Brainstem tuberculoma as a manifestation of paradoxical reaction in a patient with tuberculous meningitis.

Tuberculosis commonly involves the CNS, During drug treatment of CNS tuberculosis paradoxical response (PR) may occasionally occur. The term “paradoxicalresponse”refers to the development of previously nonexistent tuberculosis lesions or worsening of preexisting lesions during antituberculosis treatment( ATT). Etiology is still not clear but delayed type hypersensitivity and alteration in immune system is thought to be a cause. Continued treatment improves PR without severe sequelae. We report a 41 year-old female patient with tuberculous meningitis(TBM) who developed brainstem tuberculomaduring the course of ATT, after about 9 months of treatment as a paradoxical response to ATT. Early identification, continuation of ATT with steroids and ventriculoperitoneal shunting to relieve raised intracranial pressure resulted in complete recovery of our patient. Clinicians should be aware of this phenomenon as it can lead to clinical worsening as late as 9 months. The objective of this case report is to increase knowledge of clinicians about this phenomenon and also to report its such late occurrence

Association of supine hypertension in patients with Parkinson’s disease

Parkinson’s disease is a neurodegenerative disease affecting older age populations. There is variable evidence of its relationship with hypertension. To date most of the studies have targeted orthostatic hypotension, however, rare data regarding supine hypertension has been witnessed so far. This study aimed at determining the association of supine hypertension with Parkinson’s disease

In-hospital outcome in patients with spontaneous intracerebral hemorrhage (ich)

Spontaneous intracerebral hemorrhage (ICH) is associated with a high in-hospital mortality and morbidity. One radiological parameter which was found significant in predicting mortality was the presence of hydrocephalus on CT brain (plain). The aim of this study was to determine the frequency of hydrocephalus in patients with spontaneous ICH and to determine the in-hospital outcome in patients of spontaneous ICH with hydrocephalus.MATERIALS AND METHODS: This was a descriptive case series carried out in Department of Neurology, Pakistan institute of Medical Sciences, Islamabad from December 30, 2013 to June 29, 2014. All patients who meet the inclusion criteria were selected for the study. Plain CT brain was done at the time of admission. Radiological parameters recorded included the presence of hydrocephalus on CT brain. Every patient was then being observed for outcome within 7 days. RESULTS: A total of 96 patients were included in the study. The mean age of patients was 45.1 years with standard deviation of 15.641 years. Out of 96 patients, 52 (54.17%) patients were male and 44 (45.83%) patients were female. 51 (53.12%) patients of intra-cerebral hemorrhage had hydrocephalus. Out of 51 patients of intra-cerebral hemorrhage with hydrocephalus, 33 (64.7%) patients had survived while 18 (35.3%) patients had died.CONCLUSION: In our study, significant number of patients of intracerebral hemorrhage had hydrocephalus and it is associated with high mortality and morbidit

An unusual presentation of gbs: case report and literature review

Guillain-Barre syndrome (GBS), also known as Landry paralysis is an acute idiopathic polyneuritis, believed to be immunologically mediated. It usually presents as a demyelinating neuropathy with ascending weakness, however, many clinical variants have been well documented in the medical literature, and variants involving the cranial nerves or pure motor involvement with axonal injury have also been described. We report a case of a 50 year old patient who initially presented to the ER with hemiparesis and cranial nerve palsies simulating a cerebrovascular event. Based on neurological examination, CSF analysis and needle EMG finding a diagnosis of GBS was made

Frequency of non-motor symptoms in parkinson disease: experience from Pakistan

The objective of this study was to determine the frequency of non-motor symptoms (NMS) in patients with Parkinson\u27s disease (PD) and to compare frequency in mild and severe disease. Materials and methods: This descriptive observational study was done from January 2015 to June 2015 at Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad. We used Non-Motor Symptom Questionnaire (NMS-Q); a validated scale using 30 questions related to 9 different domains of symptoms. Results: 62 patients were enrolled in the final data set of study (male 46, Female 16) with average age of 62.4 years (range=33-80). Non-motor symptoms were reported very commonly in all stages of PD including urinary urgency (74%), dizziness (71%), memory problems (71%), sexual difficulty (69%), constipation (67%) and depression (62%). Only non-motor symptom that was statistically significantly higher in the severe stages was “reported falls” (Mild 39%, severe 61%, p \u3c 0.01). Some were more common (lightheadedness, falls, sexual difficulty) while others were less (hyposmia). Conclusion: Non-motor symptoms are very common in Pakistani population of PD and are seen equally in mild and severe PD with exception of “reported falls”. The high prevalence of non-motor symptoms (especially in mild stages) should be kept in mind while managing PD. Furthermore, there may be the likely need for a culturally appropriate screening scale for our population

Neuroradiological manifestations of tuberculous meningitis

Tuberculous meningitis (TBM) represents the most severe form of extra pulmonarytuberculosis (1).The early and exact diagnosis of TBM is important but difficult due to time consuming definitive microbiological procedures (2).Neuroimaging is an important initial investigation in tuberculous meningitis(3).This study was conducted to evaluate the neuroradiological findings in patients with tuberculous meningitis, as a useful modality for itsearly diagnoses and prompt treatment

Multiple sclerosis in Pakistan and need for Multiple sclerosis registry

Multiple sclerosis(MS) is an acquired chronic demyelinating disease of central nervous system is a leading cause of non-traumatic disability in young with significant socioeconomic impact. The aim of this study was to provide a comprehensive review of all available data of MS in Pakistan

Association of serum albumin levels and guillain barre syndrome (gbs) outcome.

Guillain-Barre syndrome (GBS) is a polyradiculoneuropathy characterized by a rapidly progressive bilateral paresis of the limbs. Nadir is typically reached within a number of days or weeks, followed by a recovery that is generally much slower and often incomplete. Guillain-Barre syndrome is usually preceded by infection or other immune stimulation that induces an aberrant autoimmune response targeting peripheral nerves and their spinal roots.IVIG and Plasmapheresis are used first line treatments in GBS treatment. For better assessment of treatment response, biomarkers reflecting Plasmapheresis and IVIG efficacy are needed. Aim of this study is to determine serum albumin as an independent biomarker for clinical outcome in plasmapheresis treated-GBS patients

Role of neuroradiology in predicting outome in spontaneous intracerebral hemorrhage

Spontaneous intracerebral hemorrhage (ICH) accounts for 8-13% of all strokes and is associated with a high mortality and morbidity. Western studies have identified various clinical and radiological factors which help in predicting outcome in patients with spontaneous ICH. Materials and methods: A consecutive series of 100 patients diagnosed with spontaneous ICH admitted to the neurology department were enrolled from 1stJanuary to 30th June, 2014.Radiological parameters on CT brain (plain) were recorded. In-hospital outcome was measured at the end of 7 days of hospital stay in terms of survival or mortality. Different radiological parameters and their effect on outcome were compared by using Chi square test. Multivariate logistic regression analysis was performed to find independent predictors of mortality with a “p” value of \u3c 0.05 indicating statistical significance. Results: The mean age was 47.95 years with SD ± 1.560, with a male preponderance (56%). Of the total cohort, 34% patients expired and 66% survived at the end of 1 week. On univariate analysis age, gender and ICH location had p value \u3e0.05 whereas hematoma volume, presence of IV extension, midline shift and hydrocephalus had p value \u3c0.05. On multivariate logistic regression analysis only higher baseline hematoma volume was an independent predictor of mortality (p=0.00). Among 66 survivors, 44% had moderately severe to severe disability with mRS 4 and 5 at the time of discharge. Conclusion-Intracerebral hemorrhage is associated with high in-hospital mortality and long-term severe disability. Larger baseline hematoma volume was an independent predictor of mortality in this study

Serum calcium and magnesium abnormalities in patients with status epilepticus: a single centre tertiary care experience

Electrolyte imbalances frequently cause seizures, and these seizures may be the sole presenting symptom. Seizures are especially common in patients with sodium disorders, hypocalcemia, and hypomagnesemia. Successful management of patient seizures begins with the establishment of an accurate diagnosis of the underlying electrolyte disturbance, because rapid identification and correction of the disturbance is necessary to control seizures and prevent permanent brain damage. Objectives: To delineate the percentage of people with status epilepticus having calcium and magnesium deficiencies at admission. Methods: The study was carried out from April 2013 to October 2013 at Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. Seventy patients diagnosed with status epilepticus were enrolled in the study and frequencies of serum calcium & magnesium abnormalities were measured and compared. Results: Calcium level was low in 29 (41.4%) patients. Magnesium level was low only in 7 (10%) patients. Both calcium & magnesium levels were low in 7 (10%) patients. Among the known epileptics, 16 (76.1%) were on regular antiepileptic treatment. Among those on antiepileptic drugs, 8 (50%) had low calcium levels while 6 (37.5%) had low magnesium levels. Conclusion: Serum calcium level was lower in nearly half while magnesium in nearly 2/5th of the previously diagnosed epileptics who presented in status. Among those on antiepileptic drugs, 50% had low calcium levels while 37.5% had low magnesium levels. It is suggested that all epileptic patients, especially those on long term AEDs, should at least be worked up once in detail for electrolyte abnormalities as timely identification and correction can help reduce the morbidity and mortality associated with future status epilepticus