Journal Detail Information

1

Cite

Share

The design and development of a National Registry of Pediatric Neurological Diseases in the Philippines - A preliminary report

Bernadette C. Macrohon ; Jean Marie Ahorro ; Jo Janette R. Dela Calzada ; Ma. Rowena C. Cruda ; Gerardo Luis C. Dimaguila ; Cristina C. Urbi ; Ma. Antonia M. Valencia ; Joan R. Viado

Philippine Journal of Neurology.2018;21(1):20-29.

One of the important prerequisites in developing health programs and policies for pediatric neurologic diseases is accurate information about the status of these diseases in the country. At present, there is no existing registry of pediatric neurological diseases in the country. The Child Neurology Society Philippines (CNSP) sought to develop and implement a national registry for pediatric neurologic diseases. Specifically, it aimed to 1.) determine a consensus for the purposes of the registry, 2.) develop an implementation system from data collection until information dissemination, 3.) install a system for evaluating data reliability, and 4.) establish a feedback system for improvement. Results showed that the CNSP members wanted a census of diseases, to use the data for research, to identify participants for a research study, and for epidemiological surveillance. Data collection is by filling up forms at the clinic level and its submission to the centralized encoder. Monthly and annual census of diseases are generated and e-mailed to each member who has subscribed to these reports. Custom reports may be produced when requested. Early challenges in the implementation of the database include negative personal preconceived ideas about the database, collecting data, possible ethical concerns, and logistical limitations.

2

Cite

Share

Successful thrombolysis and mechanical thrombectomy in an early pregnant woman with protein S deficiency and arterial ischemic stroke: A case report

Ma. Ericka S. Del Mundo ; Diana-lynn Que ; Remy Margarette Berroya-Moreno

Philippine Journal of Neurology.2024;27(2):16-21.

Protein S deficiency causing arterial ischemic stroke during pregnancy is uncommon. Delay or omission of treatment with perfusion therapies may worsen outcomes for both the mother and the fetus. In this paper, we report a case of an early pregnant woman with protein S deficiency and multiple history of chronic cerebrovascular disease who underwent successful thrombolysis and mechanical thrombectomy. The patient is a 35-year-old woman, eight weeks pregnant, with a history of protein S deficiency and chronic cerebrovascular disease, presenting with rightsided weakness and aphasia. Initial National Institutes of Health Stroke Scale was 10 with cranial magnetic resonance imaging findings of acute infarcts on the left caudate, lentiform nucleus, insula, and frontal lobe with a large vessel occlusion on the proximal M1 segment of the left middle cerebral artery. Intravenous thrombolysis and mechanical thrombectomy were performed with complete recanalization. The patient improved and delivered without any complications after 8 months. Protein S deficiency can contribute to arterial thrombosis including ischemic stroke. Arterial ischemic stroke and large vessel occlusion can cause significant disability if not treated appropriately. Reperfusion therapies in pregnant women show favorable outcomes and should be performed if the benefits outweigh the risks.

Human ; Female ; Adult: 25-44 Yrs Old ; Arteries ; Ischemic Stroke ; Thrombectomy ; Protein S ; Protein S Deficiency ; Pregnant Women

3

Cite

Share

Knowledge, attitudes, and practices towards brain death and organ donation among physicians in the Philippines

Maria Kim Hernandez ; Deborah Bernardo ; Cristina Cruz-Urbi ; Marian Irene Escasura

Philippine Journal of Neurology.2024;27(2):22-37.

INTRODUCTION

Brain death occurs in patients who suffer from severe brain injuries, leading to coma, loss of brainstem reflexes, and apnea. Research indicates that misdiagnosis of brain death often arises from insufficient adherence to established guidelines. This study aims to evaluate and identify any significant variations in physicians' knowledge, attitudes, and practices regarding brain death and organ donation.

METHODOLOGY

This cross-sectional study was conducted among physicians using random sampling. The questionnaire was validated prior to distribution. After obtaining informed consent, participants completed the questionnaire. Data analysis involved the use of frequency and distribution tables, as well as analysis of variance and multivariate analysis of variance.

RESULTS

A total of 113 participants were involved in the study. While years of experience and position influenced knowledge, field of specialization did not show a significant effect. Overall, attitudes remained consistent across different levels of experience and positions. The data revealed a notable lack of training and institutional resources. Although there were some differences in practices, they were not statistically significant.

CONCLUSION AND RECOMMENDATION

Significant differences in knowledge were observed based on years of practice. However, no significant differences were found in attitudes and practices, despite variations in responses. Regular seminars and workshops are crucial for staying updated with the latest guidelines. Additionally, it is important to ensure that local guidelines are readily accessible to the broader medical community.

Human ; Brain Death ; Organ Donation ; Tissue And Organ Procurement ; Knowledge ; Attitude

4

Cite

Share

Predictors of direct medical cost for outpatient-based rehabilitation among stroke patients

Judy Ann B. Surtida ; Marian Irene S. Escasura

Philippine Journal of Neurology.2024;27(2):38-45.

BACKGROUND

This is the first study conducted to determine the predictors of outpatient based rehabilitation cost in the local setting. This aimed to determine whether demographic and clinical characteristics of post-stroke patients are predictors of direct medical costs for outpatient-based rehabilitation.

METHODS

A retrospective single-arm cohort study was utilized to determine the predictors of direct medical cost for out patient based post-stroke rehabilitation seen at the rehabilitation department of a tertiary hospital from January 1, 2019 to December 31, 2023.

RESULTS

A significant association was found between direct cost and smoking. Additionally, an association between direct cost and hypertension was evident. No significant associations were identified between direct rehabilitation cost and other factors such as age, sex, mRS score, type of stroke, intervention, and other co-morbidities, aside from hypertension and smoking.

CONCLUSION

Smoking and hypertension are predictors of direct medical cost for outpatient-based post stroke rehabilitation. These factors necessitate more intensive therapy and longer rehabilitation periods as compared to other factors which did not have significant associations with cost.

Human

5

Cite

Share

Cervicomedullary Cavernous Hemangioma presenting as Spinal Shock Syndrome and Dysfunction: A case report and review of related literature.

Jenielyn Nazaire ; Debbie Liquete

Philippine Journal of Neurology.2023;26(1):15-20.

INTRODUCTION: Cavernomas in the brainstem and spinal cord are rare than their intracranial counterparts, and occurrences specifically at the cervicomedullary junction are infrequent. In this report, we present a case of a cervicomedullary cavernoma which manifested with spinal shock and dysfunction. CASE REPORT: We describe a patient who exhibited spinal shock syndrome and a stepwise decline in spinal cord function. A 33-year-old woman initially complained of right upper arm and occipital referred pain from the atlantoaxial region. Three days later, she experienced bowel and urinary incontinence. Subsequently, quadriparesis and numbness affecting all limbs developed after one week, followed by life-threatening respiratory depression after nine days. Magnetic resonance imaging revealed a lesion in the cervicomedullary junction, identified as a cavernous hemangioma. During the hospital stay, fragmented reflex activity gradually returned. Upon follow-up, the bowel and urinary incontinence, motor impairments, and sensory impairments showed improvement. CONCLUSION The proposed mechanism for the mass effect of this cavernous malformation on the spinal cord at the cervicomedullary junction was likely due to pressure effects caused by shifting dynamics. Understanding the natural history of cavernous malformations, regional neurovascular anatomy, safe entrance points to the brainstem, routes to the craniovertebral junction from the base of the skull, and specific microsurgical procedures for their removal are necessary for appropriate treatment. However, these considerations should be balanced against knowledge of the associated hazards and treatment recommendations.
Cavernoma

6

Cite

Share

Spontaneous regression of Pituitary Adenomas: Illustrative case and systematic review.

Lady Scarlette P. Sedano ; Katrina Hannah D. Ignacio ; Kathleen Joy O. Khu

Philippine Journal of Neurology.2023;26(1):21-32.

INTRODUCTION: Spontaneous regression of pituitary adenomas is a rare occurrence that is thought to be due to pituitary apoplexy. We would like to review the demograhic data, imaging findings, and neurologic, endocrinologic, and radiologic outcomes of patients who exhibited this unusual phenomenon. METHODS: We present a case of non-functioning pituitary adenoma (NFPA) in a 66-year-old man that underwent spontaneous regression. We also performed a systematic literature review on cases of pituitary adenomas that exhibited spontaneous regression, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: There have been only 27 reported cases of spontaneous regression observed in all pituitary adenomas, 16 of which are NFPAs. Headache was the most common symptom while decreased visual acuity and oculomotor nerve palsy were the most common sign. Pituitary hemorrhage was seen in two-thirds of cases, while findings suggestive of pituitary infarct, such as enhancement of the sphenoid sinus mucosa. were seen in one-third. Complete radiographic remission was observed in 62% of cases, with an 11% recurrence rate seen at least two years after the initial imaging. Neurologic recovery was reported in 88% and endocrinologic recovery from hypopituitarism was 40%. CONCLUSION Most patients exhibited neurologic and endocrinologic improvement concomitant with the regression of the pituitary adenoma. However, these tumors may recur; thus, regular and long- term neuro-ophthalmologic and radiologic follow-up is advised.
Pituitary adenoma ; spontaneous regression

7

Cite

Share

Effects of clinical pathways on stroke outcomes at a tertiary rural hospital.

Guillermo Lacuesta Manalo III

Philippine Journal of Neurology.2023;26(1):33-60.

Stroke is the most common neurologic admission in our Center. Healthcare needs to be sustainable, while maintaining the standard of care. Will codifying acute stroke care into a pre- written clinical pathway reduce mortality, lengths of hospital stay, and costs? We pilot-tested an Acute Stroke Clinical Pathway based on the Stroke Society of the Philippines, Department of Health, and other international guidelines. Mortality rate, lengths of hospital stay, excess hospital costs and complication rates were compared. Those enrolled into the Ischemic Stroke pathway stayed one day less compared to those who were not. The hospital share for mild hemorrhagic stroke, mortality rate for moderate hemorrhagic stroke, and length of stay and hospital share in severe hemorrhagic stroke patients enrolled into a Hemorrhagic Stroke pathway were statistically significantly less. The savings in some patient groups (e.g., in Mild Hemorrhagic strokes) were offset by losses in others (e.g., in Moderate to Severe Ischemic Strokes). Patients enrolled into a stroke pathway were recorded to have more nosocomial infections. The findings show that using a pre-written clinical pathway reduces stroke patient mortality, length of stay, and hospital cost, but only in specific patient groups. The increase in reported nosocomial infections in stroke-pathway-enrolled patients is hypothesized to be due to better reporting.

8

Cite

Share

Intractable seizures as the initial presentation of two neonates with genetically diagnosed tuberous sclerosis complex.

Grael M. Dumallay ; Mel Michel G. Villaluz

Philippine Journal of Neurology.2023;26(1):61-65.

Tuberous Sclerosis Complex (TSC) is a genetic disorder that presents in a myriad of clinical manifestations affecting the different organ systems. These manifestations emerge at different times in a patient’s lifespan and diagnosis early in the disease can be challenging. Majority of patients with TSC develop epilepsy and is often one of the most difficult to manage. We report two neonates with drug resistant epilepsy with seizure onset on the first day of life and were subsequently diagnosed with Tuberous Sclerosis. These two neonates exemplified the diverse phenotypic expression of TSC.

9

Cite

Share

Asian Oceanian Association of Neurology: Past, present, future

Arnold Angelo M. Pineda

Philippine Journal of Neurology.2023;26(2):13-14.

Four and a half decades ago, Dr. Charles M. Posner, a World Federation of Neurology representative toured the Asian and Oceanian countries and challenged its neurologists to form an association that would promote and foster the advancement and exchange of neuro-scientific information within the region. In response, Dr. Shigeo Okinaka invited the region’s neurologists to a planning meeting in Tokyo, Japan which subsequently resulted to the birth of the Asian and Oceanian Association of Neurology (AOAN) on June 26, 1961. The main objectives of the association according to the AOAN Statutes, as stated in Article 2, are to promote and foster on an international scale the advancement, the exchange and diffusion of information and ideas relating to the nervous system and encourage scientific researches in neurological problems. Article 3 likewise states the hosting of the Asian and Oceanian Congress of Neurology (AOCN) once every four years.

10

Cite

Share

Acute carbon monoxide poisoning in a Filipino household

Louraine Mae J. Bagares ; Philip Rico P. Mejia ; Rene B. Punsalan ; Marc Conrad C. Molina

Philippine Journal of Neurology.2023;26(2):15-19.

There have been multiple reports already regarding acute carbon monoxide/CO poisoning in the Philippines secondary to misuse of portable generators, especially during the times of typhoon. We present a case of unintentional carbon monoxide poisoning in a Filipino household wherein three of its members were found dead and leaving other five unconscious before they were rushed to the hospital. The index patient had increased serum fraction percentage of carboxyhemoglobin level and presented with rhabdomyolysis during admission. Neuroimaging confirmed a hypoxic-ischemic encephalopathy secondary to carbon monoxide intoxication. Even without hyperbaric oxygen therapy, patient improved with adequate hydration, early rehabilitation and trauma-focused psychotherapy.
Carbon Monoxide Poisoning ; Carbon Monoxide ; Family Characteristics

DISPLAY OPTIONS

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share

Cite

Share