Pakistan Journal Of Neurological Surgery
Not a member yet
812 research outputs found
Sort by
Surgical Outcomes of Lumbar Spine Procedures; A Prospective Cohort Study in A Tertiary Care Hospital
Full text linkObjective: To know about the surgical results of lumbar spine procedures performed at MTI Hayatabad Medical Complex and Naseer Teaching Hospital Peshawar.
Material and Methods: This prospective cohort study was carried out in the Neurosurgery department at Nasser Teaching Hospital and MTI Hayatabad Medical Complex, from 1st January 2020 to 25th January 2024. We included 267 patients, consisting of both genders, that is, male and female, with the ages ranging from 17 years to 72 years. The Lumbar spine procedures included in our study were; Laminectomy, Partial laminectomy, Discectomy, Right and Left Fenestration, all the rest of the lumbar spine procedures were excluded. The surgical outcome was assessed using a VAS score for grading pain before the procedure and 6 months after the procedure.
Results: The study revealed that the average age of the patients was 41.87 years, with a standard deviation of 12.827 years. The youngest patient was 17 years old, and the oldest was 72 years. In terms of gender distribution, males accounted for 46.1% (123 out of 267), while females made up 53.9% (144 out of 267). The most commonly affected site was the L4-L5 level, observed in 133 patients (49.8%), followed by the L5-S1 level, which affected 105 patients (39.3%).
Conclusion: The results indicate that such surgeries can significantly improve patient outcomes in terms of pain relief
Exploring the Patterns of Childhood Disability in a Tertiary Care Hospital – A Demographic Analysis
Full text linkObjectives: To identify childhood disability patterns and associated demographic characteristics presenting to a tertiary care center of excellence.
Materials and Methods: This prospective observational cross-sectional study was conducted at the Department of Rehabilitation, Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi, from Dec 22 to Nov 23. We included 160 patients in our study. Demographic variables studied were age, weight, physical characteristics, reason for referral and primary diagnoses, family and birth history, access and barriers to rehabilitation services, and overall satisfaction with services provided using a 7-point Likert scale.
Results: Among 160 patients, cerebral palsy was the most common diagnosis (30%), followed by myopathies (18.8%), autism spectrum disorders (13.1%), and musculoskeletal disorders (10%). Other conditions included neurodegenerative diseases (6.9%), intellectual disabilities (6.3%), Down syndrome (4.4%), and spinal dysraphism (3.1%). Comorbidities were common, with 30% of patients showing additional health concerns such as respiratory issues, seizure disorders, and gastrointestinal problems, which further complicate their care and management. Lower-income households showed higher disability rates and early diagnosis was more common for autism and cerebral palsy.
Conclusion: Neurological disorders like cerebral palsy, autism spectrum disorders, and musculoskeletal conditions were the most common childhood disability presentation
Controlled Decompression Effects in Patients with Severe Traumatic Brain Injury: A Randomized Controlled Trial
Full text linkObjective: To investigate whether controlled decompression therapy reduces the incidence of comorbidities and enhances recovery in sTBI patients.
Materials and Methods: In a Khyber teaching hospital, sTBI patients aged 18 to 75 years were randomly divided into one of two groups: controlled decompression (CD) surgery (n = 26) and fast decompression surgery (n = 26) in a randomized control experiment. The primary outcome markers were 30-day all-cause mortality and the Extended-Glasgow Outcome-Scale (GOS-E) score at six months. Secondary outcomes included delayed bleeding, posttraumatic brain infarction, and intraoperative brain infarction.
Results: The greatest improvement in six-month GOS-E score was a remarkable reduction in 30-day all-cause mortality in the controlled decompression (CD) group in comparison to the group fast decompression group of the participants (15.3% compared with 24.6%, a P value of -0.042). Additionally, subjects in the group of supervised decompression surgery had lower intraoperative brain edema (19.2% versus 42.3%, p-value 0.033), late bleeding (11.5% versus 30.7%, p-value 0.048), and cerebral infarction after trauma than the rapid decompression group (15.0% versus 22.4%, with a p-value less than 0.001).
Conclusion: Controlled decompression (CD) surgical interventions have been found to significantly uplift the outcomes for individuals with severe traumatic brain injury (sTBI) and reduce the likelihood of related health conditions so but a more comprehensive understanding of the importance of standardized directed decompression surgical intervention in the management of sTBI requires multicenter randomized controlled trials
Correlation of MRI Findings and CSF Patterns in Children with Bacterial and Tuberculous Meningitis: A Retrospective Analysis from a Tertiary Care Hospital in Peshawar
Full text linkObjective: To evaluate the correlation between MRI findings and CSF profiles for differentiating bacterial and tuberculous meningitis.
Materials and Methods: A retrospective study of 336 pediatric patients (1 month–14 years) diagnosed with meningitis from September to December 2024. CSF biochemical and cytological parameters and MRI findings were analyzed using statistical tests, including the Mann-Whitney U test and Spearman correlation. Ethical approval was obtained.
Results: MRI revealed infarcts (53.6%) as the most common complication, followed by hydrocephalus (22.6%) and tuberculomas (27.7%). Tuberculomas were exclusive to tuberculous meningitis (p = 0.010), infarcts were more common in bacterial meningitis (p = 0.001), and hydrocephalus was more frequent in tuberculous meningitis (p = 0.042). CSF analysis showed elevated protein and lymphocytic predominance in tuberculous meningitis, while bacterial meningitis showed neutrophilic dominance and low glucose. MRI abnormalities correlated with CSF changes, with protein and glucose linked to tuberculous meningitis (r = 0.413, p < 0.001) and infarcts to bacterial meningitis (r = 0.348, p = 0.002).
Conclusion: Integrating MRI with CSF analysis improves differentiation between bacterial and tuberculous meningitis in children, enhancing diagnostic accuracy and treatment. Further research is needed
Spinal Cord Injury and Pregnancy: Obstetric Challenges and Neonatal Outcomes
Full text linkObjective: Pregnant women with spinal cord injury (SCI) can have severe obstetric and neonatal challenges. However, there is limited literature on this population. Therefore, the objective of this study is to understand the obstetric and neonatal outcomes in these highly specialized individuals.
Materials and Methods: This study was conducted at the Punjab Institute of Neurosciences (PINS) and the Department of Obstetrics and Gynecology, Lahore General Hospital, Lahore (LGH). A sample of 25 women who appeared with SCI during pregnancy at PINS were recruited in this descriptive study for data collection. Later, their pregnancy and neonatal outcomes were observed at the specified department of LGH. Descriptive statistics were computed for quantitative and qualitative variables.
Results: The average age of these SCI patients was 28 ± 5.2 years. Most of the women (72%) got SCI during motor vehicle accidents (MVA). Thirteen women got SCI during their first trimester and faced severe complications like termination (12%) and miscarriages (12%) of pregnancies. Thoracic spine injury is the most common type of injury. Further, a Cesarean section was also adopted in 58% of cases, highlighting the potential challenges associated with SCI. A very high (42%) preterm birth rate was also reported in this unique sample.
Conclusions: This study is a unique combination of gynecological and neurological aspects. The majority of the pregnancy outcomes are successful with medical support, however, a significant number of miscarriages and termination of pregnancies were also observed. Understanding these outcomes can aid healthcare professionals in improving prenatal and postnatal care and such SCI patients
MRI Patterns and Disability Correlation in Multiple Sclerosis: A Prospective Study from a Tertiary Care Center in Pakistan
Full text linkObjective: To evaluate the magnetic resonance imaging (MRI) characteristics of multiple sclerosis (MS) in a tertiary care setting and determine their correlation with clinical disability using the Expanded Disability Status Scale (EDSS).
Materials and Methods: This prospective observational study was conducted at the Department of Radiology, Lady Reading Hospital, Peshawar, over six months. A total of 84 patients diagnosed with MS as per the 2017 revised McDonald criteria were included. Standardized brain and spinal MRI sequences were analyzed for lesion distribution, contrast enhancement, T1 black holes, and spinal cord involvement.
Results: The mean age was 33.2 ± 8.7 years; 72.6% were female. The most common lesions were periventricular (90.5%), followed by juxtacortical (65.5%), infratentorial (41.7%), and spinal cord (38%). T1 black holes were present in 33.3% of cases. EDSS > 4 was seen in 34.5% of patients. Significant associations were observed between EDSS > 4 and the presence of T1 black holes (p = 0.005), spinal cord lesions (p = 0.012), and infratentorial lesions (p = 0.030). Logistic regression identified T1 black holes (OR = 3.4), spinal cord lesions (OR= 2.8), and infratentorial lesions (OR = 2.5) as independent predictors of disability.
Conclusion: MRI lesion topography, particularly T1 black holes, spinal cord, and infratentorial involvement, correlates strongly with functional disability in MS. These imaging features can aid in early risk stratification and guide treatment planning in resource-limited settings
Silent Struggles, Resilient Spirits: A Study of Psychosocial Challenges and Quality of Life in Female Brain Tumor Patients at a High-Volume Neuroscience Institute in Pakistan
Full text linkObjectives: To determine the psychosocial impact of brain tumours in the female population of Pakistan using the FACT-Br Questionnaire.
Materials and Methods: 108 female patients with diagnosed brain tumours between the ages of 13-75 years were enrolled after informed consent from Punjab Institute of Neurosciences, Lahore. After admission, patients were asked to fill out the FACT-Br questionnaire. Demographic data and symptoms were also recorded.
Results: Out of a total of 108 patients, the mean FACT-Br total score was 96.7 (out of 200). This indicated a significant deterioration in the quality of life and psychosocial well-being.
Conclusion: Our results showed that brain tumours had caused major psychosocial and quality of life impairment in our sample. It is advised, based on our findings, that recognition by physicians of these problems is essential, and effort towards a better QOL outcome is required
Cognitive and Neuropsychiatric Sequelae in Postpartum Women with Preeclampsia: A Prospective Cohort Study
Full text linkObjective: This study aimed to prospectively evaluate cognitive function and neuropsychiatric outcomes in postpartum women with a history of preeclampsia compared to normotensive controls. It further sought to identify key predictors of cognitive impairment and mood disturbances within this high-risk group.
Materials and Methods: Between January and December 2024, a forward-looking cohort investigation was implemented at a tertiary healthcare institution. A total of 280 postpartum participants were included, comprising 160 women diagnosed with preeclampsia and 120 normotensive counterparts, with both groups balanced in terms of age and parity. Cognitive performance was measured using the Montreal Cognitive Assessment (MoCA), while emotional health was monitored through the Hospital Anxiety and Depression Scale (HADS) and the Edinburgh Postnatal Depression Scale (EPDS) during follow-up visits conducted at 6 and 12 months after childbirth.
Results: At 12 months postpartum, women in the preeclampsia group exhibited significantly lower mean MoCA scores (23.6 vs. 26.1, p<0.001) and a higher prevalence of clinically significant anxiety (38.1% vs. 15.8%) and depression (29.4% vs. 10.8%) than controls. Logistic regression identified severe preeclampsia, low educational status, and elevated EPDS scores as independent predictors of cognitive impairment.
Conclusion: Women with a history of preeclampsia are at increased risk for cognitive and psychiatric sequelae in the postpartum period. These findings underscore the importance of structured neuropsychiatric screening and early intervention in postpartum care for this high-risk population
Nerve Conduction Studies: A Diagnostic Tool for Carpal Tunnel Syndrome
Full text linkObjectives: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy, yet the role of nerve conduction studies (NCS) in its diagnosis remains debated. This study aimed to evaluate the diagnostic yield of NCS and its correlation with clinical features in patients with suspected CTS.
Materials & Methods: A retrospective cross-sectional study was conducted on 201 patients referred for NCS with symptoms suggestive of CTS. Demographic characteristics, symptom profiles, physical examination findings (Tinel’s sign, Phalen’s maneuver), and NCS results were reviewed. Diagnostic accuracy measures were calculated, and associations between clinical features and NCS-confirmed CTS were assessed using chi-square tests.Results: NCS confirmed CTS in 65.2% (n=131) of patients. Bilateral symptoms p=0.007), nocturnal exacerbation ( p<0.001), and a positive Phalen’s maneuver (100 vs. 28; p<0.001) were significantly associated with NCS-confirmed CTS. Severe numbness (p<0.001) and pain (p<0.001) also correlated with positive findings, whereas comorbidities showed no significant association (p=0.396).Conclusions: NCS demonstrates higher diagnostic value in patients presenting with bilateral symptoms, nocturnal pain, and positive provocative tests, supporting a selective rather than routine approach to its use. However, its limited sensitivity in early-stage disease underscores the importance of combining clinical and electrophysiological assessments. Future longitudinal studies are warranted to determine the predictive role of NCS in treatment outcomes
Correlation Between Urodynamic Study Findings and Quality of Life in Patients With Neurogenic Bladder
Full text linkObjective: To evaluate the correlation between urodynamic parameters and quality of life in patients with neurogenic bladder using the Qualiveen-30 questionnaire. Conclusion: Urodynamic findings, particularly poor bladder compliance and detrusor overactivity, are strongly associated with diminished quality of life in neurogenic bladder patients. A multidisciplinary, patient-centered approach addressing both physiological and psychosocial domains is essential for optimal management