Background and Objective: Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterised by altered sensorium, seizures, visual impairment and behavioural changes. The objective of the study was to evaluate clinicoradiological findings and outcome of PRES in children. Methods: A prospective cross-sectional study was conducted at department of pediatric neurology, the Children’s Hospital Lahore from October 2020 to September 2023. Clinical and demographic data were colllected on a structured proforma. Investigations comprised complete blood count, biochemistry, urinalysis, complement levels, inflammatory markers, immune panel, lipid profile and abdominal ultrasonography. All patients underwent MRI brain. Outcome was categorized as complete recovery or persistence of neurological deficits and/or residual radiological abnormalities at six months. Data were analyzed using SPSS version 23. Results: Thirty patients enrolled with male predominance (53.3%; male-to-female ratio of 1.14:1) and mean age of 10.86 ± 2.22 years. Hypertension was universal followed by seizures (93.3%), headache (83.3%), altered sensorium/aphasia (80%), visual impairment (70%), pyramidal signs (70%), peripheral edema (66.7%) and motor deficits (43.3%). Renal disorders accounted for 83.3% cases, most commonly post-infectious glomerulonephritis (43.3%). MRI revealed reversible vasogenic edema on T2-weighted/FLAIR sequences, predominantly in occipital (100%) and parietal lobes (90%). 6.7% patients had ischemic changes correlating with visual loss. Conclusion: PRES in children presents with diverse neurological manifestations associated with hypertension secondary to renal diseases. MRI plays a pivotal diagnostic role. Early recognition with timely management is essential to prevent deficits.
Background and Objective:Demyelinating diseases are a heterogeneous group of disorders of the central nervous system, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and acute disseminated encephalomyelitis (ADEM). Data from South Asia remain scarce, despite potential regional variations in disease spectrum and outcomes. The objective of this study was to characterize the demographic, clinical, and disability profile of patients with demyelinating disorders across Pakistan. Methods:This multicenter cross-sectional study was conducted between August 2017 and December 2019 across 39 neurology centers in Pakistan. Adult patients (≥18 years) diagnosed with demyelinating disorders using standardized criteria were included. Data on demographics, education, comorbidities, and disability (modified Rankin Scale) were collected. Statistical analyses were performed using t-tests and chi-square tests, with significance set at p<0.05. Results:A total of 373 patients were analyzed (59.5% female; mean age 37.2 ± 11.7 years). MS was the most frequent diagnosis (79.1%), followed by NMOSD (11.8%), ADEM (5.1%), and leukodystrophy (4.0%). Females had higher MS prevalence (82.9% vs. 73.5%, p=0.02) and higher rates of illiteracy. Hypertension (9.4%) and diabetes (6.7%) were more common in older and male patients. While 33.5% were fully functional, 16.7% had moderate-to-severe disability, including 6.7% who were bedridden. Conclusion:Demyelinating diseases in Pakistan predominantly affect young adults, with MS as the leading disorder but NMOSD comprising a notable proportion. Female predominance, education disparities, and significant disability highlight the need for improved diagnostic access, equitable treatment, and targeted rehabilitation strategies in South Asia.
Cerebral venous sinus thrombosis (CVST) is a multifactorial illness seen more commonly in females as compared to males. Its diagnosis is often delayed due to variable clinical presentations. It is now identified more often due to advancements in neuroimaging modalities. We present an uncommon case of CVST caused by anemia in a 23-year-old female. Our patient presented with complaints of headache since the past two days and left sided hemiplegia since past one day. Later on during her hospital stay she developed generalized tonic clonic seizures. MRI and MRV brain with contrast revealed right cerebral venous (vein of Trolard) thrombosis. Blood tests showed hypochromic microcytic anemia which was the likely precipitating factor in our case as thrombophilia factors were normal. Headache and focal neurological symptoms should raise suspicion of CVST in anemic patients. Early commencement of anticoagulation along with correction of underlying cause, anemia in this case, leads to better prognosis.
Retraction Notice Sattar S, Soomro B. Efficacy of memantine as a preventive and therapeutic intervention for migraine and tension type headache. Pak J Neurol Sci. 2015;10(4):14-17 The Editorial Board of the Pakistan Journal of Neurological Sciences (PJNS) hereby retracts the above-mentioned article. This action follows an internal inquiry initiated after a reader’s concern and subsequent written correspondence with the authors. The investigation confirmed multiple serious breaches of publication ethics, including: Duplicate publication:The dataset, demographic characteristics, outcome measures, and statistical results were identical to those previously published in PJNS, Vol. 10, Issue 2 (Apr–Jun 2015) under a different authorship. Plagiarism: Significant portions of the abstract, methodology, results, and discussion were reproduced verbatim or with minimal changes from the earlier publication without citation or disclosure. Authorship irregularities:Three authors from the original publication were omitted and a new author was added without justification, constituting inappropriate authorship attribution. Misrepresentation of study setting: The study site description differed from that reported in the earlier publication despite the dataset being the same, indicating inaccurate reporting of research context. These findings reflect substantial violations of the ethical principles outlined by the Committee on Publication Ethics (COPE). After being notified, both authors agreed with the retraction. In order to maintain the integrity of the scholarly record, the journal is formally retracting this article. The Editorial Board recognizes that this article should not have passed the editorial process and acknowledges this lapse in the editorial review process at that time. Editor Pakistan Journal of Neurological Sciences (PJNS) Retracted article link: https://ecommons.aku.edu/pjns/vol10/iss4/5/
Background and Objective: Acute transverse myelitis (ATM) is an inflammatory spinal cord disorder presenting with motor, sensory, and autonomic dysfunction. The objective of this study was to assess the prognostic value of spinal MRI findings and treatment timing in predicting neurological outcomes in patients with acute transverse myelitis. Methods: A retrospective analysis was conducted on 90 patients diagnosed with ATM at Chandka Medical College Hospital, Larkana, between January 2021 and December 2023. All patients underwent spinal MRI at presentation, and imaging characteristics—including lesion location, longitudinal extent, and enhancement pattern—were recorded. Clinical outcomes were assessed at one month, three months, and one year using the Modified Rankin Scale (mRS) and the ASIA Impairment Scale (AIS). Statistical tests evaluated associations between MRI findings, treatment timing, and recovery patterns. Results: The mean age was 41.5 ± 5 years; 54 patients (60%) were male. MRI revealed normal findings in 20 patients (22.2%) and abnormalities in 70 (77.8%). Overall, 20 patients (22.2%) achieved full recovery, 52 (57.7%) showed partial improvement, and 18 (20%) had no recovery. Normal MRI strongly predicted favorable outcomes (85% full recovery; p < 0.0001). Early treatment (≤3 days) significantly improved recovery rates (33.3% vs. 11.5%; p = 0.0088). Conclusion: MRI characteristics and early therapeutic intervention are key predictors of neurological recovery in ATM. Normal MRI findings and prompt treatment initiation were associated with significantly better outcomes, emphasizing the importance of early imaging and rapid management to reduce long-term disability.
Background and Objective: Stroke remains a leading cause of mortality and long-term disability worldwide, with significant socioeconomic implications. This study aimed to investigate gender-based differences in acute stroke patients regarding baseline characteristics, clinical presentation, and predictors of poor outcome in an Egyptian population. Methods: We prospectively recruited 116 acute stroke patients admitted to the stroke unit at Cairo University Hospitals from January to June 2020. Detailed data on demographics, clinical characteristics, diagnostic workup, hospital course, and functional outcomes were collected. Poor outcome was defined as a modified Rankin Scale (mRS) ≥ 3 at discharge. Data were analyzed using SPSS version 28 (IBM Corp., Armonk, NY, USA). Results: The study included 60 males (51.7%) and 56 females (48.3%) with a median age of 62 years. Atrial fibrillation (32.1% vs 15%, p = 0.029) and obesity (80.3% vs 66.7%, p = 0.010) were more common in females, while smoking history was more common in males (70% vs 7.1%, p < 0.001). Females had higher levels of total cholesterol (median 238 vs 189 mg/dL, p = 0.007) and triglycerides (median 160 vs 141 mg/dL, p = 0.026). Using regression analysis, dysphagia remained an independent predictor of poor outcome in both females (OR : 23.4, 95% CI : 2.521-217.2, p=0.006) and males (OR : 15.769, 95% CI : 1.686-147.509, p=0.016). Conclusion: This pilot study highlights important gender differences in stroke charachteristics and emphasizes the need for a wide-scale stroke registry in Egypt. The strong association between dysphagia and poor outcomes in both genders highlights the importance of early dysphagia screening and management in acute stroke care.
Background and Objective: Multiple sclerosis (MS) is an autoimmune demyelinating disorder affecting the central nervous system. Ocrelizumab, a disease-modifying drug for MS, is funded by Bait ul Maal Pakistan for economically disadvantaged patients in Balochistan. The objective of this study was to evaluate the treatment response of Ocrelizumab in our population. Methods: This prospective observational study enrolled 22 patients from three tertiary care hospitals in Balochistan from July 2021 to June 2022. Patients aged 18–50 years diagnosed with MS and without contraindications for Ocrelizumab were included. The Expanded Disability Status Scale (EDSS) was calculated at baseline and at three, six, and 12 months. Patient satisfaction was assessed using a Likert scale (1 = extremely unsatisfied, 5 = extremely satisfied). Primary outcome was EDSS improvement; secondary outcomes included patient and family satisfaction. Results: Of 22 patients, 14 were female and 8 were male, with a mean age of 33.23 ± 9.75 years. RRMS was most common (81%; n=18), followed by primary progressive MS (14%; n=3). Median EDSS improved from 5.36 ± 2.50 at baseline to 3.37 ± 2.98 at follow-up. Major improvement was seen in 20% of patients, mild improvement in 50%, and no change/worsening in 30%. Patient and family satisfaction scores were 3.14 ± 1.42 and 3.10 ± 1.30, respectively. Conclusion: Ocrelizumab is an effective, safe, and acceptable treatment for MS patients in our population. EDSS scores improved significantly from 5.36 to 3.37 at the end of the follow-up period. Both patient and family satisfaction rates were high, indicating positive real-life experiences with the treatment.
Background and Objective: Incidence and prevalence of non-convulsive status epilepticus is difficult to know, especially in developing countries where access to diagnostic tools like EEG is limited. The objective of this study was to determine the treatment and outcome of non-convulsive status epilepticus in children. Methods: A total of 38 children were included in this prospective cross-sectional study, having EEG suggestive of non-convulsive status epilepticus. Response of the treatment given was measured by doing EEG after treatment to see resolution of non-convulsive status and improvement in clinical features too. Outcome was also accessed in terms of morbidity and mortality. The collected data were analyzed using SPSS version 20. Results: There were 38 patients studied who presented with NCSE .There was male predominance and most of the children presented between 2-5 years of age (n=15).These children were treated with multiple antiepileptic drugs . Majority of the patients had NCSE for more than 72 hours(n=24). There were 23 children who partially recovered from NCSE based on EEG findings while 15 got fully recovered and had less morbidity with p value of < 0.000 .In terms of morbidity and mortality a major chunk had no morbidity (n=16). Treatment and EEG based outcome were inversely proportional to each other. Duration of NCSE had great impact on EEG based outcome plus morbidity and mortality. The greater the duration , the more the morbidity with significant p value of < 0.0020 . Conclusion: Non-convulsive status epilepticus needs prompt diagnosis and treatment, as early intervention improves the prognosis in terms of morbidity and mortality.
Background and Objective: Migraine without aura is the most common subtype of migraine and causes significant distress to its sufferers. The objective of this study was to evaluate the role of physical exercise in reducing the frequency and severity of attacks in patients with migraine without aura. Methods: This multicenter cross-sectional study was conducted from March 2024 to February 2025 in departments of neurology and medicine in two tertiary care hospitals in Quetta and Khuzdar. A total of 384 adults age 18–60 years with migraine without aura, diagnosed using ICHD-3 criteria, were selected through consecutive sampling. Patients with other headache types or neurological disorders were excluded. Data were collected via data collection tool. Exercise was defined as aerobic activity for 30 minutes, three times weekly. Pain severity was measured using the Visual Analog Scale. Data were analyzed using SPSS 25. Results: In this study, 288 (75%) were females and 96 (25%) were males, with a mean age of 31.6 ± 8.7 years. Among 384 participants, 143 (37.2%) engaged in exercise, most commonly walking 101 (70.6%), and 92 (64.4%) exercised ≥3 times/week. Stress was reported in 294 (76.6%), irregular sleep in 121 (31.5%), and dietary triggers in 103 (26.8%). Regular exercisers had significantly fewer migraine attacks per month (3.1 ± 1.6) as compared with non-exercisers (4.9 ± 2.3) with p-value < 0.001. Conclusion: Regular physical exercise was associated with a significant reduction in both the frequency and severity of migraine without aura attacks.
Background and objectives: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a chronic immune-mediated neuropathy predominantly affecting the peripheral nervous system including the nerve roots. The objectives of this study were to assess autonomic dysfunction in patients with CIDP using electrodiagnostic techniques and to examine its relationship with clinical and demographic characteristics, COMPASS-31 scores, and the Hughes disability scale. Methods: This case–control observational study included 25 patients with CIDP and 26 age- and sex-matched healthy controls and was conducted at the Neurophysiology Unit of Baghdad Teaching Hospital, Baghdad from February to November, 2024. All participants underwent autonomic function assessment, including Ewing’s cardiovascular tests and sympathetic skin response (SSR). COMPASS-31 and Hughes disability scores were recorded for clinical correlation. The independent Student’s t-test was applied to normally distributed quantitative variables, while non-normally distributed variables were assessed using the Mann–Whitney U test. Categorical variables were analyzed with the chi-square test. Associations between variables were examined using Pearson’s correlation coefficient for parametric data and Spearman’s rank correlation coefficient for non-parametric data. Results: CIDP patients exhibited significantly reduced heart rate variability and exaggerated blood pressure fluctuations, along with prolonged SSR latencies and decreased amplitudes compared to controls. Autonomic dysfunction involved both parasympathetic and sympathetic systems. Significant correlations were found between autonomic parameters and age, disease duration, COMPASS-31 score, Hughes score, and sex. Conclusion: Autonomic dysfunction in CIDP is common, typically mild to moderate, and affects both divisions of the ANS. Clinical and demographic variables may influence the pattern and severity of dysfunction.
Subacute Sclerosing Panencephalitis (SSPE) is a rare and relentless neurodegenerative disorder linked to persistent measles virus infection. We present a case of a 16-year-old female with gradually worsening rigidity, cognitive decline, and myoclonic seizures, minimally responsive to valproic acid. A history of measles infection at age two years emerged. Positive cerebrospinal fluid (CSF) IgG and IgM anti-measles antibodies, along with an elevated CSF/serum antibody index, confirmed SSPE. Treatment with inosine pranobex and clonazepam yielded significant motor and seizure control improvements. This case highlights the importance of early SSPE diagnosis and tailored interventions, shedding light on clinical progression and therapeutic responses.
Background and Objective:Bilateral thalamic lesions present a significant diagnostic and therapeutic challenge due to their critical role in sensory, motor, and cognitive functions. The objective of this study was to study the causes and presentations of bilateral thalamic lesions among patients presenting to a tertiary care hospital. Methods:This retrospective study reviewed 40 patients aged 18–80 years admitted to Aga Khan University Hospital between 2006 and 2023 with MRI-confirmed bilateral thalamic lesions. Data collected included demographics, clinical presentations, radiological findings, and final diagnoses. The data was analyzed through SPSS 22.0. Results:Of the 40 cases analyzed, the most common etiology was Artery of Percheron (AOP) infarction (27.5%), followed by Wernicke’s encephalopathy (20%), Carbon monoxide poisoning (15%), lymphoma (12.5%), Fahr disease (12.5%), Cerebral Venous Sinus Thrombosis (7.5%), and Wilson’s disease (5%). Clinical presentations included altered levels of consciousness, seizures, headache, and vertigo, with MRI revealing distinct patterns for each condition. Conclusion:Bilateral thalamic lesions encompass a wide range of etiologies, each influencing management and prognosis differently. This study underscores the need for precise radiological evaluation and clinical correlation to guide effective treatment strategies.
Background and Objective: Body Mass Index (BMI) has been recognized as a significant risk factor for stroke, especially among younger populations in South Asia. Rising obesity rates contribute to non-communicable diseases, with increased stroke incidences being observed in younger adults. The objective of this study was to assess BMI distribution among Pakistani youth across various educational levels, providing insight into obesity trends and potential health risks. Methods: This cross-sectional study was conducted through an online platform, surveying 2,223 respondents across 38 cities in Pakistan. A semi-structured questionnaire was administered, covering 600 educational institutions. Participants were categorized by BMI using WHO standards: underweight (<18.5 kg/m²), normal (18.5–24.9 kg/m²), overweight (25–29.9 kg/m²), obese (≥30 kg/m²), and extremely obese (≥35 kg/m²). Data collected included participant age, gender, educational level, and institution type, ensuring anonymity and statistical analysis. Results: Among respondents, 33% were enrolled in Master’s programs, 57% were male, and 62% attended public institutions. Notably, 27% of participants had a BMI above 24.9, with a higher prevalence among females. Age analysis revealed an increase in overweight and obesity rates in older groups: 23% in ages 19-24 and 31% in ages 25-28. Educational analysis indicated that obesity rates increased with higher education levels, reaching 30% among postgraduate students. Conclusion: This study reveals a concerning trend of high BMI levels among Pakistani youth, especially at higher education levels, highlighting the need for targeted public health interventions to address obesity and related risks of stroke and other diseases.
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a form of autoimmune encephalitis that predominantly affects young individuals and often presents with neuropsychiatric symptoms. It is frequently misdiagnosed as a primary psychiatric disorder due to its initial presentation. Although first-line immunotherapy typically includes corticosteroids, intravenous immunoglobulin (IVIG), or plasmapheresis, a subset of patients shows limited response and requires escalation to second-line agents such as Rituximab. We report two adult male patients, aged 35 and 41 years, who initially presented with behavioral disturbances, confusion, memory deficits, and speech abnormalities. Both were initially misdiagnosed with psychiatric illnesses, delaying appropriate treatment. Diagnostic workups including MRI, EEG, and cerebrospinal fluid analysis were unremarkable; however, both patients tested positive for anti-NMDAR antibodies in serum and CSF. First-line immunotherapy with methylprednisolone and IVIG failed to yield significant improvement. Rituximab was subsequently initiated, leading to substantial clinical recovery in both cases. One patient experienced steroid-induced psychosis, which was resolved with psychiatric management. No Rituximab-related complications were observed. These cases highlight the importance of early consideration of anti-NMDAR encephalitis in adults presenting with acute psychiatric and cognitive symptoms. Timely diagnosis and escalation to second-line therapy with Rituximab in cases unresponsive to first-line treatment can significantly improve outcomes.
Background and Objective:Bacterial meningitis remains a neurological emergency in adults, with substantial mortality and long-term sequelae, including cognitive impairment, hearing loss, seizures, and focal deficits. The objective of this narrative review was to summarize current evidence on predictors of neurological disability and highlight strategies for prevention and long-term care. Methods:A narrative literature review was conducted using PubMed, Scopus, and Google Scholar for English-language studies published between 2000 and 2025. Keywords included bacterial meningitis, neurological sequelae, predictors, and adults. A total of 40 studies were included after screening 200 abstracts . Key prospective studies, clinical trials, and reviews were prioritized, and additional references were identified from bibliographies of relevant articles and guidelines. Results:Clinical predictors of poor neurological outcome include advanced age, low Glasgow Coma Scale score, seizures at presentation, and delayed antibiotic initiation. Laboratory predictors include low CSF glucose and elevated CSF protein. Radiological findings such as infarcts, hydrocephalus, and ventriculitis are associated with long-term disability. Among pathogens, Streptococcus pneumoniae carries the highest risk of neurological sequelae. Preventive strategies with documented benefit include timely antibiotic therapy, adjunctive corticosteroids, vaccination programs, structured neurorehabilitation, and ongoing follow-up. Conclusion:Early recognition of clinical, laboratory, and radiological prognostic indicators can reduce neurological disability in adults with bacterial meningitis. Future priorities should focus on validating biomarkers, establishing longitudinal registries, and exploring artificial intelligence based risk stratification to guide personalized care.
The novel Coronavirus disease (COVID-19) has been shown to involve the nervous system (both central and peripheral), with or without respiratory involvement in multiple ways. Although not much is known about this disease yet, seizures and status epilepticus which may evolve into refractory status epilepticus have been associated with it along with other manifestations like encephalopathy, neuropathies etc. The mechanism for development of seizures with COVID-19 related disease is not entirely known however it can be the consequence of “cytokine release syndrome” or “cytokine storm” which has been associated with this virus. Patients with COVID-19 infection who develop resistant status epilepticus may have increased morbidity hence early recognition and starting appropriate therapy are key to avoid possible poor outcomes. Here, we present a case of a patient with new onset seizures that rapidly progressed to refractory status epilepticus in the context of COVID-19 infection. Our case report highlights the need of testing for systemic viral infections like SARS-CoV-2 in refractory status epilepticus and using therapies like corticosteroids and IVIG that have shown a role in COVID-19 induced seizures and encephalitis.
Background and Objective: Periodic discharges on electroencephalograms (EEGs) are rhythmic waveforms that may indicate acute or subacute brain injury. This aim of this study was to determine the frequency distribution of periodic discharge subtypes on EEG and to assess their association with underlying etiologies and clinical outcomes in a tertiary care hospital. Methods: This retrospective observational cohort study included neurological patients aged ≥18 years admitted to the medical ICU or ward of Aga Khan University Hospital between January 1, 2021, and January 1, 2023, with periodic discharges on EEG. Patients with prior traumatic brain injury were excluded. Data on demographics, clinical presentation, EEG subtype, neuroimaging findings, management, and outcomes were extracted from medical records. Statistical analysis was performed using SPSS version 22, with categorical variables presented as frequencies and percentages, continuous variables as mean ± standard deviation, and significance set at p ≤ 0.05. Results: Out of f 41 patients, 51.2% were female, with a mean age of 58.5 years. Generalized tonic-clonic seizures were the most common presentation (48.8%), and ischemic stroke was the leading etiology (31.7%). Lateralized periodic discharges were the most frequent EEG subtype. Chronic imaging changes were present in 34%, most often encephalomalacia and gliosis. Most patients (87.8%) were discharged home, while mortality occurred in 12.2%, often linked to status epilepticus or metabolic encephalopathy. Conclusion: Periodic discharge subtypes, particularly lateralized patterns, are often associated with ischemic stroke and severe neurological presentations. Their recognition and etiological correlation are essential for timely intervention and improved patient outcomes.
