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

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

Frequency of Tension-Type Headache in Patients with Migraine: A Single-Center Cross-Sectional Study

ABSTRACT Background and objective: Migraine is a common headache disorder characterized by recurrent episodes of moderate to severe headaches which are usually unilateral. Migraine is the second most common headache disorder after tension-type headache. The objective of this study was to determine the frequency of tension-type headache in patients with migraine. Methods: This cross-sectional study was carried out at Pakistan Institute of Medical Sciences, Islamabad for a period of six months between 1st July 2018 and 31st December 2018. This study enrolled patients above the age of 12 years that were diagnosed with “Migraine without aura” or “Migraine with aura”. The patients were subsequently asked for presence of features of tension-type headache. The criteria published by International Headache Society, ICHD-3 was used for making the diagnosis of migraine and tension-type headache. The data was analyzed using SPSS version 17. In the case of numerical variables, the mean and standard deviation were calculated. In the case of categorical variables, the frequency and percentage were calculated. All data were presented in tables and figures. Results: One-hundred-forty-two patients participated in the study. The age range was between 14 and 72 years. The mean age was 30.12 years. Female patients were 76.1 percent. Eighty patients were married, and 15.5 percent patients did not receive education; 72.5 percent patients were from urban background. Seventy-five (52.8%) patients had migraine with aura while 67 (47.2%) patients had migraine without aura. Twenty-nine (20.4%) patients of migraine had coexistent tension-type headache while 113 (79.6%) patients of migraine did not have tension-type headache. Conclusion: Tension type headache was an infrequent finding in our study population of migraine patients

Anti-NMDA Receptor Encephalitis

Anti N-methyl-D-aspartate receptor (NMDA)receptor encephalitis is one of the most common type of auto immune encephalitis. Its diagnosis is often delayed due to initial clinical presentation with psychiatric clinical features. Initial clinical features resemble those of acute psychosis or depression which later evolve into frank neurological dysfunction. This was first described in association with ovarian teratoma, but it was later also found to exist without neoplastic association and in men as well. It occurs more frequently in younger age group, mostly below 50 years of age. Diagnosis is established with the help of cerebrospinal fluid (CSF) analysis for oligo clonal bands and presence of Anti NMDA receptor antibodies in serum or CSF. CSF assay for antibody is more sensitive compared to serum. This case report is of a young girl who initially presented with behavioral abnormalities to a psychiatry outpatient and was later diagnosed with anti NMDA receptor encephalitis after she developed seizures

Awareness of stroke among general Practitioners

Stroke is the 2nd leading cause of death and 3rd leading cause of disability after cancer and ischemic heart disease. The recognition of acute stroke symptoms and knowledge about timely and prompt referral of a patient for possible thrombolysis is a need of time for which general practitioners (as they have to be the first responders many a times across Pakistan) need to be equipped with the advance knowledge about stroke treatment

Hemichorea Associated with type 2 Diabetes: A Rare Neurological Complication

Diabetic hemichorea/hemiballism is a spectrum of hyper kinetic, involuntary, irregular, purposeless, non-rhythmic, rapid and unsustained movements flowing from one part of the body to another. It involves contra lateral basal-ganglia and often striatum of the brain. Here we are reporting an un-usual case of choreiform movement disorder which was sudden in onset. It was accompanied with abnormally high values of blood glucose. Our patient had a complete remission of symptoms after an adequate control of blood glucose was achieved. This case illustrates the importance and rarity of hyperglycemia as a rare cause of hemichorea. It recovers rapidly and has a good prognosis. Screening for hyperglycemia even in those patients without a prior history of diabetes is very important, once they present with an involuntary movement disorder. Recognition and early treatment is beneficial to prevent adverse outcomes. Today, in the medical literature it is often referred to as C-H-BG (chorea, hyperglycemia, basal ganglia) syndrome

Association of Hypomagnesaemia & Hypocalcemia with Intracerebral Hemorrhage and Outcome

Determine if hypomagnesemia & hypocalcemia on admission was associated with ICH and outcome. Magnesium is a vascular smooth muscle relaxant and appears to provide protection against cellular injury in experimental stroke models. The implication of low serum magnesium in primary ICH is not well defined. All patients with a primary ICH presented to PIMS, Islamabad prospectively analyzed in a pilot study. Demographics, initial lab values, ICH location, Mg+2 level, NIHSS & MRS at presentation were recorded. All patients with INR \u3c= 1.5 were included in this study. We took normal serum magnesium in our study was 1.8 - 2.5 mEq/dL. Statistical significance was determined using linear regression adjusting for admission systolic blood pressure (SBP). We identified 66 patients who met the inclusion criteria. The mean age was 52.76 years with minimum and maximum age was 25 and 80 years respectively. Total male and female patients were 40 (61%) and 26 (39.4%). The total number of patients with hypomagnesemia was 23 (30%) and with hypocalcemia was 54 (65%). All patients having hypomagnesemia (30%) also had subsequent hypocalcemia. Mean systolic Blood pressure (SBP) was 156.65 mmHg and 55patients (84.62%) presented with high SBP. All patients with hypomagnesemia presented with high SBP (p=0.001). Hypomagnesemia and hypocalcemia both were showed statically significant association with poor MRS & NIHSS score (p=0.013 and p=0.001). Hypomagnesemia was not showed statistically significant relation with the outcome (p=0.11) while hypocalcemia showed a remarkable association with outcome (p=0.001)

Experience with Anti Nmda Receptor Antibody Encephalitis in A Tertiary Care Hospital in Pakistan

ABSTRACT Background and objective: Anti NMDA receptor (Anti-NMDAR) antibody encephalitis is an increasingly recognized form of auto immune encephalitis. The objective of this study was to determine the demographic, clinical and laboratory factors associated with this syndrome. Methods: All cases presenting to neurology, Pakistan institute of medical sciences, Islamabad, from June 2017 till January 2020 were reviewed retrospectively. Patients fulfilling the diagnostic criteria for Anti NMDA receptor (Anti-NMDAR) antibody encephalitis were included. All patients were evaluated with cerebrospinal fluid (CSF)routine examination, MRI brain, autoimmune encephalitis profile and for presence of oligoclonal bands (OCB) in CSF. Statistical analysis was done using SPSS version 23.0. Results: A total of seven patients were diagnosed as having Anti-NMDAR antibody encephalitis. Five patients were female and two were male. Four patients had some type of psychiatric disturbances upon presentation of these behavioral abnormalities and irritability were found in all four. Orofacial abnormal movements were found in four patients while one patient had myoclonic seizures. Conclusion: Anti-NMDARreceptor encephalitis is a common cause of encephalitis associated with neurological and psychiatric symptoms. Delay in diagnosis can occur due to non-specific symptoms and signs present in early stages of illness,this can lead to long term neurological disabilit

Polyneuropathy associated with iga Paraproteinemia: a case report and literature Review.

Paraproteinemia is precipitated by an accumulation of monoclonal plasma cells or B lymphocytes. Idiopathic neuropathies that are associated with paraproteinemia account for only 10% of the neuropathies. Paraprotein acts like an antibody and is targeted against myelin and axons present in the peripheral nerves. Despite being of interest for quite a long time, the caudal relationship between paraproteinemias and peripheral neuropathies still remains a sorcery. We report a case of a middle aged male who presented with pain and parasthesias in both arms and legs. His workup revealed him to be having a paraproteinemic neuropathy consistent with IgA Lambda chains that account for being the most rare type of monoclonal gammopathy than IgM or IgG having the potential to progress to smouldering multiple myeloma