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Background: Depressive illness is present among Parkinson’s disease (PD) patients. Objective: The purpose of the present study was to see the influencing factors of development of depressive illness among Parkinson’s disease patients. Methodology: This comparative cross-sectional study was carried out in the Department of Neurology and Department of Psychiatry at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2009 to June 2011 for a period of two (2) years. Parkinson’s disease patients who were attended at the movement disorder clinic and general OPD of Department of Neurology and in-patient department of Neurology at BSMMU, Dhaka were selected as study population. Patients with Parkinson’s plus syndrome, with dementia or other causes of parkinsonism like vascular or drug induced parkinsonism were excluded from this study. Data were collected by filling structured clinical questionnaire, then filling up of ‘structured clinical interview for DSM-IV Axis I disorders’ (SCID-CV) and self-reported ‘Depression scale` questionnaire. Parkinson disease was diagnosed by neurologist by the presence of two or more of the four cardinal criteria namely tremor, rigidity, bradykinesia and postural instability. Then patients were screened for depression by a psychiatrist of Department of Psychiatry at BSMMU, Dhaka. Result: A total of 100 Parkinson’s disease patients were interviewed and 80 patients ultimately participated in the study. The mean age of total Parkinson’s disease patients was 57.71±12.36 years ranging from 35 to 82 years with highest percentage (35%) had age group 65 years or above, 28.7% in 55 to 64 years, 22.5% in 45 to 54 years and lowest percentage (13.8%) in age group less than 45 years. Among 80 Parkinson’s disease patients, depression was present in 34 (42%) patients and was absent in 46 (58%) patients. Diabetes mellitus (p=0.125), hypertension (p=0.097), hypothyroidism (p=1.000), other illness (p=0.595), family history of PD (p=0.758) and levodopa use (p=0.661) were not significantly associated with the development of depressive illness in Parkinson’s disease. Conclusion: Diabetes mellitus (DM), hypertension (HTN), hypothyroidism, other illness, family history of PD and levodopa use do not significantly influence in the development of depressive illness among the Parkinson’s disease. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 106-110

Background: Internal carotid artery (ICA) is one of the commonest site stenosis in patients with ischemic stroke. There is difference in the distribution of stenosis among different sites of cerebral infarct.Volume and severity of cerebral infarct may also depend on the degree of stenosis. To plan efficient evaluation and treatment of individual patient of ischemic stroke, the responsible clinician must be familiar with the relative probability of finding occlusive lesions at various sites within the vascular tree. Objective: The objective of this study was to evaluate the angiographic pattern of ICA stenosis among different types of cerebral infarct. Materials and Methods: We evaluated 53 ischemic stroke patients from indoor, outdoor, stroke and neuro intervention clinic, BSMMU. CT scan and/ or MRI of brain were done to each patient to confirm the diagnosis. After vascular imaging, the degree of stenosis was measured by the NASCET formula. Results: Cervical segment of ICA was most commonly [n=45(84.9%)] encountered site of stenosis and total occlusion of ICA was always observed in cervical segment. Among patients with moderate stenosis (n=15) of ICA, 6(40.0%) presented with subcortical infarction, 4(26.7%) presented with lacunar infarction and 5(33.0%) presented with territorial infarction. In case of severe stenosis (n=23), territorial, lacunar and watershed infarct were 9(39.1%), 8(34.8%) and 2(8.7%) respectively. Whereas total occlusion (n=15) of ICA presented as either territorial infarction [n=11(73.3%)] or watershed infarction [n= 4(26.7%)]. These differences between severity of stenosis and subtype of infarct were also significant (p-value = 0.003).A total of 25 patients presented with territorial infarction, mostly MCA territory [n=23(92%)]. Conclusion: With increasing severity of stenosis, the infarct burden rises. ICA stenosis of e”70% mainly presented as territorial infarction whereas, watershed infarct was an indicator of severe stenosis. Bangladesh Journal of Neuroscience 2019; Vol. 35 (2): 69-77

Background: Combination of propranolol and amitriptyline drugs an be effective for migraine prophylaxis.Objective: The purpose of the present study was to see the safety and efficacy of propranolol and amitriptyline combination therapy in migraine prophylaxis.Methodology: This study randomized control trial was conducted in headache clinic at Banghabandhu Sheikh Medical University (BSMMU), Dhaka, Bangladesh from July 2012 to June 2014 for a period of two (02) years. Migraine patients with or without aura of 16 to 50 years of age, patients not on any prophylactic medication and patients willing to take part in the study were included for this study. Patients meeting all the criteria was randomized for two (02) treatment groups designated as the group A who were treated with Amitriptyline and the group B who were treated with the combination of amitriptyline and propranolol. Patients was followed for a three months period during which they were instructed to maintain a headache diary. The primary outcome evaluated was the proportion of patients in each group that achieved a 50% reduction in the number of days with headache. Secondary outcomes was reduction of visual analogue pain scale score, the number of days with headache per month, frequency of side effects and the proportion of patients abandoning the study before the end of medication. The causes of noncompliance and side effects was individually registered.Result: A total number of 8 0patietns were recruited for this study. During 1st visit among the patients in group A, duration of pain 1-4 hours 1 (2.5.0%), 5-8 hours 16(13.3%) and 9-12 hours 14(35.0%). In group B, duration of pain 1-4 hours 0(0.0%), 5-8 hours 18(15.0%) 9-12 were 21(52.5%), above 13 hours pain duration were 1(2.5%) (p>0.05). Duration of pain was recorded in final follow up among the patients. In group A, duration of pain 1-4 hours 24(60.0%), 5-8 hours 14(35.0%), 9-12 hours 2(5.0%). In group B, duration of pain 1-4 hours 28(70.0%), 5-8 hours 12(30.0%), 9-12 hours were not found (p>0.05). In group A, no adverse effect was found 26(65.0%), drowsiness 6(15.0%), dryness of mouth 6(15.0%), constipation 2(5.0%), fatigue and bradycardia were not found. In group B, no adverse effect was found 29(72.5%), drowsiness, dryness of mouth and constipation were not found, fatigue and bradycardia were 7(17.5%) and 4(10.0%). Number of attack and headache before treatment and subsequent follow up with medication it was found that number of attach and headache gradually decrease (p

The major challenge of performing root canal treatment in an open apex pulp-less tooth is to obtain a good apical seal. An 11 year old boy was presented with pain in his upper anterior teeth. On clinical examination both the maxillary central incisors revealed slight discoloration and fracture of the crown. Radiographic evaluation revealed radiolucency and open apices of both central incisors. Apexification with MTA apical plug was carried out before obturation with gutta-percha and sealer and the treatment was completed within 3 consecutive appointments. In twelve months follow up both the teeth were clinically and radiographically asymptomatic and the healing of the apical area was continued. The positive clinical outcome may encourage the future use of mineral trioxide aggregate (MTA) as an apical plug material in case of non-vital open apex teeth.J Bangladesh Coll Phys Surg 2017; 35(4): 196-199

A 23-year-old Bangladeshi male was referred to our hospital for gradual worsening of breathlessness over 3 h, developed following a road-accident about 14 h previously. He had a close fracture of mid-shaft of his right tibia, which was immobilised with back slab at the previous healthcare facility. During presentation at the emergency department, he was conscious and oriented (Glasgow coma scale 15/15), tachycardic (heart rate 132 per min), blood pressure 100/70 mmHg, tachypnoeic (respiratory rate 34 per min) with oxygen saturation 89% on room air, and afebrile. Chest examination revealed restricted chest movement, hyper-resonant percussion notes and reduced breath sound on the left, and diffuse crackles on both sides., Can you diagnose this young adult with post-traumatic breathlessness, unconsciousness and rash? http://bit.ly/2LlpkiV

Acquired Hepatocerebral Degeneration (AHD) produces a panel of neurological symptoms occurring in patients with chronic liver disease. These symptoms may mimic different neurological abnormalities e.g. abnormal movements, rigidity, parkinsonism, ataxia, neuropsychiatric and cognitive manifestations.[1] Acquired Hepatocerebral Degeneration is usually encountered in patients with CLD due to accumulation of manganese & other metabolic toxins in basal ganglia, following repeated episodes of liver failure[2] .The aim of this case report is to highlight the MRI finding of Acute Hepatocerebral Degeneration which often can be underappreciated owing to the possibility of diagnosing a relatively common condition that is Bilateral Ischemic stroke.[19].Bangladesh Crit Care J March 2016; 4 (1): 54-57

Guillain Barre Syndrome (GBS) is an immune mediated polyradiculoneuropathy classically characterized by acute ascending type of motor weakness of limbs with areflexia but in AMAN variant of GBS preserved or exaggerated reflex sometimes can occur. We report a 45 year old female patient who presented with acute flaccid quadriplegia, bilateral facial lower motor type nerve palsy and bulbar involvement, initial hyperreflexia of all four limbs and bilateral plantar extensor response 7 days following an attack of diarrhoea. Sensory and bowel bladder function was intact. She was treated with IV immunoglobulin and IV methylprednisolone. Nerve Conduction study (NCS) revealed AMAN variant of GBS. All reflexes disappeared on the 2nd day onward but returned on 21st day of illness when muscle power also improved. Follow up NCS confirmed regeneration of nerves of all four limbs. So in any patient presenting with acute quadriparesis GBS should be in the differential diagnosis even if there is preserved or exaggerated deep tendon reflexes.J Bangladesh Coll Phys Surg 2014; 32: 107-109

Background: The diagnosis of ischemic stroke remains a clinical one, with confirmatory evidence obtained through neuroimaging. ECG changes are common in patients with ischemic stroke. Objective: The objective of this study was to see ECG findings among ischemic stroke patients. Materials and Methods: This study was carried out in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from July 2006 to October 2008. A total of 36 patients with acute Ischemic stroke were selected by purposive sampling method and diagnosed by history, clinical findings ard was confirmed by CT scan of head. The clinical details, investigations of the respondents were reviewed. Data were recorded in a pre-designed data collection sheet. Result: Majority of the subjects were in 7th decade 12(33.3%) and 6th decade 9(25%) with the male to female ratio was 1.25:1. Among the patients with abnormal electrocardiographic findings, 7(19.4%) patients each had myocardial ischemia, 4(11.1%) had conduction block and ventricular arrhythmias, 7(19.4%) had atrial fibrillation, 5(13.9%) had ventricular hypertrophy, 7(19.4%) had myocardial infarction, 6(16.7%) patients had non-specific ST changes. Conclusion: Myocardial ischemia, atrial fibrillation and myocardial infarction are common electrocardiographic findings of ischemic stroke patients. Bangladesh Journal of Neuroscience 2014; Vol. 30 (1): 23-26

Background: Meningiomas are usually globular encapsulated tumors. They are extra axial tumors attached to dura and compress the underlying brain without invading it. Abnormalities of bone are frequently encountered in Meningiomas. Hyperostosis or endosotsis are certainly more common than destruction of bone. Aims and Objective: Aim of study was to observe the percentage of tumour cell invasion in to the hyperostosis part of intracranial meningiomas. Materials and methods: This is an observational analytic study. Sample size was 34. Place of study was department of Neurosurgery of Square Hospitals Ltd. All the patients with the histological diagnosis of meningioma were included in to this study. Result: Female patients were predominant. Highest number of patients was from 41 to 50 years age group. Convexity meningiomas were commonest (35%) followed by parasagittal meningiomas. According to histopathological subtype meningothelimatous was commonest (56%) followed by psammomatous. About one fourth meningioma patients (26.47%) presented with hyperostosis. Among the hyperostosis patients in 44.44% patient’s cause of hyperostosis was due to tumour cell invasion into hyperostosis part. Conclusion: Tumour cell invasion is one of the causes of hyperostosis in intracranial meningiomas which was responsible in more than one third cases in this study. Bangladesh Journal of Neuroscience 2011; Vol. 27 (2) : 78-82 DOI: http://dx.doi.org/10.3329/bjn.v27i2.17573