A Case of Ulcerative Colitis Presenting with Cerebral Venous Thrombosis

Ulcerative Colitis is an autoimmune inflammatory bowel disease causing abdominal pain, bloody diarrhea and malnutrition and is associated with intestinal and extra intestinal complications. The clinical course has remissions and flare ups. Thromboembolism is a known risk associated with ulcerative colitis. Here we present a case of a young man who presented with a flare up of ulcerative colitis and developed neurological deficits that were diagnosed as due to cerebral venous thrombosis. Cerebral venous thrombosis is a rare complication of ulcerative colitis and can be missed without proper work up and consideration of diagnosis

Churg Strauss Syndrome with Neuropathy: A Case Report

A 24 years old man with known history of asthma came with acute presentation of ascending weakness for four days following flu like symptoms and worsening of asthma. His complete blood counts showed elevated eosinophil count. Nerve conduction showed neuropathy. He was diagnosed as Churg Strauss syndrome due to presence of asthma, eosinophilia, neuropathy and pulmonary infiltrates. Churg Strauss is a systemic eosinophilic vasculitis involving multiple organ systems that may present with neuropathy, as in this case

Post Covid-19 Vaccine (Sinovac) Cerebral Venous Sinus Thrombosis

SINOVAC is an inactivated virus COVID 19 vaccine given emergency authorization for COVID-19 Pandemic. Different adverse reactions have been seen in after-marketing of COVID-19 vaccines. Here we present a case of patient who developed cerebral venous sinus thrombosis two weeks after the first dose of SINOVAC vaccine

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

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

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

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

A Rare Presentation of Wilson Disease: A Case Report

Wilson Disease results from autosomal recessive mutation in ATP7B gene which leads to reduced formation of ceruloplasmin protein in the body that acts as a copper transporter. Due to its deficiency, there is the build-up of copper in the liver and brain among other organ systems and it leads to the development of various clinical abnormalities but commonly presents either as hepatic dysfunction and/or cirrhosis in young patients with movement disorder. Here we present a case that presented with hypoglycemia and hypothermia in absence of any infection, drug abuse or metabolic abnormality. He was later diagnosed as Wilson disease. Wilson Disease is mostly thought of hepatic /neurological disease. Contrary to this Wilson’s disease is a multisystem disease affecting multiple organ system including, kidneys, endocrine system and musculoskeletal system and can present with manifestations of above-mentioned systems

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

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