Pub Date : 2023-05-28DOI: 10.56310/pjns.v18i01.236
S. Mansoor
This article explores the use of multiphase CT angiography (CTA) as a valuable tool in acute stroke management. Unlike traditional imaging methods, multiphase CTA provides a more comprehensive view of the neurovascular system and can detect occlusions and aid in treatment decision-making. Recent studies have shown that multiphase CTA has high accuracy in identifying patients who are suitable for endovascular treatment. Furthermore, it has also been used to visualize intracranial aneurysms and track the development of collateral circulation during and after treatment. Despite concerns regarding radiation exposure and image interpretation, multiphase CTA remains an essential imaging modality in the management of acute stroke patients.
{"title":"Application of Multiphase CT Angiography in Acute Ischemic Stroke","authors":"S. Mansoor","doi":"10.56310/pjns.v18i01.236","DOIUrl":"https://doi.org/10.56310/pjns.v18i01.236","url":null,"abstract":"This article explores the use of multiphase CT angiography (CTA) as a valuable tool in acute stroke management. Unlike traditional imaging methods, multiphase CTA provides a more comprehensive view of the neurovascular system and can detect occlusions and aid in treatment decision-making. Recent studies have shown that multiphase CTA has high accuracy in identifying patients who are suitable for endovascular treatment. Furthermore, it has also been used to visualize intracranial aneurysms and track the development of collateral circulation during and after treatment. Despite concerns regarding radiation exposure and image interpretation, multiphase CTA remains an essential imaging modality in the management of acute stroke patients. \u0000 ","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74995892","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}
Pub Date : 2023-05-28DOI: 10.56310/pjns.v18i01.253
Bushra Khalid, Zaid Waqar, Soban Khan, Ijaz Ali, M. Tariq, Anum Irfan, W. Malik, S. Naik, M. Adil, H. Abbasi
Background and Objective: Guillain-Barré syndrome (GBS) is an immune system-mediated polyradiculoneuropathy that accounts for approximately 100,000 new patients per year globally. GBS has also been linked to respiratory failure in 20% to 40% of cases. The objective of this study was to find an association between Erasmus GBS respiratory insufficiency score (EGRIS) and the need for mechanical ventilation. Methods: We conducted our cross-sectional study at department of Neurology, Pakistan Institute of Medical Sciences from November 2019 to February 2020. Sixty patients were selected for this study. Data including demographic profile, variant of GBS, and EGRIS was calculated from all the study participants. Data was entered and analyzed using SPSS version 25. Results: All 60 patients enrolled in the study underwent continuous monitoring during admission time. Out of 60 patients, three (5%) endured mechanical ventilation with a mean EGRIS of 4.5. Others who didn't need mechanical ventilation had mean EGRIS of 1.5. The three patients requiring mechanical ventilation were one each from Acute Inflammatory Demyelinating polyradiculoneuropathy, Acute Motor Axonal Neuropathy, and Acute Motor and Sensory Axonal Neuropathy variants of GBS. p-value was non-significant for the presented data. Conclusion: EGRIS could not meet statistical significance in identifying the requirement of mechanical ventilation for GBS in this study. This may be due to low sample size.
{"title":"Exploring the relationship between EGRIS score and the need for mechanical ventilation in Guillain Barre syndrome","authors":"Bushra Khalid, Zaid Waqar, Soban Khan, Ijaz Ali, M. Tariq, Anum Irfan, W. Malik, S. Naik, M. Adil, H. Abbasi","doi":"10.56310/pjns.v18i01.253","DOIUrl":"https://doi.org/10.56310/pjns.v18i01.253","url":null,"abstract":"Background and Objective: \u0000 Guillain-Barré syndrome (GBS) is an immune system-mediated polyradiculoneuropathy that accounts for approximately 100,000 new patients per year globally. GBS has also been linked to respiratory failure in 20% to 40% of cases. The objective of this study was to find an association between Erasmus GBS respiratory insufficiency score (EGRIS) and the need for mechanical ventilation. \u0000Methods: \u0000 We conducted our cross-sectional study at department of Neurology, Pakistan Institute of Medical Sciences from November 2019 to February 2020. Sixty patients were selected for this study. Data including demographic profile, variant of GBS, and EGRIS was calculated from all the study participants. Data was entered and analyzed using SPSS version 25. \u0000Results: \u0000 All 60 patients enrolled in the study underwent continuous monitoring during admission time. Out of 60 patients, three (5%) endured mechanical ventilation with a mean EGRIS of 4.5. Others who didn't need mechanical ventilation had mean EGRIS of 1.5. The three patients requiring mechanical ventilation were one each from Acute Inflammatory Demyelinating polyradiculoneuropathy, Acute Motor Axonal Neuropathy, and Acute Motor and Sensory Axonal Neuropathy variants of GBS. p-value was non-significant for the presented data. \u0000Conclusion: \u0000EGRIS could not meet statistical significance in identifying the requirement of mechanical ventilation for GBS in this study. This may be due to low sample size.","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"398 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76625951","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}
Pub Date : 2023-05-28DOI: 10.56310/pjns.v18i01.231
Shumaila Rafique, Muhammad Asif Ibrahim, Natasha Ghani, Muhammad Athar Khalily, Syed Zubair Shah, Tipu Sultan
Background and Objective: Duchenne Muscular Dystrophy is caused by mutations in dystrophin gene that include deletion, duplication and small mutations. Introduction to newer drug therapies in DMD is based on the type of mutation. The objective of this study was to assess distribution and percentage of different mutations among DMD patients. Methods: This retrospective cross-sectional study was conducted in Pediatric Neurology department of UCHS & Children Hospital Lahore. All the cases of Duchenne Muscular Dystrophy confirmed through genetic analysis from January 2022 to June 2022 through MLPA method were enrolled in the study. Data was recorded on detailed history and physical examination of the subjects and all lab investigations along with genetic study was reviewed to collect the data on given Performa. All the collected data was saved for final analysis. Results: Total 60 patients were enrolled in the study. The most common mutation was deletion, detected in 32 (56%) cases, duplication was detected in 10 (17.5%) cases and genetic study of 15 (26.5 ) patients was turned out to be normal. The most common deletion was found to be at 45-52 (43%) exons. Conclusion: The most common mutation among genetically confirmed cases of DMD was found to be deletion at 45-52 exons. This mutational evaluation is the first step toward trial of new medicines while treating DMD, as mechanism of action of new drugs is based on the type of mutation.
{"title":"Mutational analysis among patients with Duchenne muscular dystrophy","authors":"Shumaila Rafique, Muhammad Asif Ibrahim, Natasha Ghani, Muhammad Athar Khalily, Syed Zubair Shah, Tipu Sultan","doi":"10.56310/pjns.v18i01.231","DOIUrl":"https://doi.org/10.56310/pjns.v18i01.231","url":null,"abstract":"Background and Objective: \u0000Duchenne Muscular Dystrophy is caused by mutations in dystrophin gene that include deletion, duplication and small mutations. Introduction to newer drug therapies in DMD is based on the type of mutation. The objective of this study was to assess distribution and percentage of different mutations among DMD patients. \u0000Methods: \u0000This retrospective cross-sectional study was conducted in Pediatric Neurology department of UCHS & Children Hospital Lahore. All the cases of Duchenne Muscular Dystrophy confirmed through genetic analysis from January 2022 to June 2022 through MLPA method were enrolled in the study. Data was recorded on detailed history and physical examination of the subjects and all lab investigations along with genetic study was reviewed to collect the data on given Performa. All the collected data was saved for final analysis. \u0000Results: \u0000Total 60 patients were enrolled in the study. The most common mutation was deletion, detected in 32 (56%) cases, duplication was detected in 10 (17.5%) cases and genetic study of 15 (26.5 ) patients was turned out to be normal. The most common deletion was found to be at 45-52 (43%) exons. \u0000Conclusion: \u0000 The most common mutation among genetically confirmed cases of DMD was found to be deletion at 45-52 exons. This mutational evaluation is the first step toward trial of new medicines while treating DMD, as mechanism of action of new drugs is based on the type of mutation.","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"69 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79929096","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}
Pub Date : 2023-05-28DOI: 10.56310/pjns.v18i01.219
Maryum Khadim, Safia Bano, Ahsan Numan
Background and Objective: Sciatic nerve injury (SNI) is the second most common neuropathy of the lower extremities. The objective of this study was to find out the clinical spectrum and risk factors of SNI and to evaluate correlation between electrophysiological and clinical severity. Methods: In this cross-sectional study, 85 consecutive patients clinically diagnosed with sciatic neuropathy in the months of July 2022 to Dec 2022 who presented in department of Neurology, King Edward Medical University were examined electrophysiologically. Patients with polyneuropathy, plexopathy, radiaculopathy were excluded from the study. NCS & EMG were performed by conventional methods. Findings were noted in the predesigned pro forma along with history & demographic variables. Results: Out of total of 85 patients, 80% were males and 20% were females. Forty-three patients presented with traumatic injuries (49.4%), 34 patients had injection-induced nerve injury in gluteal region (40%), and remaining eight presented with history of hip surgeries (9.4%). Electrodiagnostic studies (EDX) revealed axonal damage in all the injuries. Peroneal division was predominantly involved in 55% of patients, and 26.6% had equal involvement of both the components. Common clinical presentations were sensory loss and foot drop. There was a moderate positive correlation between EDX and clinical severity (R = 0.65) Conclusion: SNI is not an uncommon in our setup and often remains under-reported. Common etiology of SNI was improper intramuscular injection in our study and pattern of injury was axonal in nature.
{"title":"Clinical spectrum, risk factors & electrophysiological evaluation of sciatic nerve injury in patients presenting to a tertiary care hospital","authors":"Maryum Khadim, Safia Bano, Ahsan Numan","doi":"10.56310/pjns.v18i01.219","DOIUrl":"https://doi.org/10.56310/pjns.v18i01.219","url":null,"abstract":"Background and Objective: \u0000Sciatic nerve injury (SNI) is the second most common neuropathy of the lower extremities. The objective of this study was to find out the clinical spectrum and risk factors of SNI and to evaluate correlation between electrophysiological and clinical severity. \u0000Methods: \u0000In this cross-sectional study, 85 consecutive patients clinically diagnosed with sciatic neuropathy in the months of July 2022 to Dec 2022 who presented in department of Neurology, King Edward Medical University were examined electrophysiologically. Patients with polyneuropathy, plexopathy, radiaculopathy were excluded from the study. NCS & EMG were performed by conventional methods. Findings were noted in the predesigned pro forma along with history & demographic variables. \u0000Results: \u0000Out of total of 85 patients, 80% were males and 20% were females. Forty-three patients presented with traumatic injuries (49.4%), 34 patients had injection-induced nerve injury in gluteal region (40%), and remaining eight presented with history of hip surgeries (9.4%). Electrodiagnostic studies (EDX) revealed axonal damage in all the injuries. Peroneal division was predominantly involved in 55% of patients, and 26.6% had equal involvement of both the components. Common clinical presentations were sensory loss and foot drop. There was a moderate positive correlation between EDX and clinical severity (R = 0.65) \u0000Conclusion: \u0000SNI is not an uncommon in our setup and often remains under-reported. Common etiology of SNI was improper intramuscular injection in our study and pattern of injury was axonal in nature.","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"111 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80617545","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}
Pub Date : 2023-02-19DOI: 10.56310/pjns.v17i04.220
Anjum Farooq, Muhammad Essa, Nimra Shafique, Sakina Gull
Background and objective: Intravenous thrombolysis (IVT) with alteplase tPA (tissue plasminogen Activator) is the FDA approved treatment for acute ischemic stroke. The objective of this study was to determine the hurdles of intravenous thrombolysis in acute ischemic stroke in Balochistan. Methods: A prospective cross-sectional observational study was carried out from June 2021 to December 2021 at Neurology department of Bolan Medical Complex Hospital Quetta on 272 patients of acute ischemic stroke who fulfilled the criteria. Proforma was filled by relative or patient after informed consent. Proforma included sex, age, diagnosis, time of presentation after stroke and reason of delay. Data was collected, tabulated, and statistically analyzed using an IBM Statistical Package for the Social Sciences (SPSS), version 20. Results: Out of 272 patients, 156 patients were male and 116 patients were female. Only two patients presented within 4.5 hours of onset of acute ischemic stroke, 27 patients within 13- 24 hours,44 patients within 25-72 hours and 171 patients beyond three days. Two-hundred patients first took advice from faith healer (peer), 50 patients from general practitioner and 22 patients preferred neurologist. Conclusion: Very few patients presented within Alteplase window. Major reason of delay was contacting faith healer first. There is necessity of awareness campaigns to overcome this hurdle and to minimize barriers for improving access to thrombolysis and specialized stroke care in Balochistan.
背景和目的:静脉溶栓(IVT)与阿替普酶tPA(组织纤溶酶原激活剂)是FDA批准的治疗急性缺血性卒中。本研究的目的是确定在俾路支省急性缺血性中风静脉溶栓的障碍。方法:于2021年6月至2021年12月在奎达博兰综合医院神经内科对272例符合标准的急性缺血性脑卒中患者进行前瞻性横断面观察研究。表格由家属或患者在知情同意后填写。形式资料包括性别、年龄、诊断、中风后出现的时间和延迟的原因。使用IBM Statistical Package for the Social Sciences (SPSS)， version 20收集、制表和统计分析数据。结果:272例患者中，男性156例，女性116例。4.5 h内出现急性缺血性脑卒中2例，13 ~ 24 h内出现27例，25 ~ 72 h内出现44例，3天以上出现171例。200名患者首先从信仰治疗师(同伴)那里得到建议，50名患者从全科医生那里得到建议，22名患者更喜欢神经科医生。结论:极少患者出现在阿替普酶窗期。延误的主要原因是先联系了信仰治疗师。有必要开展提高认识运动，以克服这一障碍，并尽量减少在俾路支省改善获得溶栓和专门中风护理的障碍。
{"title":"Hurdles of intravenous thrombolysis in acute ischemic stroke at Balochistan","authors":"Anjum Farooq, Muhammad Essa, Nimra Shafique, Sakina Gull","doi":"10.56310/pjns.v17i04.220","DOIUrl":"https://doi.org/10.56310/pjns.v17i04.220","url":null,"abstract":"Background and objective: \u0000Intravenous thrombolysis (IVT) with alteplase tPA (tissue plasminogen Activator) is the FDA approved treatment for acute ischemic stroke. The objective of this study was to determine the hurdles of intravenous thrombolysis in acute ischemic stroke in Balochistan. \u0000Methods: \u0000A prospective cross-sectional observational study was carried out from June 2021 to December 2021 at Neurology department of Bolan Medical Complex Hospital Quetta on 272 patients of acute ischemic stroke who fulfilled the criteria. Proforma was filled by relative or patient after informed consent. Proforma included sex, age, diagnosis, time of presentation after stroke and reason of delay. Data was collected, tabulated, and statistically analyzed using an IBM Statistical Package for the Social Sciences (SPSS), version 20. \u0000Results: \u0000Out of 272 patients, 156 patients were male and 116 patients were female. Only two patients presented within 4.5 hours of onset of acute ischemic stroke, 27 patients within 13- 24 hours,44 patients within 25-72 hours and 171 patients beyond three days. Two-hundred patients first took advice from faith healer (peer), 50 patients from general practitioner and 22 patients preferred neurologist. \u0000Conclusion: \u0000 Very few patients presented within Alteplase window. Major reason of delay was contacting faith healer first. There is necessity of awareness campaigns to overcome this hurdle and to minimize barriers for improving access to thrombolysis and specialized stroke care in Balochistan.","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"172 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87121366","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}
Pub Date : 2023-02-19DOI: 10.56310/pjns.v17i04.216
Rizwana shahid
Background and objective:Ischemic stroke still poses a significant health concern throughout the world. However, low and middle-incomecountries (LMIC) in Asia have more devastating outcome. The vascular risk factors are prevalent in most parts of Asia, contributing to increasing incidence. The recommended approved treatment for acute stroke is limited to a few areas in these countries. We aimed to identify stroke risk factors, its incidence and prevalence; treatment opportunities offered in various parts of the region and utilizing the alternate pathways to improve the disease recognition and management outcome.Method:A comprehensive search using PubMed, MEDLINE, Medline Plus, PubMed Central and Pak Medinet, including the various key words was performed.Results:Two-hundred-fifty-five articles of potential interest were found through the initial search. The studies were analyzed in detail in order to obtain relevant information according to the objectives of the review. Most of the literature was regarding the stroke risk factors. Only few articles regarding the current status of stroke services and management options in LMIC were available.Conclusion:Some of the factors identified in previous studies preventing the utilization of recent advancement in the diagnosis and management of stroke in LMIC, including Pakistan, were lack of awareness of stroke symptoms among general population and physicians, poor knowledge of management options, unavailability of trained stroke neurologists, poor infrastructure, cost effectiveness and patients’ trust more on homeopathic physicians, quacks and spiritual healers instead of medical doctors. Stroke is still managed conservatively in most part of these countries. There is strong need of alternate means to overcome these shortcomings in managing this highly morbid condition. As only few studies specifying the prevalence and management outcome in LMIC including Pakistan are available, a strong database is needed to quantify the real burden.
{"title":"The sub-standardized approach to stroke management in low and middle-income countries including Pakistan: limitations and suggested options to overcome some of the shortcomings via teleneurology/telestroke application","authors":"Rizwana shahid","doi":"10.56310/pjns.v17i04.216","DOIUrl":"https://doi.org/10.56310/pjns.v17i04.216","url":null,"abstract":"Background and objective:Ischemic stroke still poses a significant health concern throughout the world. However, low and middle-incomecountries (LMIC) in Asia have more devastating outcome. The vascular risk factors are prevalent in most parts of Asia, contributing to increasing incidence. The recommended approved treatment for acute stroke is limited to a few areas in these countries. We aimed to identify stroke risk factors, its incidence and prevalence; treatment opportunities offered in various parts of the region and utilizing the alternate pathways to improve the disease recognition and management outcome.Method:A comprehensive search using PubMed, MEDLINE, Medline Plus, PubMed Central and Pak Medinet, including the various key words was performed.Results:Two-hundred-fifty-five articles of potential interest were found through the initial search. The studies were analyzed in detail in order to obtain relevant information according to the objectives of the review. Most of the literature was regarding the stroke risk factors. Only few articles regarding the current status of stroke services and management options in LMIC were available.Conclusion:Some of the factors identified in previous studies preventing the utilization of recent advancement in the diagnosis and management of stroke in LMIC, including Pakistan, were lack of awareness of stroke symptoms among general population and physicians, poor knowledge of management options, unavailability of trained stroke neurologists, poor infrastructure, cost effectiveness and patients’ trust more on homeopathic physicians, quacks and spiritual healers instead of medical doctors. Stroke is still managed conservatively in most part of these countries. There is strong need of alternate means to overcome these shortcomings in managing this highly morbid condition. As only few studies specifying the prevalence and management outcome in LMIC including Pakistan are available, a strong database is needed to quantify the real burden.","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75030827","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}
Pub Date : 2023-02-16DOI: 10.56310/pjns.v17i04.223
Wajid Jawaid
{"title":"Multiple sclerosis and Parkinson’s disease: poles apart or cut from the same cloth?","authors":"Wajid Jawaid","doi":"10.56310/pjns.v17i04.223","DOIUrl":"https://doi.org/10.56310/pjns.v17i04.223","url":null,"abstract":"","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74292696","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}
Pub Date : 2023-02-16DOI: 10.56310/pjns.v17i04.210
Anum Irfan, Soban Khan, Zaid Waqar, S. Nabi, Bushra Khalid, Muhammad Tariq
Background and Objective: Cerebral venous thrombosis (CVT) is a common cause of cerebrovascular accident (stroke). CVT is caused due to blockage in blood flow either in cerebral veins or in dural sinuses. The objective of this study was to determine prevalence of various clinical and imaging characteristics in patients with cerebral venous thrombosis. Methods: A descriptive retrospective cross-sectional patient data was collected from November 2019 to February 2021. This study was conducted in Neurology Department in Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. This study contains patient medical histories of 60 patients who were admitted in two and a half year time. Monitoring for any seizure occurrence was carried out for all the patients included in this study. Patient medical histories were examined and CT, MRI and MRV Brain were performed. Results: Superior sagittal sinus was spotted as a hot spot location for CVT. Mean age calculated was 30 while more frequency was recorded in female patients. Conclusion: CVT is a condition with more prevalence in younger population with more affected females than males. Most common presentation of CVT is headache. Superior sagittal sinuses involved in majority of cases reported. Specificity of modalities used and neurological manifestations needs a validation through a larger cohort study.
{"title":"Neurological manifestations of cerebral venous thrombosis: experience from a tertiary care center","authors":"Anum Irfan, Soban Khan, Zaid Waqar, S. Nabi, Bushra Khalid, Muhammad Tariq","doi":"10.56310/pjns.v17i04.210","DOIUrl":"https://doi.org/10.56310/pjns.v17i04.210","url":null,"abstract":"Background and Objective: \u0000Cerebral venous thrombosis (CVT) is a common cause of cerebrovascular accident (stroke). CVT is caused due to blockage in blood flow either in cerebral veins or in dural sinuses. The objective of this study was to determine prevalence of various clinical and imaging characteristics in patients with cerebral venous thrombosis. \u0000Methods: \u0000 A descriptive retrospective cross-sectional patient data was collected from November 2019 to February 2021. This study was conducted in Neurology Department in Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. This study contains patient medical histories of 60 patients who were admitted in two and a half year time. Monitoring for any seizure occurrence was carried out for all the patients included in this study. Patient medical histories were examined and CT, MRI and MRV Brain were performed. \u0000Results: \u0000 Superior sagittal sinus was spotted as a hot spot location for CVT. Mean age calculated was 30 while more frequency was recorded in female patients. \u0000Conclusion: \u0000 CVT is a condition with more prevalence in younger population with more affected females than males. Most common presentation of CVT is headache. Superior sagittal sinuses involved in majority of cases reported. Specificity of modalities used and neurological manifestations needs a validation through a larger cohort study.","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83683667","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}
Pub Date : 2023-02-16DOI: 10.56310/pjns.v17i04.164
Sadaf Majid, Waseem Tariq Malik, Asfandyar Khan Niazi, Ehsan Ul Haq, Hina Yusuf, Raja Farhat Shoaib, Maimoona Siddiqui
Background and objective: Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke and may lead to the development of raised intracranial pressure due to edema, infarct or bleed. These patients may require decompressive hemicraniectomy to reduce the raised intracranial pressure. However, the evidence for hemicraniectomy in these patients is scanty. Our objective was to perform a retrospective chart review to describe the clinical characteristics of patients who underwent decompressive hemicraniectomy for malignant CVT and their outcomes. Methods: We retrospectively analyzed the medical records of patients with CVST who underwent decompressive hemicraniectomy between 2013 and 2020 at Shifa International Hospital. All patients with CVST diagnosed on the basis of clinical and radiographic findings were included in the study. Patients with primary or metastatic brain tumors were excluded from the study. Results: A total of 138 patients with CVST presented to our hospital. Twenty-seven (19.6) developed malignant CVST. Of these patients, 10 underwent decompressive hemicraniectomy (7.2% of total). None of the patients died and seven patients (70%) had a modified Rankin scale score of 2 or less at three months. Conclusion: Decompressive hemicraniectomy should be considered for patients presenting with malignant CVST who do not respond to medical treatment.
{"title":"Decompressive hemicraniectomy for patients with malignant cerebral venous sinus thrombosis","authors":"Sadaf Majid, Waseem Tariq Malik, Asfandyar Khan Niazi, Ehsan Ul Haq, Hina Yusuf, Raja Farhat Shoaib, Maimoona Siddiqui","doi":"10.56310/pjns.v17i04.164","DOIUrl":"https://doi.org/10.56310/pjns.v17i04.164","url":null,"abstract":"Background and objective: \u0000Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke and may lead to the development of raised intracranial pressure due to edema, infarct or bleed. These patients may require decompressive hemicraniectomy to reduce the raised intracranial pressure. However, the evidence for hemicraniectomy in these patients is scanty. Our objective was to perform a retrospective chart review to describe the clinical characteristics of patients who underwent decompressive hemicraniectomy for malignant CVT and their outcomes. \u0000Methods: \u0000We retrospectively analyzed the medical records of patients with CVST who underwent decompressive hemicraniectomy between 2013 and 2020 at Shifa International Hospital. All patients with CVST diagnosed on the basis of clinical and radiographic findings were included in the study. Patients with primary or metastatic brain tumors were excluded from the study. \u0000Results: \u0000A total of 138 patients with CVST presented to our hospital. Twenty-seven (19.6) developed malignant CVST. Of these patients, 10 underwent decompressive hemicraniectomy (7.2% of total). None of the patients died and seven patients (70%) had a modified Rankin scale score of 2 or less at three months. \u0000Conclusion: \u0000Decompressive hemicraniectomy should be considered for patients presenting with malignant CVST who do not respond to medical treatment.","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86688343","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}
Pub Date : 2023-02-16DOI: 10.56310/pjns.v17i04.211
S. Hameed, Bashir Soomro, Samar Iltaf, Abdul Malik, Anjum Farooq, Alam Ibrahim Siddiqui, Safia Awan, Mohammad Wasay
Background and objectives: There is a need to improve the understanding of Covid-19 neurological complications in a temporal manner. The objective of our study was to find out temporal relationship of neurological manifestations and outcome in Covid-19 Patients. Methods: This was a multi-center observational study from six centers in Pakistan. Data of covid patients with six months follow up was retrospectively collected from the hospital records. Time periods were divided into short-term (< 1 month), medium-term (2-3 months) and long-term (>4 months). SPSS version 26.0 (SPSS Inc., Chicago, IL, USA) was used to analyze the data. Results: Neurological manifestations were reported in 208 out of 905 covid patients. One-hundred-twenty-five (60%) developed neurological manifestations within one month, 62 (30%) developed within 2-3 months and 21 (10%) developed between 4-6 months. Most common manifestations within one month included cerebrovascular disease (59%), neuromuscular disorders (14%) and neuropsychiatric disorders (10%). Common manifestations in 2-3 months group included neuromuscular manifestations (32%), neuropsychiatric manifestations (19%), cerebrovascular diseases (14 %), myalgia or musculoskeletal pain (14%), and vertigo, hearing problems or tinnitus (14%). Common manifestations in 4-6 months group included neuromuscular disorders (33%) cerebrovascular diseases (19%), fatigue / malaise (9%) anosmia/dysgeusia (9%) and Bell’s palsy (25%). The long-term patients differed from the short-term patients by a mean younger age on presentation (44.7 vs. 59 years), female predominance (52% vs. 28%), higher asymptomatic Covid infection (29% vs. 14%), better clinical outcomes (mean mRS of 1.6 vs. 3), and low mortality (0 vs 18%). Conclusion: Neurological manifestations of covid infection may differ based on time duration since infection. Vascular complications are high in early period while neuromuscular manifestations are high in late period.
背景和目的:有必要从时间角度提高对Covid-19神经系统并发症的认识。本研究的目的是了解Covid-19患者神经学表现与转归的时间关系。方法:这是一项来自巴基斯坦六个中心的多中心观察性研究。回顾性收集医院记录中随访6个月的新冠肺炎患者资料。时间段分为短期(< 1个月)、中期(2-3个月)和长期(>4个月)。使用SPSS 26.0版本(SPSS Inc.， Chicago, IL, USA)对数据进行分析。结果:905例患者中有208例出现神经系统症状。125例(60%)在1个月内出现神经系统症状，62例(30%)在2-3个月内出现，21例(10%)在4-6个月内出现。一个月内最常见的症状包括脑血管疾病(59%)、神经肌肉疾病(14%)和神经精神疾病(10%)。2-3个月组的常见症状包括神经肌肉表现(32%)、神经精神表现(19%)、脑血管疾病(14%)、肌痛或肌肉骨骼疼痛(14%)、眩晕、听力问题或耳鸣(14%)。4-6个月组常见表现为神经肌肉疾病(33%)、脑血管疾病(19%)、疲劳/不适(9%)、嗅觉缺失/语言障碍(9%)和贝尔氏麻痹(25%)。长期患者与短期患者的差异在于平均发病年龄更年轻(44.7岁对59岁)，女性优势(52%对28%)，更高的无症状Covid感染(29%对14%)，更好的临床结果(平均mRS为1.6对3)和低死亡率(0对18%)。结论:新冠病毒感染的神经学表现可能因感染时间的不同而不同。早期以血管并发症为主，晚期以神经肌肉表现为主。
{"title":"Short, medium and long term neurological manifestations and outcome in Covid-19 Patients","authors":"S. Hameed, Bashir Soomro, Samar Iltaf, Abdul Malik, Anjum Farooq, Alam Ibrahim Siddiqui, Safia Awan, Mohammad Wasay","doi":"10.56310/pjns.v17i04.211","DOIUrl":"https://doi.org/10.56310/pjns.v17i04.211","url":null,"abstract":"Background and objectives: \u0000There is a need to improve the understanding of Covid-19 neurological complications in a temporal manner. The objective of our study was to find out temporal relationship of neurological manifestations and outcome in Covid-19 Patients. \u0000Methods: \u0000This was a multi-center observational study from six centers in Pakistan. Data of covid patients with six months follow up was retrospectively collected from the hospital records. Time periods were divided into short-term (< 1 month), medium-term (2-3 months) and long-term (>4 months). SPSS version 26.0 (SPSS Inc., Chicago, IL, USA) was used to analyze the data. \u0000Results: \u0000Neurological manifestations were reported in 208 out of 905 covid patients. One-hundred-twenty-five (60%) developed neurological manifestations within one month, 62 (30%) developed within 2-3 months and 21 (10%) developed between 4-6 months. Most common manifestations within one month included cerebrovascular disease (59%), neuromuscular disorders (14%) and neuropsychiatric disorders (10%). Common manifestations in 2-3 months group included neuromuscular manifestations (32%), neuropsychiatric manifestations (19%), cerebrovascular diseases (14 %), myalgia or musculoskeletal pain (14%), and vertigo, hearing problems or tinnitus (14%). Common manifestations in 4-6 months group included neuromuscular disorders (33%) cerebrovascular diseases (19%), fatigue / malaise (9%) anosmia/dysgeusia (9%) and Bell’s palsy (25%). The long-term patients differed from the short-term patients by a mean younger age on presentation (44.7 vs. 59 years), female predominance (52% vs. 28%), higher asymptomatic Covid infection (29% vs. 14%), better clinical outcomes (mean mRS of 1.6 vs. 3), and low mortality (0 vs 18%). \u0000Conclusion: \u0000Neurological manifestations of covid infection may differ based on time duration since infection. Vascular complications are high in early period while neuromuscular manifestations are high in late period. \u0000 ","PeriodicalId":19818,"journal":{"name":"Pakistan Journal of Neurological Sciences","volume":"62 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84903829","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}
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