The ability of primary care physicians (PCPs) to diagnose neurologic disorders was assessed from ... more The ability of primary care physicians (PCPs) to diagnose neurologic disorders was assessed from the records of 166 patients referred to the neurology outpatient clinic in one year. At the time of referral, 74.7% were correctly diagnosed. Primary care physicians were competent in the diagnosis of cerebrovascular accidents, epilepsy, space-occupying lesions, dementia, extrapyramidal and cerebellar disorders. More specific diagnosis was difficult at the primary care level in cases of headache, spinal cord and peripheral nerve disorders. The implications of these results and possible reasons for them are discussed. Solutions to improve on this situation are recommended with emphasis on both undergraduate and postgraduate training in neurological bedside skills. The complementary roles of the primary care physician and the neurologist are stressed.
We report a 60-year-old Saudi patient with the clinical diagnosis of Alzheimer`s disease (AD) and... more We report a 60-year-old Saudi patient with the clinical diagnosis of Alzheimer`s disease (AD) and a novel mutation in the presenilin gene. We investigated mutations in the presenilin-1 gene in Saudi patients with AD using polymerase chain reaction and direct DNA sequencing methods. We extracted genomic DNA from the whole blood of both patients and normal control individuals. We sequenced and compared amplicons with the sequences of the respective exons of normal individuals as well as data available in GenBank. We detected a homozygous mutation (g-c) in exon 12, resulting in the missense mutation (Arg377Thr), in the DNA of a 60-year-old patient. We located this mutation in the cytoplasmic loop near the transmembrane domain 7.
We examined the deletion of the survival motor neuron (SMN) and neuronal apoptosis inhibitory pro... more We examined the deletion of the survival motor neuron (SMN) and neuronal apoptosis inhibitory protein (NAIP) genes in patients with spinal muscular atrophy (SMA) using polymerase chain reaction followed by restriction site assay methods. The study included 16 Saudi patients (9 SMA type I and 7 SMA type II) and 6 healthy Saudi volunteers. The homozygous deletions of exons 7 and 8 of the telomeric SMN gene, and exon 5 of the NAIP gene were found in all SMA type I patients. Exons 7 and 8 of telomeric SMN were deleted in all SMA type II patients. However, exon 5 of NAIP was deleted in three of the seven cases. All control volunteers and all family members of the patients had normal SMN and NAIP. The incidence of NAIP deletion was higher in the more severe SMA cases and the dual deletion of the SMN and NAIP genes was more common in Saudi SMA type I patients compared with patients of other ethnic groups.
The anesthetic management of a 17-year-old female with von Recklinghausen's disease (mult... more The anesthetic management of a 17-year-old female with von Recklinghausen's disease (multiple neurofibromatosis) is described. Multiple neurofibromatosis is a rare syndrome characterized by abnormal cutaneous pigmentation and numerous skin tumors. In addition to the usual stigmata of the syndrome, patients with neurofibromatosis have been reported to be either sensitive or resistant to succinylcholine. Further, all reports indicate that response to nondepolarizing muscle relaxants is exaggerated. In this patient, the nerve conduction studies were within limit of normal values. During surgery, neuromuscular function was monitored throughout using the train-of-four mechanical twitch response. The response of this patient to succinylcholine was normal and the response to atracurium was slightly prolonged. It is concluded that atracurium offers advantages over the other nondepolarizing muscle relaxants in patients with von Recklinghausen's disease.
The epidemiology of stroke at different geographical locations in the Kingdom of Saudi Arabia has... more The epidemiology of stroke at different geographical locations in the Kingdom of Saudi Arabia has not been adequately investigated. In this study, clinical types and risk factors of stroke were compared among patients at low-altitude (Riyadh, 620 m) and high-altitude (Al Baha > 2000 m) areas using a case-control study design. One-hundred ninety recently diagnosed cases (109 from Riyadh and 81 from Al Baha) were verified and subjects were interviewed. An equal number of age- and sex-matched controls from the corresponding areas were also interviewed using a specific standard questionnaire. The frequency of thrombotic stroke at high altitude was 93.4% as compared to 79.3% at low altitude (P < 0.05). The odds ratios (OR) for the different risk factors at high and low altitudes, respectively, were: hypertension 4.4 and 2.1; diabetes mellitus: 2.7 and 1.9; ischemic heart disease (IHD): 2.4 and 1.9; atrial fibrillation: 3.9 and 3.3, and smoking: 2.3 and 2.5. The mean hematocrit valu...
The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques, 1997
Tuberculosis of the nervous system has protean manifestations. Syringomyelia, though an uncommon ... more Tuberculosis of the nervous system has protean manifestations. Syringomyelia, though an uncommon complication of it, is usually of late onset. We report two patients with tuberculosis meningitis who developed syringomyelia acutely. The diagnosis was supported by neuroimaging and findings at laminectomy. The two patients developed syringomyelia between 11 days and 6 weeks of the onset of tuberculous meningitis. They both had cord swelling and softening. Acute-onset syringomyelia should be suspected in any patient being treated for tuberculosis meningitis who subsequently develops limb weakness and/or sphincteric dysfunction. Inflammatory edema and cord ischemia appeared to be the underlying mechanisms in these early onset cases rather than arachnoiditis which is important in late-onset cases.
Twenty-one cases of stroke were observed in children aged between 4 months and 15 years attending... more Twenty-one cases of stroke were observed in children aged between 4 months and 15 years attending two large hospitals in Saudi Arabia over a 10-year period. The number constitutes two per cent of all cases of stroke managed in these hospitals during that period. Eleven cases were associated with cerebral arterial infarction, nine with cerebral haemorrhage and one with venous infarction. The main aetiological factors were attributable to embolism of cardiac origin, infections, coagulation disorders, haemoglobinopathies and arteriovenous malformations. Although stroke in children is regarded as rare, its relative frequency in Saudi society is probably higher than in western societies.
The records of 99 Saudis (68 males and 31 females) admitted to the King Fahd Hospital of the Univ... more The records of 99 Saudis (68 males and 31 females) admitted to the King Fahd Hospital of the University (KFHU) over a two-year period were reviewed. There was a male to female ratio of 2.2:1. Eighty-five (86%) patients were above 44 years old. All the patients under 44 years old were males. The major predisposing factors identified were hypertension (65%), diabetes mellitus (36%), cardiac disease (20%) and cigarette smoking (29%). The combination of hypertension and diabetes mellitus seemed to carry a higher risk especially in women. Motor dysfunction, encountered in 95 (96%) patients was the dominant clinical feature, and presented mainly as hemiparesis (83 out of 95). Impaired level of consciousness at presentation carried a poor prognosis particularly in the elderly.
We report our experience of stroke in 136 young adults aged from 18 to 45 years seen in the Easte... more We report our experience of stroke in 136 young adults aged from 18 to 45 years seen in the Eastern Province of Saudi Arabia over a 10-year period. They constituted 25% of all our stroke cases. Thirty-eight percent were Saudi nationals and 62% expatriates. Males largely outnumbered females. The frequency of cerebral infarction (54%) was not very different from that of intracranial hemorrhage (45%). Atherosclerosis and embolism of cardiac origin were the major causes of infarction. The main causes of intracranial bleeding were arterial aneurysms, arteriovenous malformations and hypertension. However, the causes of 29% of ischemic strokes and 44% of hemorrhagic ones remained undetermined. Interethnic comparison of the causes showed that hemorrhages were significantly more frequent in Far East immigrants. Sixty five percent of cerebral infarctions in Asiatic patients remained of undetermined origin. The local variant of sickle cell gene did not seem to play a major role in the pathogen...
There are significant variations among countries in the incidence of brain abscess. We report her... more There are significant variations among countries in the incidence of brain abscess. We report here 26 cases of brain abscess treated at the Neurosurgery Department of King Faisal University and Dammam Central Hospital Saudi Arabia over a six year period (1982-1988). This is 2.3% of total admissions to the two neurosurgery departments serving a population of approximately 1.2 million in the same period. Young males were most often affected (M/F ratio 3.3:1; 31% were less than 15 years old, 46% aged between 15-39 years, and 23% older than 40 years). Streptococcus was found to be the most common microorganism (38.4%). Mixed infection was seen in 15.3%, and sterile abscesses were found in 11.5% of the patients after aerobic and anaerobic cultures of the pus. Chronic otitis media and paranasal sinusitis predisposed the patients to abscess formation in 57.6% of the cases. The temporo-parietal area was the commonest site. Epilepsy was a complication in 30.7% of our patients, and the mortality rate was 15.3%.
We report the findings of a total population survey of Thugbah community in the Eastern Province ... more We report the findings of a total population survey of Thugbah community in the Eastern Province of Saudi Arabia (SA) to determine its point prevalence of neurological diseases. During this two-phase door-to-door study, all Saudi nationals living in Thugbah were first screened by trained interviewers using a pretested questionnaire (sensitivity 98%, specificity 89%) administered at a face-to-face interview. Individuals with abnormal responses were then evaluated by a neurologist using specific guidelines and defined diagnostic criteria to document neurological disease. The questionnaire was readministered blind by a neurologist to all those with abnormal responses and a 1-in-20 random sample of those without abnormal responses, respectively. The family members of an individual with an abnormal response were also screened to improve accuracy. A total of 23,227 Saudis (98% of the eligible subjects) were screened and those residing in Thugbah on the reference date (22,630) were used to calculate the point prevalence rates. Forty-two percent of those screened were in the first decade of life and only 1.5% were more than 60 years old. There were marginally more females (50.2%) than males (49.8%). Consanguineous marriages especially between first cousins were present in 54.6%. The demographic characteristics of Thugbah community were similar to those in other parts of SA. The overall crude prevalence ratio (PR) for all forms of neurological disease was 131/1,000 population. All subsequent PRs are per 1,000 population. Headache syndromes were the most prevalent disorder (PR 20.7). The PR for all seizure disorders was 7.60, and the epilepsies (6.54) were more frequent than febrile convulsions (0.84). Mental retardation, cerebral palsy syndrome, and microcephaly were common pediatric problems with PRs of 6.27, 5.30 and 1.99, respectively. Stroke, Parkinson&amp;amp;#39;s disease, and Alzheimer&amp;amp;#39;s disease were uncommon with respective PRs of 1.8, 0.27 and 0.22. Central nervous system (CNS) malformations (0.49) such as hydrocephalus and meningomyelocele were more prevalent than spinal muscular atrophy (0.13), congenital brachial palsy (0.13) and narcolepsy (0.04). Multiple sclerosis was rare (0.04). Osteoarthritis and low back pain syndromes were the main non-neurological conditions seen. The major medical diseases that may be neurologically relevant were diabetes mellitus, hypertension, and connective tissue disorders.(ABSTRACT TRUNCATED AT 400 WORDS)
The ability of primary care physicians (PCPs) to diagnose neurologic disorders was assessed from ... more The ability of primary care physicians (PCPs) to diagnose neurologic disorders was assessed from the records of 166 patients referred to the neurology outpatient clinic in one year. At the time of referral, 74.7% were correctly diagnosed. Primary care physicians were competent in the diagnosis of cerebrovascular accidents, epilepsy, space-occupying lesions, dementia, extrapyramidal and cerebellar disorders. More specific diagnosis was difficult at the primary care level in cases of headache, spinal cord and peripheral nerve disorders. The implications of these results and possible reasons for them are discussed. Solutions to improve on this situation are recommended with emphasis on both undergraduate and postgraduate training in neurological bedside skills. The complementary roles of the primary care physician and the neurologist are stressed.
We report a 60-year-old Saudi patient with the clinical diagnosis of Alzheimer`s disease (AD) and... more We report a 60-year-old Saudi patient with the clinical diagnosis of Alzheimer`s disease (AD) and a novel mutation in the presenilin gene. We investigated mutations in the presenilin-1 gene in Saudi patients with AD using polymerase chain reaction and direct DNA sequencing methods. We extracted genomic DNA from the whole blood of both patients and normal control individuals. We sequenced and compared amplicons with the sequences of the respective exons of normal individuals as well as data available in GenBank. We detected a homozygous mutation (g-c) in exon 12, resulting in the missense mutation (Arg377Thr), in the DNA of a 60-year-old patient. We located this mutation in the cytoplasmic loop near the transmembrane domain 7.
We examined the deletion of the survival motor neuron (SMN) and neuronal apoptosis inhibitory pro... more We examined the deletion of the survival motor neuron (SMN) and neuronal apoptosis inhibitory protein (NAIP) genes in patients with spinal muscular atrophy (SMA) using polymerase chain reaction followed by restriction site assay methods. The study included 16 Saudi patients (9 SMA type I and 7 SMA type II) and 6 healthy Saudi volunteers. The homozygous deletions of exons 7 and 8 of the telomeric SMN gene, and exon 5 of the NAIP gene were found in all SMA type I patients. Exons 7 and 8 of telomeric SMN were deleted in all SMA type II patients. However, exon 5 of NAIP was deleted in three of the seven cases. All control volunteers and all family members of the patients had normal SMN and NAIP. The incidence of NAIP deletion was higher in the more severe SMA cases and the dual deletion of the SMN and NAIP genes was more common in Saudi SMA type I patients compared with patients of other ethnic groups.
The anesthetic management of a 17-year-old female with von Recklinghausen&#39;s disease (mult... more The anesthetic management of a 17-year-old female with von Recklinghausen&#39;s disease (multiple neurofibromatosis) is described. Multiple neurofibromatosis is a rare syndrome characterized by abnormal cutaneous pigmentation and numerous skin tumors. In addition to the usual stigmata of the syndrome, patients with neurofibromatosis have been reported to be either sensitive or resistant to succinylcholine. Further, all reports indicate that response to nondepolarizing muscle relaxants is exaggerated. In this patient, the nerve conduction studies were within limit of normal values. During surgery, neuromuscular function was monitored throughout using the train-of-four mechanical twitch response. The response of this patient to succinylcholine was normal and the response to atracurium was slightly prolonged. It is concluded that atracurium offers advantages over the other nondepolarizing muscle relaxants in patients with von Recklinghausen&#39;s disease.
The epidemiology of stroke at different geographical locations in the Kingdom of Saudi Arabia has... more The epidemiology of stroke at different geographical locations in the Kingdom of Saudi Arabia has not been adequately investigated. In this study, clinical types and risk factors of stroke were compared among patients at low-altitude (Riyadh, 620 m) and high-altitude (Al Baha > 2000 m) areas using a case-control study design. One-hundred ninety recently diagnosed cases (109 from Riyadh and 81 from Al Baha) were verified and subjects were interviewed. An equal number of age- and sex-matched controls from the corresponding areas were also interviewed using a specific standard questionnaire. The frequency of thrombotic stroke at high altitude was 93.4% as compared to 79.3% at low altitude (P < 0.05). The odds ratios (OR) for the different risk factors at high and low altitudes, respectively, were: hypertension 4.4 and 2.1; diabetes mellitus: 2.7 and 1.9; ischemic heart disease (IHD): 2.4 and 1.9; atrial fibrillation: 3.9 and 3.3, and smoking: 2.3 and 2.5. The mean hematocrit valu...
The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques, 1997
Tuberculosis of the nervous system has protean manifestations. Syringomyelia, though an uncommon ... more Tuberculosis of the nervous system has protean manifestations. Syringomyelia, though an uncommon complication of it, is usually of late onset. We report two patients with tuberculosis meningitis who developed syringomyelia acutely. The diagnosis was supported by neuroimaging and findings at laminectomy. The two patients developed syringomyelia between 11 days and 6 weeks of the onset of tuberculous meningitis. They both had cord swelling and softening. Acute-onset syringomyelia should be suspected in any patient being treated for tuberculosis meningitis who subsequently develops limb weakness and/or sphincteric dysfunction. Inflammatory edema and cord ischemia appeared to be the underlying mechanisms in these early onset cases rather than arachnoiditis which is important in late-onset cases.
Twenty-one cases of stroke were observed in children aged between 4 months and 15 years attending... more Twenty-one cases of stroke were observed in children aged between 4 months and 15 years attending two large hospitals in Saudi Arabia over a 10-year period. The number constitutes two per cent of all cases of stroke managed in these hospitals during that period. Eleven cases were associated with cerebral arterial infarction, nine with cerebral haemorrhage and one with venous infarction. The main aetiological factors were attributable to embolism of cardiac origin, infections, coagulation disorders, haemoglobinopathies and arteriovenous malformations. Although stroke in children is regarded as rare, its relative frequency in Saudi society is probably higher than in western societies.
The records of 99 Saudis (68 males and 31 females) admitted to the King Fahd Hospital of the Univ... more The records of 99 Saudis (68 males and 31 females) admitted to the King Fahd Hospital of the University (KFHU) over a two-year period were reviewed. There was a male to female ratio of 2.2:1. Eighty-five (86%) patients were above 44 years old. All the patients under 44 years old were males. The major predisposing factors identified were hypertension (65%), diabetes mellitus (36%), cardiac disease (20%) and cigarette smoking (29%). The combination of hypertension and diabetes mellitus seemed to carry a higher risk especially in women. Motor dysfunction, encountered in 95 (96%) patients was the dominant clinical feature, and presented mainly as hemiparesis (83 out of 95). Impaired level of consciousness at presentation carried a poor prognosis particularly in the elderly.
We report our experience of stroke in 136 young adults aged from 18 to 45 years seen in the Easte... more We report our experience of stroke in 136 young adults aged from 18 to 45 years seen in the Eastern Province of Saudi Arabia over a 10-year period. They constituted 25% of all our stroke cases. Thirty-eight percent were Saudi nationals and 62% expatriates. Males largely outnumbered females. The frequency of cerebral infarction (54%) was not very different from that of intracranial hemorrhage (45%). Atherosclerosis and embolism of cardiac origin were the major causes of infarction. The main causes of intracranial bleeding were arterial aneurysms, arteriovenous malformations and hypertension. However, the causes of 29% of ischemic strokes and 44% of hemorrhagic ones remained undetermined. Interethnic comparison of the causes showed that hemorrhages were significantly more frequent in Far East immigrants. Sixty five percent of cerebral infarctions in Asiatic patients remained of undetermined origin. The local variant of sickle cell gene did not seem to play a major role in the pathogen...
There are significant variations among countries in the incidence of brain abscess. We report her... more There are significant variations among countries in the incidence of brain abscess. We report here 26 cases of brain abscess treated at the Neurosurgery Department of King Faisal University and Dammam Central Hospital Saudi Arabia over a six year period (1982-1988). This is 2.3% of total admissions to the two neurosurgery departments serving a population of approximately 1.2 million in the same period. Young males were most often affected (M/F ratio 3.3:1; 31% were less than 15 years old, 46% aged between 15-39 years, and 23% older than 40 years). Streptococcus was found to be the most common microorganism (38.4%). Mixed infection was seen in 15.3%, and sterile abscesses were found in 11.5% of the patients after aerobic and anaerobic cultures of the pus. Chronic otitis media and paranasal sinusitis predisposed the patients to abscess formation in 57.6% of the cases. The temporo-parietal area was the commonest site. Epilepsy was a complication in 30.7% of our patients, and the mortality rate was 15.3%.
We report the findings of a total population survey of Thugbah community in the Eastern Province ... more We report the findings of a total population survey of Thugbah community in the Eastern Province of Saudi Arabia (SA) to determine its point prevalence of neurological diseases. During this two-phase door-to-door study, all Saudi nationals living in Thugbah were first screened by trained interviewers using a pretested questionnaire (sensitivity 98%, specificity 89%) administered at a face-to-face interview. Individuals with abnormal responses were then evaluated by a neurologist using specific guidelines and defined diagnostic criteria to document neurological disease. The questionnaire was readministered blind by a neurologist to all those with abnormal responses and a 1-in-20 random sample of those without abnormal responses, respectively. The family members of an individual with an abnormal response were also screened to improve accuracy. A total of 23,227 Saudis (98% of the eligible subjects) were screened and those residing in Thugbah on the reference date (22,630) were used to calculate the point prevalence rates. Forty-two percent of those screened were in the first decade of life and only 1.5% were more than 60 years old. There were marginally more females (50.2%) than males (49.8%). Consanguineous marriages especially between first cousins were present in 54.6%. The demographic characteristics of Thugbah community were similar to those in other parts of SA. The overall crude prevalence ratio (PR) for all forms of neurological disease was 131/1,000 population. All subsequent PRs are per 1,000 population. Headache syndromes were the most prevalent disorder (PR 20.7). The PR for all seizure disorders was 7.60, and the epilepsies (6.54) were more frequent than febrile convulsions (0.84). Mental retardation, cerebral palsy syndrome, and microcephaly were common pediatric problems with PRs of 6.27, 5.30 and 1.99, respectively. Stroke, Parkinson&amp;amp;#39;s disease, and Alzheimer&amp;amp;#39;s disease were uncommon with respective PRs of 1.8, 0.27 and 0.22. Central nervous system (CNS) malformations (0.49) such as hydrocephalus and meningomyelocele were more prevalent than spinal muscular atrophy (0.13), congenital brachial palsy (0.13) and narcolepsy (0.04). Multiple sclerosis was rare (0.04). Osteoarthritis and low back pain syndromes were the main non-neurological conditions seen. The major medical diseases that may be neurologically relevant were diabetes mellitus, hypertension, and connective tissue disorders.(ABSTRACT TRUNCATED AT 400 WORDS)
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