Background: Headache disorders are one of the most common neurological disorders in the world and a significant but under-acknowledged burden to the population. Objective: The purpose of the present study was to perform the multidimensional assessment of chronic headache burden using VAS, MIDAS, and HIT-6 among the patients attended at a tertiary care center in Bangladesh. Methodology: This was a cross-sectional observational study that was carried out in a tertiary care hospital in Bangladesh during the month of May to July 2025. Consecutive enrolment of adult patients (patients aged 18 years and above) with chronic headache. The diagnosis of headaches has been laid down based on the ICHD, 3rd edition. Structured questionnaires and assessments that were conducted by physicians were used to gather sociodemographic, clinical, lifestyle, and headache-related variables. The VAS, MIDAS, and HIT-6 were used to assess the severity of headaches, disability, and impact. Results: A total number of 17 patients were included (mean age 42.9 ± 15.2 years; 53.8 per cent men), and the median BMI was 27.7 kg/m². The median VAS, MIDAS, and HIT-6 scores were 6 (4 to 8), 33 (17 to 47), and 58 (47 to 71), which reflects a high disease burden. Unilateral headache was present in 52.1%, visual aura happened in 50.4% and stress and sleep deprivation were some of the frequent inducers. It was common to find cardiometabolic comorbidities. The individual headache characteristics, lifestyle, and comorbidity did not have any significant negative relations with disability and impact (all p > 0.05). The only predictor of severe disability (MIDAS ≥ 21) was the risk of medication overuse, aOR is 0.20, 95% CI is 0.05-0.75; p =0.017). The female scores of HIT-6 were higher than those of the males (p = 0.044). Conclusion: The prevalence of chronic headache is very high in adults taking tertiary care in Bangladesh and is linked to a significant personal and socioeconomic burden. Journal of National Institute of Neurosciences Bangladesh, July 2025;11(2):150-158
Sodium valproate, a first-line antiepileptic drug, is extensively utilized in the treatment of both primary and secondary generalized seizures. Approved by the U.S. Food and Drug Administration (FDA) since 1978, this compound is integral to seizure management. However, clinicians must remain vigilant regarding its potential adverse effects, which can include tremors, Reye-like syndrome, sedation, hepatic toxicity, reduced platelet counts, and pancreatitis. Understanding the pharmacodynamics and safety profile of sodium valproate is crucial for optimizing therapeutic outcomes while minimizing risks in patients requiring long-term antiepileptic therapy. Continuous monitoring is advised to manage and mitigate these side effects effectively. A 19-year-old male student admitted to the emergency department of a teaching hospital with gradually worsening drowsiness, accompanied by nausea and short-lived vomiting. He displayed signs of confusion and altered mental status, including disorganized speech, and complained of severe muscle cramps in his legs. After taking a detailed history from the patient’s representative, it was confirmed that the patient experienced an epileptic seizure six months ago. The patient is currently receiving treatment from a psychiatrist and is prescribed Sodium Valproate at a dosage of 500 mg once daily. The patient's blood was sent for pathological tests, and symptomatic treatment was initiated, which included the administration of normal saline, as well as antiemetics and analgesics. Upon review of the blood report, it was revealed that the sodium level was markedly decreased (86 mEq/L). Considering the clinical literature and the patient's medical history, a provisional diagnosis of drug-induced hyponatremia was established. Clinicians should emphasize the importance of closely monitoring patients taking sodium valproate for hyponatremia and associated complications. Journal of National Institute of Neurosciences Bangladesh, January 2025;11(1):88-91
Background: Surgical management of degenerative cervical disc disease is very challenging. Objective: The purpose of the present study was to assess the surgical management and post-operative outcomes during anterior cervical discectomy and fusion among patients presented with degenerative cervical disc disease. Methodology: This non-randomized clinical trial was conducted in the Department of Neurosurgery at National Institute of Neurosciences and Hospital Dhaka, Bangladesh from January 2022 to December 2023 for a period of two periods. All the patients with the more than or equal to 18 years of age of both male and female who were presented with degenerative cervical disc disease were selected for this study. Patients were undergoing single- or two-level anterior cervical discectomy and fusion (ACDF) for degenerative cervical disc disease. Results: The mean age was 45.5 ± 15.6 years (range: 19 to 79 years). Majority of the patients were male (87/100). Presenting symptoms were neck pain (79.0%), limb weakness (75.0%), paresthesias (57.0%), radicular pain (47.0%), stiffness in limbs (17.0%), and bladder involvement (15.0%). During discharge, significant improvement in preoperative symptoms were reported like neck pain (61%), stiffness in limbs (81.0%), limb weakness (72.6%), radicular pain (63.0%), paresthesias (83.0%), and bladder symptoms (61.0%). There were several postoperative complications reported like dysphagia (19.0%), hoarseness of voice (29.0%), deterioration of motor power (8.0%), and postoperative hematoma (7.0%). Conclusion: In conclusion most of the patients show remarkable recovery after ACDF who are presented with degenerative cervical disc disease. Journal of National Institute of Neurosciences Bangladesh, July 2024;10(2):98-103
Background: Patient admitted with hemorrhagic stroke, particularly primary intracerebral hemorrhage (ICH) may develop different form of complications during their hospital stay. Objective: The objectives of the study were to find out the different complications of primary intracerebral hemorrhage among admitted patient and their effect on hospital stay and outcome. Methodology: This was a hospital based observational follow up study conducted at National Institute of Neurosciences and Hospital, Dhaka, Bangladesh in a period of 18 months (from February 2021 to August 2022). Total 570 (504 finally analyzed) primary intracerebral hemorrhage patient who admitted within 48 hours of onset of stroke were enrolled consecutively by purposive sampling method. Routine biochemical, hematological tests and computed tomography scan were done to all participants. All patients were followed up every day during hospital stay and any complication developed were noted. Patients’ outcome (discharge / death) was recorded. Results: This study revealed that mean (SD) age of participants were 59.1 (±13.4) years with majority male 262(52.0%). Electrolyte imbalance (hyponatremia) was the commonest complication found in 212 (42.1%) of patient followed by hematoma expansion 22.6%, hydrocephalus 15.5%, aspiration pneumonia 11.1%, convulsive seizure 10.0%, urinary tract infection and pressure sore both are 3.6%. Deep vein thrombosis was found in1.2%. Hypertension was the commonest risk factor (93.0%) followed by Diabetes mellitus (28.1%). Older (>50 years) age (OR: 0.53; 95% CI: 0.36-0.80; p = 0.002), urban dwellers (OR: 1.56; 95% CI: 1.04-2.27; p =0.013) and poor (<9.0) admission Glasgow Coma Scale (GCS) were associated with higher rate of complications (p = 0.001). Presence of Hydrocephalus (OR:0.66; 95% CI: 0.48-0.90; p = 0.001), Aspiration pneumonia (OR:0.53; 95% CI:0.99-0.73; p=0.0001), and convulsive seizure (OR: 0.63; 95% CI: 0.44-0.89; p=0.015) were associated with higher mortality. During hospital stay different form of complications developed in 338(67.0%) of patients and 356(70.6%) of patient discharged to home successfully. Different form of complication leads to longer hospital stay (p = 0.001) and higher mortality rate (p = 0.001) compared to those who developed no complication. Conclusion: Hyponatremia is the most common complication followed by hematoma expansion and hydrocephalus. Longer hospital stays and higher incidence of mortality was observed in patients who developed in-hospital complication after the stroke event. Journal of National Institute of Neurosciences Bangladesh, July 2024;10(2):87-93
Background: Biofilm are associated with many medical conditions including indwelling medical devices, dental plaque, upper respiratory tract infection, peritonitis and urogenital infections and microorganisms growing in a biofilm are intrinsically more resistant to antimicrobial agents than planktonic cells. Objective: The aim of the study was to investigate that biofilm formation and antibiotic resistance by Enterococci species is common in urine of catheterized patients and more than urine of non-catheterized patients. Methodology: This cross-sectional study was carried out in the Department of Microbiology at Dhaka Medical College, Dhaka, Bangladesh. All the suspected cases of urinary tract infection patients were selected as study population. Among the Enterococci, biofilm detection was done by tissue culture plate method. Susceptibility to antimicrobial agents of all isolates were done by Kirby-Bauer modified disk-diffusion technique. Results: Biofilm formation and antibiotic resistance by Enterococci was more in catheter associated urine than catheter non associated urine. Conclusion: The purpose of the study was to show biofilm producing Enterococci and antibiotic resistance pattern of them. Journal of National Institute of Neurosciences Bangladesh, July 2024;10(2):110-113
Tuberculosis (TB) remains one of the world’s leading infectious causes of morbidity and mortality, despite decades of public health efforts and the availability of effective treatment. This narrative review explores the current understanding of the epidemiology, clinical features, diagnostic approaches, and challenges related to treatment failure in TB. Globally, an estimated 10 million new TB cases and 1.3 million TB-related deaths were reported in 2022, with the burden disproportionately affecting low- and middle-income countries. Risk factors such as HIV co-infection, malnutrition, poverty, and crowded living conditions contribute significantly to disease transmission and persistence. Clinically, TB primarily affects the lungs but can involve almost any organ, presenting with a wide spectrum of symptoms ranging from persistent cough, fever, night sweats, and weight loss to non-specific signs in extra-pulmonary cases. Early and accurate diagnosis is crucial for controlling the spread and improving patient outcomes. Conventional diagnostic methods such as sputum smear microscopy have limited sensitivity, while newer tools like GeneXpert MTB/RIF and culture methods have improved diagnostic accuracy but face challenges of cost and accessibility in resource-limited settings. Despite standardized treatment regimens, treatment failure remains a critical issue due to factors including non-adherence, drug resistance, inadequate healthcare infrastructure, and patient-related social determinants. Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) have emerged as major threats to global TB control, requiring longer, more toxic, and costlier treatment courses with variable success rates. Addressing treatment failure demands a multifaceted approach, incorporating patient education, community-based support, strengthened healthcare systems, and robust public health policies. This review underscores the need for continuous innovation in diagnostics, treatment regimens, and patient-centered interventions to achieve global targets for TB elimination. Journal of National Institute of Neurosciences Bangladesh, July 2024;10(2):130-137
Abstract not available Journal of National Institute of Neurosciences Bangladesh, July 2024;10(2):139-140
Abstract not available Journal of National Institute of Neurosciences Bangladesh, July 2024;10(2):138
Background: Therapeutic Plasma Exchange (TPE) is a very effective modality of treatment for many of the immune-mediated neurological disorders. Objective: The aim of study was to evaluate demographics, indications, adverse reactions and outcome of TPE in patients with neurological disorders. Methodology: This prospective study was conducted in the Department of Transfusion Medicine at National Institute of Neurosciences and Hospital (NINS), Dhaka from January 2023 to December 2023 for a period of one year. All the available data were systematically recorded and these were variables of demographics, clinical indications, numbers of sessions, volume of exchanged plasma, clinical response and complications during or after the procedure. Results: A total number of 110 patients with different neurological disorders had undergone 362 sessions of TPE among which 71 (64.5%) were male. The mean age, number of TPE session and volume of plasma exchange were 33.6±12.3 years (Range 15 to 71), 3.8±1.1 (Range 2 to 7), 2105±320mL (Range 1400 to 3200) respectively. Guillain-Barre Syndrome (GBS) (n=68, 61.8%) was the most common indication of TPE followed by Myasthenia gravis (MG) (n=18, 16.4%). In 362 sessions of TPE, overall incidence of adverse reaction was in 47(12.98%). Allergic reaction (n=15, 4.14%) and hypotension (n=9, 2.48%) were most commonly reported. Reactions were mild and were reversed by bed side managements. Conclusion: A variety of neurological disorders require TPE as a treatment option, with Guillain-Barré Syndrome and Myasthenia gravis being the most common cases in our setting. Journal of National Institute of Neurosciences Bangladesh, July 2024;10(2):77-82
Background: Prolapse lumbar intervertebral disc (PLID) can occur in different age and gender patients. Objective: The purpose of the present study was to observe the demographic profiles of prolapse lumbar intervertebral disc (PLID) patients. Methodology: This cross-sectional study was carried out in the department of Neurosurgery at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from March 2006 to October 2007 for a period of one and half year. Prolapse lumbar intervertebral disc (PLID) patients who were admitted in the Department Neurosurgery at BSMMU, Dhaka, Bangladesh after clinical and radiological evaluation were selected as study population. Age, sex, occupations of the patients were recorded. Results: A total number of 59 PLID patients were recruited of this study. Among them 54 cases were male and the rest 5 cases were female patients. The mean age of the patients was 40.8±11.9 years and the lowest and highest ages were 21 and 65 years respectively. The male to female ratio was 11:1. Nearly 55.0% cases of the patients engaged with manual work and the rest 45.8% cases were non-manual worker. Conclusion: In conclusion young adult male patients engaged in manual works are the most commonly suffering from PLID. Journal of National Institute of Neurosciences Bangladesh, July 2024;10(2):83-86
Background: There are several indications for performing the caesarean section. Objective: The purpose of the present study was to see indication of operations and pattern of referral among women presented with post-caesarean section complications. Methodology: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecological at Dhaka Medical College and Hospital, Dhaka, Bangladesh from January 2013 to June 2013 for a period of six months. All women admitted with post caesarean section complications referred from different level of hospitals with the age group of more than or equal to 18 years were included as study population. All relevant data were recorded in a predesigned data collection sheet which included pattern of referral, causes of referral and history of primary operation. Results: A total number of 50 women were included in this study. Maximum (40%) patients were within the age group of 21 to 25 years. For majority caesarean delivery were done for prolonged labor (24.0%) followed by previous one or two caesarean section (16.0%). However, obstructed labour and postdated pregnancy were also reported which were 6(12.0%) cases in each. Maximum cases of CS were performed by practicing doctors (46%). About 48.0% patients came with referral notes from the referring hospitals and majority (52%) were referred without any referral notes. Conclusion: In conclusion the most common indication for referral of women presented with post-caesarean section complications has been performed by practicing doctor for prolonged labor without referral notes in the advice. Journal of National Institute of Neurosciences Bangladesh, July 2024;10(2):119-123
Background: Threatened abortion is very crucial condition among the pregnant women. Objective: The purpose of the present study was to assess the prevalence and socio-demographic characteristics of threatened abortion. Methodology: This cross-sectional study was done in the Department of Obstetrics & Gynaecology at Rajshahi Medical College Hospital, Rajshahi, Bangladesh from January 2004 to December 2004 for a period of one year. Patients admitted with the history of pregnancy with per vaginal bleeding before 20 weeks without having any cervical effacement or dilatation were included in this study group. Socioeconomic status of the patients was reflected by their places of habitations, educational back ground, occupations, and level of income. Results: The threatened abortion was reported at all stage of reproductive age. Women between 20 to 30 years had constituted the largest age group (58.0%). About 80.0% of the patients were illiterate. Of the 100 patients, 58 lived in rural areas or urban slums and 81 in kucha floored houses or slums. A large majority (77 out of 100) belonged to low or very low-income groups. Most of the study population were coming from low-income group (10,000.00 to 20,000 BDT) which was 63.0% cases followed by middle Income (20,000.00 to 50,000 BDT) and very low Income (less than 10,000.00 BDT) were in 22.0% cases and 14.0% cases respectively. Conclusion: In conclusion middle age illiterate women are the most commonly suffering from threatened abortion. Journal of National Institute of Neurosciences Bangladesh, July 2024;10(2):114-118
Background: Children often undergo medical evaluation for fever, which can be difficult to diagnose as serious infection or viral illness. Fever of unknown origin (FUO) is categorized within prolonged fever lasts at least 14 days. Objectives: This study aimed to find a clinical and etiologic profile of children presenting with prolonged fever in tertiary care hospital in Bangladesh. Methods: This prospective observational study was conducted at the Department of Pediatrics, Monno Medical College and Hospital, Manikganj, Bangladesh from January 2020 to July 2021. A total of 100 children with fever for seven days or more were enrolled as the study subjects using a purposive sampling technique. Results: In this study, 55% of participants were aged 3-10 years, with a male-female ratio of 1.8:1. Most patients (69%) were well-nourished. All participants had fever, while 43% experienced vomiting, 32% abdominal pain, 24% cough, and 16% headache. Clinical findings included coated tongue (36%), hepatosplenomegaly (24%), isolated hepatomegaly (12%), and eschar marks (10%). The causes of prolonged fever identified were enteric fever (42%), rickettsia (21%), UTI (13%), combined enteric fever and UTI (8%), and pneumonia (7%). Conclusion: Male children aged 3 to 10 years are particularly prone to prolonged fever, regardless of nutritional status. Common symptoms include vomiting, abdominal pain, cough, headache, coated tongue, and hepatosplenomegaly. Potential causes of prolonged fever in children include enteric fever, rickettsia, and urinary tract infections. Journal of National Institute of Neurosciences Bangladesh, July 2024;10(2):104-109
Abstract Not Available Journal of National Institute of Neurosciences Bangladesh, July 2024;10(2): 75-76
Background: Guillain Barre Syndrome can occur in different group of people. Objective: The purpose of the present study was to sociodemographic characteristics of patients presented with Guillain Barre Syndrome. Methodology: This cross-sectional study was conducted from October 2017 to September, 2018 in the Department of Clinical Neurology at the National Institute of Neurosciences and Hospital, Dhaka, Bangladesh. The patients were selected according to the selection criteria and after confirmation by electrophysiological study. Details socio-demographic variables of the study population were collected like age, gender, education, occupation, socioeconomic status and so one. Details history and meticulous examination were performed to collect the data according to the variable of interest. All necessary investigations were done at an optimum time. Nerve conduction study and CSF were done after 1st week of onset of the disease in the respective department of the institute. Results: A total number of 108 GBS patients were recruited for this study. Mean age of the study participant was 36.39 ± 16.03 years. Male was predominantly affected with a ratio of male and female in 2.4:1. Maximum patients were in the primary level of education which was 31(28.7%) cases. Highest number of cases were observed in the spring which was 43 (39.8%) cases. Conclusion: In conclusion middle age male patients are most commonly admitted in the hospital presented with GBS which are mostly occurs in Springs. Journal of National Institute of Neurosciences Bangladesh, July 2024;10(2):124-129
Abstract Not Available Journal of National Institute of Neurosciences Bangladesh, January 2025;11(1):1-2
Background: Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare and heterogeneous immune-mediated neuropathy. Objectives: The aim of this study was to evaluate the clinical and electrophysiological aspects of CIDP in adult. Methodology: This cross-sectional study was carried out in the department of Neurophysiology of National Institute of Neurosciences and Hospital, Bangladesh from July 2020 to July 2022. We included 50 consecutive patients aged 18 years to 70 years fulfilling criteria for CIDP proposed by the European Federation of Neurological Societies and the peripheral nerve society, 2010. These patients were evaluated by detailed history, physical examination and electrophysiological findings. Results: The mean age was 43.82 ± 13.43year. Males were more affected than female. Weakness and paresthesia were the most common symptoms. 92% patients had a progressive and 8% had relapsing course. Most patients were classified as typical CIDP (90.0%) and 92.0% patients had electrophysiological definite CIDP. Conclusion: CIDP affects males mostly in the 3rd to 5th decades. Typical CIDP was most common. Weakness in both proximal and distal muscle groups along with paresthesia were the most common symptoms. Few patients had distal wasting. Diabetes mellitus was associated disease in 36% of the cases. Journal of National Institute of Neurosciences Bangladesh, January 2025;11(1):34-40
Background: Brain death is the irreversible end of all brain activity (including involuntary activity necessary to sustain life) due to total necrosis of the cerebral neurons following loss of brain oxygenation. In medical practice, common causes of death include stroke, acute myocardial infraction, heart failure, septicemia, COPD with respiratory failure, poisoning etc. Vital statistics outlining the major causes of death in a population are an important measure of public health. Objective: The aim of this study was to identify the causes of death from acute emergency and in chronic medical diseases with their demographic profiles. Methodology: It was a hospital based observational study, and the study period was 3 months (July, 2010 to September, 2010). The patients who died after admission in medicine ward of Dhaka Medical College Hospital were enrolled. The death certificate was collected from the office copy and the ICD code-based certificate writing was noted. The underlying cause of death, immediate cause of death and contributory cause of death was observed to understand the exact etiology of death in Medicine department. Results: The study group consisted of 100 subjects of whom 56 were male and 44 were female. Male: female ratio was 1.27:1. The age range was 18-90 years. Mean age was 49.34 for male and 42.94 for female. Death occurred in 45% cases within 24 hours, 49% cases from 1 to 7 days, 6% after 7 days. The major cause of death was stroke (26%) followed by poisoning (14%). Conclusion: The death audit revealed that the majority cases of death in medicine happen due to cerebrovascular accident and poisoning. Journal of National Institute of Neurosciences Bangladesh, January 2025;11(1):28-33
Background: Uterine abnormalities are common but often underdiagnosed contributors to female infertility, and transvaginal ultrasonography provides a sensitive, non-invasive method to detect these structural pathologies—an area particularly relevant in Bangladesh, where infertility poses a growing reproductive health challenge. Objective: This study aimed to assess the presence and pattern of uterine abnormalities using transvaginal ultrasonography (TVS) in women presenting with infertility in a tertiary care hospital of Bangladesh. Methodology: This cross-sectional study was conducted from January to December 2020 at the Department of Reproductive Endocrinology and Infertility, Dhaka Medical College Hospital. A total of 98 women presenting with infertility and undergoing routine TVS were enrolled. Women with hormonal disorders or male factor infertility were excluded. Data on sociodemographic characteristics, reproductive and menstrual history were collected through face-to-face interviews using a semi-structured questionnaire. TVS findings were also recorded. Results: The mean age of participants was 30 ± 5 (SD) years; 67.0% resided in urban areas and 69.0% had primary infertility. Menorrhagia was reported in 54% and dysmenorrhea in 26.0% of participants. TVS revealed uterine pathologies in 93.0% of cases, with acquired causes being predominant. Fibroids were the most common finding (54.0%), followed by adenomyosis (28.0%). Other acquired abnormalities included endometrial polyps (6.0%), endometrial hyperplasia (4.0%), and intrauterine adhesions (1.0%). Congenital uterine anomalies were observed in 16.0% of women, with arcuate uterus being the most frequent (11.0%). Congenital uterine pathologies were more common in participants with primary infertility (21.0% vs 8.0%), while acquired uterine causes were more frequent in participants with secondary infertility (92.0% vs. 79.0%). No statistically significant association was observed (p>0.05). Conclusion: TVS identified a high prevalence of uterine pathologies, with fibroids and adenomyosis being the most common. Journal of National Institute of Neurosciences Bangladesh, January 2025;11(1): 81-87
Background: Cerebral venous sinus thrombosis (CVST) is a rare form of stroke frequently underdiagnosed due to its variable clinical presentation which may be related to different pattern of dural sinus involvement. Objective: The purpose of the present study was to evaluate the clinical and radiological profiles of patients diagnosed with Cerebral Venous Sinus Thrombosis (CVST) and to categorize the findings based on their mode of presentation. Methodology: This cross-sectional study was conducted in the Department of Neurology at National Institute of Neurosciences & Hospital, Dhaka, Bangladesh from January 2023 to May 2025 for a period of approximately two and half years. All the patients diagnosed as CVST, admitted at IPD were selected as study population. The patients were examined clinically and radiologically confirmed. Results: Of the total of 100 patients, majority of the patients were young adult (mean age 33.58 ± 13.47) with female predominance (76.0%). Headache was the most common presenting complaint (95.0%), followed by vomiting in (82%) and Impaired consciousness (43.0%). Focal deficit was found in 44.0% and papilledema 52.0% of participants. Majority of presented in the sub-acute phase (74%), while chronic presentations were relatively rare (5.0%). The majority of patients (79.0%) had multiple sinus involvement. The transverse sinus was the most frequently affected (83.0%) followed by Superior Sagittal Sinus (65.0%) and Sigmoid sinus (65.0%). Visual disturbances and papilledema were significantly more prevalent in the CVST patients with sub-acute presentation compared to the acute CVST patients (p = 0.002 and p = 0.001 respectively). Conclusion: In conclusion, cerebral venous thrombosis presents with diverse clinical features, often with overlapping symptoms across different stages. Journal of National Institute of Neurosciences Bangladesh, January 2025;11(1):3-8
