Misdiagnosis of rarest subtype of sporadic Creutzfeldt Jakob Disease: a case report.

BACKGROUND: Creutzfeldt-Jakob disease (CJD), is a deadly degenerative condition of the central nervous system marked by rapidly progressive dementia. Magnetic resonance imaging (MRI) abnormalities in the cerebral cortex, basal ganglia, thalamus, and cerebellum could indicate severe acute diseases caused by a variety of factors. Although their MRI patterns may resemble those of CJD, clinical history, additional MRI findings, and laboratory testing are all necessary to provide a reliable difference. Here, we report a misdiagnosed case of probable VV1 subtype of sporadic CJD (sCJD) in which follow-up MRI supported the diagnosis. CASE PRESENTATION: A 41-year-old male patient attended the Neuropsychiatry Department with rapidly progressive dementia, akinetic mutism, and difficulty walking and speaking. His problem began with forgetfulness, disorganized behavior, and disorganized speech 7 months earlier which progressed rapidly and was accompanied by aphasia, apraxia, agnosia, and akinetic mutism in the last 2 months. On neurologic examination, hypertonia, hyperreflexia, frontal ataxia, bradykinesia, gait apraxia, and aphasia were noted. Based on clinical features and rapid symptoms progression the likely diagnosis of CJD was suspected. MRI and electroencephalography (EEG) were advised. MRI revealed features of diffuse cortical injury of both cerebral hemispheres also involving bilateral corpus striatum with evidence of cerebral volume loss. EEG showed lateralized periodic theta slow waves on the right side. According to the CDC's diagnostic criteria for CJD, the diagnosis of probable sCJD was established. Supportive care and symptomatic treatment are provided for the patient. After a 1-month follow up the patient's condition deteriorated significantly. The time-lapse from the first reported symptom to death was about 13 months. CONCLUSION: The need of addressing CJD in patients presenting with rapidly progressive dementia is highlighted in this case report. In the early stages of the disease, interpretation of MRI results might cause diagnostic difficulties; therefore, follow-up MRI is critical in obtaining the correct diagnosis.

A Rare Case of Dandy-Walker Syndrome.

Dandy-Walker syndrome (DWS) is a rare congenital malformation characterized by hypoplasia of the cerebellar vermis and its upward rotation and cystic enlargement of the fourth ventricle. The clinical manifestations include psychomotor retardation, ataxia and hydrocephalus. We report a case of 16-year-old female patient in Ali Abad Teaching Hospital who was suffering from unsteady gait, memory deterioration and urinary incontinence. A brain magnetic resonance imaging revealed enlarged cystic posterior fossa, dilated fourth ventricles and upward rotated cerebellar vermis which were indicating DWS. The patient prepared for planned surgical operation and a written informed consent was obtained from her parents for surgery and general anesthesia. A cystoperitoneal (CP) shunt was placed and then the patient transferred to recovery room. After recovery and hospital stay, the patient discharged with improved clinical symptoms.

Prevalence of Symptoms of Anxiety Among Residents of Kabul During Pandemic of COVID-19: A Report from Capital of Afghanistan.

PURPOSE: This study was conducted to evaluate the prevalence of symptoms of anxiety among residents of Kabul during the present COVID-19 pandemic. METHODS: This descriptive cross-sectional, community based survey was conducted in Kabul, Afghanistan, during the COVID-19 pandemic. Data were collected from July 11, 2020, to July 16, 2020. A bilingual (Dari and English) questionnaire was used for data collection. The first section of the questionnaire collected sociodemographic information of the respondents and the second comprised a self-report standardized scale, i.e. Generalized Anxiety Disorder-7 (GAD-7) to assess symptoms of anxiety. The survey form was distributed through online platforms. All residents of Kabul who used social apps such as WhatsApp and Facebook were eligible to participate in the study and participation was voluntary and non-commercial. RESULTS: Altogether 1135 complete responses were received. The majority of them were males and aged 18-34 years. Almost 18% were healthcare workers. Overall, 28.2% of the respondents reported symptoms of moderate to severe anxiety, 38.8% reported symptoms of mild anxiety, and nearly one third of the respondents reported no symptoms. Female participants reported significantly higher levels of anxiety compared with males (39.7% versus 25.6%; p = 0.0001). No significant association was noted between anxiety levels and age groups, occupations, and healthcare workers versus non-healthcare workers. CONCLUSION: The findings suggest that a gender-specific psychosocial protocol needs be integrated into the public health emergency plans to fight against the current pandemic.

Wilson's Disease Presenting with Generalized Tonic-Clonic Seizure and Cerebellar Dysfunction.

Wilson's disease (WD) is a rare inherited impaired copper metabolism with diverse clinical pictures dominated by hepatic and neurologic manifestations. We report the case of a 14-year-old female patient who attended the Department of Neuropsychiatry at Ali Abad Teaching Hospital, Kabul, Afghanistan, with generalized tonic-clonic seizure and cerebellar dysfunction. The patient was initially diagnosed as encephalitis and epilepsy and finally diagnosed with WD based on the clinical and laboratory findings. After 6 months of follow-up, the patient showed substantial clinical recovery.

Knowledge, Attitudes, and Practices of Medical Students Regarding COVID-19 in Afghanistan: A Cross-Sectional Study.

BACKGROUND: The coronavirus pandemic has had devastating effects on many nations, including Afghanistan. Public awareness and following recommendations play an important part in managing such a large-scale crisis, which are affected largely by knowledge, attitudes, and practices (KAP). Medical students can act as reliable sources of information for the public in such a scenario. This study aimed to investigate KAP of medical students regarding COVID-19. METHODS: A cross-sectional online survey was conducted in October 2020 among medical students in Afghanistan, Kabul University of Medical Sciences. Information on sociodemographics and KAP, was collected using a web-based questionnaire. RESULTS: A total of 1,169 medical students completed the survey. More than half were female (54.6%), a majority (95%) aged ≥20 years, and more than half (56.2%) lived in the city of Kabul. Overall, students had acceptable KAP regarding COVID-19, except for a few undesirable responses with regard to the risks of close contact with COVID-19 patients, incubation periods, and groups vulnerable to COVID-19. CONCLUSION: Overall, the students had acceptable KAP regarding COVID-19, except for the few undesired aforementioned responses, which need more focus during awareness campaigns in future.