Myositis as A Complication of Dengue Viral Infection

Dengue fever is a febrile illness caused by an arbovirus transmitted by the Aedes aegypti mosquito. It occurs as a seasonal epidemic every year in Pakistan. Apart from febrile illness and its associated hemorrhagic complication, dengue fever is associated with multi-system involvement and their respective complications, including myriad neurological complications. In this case report we describe two patients who developed acute viral myositis

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

Creutzfeldt-Jakob Disease Experience in Patients Presenting to A Tertiary Care Hospital: A Case Series

Creutzfeldt-Jakob disease (CJD) is a rare cause of rapidly progressive dementia, it is a neurodegenerative disorder caused by the misfolding of prion proteins in the brain, and misfolded proteins further propagate by causing misfolding of other proteins. It presents with insidious onset of neurobehavioral symptoms that rapidly develop into cognitive and motor decline and uncontrolled seizures. The diagnosis is established with help of clinical signs and symptoms, and using imaging and lab investigations to rule out other treatable causes. Some imaging findings point to the diagnosis of CJD that will be viewed in the cases below. Diagnosis can be augmented by CSF studies but due to the risk of biohazard and spread of CJD, special care needs to be taken. Confirmation is only via brain biopsy. In this article we share our experience with four cases of CJD that presented to our hospital

Predictors of Early Seizures After First Acute Stroke

ABSTRACT Background and objective: There is a lack of local data regarding the frequency and predictors of early seizures after stroke. The objective of this study was to determine the frequency of early seizures after stroke and identify the predictors which lead to them after first acute stroke. Methods: This cross-sectional observational study was conducted in the Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad from October 2021 to June 2022. A total of 310 consecutive eligible patients of acute stroke were recruited. Key inclusion criteria included any patient of \u3e20 years of age with confirmed diagnosis of stroke on imaging, non-traumatic, with no history of seizures in past. Data was analyzed by SPSS version 23.0. Results: The mean age of patients in the seizures group was 48.40 ± 20.9 years. Hypertension was the most common co-morbid present in 225 (76.5%) patients. Early seizures were found in 52 (16.8%) patients with 42 (80.76%) having seizures in first 24 hours of stroke (p value 0.001). On National Institute of Health Sciences Scale (NIHSS) score most patients 125 (40.3%) had moderate severity score i.e. score in between 7 to 25 (p value 0.05). Ischemic stroke was identified as the stroke variety with most of the early seizures i.e. 16 (30.76%) (p value 0.003). Conclusion: Early seizures were not infrequent after acute stroke (16.77%) in our study. Early seizures were associated with younger age, cortical region lesion, ischemic stroke, followed by cerebral venous thrombosis. Higher NIHSS score and greater disability was associated with increased incidence of early seizures

Anti-Caspr 2 Antibody Encephalitis: A Case Report

Encephalitis is a term denoted to Inflammation in the brain which can be due to infection, autoimmunity, or can be a part of a paraneoplastic phenomenon with malignancy. Anti-CASPR 2 antibody encephalitis is a rare form of encephalitis that can be associated with malignancy, paraneoplastic phenomenon or can be an autoimmune disease. We present a case of a young boy who presented with new onset seizures and altered sensorium and was diagnosed with anti-CASPR 2 antibody encephalitis. Anti-CASPR 2 Antibody Encephalitis is a rare form of encephalitis which due to its great diverse presentation should be kept in the differential diagnosis of conditions like limbic encephalitis

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

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