1.EEG is sensitive in early diagnosis of anti NMDAR encephalitis and useful in monitoring disease progress
Suhailah Abdullah ; Kheng Seang Lim ; Won Fen Wong ; Hui Jan Tan ; Chong Tin Tan
Neurology Asia 2015;20(2):167-175
Background& Objective: Investigation modalities, such as MRI and CSF examination, are neither
sensitive nor specific in the early phase of anti-NMDAR encephalitis. Nuclear imaging may be
useful to monitor the response to treatment but limited by the availability.We aimed to determine
the role of EEG as a tool for early diagnosis as well as a tool to assess disease progression and
response to treatment. Methods: A total of 99 EEGsdone in 16 patients diagnosed with anti-NMDAR
encephalitis throughout the course of illness, were reviewed retrospectively. The EEG changes were
correlated with the clinical presentations and response to treatment. Sixteen EEGs of patients with
schizophrenia and mood disorder, and 10 EEGs of patients with infective encephalitis were included
as control. Results: EEGs performed during the psychiatric and cognitive dysfunctionphase in patient
with anti-NMDAR encephalitis, showed diffuse background slowing in the delta-theta range in all the
patients. Serial EEGs showed that the dominant background frequency improved with improvement in
cognitive status. Nine patients had complete recovery with normalisation of the EEG abnormalities.
Eight patients had their typical clinical seizure recorded during EEG monitoring, but only 2 (25.0%)
with EEG correlation. Ten patients had status epilepticus (62.5%), 5 had EEG recorded during their
status epilepticus, of which only one with EEG correlation (20.0%). Eleven patients had asymmetric
background (68.8%), but only 1 has correlation with focal changes in the MRI brain (9.1%). Even
though the EEGs of patients with infective encephalitis also showed background slowing, their CSF
analysis was supportive of an infective cause. EEGs of patients with established psychiatric disorder
were within normal limits.
Conclusion: EEG abnormality has a good correlation with the degree of psychiatric and cognitive
dysfunction in patient with anti-NMDAR encephalitis, and is useful in early diagnosis, monitoring the
progress and the response to treatment. However, it has poor correlation with clinical seizures.
Electroencephalography
2.Prevalence of Helicobacter pylori infection in epilepsy patients in a teaching hospital in Malaysia
Megat Razeem Abdul Razak ; Hui Jan Tan ; Hamizah Razlan ; Norlinah Mohamed Ibrahim ; Rosnah Sutan
Neurology Asia 2012;17(4):293-296
Background & Objective: Helicobacter pylori infection has been associated with extradigestive diseases
including epilepsy. The main aim of the study was to determine the prevalence of Helicobacter
pylori using 13C urea breath test (UBT) in epilepsy patients in a teaching hospital in Malaysia and
compared to control. Methods: The study subjects were epilepsy patients from the neurology clinic
in a teaching hospital. The study was conducted from August 2010 to February 2011. The control
consisted of healthy individuals matched for age and gender, not on any acid suppression medications
and antibiotics. All subjects underwent UBT as per protocol. Variables such as age, race, household
income, types of epilepsy, duration of epilepsy, number of antiepileptic drugs, prognosis were analysed.
Good prognosis was defi ned as seizure free for 3 years. Results: Forty eight epilepsy patients and 47
control subjects were studied. Prevalence of H. pylori infection in the epilepsy patients was 37.5%
(n=18) and was 36.2% (n=17) in control. There were signifi cantly more subjects in the epilepsy
group with lower income. There were also more smokers in the epilepsy group but there was no
association between smoking and positive UBT. Epilepsy patients with poor prognosis have a higher
UBT positive rate compared to the good prognosis group (64.3% vs 35.7 %). However the difference
was not statistically signifi cant.
Conclusion: The prevalence of H. pylori infection in epilepsy patients is similar to that of the control
in this study involving Malaysian subjects.
3.Parkinsonism complicating acute organophosphate insecticide poisoning.
Hasnur Zaman HASHIM ; Wan Rosmaiza Wan MUSA ; Chai Soon NGIU ; Wan Nafisah Wan YAHYA ; Hui Jan TAN ; Norlinah IBRAHIM
Annals of the Academy of Medicine, Singapore 2011;40(3):150-151
Acute Disease
;
Adult
;
Antidotes
;
therapeutic use
;
Antiparkinson Agents
;
therapeutic use
;
Benserazide
;
Cholinesterase Inhibitors
;
poisoning
;
Humans
;
Insecticides
;
poisoning
;
Levodopa
;
therapeutic use
;
Male
;
Organophosphate Poisoning
;
Parkinson Disease
;
drug therapy
;
pathology
;
Pralidoxime Compounds
;
therapeutic use
;
Trihexyphenidyl
;
therapeutic use
4.Stroke Thrombolysis at 5.5 Hours Based on Computed Tomography Perfusion
Ramesh Sahathevan ; Shahrul Azmin ; Sivakumar Palaniappan ; Wan Yahya Nafisah ; Hui Jan Tan ; Mohamed Ibrahim Norlinah ; Mukari Shahizon
Malaysian Journal of Medical Sciences 2014;21(2):79-82
A young man was admitted with sudden onset of right-sided weakness. He was assessed in the emergency department, and an immediate computed tomography (CT) perfusion study of the brain was arranged, which showed a left middle cerebral artery territory infarct with occlusion of the M1 segment. There was a significant penumbra measuring approximately 50% of the arterial territory. By the time his assessment was completed, it was 5.5 hours from the onset of symptoms. He was nonetheless administered intravenous recombinant tissue plasminogen activator (rtPA) based on the significant penumbra. He was discharged from the hospital after one week with significant residual deficit. At 2 months clinic follow-up, he showed almost complete recovery with a Modified Rankin Score of 1. We hope to demonstrate that a significant penumbra is an important determinant for good neurological recovery and outcome following stroke thrombolysis, even when patients present outside the 4.5 hours onset-to-treatment time window.
5.A case of biopsy proven acute demyelinating encephalomyelitis (ADEM) with haemorrhagic leucoencephalitis.
Hasnur Zaman HASHIM ; Norlinah Mohamed IBRAHIM ; Nafisah WANYAHYA ; Hui Jan TAN ; Khairul Anuar ZAINUN ; Siti Aishah Mohd ALI ; Ahmad Sobri MUDA ; Shahizon Azura Mohamed MUKARI ; Izwan Zannie ZAINIESSOR
Annals of the Academy of Medicine, Singapore 2011;40(4):197-200
6.Evaluation of time-dependent pathways in an acute ischemic stroke protocol that incorporates CT perfusion: A tertiary referral center experience
Hilwati Hashim ; Radhiana Hassan ; Syazarina Sharis ; Shahrul Azmin ; Rabani Remli ; Shahizon Azura Mukari ; Nafisah Yahya ; Hui Jan Tan ; Norlinah Mohamed Ibrahim ; Mohd Saiboon Ismail ; Sobri Muda ; Ramesh Sahathevan
Neurology Asia 2013;18(4):355-360
Background and Objective: Intravenous thrombolysis service for stroke was introduced at the Universiti
Kebangsaan Malaysia Medical Centre (UKMMC) in 2009, based on the recommendations of a
multidisciplinary team of clinicians. We report the experience at our center in establishing a stroke
protocol incorporating computed tomography perfusion (CTP) of the brain, to assess the feasibility
of incorporating CTP in the stroke protocol.
Methods: A retrospective review of all patients who had a CTP between January 2010 and December
2011 was performed. Results: Of 272 patients who were admitted with acute ischemic stroke, 44
(16.2%) arrived within 4.5 hours from symptom onset and had a CTP performed with the intention to
treat. The median time for symptom-to-door, symptom-to-scan and door-to-scan was 90.0 minutes (62.5
– 146.3), 211.0 minutes (165.5 – 273.5) and 85.0 minutes (48.0 – 144.8) respectively. Eight patients
(2.9%) were thrombolysed of whom five received IV thrombolysis and three underwent mechanical
thrombolysis. The median symptom-to-needle and door-to-needle times were 290.5 minutes (261.3
– 405.0) and 225.0 minutes (172.5 – 316.8) respectively. Four patients were thrombolysed despite
being outside the window of treatment based on the CTP findings. Six of the thrombolysed patients
had a Modified Rankin Score (MRS) of 1-2 at 5 months post procedure.
Conclusions: CTP provides a benefit to management decisions and subsequent patient outcome. It is
feasible to incorporate CTP as a standard imaging modality in a stroke protocol. The delays in the
time-dependent pathways are due to our work flow and organisational process rather than performing
the CTP per se.
7.Role of high resolution ultrasound in ulnar nerve neuropathy
Radhika Sridharan ; Lee Yee Ling ; Low Soo Fin ; Fazalina Mohd Fadzilah ; Sharifah Majedah Idrus Alhabshi ; Suraya Aziz ; Rajesh Singh ; Jamari Sapuan ; Tan Hui Jan ; Norlinah Mohamed Ibrahim
The Medical Journal of Malaysia 2015;70(3):158-161
SUMMARY
Aim: This study was conducted to measure the cross
sectional area (CSA) of the ulnar nerve (UN) in the cubital
tunnel and to evaluate the role of high-resolution
ultrasonography in the diagnosis of ulnar nerve neuropathy
(UNN).
Materials and Methods This was a cross sectional study with
64 arms from 32 patients (34 neuropathic, 30 nonneuropathic).
Diagnosis was confirmed by nerve conduction
study and electromyography. The ulnar nerves were
evaluated with 15MHz small footprint linear array transducer.
The ulnar nerve CSA was measured at three levels with arm
extended: at medial epicondyle (ME), 5cm proximal and 5cm
distal to ME. Results from the neuropathic and nonneuropathic
arms were compared. Independent T-tests and
Pearson correlation tests were used. P value of less than
0.05 was considered significant.
Results: Mean CSA values for the UN at levels 5cm proximal
to ME, ME and 5cm distal to ME were 0.055, 0.109, 0.045 cm2
respectively in the neuropathic group and 0.049, 0.075, 0.042
cm2 respectively in the non-neuropathic group. The CSA of
the UN at the ME level was significantly larger in the
neuropathic group, with p value of 0.005. However, there was
no statistical difference between the groups at 5cm proximal
and distal to the ME, with p values of 0.10 and 0.35
respectively.
Conclusion: There is significant difference in CSA values of
the UN at ME between the neuropathic and non-neuropathic
groups with mean CSA value above the predetermined
0.10cm2 cut-off point. High-resolution ultrasonography is
therefore useful to diagnose and follow up cases of elbow
UNN.
Ulnar Nerve
10.High prevalence of diabetes in stroke patients and its association with lacunar infarction
Zhe Kang Law ; Wan Nur Nafisah ; Ramesh Sahathevan ; Jee Yong Hing ; Mohd Firdaus Zakaria ; Nurul Munirah Mohd Shuhari ; Nur Fathihah Ahmad ; Teong Kui Ting ; Hui Jan Tan ; Shahrul Azmin ; Rabani Remli ; Azmawati Mohammed Nawi ; Norlinah Mohamed Ibrahim
Neurology Asia 2015;20(2):121-127
Background & Objectives: The burden of stroke is increasing, in part due to increasing prevalence of
diabetes mellitus. Given the high prevalence of diabetes in the Malaysian population (22.6%), we aimed
to determine the prevalence of diabetes in our stroke population. We also aimed to study the stroke
subtype associated with diabetes. We hypothesized that lacunar infarction would be more prevalent
in diabetics. Methods: We retrospectively reviewed data of consecutive patients with acute ischaemic
stroke admitted from October 2004 to December 2010 from our stroke registry. Demographic data, risk
factors profile and stroke subtypes were reviewed and analyzed. Results: Eight hundred and fifty eight
patients were identified from the registry. As high as 59.3% (n=509) of our patients were diabetics,
of which 49.2% (n=422) had pre-existing diabetes and 10.1% (n=87) were newly diagnosed. Lacunar
infarction was the commonest stroke subtype, comprising 60.6% (n=519) of all strokes. Diabetes was
significantly associated with lacunar infarction (OR 1.5, CI 95% 1.16-2.01, p=0.003), particularly in
those aged ≤ 55 years (OR 2.29, 95% CI 1.12-4.67) and HbA1C ≥ 6.5% (χ²=8.77, p=0.003).
Conclusions: The prevalence of diabetes in our stroke patients is amongst the highest reported.
Diabetes mellitus, particularly those with poor glycaemic control is strongly associated with lacunar
infarction.
Diabetes Mellitus
;
Stroke