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Search Results: 1 - 10 of 16 matches for " Majaz Moonis "
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Intracranial Hypotension with Multiple Complications: An Unusual Case Report
Swetha Ade,Majaz Moonis
Case Reports in Neurological Medicine , 2013, DOI: 10.1155/2013/913465
Abstract: Background. Undiagnosed intracranial hypotension can result in several complications including subdural hematoma (SDH), subarachnoid hemorrhage (SAH), dural venous sinuses thrombosis (CVT), cranial nerve palsies, and stupor resulting from sagging of the brain. It is rare to see all the complications in one patient. Furthermore, imaging of the brain vasculature may reveal incidental asymptomatic small aneurysms. Given the combination of these imaging findings and a severe headache, the patients are often confused to have a primary subarachnoid hemorrhage. Case Report. We present a patient with spontaneous intracranial hypotension (SIH) who had an incidental ophthalmic artery aneurysm on MR imaging, and this presentation led to coiling of the aneurysm. The key aspect in the history “postural headaches” was missed, and this led to life threatening complications and unnecessary interventions. Revisiting the history and significant improvement in symptoms following an epidural blood patch resulted in the diagnosis of SIH. Conclusion. We strongly emphasize that appropriate history taking is the key in the diagnosis of SIH and providing timely treatment with an epidural blood patch could prevent potentially life threatening complications. 1. Introduction Spontaneous intracranial hypotension (SIH) is often an underdiagnosed condition resulting from low cerebral spinal fluid (CSF) pressure. SIH usually presents with headaches following a dural sleeve tear resulting in CSF leak [1]. Headaches are typically orthostatic [2] but can also present as persistent daily headaches. Careful history taking is the key in making the diagnosis. Failure to diagnose may lead to life threatening complications including SAH, SDH, and CVT. We report a case of SIH, with all three complications described above. Our case is unique because, to the best of our knowledge, we have not come across any reported case of SIH with all the complications in one patient. 2. Case Report A 54-year-old woman with history of migraines presented to ER with worst headaches of life for the past few days. Although she had a history of migraines, this headache differed from her usual migraines. In the ER subarachnoid hemorrhage (SAH) was suspected and a noncontrast head CT was done which was negative for any hemorrhage. As she continued to have severe headache, a lumbar puncture (LP) was done which was negative for xanthochromia, and thus SAH was ruled out. She was sent home with recommendation for over-the-counter analgesics. Following discharge patient continued to experience worsening of headaches
Paroxysmal atrial fibrillation in cryptogenic stroke
Neha S Dangayach, Kevin Kane, Majaz Moonis
Therapeutics and Clinical Risk Management , 2011, DOI: http://dx.doi.org/10.2147/TCRM.S15079
Abstract: roxysmal atrial fibrillation in cryptogenic stroke Original Research (4500) Total Article Views Authors: Neha S Dangayach, Kevin Kane, Majaz Moonis Published Date January 2011 Volume 2011:7 Pages 33 - 37 DOI: http://dx.doi.org/10.2147/TCRM.S15079 Neha S Dangayach1, Kevin Kane2, Majaz Moonis3 1Saint Vincent Hospital, 2University of Massachusetts Medical School, 3University of Massachusetts Memorial Health Center, Worcester, MA, USA Introduction: Paroxysmal atrial fibrillation (PAF) is perhaps the most underdiagnosed mechanism of apparent cryptogenic stroke (CS). Various studies have shown that increasing the duration of monitoring can increase the diagnosis of PAF in CS. Methods: We compared demographic and risk factors for ischemic stroke across different TOAST (Trial of ORG 10172 in Acute Stroke Treatment) stroke subtypes to look for clinical differences between other subtypes and CS and subsequently performed periodic Holter monitoring and imaging studies in apparent CS patients. Results: Of the 298 patients with ischemic stroke, 17% had CS. Periodic holter monitoring enabled diagnosis of PAF in 29% of patients. Five of 51 patients with CS had recurrent ischemic stroke and all 5 were demonstrated as PAF on repeated Holter monitoring. Conclusions: Long-term periodic rhythm monitoring in patients with apparent CS showed PAF in a significant percentage of CS patients, which altered subsequent treatment.
Antiplatelet agents and proton pump inhibitors – personalizing treatment
Eugene Lin, Rajiv Padmanabhan, Majaz Moonis
Pharmacogenomics and Personalized Medicine , 2010, DOI: http://dx.doi.org/10.2147/PGPM.S7298
Abstract: ntiplatelet agents and proton pump inhibitors – personalizing treatment Review (4049) Total Article Views Authors: Eugene Lin, Rajiv Padmanabhan, Majaz Moonis Published Date June 2010 Volume 2010:3 Pages 101 - 109 DOI: http://dx.doi.org/10.2147/PGPM.S7298 Eugene Lin, Rajiv Padmanabhan, Majaz Moonis Department of Neurology, University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, Massachusetts, USA Introduction: Antiplatelet therapy remains one of the cornerstones in the management of noncardioembolic ischemic stroke. However, a significant percentage of patients have concomitant gastroesophageal reflux or peptic ulcer disease that requires acid-reducing medications, the most powerful and effective being the proton pump inhibitors (PPIs). Antiplatelet efficacy, at least in vivo, and particularly for clopidogrel, has been shown to be reduced with concomitant proton pump inhibitor use. Whether this is clinically relevant is not clear from the limited studies available. Methods: We conducted an extensive review of studies available on Medline related to pharmacodynamic interactions between the antiplatelet medications and proton pump inhibitors as well as clinical studies that addressed this potential interaction. Results: Based on the present pharmacodynamic and clinical studies we did not find a significant interaction that would reduce the efficacy of antiplatelet agents with concomitant user of proton pump inhibitors. Conclusions: Patients on antiplatelet agents after a transient ischemic attack or ischemic stroke can safely use aspirin, and extended release dipyridamole/aspirin with proton pump inhibitors. Patients on clopidogrel may use other acid-reducing drugs besides proton pump inhibitors. In rare cases where proton pump inhibitors and clopidogrel have to be used concurrently, careful close monitoring for recurrent vascular events is required.
Paroxysmal atrial fibrillation in cryptogenic stroke
Neha S Dangayach,Kevin Kane,Majaz Moonis
Therapeutics and Clinical Risk Management , 2011,
Abstract: Neha S Dangayach1, Kevin Kane2, Majaz Moonis31Saint Vincent Hospital, 2University of Massachusetts Medical School, 3University of Massachusetts Memorial Health Center, Worcester, MA, USAIntroduction: Paroxysmal atrial fibrillation (PAF) is perhaps the most underdiagnosed mechanism of apparent cryptogenic stroke (CS). Various studies have shown that increasing the duration of monitoring can increase the diagnosis of PAF in CS.Methods: We compared demographic and risk factors for ischemic stroke across different TOAST (Trial of ORG 10172 in Acute Stroke Treatment) stroke subtypes to look for clinical differences between other subtypes and CS and subsequently performed periodic Holter monitoring and imaging studies in apparent CS patients.Results: Of the 298 patients with ischemic stroke, 17% had CS. Periodic holter monitoring enabled diagnosis of PAF in 29% of patients. Five of 51 patients with CS had recurrent ischemic stroke and all 5 were demonstrated as PAF on repeated Holter monitoring.Conclusions: Long-term periodic rhythm monitoring in patients with apparent CS showed PAF in a significant percentage of CS patients, which altered subsequent treatment.Keywords: cryptogenic stroke, atrial fibrillation, stroke of undetermined etiology
Antiplatelet agents and proton pump inhibitors – personalizing treatment
Eugene Lin,Rajiv Padmanabhan,Majaz Moonis
Pharmacogenomics and Personalized Medicine , 2010,
Abstract: Eugene Lin, Rajiv Padmanabhan, Majaz MoonisDepartment of Neurology, University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, Massachusetts, USAIntroduction: Antiplatelet therapy remains one of the cornerstones in the management of noncardioembolic ischemic stroke. However, a significant percentage of patients have concomitant gastroesophageal reflux or peptic ulcer disease that requires acid-reducing medications, the most powerful and effective being the proton pump inhibitors (PPIs). Antiplatelet efficacy, at least in vivo, and particularly for clopidogrel, has been shown to be reduced with concomitant proton pump inhibitor use. Whether this is clinically relevant is not clear from the limited studies available.Methods: We conducted an extensive review of studies available on Medline related to pharmacodynamic interactions between the antiplatelet medications and proton pump inhibitors as well as clinical studies that addressed this potential interaction.Results: Based on the present pharmacodynamic and clinical studies we did not find a significant interaction that would reduce the efficacy of antiplatelet agents with concomitant user of proton pump inhibitors.Conclusions: Patients on antiplatelet agents after a transient ischemic attack or ischemic stroke can safely use aspirin, and extended release dipyridamole/aspirin with proton pump inhibitors. Patients on clopidogrel may use other acid-reducing drugs besides proton pump inhibitors. In rare cases where proton pump inhibitors and clopidogrel have to be used concurrently, careful close monitoring for recurrent vascular events is required.Keywords: proton pump inhibitors, antiplatelet medications, clopidogrel, ischemic stroke, cardiovascular events
Depression Increases Stroke Hospitalization Cost: An Analysis of 17,010 Stroke Patients in 2008 by Race and Gender
Baqar Husaini,Robert Levine,Linda Sharp,Van Cain,Meggan Novotny,Pamela Hull,Gail Orum,Zahid Samad,Uchechukwu Sampson,Majaz Moonis
Stroke Research and Treatment , 2013, DOI: 10.1155/2013/846732
Abstract: Objective. This analysis focuses on the effect of depression on the cost of hospitalization of stroke patients. Methods. Data on 17,010 stroke patients (primary diagnosis) were extracted from 2008 Tennessee Hospital Discharge Data System. Three groups of patients were compared: (1) stroke only ( , ), (2) stroke + depression ( , ), and (3) stroke + other mental health diagnoses ( , ). Results. Of all adult patients, 4.3% were diagnosed with stroke. Stroke was more prevalent among blacks than whites (4.5% versus 4.2%, ) and among males than females (5.1% versus 3.7%, ). Nearly one-quarter of stroke patients (23.3%) were diagnosed with depression/anxiety. Hospital stroke cost was higher among depressed stroke patients ( ) compared to stroke only ( ) patients ($77,864 versus $47,790, ), and among , cost was higher for black males compared to white depressed males ($97,196 versus $88,115, ). Similar racial trends in cost emerged among females. Conclusion. Depression in stroke patients is associated with increased hospitalization costs. Higher stroke cost among blacks may reflect the impact of comorbidities and the delay in care of serious health conditions. Attention to early detection of depression in stroke patients might reduce inpatient healthcare costs. 1. Background Between 20% and 60% of stroke patients are diagnosed with depression/anxiety [1], and these are often newly diagnosed in stroke patients both during hospitalization and up to 3 years after discharge [1–20]. Depression is associated with longer institutionalization and poorer rehabilitation outcomes [21, 22]. Further, depression is more often diagnosed for females and white stroke patients [23, 24], and it is correlated with higher rates of suicidal ideation and stroke mortality [25–27]. Depression increases the risk of stroke [28] as well as increased healthcare costs [29–34]. As these and other stroke related factors are evaluated, understanding their impact on healthcare cost is necessary for better management, improved therapeutic outcomes, and reduced healthcare cost. 2. Depression and Healthcare Cost Several studies have reported the effect of depression/anxiety on healthcare costs. For example, while female Medicare patients had a higher prevalence of depression and higher use of outpatient services, inpatient hospital costs for male patients were 47% higher compared to females ($15,060 versus $10,240, ) [30]. In another study, the medical cost of depressed patients was 54% higher compared to nondepressed patients [34]. While higher cost among stroke patients is associated with
Prevention of Alzheimer's disease in high risk groups: statin therapy in subjects with PSEN1 mutations or heterozygosity for apolipoprotein E epsilon 4
Daniel A Pollen, Stephen Baker, Douglas Hinerfeld, Joan Swearer, Barbara A Evans, James E Evans, Richard Caselli, Ekaterina Rogaeva, Peter St George-Hyslop, Majaz Moonis
Alzheimer's Research & Therapy , 2010, DOI: 10.1186/alzrt55
Abstract: To date, there have been no systematic treatment studies on subjects with presenilin (PSEN) mutations [1] who inherit an autosomal dominant form of early onset familial Alzheimer's disease (AD). The principal objective of this review is to summarize the existing published pilot studies that address the issues of presymptomatic intervention in early onset familial AD and to compare these results with analogous treatment studies in hyperlipidemic subjects who are heterozygous for apolipoprotein Eε4 (ApoEε4). Our decision to focus on studies of presymptomatic rather than symptomatic subjects was based on the premise that most putative therapies for AD are likely to have more demonstrable effects on normal subjects compared to those with overt AD whose brains have already been subject to extensive neurodegenerative changes. We also recognize that it is not yet known whether any preventative opportunities that may arise as a consequence of an understanding of the pathogenesis of PSEN1 mutations will be applicable to the vastly larger number of cases of mild cognitive impairment and late onset AD (LOAD).Both groups of subjects exhibit early increased brain deposition of amyloid-beta 42 (Aβ42), which many researchers [2,3] have proposed is either a direct or intermediary toxic agent in the genesis of the neurodegeneration that subsequently leads to AD. Homozygotes for ApoEε4 are at far greater risk for late onset AD than are heterozygotes, but we did not identify a sufficiently large enough group of the former to comprise a separate study group. Decreases in cerebral spinal fluid (CSF) Aβ42 levels precede cognitive decline in subjects with PSEN1 mutations [4,5]. Consequently, in these subjects there is a window of opportunity - estimated as at least 4 to 12 years - to evaluate the ability of any putative prophylactic therapy to decrease, arrest or reverse abnormalities in Aβ42 metabolism many years before clinical symptoms of AD occur. For example, increased levels of CSF
Lipodystrophy of HIV (LDHIV) in the Head and Neck: Imaging and Clinical Features  [PDF]
Saman Hazany, Rafael Rojas, Gul Moonis
International Journal of Otolaryngology and Head & Neck Surgery (IJOHNS) , 2012, DOI: 10.4236/ijohns.2012.12005
Abstract: A subset of HIV-1 infected patients undergoing antiretroviral treatment with HIV-1 protease inhibitors (PI’s) develops a syndrome called Lipodystrophy of HIV (LDHIV). LDHIV is characterized by loss of peripheral subcutaneous adipose tissue (face, limbs, buttocks), visceral fat accumulation, and in some cases, lipomatosis in the neck and dorsocervical area .We describe the clinical and imaging features of LDHIV in the head and neck in a series of 5 cases. There is a consistent pattern of fat accumulation in the dorsocervical region with paucity of fat in the face. This classic appearance should be recognized as potentially related to drug toxicity in the HIV infected population.
Acute Stroke Imaging: Recent Updates
Prachi Dubey,Sachin Pandey,Gul Moonis
Stroke Research and Treatment , 2013, DOI: 10.1155/2013/767212
Abstract: Acute ischemic stroke imaging is one of the leading causes of death and disability worldwide. Neuroimaging plays a crucial role in early diagnosis and yields essential information regarding tissue integrity, a factor that remains a key therapeutic determinant. Given the widespread public health implications of stroke and central role of neuroimaging in overall management, acute stroke imaging remains a heavily debated, extensively researched, and rapidly evolving subject. There has been recent debate in the scientific community due to divided opinions on the use of CT perfusion and access-related limitations of MRI. In this paper we review and summarize recent updates relevant to acute stroke imaging and propose an imaging paradigm based on the recently available evidence. 1. Introduction Acute ischemic stroke is one of the leading causes of mortality and morbidity worldwide. Statistics from the American Heart Association estimate an average of 1 stroke every 40 seconds in the United States amounting to approximately 795,000 people experiencing new or recurrent strokes, per year [1]. In view of the widespread public health impact of stroke and its profound impact on patients, stroke research has remained in the forefront. A recent systematic review article reported no significant difference between reperfusion strategies based on the current literature, emphasizing need for future randomized clinical trials to determine the efficacy of alternative reperfusion strategies [2]. As noted by Gonzales R in a recent commentary, the failure to recognize relative efficacy of treatment strategies can be partially attributed to lack of appropriate patient selection due to ineffective, inconsistent, and contradictory neuroimaging approach. This was one of the potential causes that lead to the halting of the Interventional Management of Stroke III Trial [3]. There is a critical need for reproducible and sensitive imaging biomarkers that allow accurate assessment of efficacy of rapidly evolving thrombolytic treatments. This underscores the primary need for standardization of imaging techniques across institutions so data from multicenter trials can be collectively analyzed. The glaring lack such consensus amongst imaging techniques was highlighted in a recent systematic review which found wide variability in the employed thresholds for CT and MR perfusion imaging and significant inconsistency in definitions of tissue states; factors which add to the widespread variability in perfusion-based assessment [4]. Despite the inherent challenges and past failures, stroke
Superior semicircular canal dehiscence in East Asian women with osteoporosis
Yu Alexander,Teich Douglas L,Moonis Gul,Wong Eric T
BMC Ear, Nose and Throat Disorders , 2012, DOI: 10.1186/1472-6815-12-8
Abstract: Background Superior semicircular canal dehiscence (SSCD) may cause Tullio phenomenon (sound-induced vertigo) or Hennebert sign (valsalva-induced vertigo) due to the absence of bone overlying the SSC. We document a case series of elderly East Asian women with atypical SSCD symptoms, radiologically confirmed dehiscence and concurrent osteoporosis. Methods A retrospective record review was performed on patients with dizziness, vertigo, and/or imbalance from a neurology clinic in a community health center serving the East Asian population in Boston. SSCD was confirmed by multi-detector, high-resolution CT of the temporal bone (with P schl and Stenvers reformations) and osteoporosis was documented by bone mineral density (BMD) scans. Results Of the 496 patients seen in the neurology clinic of a community health center from 2008 to 2010, 76 (17.3%) had symptoms of dizziness, vertigo, and/or imbalance. Five (6.6%) had confirmed SSCD by multi-detector, high-resolution CT of the temporal bone with longitudinal areas of dehiscence along the long axis of SSC, ranging from 0.4 to 3.0 mm, as seen on the P schl view. Two of the 5 patients experienced motion-induced vertigo, two fell due to disequilibrium, and one had chronic dizziness. None had a history of head trauma, otologic surgery, or active intracerebral disease. On neurological examination, two patients had inducible vertigo on Dix-Hallpike maneuver and none experienced cerebellar deficit, Tullio phenomenon, or Hennebert sign. All had documented osteoporosis or osteopenia by BMD scans. Three of them had definite osteoporosis, with T-scores < 2.5 in the axial spine, while another had osteopenia with a T-score of 2.3 in the left femur. Conclusions We describe an unusual presentation of SSCD without Tullio phenomenon or Hennebert sign in a population of elderly, East Asian women. There may be an association of SSCD and osteoporosis in this population. Further research is needed to determine the incidence and prevalence of this disorder, as well as the relationship of age, race, osteoporosis risk, and the development of SSCD.
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