Primary Angiitis of The Central Nervous System Presenting As Sudden Vision Loss In A Young Patient

Primary angiitis of the central nervous system is a rare disorder that primarily affects the cerebral vessels and can prove to be a diagnostic challenge to the clinicians. It can present with a variety of clinical manifestations and lacks the evidence of any systemic disease. Digital subtraction angiography is often necessary to confirm the diagnosis of cerebral vasculitis but in cases where it may fail to do so, brain biopsy is eventually required. Obliviousness to this condition may lead to false management strategies and hence it is imperative to make an accurate diagnosis to facilitate proper treatment that mainly includes a combination of steroids and immunosuppressive agents. We report a case of a 27-year-old male with sudden bilateral vision loss who underwent extensive workup and was ultimately diagnosed with primary angiitis of the central nervous system. He was treated with steroids and responded well to it

Utility of Pudendal Nerve Electrodiagnostics in Cases of Bladder-Bowel Dysfunction- A Retrospective Study from A Tertiary Care Center in Pakistan

Background and Objective: Electrodiagnostic studies play a crucial role in identifying neurogenic and non-neurogenic causes of bladder and bowel dysfunction. Such data is scarce in Pakistan. The objective of this study was to evaluate utility of pudendal nerve assessment in bladder-bowel dysfunction. Methods: A retrospective observational study was carried out at the neurophysiology lab in Aga Khan University Hospital. Patients referred for electromyography/nerve conduction studies (EMG/NCS) for pudendal nerve assessment from June 2013 to June 2023 were included. Clinical data, EMG/NCS results, and demographic information were analyzed using SPSS. Results: Twenty patients (11 male and nine female) were included. Five patients experienced backache radiating to one or both lower extremities, along with urinary or fecal incontinence. Three patients had urinary incontinence, and additional three presented with both urinary and fecal incontinence. Three patients reported perianal numbness. Four patients had fecal incontinence, while one patient each reported painful defecation and backache along with perianal numbness. Three patients were diagnosed with pudendal neuropathy, out of which one had a coexisting lumbosacral radiculopathy as well. Five patients had isolated lumbosacral radiculopathy. Twelve patients exhibited normal EMG/NCS results. Conclusion: This study highlights the diagnostic utility of EMG/NCS in diagnosing pudendal nerve injuries. Despite its widespread use worldwide, the utilization of these tests in Pakistan is hindered by factors such as limited awareness, inadequate training, and resource constraints

Cerebral cavernous malformation presenting as seizures

Cerebral cavernous malformations (CCMs) is one of the rare vascular malformation. It is diagnosed by characteristic lesions on magnetic resonance imaging (MRI). CCMs typically appears as a “popcorn-like” masses on T2-weighted images on MRI studies.And clinically can lead to headaches, seizures,focal neurological deficits or intracerebral hemorrhages. . A familial form is suggested if lesions are multiple, and a sporadic form, if singl

A Comprehensive Electroencephalogram Audit in A Tertiary Care Center in Pakistan: Demographic Distribution, Referral Indications and Findings

Background and Objective: Electroencephalography (EEG) is a widely employed non-invasive technique for recording brain electrical activity, pivotal for diagnosing various neurological conditions. The study aims to provide insight into demographic distribution, referral indications, and EEG findings in a tertiary care hospital in Pakistan. Methods: A retrospective cross-sectional analysis was conducted involving 2,924 patients who underwent routine EEG evaluations over a three-year period. Data was collected from the EEG records after approval from the ethical review committee. Demographic variables, referral reasons, and EEG findings were recorded and analyzed using descriptive statistics. Results: The study revealed a gender distribution of 41.35 % females and 58.65 % males, aligning with broader epidemiological trends. Participants were categorized into different age groups and most of the patients in our study belonged to the five to 18 years of age group. Most common indication was a suspected seizure disorder (78.32 %), followed by subclinical seizures (7.38 %) and medication adjustment (6.81 %). Notably, encephalopathy was the most common abnormal EEG finding (31 %), with temporal epilepsies being predominant within the focal seizure category. Conclusion: The descriptive nature of the study contributes novel insights. The study’s contribution provides valuable guidance for healthcare professionals, enhancing their comprehension of neurological conditions and refining diagnostic and treatment strategies

Electrodiagnostic findings in COVID-19 patients: A single center experience

Objective: Neurological manifestations in patients with coronavirus disease 2019 (COVID-19) have been reported from early features of anosmia and dysgeusia to widespread involvement of the central nervous system, peripheral nervous system, as well as the neuromuscular junction and muscle. Our study objective is to evaluate the electromyography and nerve conduction study (EMG/NCS) findings among COVID-19 patients and look for possible correlations.Methods: This is a hospital-based retrospective observational study. All COVID-19 patients between the period of 1st January 2020 to 31st December 2020 undergoing an EMG/NCS were included.Results: Eighteen patients (12 male and 6 female) were included. Mean age was 55 ± 12 years. 11 patients required intubation for a mean period of 18.6 days (range: 3-37 days). Electrodiagnostic findings were consistent with a myopathy in a majority of these patients (82%). Five of them also had a concurrent axonal neuropathy. In the remaining patients who did not require intubation (n = 7), three patients had myopathic EMG changes and one had Guillain Barre syndrome.Conclusion: At this time, there are no neuromuscular-specific recommendations for patients who contract COVID-19. Only time and additional data will unveil the varying nature and potential neurological sequelae of COVID-19.Significance: Myopathic EMG changes are commonly seen in critically ill COVID-19 patients, especially with a prolonged hospital stay

Neurological Syndromes After Recent Covid-19 Vaccination; A Possible Association

ABSTRACT OBJECTIVE: Coronavirus disease 2019 (COVID-19) pandemic is one of the deadliest pandemics of our time. Vaccines are our best hope to put an end to this pandemic. An emergency use authorization (EUA) has been given to seven vaccines and more than 4 billion doses have been globally administered. Because of EUA, the large-scale safety trials were not conducted before their use and adverse effects were one of the chief concerns resulting in vaccine hesitancy. METHODS: This is a retrospective observational study. All the inpatients admitted to the Department of Neurology, Aga Khan University during the period from 1st April 2021 to 31st July 2021 with a recent history of COVID-19 vaccination within previous 8 weeks were included in this study. Patients with the pre-existing neurological condition were excluded. RESULTS: Eleven patients were included in the study. Most of our patients were male (82%; n=9) with a median age of 53 14.6 years. 6 of these patients received the Sinopharm vaccine and 2 received AstraZeneca. Six patients had stroke, two had cerebral venous thrombosis, and onepatient each had autonomic neuropathy, transverse myelitis, and seizures. The majority of the patients presented within 4 weeks post-vaccination. No mortality was noted. The mean discharge mRS was 1.1. Only one patient had a history of previous COVID-19 infection. CONCLUSION: Almost three-quarters (73%) of inpatients with a recent COVID-19 vaccination had a cerebrovascular disease. This may be a coincidental finding or may indicate a probable association. Our patients also had multiple risk factors in addition to a recent history of COVID-19 vaccination. The potential neurological sequelae of the COVID-19 vaccine will be unraveled as the vaccinated population increase

First report of cerebral venous thrombosis following inactivated- virus covid vaccination (Sinopharm and Sinovac)

Cerebral venous thrombosis (CVT) is an uncommon cerebrovascular disease, which has been reported with covid infection as well as covid vaccines, particularly AstraZeneca and Janssen vaccines. We present four consecutive cases of CVT after receiving either Sinopharm or Sinovac vaccine, both of which are composed of an inactivated-virus. All the patients recovered well with anticoagulation and discharged with a good functional outcome. This is the first case series reporting CVT following the administration of these vaccines