Pakistan Journal of Neurological Sciences

Raising awareness in South Punjab: the importance of consulting neurologists for neurological Disorders

Muhammad Fahad Saleem — 2025-12-25

Clinicoradiological findings and outcome of posterior reversible encephalopathy syndrome in children: a cross-sectional study

Zia ur Rehman Muhammad — 2026-01-11

Background and Objective:

Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological syndrome characterised by altered sensorium, seizures, visual impairment and behavioural changes. The objective of the study was to evaluate clinicoradiological findings and outcome of PRES in children.

Methods:

A prospective cross-sectional study was conducted at department of pediatric neurology, the Children’s Hospital Lahore from October 2020 to September 2023. Clinical and demographic data were colllected on a structured proforma. Investigations comprised complete blood count, biochemistry, urinalysis, complement levels, inflammatory markers, immune panel, lipid profile and abdominal ultrasonography. All patients underwent MRI brain. Outcome was categorized as complete recovery or persistence of neurological deficits and/or residual radiological abnormalities at six months. Data were analyzed using SPSS version 23.

Results:

Thirty patients enrolled with male predominance (53.3%; male-to-female ratio of 1.14:1) and mean age of 10.86 ± 2.22 years. Hypertension was universal followed by seizures (93.3%), headache (83.3%), altered sensorium/aphasia (80%), visual impairment (70%), pyramidal signs (70%), peripheral edema (66.7%) and motor deficits (43.3%). Renal disorders accounted for 83.3% cases, most commonly post-infectious glomerulonephritis (43.3%). MRI revealed reversible vasogenic edema on T2-weighted/FLAIR sequences, predominantly in occipital (100%) and parietal lobes (90%). 6.7% patients had ischemic changes correlating with visual loss.

Conclusion: PRES in children presents with diverse neurological manifestations associated with hypertension secondary to renal diseases. MRI plays a pivotal diagnostic role. Early recognition with timely management is essential to prevent deficits.

Correlation of magnetic resonance imaging findings with clinical outcomes in acute transverse myelitis : a comprehensive retrospective study

Anjali Shankar — 2026-01-13

Background and Objective:

Acute transverse myelitis (ATM) is an inflammatory spinal cord disorder presenting with motor, sensory, and autonomic dysfunction. The objective of this study was to assess the prognostic value of spinal MRI findings and treatment timing in predicting neurological outcomes in patients with acute transverse myelitis.

Methods:

A retrospective analysis was conducted on 90 patients diagnosed with ATM at Chandka Medical College Hospital, Larkana, between January 2021 and December 2023. All patients underwent spinal MRI at presentation, and imaging characteristics—including lesion location, longitudinal extent, and enhancement pattern—were recorded. Clinical outcomes were assessed at one month, three months, and one year using the Modified Rankin Scale (mRS) and the ASIA Impairment Scale (AIS). Statistical tests evaluated associations between MRI findings, treatment timing, and recovery patterns.

Results:

The mean age was 41.5 ± 5 years; 54 patients (60%) were male. MRI revealed normal findings in 20 patients (22.2%) and abnormalities in 70 (77.8%). Overall, 20 patients (22.2%) achieved full recovery, 52 (57.7%) showed partial improvement, and 18 (20%) had no recovery. Normal MRI strongly predicted favorable outcomes (85% full recovery; p < 0.0001). Early treatment (≤3 days) significantly improved recovery rates (33.3% vs. 11.5%; p = 0.0088).

Conclusion:

MRI characteristics and early therapeutic intervention are key predictors of neurological recovery in ATM. Normal MRI findings and prompt treatment initiation were associated with significantly better outcomes, emphasizing the importance of early imaging and rapid management to reduce long-term disability.

Spectrum of Demyelinating Diseases in Pakistan: A multicenter cross-sectional study

Zainab Memon — 2026-01-01

Background and Objective:
Demyelinating diseases are a heterogeneous group of disorders of the central nervous system, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and acute disseminated encephalomyelitis (ADEM). Data from South Asia remain scarce, despite potential regional variations in disease spectrum and outcomes. The objective of this study was to characterize the demographic, clinical, and disability profile of patients with demyelinating disorders across Pakistan.

Methods:
This multicenter cross-sectional study was conducted between August 2017 and December 2019 across 39 neurology centers in Pakistan. Adult patients (≥18 years) diagnosed with demyelinating disorders using standardized criteria were included. Data on demographics, education, comorbidities, and disability (modified Rankin Scale) were collected. Statistical analyses were performed using t-tests and chi-square tests, with significance set at p<0.05.

Results:
A total of 373 patients were analyzed (59.5% female; mean age 37.2 ± 11.7 years). MS was the most frequent diagnosis (79.1%), followed by NMOSD (11.8%), ADEM (5.1%), and leukodystrophy (4.0%). Females had higher MS prevalence (82.9% vs. 73.5%, p=0.02) and higher rates of illiteracy. Hypertension (9.4%) and diabetes (6.7%) were more common in older and male patients. While 33.5% were fully functional, 16.7% had moderate-to-severe disability, including 6.7% who were bedridden.

Conclusion:
Demyelinating diseases in Pakistan predominantly affect young adults, with MS as the leading disorder but NMOSD comprising a notable proportion. Female predominance, education disparities, and significant disability highlight the need for improved diagnostic access, equitable treatment, and targeted rehabilitation strategies in South Asia.

Impact of physical exercise On reducing the frequency and severity of migraine without aura: a multi-center cross-sectional study

Amir Hamza — 2025-12-25

Background and Objective:

Migraine without aura is the most common subtype of migraine and causes significant distress to its sufferers. The objective of this study was to evaluate the role of physical exercise in reducing the frequency and severity of attacks in patients with migraine without aura.

Methods:

This multicenter cross-sectional study was conducted from March 2024 to February 2025 in departments of neurology and medicine in two tertiary care hospitals in Quetta and Khuzdar. A total of 384 adults age 18–60 years with migraine without aura, diagnosed using ICHD-3 criteria, were selected through consecutive sampling. Patients with other headache types or neurological disorders were excluded. Data were collected via data collection tool. Exercise was defined as aerobic activity for 30 minutes, three times weekly. Pain severity was measured using the Visual Analog Scale. Data were analyzed using SPSS 25.

Results:

In this study, 288 (75%) were females and 96 (25%) were males, with a mean age of 31.6 ± 8.7 years. Among 384 participants, 143 (37.2%) engaged in exercise, most commonly walking 101 (70.6%), and 92 (64.4%) exercised ≥3 times/week. Stress was reported in 294 (76.6%), irregular sleep in 121 (31.5%), and dietary triggers in 103 (26.8%). Regular exercisers had significantly fewer migraine attacks per month (3.1 ± 1.6) as compared with non-exercisers (4.9 ± 2.3) with p-value < 0.001.

Conclusion:

Regular physical exercise was associated with a significant reduction in both the frequency and severity of migraine without aura attacks.

Assessment of autonomic nervous system functions in patients with chronic inflammatory demyelinating polyradiculoneuropathy: an electrodiagnostic study

Raghda Nidal Hathal — 2025-12-25

Background and objectives:

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a chronic immune-mediated neuropathy predominantly affecting the peripheral nervous system including the nerve roots. The objectives of this study were to assess autonomic dysfunction in patients with CIDP using electrodiagnostic techniques and to examine its relationship with clinical and demographic characteristics, COMPASS-31 scores, and the Hughes disability scale.

Methods:

This case–control observational study included 25 patients with CIDP and 26 age- and sex-matched healthy controls and was conducted at the Neurophysiology Unit of Baghdad Teaching Hospital, Baghdad from February to November, 2024. All participants underwent autonomic function assessment, including Ewing’s cardiovascular tests and sympathetic skin response (SSR). COMPASS-31 and Hughes disability scores were recorded for clinical correlation. The independent Student’s t-test was applied to normally distributed quantitative variables, while non-normally distributed variables were assessed using the Mann–Whitney U test. Categorical variables were analyzed with the chi-square test. Associations between variables were examined using Pearson’s correlation coefficient for parametric data and Spearman’s rank correlation coefficient for non-parametric data.

Results:

CIDP patients exhibited significantly reduced heart rate variability and exaggerated blood pressure fluctuations, along with prolonged SSR latencies and decreased amplitudes compared to controls. Autonomic dysfunction involved both parasympathetic and sympathetic systems. Significant correlations were found between autonomic parameters and age, disease duration, COMPASS-31 score, Hughes score, and sex.

Conclusion:

Autonomic dysfunction in CIDP is common, typically mild to moderate, and affects both divisions of the ANS. Clinical and demographic variables may influence the pattern and severity of dysfunction.

Predictors and prevention of neurological disability in adult bacterial meningitis: a narrative review with clinical perspective

Sadiq Shah — 2025-12-14

Background and Objective:
Bacterial meningitis remains a neurological emergency in adults, with substantial mortality and long-term sequelae, including cognitive impairment, hearing loss, seizures, and focal deficits. The objective of this narrative review was to summarize current evidence on predictors of neurological disability and highlight strategies for prevention and long-term care.

Methods:
A narrative literature review was conducted using PubMed, Scopus, and Google Scholar for English-language studies published between 2000 and 2025. Keywords included bacterial meningitis, neurological sequelae, predictors, and adults. A total of 40 studies were included after screening 200 abstracts . Key prospective studies, clinical trials, and reviews were prioritized, and additional references were identified from bibliographies of relevant articles and guidelines.

Results:
Clinical predictors of poor neurological outcome include advanced age, low Glasgow Coma Scale score, seizures at presentation, and delayed antibiotic initiation. Laboratory predictors include low CSF glucose and elevated CSF protein. Radiological findings such as infarcts, hydrocephalus, and ventriculitis are associated with long-term disability. Among pathogens, Streptococcus pneumoniae carries the highest risk of neurological sequelae. Preventive strategies with documented benefit include timely antibiotic therapy, adjunctive corticosteroids, vaccination programs, structured neurorehabilitation, and ongoing follow-up.

Conclusion:
Early recognition of clinical, laboratory, and radiological prognostic indicators can reduce neurological disability in adults with bacterial meningitis. Future priorities should focus on validating biomarkers, establishing longitudinal registries, and exploring artificial intelligence based risk stratification to guide personalized care.

Anemia: an uncommon cause of cerebral venous sinus thrombosis

Iqra Athar — 2026-01-01

Cerebral venous sinus thrombosis (CVST) is a multifactorial illness seen more commonly in females as compared to males. Its diagnosis is often delayed due to variable clinical presentations. It is now identified more often due to advancements in neuroimaging modalities. We present an uncommon case of CVST caused by anemia in a 23-year-old female. Our patient presented with complaints of headache since the past two days and left sided hemiplegia since past one day. Later on during her hospital stay she developed generalized tonic clonic seizures. MRI and MRV brain with contrast revealed right cerebral venous (vein of Trolard) thrombosis. Blood tests showed hypochromic microcytic anemia which was the likely precipitating factor in our case as thrombophilia factors were normal. Headache and focal neurological symptoms should raise suspicion of CVST in anemic patients. Early commencement of anticoagulation along with correction of underlying cause, anemia in this case, leads to better prognosis.

Role of rituximab in autoimmune encephalitis: a report of two cases

Salman Farooq — 2025-12-25

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a form of autoimmune encephalitis that predominantly affects young individuals and often presents with neuropsychiatric symptoms. It is frequently misdiagnosed as a primary psychiatric disorder due to its initial presentation. Although first-line immunotherapy typically includes corticosteroids, intravenous immunoglobulin (IVIG), or plasmapheresis, a subset of patients shows limited response and requires escalation to second-line agents such as Rituximab. We report two adult male patients, aged 35 and 41 years, who initially presented with behavioral disturbances, confusion, memory deficits, and speech abnormalities. Both were initially misdiagnosed with psychiatric illnesses, delaying appropriate treatment. Diagnostic workups including MRI, EEG, and cerebrospinal fluid analysis were unremarkable; however, both patients tested positive for anti-NMDAR antibodies in serum and CSF. First-line immunotherapy with methylprednisolone and IVIG failed to yield significant improvement. Rituximab was subsequently initiated, leading to substantial clinical recovery in both cases. One patient experienced steroid-induced psychosis, which was resolved with psychiatric management. No Rituximab-related complications were observed. These cases highlight the importance of early consideration of anti-NMDAR encephalitis in adults presenting with acute psychiatric and cognitive symptoms. Timely diagnosis and escalation to second-line therapy with Rituximab in cases unresponsive to first-line treatment can significantly improve outcomes.

Hope in the face of subacute sclerosing panencephalitis: a case report of remarkable improvement with inosine pranobex

Nimra Shafique — 2025-12-14

Subacute Sclerosing Panencephalitis (SSPE) is a rare and relentless neurodegenerative disorder linked to persistent measles virus infection. We present a case of a 16-year-old female with gradually worsening rigidity, cognitive decline, and myoclonic seizures, minimally responsive to valproic acid. A history of measles infection at age two years emerged. Positive cerebrospinal fluid (CSF) IgG and IgM anti-measles antibodies, along with an elevated CSF/serum antibody index, confirmed SSPE. Treatment with inosine pranobex and clonazepam yielded significant motor and seizure control improvements. This case highlights the importance of early SSPE diagnosis and tailored interventions, shedding light on clinical progression and therapeutic responses.

Neurosurgery Research in Pakistan: An Analysis of Publications, Citations, and Gender Disparities

Waseem Hassan — 2025-12-14

Retraction notice

Editor PJNS — 2026-01-11

Retraction Notice

Sattar S, Soomro B. Efficacy of memantine as a preventive and therapeutic intervention for migraine and tension type headache. Pak J Neurol Sci. 2015;10(4):14-17

The Editorial Board of the Pakistan Journal of Neurological Sciences (PJNS) hereby retracts the above-mentioned article.

This action follows an internal inquiry initiated after a reader’s concern and subsequent written correspondence with the authors. The investigation confirmed multiple serious breaches of publication ethics, including:

Duplicate publication:
The dataset, demographic characteristics, outcome measures, and statistical results were identical to those previously published in PJNS, Vol. 10, Issue 2 (Apr–Jun 2015) under a different authorship.
Plagiarism:

Significant portions of the abstract, methodology, results, and discussion were reproduced verbatim or with minimal changes from the earlier publication without citation or disclosure.

Authorship irregularities:
Three authors from the original publication were omitted and a new author was added without justification, constituting inappropriate authorship attribution.
Misrepresentation of study setting:

The study site description differed from that reported in the earlier publication despite the dataset being the same, indicating inaccurate reporting of research context.

These findings reflect substantial violations of the ethical principles outlined by the Committee on Publication Ethics (COPE). After being notified, both authors agreed with the retraction.

In order to maintain the integrity of the scholarly record, the journal is formally retracting this article. The Editorial Board recognizes that this article should not have passed the editorial process and acknowledges this lapse in the editorial review process at that time.

Editor

Pakistan Journal of Neurological Sciences (PJNS)

Retracted article link: https://ecommons.aku.edu/pjns/vol10/iss4/5/