Aetiology of optic atrophy

Objective: to investigate the patients of opt c atrophy to find the cause

Material and Methods: this descriptive study was conducted at department of neurology, Mayo Hospital Lahore and department of medicine, Wapda Teaching Hospital, Lahore. Patients of all ages and both sexes with optic atrophy were included. Patients of pure eye diseases like glaucoma and those having any contraindication to essential investigations were excluded. First 118 patients were studied. After history and physical examination some initial and predetermined tests were performed on all patients. Further advance investigations were performed to reach the diagnosis on case to case basis. All the data obtained was processed for the results

Results: out of these 118 patients, 75 [63.56%] were male and 43 [36.44%] were female. Mean age was 43.97 +/- 17.54 years [range 3 to 71 years]. Causes of optic atrophy included, Tumours in 29 [24.58%], demyelinating diseases in 19 [16.10%], infections in 18 [15.25%], methanol toxicity in 11 [9.32%] and ischemic optic neuropathies in 9 [7 .63%] patients. Hydrocephalus and hereditary optic neuropathies, each in 4 [3.39%] patients while non-neoplastic compressive lesions, drugs and trauma, each in 3 [2.54 %] patients caused optic atrophy. Nine patients had rare causes while six patients remained undiagnosed

Conclusion: tumours, demyelinating diseases, infections, methanol toxicity and ischemic optic neuropathies were the frequent causes of optic atrophy. Methanol toxicity is more common in our society as compared to the rest of the world

Frequency of raised plasma homocysteine levels in patients of ischemic stroke

This descriptive study was conducted at Mayo Hospital, Lahore. A total number of 37 continuous patients with ischemic stroke were registered in one month. Imaging of the brain was done in each case. Both male and female patient of all age groups were included. Among these, 27 were males and 10 were females with the age range from 20 to 90 years. Nineteen patients [51.35%] had raised plasma homocysteine levels more than 15umol/l. Among patients with raised homcysteine levels, 14 [73.6%] were males and 5 [26.3%] were females. Eighteen [48.64%] patient fell in to group between 41-60 years of age. Eleven patients were younger than 40 and 8 were more than 60 years of age at the time of presentation. Out of 19 patients with raised plasma homocysteine levels 5 [26.3%] were also smokers and others were either non smokers or had stopped smoking more than 5 years back from the time of presentation. Four out of 19 [21.04%] patients had no other known cause of their stroke except raised plasma homocysteine. Theses patients were all males and were 23, 42, 60 and 68 years old. From our study we conclude that in our population, plasma homocysteine levels are raised commonly in patients of ischemic strokes, and it has already been established, as risk factor for all vascular events. We recommend routine measurements of Homocysteine levels in all Ischemic stroke patients and administration of Folic acid and Vitamin B12 as secondary preventive therapy

Creutzfeldt-Jakob disease

Creutzfeldt-Jakob disease is a prion related disease, characterized by rapidly progressive dementia, associated with myoclonus and ataxia. A 55-year-old male, who initially developed depressive symptoms and obsessive-compulsive disorder one year before presentation, and in due course, developed ataxia, forgetfulness and disorientation in time and space followed by myoclonic jerks with increasing difficulty in walking, finally becoming bed bound and developing startle response to sound and touch, presented in mute and bed bound state. On the basis of typical clinical syndrome, suggestive electroencephalography and magnetic resonance imaging, and absence of any other cause, diagnosis of Creutzfeldt-Jakob disease was made