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Virtual Reality (VR) is an approach in stroke rehabilitation with ever-improving technological advancement for targeted motor rehabilitation by providing a user interface in a simulated environment with proprioceptive and visual feedback. This meta-analysis intended to evaluate the impact of immersive and non-immersive VR-based interventions compared to conventional rehabilitation in sensorimotor recovery following stroke. Randomized Controlled Trials based on the impact of VR, either immersive or non-immersive type in comparison to conventional rehabilitation on post-stroke patients (>18 years) sensorimotor recovery were searched on six databases including Google Scholar, PEDro, MEDLINE, Cochrane Library, EMBASE, and Web of Science from August to November 2020. A total of 17 randomized controlled trials on VR based intervention showed significant improvement in sensorimotor recovery following a stroke in overall FMA outcomes in comparison to the control group with pool effects in terms of SMD in a random effect model showed an impact of 0.498 at 95% CI (p

Ischemic stroke associated with coronavirus 2019 (COVID-19) has been well recognized by now. Few studies have compared COVID related versus unrelated strokes. We intend to report on a large group of Asian patients from two countries and compare COVID with non-COVID strokes admitted during the same time period.Consecutive cases of acute ischemic stroke either presenting or developing, between March 2020 and December 2021 in four tertiary care hospitals (1 in Dubai, UAE and 3 in Karachi, Pakistan) and testing positive for COVID-19 were included in the study. Patients admitted with ischemic stroke during the same time period and who tested negative for COVID-19 were also randomly selected from the four hospitals. All data was collected from the medical records of the patients and recorded on a standard questionnaire before it was entered in SPSS version 21 for analysis.There were 139 COVID positive and 271 COVID negative patients with acute ischemic stroke included in the current study. There were significantly more males (80.6% vs 64.9%, p=0.001) and more large vessel strokes in the COVID positive group (41% vs 21.8%, p0.001). Being COVID positive was an independent predictor of poor outcome at discharge, defined as a modified Rankin score of 3-6 (OR 3.87, 95% CI 2.21-6.77) after adjusting for country, age, sex, vascular comorbid conditions and stroke subtype.In this largest series of patients with COVID related strokes from Asia, COVID-19 was an independent predictor of poor outcomes at discharge after adjusting for other variables.

Background and Purpose: Coronavirus disease 2019 (CO­VID-19) has an increased propensity for systemic hypercoagulability and thromboembolism. An association with cerebrovascular diseases, especially cerebral venous thrombosis (CVT), has been reported among these patients. The objective of the present study was to identify risk factors for CVT as well as its presentation and outcome in COVID-19 patients. Methods: This is a multicenter and multinational observational study. Ten centers in 4 countries (Pakistan, Egypt, Singapore, and the United Arab Emirates) participated in this study. The study included patients (aged >18 years) with symptomatic CVT and recent COVID-19 infection. Results: Twenty patients (70% men) were included. Their mean age was 42.4 years, with a male-to-female ratio of 2.3:1. Headache (85%) and seizures (65%) were the common presenting symptoms, with a mean admission Glasgow Coma Scale (GCS) score of 13. CVT was the presenting feature in 13 cases (65%), while 7 patients (35%) developed CVT while being treated for COVID-19 infection. Respiratory symptoms were absent in 45% of the patients. The most common imaging finding was infarction (65%), followed by hemorrhage (20%). The superior sagittal sinus (65%) was the most common site of thrombosis. Acute inflammatory markers were raised, including elevated serum D-dimer (87.5%), erythrocyte sedimentation rate (69%), and C-reactive protein (47%) levels. Homocysteine was elevated in half of the tested cases. The mortality rate was 20% (4 patients). A good functional outcome was seen in the surviving patients, with a mean modified Rankin Scale score at discharge of 1.3. Nine patients (45%) had a modified Rankin Scale score of 0–1 at discharge. Conclusion: COVID-19-related CVT is more common among males at older ages when compared to previously reported non-COVID-19-related CVT cases. CVT should be suspected in COVID-19 patients presenting with headache or seizures. Mortality is high, but functional neurological outcome is good among survivors.

Objective:To evaluate the efficacy of Memantineas a therapeutic intervention for dementia and fibromyalgia. Methods: This clinical trial was conducted between October 2014 and December 2014. A total of 60 subjects, with diagnosed dementia or fibromyalgia, presenting to a private neurology clinic in Karachi, Pakistan were selected through purposive sampling technique. Adult patients belonging to both genders were included in the study. Patients were treated with incremental doses of Memantine. Data was analyzed using SPSS version 20 and associations were made using the Chi square test with p-value of less than 0.05 taken as significant. Results: Out of 30 patients with dementia, 12 (40%) were males and 18 (60%) were females. The mean age of the subjects with dementia was found to be 70 years while that of with fibromyalgia was 38 years. Out of 30 patients with fibromyalgia, 2 (6.7%) were males and 28 (93.3%) were females, which shows a very high occurrence of fibromyalgia in females. The efficacy of the drug in patients with dementia was observed to be 96.7%, whereas in patients with fibromyalgia it was found to be 93.3%, both of which are significantly high. The baseline MMSE score when compared with the score at 3-month follow-up by applying Wilcoxon signed rank test showed mean±SD (17.93±4.69 vs. 23.27±4.69) where p=0.000. The baseline FIQ score when compared with the 3-month follow-up score showed mean ± S.D (67.18±13.23 vs. 34.17±15.18) where p=0.000. Both of these show a highly significant result (?0.05). Results showed that cognitive functions, improved significantly by the end of the 3rd month of treatment in patients with dementia. All of the patients with fibromyalgia reported improvement in their physical functioning and majority of the patients felt less anxious and less depressed on their final follow-up visit. By the end of the 3rd month, the level of stiffness and intensity of the pain decreased significantly and patients reported less difficulty in performing work. Conclusion: Memantine has shown significant beneficial effects in improving cognitive functions in patients with dementia and in reducing the intensity of pain and disability in patients with fibromyalgia.

To identify the frequency of risk factors in various subtypes of acute ischemic stroke according to TOAST criteria.Cross-sectional, observational study.Ziauddin Hospital, Karachi, from January to December 2007.Patients with acute ischemic stroke were enrolled. Studied variables included demographic profile, history of risk factors, physical and neurological examination, and investigations relevant with the objectives of the study. Findings were described as frequency percentages. Proportions of risk factors against subtypes was compared using chi-square test with significance at p0.05.Out of the 100 patients with acute ischemic stroke, mean age at presentation was 63.5 years. Risk factor distribution was hypertension in 85%, Diabetes mellitus in 49%, ischemic heart disease in 30%, dyslipedemia in 22%, smoking in 9%, atrial fibrillation in 5%, and previous history of stroke in 29%. The various subtypes of acute ischemic stroke were lacunar infarct in 43%, large artery atherosclerosis in 31%, cardioembolic type in 8%, stroke of other determined etiology in 1% and stroke of undetermined etiology in 18%. Hypertension and Diabetes were the most important risk factors in both large and small artery atherosclerosis. In patients with cardio-embolic stroke significant association was found with ischemic heart disease (p=0.01).Importance and relevance of risk factors evaluated for subtypes rather than ischemic stroke as a whole should be reflected in preventive efforts against the burden of ischemic stroke.