Fulminant variants of multiple sclerosis: local experience at Shifa International Hospital, Islamabad, Pakistan

To report a series of patients with fulminant variants of multiple sclerosis [MS] based on their clinical and radiological features This retrospective study consists of series of four patients with fulminant variants of MS seen between January 2008 and February 2011 at Shifa International Hospital, Islamabad. Pakistan. Out of Four patients, three were females, with mean age of 27 [range 13-40] years. Onset was acute with significant progression over 2 weeks in all cases. Presenting symptoms were hemiparesis and speech difficulty in all patients, 3 had visual impairment, and 2 had headache. CSF pleocytosis and raised CSF protein was seen in 3 patients. Visual evoked potentials were abnormal in one patient. Based on the characteristic MRI findings. 3 patients were diagnosed as Balo's concentric sclerosis and one patient with Marburg's variant of MS. All patients were initially treated with intravenous methylprednisolone followed by immunomodulatory therapy. Two patients received intravenous immunoglobulins [IVIG] and mitoxantrone, one received IVIG only and one received mitoxantrone only. On follow up, all 4 patients had shown marked improvement with independence in activities of daily living. Aggressive treatment with IVIG and mitoxantrone resulted in significant improvement in this small case series. Early and aggressive immunosuppression should be considered in patients with fulminant variants of MS

EEG findings in post stroke seizures: an observational study

Stroke is an important cause of epilepsy especially in the elderly. We conducted an observational study in a tertiary referral center to describe different EEG findings in patients who developed seizures after stroke. We reviewed alt EEGs that were performed for evaluation of seizures after stroke from January to December 2006 and retrospectively recorded demographic data, side of stroke, type of seizures and EEC findings. All this information was entered on a specially designed proforma. A total of 41 patients with post stroke seizures had EEG done at our laboratory that were reviewed and analyzed. Of these patients, 51.2% [n=21] were males [mean age 60.7; range 22-84 years] and 48.8% [n=20] were females [mean age 63; range 3-90 years]. The commonest seizure semiology was generalized seizure in 56.1% [n=23], focal seizures in 36.6% [n=1 5] and focal with secondary generalization in 7.3% [n=3] patients.51 .2% [n=21] had right hemispheric involvement, 26.8% [n=11] had left hemispheric involvement and in 22% [n=9] patients side of stroke was not identified. The commonest EEG finding was generalized slow waves seen in 39.0% [n=16] patients. Other abnormalities found were focal slowing in 19.5% [n=8], focal sharp and stow waves in 9.8% [n=4], focal spikes and slow waves in 4.9% [n=2], focal sharp waves in 4.9% [n=2] of the patients. Focal spike waves in 2.4% [n=1] and PLEDS were seen in 2.4% [n=1] patients. 17.1% [n=7] patients had normal EEG. Generalized seizures and generalized slowing on EEG were the commonest findings in our patients who developed seizures after stroke. The commonest epileptiform discharges were focal sharp and slow waves seen in 9.8% of patients with post stroke seizures

Pattern of stroke in type 2 diabetic subjects versus non diabetic subjects

Diabetes mellitus is a well-recognized risk factor for ischaemic stroke. Stroke in diabetic patients is different from stroke in non-diabetics from several perspectives. There is no local study on this topic. This is the first study from Pakistan, in which pattern of stroke in diabetics have been described and compared with non-diabetics. The object of this study was to compare pattern of stroke in diabetic subjects with non-diabetics. This is a prospective comparative cross sectional study, carried out at Liaquat national hospital, Karachi, neurology department from October to March 2006. Fifty patients were enrolled in diabetic group and 50 in non-diabetic. Clinical features, risk factors and stroke patterns were identified. Mean age was 59.5 [ +/- 11.82] in diabetics and 60.4 [ +/- 14.8] in non diabetics. There was slight preponderance of male patients in non diabetic group. Out of 50 diabetic patients, 44 [88.0%] had ischaemic stroke and 6 [12.0%] had intracerebral haemorrhage. In non-diabetics, 29 [58.0%] had ischaemic stroke while 21 [42.0%] had intracerebral haemorrhage. On further analysis of ischaemic stroke, cortical infarcts [CI] was found in 22, sub cortical infarcts [SCI] in 14, brainstem in 5 and cerebellar in 2 diabetic patients. CI was also the commonest subtype of ischaemic stroke in nondiabetics. Patterns of stroke in diabetics are different from non-diabetics. Ischaemic stroke is more prevalent than hemorrhagic stroke in diabetics. Sub cortical infarcts are more common in diabetics than non diabetics [p=0.04]