Pakistan Journal of Neurological Sciences最新文献

{"title":"Catatonia in the general hospital: a case series wading through diagnostic & management challenges","authors":"Shireen Najam, Marium Mansoor, M. Hafiz, A. Shafique, Ifrah Hambal, Banafsha Gul, Tania Nadeem","doi":"10.56310/pjns.v17i03.201","DOIUrl":"https://doi.org/10.56310/pjns.v17i03.201","url":null,"abstract":"Catatonia is a cluster of affective, behavioral, and motor symptoms. Its causes are multifactorial ranging from severe and untreated psychiatric illnesses to neurological diseases and other general medical conditions. It is estimated that 20% of catatonia causes are due to medical conditions out of which two thirds are due to an underlying neurological condition which might include encephalitis, neural injury, developmental disorders, structural brain pathology, or seizures. Symptoms of catatonia can wax and wane, fluctuating between the retarded and the excited type within hours making it more difficult to identify and diagnose. If left untreated, catatonia can lead to multiple medical complications which can lead to significant long-term morbidity and mortality. The initial complications include dehydration, malnourishment, electrolyte imbalance, deep venous thrombosis, pulmonary embolism, pneumonia, urinary tract infection, and retention. In the long run, patients can have sepsis, rhabdomyolysis, DIC, decubitus ulcers, arrhythmia, renal failure, and liver dysfunction. This article  will describe  three patients (adolescent & adult) that presented to Aga Khan University Hospital (AKUH), Karachi with challenging presentations of catatonia. Their diagnostic and management difficulties will be discussed.","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83738115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MR textural features (RADIOMICS) for predicting response to treatment in patients with intracranial tuberculoma: A retrospective cross-sectional study","authors":"A. Muhammad, Shahmeer Khan, Wasay Muhammad, Azeemuddin Muhammad, A. Shoukat, Hamzullah Khan","doi":"10.56310/pjns.v17i03.176","DOIUrl":"https://doi.org/10.56310/pjns.v17i03.176","url":null,"abstract":"Background and objective: \u0000MR based radiomics can potentially response to treatment in intracranial tuberculoma, but very scarce literature is available in this regard. The purpose of this study was to determine whether MR based radiomic features can be used to predict response to antituberculosis (AT) treatment. \u0000Methods: \u0000Data of patients with intracranial tuberculomas who underwent MR imaging and AT treatment at our institution during the last 10 years was analyzed. In each case follow-up imaging performed at 6 months post initiation of treatment was reviewed to establish response to treatment. The textural analysis was performed by two consultant neuroradiologists, using open-source software (Lifex) with FLAIR coronal image after contrast administration from pretreatment MRI study radiomic analysis. \u0000Results:  \u0000Twenty-four patients with mean age 33.8 years were included in the study. Sixteen patients were in the treatment responsive group while eight patients were in the treatment resistant group. Thirty-eight radiomic parameters were extracted for each patient. There was a significant difference in three out of 38 parameters (histogram skewness, GLCM correlation and NGLDM Coarseness) in patients amongst the two groups. Logistic regression model was developed using these parameters which accurately predicted 83.3% of the cases according to the response to the AT treatment (χ2=11.517, p=0.003). ROC curve analysis was performed using histogram skewness which showed acceptable discrimination (p=0.037 and 95% CI =0.577-0.954) for predicting the response to treatment. \u0000Conclusion: \u0000MR textural parameters (histogram skewness, GLCM correlation and NGLDM Coarseness) may be used as imaging biomarkers to predict response to treatment in patients with intracranial tuberculoma.","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83298568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-NMDA Receptor Encephalitis presenting with severe episodic hypertension: a case report","authors":"T. Arshad, M. Hussain, A. Yousafzai, Arsalan Ahmad","doi":"10.56310/pjns.v17i03.202","DOIUrl":"https://doi.org/10.56310/pjns.v17i03.202","url":null,"abstract":"Anti-N-methyl-D-aspartate receptor (Anti-NMDAR) encephalitis is one of the most commonly emerging autoimmune encephalitis in children and young adults in recent years. Clinical manifestations range from prodromal symptoms to seizures, movement disorder, psychiatric manifestations, cognitive/speech impairment, and autonomic dysfunction. Our case presented with initial symptoms of severe episodic hypertension, sweating, agitation, and tachycardia. She received early care for pheochromocytoma and panic disorder in Qatar, but there was no relief. Three weeks later, she presented in our emergency room with seizures, cognitive/speech impairment, and orofacial dyskinesia. Electroencephalography EEG revealed right hemispheric delta activity and cerebrospinal fluid CSF anti-NMDA Receptor IgG was positive. Magnetic resonance imaging MRI brain and CSF studies were normal. She was treated symptomatically for hypertension and psychiatric manifestations. She received high dosage pulse intravenous methylprednisolone, followed by intravenous immunoglobulin, which significantly alleviated her cognitive, neuropsychiatric, and autonomic features. Severe Hypertension is an uncommon presentation of Anti- NMDAR encephalitis.  Early recognition and prompt management improves prognosis and long term sequelae.","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88360490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experience with anti NMDA receptor antibody encephalitis in a tertiary care hospital in Pakistan","authors":"H. Rajput, Zaid Waqar, Muhammad Hassan, Neelma Naz Khattak, Umair Hassan, Iqra Athar, Mazhar Badshah","doi":"10.56310/pjns.v17i03.189","DOIUrl":"https://doi.org/10.56310/pjns.v17i03.189","url":null,"abstract":"Background and objective: \u0000Anti NMDA receptor (Anti-NMDAR) antibody encephalitis is an increasingly recognized form of auto immune encephalitis. The objective of this study was to determine the demographic, clinical and laboratory factors associated with this syndrome.   \u0000Methods: \u0000All cases presenting to neurology, Pakistan institute of medical sciences, Islamabad, from June 2017 till January 2020 were reviewed retrospectively. Patients fulfilling the diagnostic criteria for Anti NMDA receptor (Anti-NMDAR) antibody encephalitis were included. All patients were evaluated with cerebrospinal fluid (CSF)routine examination, MRI brain, autoimmune encephalitis profile and for presence of oligoclonal bands (OCB) in CSF. Statistical analysis was done using SPSS version 23.0. \u0000Results: \u0000A total of 7 patients were diagnosed as having Anti-NMDARantibody encephalitis. Five patients were female and two were male. Four patients had some type of psychiatric disturbances upon presentation of these behavioral abnormalities and irritability were found in all four. Orofacial abnormal movements were found in four patients while one patient had myoclonic seizures. \u0000Conclusion: \u0000Anti-NMDARreceptor encephalitis is a common cause of encephalitis associated with neurological and psychiatric symptoms. Delay in diagnosis can occur due to non-specific symptoms and signs present in early stages of illness,this can lead to long term neurological disability.","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76644987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of early seizures after first acute stroke","authors":"Malik Muhammad Adil, Sumaira Nabi, Maryam Khalil, Zeeshan Munawar, Nayab Aslam, Zaid Waqar","doi":"10.56310/pjns.v17i03.196","DOIUrl":"https://doi.org/10.56310/pjns.v17i03.196","url":null,"abstract":"Background and objective: \u0000There is a lack of local data regarding the frequency and predictors of early seizures after stroke. The objective of this study was to determine the frequency of early seizures after stroke and identify the predictors which lead to them after first acute stroke. \u0000Methods: \u0000This cross-sectional observational study was conducted in the Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad from October 2021 to June 2022.  A total of 310 consecutive eligible patients of acute stroke were recruited. Key inclusion criteria included any patient of >20 years of age with confirmed diagnosis of stroke on imaging, non-traumatic, with no history of seizures in past. Data was analyzed by SPSS version 23.0. \u0000Results: \u0000The mean age of patients in the seizures group was 48.40 ± 20.9 years. Hypertension was the most common co-morbid present in 225 (76.5%) patients. Early seizures were found in 52 (16.8%) patients with 42 (80.76%) having seizures in first 24 hours of stroke (p value 0.001). On National Institute of Health Sciences Scale (NIHSS) score most patients 125 (40.3%) had moderate severity score i.e. score in between 7 to 25 (p value 0.05). Ischemic stroke was identified as the stroke variety with most of the early seizures i.e. 16 (30.76%) (p value 0.003). \u0000Conclusion: \u0000Early seizures were not infrequent after acute stroke (16.77%) in our study. Early seizures were associated with younger age, cortical region lesion, ischemic stroke, followed by cerebral venous thrombosis. Higher NIHSS score and greater disability was associated with increased incidence of early seizures. \u0000 ","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"95 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91125410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric stroke: a review","authors":"T. Sultan","doi":"10.56310/pjns.v17i03.215","DOIUrl":"https://doi.org/10.56310/pjns.v17i03.215","url":null,"abstract":"Background & Objectives: \u0000Pediatric stroke is a focal neurological deficit lasting more than 24 hours because of stenosis, occlusion or rupture of cerebral blood vessels. Variable etiological factors are involved ranging from cardiac, haematological, infectious, immune mediated to arteriopathies which is emerging as most important cause of arterial ischemic stroke in children. In this review article we will discuss paediatric stroke with its epidemiology, etiological factors in particular arteriopathies, diagnostic modalities, management protocols and outcome. \u0000Methods: \u0000We searched stroke in Pubmed and found 15315 articles, narrowed down to stroke in children (3814) and selected 45 articles for review. \u0000Review: \u0000Stroke in children is defined as a focal neurological deficit that persists for more than 24 hours and is caused by stenosis, occlusion or rupture of cerebral blood vessels. Stroke may be arterial, venous or because of occlusion of venous sinuses. Arterial strokes may be ischemic, haemorrhagic or ischemic-haemorrhagic. \u0000About half of strokes in children are of arterial ischemic strokes in contrast to adults where about 80-85% strokes are of arterial ischemic strokes. Stroke in children is comparable to brain tumors and is one of top ten common causes of death in children. \u0000Arterial ischemic stroke in children has significant risk of mortality and morbidity leading to functional disability of patient along with financial burden over family and society. In one study it was estimated that 10-25% of children with stroke die, 25% have recurrence and about 66% of children have neurological deficit after recovery from acute illness or have future epilepsy, behaviour disorder or learning disabilities. \u0000Early recognition and prompt treatment of paediatric stroke can reduce mortality, morbidity and in return can reduce both social and financial burden over society. \u0000Conclusion: \u0000In this review article we will discuss paediatric strokes, epidemiology, risk factors, differential diagnosis, investigations, management protocols, preventive measures and outcome.","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"85 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82938501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post COVID-19 vaccine Guillain Barre Syndrome","authors":"Soban Khan, M. Khalil, Zaid Waqar, Sajid Khan, Zakir Jan","doi":"10.56310/pjns.v17i02.174","DOIUrl":"https://doi.org/10.56310/pjns.v17i02.174","url":null,"abstract":"The Guillain Barre Syndrome (GBS) is an acute immune mediated progressive polyneuropathy having an acute monophasic illness leading to paralysis. The clinical features are progressive ascending symmetrical muscle weakness that may lead to respiratory failure. Diagnosis is based upon clinical presentation and is supported by a lumbar puncture with CSF analysis demonstrating albumin cytological dissociation and electrophysiological studies. Our patient presented to us with progressive ascending paralysis after receiving COVID 19 vaccine.","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77175507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Succinic semialdehyde dehydrogenase deficiency – a rare cause of metabolic stroke","authors":"A. Wasim, Javeria Alvi, T. Sultan","doi":"10.56310/pjns.v17i02.180","DOIUrl":"https://doi.org/10.56310/pjns.v17i02.180","url":null,"abstract":"Succinic semialdehyde dehydrogenase (SSADH) deficiency is a rare neurometabolic disorder characterized by defective degradation of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter of the brain. Children with SSADH deficiency present with motor mental delay, intractable seizures, infantile onset hypotonia, speech disturbances, extrapyramidal symptoms and ataxia. This wide spectrum results from increased accumulation of 4hydroxy butyric acid (4HBA) leading to down regulation of GABA receptors, which likely explain epileptogenesis but the pathophysiology of stroke in SSADH deficiency is not much elucidated. Here, we report an infant aged 11 months, product of consanguineous marriage with significant family history of motor delay and intellectual disability, presented with sudden onset focal neurological deficit preceded by diarrheal illness. Examination revealed an infant with age-appropriate milestones having left uncrossed hemiplegia along with neuroradiological evidence of right globus pallidus ischemic infarct. Urinary organic acid profile by chromatography was suggestive of 4 hydroxybutyric aciduria.","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82220712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Iranian stroke model-how to involve health policymakers","authors":"M. Farhoudi, E. Sharifipour","doi":"10.56310/pjns.v17i02.178","DOIUrl":"https://doi.org/10.56310/pjns.v17i02.178","url":null,"abstract":"Stroke in Iran, with more than 83 million population, is a leading cause of disability and mortality in adults. Stroke has higher incidence in Iran comparing the global situation and unfortunately the onset age of first ever stroke is dropping about 10 years (1). Intravenous thrombolysis, as an approved treatment in ischemic stroke, has been used only in some university or private hospitals in Iran since 2008 (2). The main limit for this therapy in Iran was the lack of coverage by health insurance companies for tPA. A project for situation analysis of stroke cases entering to Imam Reza Hospital, a tertiary university hospital in North-West of Iran, was performed in 2010 by Neurosciences Research Center and the percentage of cases referring on time and are eligible for thrombolysis, barriers, pitfalls and delay gaps in the hospital were detected (3). After analyzing and involving all the related authorities & departments of the Tabriz University of Medical Sciences University and performing a maneuver, thrombolysis in all eligible stroke cases was systematically started as pilot in the hospital since 2010. Other centers such as Firoozgar Hospital in Tehran, Ghaem Hospital in Mashhad, Namazi Hospital in Shiraz, and Alzahra Hospital in Isfahan were active in thrombolysis but non-systematically. \u0000   After the first International and the sixth National Iranian Stroke Congress-2013, a WSO endorsed meeting and report of pilot center results, a statement was distributed to offer more motivation and assistance to stroke programs by health policy makers (4). Finally by Iranian stroke association and Iranian Neurological Society follow up, Ministry of health detected stroke as a main health crisis and decided to design and run a program for improving the stroke care in Iran. National stroke committee was organized in 2014 by inviting stroke experts throughout the country. A road map and national strategy were planned to arrange stroke treatment network in Iran reflecting national needs (5). “724” hospitals (means active hospitals for stroke service every 7 days of week and 24 hours a day) were defined for those covering at least 300,000 population around it with basic requirements for acute stroke services including thrombolysis. The plan implemented in 2016 in fifty four hospitals in the early phase. The requirements, characteristics and protocols for primary and comprehensive stroke care units were defined for “724” hospitals. Meanwhile a plan for prehospital emergency system education to increase their knowledge about stroke and upgrade the system to transfer the stroke cases to “724” hospitals was activated. This new stroke plan was presented in 10th World Stroke Congress, 2016. (6). An especial national document for acute stroke treatment was published by Ministry of Health. This plan led to coverage of tPA for eligible stroke cases by insurances companies and finally the decrease of its cost. \u0000The main components of Iranian Stroke Program “724” are as","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"112 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82469011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors of intracerebral hemorrhage- a cross sectional study","authors":"Mir Jalal-ud-din, Raheel Jehangir Jadoon, Samia Wazir Khawaja, Rashid Ali, Syed Affan Ali, Ibtisam","doi":"10.56310/pjns.v17i02.142","DOIUrl":"https://doi.org/10.56310/pjns.v17i02.142","url":null,"abstract":"BACKGROUND: \u0000Stroke is the most common cause of disability and a leading cause of mortality worldwide. Though the incidence is falling in West but probably rising in Asia. The burden of stroke risk factors in Pakistan is enormous. Data on stroke incidence and prevalence from Pakistan is scarce; however, there are several reported case series in literature highlighting significant differences in terms of stroke epidemiology, risk factors and stroke subtypes/patterns. METHODS: This descriptive cross sectional study was conducted from August 2019 to February 2020, on 109 patients from medical units of DHQ Teaching Hospital Abbottabad. Diagnosis of cerebrovascular accidents was made on focal neurological deficit lasting more than 24 hours. CT scan brain was done in all patients to detect intra cerebral bleed. Detailed history and medical records were carefully scrutinized in the patients of intracerebral bleed to detect factors leading to it like uncontrolled hypertension. Fasting blood glucose, fasting serum cholesterol and fasting triglycerides were done to detect uncontrolled diabetes and hyperlipidemia. Data was collected on a structured proforma and analysed using SPSS 20. RESULTS: Majority of the patients were 39.81%(n=41) >70 years of age, 71 (68.93%) were male and 32 (31.07%) female, frequency of intracerebral bleed among patients presenting with acute cerebrovascular accidents was recorded in 8.74%(n=9), among them 66.67%(n=6) had history of uncontrolled hypertension, 44.44%(n=4) had diabetes and 33.33%(n=3) had hyperlipidemia. \u0000CONCLUSIONS: Frequency of intracerebral bleed is higher among patients presenting with cerebrovascular accidents, hypertension is recorded the most common risk factor for this complication.","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80209335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}