Neurological disorders and disability in Pakistan: A cross-sectional multicenter study.

BACKGROUND/OBJECTIVE: The aim of this study is to identify frequencies of various neurological disorders (NDs) and associated disability in patients attending neurologic clinics in rural and urban centers in Pakistan. METHODS: This is an observational study conducted in 39 neurological centers in both rural and urban areas, public and private health sectors all over Pakistan. This study was conducted between august 2017 to December 2019. RESULTS: A total of 28,845 adults were enrolled. Mean age of the study participants was 46.2 ± 17.2 years, 15,252 (52.9%) were men and 13,593 (47.1%) were women. Most common comorbid medical condition was hypertension 7622(26.4%) followed by Diabetes 3409(11.8%). Among neurological diagnoses, vascular diseases (20%) were the most common followed by Headache disorders (18.6%), Epilepsy (12.5%), nerve and root diseases (12.4%), Psychiatric diseases (10%), Dementias (8%) and movement disorders (7.9%). Half of the patients 15,503(53.7%) had no neurological disability, while minor disability was present in 10,442(36.2%) of cases. Moderate to severe disability was present in 2876(10%) cases. Headache disorders, psychiatric diseases, muscle pain/muscle related disorders and demyelinating diseases were more common in women. Vascular diseases, movement disorders and Dementias were more common in 46 years and above age group whereas headache disorders, Epilepsy and Psychiatric disorders were more prevalent in <46 years age groups. CONCLUSION: Vascular diseases are the most common presentation of patients in neurology clinics followed by headache disorders and epilepsies. Minor disability was present in 36% while moderate to severe disability was present in 10% cases.

Neurological Manifestations in Two Cases of En Coup De Sabre.

Scleroderma En Coup de Sabre (ECDS) is a form of localised scleroderma that primarily develops in the younger population, usually before the age of 18 years and occurs on the scalp or forehead. In localised scleroderma, en coup de sabre, many studies and case reports describe neurological signs and symptoms. Two patients with the disease are reported here who were noted to have brain cysts by neuroimaging. It is important to specifically inquire about neurological symptoms and signs in the history and examination, respectively, and to consider neuroimaging in patients with scleroderma en coup de sabre to diagnose and treat neurological complications. Key Words: Localised  scleroderma, en Coup de Sabre, Neurological manifestations.

Cerebral venous sinus thrombosis sequel of COVID encephalitis; a rare presentation.

The SARS Covid-19 pneumonia became a pandemic in 2019 affecting millions worldwide and carried a significant high mortality rate. The common presentation of this novel virus is upper and lower respiratory tract infection. However, its popularity as neuropathogen has increased dramatically. Patient presents a wide range of symptoms. We report a case of Covid-19 encephalitis which was incidentally found to have cerebral venous sinus thrombosis, presented with acute delirium and then developed new onset seizures.

Preparedness and impact of COVID 19 infection at tertiary care neurology centers in Pakistan.

OBJECTIVE: We aimed to assess the response and impact of covid 19 pandemic at tertiary care centers in Pakistan especially pertaining to neurological care, facilities and training. METHODS: A pre-tested survey form was sent to 40 neurology tertiary care centers in all the provinces in the country in the first week of July 2020. 33 filled forms were received, out of which 18 were public (government) and 15 were private hospitals. RESULTS: Estimated 1300 HCW (faculty, medical officers, trainees and nurses) work at these 33 participating centers. There were 17 deaths among HCW (1.3%) at ten centers. Sufficient personal protective equipment (PPE) were provided to 158 HCW (12%). 129 (10%)HCW tested positive for COVID 19 at 31 centers including trainees/medical officers (39), consultants (29) and nursing and other staff (61). Due to low neurology admissions, 23/33 hospitals (70%) posted neurology trainees in COVID 19 units to contribute to covid care. Less than 50% hospitals did covid screening PCR before admission to neurology wards. Only 10% hospitals provide training and regular update to HCW. Neurology tele-health services were started for clinically stable patients at 15 (45%) centers. Only 60% neurology training programs were able to start online training. Ongoing research studies and trials focusing neurological manifestations of COVID-19 were done at 10 (30%) centers. Modification of facilities for COVID patients showed that 24(72%) hospitals strictly reduced the number of attendants accompanying patients. Only 10 (30%) centers had neurophysiological tests being conducted on COVID-19 patients. Mental health support services to HCW were provided at 12 (36%) centers. CONCLUSIONS: Among HCW 10% tested positive for covid and 1.3% died. Mental health support services offered for HCW were available in 36% institutions. Neurology training was substantially affected due to low admissions, limited ward rounds and limited availability of online training.

Anti-NMDA Receptor Encephalitis in a Young Girl with Altered Behaviour and Abnormal Movements.

Autoimmune encephalitis is a rare central nervous system disorder in which the patient presents with neuropsychiatric symptoms. We herein present a case of anti-NMDA receptor encephalitis in which the patient initially presented in the psychiatric department. A 14-year girl was brought with complains of irritability, altered behaviour, abnormal movements, self biting, and decreased sleep for the past 10 days. Her condition deteriorated during the admission and she became mute, immobile, and drowsy. Her baseline investigations and CT scan brain were normal. CPK was high and the CSF showed pleocytosis. Autoimmune encephalitis profile showed presence of antibodies against the NMDA receptors. Improvement in the symptoms was noted after treatment with steroids and plasmapharesis. This case report highlights the importance of multidisciplinary approach involving the neurologist, psychiatrist, and immunologist in accurately diagnosing and managing a rare neurological disorder presenting mainly with psychiatric symptoms.