Background: AD is the most common cause of dementia in elderly which causes economic burden for the affected individual, caregivers and society. The objective of this study was to see demographic characteristics among AD patients and it will provide magnitude of the problem and planning of health programme for prevention of disease. Methods: This observational analytical study was carried out in the Neurology ward, OPD and Dementia clinic of BSMMU, Dhaka from May’ 15 to February’ 17. A total of 45 patients were recruited as study population after satisfying all the criteria for enrollment. Results: A total of 27 male and 18 female with mean age of 69.20 ± 11.16 years, constituted as cases. Conclusion: The occurrence of AD found more after the age of 65 years. The present study found that lower educational level is associated with more chance of getting AD. Higher rate of Alzheimer’s disease was found in older man than women. Bangladesh Journal of Neuroscience 2019; Vol. 35 (1): 10-13
Migraine is a common type of headache. After tension type headache, it is the second common cause of primary headache disorder with a female preponderance.This cross sectional study was done toassess the sociodemographic characteristics of migraine patients in Bangladeshi population and to see the characteristics of headache and associated comorbidities of migraine patients.The study was conducted in a tertiary care hospital (Mymensingh medical college) of Bangladesh.The study subjects consisted of 60 patients with migraine headache seen in neurology OPD.Mean age was 32.03± 11.74 yrs. Male female ratio was 1: 2.7.Most of them are housewives (61.6%). 22% had family history of headache. Most of the patients had severe (53.4%) and frequent (e”3 per month) headache attacks. Aura was present in 25% patients. Depressive illness was the associated comorbid condition which was found in 15% patients. Bangladesh Journal of Neuroscience 2019; Vol. 35 (1): 22-26
Background: Internal carotid artery (ICA) is one of the commonest site stenosis in patients with ischemic stroke. There is difference in the distribution of stenosis among different sites of cerebral infarct.Volume and severity of cerebral infarct may also depend on the degree of stenosis. To plan efficient evaluation and treatment of individual patient of ischemic stroke, the responsible clinician must be familiar with the relative probability of finding occlusive lesions at various sites within the vascular tree. Objective: The objective of this study was to evaluate the angiographic pattern of ICA stenosis among different types of cerebral infarct. Materials and Methods: We evaluated 53 ischemic stroke patients from indoor, outdoor, stroke and neuro intervention clinic, BSMMU. CT scan and/ or MRI of brain were done to each patient to confirm the diagnosis. After vascular imaging, the degree of stenosis was measured by the NASCET formula. Results: Cervical segment of ICA was most commonly [n=45(84.9%)] encountered site of stenosis and total occlusion of ICA was always observed in cervical segment. Among patients with moderate stenosis (n=15) of ICA, 6(40.0%) presented with subcortical infarction, 4(26.7%) presented with lacunar infarction and 5(33.0%) presented with territorial infarction. In case of severe stenosis (n=23), territorial, lacunar and watershed infarct were 9(39.1%), 8(34.8%) and 2(8.7%) respectively. Whereas total occlusion (n=15) of ICA presented as either territorial infarction [n=11(73.3%)] or watershed infarction [n= 4(26.7%)]. These differences between severity of stenosis and subtype of infarct were also significant (p-value = 0.003).A total of 25 patients presented with territorial infarction, mostly MCA territory [n=23(92%)]. Conclusion: With increasing severity of stenosis, the infarct burden rises. ICA stenosis of e”70% mainly presented as territorial infarction whereas, watershed infarct was an indicator of severe stenosis. Bangladesh Journal of Neuroscience 2019; Vol. 35 (2): 69-77
Hemifacial Spasm is a rare condition and often misdiagnosed even by neurologists. Although etiology, pathophysiology is clear, treatment is unsuccessful in many cases. In this review article we focus on etiology, pathophysiology, diagnosis and management of this infrequent movement disorder. Bangladesh Journal of Neuroscience 2019; Vol. 35 (2): 104-109
Background: Mortality and morbidity due to recurrent ischemic stroke is gradually increasing in Bangladesh due to gradual increase of life expectancy. Previously many studies were done to identify the risk factors of ischemic stroke. But there was scanty data about risk factors of recurrent ischemic stroke. So,it is time demanding to find out those risk factors for ischemic stroke recurrence to reduce the mortality and morbidity from recurrent ischemic stroke. The objective of the study was to determine the frequency of recurrence ischemic stroke events within one year of follow up after discharge from hospital admitted due to first ever stroke. Methods: This is a prospective cohort study. This study was conducted on 150 patients admitted in Neurology ward of BSMMU, presenting with first ever ischemic stroke. Patients mRS were evaluated three monthly interval for one year. Sudden onset mRS deterioration than previous one during this one year period was categorized as recurrence. Results: Stroke recurrence was found in 30 patients including 8 patients who died due to stroke recurrence. the most frequent age group was > 75 years representing 44.4% who developed recurrence of stroke The cumulative risk of recurrence rate was 14.7% at three months, 15.3% at six months, 17.3% at ninth months,20% at one year. Old age, Male sex, Hypertension, DM and dyslipidemia were the most common risk factors among recurrent stroke patients. Conclusion: It was concluded that in hospital admitted patients of first ever stroke, recurrence events was more in patients of older male patients with multiple risk factors.First three months was the worst period for recurrence after index stroke. Bangladesh Journal of Neuroscience 2019; Vol. 35 (1): 33-38
Background: Un-ruptured intracranial aneurysms (UIAs) are common and prevalence is about 2 to 8%. Several studies have shown that the decision to treat un-ruptured aneurysms should not be based on aneurysm size alone. A study suggest that treatment of UIAs smaller than 7 mm in hypertensive patients and smokers may be beneûcial. Aim and objective: The goal of this study is analysis of correlation of age, gender, location of the aneurysm, history of hypertension and cigarette smoking, previous history of SAH with the size of ruptured aneurysms. Materials and Methods: This hospital based observational cross-sectional study was conducted in the Department of Neurology & Neurosurgery, Dhaka Medical College Hospital (DMCH), Dhaka. Total 44 patients with SAH were taken by inclusion & exclusion criteria. The aneurysms size, site of location and aneurysm multiplicity was assessed by three-dimensional rotational digital subtraction angiography (DSA). Results:The mean age of the study population was 49.24 ±11.5. About half of the population were within 51-60 years. The male female ratio was 1:1.2. Out of 44 population, 93.2% were presented with headache, 90.9% with vomiting. In this study aneurysms mean size was 5.72±4.010 mm. 93.2% of aneurysms were below 10 mm, 75.0% were below 7 mm and 50.0% below 5 mm. Size of ruptured aneurysm is small in hypertensive population and is significant (p-value 0.037). Aneurysm size was significantly (p- value 0.013) smaller in case of smoker. Mean aneurysm size in hypertensive smoker population was significantly (p-value-0.004) smaller than hypertensive non-smoker. Population with one risk factor had mean aneurysm size was 8.32±6.84 mm, two risk factors had 5.26±1.86mm, three risk factors had 4.79±2.05 mm and more than three risk factors had 2.85±1.43. Conclusion: This study shows that more the risk factors, smaller the size of aneurysms. Therefore, history of hypertension, cigarette smoking, female sex, age and positive family history should be considered in the assessment of treatment of un-ruptured intracranial aneurysms. Bangladesh Journal of Neuroscience 2019; Vol. 35 (2): 86-94
Focal Cortical Dysplasia (FCD) is one of the most common causes of refractory epilepsy in children as well as adult where malformed cortical development occurs resulting from abnormal neuronal migration due to both genetic and acquired factors. Herein, a 22-year-old male presented with recurrent secondary generalized tonic seizure with aura since childhood. Despite adequate anti-epileptic medications with good compliance the seizure was uncontrolled. As a cause, Type II FCD was diagnosed by specific neuroimaging findings supported by EEG abnormalities. Till now in refractory epilepsy FCD is rarely diagnosed but there remains a good hope of cure by surgical intervention. Bangladesh Journal of Neuroscience 2019; Vol. 35 (1): 46-50
Congenital myasthenic syndromes (CMS) comprise a heterogeneous group of rare inherited diseases in which the neuromuscular transmission in the motor plate is compromised by one or more genetic pathophysiological specific mechanisms are characterized by fatigable weakness of skeletal muscle (e.g., ocular, bulbar, limb muscles) with onset at or shortly after birth or in early childhood; rarely, symptoms may not manifest until later in childhood. The diagnosis of CMS is based on clinical findings, a decremental EMG response of the compound muscle action potential (CMAP) on low-frequency (2- 3 Hz) stimulation, absence of anti-acetylcholine receptor (AChR) and anti-MuSK antibodies in the serum, a positive response to acetylcholinesterase (AchE) inhibitors and lack of improvement of clinical symptoms with immunosuppressive therapy. Pathogenic variants in one of multiple genes encoding proteins expressed at the neuromuscular junction are currently known to be associated with subtypes of CMS. The most commonly associated genes include: CHAT, CHRNE, COLQ, DOK7, GFPT1 and RAPSN. We studied on a sibling presented with progressive fatigability and fluctuating ptosis with frequent exacerbations of muscle weakness during infections since infancy. On both cases CT scan of chest were negative for thymoma, antibodies against the acetylcholine receptor (AChR) and the muscle specific kinase (MuSK) were negative and decremental response on electrophysiological study of Repetitive nerve stimulation (RNS) and EMG were consistent with disease of neuromuscular junction (post synaptic) and they were only on pyridostigmine for long time with marked improvement of symptoms and signs. Considering all scenario both of our cases mostly fits with the autosomal recessive, post synaptic CMS associated with Rapsyn deficiency. Objective : As in Bangladesh, there is inadequate data on the epidemiological profile of CMS, our aim is to describe these cases for their rarity and the difficulty encountered in diagnosis as they are easily confused with Juvenile Myasthenia Gravis (JMG) and familial myopathies. As both the cases are very rare, it should be an original article. Bangladesh Journal of Neuroscience 2019; Vol. 35 (2): 95-103
Aging is a progressive process associated with decline in structure and function, hindered maintenance and repair systems, increased vulnerability to disease and death, and reduced reproductive capacity. Healthy aging can be prolonged by calorie limitation or by pharmacologic agents that mimic the effects of caloric restriction. Both fasting and the genetic inactivation of nutrient signaling converge on the induction of autophagy, a cytoplasmic recycling process that counteracts the age-associated accumulation of damaged organelles and proteins as it improves the metabolic fitness of cells. Holy Quran made it compulsory for all healthy adult Muslim to fast during Arabic month of Ramadan from early dawn to dusk. Believers of other religions also have the tradition of fasting as religious rituals in different way. The importance offasting and the autophagy process was highlighted very recently by Prof. Yoshinori Ohsumi, a Noble prize winner in medicine for his pioneering studies revealing the mechanisms of autophagy in baker’s yeast 30 years ago. Here we made literature search to review experimental findings on intermittent fasting (IF) and autophagy that influences the major nutrient and growthrelated signaling pathways as well as the up regulation of anti-aging pathways. Bangladesh Journal of Neuroscience 2019; Vol. 35 (1): 39-45
Background: Guillain-Barre Syndrome (GBS) is the most common cause of acute flaccid paralysis in the adult population. It is an acute post infectious immune mediated peripheral neuropathy with a marked variation in pathology, clinical presentation and prognosis. Objective: The aim of the study were to evaluate clinical profile, to assess autonomic involvement & electrophysiological findings in adult patients with GBS. Methods: An observational, cross sectional study was carried out in the Department of Neurology, BSMMU, Dhaka from March, 2015 to September, 2017. Total 43 patients of GBS fulfilling the inclusion criteria were recruited as the study population. Detailed clinical examination, CSF study & nerve conduction study were done. Disability status was measured by Hughes functional grading scale. For autonomic assessment 35 adult healthy control were also included for comparison. Then following tests of autonomic nervous system were performed in both patient and control group 1) resting heart rate and heart rate on changing posture (30: 15 ratio) 2) supine blood pressure and blood pressure on changing posture 3) heart rate response to valsalva maneuver 4) heart rate response to deep breathing and E: I ratio 5) sphincter disturbance by symptoms questionnaire. Results: The mean age of patients was 35±12 years (range18 to 65 years) with slight male predominance (58.1%). Major clinical presentation was weakness of all 4 limbs followed by sensory complaints (44.2%). 7% of the patient had breathing difficulty and dysphagia. Only 4.7 % had diplopia. Among the symptoms of autonomic dysfunction most common symptoms was constipation (30.2 %) followed by palpitation (14%), urinary retention (7%), lightheadedness and urinary incontinence (4.7%). Cranial nerve palsy was present in 34.9% of cases among them facial palsy was found commonly (27.9%), followed by bulbar palsy (7%) and ophthalmoplegia (4.7%). One patient (2.3%) had both facial palsy and ophthalmoplegia. AIDP, AMAN and AMSAN subtypes comprised 32.6%, 37.2% and 20.9% of cases respectively. Regarding autonomic dysfunction variation of heart rate by different maneuver like posture change, deep breathing and valsalva maneuver was found commonly. 30:15 ratio was abnormal in majority of the patients (82.4%) followed by abnormal max-min HR/min on deep breathing (58.1%) and abnormal valsalva ratio (37.2%). Other abnormalities were postural hypotension (38.2%), sinus tachycardia (25.6%), hypertension (16.3%), hypotension (4.7%), and sinus arrhythmia (4.7%). Bowel bladder dysfunction was another autonomic dysfunction among them constipation 30%, urinary retention 7% and urinary incontinence 4.7% of cases. Conclusion: GBS can be presented with variable presentation including autonomic dysfunction. In this study common clinical presentation was limb weakness & different patterns of autonomic dysfunction was found in patients with GBS. Common electrophysiological subtype was AMAN. So in addition to clinical & electrophysiological analysis autonomic evaluation is essential in every patients with GBS as autonomic dysfunction is one of important cause of mortality. Bangladesh Journal of Neuroscience 2019; Vol. 35 (2): 57-62
Background: Most strokes and stroke related death & disability happened in low and middle income countries. The clinician should be familiar with the sub typing of ischemic stroke patients and the risk factors analysis. Vascular imaging is necessary for classifying the patient. The main objective of this study was to evaluate the subtype of ischemic stroke patients and risk factor analysis of different etiology. Method: This is a hospital based prospective study in Bangladesh. Within the time frame of 2014 March to 2017 November; we analyzed 1978 patients of ischemic stroke within 10 days of symptom onset. Among them 877 patients have been selected for this study to whom brain imaging (CT/ MRI), vascular imaging (MRA, DSA), ECG and echocardiography have been done. We did subtyping according to TOAST criteria. Results: The mean age of patients was 60.5±11 years with 70.47% subjects male and 29.53% female. Within the classification of TOAST, we have found 43.87% of patients were in large artery atherosclerosis group, 23.83.% in small vessel occlusion group, 8.46% in cardiac embolism group, 19.30% in undetermined etiology group and 4.54% in other determined etiology. Among risk factors hypertension in 58.15%, DM was found in 38.42%, hypercholesterolemia in 38.88% of patients. Hypertension was significantly high in large artery atherosclerosis group. Conclusion: In ischemic stroke patients, large artery atherosclerosis was the most common subtype and hypertension was significant in this group. Bangladesh Journal of Neuroscience 2019; Vol. 35 (1): 27-32
Background: Migraine is one of the most common neurological disorder and fourth most important factor for debility in human. The presentation of migraine is complex. All patients do not have same features of migraine. Objectives: The purpose of the study was to evaluate demographic and clinical patterns of headache in migraine patients. Methods: A total of 30 migraine patients who were visited in the Headache clinic, Department of Neurology, BSMMU, Dhaka were enrolled for the study. Migraine patients diagnosed according to ICHD-3 (International Classification of Headache Disorders 3rd edition) criteria. Results: Out of 30 patients mean age was 30.63±10.95 years with age range 15-60 years in migraine patients. Female were more common. Positive family history was present in 56.7% patients. Common associated symptoms were photophobia, phonophobia (96.7%) and nausea (83.3%) in migraine patients. Common precipitating factors were stress and sunlight (90%) followed by journey (80%) and insomnia (73.3%). A major portion of migraine was without aura (73.3%) and the ratio of aura to without aura is 1: 2.75. Major portion of migraine patients were complained of 4-6 attacks/ month (46.7%) which was followed by 1-3 attacks/month (36.7%). Most of the migraine patients complained as moderate headache (60%) followed by severe headache (40%). Conclusion: This study concluded that migraine is a disease of younger age group and it affects female more commonly than male, pattern of headache in migraine patients is unique. Bangladesh Journal of Neuroscience 2019; Vol. 35 (2): 63-68
Polyneuropathy is an initial presentation and essential feature of POEMS ( polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes) syndrome. Neuropathy is typically distal, symmetric and slowly progressive with demyelinating changes. After a gradual proximal spread, it usually results in severe muscle weakness and functional disabilities. In the present report, we describe a 40-year-old diabetic male presented with gradually progressive weakness of both lower limbs for 1 year followed by the involvement of both upper limbs for the last 3 months. On examination hyperpigmentation, lymphadenopathy, gynecomastia, anasarca, hepatomegaly, bilateral optic disc swelling, sensory-motor polyneuropathy was found. Laboratory findings showed IgG lambda monoclonal gammopathy, raised VEGF, sensory-motor demyelinating and axonal polyneuropathy. All findings were consistent with POEMS syndrome. The patient was treated with lenalidomide and dexamethasone cyclical therapy with some clinical improvement. Bangladesh Journal of Neuroscience 2019; Vol. 35 (1): 51-56
Hirayama disease (HD) is considered to be a relatively benign, slowly progressive and less disabling rare neurological disorder where flexion induced compressive ischemic lower cervical myelopathy causes selective anterior horn cell injury resulting weakness and atrophy of distal upper limb without any pyramidal, spinothalamic and posterior column disturbance. Herein, we report a young male with clinical and imaging features suggestive of Hirayama disease presented with dissociated hand muscle atrophy (hypothenar more affected than thenar) in both hands. This less recognized finding was previously termed as reverse split-hand syndrome just opposite to split-hand syndrome found in amyotrophic lateral sclerosis. We also observe electrophysiological correlation of reverse split-hand syndrome in HD. Bangladesh Journal of Neuroscience 2019; Vol. 35 (2): 110-114
Subcortical Heterotopia is a rare developmental disorder of human brain due to mutation in the DCX or LIS1gene.It is predominantly a disease of female. It usually present with refractory seizure and varying degree of mental retardation. Here a case of 22 years lady who presented with refractory seizure is reported. Her MRI revealed Double cortex and her EEG revealed Frontal intermittent rhythmic delta activity (FIRDA). Bangladesh Journal of Neuroscience 2018; Vol. 34 (2): 106-109
Background: Stroke is the third leading cause of death in adult population throughout the world and is the most common cause of severe adult physical disability. The aim of the study is to identify the major risk factors in various subtypes of ischemic stroke according to TOAST criteria. Methods: A Cross-sectional observational study was conducted from January, 2018 to December 2018 in the department of Neurology, Bangabandhu Sheikh Mujib Medical University, Dhaka. All the patients of first ever ischemic stroke within 14 days diagnosed by history, clinical examination and neuroimaging (CT scan of head / MRI of brain), meeting the inclusion and exclusion criteria were included in the study. Results: Present study showed that among the 52 ischemic stroke patients mean age of the respondents was 57 ± 12.37 years with a slightly higher male predominance. Male to female ratio was 1.2:1. Dyslipidemia 44 (84.6 %) and hypertension 37 (71.2 %) were the most common risk factors, followed by obesity and overweight 33(63.5%), smoking 32 (61.5%), diabetes mellitus 29 (55.8%), family history of vascular event 27(51.9 %) and past history of vascular event 14 (26.9%). TOAST Subtype distribution of study population was large-artery atherosclerosis 18 (34.6%) followed by cardioembolism 11(21.2%), small-vessel occlusion 10(19.2%), stroke of other determined etiology 3(5.8%), and stroke of undetermined etiology 10(19.2 %) of patients. In cardioembolic subtype significant association was found with ischemic heart disease (P=0.001) and chronic rheumatic heart disease (P= <0.001). Conclusion: In this study large-artery atherosclerosis was the most common subtype, followed by cardioembolism, small vessel occlusion, stroke of undetermined etiology and stroke of other determined etiology subtypes. Dyslipidemia was found to be the most common risk factor, others were HTN, diabetes and smoking. Ischemic heart disease and rheumatic heart disease were very important cause and comorbidities of cardioembolic types of ischemic stroke. Bangladesh Journal of Neuroscience 2019; Vol. 35 (1): 14-21
Background:Prognosticating the outcome of Intracerebral Hemorrhage (ICH) at the time of admission is important to customize treatment in a cost-effective manner in such cases. ICH sore is a widely used prognosticating tool but yet not evaluated in our setting. This study was aimed to assess the prognostic factors influencing outcome and validating the ICH score for prediction of 30-day mortalityin hospitalized patients with ICH. Materials and methods:This prospective observational study was conducted in Chittagong Medical College Hospital, Bangladesh among 105 consecutively admitted patients aged 18 years and above with a computed tomography evidence of spontaneous ICH. ICH score was calculated soon after confirmation of diagnosis. Primary outcome measure was 30-day mortality after admission. Modified Rankin Scale (mRS) was used to assess outcome at discharge and at 30-day follow up. Results:A total of 104 patients were analyzed. Mean age of this cohort was 59.30±19.91 years. At 30 days all 27 patients with an ICH score of 0 survived, whereas those having scores of 1, 2, 3, and 4 had 5.9%, 33.3%, 46.2% and 88.9% mortality, respectively. ICH score was good for discriminating 30-day mortality with having an area under the ROC curve of 0.886 (95% CI:0.816-0.956; p<0.001]. For patients scoring above 2, the rate of poor functional outcome (mRS score e”4) approaches 100%. On the other hand, 18.5% of patients with score of 0 and 64.7% of patients with a score of 1 are not functionally independent after 30 days. Conclusion:In conclusion, the present study has demonstrated that the ICH score is a strong prognostic indicator of ICH outcomes (30-day mortality and 30- day functional outcome) among hospitalized patients in Bangladesh. Bangladesh Journal of Neuroscience 2019; Vol. 35 (2): 78-85
Background: Migraine headache is one of the commonest cause of primary headache. This study aims to reveal the clinical profile of migraine headache in Bangladeshi people presented in Headache clinic, Dhaka Medical College Hospital. It will give an overview on presentation of migraine and its functional consequences among the people of Bangladesh. Methods: The study was a hospital based cross sectional observational study. It was conducted in the Headache clinic Dhaka Medical college Hospital from January 2018 to December 2018. About 854 patients with headache was attended in the headache clinic during the study period. Of that 234 patients were diagnosed as migraine according to ICHD-3 classification and 75 patents were enrolled in this study by systematic sampling. Details were collected using a preformed questioner. Results: In this study migraine burden among the headache patients found to be about 25%.The mean age of the onset of the migraine headache in this study was found to be 25.2±11.86 years, in most of the cases (4 68%) in 15-34 years age group. In this study 36% of the patient with migraine had positive family history which is significantly higher in patients with migraine with aura (52% vs. 30% p value <0.5). In this study about 81% of the patient has single or multiple trigger factors. Along with other known factor sun exposure and journey was found to be the important trigger factors for Bangladeshi population. In this study 22% of the female migraineurs and 33% of male migraineurs had aura. About 53% of the patient with aura had combinations of aura and 47% patient had exclusive visual aura. In the present study 100% of the patient had visual aura, 42% had brainstem aura and 10% had sensory aura. The study revealed that 25% patient had chronic daily headache due to migraine, 26% patient had >5 attack/ month and 15% patient had < 4 attack per month. In this study 44% had moderate headache and 56% had severe headache according to VAS score. Chronic migraine with anxiety, chronic migraine with medication overuse Migralepsy, Status migrainosus were found as a complications of migraine in this study. According to MIDAS score Patient largely had Mild (32%) to Moderate (34.67%) disability. Conclusions: Clinical profile of migraine in Bangladesh differs in some trigger points and migraine subtypes than the western world. Sun exposure and journey found to be most important triggers. Migraine with brainstem aura occurs in a significant number of the patient. Bangladesh Journal of Neuroscience 2019; Vol. 35 (1): 1-9
Background: The diagnosis of Extra Pulmonary Tuberculosis, especially tubercular meningitis (TBM) is challenging due to frequent atypical clinical presentation, inadequate clinical sample, and paucibacillary nature of the biological samples, which frequently results in a delay or deprivation of treatment. A semi quantitative, nested, real time PCR Gene-Xpert test is showing promising result in diagnosing pulmonary TB diagnosis, but its role in TBM is yet to be validated. Methods: It was a cross sectional observational study carried out on 40 clinically suspected TBM patients admitted in neuromedicine, medicine and pediatric medicine at CMCH. Clinical, radiological evaluation and conventional tests were done before PCR (Gene-Xpert) using cerebrospinal fluid. Results: The mean age of the study population was 28.59 (±16.87) years. Seventeen (42.5%) were male and 23 (57.5%) were female with a male to female ratio of 1:1.35. Out of 40 study cases AFB was presesnt in direct microscopy in only 1(2.5%) case, positive growth on culture in 5 (12.5%) cases and positive Gene-Xpert test in 9 (22.5%) cases. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of Gene-Xpert (PCR) was 44.44%, 96.77%, 80%, 85.71%, and 85.0% respectively considering culture as gold standard. Sensitivity of Gene-Xpert in CSF was 22.5% as compared to culture which was only 12.5 % among the study cases. Conclusion: PCR (Gene-Xpert) is highly sensitive and speed in diagnosis of TBM compared to conventional methods. Bangladesh Journal of Neuroscience 2018; Vol. 34 (1): 1-8
