MS in Asian countries

This paper reviews all available English language literature on MS from Asian countries published between 1970 and 2005. Although limited data are available, the review reveals that western Asia--including the Middle East--has the highest prevalence of MS across the continent, and that MS in Asia largely resembles conventional MS in western countries. Opticospinal MS (a distinct clinical entity from conventional MS) is more common in eastern Asian regions. Larger epidemiological and genetic studies, with more complete ascertainment in various Asian populations, are needed so that we can understand the diversity of Asian MS

Cerebral Venous Sinus Thrombosis in Children: A Multicenter Cohort From the United States

This study presents a large multicenter cohort of children with cerebral venous thrombosis from 5 centers in the United States and analyzes their clinical findings and risk factors. Seventy Patients were included in the study (25 neonates, 35%). The age ranged from 6 days to 12 years. Thirty-eight (55%) were younger than 6 months of age, and 28 (40%) were male. Presenting features included seizures (59%), coma (30%), headache (18%), and motor weakness (21%). Common neurological findings included decreased level of consciousness (50%), papilledema (18%), cranial nerve palsy (33%), hemiparesis (29%), and hypotonia (22%). Predisposing factors were identified in 63 (90%) Patients. These included infection (40%), perinatal complications (25%), hypercoagulable/hematological diseases (13%), and various other conditions (10%). Hemorrhagic infarcts occurred in 40% of the Patients and hydrocephalus in 10%. Transverse sinus thrombosis was more common (73%) than sagittal sinus thrombosis (35%). Three children underwent thrombolysis, 15 Patients received anticoagulation, and 49 (70%) were treated with antibiotics and hydration. Nine (13%) Patients (6 of them neonates) died. Twenty-nine Patients (41%) were normal, whereas 32 Patients (46%) had a neurological deficit at discharge. Seizures and coma at presentation were poor prognostic indicators. In conclusion, cerebral venous thrombosis predominantly affects children younger than age 6 months. Mortality is high (25%) in neonatal cerebral venous thrombosis. Only 18 (25%) Patients were treated with anticoagulation or thrombolysis

Radiologic features of Hallervorden Spatz Disease

Hallervorden Spatz Disease is a rare familial neurodegenerative disorder, which primarily affects children but also can occur in adults1 . Major clinical features are abnormal involuntary movements and cognitive impairment2 . Diagnosis is based on clinical and radiological features. The radiological features are hypointense signals in globus pallidus and substantia niagra on MR! of brain3 . Occasionally the pallidal hypointense signals surround hyperintense signals, this is known as “tigereye-sign”4 and is postulated to be specific for Hallervorden Spatz Disease. We report two brothers with such MRI findings

CNS tuberculosis and stroke, burden, management challenges and future needs for care and research

An estimated 10 million cases of Tuberculosis (TB) and 1.6 million deaths due to this disease occurred worldwide in 2017 (1). About 1.7 billion people, 23% of the world’s population are estimated to have latent TB infection and are thus at risk of developing active TB disease during their life time. TB is mostly common in developing countries and Pakistan ranks 5th among 30 high-burden countries and 5th for Drug Resistant TB (DRTB). The incidence of TB in Pakistan is 267 per 100,000 (1) with an estimated 525,000 cases in 2017 including 57,000 cases among those who were less than 15 years of age

Should Carotid Endarterectomy be performed for Symptomatic Carotid Stenosis Pakistan?

Objective: The risk of stroke and death associated with carotid endarterctomy is operator dependant. Data regarding risks of this procedure are not available in Pakistan and therefore it is difficult to make accurate risk benefit analysis for individual patients. Our objective was to determine safety of carotid endarterectomy at an academic tertiary care center in Pakistan. Methods: Patients who underwent carotid endarterectomy (CEA) at our hospital during a ten-year period were identified through ICD-9 coding system of the hospital medical records. Demographic features. associated medical problems and immediate postoperative complications were recorded and analyzed. Results: Sixty-three carotid endarterectomies were performed on 59 patients. Ages range from 43 to 80 (mean 61±8) years; 53 were male and 10 were female. Common associated diseases among these patients were hypertension; 38 (64.4°/x), ischemic heart disease; 26 (44%), diabetes mellitus: 24 (40.7%); dyslipidemia; 19 (32.2%) and renal insufficiency; 13 (22%). Most common complication was neuropraxia (transient neuropathy) 5 (7.9%), followed by pneumonia and stroke; each in 3 (4.8%) patients. None of the strokes related to the surgical procedure were disabling. Two of the patients who had stroke, recovered fully within 17 weeks and one recovered partly but was independent in all daily activities of living (ADLs). One patient died following simultaneous coronary artery bypass graft (CABG) and CEA. The risk of stroke or death for patients undergoing CEA was high with simultaneous CABG (3/11, 27%) and low for patients undergoing CEA alone (1/52, 2%). Conclusion: Carotid endarterectomy is a safe procedure in patients with symptomatic carotid stenosis at our hospital and should be performed, when indicated. (JPMA 53:589;2003)

An Inconsistency in the Spectrum of Bosonic Open 2-Brane

We show that the spectrum of a bosonic open 2-brane does not contain any massless states to take the role of gravitons. Moreover, the spectrum of this open 2-brane only contains half integer mass squared values