No abstract

Due to pervasive pandemic of SARS CoV-2 the reports of rare neurological complications have turned up out of the ordinary. The public health concerns are raised due to SARS-CoV-2 infection and vaccinations as this recent pandemics has set the development and deployment of vaccines at large scale. The randomized controlled trials being carried were underpowered to foresee these rare adverse effects. Amongst other neurological complications acute disseminated encephalomyelitis ADEM has been reported with vaccination for SARS-CoV-2. Herein, we report a patient with a unique presentation of ADEM, a severe neuroinflammatory disorder developed shortly after mRNA based Moderna vaccine for SARS-CoV-2.

A 24 years old man with known history of asthma came with acute presentation of ascending weakness for4 days following flu like symptoms and worsening of asthma. His complete blood counts showed elevated eosinophil count. Nerve conduction showed neuropathy. Diagnosed Churg Strauss syndrome due to presence of asthma, eosinophilia, neuropathy and pulmonary infiltrates. Churg Strauss is systemic eosinophilic vasculitis involving multiple organ systems.

Background and objective: Not much is known about the prevalence and significance of hypodensities within hematoma after spontaneous intracerebral hemorrhage (ICH). The objective of this study was to determine the prevalence of hypodensities within hematoma after spontaneous ICH and their significance to predict poor outcome after ICH. Methods: This observational cross sectional study was conducted in the Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad, from October 2021 to June 2022. Total 140 patients of acute stroke were included. Inclusion criteria was any patient of >20 years of age with confirmed diagnosis of ICH on imaging, non-traumatic, who presented within 24 hours after onset of symptoms. Data was analyzed by SPSS ver.23.0. Results: Total 150 patients were included in the study. The mean age of patients was 52.28 ± 1.29 years. There were 100 (71.4%) males and 40 (28.6%) females. Hypertension was the most common comorbid present in 87 patients (62.1%).55% of patients had on presentation National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale score of moderate severity. The mean ICH score on presentation was 2.64 +1.26. Hematoma expansion was present in 55(39.3%) patients while interventricular extension was seen in 100(71.4%) patients. Hypodensities were seen in 125(89.3%) patients( p value 0.001). When hematoma volume were compared in both groups it was also significant (p value 0.002). Conclusion: We conclude that hypodensities within hematoma are a reliable marker of hematoma expansion after spontaneous ICH. Such reliable marker can be easily employed in resource-poor countries where CT angiography is not available everywhere. The higher NIHSS score and low GCS are significantly associated with hypodensities within hematoma.

Background and objective: There is a lack of local data regarding the frequency and predictors of early seizures after stroke. The objective of this study was to determine the frequency of early seizures after stroke and identify the predictors which lead to them after first acute stroke. Methods: This cross-sectional observational study was conducted in the Department of Neurology, Pakistan Institute of Medical Sciences, Islamabad from October 2021 to June 2022.  A total of 310 consecutive eligible patients of acute stroke were recruited. Key inclusion criteria included any patient of >20 years of age with confirmed diagnosis of stroke on imaging, non-traumatic, with no history of seizures in past. Data was analyzed by SPSS version 23.0. Results: The mean age of patients in the seizures group was 48.40 ± 20.9 years. Hypertension was the most common co-morbid present in 225 (76.5%) patients. Early seizures were found in 52 (16.8%) patients with 42 (80.76%) having seizures in first 24 hours of stroke (p value 0.001). On National Institute of Health Sciences Scale (NIHSS) score most patients 125 (40.3%) had moderate severity score i.e. score in between 7 to 25 (p value 0.05). Ischemic stroke was identified as the stroke variety with most of the early seizures i.e. 16 (30.76%) (p value 0.003). Conclusion: Early seizures were not infrequent after acute stroke (16.77%) in our study. Early seizures were associated with younger age, cortical region lesion, ischemic stroke, followed by cerebral venous thrombosis. Higher NIHSS score and greater disability was associated with increased incidence of early seizures.