH and outcome.

Magnesium is a vascular smooth muscle relaxant and appears to provide protection against cellular injury in experimental stroke models. The implication of low serum magnesium in primary ICH is not well defined.

All patients with a primary ICH presented to PIMS, Islamabad prospectively analyzed in a pilot study. Demographics, initial lab values, ICH location, Mg+2 level, NIHSS & MRS at presentation were recorded. All patients with INR <= 1.5 were included in this study. We took normal serum magnesium in our study was 1.8 - 2.5 mEq/dL. Statistical significance was determined using linear regression adjusting for admission systolic blood pressure (SBP).

We identified 66 patients who met the inclusion criteria. The mean age was 52.76 years with minimum and maximum age …

Criminal Thinking Styles And Criminal Social Identity Among Juvenile Delinquents: Moderating Role Of Parenting Styles, Fatima Sana, Muhammad Rafiq, Muhammad Nasar Iqbal

Pakistan Journal of Neurological Sciences (PJNS)

Parenting is considered imperative in the development of juvenile's cognitions, and beliefs. The parent-child relationship might significantly influence juvenile’s thought patterns and social communications. Different parenting styles perhaps indicate criminal involvement of juveniles, resultantly turns them into delinquent. The present study was done to discover whether parental authority styles moderate the path that links criminal thinking styles to criminal social identity amongst juvenile delinquents. Participants of the study were 211 juvenile delinquents who responded on Juvenile Criminal Thinking Styles’ Inventory (Sana & Rafiq, 2019), Measure of Criminal Social Identity (Boduszek, et al., 2012), Parental Authority Questionnaire (Babree, 1997) and approached …

Valproate Used In Women Of Childbearing Age With Epilepsy, Salman Mansoor, Kevin Murphy, Siobhan Kelly, Shoab Saadat

Pakistan Journal of Neurological Sciences (PJNS)

Valproate is one of the oldest known anti-epileptic drugs (AED) in practice which was discovered in 1881 and later in 1962 was approved for treating epilepsy. It is indicated in most of the seizure types including generalized onset (motor, non-motor and myoclonic), focal onset, unknown onset and unclassified. Valproate has other indications in migraine prophylaxis, and bipolar disorder.

Early Neurological Deterioration After Acute Stroke; Mechanism And Predictors, Bushra Ammad Taimuri, Sajid Hameed, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Neurological deterioration after acute ischemic stroke (AIS)is a common occurrence, leading to increased mortality, morbidity, and poor quality of life among stroke survivors. Recognition of the individuals at a greater risk for neurological deterioration may contribute to making early decisions and monitoring the therapy. Neurological deterioration arises in up to 40% of subjects after AIS during hospitalization and is followed by neurological and functional debility. Numerous predictors have been devised that predict this progression. This includes preliminary assessment of the severity of stroke, brainstem infarction, hyperglycemia, atrial fibrillation, diabetes mellitus and substantial fluctuations in blood pressure. Sequential observations, in depth …

Migraine And Fasting, Lubna Ashraf Jafri, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Migraine is considered as the second leading cause of disability worldwide, most commonly seen in young women. Skipping meals, dehydration and fasting are among many triggering factors which have been described in literature as a cause of increased frequency and severity of migraine attacks. The underlying pathophysiology, prevention and management of fasting induced migraine has been documented, however, there is a lack of randomized controlled trials for the same. This review article discusses these important aspects in the light of published literature and gives directions on future areas of research.

Juvenile Dermatomyositis And Posterior Reversible Encephalopathy Syndrome: A Rare Association., Shazma Shamim

Pakistan Journal of Neurological Sciences (PJNS)

Juvenile dermatomyositis or JDM is a rare but debilitating pediatric disease that affects the proximal muscles and skin, as implied by its name. Although rare, it is the most common childhood idiopathic inflammatory myopathy (1). The estimated incidence is 3.2 cases per million children (2). The diagnosis is based on clinical signs and symptoms supported by investigations including, but not limited to, muscle biopsy, muscle enzymes and EMG studies. Bohan and Peter’s criterion is most widely used for diagnosis. It includes the presence of Gottron’s rash, raised muscle enzymes, proximal muscle weakness and suggestive findings on muscle biopsy (3). Treatment …

Machine Learning Classification Of Traumatic Brain Injury Patients Versus Healthy Controls Using Arterial Spin Labeled Perfusion Mri, Vanessa I. Grass

Dissertations, Theses, and Capstone Projects

Traumatic brain injury (TBI) is one of the most common causes of death and disability worldwide, yet accurate in vivo detection of TBI neuropathology remains challenging due to complexities in the structural and functional changes observed post-injury as well as limitations in conventional neuroimaging modalities. Although advanced neuroimaging techniques such as arterial spin labeling (ASL) can noninvasively assess cerebral blood flow (CBF) changes observed post-injury, this technique is underutilized in TBI research partly due to the low signal-to-noise-ratio (SNR) inherent in ASL imaging. The aim of the current study is to examine the use of machine learning, specifically a Support …

Are Lumbar Fusion Guidelines Followed? A Survey Of North American Spine Surgeons, Thiago Montenegro, Christopher Elia, Kevin Hines, Zorica Buser, Jefferson Wilson, Zoher Ghogawala, Shekar N Kurpad, Daniel M Sciubba, James Harrop

Department of Neurosurgery Faculty Papers

OBJECTIVE: To evaluate the use of guidelines for lumbar spine fusions among spine surgeons in North America.

METHODS: An anonymous survey was electronically sent to all AO Spine North America members. Survey respondents were asked to indicate their opinion surrounding the suitability of instrumented fusion in a variety of clinical scenarios. Fusion indications in accordance with North America Spine Society (NASS) guidelines for lumbar fusion were considered NASS-concordant answers. Respondents were considered to have a NASS-concordant approach if ≥ 70% (13 of 18) of their answers were NASS-concordant answers. Comparisons were performed using bivariable statistics.

RESULTS: A total of 105 …

The Contribution Of Dysphagia To Acute Stroke Morbidity And Mortality In Nigeria: A Prospective Study, O O. Olajide, Philip Adebayo, F T. Taiwo, M O. Owolabi, A Ogunniyi

Internal Medicine, East Africa

Background: The assessment of time-trend morbidity and mortality in acute stroke is critical to clinical policy decisions and resource allocation.

Objectives: To determine the prevalence of dysphagia in acute stroke and the impact of dysphagia on short term stroke outcome (30 days post-stroke).

Methods: This was a prospective longitudinal study. Bedside screening for dysphagia modified Rankin score (MRS) and Barthel Index (BI) were performed on acute stroke patients on day 1, day 7, day 14 and day 30 after stroke to determine the frequency of dysphagia. Patients with dysphagia were then compared with age- and gender-matched controls (stroke patients without …