The rare and the unexpected; Miller Fisher Syndrome

Miller Fisher Syndrome (MFS) is a rare variant of Guillain-Barré syndrome (GBS) which is an idiopathic neuromuscular paralysis. It is considered as autoimmune disease because there are antibodies which attack the nerve cell fibers resulting in paralysis of muscles. This disease exhibits a classic clinical triad of ataxia,areflexia, and ophthalmoplegiawhereas it could have more neurological symptoms.Basically it is diagnosed clinically but have a serological test for its confirmation i.e. anti-GQ1b antibody levels.Here, we report a stereotypical case of MFS with all of its cardinal symptoms with addition of some other symptoms like diplopia, ptosis of an eye and unilateral facial nerve palsy. This patient presented with all of these signs and symptoms preceded by an upper respiratory tract illness. The suspected diagnosis was aided with itsserological marker anti-GQ1b antibody levels and nerve conduction studies(NCS)/electromyographic(EMG)studies and the patient was successfully treated with multiple sessions of plasmapheresis and reduction in severity of the disease was noticed

Neuromyelitis Optica (nmo); A case report

Devic’s disease or syndrome also known as Neuromyelitis optica (NMO) which is a demyelinating central nervous system (immune-mediated) ailment that predominantly targets the optic nerves and spinal cord. NMO-IgG seropositivity & longitudinally extensive spinal-cord lesions typically represents the Devic’s disease & differentiates it from Multiple Sclerosis (MS).Treatment for NMO is based upon its presentation such as for acute phase(steroids, IVIG etc), prevention of relapse (steroid sparing immunosuppression etc) and symptom based therapy (e.g spasticity etc). Here, we present a case of NMO in a young female (26 years old), married patient who presented to us with total vision loss, urinary & fecal incontinence & paraplegia. She was being treated as a case of Multiple Sclerosis (MS) several years ago but we further investigated & found NMO-IgG seropositivity and other findings in the history that conforms the diagnostic criteria of NMOSD for this patient. Furthermore, the patient was treated with IV glucocorticoids for its acute phase of disease & sent home when symptoms of transverse myelitis improved

The Frequency of Low Serum Cortisol Level in Acute Traumatic Brain Injury

Objective:  The study focused on evaluating the frequency of low serum cortisol levels in acute traumatic brain injury. Material and Methods:  Patients with Acute Traumatic Brain Injury of both genders between the ages of 2 and 70 years old with a GCS of 12 or below were included. Information including name, age, gender, pregnancy, GCS, serum cortisol level, history of steroid use, and hypothalamic-pituitary dysfunction were all recorded on a predesigned proforma. The results were stratified among age, sex, and GCS concerning outcome variables. Results:  The majority of patients (42%) ranged in age from 26 to 50. Male patients outnumbered female patients (77%). The GCS ranged between 9 and 12 in 63% of cases. Furthermore, 88 percent of patients had cortisol levels greater than 300nm/L. Hypocortisolemia was found in 13 people aged 26 to 50, 12 between the ages of 2 and 25, and only 7 between the ages of 51 and 70. There were 25 males and 7 women in the group. In 86 instances, GCS ranged from 9 to 12, while in 12 individuals, it varied from 3 to 8. Conclusion:  Although the majority of patients recovered, early hypopituitarism was common in severe TBI. It is required to identify concealed pituitary dysfunction in the course of the rehabilitation process of TBI patients. Keywords:  Cortisol, Traumatic Brain Injury, Hypocortisolemi

The Prevalence of Chiari II Malformation in Neonates with Myelomeningocele at Ayub Teaching Hospital, KPK

Objective:  Neural tube defects (NTDs) are common in northern areas of Khyber Pakhtunkhwa (KPK) and need a lot of community education for the parents regarding this disease, which impaired the patients for their whole life. The study aimed to assess the contribution of a family history of myelomeningocele and the resulting incidence of Chiari II malformation. Materials and Methods:  A total of 131 patients were observed to determine the frequency of the Chiari II malformation in patients with myelomeningocele who presented in Ayub Teaching Hospital, Abbottabad. All neonates were sent to the radiology department for MRI. A repair procedure for meningomyelocele was done. Results:  The mean age was 16.56 days. In 53.4% of neonates, there was a familial history of spinal dysraphism, while in 46.6% there was no familial history. Chiari II malformation was present in 23.7% of patients who presented with myelomeningocele. A significant difference (p-value < 0.00001) existed between the presence/absence of a family history of myelomeningocele and Chiari II malformation out of the total. Conclusion:  Early surgery, along with a multidisciplinary approach, provides the best opportunity for improved results and survival. Keywords:  Meningomyelocele, Neural Tissue, Maternal Folate Intake, Meningomyelocele (MMC) Repair

Incidence of Acute Complications Associated with Spinal Cord Injury (SCI): A Study of the Ayub Teaching Hospital, Abbottabad

Objective:  To document the occurrence of acute problems as well as post-surgical improvements in individuals suffering from spinal cord injury. Materials and Methods:  This study was conducted retrospectively in the Department of Neurosurgery. All patients of any age and both genders were included who were admitted with spinal injuries. The patients with cervical fractures received the anterior cervical plating plus graft placement in the cervical spine, whereas the patient with thoracolumbar fractures received the transpedicular fixation in thoracolumbar spine fractures. ASIA Impairment Scale for neurological status, GCS at admission, and acute complications developed within two weeks were noted. Results:  200 patients were included (mean age of 34.6 years). The common cause of SCI was a fall from an elevated position of 62.5%. On admission, 50% of patients’ neurological state was Asia grade A. The most common location involved in patients (70%) was a thoracolumbar junction. 20% of patients presented with neurogenic shock. Postoperatively, the GCS scores in all patients were been improved. The commonest acute complications associated with SCI were pulmonary in 60% of patients. 17% of patients developed an infection, 5% suffered from gastrointestinal issues, and 3% suffered from renal issues. Deep vein thrombosis (DVT) was observed in 9%.  Conclusion:  During the early phase of hospitalization, respiratory difficulties were among the most prevalent complications encountered in those suffering from traumatic SCI. These outcomes exacerbate the eventual suffering caused by the spinal cord injury; hence, recognizing the likelihood of occurrence, early detection, exact surgical treatment, and prevention are essential