Bilateral wrist drop in a middle age man

Peripheral neuropathy is a common disorder which often causes disability.Among metals lead intoxication leads to bilateral radial neuropathy. Patients with lead neuropathy present with weakness that primarily involves the wrist and finger extensors. Lead intoxication in humans causes axonal degeneration. We report a case of middle age male who presented with bilateral wristsdrop, workup revealed that he had bilateral radial nerve neuropathy which was secondary to his occupational exposure to lead causing lead intoxication. Chronic lead exposure as a risk factor for neuropathy should be identified and treated promptly as its avoidance and treatment can save major disabilities

Cerebellar Symptoms After Dengue Fever with Bright Middle Cerebellar Peduncle Sign

Dengue fever is a seasonal epidemic that effects population all across Pakistan every monsoon season and leads to thousands of cases every year. Dengue fever can be associated with neurological complications both during the acute stage and after recovery. These include encephalitis and hemorrhagic complications as well as late immune-related conditions such as Guillain-Barre syndrome and acute disseminated encephalomyelitis. Here we present case of a patient who developed new onset cerebellar symptoms two weeks after recovery from dengue fever, with a middle cerebellar peduncle sign on MRI Brain

Post Covid-19 Vaccine Guillain Barre Syndrome

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

Cutaneous allodynia in migraine

OBJECTIVE: Objective of this study is to find out the presence and severity of cutaneous allodynia in migraine sufferers. BACKGROUND: Cutaneous allodynia is the perception of pain in response to non noxious stimuli. It occurs due to repeated stimulations that lead to sensitization and abnormal skin response. MATERIALS AND METHODS: It was a descriptive case study and conducted at Neurology department Pakistan Institute of Medical Sciences from June 2017 to May 2018. All patients of both genders above age 13 years of age with migraine diagnosed as having “Migraine without aura” or “Migraine with aura” according to the International Headache society criteria, ICHD-3 beta, were enrolled in this study. Cutaneous allodynia was evaluated by using Allodynia Symptom Checklist that consisted of 12-items. Cutaneous allodynia severity was defined according to score i.e No allodynia if score was 0-2, mild allodynia if score was 3-5, moderate allodynia if score was 6-8 and severe allodynia with a score of 9 or more

An analysis of pattern and burden of patients Referred for nerve conduction study in a Tertiary care hospital in Pakistan

Background: To analyze the trend and load of neurological diseases in a university medical center for reffered electrophysiology. Methodology: From January 2016 to December 2018, this retrospective study was carried out in department of Neurology, Pakistan Institute of Medical Sciences (PIMS) Islamabad. A total of 4527 patients were evaluated during this time period in neurophysiology lab through computerized data

Myotonic dystrophy in a Pakistani family: a case series and literature review

Myotonic dystrophy also known as (Steinert\u27s disease) is a clinically and genetically heterogeneous multisystem disorder with a prevalence of 1 in 8000 in the general population. It is inherited as an autosomal dominant trait. It is characterized by myotonia, myopathy of voluntary and involuntary muscles, frontal baldness in men, cardiac conduction abnormalities, cataracts, intellectual deterioration and endocrinopathies. Affected men may have gonadal atrophy and infertility. On the other hand women are generally fertile. We report a case series of three individuals belonging to the same family presenting with characteristic features of myotonic dystrophy. The presentation of these cases depicts that this disease can lead to disability, loss of independence and social isolation especially in the elderly. They warrant adequate work up for diagnosis which may sometimes be extensive. Proper genetic counseling of the family is required regarding nature of the disease and with risks and prognosis

Cyclic Alternating Pattern of Encephalopathy (Cape) In CNS Infection: A Case Report

Cyclic Alternating Pattern of Encephalopathy (CAPE) is rare EEG phenomenon first described in 1944 in a comatose patient. It is similar to sleep EEG pattern of cyclic alternating pattern (CAP) which is a periodic electroencephalogram activity of non-REM sleep. The cyclic alternating pattern (CAP) is defined by sequences of transient electrocortical events that are different from the tonic background and repeat at intervals of up to one minute. CAPE, however, is abnormal EEG pattern. In this pattern of EEG abnormality slow wave activity of 1-2Hz alternates with fast activity of 6-10 hertz. Here we present a case of patient with CNS infection on mechanical ventilation whose EEG showed the above-mentioned pattern

A Rare Case of X-Linked Bulbo-Spinal Muscular Atrophy with Sensory Neuropathy and Tremors

Kennedy disease (KD) is also known as spino bulbar muscular atrophy caused by a tandem C-A-G tri-nucleotide repeat. It is an adult-onset X-linked recessive inherited neurodegenerative disease involving lower motor neuron damage with predominance of facial muscles. It is often accompanied with androgen sensitivity, sensory nerve damage and endocrinal involvement. It has similar confusing symptoms and is often mis-diagnosed with most of the neuromuscular diseases like POEMS syndrome, myasthenia gravis, mitochondrial myopathy and amyotrophic lateral sclerosis. Hence clinical differentiation is important to prevent adverse outcomes and un-necessary treatment. Here we describe a rare case of a 46 year old Pakistani male who presented to us with progressive weakness and tingling of the limbs, bulbar symptoms, postural tremors and painful recurrent ulceration of the feet. Based on family history, clinical and electro diagnostic study he was diagnosed to have Kennedy disease. To the best of our knowledge, it is the first case report of Kennedy disease from Pakistan

Albuminocytological dissociation in different electrophysiological gbs variants

The objective of our study was to determine the distribution of different electrophysiological variants of GBS and its relationship with albuminocytological dissociation (ACD). The rationale of the study was to determine whether presence or absence of albuminocytological dissociation has any association with NCS findings and whether can be relied upon as an indirect predictor of axonal variant which warrants poor patient out comes versus demyelinating. Materials and Methods: A consecutive series of 76 patients who presented at PIMS over a 12 month period with GBS were included. Nerve Conduction studies (NCS) and Electromyographic (EMG) findings with CSF characterization for albuminocytological dissociation were recorded. P value \u3c 0.05 was taken significant. Results: NCS revealed AIDP as the most common variant (44; 57.8%) followed by AMAN (19; 25%) and AMSAN (7; 9.2%).For 5(6.5%) patients with normal NCS, EMG revealed early neuropathic changes in 4 (80% of normal NCS; 5.2% of total) (suggesting axonal degeneration). Total axonal degenerative type accounted for (AMAN + AMSAN + axonal neuropathy on EMG=30) 39.4% while demyelinating (AIDP + prolonged/absent F-wave=45) 59.2%. ACD was found in 60 (78.9%) patients.There was no signification association between ACD and NCS variants (p\u3e0.05). Conclusion: AIDP is the most prevalent (58%) GBS variant in our population, at least in the vicinity of Islamabad. There is high prevalence of axonal variants (≈40% of total) as compared to Western countries. There is no correlation between ACD and NCS variants. ACD cannot be used as an independent predictor of NCS variant. Presence or absence of ACD has no definite predilection for axonal variant which itself warrants poor patient outcomes versus demyelinating type

Terson Syndrome in A Patient with Unrepaired Tetralogy of Fallot

Tetralogy of Fallot is the most commonly seen cyanotic congenital heart disease. It includes four cardinal features: right ventricular outflow tract obstruction, misaligned ventricular septal defect, overriding aorta, and concentric right ventricular hypertrophy. Intracranial pathologies such as brain abscesses, cerebrovascular accidents, and intracranial haemorrhage all have been reported with Tetralogy of Fallot. Here we present a case who had subarachnoid haemorrhage with vitreous haemorrhage in Tetralogy of Fallot