Neurology Commons^™

Neurological Complications Of Immune Checkpoint Inhibitors: What Happens When You 'Take The Brakes Off' The Immune System., Marinos Dalakas

Department of Neurology Faculty Papers

Patients with advanced malignancies treated with immune checkpoint inhibitors are at increased risk for developing immune-related neurological complications. It is a phenomenon of immunological twist when immunotherapy against co-stimulatory molecules activates previously normal T cells to kill tumor cells but, in so doing, the T cells become unrestrained, triggering other autoimmune diseases for which conventional immunotherapy is needed. The most common autoimmune neurological diseases, usually occurring within 2-12 weeks after immune checkpoint inhibitor initiation, include: inflammatory myopathies, myasthenia gravis, acute and chronic demyelinating polyradiculoneuropathies, vasculitic neuropathies, isolated cranial neuropathies, aseptic meningitis, autoimmune encephalitis, multiple sclerosis and hypophysitis. The neurological events …

Bilateral Displacement Of The Common Carotid Arteries By A Large Goiter., Lexian J Mcbain, Joe Iwanaga, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

Large goiters are less common in the developing world due to the use of iodized salt. However, these are seen occasionally. Herein, we report a case of very large goiter identified in a cadaver. This case is also of interest due to the significant lateral displacement of the common carotid arteries (CCA) and the midline shift of the trachea. This case and the salient literature addressing this topic have been discussed.

In Vivo Brainstem Imaging In Alzheimer’S Disease: Potential For Biomarker Development, David J. Braun, Linda J. Van Eldik

Neuroscience Faculty Publications

The dearth of effective treatments for Alzheimer’s disease (AD) is one of the largest public health issues worldwide, costing hundreds of billions of dollars per year. From a therapeutic standpoint, research efforts to date have met with strikingly little clinical success. One major issue is that trials begin after substantial pathological change has occurred, and it is increasingly clear that the most effective treatment regimens will need to be administered earlier in the disease process. In order to identify individuals within the long preclinical phase of AD who are likely to progress to dementia, improvements are required in biomarker development. …

Variations Of The Transverse Sinus: Review With An Unusual Case Report., Chrissie Massrey, Juan J Altafulla, Joe Iwanaga, Zachary Litvack, Basem Ishak, Rod J Oskouian, Marios Loukas, R Shane Tubbs

Articles, Abstracts, and Reports

The dural venous sinuses are venous channels in the cranium that drain blood and cerebrospinal fluid circulating from the brain into the vascular system via the internal jugular veins. The transverse sinus is a dural venous sinus present in the posterior aspect of the cranium. We report an unusual variant of this sinus with the presence of a fenestration at its proximal segment. We will review and discuss the background and the potential clinical relevance of this anatomical variation.

Role Of Palliative Csf Diversion In Patients With Intracranial Metastatic Disease And Symptomatic Hydrocephalus, Farhan A. Mirza, Muhammad Shahzad Shamim

Section of Neurosurgery

Hydrocephalus, unless treated, is one of the terminal manifestations of intracranial metastatic disease. Single lesions causing obstructive hydrocephalus are amenable to surgical resection, but in the setting of multiple lesions and communicating hydrocephalus from leptomeningeal disease, the approach to treatment is much less defined. The use of endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunting (VPS) has been described, but data is limited. In this review, we summarize the sparse data available in literature describing the use of CSF diversion for patients with metastatic disease presenting with hydrocephalus and neurological decline.

Neurology Advocacy In Pakistan, Abdul Malik

Pakistan Journal of Neurological Sciences (PJNS)

Advocacy is an activity by an individual or group which aims to influence decisions within political, economic, and social systems and institutions. Advocacy can include many activities that a person or organization undertakes including media campaigns, public speaking, commissioning and publishing research or conducting exit poll or the filing of an amicus brief. Lobbying (often by lobby groups) is a form of advocacy where a direct approach is made to legislators on an issue which plays a significant role in modern politics

Parametric And Nonparametric Tests In Spine Research: Why Do They Matter?, Sarah Hopkins, Joseph R Dettori, Jens R Chapman

Articles, Abstracts, and Reports

No abstract provided.

Distinctive Structural And Molecular Features Of Myelinated Inhibitory Axons In Human Neocortex., Kristina D Micheva, Edward F Chang, Alissa L Nana, William W Seeley, Jonathan T Ting, Charles Cobbs, Ed Lein, Stephen J Smith, Richard J Weinberg, Daniel V Madison

Articles, Abstracts, and Reports

Numerous types of inhibitory neurons sculpt the performance of human neocortical circuits, with each type exhibiting a constellation of subcellular phenotypic features in support of its specialized functions. Axonal myelination has been absent among the characteristics used to distinguish inhibitory neuron types; in fact, very little is known about myelinated inhibitory axons in human neocortex. Here, using array tomography to analyze samples of neurosurgically excised human neocortex, we show that inhibitory myelinated axons originate predominantly from parvalbumin-containing interneurons. Compared to myelinated excitatory axons, they have higher neurofilament and lower microtubule content, shorter nodes of Ranvier, and more myelin basic protein …

Editorial., Jeffrey C Wang, Jens R Chapman, Karsten Wiechert

Articles, Abstracts, and Reports

No abstract provided.

Behavioral Challenges In Childhood Epilepsy, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Behavioral problems among children with epilepsy is one of the most common problem. Severity of the problem ranges from 16% to 77% as compared to 9% in the general pediatric population. Such a huge variation in the results reflects probable difference in the methodology. Structured interviews that include parents, children and clinician’s reports have identified a higher rate of behavioral problems when compared to self-report instruments. Higher rates are reported in clinical samples recruited from tertiary care medical centers, where they have a lot of referrals from the peripheral small units. Most researchers agree that children with epilepsy have three …

Prevention Of Neural Tube Defects By Folic Acid In Pregnancy., Atiq Ahmed Khan, Ruth K.M.

Pakistan Journal of Neurological Sciences (PJNS)

Pakistan is a developing country facing variety of challenges including maternal malnutrition and neonatal mortality. Globally Pakistan has the third highest neonatal mortality rate(1). Maternal malnutrition contributes to low birth weight neonates and birth anomalies. A study conducted in tertiary care hospital of Karachi catering to lower socioeconomic background showed 10.9% of birth defects to be of central nervous system. Maternal factor related to neural tube defects in same study showed 81.3 % mothers had not taken folic acid during pregnancy(

Hyperglycemia In Acute Subarachnoid Hemorrhage, Maher Bano Malik, Jehangeer Shoro, Haris Majid Rajput

Pakistan Journal of Neurological Sciences (PJNS)

Subarachnoid hemorrhage (SAH) is associated with high inhospital mortality and morbidity. Hyperglycemia occurs frequently in acute medical conditions including SAH and is associated with poor outcome. The aim of the study was to determine the frequency of Hyperglycemia in patients of subarachnoid hemorrhage.

Chikungunya Virus Associated Guillain-Barre Syndrome With Variable Presentation: A Case Series., Salman Farooq, Muhammad Imran, Ejaz Karim, Dureshahwar Kanwar, Muhammad Bilal Tariq

Pakistan Journal of Neurological Sciences (PJNS)

Chikungunya Virus Is A Mosquito-borne Alpha Virus Which Occasionally Causes Neurologic Complications Including Guillain-barre Syndrome, Myelitis, Myopathies And Encephalitis. Pakistan Experienced Its First Chikungunya Outbreak In The Metropolis Of Karachi Officially Confirmed By World Health Organization In December 2016. During This Outbreak, Over 30,000 People Have Been Reported To Be Infected In Different Parts Of Karachi. We Report Four Cases Of Chikungunya Virus Infection Associated Guillain-barre Syndrome Having An Atypical Clinical Presentation And Variable Outcome. Each Case Presented As A Different Variant Of Gbs Including Acute Inflammatory Demyelinating Polyneuropathy, Acute Motor And Sensory Axonal Neuropathy And Pharyngeal-cervical-brachial.

Personality Traits And Mental Health Of University Male Students Viewing Internet Pornography, Komal Razzaq, Muhammad Rafiq, Fatima Sana, Zahid Mahmood

Pakistan Journal of Neurological Sciences (PJNS)

Studies have indicated that viewing internet pornography is like addiction and has been implicated in the development of psychosocial issues leading to mental health. However, in view of Pakistani culture, psychosocial issues and mental health problems associated with viewing internet pornography especially in perspective to personality traits are not studied yet. Objective: Objective of the current study was to investigate any effect of personality traits on mental health of university male students viewing internet pornography.

Stroke Like Migraine Attacks After Radiation Therapy (Smart) Vs Radiation Vasculopathy, Farheen Niazi

Pakistan Journal of Neurological Sciences (PJNS)

Stroke like migraine attacks after radiotherapy (SMART) syndrome is a phenomenon of reversible neurologic dysfunction which occurs rarely years after radiotherapy for brain tumors. We present a 35years old patient who had new onset neurological dysfunction with fits twice in between a symptom free interval of one year. He had radiotherapy for grade 1 astrocytoma about 27 years ago. Tumor recurrence or growth was ruled out both times by neuroimaging. Alternate diagnosis like meningoencephalitis were also ruled out by appropriate workup. Patient was managed on antiepileptics and antiplatelets. Radiation induced vasculopathy was an important differential. The mechanism of both SMART …

Three Siblings With Charcot-Marie-Tooth Disease With No Other Family History, Prem Chand, Pooja Manglani, Faiq Amin, Fazal Manzoor Arain

Pakistan Journal of Neurological Sciences (PJNS)

Charcot-Marie-Tooth (CMT) disease is one of the most common inherited disorders of the peripheral nervous system. Patients diagnosed with CMT disease have axonal degeneration which results in muscle wasting, sensory loss and weakness. These patients have a very characteristic walking gait and shape of hands, along with other changes. Despite many common visible changes, no singular common genetic mutation for this disease or its cure has been identified. Therefore more case series for this disease needs to be identified so that future studies increase our knowledge about this disease. Here, we present a case series of 3 out of 4 …

Neuromyelitis Optica (Nmo); A Case Report, Saad Waheed, Jawad Hussian, Yasir Saood, Aqsa Shehzadi

Pakistan Journal of Neurological Sciences (PJNS)

Devic’s disease or syndrome also known as Neuromyelitis optica (NMO) which is a demyelinating central nervous system (immune-mediated) ailment that predominantly targets the optic nerves and spinal cord. NMO-IgG seropositivity & longitudinally extensive spinal-cord lesions typically represents the Devic’s disease & differentiates it from Multiple Sclerosis (MS).Treatment for NMO is based upon its presentation such as for acute phase(steroids, IVIG etc), prevention of relapse (steroid sparing immunosuppression etc) and symptom based therapy (e.g spasticity etc). Here, we present a case of NMO in a young female (26 years old), married patient who presented to us with total vision loss, urinary …

Cerebral Venous Thrombosis At High Altitude, Maryam J Syed, Wasim Alamgir, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Cerebral Venous Thrombosis (CVT) is one of the rarest causes of stroke. It is described as complete or partial occlusion of the sinuses or cortical veins of the brain. A relationship between high altitude (HA) and cerebral venous thrombosis has been long suspected due to various case reports and studies, however, the exact underlying mechanisms and etiologies are highly complex and debatable. In this article review we discuss the incidence etiologies, risk factors, clinical presentations and management of CVT at high altitude. CVT majorly affects young people [2]. It presents with a wide variety of clinical presentations due to the …

Procarbazine, Ccnu And Vincristine (Pcv) Versus Temozolomide Chemotherapy For Patients With Low-Grade Glioma: A Systematic Review., Karim Hafazalla, Arjun Sahgal, Blessing Jaja, James R Perry, Sunit Das

Student Papers, Posters & Projects

Low-grade gliomas (LGG) encompass a heterogeneous group of tumors that are clinically, histologically and molecularly diverse. Treatment decisions for patients with LGG are directed toward improving upon the natural history while limiting treatment-associated toxiceffects. Recent evidence has documented a utility for adjuvant chemotherapy with procarbazine, CCNU (lomustine), and vincristine (PCV) or temozolomide (TMZ). We sought to determine the comparative utility of PCV and TMZ for patients with LGG, particularly in context of molecular subtype. A literature search of PubMed was conducted to identify studies reporting patient response to PCV, TMZ, or a combination of chemotherapy and radiation therapy (RT). Eligibility …

Distinct Neuropsychological Profile And Associated Neurochemical Changes In Individuals With Mitochondrial Encephalomyopathy, Lactic Acidosis, And Stroke-Like Episodes (Melas), Emily B. Leaffer

Dissertations, Theses, and Capstone Projects

Background: Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like Episodes (MELAS) is a maternally inherited progressive multisystemic disorder. Occurrence of seizure and/or stroke-like episode, as well as classic biomarkers (i.e., cerebral lactic acidosis, depleted N-acetylaspartate (NAA)), have been linked to neuropsychological deficit and trigger the developmental cascade of neurodegeneration affecting posterior prior to anterior brain regions. While a pattern of global deterioration has been reported, systematic examination in a large MELAS cohort has not been conducted.

Objective: First, we examined verbal and visual memory function and its relationship to brain metabolites (lactate, NAA) in individuals with MELAS. Second, we hypothesized that MELAS …