The “Type of Article” of this paper is “Letter to the Editor”. This paper discuses about: “Stroke Thrombolysis in Difficult Circumstance: When Benefit May Not OverruleRisk!”. No formal abstract is available. Readers are
The “Type of Article” of this paper is “Letter to the Editor”. This paper discuses about: “Is High Blood Pressure Always an Obstacle in Stroke Thrombolysis?”. No formal abstract is available. Readers are requested to read the full article.
Cervical artery dissection accounts for almost 20% of ischemic strokes in young patients. Vertebral artery dissection is considered less common than carotid dissection, and 18% of cases are bilateral. The typical presentation is posterior neck pain, holocranial or frontal headache, and focal neurological manifestations if a secondary ischemic event occurred. Compressive radiculopathy is a rare complication of vertebral artery dissection and C5 is the most commonly affected root. We report two cases of cervical radiculopathy, a rare complication of vertebral artery dissection.
Tetanus remains a major public health problem in developing countries. The annual number of cases in Morocco is relatively low. The prognosis for this disease is as severe as ever, and all the gloomier as the diagnosis and treatment are late. Despite the improvement in intensive care, its lethality is still high, especially due to respiratory complications, Managing injuries is a major tetanus prevention strategy. Failure to manage injuries places victims dangerously at risk of disease. It is important to also assess tetanus immunization through the health or vaccination record. Symptomatic treatment is based on the use of muscle relaxant and sedative therapy, in which diazepam is the leader. Barbiturates, in particular phenobarbital, can be used alone or in combination with diazepam in severe forms. Central analgesics, and sometimes curares, are used in the sedation of patients placed on mechanical ventilation through a tracheal intubation tube, or secondarily through a tracheostomy tube which is often necessary. The specific treatment consists of antibiotic therapy (Peni G or Metronidazole), serotherapy, and tetanus vaccination as well as the management of tetanus-prone wounds. Vaccination should be routine to prevent recurrence, because tetanus is not an immunizing disease. We report a case of tetanus following a puncture wound to the soles of the feet by a rusty nail. The objective is to remind clinicians of the importance of this prophylaxis in any injured person who is not vaccinated or has a questionable immune status. Our Patient is a 28-year-old vaccinated against tetanus but without a booster for more than 5 years, was admitted to intensive care at the Avicenna military hospital in Marrakech, for neck pain, difficulty walking and opening the mouth(masseter muscle spasm, or lockjaw), abdominal contracture and para-vertebral muscles. In his history, he points to a perforating wound on the sole of the foot with a rusty nail that was treated without tetanus prophylaxis about two weeks ago. The examination on admission noted a trismus, abdominal contracture, and a puncture scar on the soles of the feet. The diagnosis of a generalized tetanus at portal of entry a puncture plantar wound was retained. Under treatment the initial evolution was favorable and he was released from the hospital onAugust 04, 2021.He was readmitted eight days later for the reappearance of neck stiffness, pain in back, painful tonic contractions and spasms and thoracic rigidity, the course was characterized by the occurrence of a spectacular opisthotonus particularly triggered by light stimuli. The introduction of phenobarbital with gradual reduction in dose of diazepam allowed a remarkable reduction in the frequency of spasm and paroxysms, he was discharged from the hospital on August 20, 2021 on Phenobarbital 50 mg twice a day in the morning and in the evening.
Subacute Sclerosing Panencephalitis (SSPE) is a progressive demyelinating disease of the central nervous system, associated with chronic infection of brain tissue with measles virus. Dykan criteria for definite diagnosis of SSPE includes a) clinical features of declining cognition and myoclonus b) periodic discharges on EEG c) increased cerebrospinal fluid globulin levels d) elevated titers of anti-measles antibody and e) brain biopsy. Short term video EEG is a non invasive procedure with simultaneous EEG and video recording. EEG patterns in SSPE are characteristic and specific; which includes repetitive high amplitude paroxysmal polyphasic complexes with duration of 0.5-2 seconds and repetitive rate of 4-30 seconds. Short term video EEG is a useful diagnostic tool for confirming the diagnosis of SSPE. A simultaneous video recording will be helpful to documenting slow myoclonus and EEG correlation.
Background: Over the last few years, there has been a steady increase in the incidence of neurological diseases in Nigeria particularly stroke, epilepsy and dementia. Therefore, it was needful to determine the current burden imposed by such disorders in Nigeria especially in the rural communities. This survey was carried out in Ilie community, Southwest Nigeria. The aim of this report is to address some of the findings of the survey including the high treatment gap, social issues and societal impact of these common neurological disorders on the community.
Methods: The study was carried out in a remote community known as Ilie which is located in Osun state, Nigeria. Ilie ward was screened from door to door, to identify people who had suffered from Neurological Disorders (ND) (lifetime prevalence).In determining the prevalence of ND, a two-phase cross-sectional study design was adopted. The first phase involved the demographic data collection from each screened household and the administration of WHO screening questionnaire for ND by the trained field interviewers. The second phase was the clinical examination of the participants who were positivenduring the first phase of screening by the neurologists to confirm the diagnosis of the identified neurological disease. Social issues such as access to education, employment opportunities and marital prospects as well as treatment issues were also assessed.
Results: In the first phase, the numbers of individuals screened were 2212, all from 231 households. The female participants accounted for 1111(50.3%) and males were 1101(49.7%), therefore the females were slightly more than the males. Thirty-three (33) cases of ND were detected giving a point prevalence of 1.9% and epilepsy was discovered to be the commonest. Traditional medicine as well as spiritual healing was the mainstay of treatment.
Conclusions: The burden of neurological disease was still high in this rural community of Southwest Nigeria and knowledge, social and treatment issues were still present.
Aim: The purpose of this study was to assess the variations in the of sphenoid sinus pneumatization in the Sudanese.
Materials and Methods: The study is a cross sectional observational descriptive study included 100 patients (50 males, 50 females) who underwent Magnetic Resonance Image (MRI) of the paranasal sinuses. The paranasal sinus was assessed for the type of pneumatization.
Results: The conchal, presellar, and sellar types comprised 1%, 17%, and 82%, of participants. No significant differences were found between males and females of the study group. These results were relatively different when compared to the Indians but relatively the same with Turkish.
Conclusion: The type of pneumatization of the sphenoid sinus has different prevalence worldwide, so meticulous assessment of sphenoid sinus is mandatory before sellar and skull base surgery.
Background: Inherited neuropathy is a group of common neurologic disorders with heterogeneous clinical presentations. The study aimed to evaluate the clinical and electrophysiological profiles of children with inherited neuropathies and categorize them under various inherited neuropathies considering the clinical and electrophysiological parameters.
Study design: This was a hospital-based retrospective observational study.
Place and duration of study: The study was taken place in the department of Neurophysiology at a tertiary care hospital in Bangladesh. The duration of the study was three years, from January 2018 to December 2020.
Methodology: A total of 38 children with inherited neuropathies aged 0-17 years were included in the study. Considering the clinical, electrodiagnostic data, and other investigation reports obtained by review of medical records, we categorized the patient as having hereditary neuropathy affecting primarily the peripheral nervous system (PNS) and neuropathy as a part of other neurologic or multisystem disorders. Charcot-Marie-Tooth disease (CMT) was further divided depending on the electrophysiological findings.
Results: Among 38 enrolled children, 52.63% were male. Their mean age at the time of enrollment was 8.69 ±3.55 years. Family history of the same type of disease was found in 13.16% of cases and consanguinity was present in 15.79% of cases. Most of the children (78.95%) had neuropathy primarily involving the PNS. CMT1 (44.74%) was the most frequent phenotype among all inherited neuropathies, followed by CMT2 (18.42%). Frequently observed clinical findings of CMT include weakness (92.86%), small muscle wasting (78.57%), reduced or loss of deep tendon reflexes (96.42%), and foot deformities (57.14%). Only five patients received a definite genetic diagnosis.
Conclusions: The clinical spectrum of inherited neuropathies is diverse. Electrophysiological studies remain a powerful diagnostic tool in the evaluation of children with peripheral nerve disorders. Although CMT was the most frequent phenotype, neuropathy associated with other neurologic or multisystem disorders is not rare.
The key to accurate classification of epilepsies is the accurate characterization of seizure types and clinical history. Accurate clinical characterization of seizures is important in selecting candidates who are more likely to benefit from radio-imaging. Few studies have addressed the clinical characteristic of seizures in people living with epilepsy (PWE) in southeast Nigeria. A total of 150 cases of epilepsy were reviewed with a male to female ratio of 1.7:1. P=0.96. The mean age of the patients was 33.6(16.4) years. The peak age group of the patients was 20-29 years with a smaller peak after 50 years. The mean age-of-onset was 30.9(15.3) years, earlier in females than males. P=0.01. The peak age onset was 0-9 years. More than half of the PWE (54%) reported that seizures could occur at any time of the day while 4(2.7%) said they had seizures on awakening. Seventy (46.7%) could never predict the onset of seizures. Sixty-eight(45.3%) had experienced multiple seizures within a week in the past and 54(36%) had experienced prolonged seizures lasting more than 10 minutes. Overall, 78(52%) reported a history of bodily injury but only 12(8%) considered their injury as severe. The commonest medication used 114(76%). In conclusion, there is second peak of age-of-onset after 50 years in epilepsy patients attending a hospital clinic in southeast Nigeria. About 46.7% could predict the onset of seizures. PWE also reported high rates of possible status epilepticus and seizure clusters, high rates of injury.
Background: Pediatric neurodevelopmental disorders have a large burden on the health care system all over the world particularly in developing countries. Due to the constraints of the appropriate diagnostic tools many of these children report late and identification in appropriate time is not possible. These missed opportunities thus increase the number of children with disability. Therefore simple measures are needed to determine neurodevelopmental impairment (NDI) at an early age where professional expertise is sparse.
Objective: To determine the proportion of children having NDIs in a tertiary care hospital by using Development Screening Questionnaire (DSQ); and to estimate the specific types of NDIs within the study population.
Methods: It was a cross sectional observational study held in Department of Pediatric Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from January 2018 to December 2018. Children aged 0-2 years who were attending Pediatric Neurology out patient department were included in the study. Screening of all children in the sample was done by DSQ for NDIs.
Results: Among the study subjects, 7.26% children were found to have DSQ positive for NDIs. Cognition (64.71%) and speech (64.71%) were the mostly affected domain. Detection of NDIs by DSQ in other domains were: gross motor (35.29%), fine motor (17.65%), hearing (29.41%), vision (25.53%), behavior (5.89%) and socialization (0.0%).
Conclusion: In this study group, the frequency of NDIs was 7.26%. In certain developmental domain (i.e. cognition, speech, gross motor, hearing) NDIs were detected more in this small scale study by using DSQ.
Aim: To identify the difference in motor learning duration between right and left dominant subjects for a novel task.
Study Design: Quasi-experimental study design with two groups, pre and post-intervention assessment
Place and Duration of Study: The study was conducted at KMCH College of Physiotherapy, Coimbatore, between January to July 2018.
Methodology: 30 healthy subjects, 15 right dominant in group A and 15 left dominant in group B, within the age group of 18 to 25 years, were selected for the study. A well-designed practice protocol was made for a novel motor task of transferring wooden cubes of 1cm3 from one tray to another using chopsticks. Pre and post-test scores were recorded as the total time taken to transfer 50 cubes.
Results: 9 males and 6 females were recruited in each group. It was identified that both groups had a significant reduction in the time taken to complete the task. (Mean Difference Group A=109.2±5.5; B=111.1±5.7).
Conclusion: We conclude that there is no difference in the duration of motor learning between right and left dominant subjects. Both groups demonstrated a significant reduction in the time taken to complete the novel task with 7 sessions of practice. Hand dominance will not influence the time taken in acquiring skill in performing a motor activity through practice/training.
Superior orbital fissure syndrome (SOFS) is a rare condition characterized by ophthalmoplegia, proptosis, ptosis, and dilation and fixation of the pupil. We present a case series with clinical and radiological findings of patients with idiopathic SOFS. All five patients had a subacute onset of lateralized painful ophthalmoplegia. All patients were female, and 3 patients were aged >50 years. Diabetes was the common (n=3) comorbidity and 4 patients sought medical help in the second/third week after symptom onset. The most common presenting symptom was drooped eyelid followed by mild-to-moderate headache. The ophthalmic division of the trigeminal nerve was involved in 3 patients. The most common radiologic abnormality was visible soft tissue in superior orbital fissure extending anteriorly, which showed faint enhancement. Patients were managed with corticosteroids, with complete recovery seen within 8 weeks. One patient had disease relapse after 6 months with the same side affected but with a larger granulomatous lesion, who responded well with a second course of corticosteroids. In conclusion, most cases of SOFS are idiopathic or inflammatory and respond well to corticosteroids. The treatable causes need to be ruled out before considering neoplastic etiology. The early recognition of symptoms and prompt treatment may result in better outcomes.