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Introduction. Carpal tunnel syndrome (CTS) is one of the most frequent entrapment neuropathies of the upper limb. Carpal tunnel syndrome (CTS) and diabetic polyneuropathy (DPN) are common conditions in patients with diabetes and therefore frequently occur concomitantly. Diagnosis of CTS in patients with DPN is important, as therapeutic interventions directed toward relief of CTS may be effective irrespective of diffuse neuropathy. Methods. This study was a hospital based descriptive cross sectional study done in BIRDEM general hospital between July, 2015 and June, 2016, for a period of twelve months. The initial clinical diagnosis of DPN was made and was confirmed by doing nerve conduction study. After having informed written consents, a standard preformed questionnaire was filled up for each case. Results. A total of 354 cases were finally analyzed with 153 (43.2%) patients being symptomatic and among those 54 (58.7%) had electrophysiology proven CTS. It was observed that 26.0% of patients established as having DPN also had CTS. The frequency of CTS among those with symptoms was significantly higher than in asymptomatic participants. Majority (38.4%) of patients belonged to the age group of 51-60 years. The mean age was found to be 55.99 ± 9.25 years with a range from 28 to 80 years. Among all cases of electrophysiology proven CTS (92 patients), females (53.3%) numbered greater in comparison to males (46.7%). Study subjects with CTS had significantly higher BMI, higher fasting blood sugar and higher HbA1c in comparison to patients without CTS. The mean compound motor action potential was not significantly different between patients with and without CTS. Conclusion. Given the high prevalence of CTS in subjects with DPN, it is recommended that therapeutic decisions should be made carefully after nerve conduction study and proper diagnosis.

Small cell lung cancer (SCLC) is the most frequent cancer histology associated with paraneoplastic syndromes. These syndromes are typically caused by ectopic hormone production or immune-mediated tissue destruction caused by neural antigen expression from cancer cells. Lambert-Eaton myasthenic syndrome is well known to be a classical paraneoplastic syndrome of small cell lung carcinoma (SCLC).Only a few cases of myasthenia gravis (MG) and SCLC were previously reported. The causal association between lung cancer and non-thymomatous myasthenia gravis has not been clarified yet. To date, there has been no evidence supporting the speculation that association of myasthenia gravis with lung cancer might be one of the phenotypes of paraneoplastic syndrome. We present a case of a 47-year-old male ex-smoker with SCLC associated with myasthenia gravis evidenced by the clinical findings of ptosis, dysphagia, proximal weakness, and positive repetitive nerve stimulation (RNS) test. Bangladesh Journal of Neuroscience 2015; Vol. 31 (1): 50-55

Cauda equina compression following vertebral compression fractures or vertebral plasmacytomas is relatively uncommon presentation of multiple myeloma. Here we describe a case of cauda equina syndrome due to multiple myeloma in an elderly Bangladeshi male who presented with difficulty in walking, urinary complaints & unexplained weight loss. CT guided FNAC from lesion of spine, bone marrow study, skeletal survey, MRI of spine & immune electrophoresis confirmed the diagnosis of multiple myeloma. We treated the patient with radiotherapy, dexamethasone, antimyeloma therapy, physiotherapy & bisphosphonates in collaboration with hematologists & neurosurgeons. He showed significant improvement both clinically & biochemically in the follow up. Bangladesh Journal of Neuroscience 2014; Vol. 30 (1): 57-61

Background and Aims: Diabetes mellitus and dyslipidemia, in particular triglyceridemia pose independent risk factors of stroke. Hypertriglyceridemia implicated in the pathogenesis of ischemic stroke by imparting endothelial dysfunction, oxidative stress and lowering fibrinolytic activity. This study was aimed to explore risk incurred by blood triglyceride level for ischemic stroke in type 2 diabetic patients. Materials and Methods: A total number of 80 [50 with acute ischemic stroke and 30 without stroke] type 2 diabetic patients consecutively admitted in the neurology department, during the period of April to September 2012, fulfilling the recruitment criteria were included in the study. Ischemic stroke was confirmed by CT-scan. Informed written consent from the legal attendant of each patient was obtained. Data regarding clinicobiochemical and images studies were retrieved from patient’s record form. Results: Male to female ratio was 1.2:1 of the study subjects. Mean (±SD) age (yrs) was 61.0±10.6 in patients with ischemic stroke (Group I) and 57.0±12.3 in patients without stroke (Group II). Risk factors like BMI, lifestyle, smoking, alcohol intake did not show any statistical significance with incidence of ischemic stroke. Mean (±SD) triglyceride (mg/ dl) was 241±56 and 217±102 in Group I and Group II respectively (p=0.024). Eighty eight percent patients had triglyceride 150 mg/dl in Group I and 70 percent in Group II. Triglyceride level (mean±SD, mg/dl) was significantly higher (335±101) in overweightobese patients (BMI 25 Kg/m2) compared to those (232±68) with normal body weight (BMI

Background and objectives: Carotid atherosclerosis constitutes an important cause of ischemic stroke. Type 2 diabetes mellitus is known to be an independent risk factor for stroke and its recurrence. This study was aimed to explore relationship between carotid atherosclerosis and ischaemic stroke in patients with diabetes and its association with other risk factors. Materials and Methods: A total number of 50 ischemic stroke patients, as confirmed by CT/MRI, patients with type 2 diabetes mellitus, of both sexes, age range 40-79 years, were recruited in the study from in-patient Neurology department, BIRDEM. Carotid duplex study was done. Ischemic Stroke patients were sub grouped into normal, mild (4) on the basis of ICA/CCA flow velocity ratio. Blood glucose and fasting lipid levels and blood pressure were recorded. Lipid abnormality ,LDL 130mg/dl, total cholesterol 200 mg/dl was defined following NCEP and AHA guidelines. Data were collected in a pre-formed printed case record form and analyzed using SPSS software. Results: Of the 50 cases only 9 (18%) had normal ICA/CCA flow velocity ratio. Their mean age was 48.0±4.4 years. Three (6%) cases had severe form of ICA/CCA flow velocity ratio 47.67±2.08. Subjects with stroke having mild to moderate compromised flow velocity ratio were significantly older (p

Back ground: Treatment compliance in patients with Alzheimer’s disease is particularly important as patients receiving regular treatment have a greater chance of slowing or delaying disease progression. Transdermal delivery has the potential for providing continuous drug delivery and steady plasma levels. Current study aimed to evaluate safety and tolerability of rivastigmine patch, to assess patient compliance and to assess the efficacy of treatment in patients with dementia (with probable Alzheimer’s disease). Methods: A total of 112 dementia patients (with a diagnosis of probable Alzheimer’s disease) from 12 centers were enrolled who were residing with someone in the communities throughout the study. After eligibility, and baseline assessments, patients were entered a 24-week open label treatment phase. All patients were started with application of one 5 cm² patch, followed by an up-titration to the target dose of 10 cm² patch size. Efficacy assessments were performed at weeks 12 and 24 in terms of MMSE and GDS score. Safety was monitored at all assessment points based mainly on the frequency of adverse events. Results: Analysis of baseline and available data until the drop out revealed no significant differentials. Around 95% of the study participants could receive 10 cm² patch size, showing a very high tolerability of the patch. Concurrent medication use also showed significant reduction to 16.3% patient in the end from 25% at baseline. The average MMSE score increased to 19.3 (±3.1) at 12th week and to 20.6(±3.4) at 24th week from 16.8 (±3.2) at baseline. GDS score reduced to 3.7 (±1.4) at 12th week and to 3.2 (±1.3) at 24th week from 4.3 (±1.5) at baseline. Only eight occasions of adverse event was reported (8.2%); no serious adverse event (SAE) were reported. Lost to follow up in the study was 14 (12.5%). Analysis of baseline data shows no significant difference. Their withdrawal seems to be unrelated to the adverse events and treatment outcome. Among the lost to follow up only one 1 (7.1%) had some side effect. Conclusion: Our study supports the pharmacokinetic rationale for the rivastigmine patch, indicating that smooth and continuous delivery of rivastigmine translates into an improved tolerability profile versus conventional oral administration, while maintaining clinical effectiveness. Bangladesh Journal of Neuroscience 2013; Vol. 29 (1) : 5-14

Background.Stroke is an important morbidity for low and middle income countries like Bangladesh. We established the first stroke registry in Bangladesh.Methods.Data was collected from stroke patients who were admitted in Department of Neurology of BIRDEM with first ever stroke, aged between 30 and 90 years. Patients with intracerebral hemorrhage, subarachnoid and subdural hemorrhage, and posttrauma features were excluded.Results.Data was gathered from 679 stroke patients. Mean age was 60.6 years. Almost 68% of patients were male. Small vessel strokes were the most common accounting for 45.4% of all the patients followed by large vessel getting affected in 32.5% of the cases. Only 16 (2.4%) died during treatment, and 436 (64.2%) patients had their mRS score of 3 to 5. Age greater than 70 years was associated with poor outcome on discharge [OR 1.79 (95% CI: 1.05 to 3.06)] adjusting for gender, duration of hospital stay, HDL, and pneumonia. Age, mRS, systolic blood pressure, urinary tract infection, pneumonia, and stroke severity explained the Barthel score.Conclusion.Mortality was low but most of patient had moderate to severe disability at discharge. Age, mRS, systolic blood pressure, urinary tract infection, pneumonia, and stroke severity influenced the Barthel score.