A previously healthy 30-year old lady presented with 1-day history of high grade fever and drowsiness. Five days prior to presentation, she developed insomnia and visual hallucinations of seeing unknown faces. Three days prior to presentation, she suffered from 5 episodes of generalized tonic colonic fits. On admission, she had a temperature of 102oF and GCS of 10/15 with no signs of meningeal irritation, no focal neurological deficit, normal deep tendon reflexes and down-going plantar reflex bilaterally. Her brain MRI scan showed mild hyper-intense signals in right cerebellum. Her CSF was tested for Anti-NMDA receptor antibodies which were positive. She was diagnosed as having Anti-NMDA Receptor Encephalitis and started on immediate Plasma Exchange with drastic improvement.

To explore the pattern and prevalence of inpatient psychiatricmorbidity and to see how it differs from the pattern of psychiatric morbidity in community. Design: The details of all inpatients from the case register developed for a health information system was included in study Setting: In Departmentof Psychiatry and Behavioral Sciences, Bahawal Victoria Hospital, Bahawalpur. Period: From 1998-2003. Results: Atotal of 5426 patients were admitted in the six year. There was a slight difference of 0.8% in total number of males andfemales cases (i.e., 2764 males Vs 2662 females). Overall difference reported in the present study, in mean ages ofmales and females was 3.45 years (i.e., males = 31.85 Vs females = 28.40). Mean stay of patients in ward is 10-12days. Most patients were admitted with Conversion disorder 24% followed by Schizophrenia 23%, Depressive disorder20%, Drug Dependence 10%, Bipolar Disorder 7%. The patients with Neurotic Disorder and Organic Disorder werebelow 5%. Conclusion: The study showed that overall general pattern of inpatient psychiatric morbidity is in line withpattern of psychiatric morbidity in community and the partial variance can be explained in terms of social variables, asthis variance exist even across studies within community samples.

Background: Obesity and migraine are the most common disorders among general population that are linked with disability and impaired life quality. Though, several studies have investigated the relationship between obesity and migraine but yet there is no complete knowledge regarding association between BMI and migraine, particularly chronic migraine. Objective: The objective of the study was to find the association between body mass index and migraine. Material and Methods: It was a prospective study carried out at Neurology Outpatient Department of Lahore General Hospital, Lahore. Total of 545 patients with major complaint of headache were included after fulfilling “episodic migraine” (n=370) and “chronic migraine” (n=175) criteria according to International Headache Society (IHS) criteria. Results: Among 370 patients with episodic migraine (EM), 78.4% were females while among 175 patients with chronic migraine (CM), 81.1% were females. In EM group, the mean age of the patients was 41.72+21.35 years and in CM group, it was 45.80+15.79 years. In EM group, mean pain intensity was 4.6+2.41 and in CM group, mean pain intensity was 4.3+2.51. Among EM group patients, mean duration of headache was 4.85+5.17 days and among CM group patients, mean duration was 20.88+8.86 days. Mean BMI (Body Mass Index) of patients in EM groups was 22.91+3.89 while in CM groups was 24.43+3.43 (P=0.002). In EM group, 9.7% patients and in CM group, 6.3% patients were underweight (P=0.189). In EM group, 11.4% patients and in CM group, 30.3% patients were overweight (P=0.002). However, in EM group, only 1.3% patients and in CM group, 3.4% patients were obese (P=0.087). Multiple logistic regression analysis of chronic migraine group showed significant results (P <0.05) regarding headache days/month, BMI, overweight and obese. Conclusion: Study concluded that overweight and obesity were associated factors for migraine. Chronic migraine patients were more likely to have elevated BMI than the episodic migraine patients. Keywords: Body mass index, migraine, obesity, chronic, headache

Background: Headache is a most common complaint seen among patients visiting neurologist and general physicians. The incidence of headache was reported between 12–50 percent among elderly people. Headache has ability to affect adversely the life quality of patients, limits community and domestic activities and hence, carries a significant disability burden. Objective: The objective of the study is to investigate the primary headache among elderly people of Lahore. Material and Methods: It was a prospective cross-sectional study conducted in Lahore General Hospital, Lahore. Patients aged 18 years and above referred to Neurology Outpatient Department of LGH for headache were included. The participants were divided into 2 groups: aged 18 to 64 years (younger patients) and aged >65 years (elderly patients). Results: Among 90 younger respondents the mean age was 28.7+5.3 years while among 75 elderly respondents the mean age was 75.6+8.7 years. In younger and elderly groups, 8.9% & 38.7% patients had mild headache, 47.8% & 21 28.0% had moderate headache and 43.3% & 25 33.3% patients had severe headache, respectively. In younger and elderly groups, 54.5% & 10.7% patients had migraine without aura, 14.5% & 6.6% had migraine with aura, 11.1% & 4.0% had chronic migraine, 10.0% & 20.0% patients had infrequent and frequent episodic tension-type headache, 3.3% & 22.7% patients had chronic tension-type headache, 1.1% & 2.7% patients had cluster headache, 1.1% & 8.0% had trigeminal neuralgia, 0.0% & 2.7% had glossopharyngeal neuralgia and 4.4% & 22.6% patients had unspecified headache, respectively. Conclusion: Study concluded that among elderly patients, headache was started any time while mild headache, chronic tension-type headache, unspecified headache, throbbing/pulsating and <15 headache days per month were more prevalent among elderly patients. Keywords: Primary headache, elderly, people, intensity