Aziz Sonawalla

A 32-year-old male, with a history of recurrent throbbing headaches, presented with three episodes of minor trauma to the head followed by throbbing headaches and blurred vision. In two of these episodes, he also had clinical features suggesting the occurrence of transient global amnesia (TGA) at the same time. Although migraines as well as TGAs are reported to occur following minor head trauma, the simultaneous occurrence of both is rather unusual and would support the fact that spreading depression is the main pathophysiological mechanism underlying TGAs as it is for migraines. We report an unusual case of migraine and TGA occurring simultaneously in a footballer after minor head trauma.

Note: The editors of PJNS are aware that this article contains old data. However, we have decided to publish this article because a) the data is still important as there is paucity of data in this regard from Pakistan, and b) the authors have written the article well and have mentioned this limitation of their manuscript. Background and objectives: Little is known about the clinical profile and outcome of myasthenia gravis in Pakistan. The objective of this study is to review the clinical characteristics of patients with myasthenia gravis in Pakistan, and the outcome of investigations and treatment. Methods: The study comprised a retrospective review of charts of patients diagnosed with myasthenia gravis at Aga Khan University Hospital in Karachi, Pakistan, over a period of 16 years from 1987 to 2003. The following features were reviewed: (i) clinical presentation, (ii) investigations especially nerve conduction studies, acetylcholine receptor antibodies, and imaging studies of the thorax, (iii) treatments administered (including thymectomy). Data analysis was done using Excel sheets. Results: Of the 83 patients, 51(61.4%) were males, whereas 32 (38.6%) were females. The age range was from 12 to 81 years, mean age of 43.7 years (SD± 18.2). In the 60 years plus group, there were three times as many males as compared to females. Limb weakness was noted in 58 (69.9%), ocular symptoms in 57(68.7%), and oropharyngeal symptoms in 54(65.1%) patients. Three (3.6%) presented in a state of myasthenic crisis. Tensilon test was performed in 34 patients and was positive in 31(91.2%), repetitive nerve conduction studies (RNS) were performed in 37 patients and was positive in 26(70.3%), acetylcholine receptor antibodies were done in 60 patients, and were positive in 55(91.7%). Thymic enlargement was seen in 28 out of 43 patients who underwent CT-Scan/MRI studies of the thorax. Besides pyridostigmine, most patients received immunosuppressive therapy with either steroids or azathioprine or both. The thymectomy was performed in 44 patients.   Conclusion: The general disease pattern of MG, as noted in our series, appears to follow a similar pattern as noted worldwide. However, this retrospective and hospital-based study has its limitations, and more prospective and epidemiological studies are needed.

The burden of neurological diseases in developing countries is rising although little is known about the epidemiology and clinical pattern of neurological disorders. The objective of this study was to understand the burden of disease faced by neurologists a in tertiary care setting. A prospective observational study was conducted of all presentations to neurology clinics at Aga Khan University Hospital Karachi over a period of 2 years. A total of 16,371 out-patients with neurological diseases were seen during the study period. The mean age of the study participants were 46.2 ± 18.3 years and 8508 (52%) were male. Headache disorders were present in 3058 (18.6%) of patients followed by vascular diseases 2842 (17.4%), nerve and root lesions 2311 (14.1%) and epilepsies 2055 (12.5%). Parkinson’s disease was more prevalent in male participants 564 (70.8%) as compared to female 257 (62.1%) (p = 0.002). Migraines and vertigo disease were more diagnosed in females as compared to males. Epilepsies were seen more in younger age groups. Parkinson’s disease was seen in 50.9% of participants between the ages of 45 and 65 years, and the frequency increased with age.