Suhail Alrukn | McGill University (original) (raw)

Papers by Suhail Alrukn

BMC Research Notes, Jul 6, 2017

Background: Emergency medical services (EMS) play a vital role in expediting hospital arrival in ... more Background: Emergency medical services (EMS) play a vital role in expediting hospital arrival in stroke patients. The objective of our study was to assess the level of awareness regarding pre-hospital identification and management of acute stroke among EMS Staff in Dubai and to evaluate the impact of an educational lecture on their knowledge. Methods: Ours was a cross-sectional study with a pre-test and post-test design. The intervention was an educational lecture, based on the updated guidelines in pre-hospital care of acute stroke. Participants were assessed before and after the intervention on various aspects of stroke care. Paired t test were used to compare the impact of the intervention. Results: A total of 274 EMS workers participated in our study. The baseline knowledge of participants regarding stroke types was inadequate with only 68% correctly identifying these. 79% were able to name the cardinal stroke symptoms. Knowledge of stroke mimics was poor with only 6.6% identifying stroke mimics correctly. With respect to management, most participants were unable to correctly identify the points to illicit in the history of an acute stroke patient (25.2%) and also the steps in pre-hospital management (40%). All these aspects showed remarkable improvement post intervention. Conclusion: The baseline awareness of most aspects of acute stroke identification and management was poor in our EMS participants. Our educational lecture proved effective in improving this knowledge when tested immediately post intervention. However, there is a need to reassess this at periodic intervals to identify the need for refresher courses on pre-hospital stroke management.

International Journal of Stroke, Jun 26, 2020

Normal range: D-dimer <0.5 ng/ml. b Normal range: Ferritin, 15-150 ng/ml. c Normal range: C-react... more Normal range: D-dimer <0.5 ng/ml. b Normal range: Ferritin, 15-150 ng/ml. c Normal range: C-reactive protein <5 mg/L.

Journal of the Neurological Sciences, Oct 1, 2019

Journal of the Neurological Sciences, Oct 1, 2013

PLOS ONE

Objectives Stroke represents a health care challenge to most parts of the world including the Mid... more Objectives Stroke represents a health care challenge to most parts of the world including the Middle East and North Africa (MENA) region. The MENA represents 6% of the world population with an age-standardized stroke rate of 87.7 (78.2–97.6) per 100,000 population. This number is subject to increase given that the cause of morbidity has recently shifted from infectious diseases to non-communicable diseases. Thus, in the coming years, treatment of stroke will pose a major burden on MENA countries which mostly lie in the low to middle income economies. Accordingly, we need to study the state of MENA stroke services in order to recognize and further inform policy makers about any gaps that need to be bridged in this domain. Methods and results Stroke specialists representing 16 countries filled an online survey that included: screening for risk factors, acute management, diagnostics, medications, post-discharge services, and stroke registries. Results showed that 11 countries screen fo...

Presentation Abstracts, 2021

Journal of the Neurological Sciences, 2019

International Journal of Stroke, 2019

Background and methods Stroke incidence and mortality are reported to have increased in the Middl... more Background and methods Stroke incidence and mortality are reported to have increased in the Middle-East and North African (MENA) countries during the last decade. This was a prospective observational study to examine the baseline characteristics of stroke patients in the MENA region and to compare the MENA vs. the non-MENA stroke cohort in the Safe Implementation of Treatments in Stroke (SITS) International Registry. Results Of the 13,822 patients with ischemic and hemorrhagic stroke enrolled in the SITS-All Patients Protocol between June 2014 and May 2016, 5897 patients (43%) were recruited in MENA. The median onset-to-door time was 5 h (IQR: 2:20–13:00), National Institutes of Health Stroke Scale (NIHSS) score was 8 (4–13) and age was 65 years (56–76). Hypertension (66%) and diabetes (38%) were the prevailing risk factors; large artery stenosis > 50% (25.3%) and lacunar strokes (24.1%) were the most common ischemic stroke etiologies. In comparison, non-MENA countries displayed ...

Clinical Pediatrics, 2011

Papular purpuric gloves and socks syndrome (PPGSS) is a self-limited, often febrile illness with ... more Papular purpuric gloves and socks syndrome (PPGSS) is a self-limited, often febrile illness with symmetric edema and erythema of the hands and feet; papular, petechial, and purpuric acral dermatosis; and mucosal lesions in children and young adults. Most of the cases of PPGSS have been reported to be caused by parvovirus B19 and other viruses. This study describes a case resulting from Mycoplasma pneumoniae infection in an adolescent male and reviews the literature.

The American Journal of Emergency Medicine, 2009

The objective of the study is to demonstrate the pitfalls in the diagnosis of cerebral venous thr... more The objective of the study is to demonstrate the pitfalls in the diagnosis of cerebral venous thrombosis (CVT) especially when subarachnoid hemorrhage (SAH) is associated and discuss the diagnostic value of computed tomography (CT) imaging as well as the use of other diagnostic modalities. In addition, we will briefly summarize the pathophysiology of SAH in the setting of CVT. Methods: We reviewed 16 articles, which included 26 different case reports of SAH associated with CVT. In addition, we presented our experience with a case of SAH secondary to CVT. Results: Nonenhanced CT was able to detect SAH in 86% of cases and CVT in only 36%. Further imaging testing was necessary to further characterize the extent of the thrombosis. The location of the SAH varied, but it never involved the skull base. Risk factors for CVT development included hypercoagulable states, oral contraceptives use, history of recent fracture or surgery, family or personal history of deep vein thrombosis, smoking, and hyperlipidemia and migraines. Sixty-two percent of patients had acute onset severe headaches, 35% presented with nuchal rigidity, and 35% presented with seizures. Conclusions: Cerebral venous thrombosis must be considered in the differential diagnosis of patients presenting with a broad range of neurological presentations especially in the presence of new onset of seizures. Computed tomographic offers many clues to the diagnosis of CVT when concomitant SAH is present. These include the presence of SAH at cerebral convexities with associated basal cisterns and skull base sparing. Recognition of these subtleties will allow prompt and appropriate management and, when in doubt, encourage further investigations.

Journal of the Neurological Sciences, 2019

Journal of Neurology and Neurophysiology, 2014

Journal of the Neurological Sciences, 2019

Despite of normal CSF analysis prednisolone 10 mg once a day was administered. Headache regressed... more Despite of normal CSF analysis prednisolone 10 mg once a day was administered. Headache regressed next day after starting this treatment. During the treatment with prednisolone the patient demonstrated cognitive improvement. When we tried to decrease the dose of prednisolone the patent had a deterioration with his oculomotor nerves without lesion on the MRI Conclusion Activation of immune system in some patients with FD could lead to autoinflammation in the central nervous system, as a resultaseptic meningitidis. Prednisolone administration in spite of recurrent stroke could improve outcome in such patients.

BMC research notes, Jan 6, 2017

Emergency medical services (EMS) play a vital role in expediting hospital arrival in stroke patie... more Emergency medical services (EMS) play a vital role in expediting hospital arrival in stroke patients. The objective of our study was to assess the level of awareness regarding pre-hospital identification and management of acute stroke among EMS Staff in Dubai and to evaluate the impact of an educational lecture on their knowledge. Ours was a cross-sectional study with a pre-test and post-test design. The intervention was an educational lecture, based on the updated guidelines in pre-hospital care of acute stroke. Participants were assessed before and after the intervention on various aspects of stroke care. Paired t test were used to compare the impact of the intervention. A total of 274 EMS workers participated in our study. The baseline knowledge of participants regarding stroke types was inadequate with only 68% correctly identifying these. 79% were able to name the cardinal stroke symptoms. Knowledge of stroke mimics was poor with only 6.6% identifying stroke mimics correctly. W...

Neurology, Feb 12, 2013

OBJECTIVE: To describe clinical, imaging, histopathological characteristics, treatment options an... more OBJECTIVE: To describe clinical, imaging, histopathological characteristics, treatment options and outcome in a patient with ANHLE. BACKGROUND: ANHLE is a rare often fatal disease and few cases with histopathological and MRI correlation has been reported in literature. ANHLE can be hyper acute frequently fatal form of ADEM. The etiology and pathogenesis of this disease remain unknown. Although some viruses have been reported as causative agents, it is now believed that this disease is likely immune-mediated or metabolic. DESIGN/METHODS: A previously healthy 29 year old Syrian left handed male lived in Dubai 4 month prior to presentation as an emergency with few days9 history of ophthalmoplegia, ataxia, and generalized tonic colonic seizure and progressed rapidly to coma and quadriplegia and subsequently required intubation and mechanical ventilation. RESULTS: Initial MRI of the Brain showed bilateral basal ganglia, thalamic and brainstem well-defined T2 high signals and T1 mixed signals non enhancing lesions, and multiple smaller superficial white matter similar lesions involving parietal regions. Further extensive diagnostic workup with metabolic, hematologic, hormonal, vasculitic, para neoplastic, viral, neurophysiology and immunology studies was negative. CSF analysis was repeatedly normal. Brain biopsy and histopathological studies performed by neuropathologist in UK showed necrotizing grey matter lesions within sulcal cortex accompanied by capillary proliferation and endothelial hyperplasia and vaculation of white matter . These findings raised many diagnostic possibilities including ANHLE. Patient was initially treated with high dose steroids, followed by IVIG and plasma exchange. Patient recovered but remained with mild residual cognitive dysfunction and limbs spasticity. Follow up MRI showed that the lesions almost disappeared. CONCLUSIONS: Early diagnosis with high index of suspicion for ANHLE is required. Early and aggressive treatment of ANHLE may increase the chances of survival and improve the outcome even before the diagnosis is confirmed with brain biopsy which is often needed. Disclosure: Dr. Inshasi has nothing to disclose. Dr. Almadani has nothing to disclose. Dr. Alrukn has nothing to disclose. Dr. Noori has nothing to disclose. Dr. Abdool has nothing to disclose. Dr. Thakre has nothing to disclose.

Objective: To report the clinical, electrophysiological and CSF profile of three patients with re... more Objective: To report the clinical, electrophysiological and CSF profile of three patients with recurrent Guillain Barre Syndrome Background: Recurrence of Guillain Barre Syndrome (GBS) is very rare, it occurs in 1-3[percnt] of GBS patients. Recurrences occur more frequently in patients under 30, with milder symptoms and in those with Miller Fischer syndrome. Most patients with recurrent GBS respond favorably to treatment with plasmapheresis or IVIG. Generally the recurrence comes months to years after the initial episode. Respiratory or intestinal infections often precede the second episode. Patients who had one recurrence of GBS usually return to their previous level of function while those with multiple recurring episodes of GBS accumulated small neurological deficits Methods: We conducted a cross sectional retrospective observational study where 87 patients with GBS admitted to Rashid Hospital from 2008- 2014 were analyzed. 3 patients were admitted with 2nd episode of GBS. The ag...

OBJECTIVE: to find out if there is any benifit of the rescue treatment used in unresponsive Guill... more OBJECTIVE: to find out if there is any benifit of the rescue treatment used in unresponsive Guillain Barre syndrome patients BACKGROUND: no clear data how to treat patients with GBS , who do not respond to the first line treatment DESIGN/METHODS: We reviewed 87patients retrospectively , and collected the data demographically, clinically and prognostically. All the patients were diagnosed depending on the NINDS criteria of GBS. And Hughes disability scale at discharge and at 1month was used to estimate the prognosis RESULTS: we found 19 patients (about 30[percnt]) needed rescue treatment (11 male 57[percnt]) , with age between 17-81 y old, either because of no improvement or because deterioration. All our patient had IVIG as first line treatment, and the rescue treatment was given after a period about 2weeks from the first line. Which was IVIG(7.2[percnt]) , Plasma exchange (13.3[percnt]) or steroids (2.4[percnt]). There was no significant statistical difference among any of those gr...

BMC Research Notes, Jul 6, 2017

Background: Emergency medical services (EMS) play a vital role in expediting hospital arrival in ... more Background: Emergency medical services (EMS) play a vital role in expediting hospital arrival in stroke patients. The objective of our study was to assess the level of awareness regarding pre-hospital identification and management of acute stroke among EMS Staff in Dubai and to evaluate the impact of an educational lecture on their knowledge. Methods: Ours was a cross-sectional study with a pre-test and post-test design. The intervention was an educational lecture, based on the updated guidelines in pre-hospital care of acute stroke. Participants were assessed before and after the intervention on various aspects of stroke care. Paired t test were used to compare the impact of the intervention. Results: A total of 274 EMS workers participated in our study. The baseline knowledge of participants regarding stroke types was inadequate with only 68% correctly identifying these. 79% were able to name the cardinal stroke symptoms. Knowledge of stroke mimics was poor with only 6.6% identifying stroke mimics correctly. With respect to management, most participants were unable to correctly identify the points to illicit in the history of an acute stroke patient (25.2%) and also the steps in pre-hospital management (40%). All these aspects showed remarkable improvement post intervention. Conclusion: The baseline awareness of most aspects of acute stroke identification and management was poor in our EMS participants. Our educational lecture proved effective in improving this knowledge when tested immediately post intervention. However, there is a need to reassess this at periodic intervals to identify the need for refresher courses on pre-hospital stroke management.

International Journal of Stroke, Jun 26, 2020

Normal range: D-dimer <0.5 ng/ml. b Normal range: Ferritin, 15-150 ng/ml. c Normal range: C-react... more Normal range: D-dimer <0.5 ng/ml. b Normal range: Ferritin, 15-150 ng/ml. c Normal range: C-reactive protein <5 mg/L.

Journal of the Neurological Sciences, Oct 1, 2019

Journal of the Neurological Sciences, Oct 1, 2013

PLOS ONE

Objectives Stroke represents a health care challenge to most parts of the world including the Mid... more Objectives Stroke represents a health care challenge to most parts of the world including the Middle East and North Africa (MENA) region. The MENA represents 6% of the world population with an age-standardized stroke rate of 87.7 (78.2–97.6) per 100,000 population. This number is subject to increase given that the cause of morbidity has recently shifted from infectious diseases to non-communicable diseases. Thus, in the coming years, treatment of stroke will pose a major burden on MENA countries which mostly lie in the low to middle income economies. Accordingly, we need to study the state of MENA stroke services in order to recognize and further inform policy makers about any gaps that need to be bridged in this domain. Methods and results Stroke specialists representing 16 countries filled an online survey that included: screening for risk factors, acute management, diagnostics, medications, post-discharge services, and stroke registries. Results showed that 11 countries screen fo...

Presentation Abstracts, 2021

Journal of the Neurological Sciences, 2019

International Journal of Stroke, 2019

Background and methods Stroke incidence and mortality are reported to have increased in the Middl... more Background and methods Stroke incidence and mortality are reported to have increased in the Middle-East and North African (MENA) countries during the last decade. This was a prospective observational study to examine the baseline characteristics of stroke patients in the MENA region and to compare the MENA vs. the non-MENA stroke cohort in the Safe Implementation of Treatments in Stroke (SITS) International Registry. Results Of the 13,822 patients with ischemic and hemorrhagic stroke enrolled in the SITS-All Patients Protocol between June 2014 and May 2016, 5897 patients (43%) were recruited in MENA. The median onset-to-door time was 5 h (IQR: 2:20–13:00), National Institutes of Health Stroke Scale (NIHSS) score was 8 (4–13) and age was 65 years (56–76). Hypertension (66%) and diabetes (38%) were the prevailing risk factors; large artery stenosis > 50% (25.3%) and lacunar strokes (24.1%) were the most common ischemic stroke etiologies. In comparison, non-MENA countries displayed ...

Clinical Pediatrics, 2011

Papular purpuric gloves and socks syndrome (PPGSS) is a self-limited, often febrile illness with ... more Papular purpuric gloves and socks syndrome (PPGSS) is a self-limited, often febrile illness with symmetric edema and erythema of the hands and feet; papular, petechial, and purpuric acral dermatosis; and mucosal lesions in children and young adults. Most of the cases of PPGSS have been reported to be caused by parvovirus B19 and other viruses. This study describes a case resulting from Mycoplasma pneumoniae infection in an adolescent male and reviews the literature.

The American Journal of Emergency Medicine, 2009

The objective of the study is to demonstrate the pitfalls in the diagnosis of cerebral venous thr... more The objective of the study is to demonstrate the pitfalls in the diagnosis of cerebral venous thrombosis (CVT) especially when subarachnoid hemorrhage (SAH) is associated and discuss the diagnostic value of computed tomography (CT) imaging as well as the use of other diagnostic modalities. In addition, we will briefly summarize the pathophysiology of SAH in the setting of CVT. Methods: We reviewed 16 articles, which included 26 different case reports of SAH associated with CVT. In addition, we presented our experience with a case of SAH secondary to CVT. Results: Nonenhanced CT was able to detect SAH in 86% of cases and CVT in only 36%. Further imaging testing was necessary to further characterize the extent of the thrombosis. The location of the SAH varied, but it never involved the skull base. Risk factors for CVT development included hypercoagulable states, oral contraceptives use, history of recent fracture or surgery, family or personal history of deep vein thrombosis, smoking, and hyperlipidemia and migraines. Sixty-two percent of patients had acute onset severe headaches, 35% presented with nuchal rigidity, and 35% presented with seizures. Conclusions: Cerebral venous thrombosis must be considered in the differential diagnosis of patients presenting with a broad range of neurological presentations especially in the presence of new onset of seizures. Computed tomographic offers many clues to the diagnosis of CVT when concomitant SAH is present. These include the presence of SAH at cerebral convexities with associated basal cisterns and skull base sparing. Recognition of these subtleties will allow prompt and appropriate management and, when in doubt, encourage further investigations.

Journal of the Neurological Sciences, 2019

Journal of Neurology and Neurophysiology, 2014

Journal of the Neurological Sciences, 2019

Despite of normal CSF analysis prednisolone 10 mg once a day was administered. Headache regressed... more Despite of normal CSF analysis prednisolone 10 mg once a day was administered. Headache regressed next day after starting this treatment. During the treatment with prednisolone the patient demonstrated cognitive improvement. When we tried to decrease the dose of prednisolone the patent had a deterioration with his oculomotor nerves without lesion on the MRI Conclusion Activation of immune system in some patients with FD could lead to autoinflammation in the central nervous system, as a resultaseptic meningitidis. Prednisolone administration in spite of recurrent stroke could improve outcome in such patients.

BMC research notes, Jan 6, 2017

Emergency medical services (EMS) play a vital role in expediting hospital arrival in stroke patie... more Emergency medical services (EMS) play a vital role in expediting hospital arrival in stroke patients. The objective of our study was to assess the level of awareness regarding pre-hospital identification and management of acute stroke among EMS Staff in Dubai and to evaluate the impact of an educational lecture on their knowledge. Ours was a cross-sectional study with a pre-test and post-test design. The intervention was an educational lecture, based on the updated guidelines in pre-hospital care of acute stroke. Participants were assessed before and after the intervention on various aspects of stroke care. Paired t test were used to compare the impact of the intervention. A total of 274 EMS workers participated in our study. The baseline knowledge of participants regarding stroke types was inadequate with only 68% correctly identifying these. 79% were able to name the cardinal stroke symptoms. Knowledge of stroke mimics was poor with only 6.6% identifying stroke mimics correctly. W...

Neurology, Feb 12, 2013

OBJECTIVE: To describe clinical, imaging, histopathological characteristics, treatment options an... more OBJECTIVE: To describe clinical, imaging, histopathological characteristics, treatment options and outcome in a patient with ANHLE. BACKGROUND: ANHLE is a rare often fatal disease and few cases with histopathological and MRI correlation has been reported in literature. ANHLE can be hyper acute frequently fatal form of ADEM. The etiology and pathogenesis of this disease remain unknown. Although some viruses have been reported as causative agents, it is now believed that this disease is likely immune-mediated or metabolic. DESIGN/METHODS: A previously healthy 29 year old Syrian left handed male lived in Dubai 4 month prior to presentation as an emergency with few days9 history of ophthalmoplegia, ataxia, and generalized tonic colonic seizure and progressed rapidly to coma and quadriplegia and subsequently required intubation and mechanical ventilation. RESULTS: Initial MRI of the Brain showed bilateral basal ganglia, thalamic and brainstem well-defined T2 high signals and T1 mixed signals non enhancing lesions, and multiple smaller superficial white matter similar lesions involving parietal regions. Further extensive diagnostic workup with metabolic, hematologic, hormonal, vasculitic, para neoplastic, viral, neurophysiology and immunology studies was negative. CSF analysis was repeatedly normal. Brain biopsy and histopathological studies performed by neuropathologist in UK showed necrotizing grey matter lesions within sulcal cortex accompanied by capillary proliferation and endothelial hyperplasia and vaculation of white matter . These findings raised many diagnostic possibilities including ANHLE. Patient was initially treated with high dose steroids, followed by IVIG and plasma exchange. Patient recovered but remained with mild residual cognitive dysfunction and limbs spasticity. Follow up MRI showed that the lesions almost disappeared. CONCLUSIONS: Early diagnosis with high index of suspicion for ANHLE is required. Early and aggressive treatment of ANHLE may increase the chances of survival and improve the outcome even before the diagnosis is confirmed with brain biopsy which is often needed. Disclosure: Dr. Inshasi has nothing to disclose. Dr. Almadani has nothing to disclose. Dr. Alrukn has nothing to disclose. Dr. Noori has nothing to disclose. Dr. Abdool has nothing to disclose. Dr. Thakre has nothing to disclose.

Objective: To report the clinical, electrophysiological and CSF profile of three patients with re... more Objective: To report the clinical, electrophysiological and CSF profile of three patients with recurrent Guillain Barre Syndrome Background: Recurrence of Guillain Barre Syndrome (GBS) is very rare, it occurs in 1-3[percnt] of GBS patients. Recurrences occur more frequently in patients under 30, with milder symptoms and in those with Miller Fischer syndrome. Most patients with recurrent GBS respond favorably to treatment with plasmapheresis or IVIG. Generally the recurrence comes months to years after the initial episode. Respiratory or intestinal infections often precede the second episode. Patients who had one recurrence of GBS usually return to their previous level of function while those with multiple recurring episodes of GBS accumulated small neurological deficits Methods: We conducted a cross sectional retrospective observational study where 87 patients with GBS admitted to Rashid Hospital from 2008- 2014 were analyzed. 3 patients were admitted with 2nd episode of GBS. The ag...

OBJECTIVE: to find out if there is any benifit of the rescue treatment used in unresponsive Guill... more OBJECTIVE: to find out if there is any benifit of the rescue treatment used in unresponsive Guillain Barre syndrome patients BACKGROUND: no clear data how to treat patients with GBS , who do not respond to the first line treatment DESIGN/METHODS: We reviewed 87patients retrospectively , and collected the data demographically, clinically and prognostically. All the patients were diagnosed depending on the NINDS criteria of GBS. And Hughes disability scale at discharge and at 1month was used to estimate the prognosis RESULTS: we found 19 patients (about 30[percnt]) needed rescue treatment (11 male 57[percnt]) , with age between 17-81 y old, either because of no improvement or because deterioration. All our patient had IVIG as first line treatment, and the rescue treatment was given after a period about 2weeks from the first line. Which was IVIG(7.2[percnt]) , Plasma exchange (13.3[percnt]) or steroids (2.4[percnt]). There was no significant statistical difference among any of those gr...