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

Neurology training in Pakistan: perspectives From physicians in a neurology unit working At different levels

Pakistan is a developing country of South East Asia. It stands amongst the highest in the list of high disease burden countries including that for neurological diseases. The current number of trained neurologists in the country is extremely low and the facilities not too frequently available

Respiratory distress in patients of guillain-barre Syndrome with sensory manifestations

Guillain-Barré syndrome (GBS) is one of the most frequent disorder of peripheral nervous system associated with respiratory distress. One clinical parameter that was found significant in heralding the onset of respiratory failure in GBS weresensory manifestations. The aim of the study was to determine the frequency of respiratory distress in patients of GuillainBarresyndrome with or without sensory manifestations in the disease. MATERIALS AND METHODS: This was a descriptive case seriesthat was conducted from January 19, 2013 to July 18, 2013 in Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad. All patients who met the inclusion criteria were selected for the study. Sensory manifestations of GBS were determined clinically, and patients were divided into two groupsi.e patients with sensory manifestations and without sensory manifestations. These two groups were followed for a period of 10 days and monitored for the presence of respiratory distress. RESULTS: A total of 110 patients were included. The mean age of patients was 34.41 years with standard deviation of 17.12 years. 76 (69.09%) patients were male and 34 (30.91%) patients were female. 85 patients had sensory manifestations while 25 patients had no sensory manifestations. 33 patients of GBS with sensory manifestation had respiratory distress while 52 patients had no respiratory distress.CONCLUSION: In our study moderate to severe pain is a common and early symptom of Guillain-Barre Syndrome. Respiratory involvement is more common in patients with sensory manifestation. Early detection and aggressive treatment of sensory manifestations of GuillainBarresyndrome should be a part of initial management so as to minimize the risk of respiratory failure

Hyperglycemia in acute subarachnoid hemorrhage

Subarachnoid hemorrhage (SAH) is associated with high inhospital mortality and morbidity. Hyperglycemia occurs frequently in acute medical conditions including SAH and is associated with poor outcome. The aim of the study was to determine the frequency of Hyperglycemia in patients of subarachnoid hemorrhage

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

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

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

Hepetatis c virus a rare cause of cereberal venous sinus thrombosis

Cerebral venous sinus thrombosis is challenging condition because of its variability of underlying pathological causes. Numerous conditions can cause cerebral venous sinus thrombosis (CVST), and often more than one cause can be found in an individual patient. The causes leading to CVST can be classified into two broad categories; infective and non-infective. Among infective causes, chronic hepatitis C infection is considered as one of the extremely rare causes of cerebral venous sinus thrombosis

Ataxic Variant Of Guillain Barre Syndrome: A Case Report

A 17-year-old girl was admitted after acute onset of unsteady gait succeeding acute gastroenteritis. Neurological examination reported normal power in all four limbs, impaired finger-nose, heel-shin tests, areflexia and ataxic gait. We eliminated other diseases with cerebellar symptoms; for example, Wernicke encephalopathy, multiple sclerosis, cerebellar vascular disease , encephalitis in the brain stem and cerebellum. Blood serum collected from the patient during the acute phase showed no anti-ganglioside antibodies. As the patient presented with evident cerebellar ataxia without muscle weakness, ophthalmoplegia or proprioceptive sensory disruption a diagnosis of ataxic form of Guillain-Barré syndrome (GBS) after nerve conduction studies. Though ataxic GBS is not a settled impression, we should have to give heed to the potential existence of such a scarce GBS variant

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