1.Karaoke, power failure and carbon monoxide poisoning
Chiun-Hian Chai ; Shen-Yang Lim ; Khairul Azmi Abdul Kadir ; Khean-Jin Goh ; Chong-Tin Tan
Neurology Asia 2011;16(3):255-257
Accidental carbon monoxide poisoning in countries with cold climates is commonly related to indoor
heating. This condition appears to be relatively uncommon in tropical Asian countries and therefore
the diagnosis may be unsuspected. We report a case of a Malaysian patient who presented with a
severe, and ultimately fatal, delayed (biphasic) neuropsychiatric syndrome due to carbon monoxide
poisoning. The diagnosis was made only when a history compatible with carbon monoxide poisoning
subsequently surfaced, and neuroimaging demonstrated the typical pallidal lesions, associated with
marked leukoencephalopathy, seen in this condition. Our case is unique because the poisoning occurred
in the setting of indoor operation of a portable electricity generator in a karaoke centre because of
power failure. Karaoke is a highly popular form of entertainment in many parts of Asia and we suggest
that a high index of suspicion of carbon monoxide poisoning is required in this setting.
2.Ruptured right atrial appendage secondary to blunt chest trauma.
Mohd Khairul Azmi ABDUL KADIR ; Wilson Cher Cheong CHONG ; Kim Hong LIM ; Kian Soon LIM ; Chee Fui CHONG
Brunei International Medical Journal 2010;6(2):105-108
Rupture of one or more cardiac chambers following domestic blunt chest trauma is rare. A positive outcome depends on high level of suspicion and early surgical intervention. We report here an interesting case of a ruptured right atrial appendage in a four year old boy following a blunt crushing injury to the chest and abdomen by a heavy porcelain sink which was successfully repaired. Therefore, accurate diagnosis is very important for appropriate management.
3.Diffusion-weighted magnetic resonance imaging in a case of osmotic demyelination syndrome with fatal outcome
Shen-Yang Lim ; ,Ismaliza Ismail ; Sharon Mei-Ling Tai ; Khairul Azmi Abdul Kadir ; Li-Ping Tan ; Yip-Boon Chong ; Nortina Shahrizaila
Neurology Asia 2011;16(1):89-92
Hyponatraemia with rapid correction of serum sodium may cause an osmotic demyelination syndrome
(ODS) with damage to pontine and/or extrapontine areas of the brain. The prognosis of ODS can range
from complete recovery to death; at present, our ability to predict clinical outcome is very limited. We
describe here a patient with ODS and increased signal intensity in the striatum on diffusion-weighted
MRI, with corresponding low apparent diffusion coeffi cient values (indicating restricted water diffusion).
This case provides a further example of the typical MRI appearance of extrapontine ODS and suggests
the potential value of diffusion-weighted MRI in predicting prognosis in ODS.
4.Cerebral venous thrombosis in multi-ethnic patients from Malaysia
Mei-Ling Sharon TAI ; Khairul Azmi Abdul KADIR ; Chong Tin TAN ; Kay Sin TAN
Neurology Asia 2020;25(2):127-138
Background & Objectives: The literature on cerebral venous thrombosis (CVT) in South East Asia is
limited. The objectives were to evaluate the clinical profile, predisposing factors and clinical outcome
of the CVT patients in Malaysia. Methods: We conducted a retrospective descriptive study of the CVT
patients admitted to the neurology ward. The clinical presentation, predisposing factors, radiological
findings, treatment and prognostic characteristics were evaluated from the charts. Clinical outcome
on discharge and six months was measured by Modified Rankin Scale (mRS) scores. Poor outcome
and good outcome was defined as Modified Rankin Scale (mRS) scores of 3-6 and 0-2 respectively.
Results: Forty nine CVT patients who presented between 2007 and 2017 were recruited. The mean age
was 43.51±16.52. The patients consisted of 39 Malaysians (13 Indians, 12 Malays, 12 Chinese, one
Iban, one Eurasian descent), and ten non-Malaysians. Thirty (61.2%) patients were women. The most
common presenting complaint was headache (75.5%). Six percent had multiple risk factors, whereas
51% had idiopathic CVT. The most common predisposing factors were oral contraceptive pill use
(18.4%), followed by infection (12.2%), especially central nervous system (CNS) infection (6.1%);
11.8% had prothrombotic disorder. The most common location for CVT was superior sagittal sinus
(83.7%). On neuroimaging, 77.6% had parenchymal lesions, 53.1% had venous infarcts and 38.8% had intracerebral haemorrhage, one patient had CVT complicated by rare venous collateral channels. Poor outcome on discharge and at six months was 38.8% and 33.3% respectively. On univariate analysis, female gender (p=0.002), seizures (p=0.037) and cerebral oedema (p=0.018) were associated with poor functional outcome. On binary logistic regression, female gender (OR=14.50, 95% CI 2.10-99.94,p=0.003) and seizures (OR=6.54, 95% CI 1.33-32.07, p=0.017) were associated with poor outcome.
Conclusion: The CVT patients in this study had a higher proportion of CNS infections. Poor outcome
was independently associated with female gender and seizures.
5.Disseminated Takayasu arteritis with neurovascular small and medium vessel involvement
Peng L ; Kartini Rahmat ; Khairul Azmi Abdul Kadir ; Kheng-Seang Lim ; Fariz Yahya ; Mei-Ling Sharon Tai
Neurology Asia 2019;24(1):53-59
Takayasu arteritis is a rare granulomatous vasculitis that is commonly classified as a large vessel
disease. Small and medium vessel involvement are extremely rare, with only a few case reports
describing neurovascular, ocular and cutaneous involvement. We describe a 21 year old Malaysian
woman with pre-existing Takayasu arteritis confined to the large vessels, presenting one year later
to our centre with status epilepticus. Extensive radiologic studies revealed diffuse encephalopathic
changes and multifocal neurovascular involvement, with the vasculitis progressing to encompass
the large, medium and small vessels. The patient was treated with high dose steroid therapy and
discharged well with long term steroid and immunosuppressive therapy. Follow up MRI with vessel
wall imaging sequence (VW-MR) and arterial spin labelling (ASL) perfusion imaging demonstrated
intra and extracranial vessel wall inflammation, with generalized reduction in left sided cerebral blood
flow. This case demonstrates that Takayasu arteritis is not exclusively a large vessel vasculitis, and
that small and medium vessel involvement does not preclude its diagnosis.
6.Neuroimaging findings are sensitive and specific in diagnosis of tuberculous meningitis
Mei-Ling Sharon Tai ; Hazman Mohd Nor ; Kartini Rahmat ; Shanthi Viswanathan ; Khairul Azmi Abdul Kadir ; Norlisah Ramli ; Fatimah Kamila Abu Bakar ; Norzaini Rose Mohd Zain ; Suhailah Abdullah ; Jun Fai Yap ; Ahmed Shaheed ; Boon Seng Ng ; Mohd Hanip Rafia ; Chong Tin Tan
Neurology Asia 2017;22(1):15-23
Objective: The primary objective of this study was to describe the neuroimaging changes of tuberculous
meningitis (TBM), and to determine the role of neuroimaging in the diagnosis of TBM. Methods:
Between January 2009 and July 2015, we prospectively recruited TBM patients in two hospitals in
Malaysia. Neuroimaging was performed and findings were recorded. The control consists of other types
of meningo-encephalitis seen over the same period. Results: Fifty four TBM patients were recruited.
Leptomeningeal enhancement was seen in 39 (72.2%) patients, commonly at prepontine cistern and
interpeduncular fossa. Hydrocephalus was observed in 38 (70.4%) patients, 25 (46.3%) patients had
moderate and severe hydrocephalus. Thirty four patients (63.0%) had cerebral infarction. Tuberculoma
were seen in 29 (53.7%) patients; 27 (50.0%) patients had classical tuberculoma, 2 (3.7%) patients
had “other” type of tuberculoma, 18 (33.3%) patients had ≥5 tuberculoma, and 11 (20.4%) patients
had < 5 tuberculoma. Fifteen (37.2%) patients had vasculitis, 6 (11.1%) patients had vasospasm. Close
to nine tenth (88.9%) of the patients had ≥1 classical neuroimaging features, 77.8% had ≥ 2 classical
imaging features of TBM (basal enhancement, hydrocephalus, basal ganglia / thalamic infarct, classical
tuberculoma, and vasculitis/vasospasm). Only 4% with other types of meningitis/encephalitis had ≥1
feature, and 1% had two or more classical TBM neuroimaging features. The sensitivity of the imaging
features of the imaging features for diagnosis of TBM was 88.9% and the specificity was 95.6%.
Conclusion: The classic imaging features of basal enhancement, hydrocephalus, basal ganglia/thalamic
infarct, classic tuberculoma, and vasculitis are sensitive and specific to diagnosis of TBM.
Tuberculosis, Meningeal
7.Predictors of functional outcome in patients with stroke thrombolysis in a tertiary hospital in Malaysia.
Mei-Ling Sharon TAI ; Khean Jin GOH ; Khairul Azmi Abdul KADIR ; Mohd Idzwan ZAKARIA ; Jun Fai YAP ; Kay Sin TAN
Singapore medical journal 2019;60(5):236-240
INTRODUCTION:
Intravenous (IV) thrombolysis with alteplase (rt-PA) is effective in ischaemic stroke. The primary objective was to evaluate predictors of functional outcome in acute ischaemic stroke (AIS) patients treated with IV rt-PA. The secondary objective was to assess the outcome with the modified Rankin scale (mRS). We also examined the predictive value of the Totaled Health Risks in Vascular Events (THRIVE) score.
METHODS:
AIS patients treated with IV rt-PA from February 2012 to August 2016 were recruited. Demographic data, National Institutes of Health Stroke Scale (NIHSS) scores, timing and neuroradiological findings were recorded. Patients received a dose of 0.9 mg/kg IV rt-PA within 4.5 hours of symptom onset. mRS score was evaluated at discharge and three months, and good and poor clinical outcomes were defined as scores of 0-2 and 3-6, respectively. Baseline THRIVE scores were assessed.
RESULTS:
36 patients received IV rt-PA. 20 (55.6%) patients had an mRS score of 0-2 at three months. Based on THRIVE score, 86.1% had a good or moderately good prognosis. On univariate analysis, poor outcome was associated with NIHSS score before rt-PA (p = 0.03), THRIVE score (p = 0.02), stroke subtype (p = 0.049) and diabetes mellitus (DM; p = 0.06). Multiple logistic regression showed that outcome was significantly associated with NIHSS score before rt-PA (p = 0.032) and DM (p = 0.010).
CONCLUSION
Our newly developed Malaysian IV rt-PA service is safe, with similar outcomes to the published literature. Functional outcome after thrombolysis was associated with baseline NIHSS score and DM.
8.FLUOROSCOPIC VS CT GUIDED TRANSPEDICULAR CORE NEEDLE BIOPSY FOR SPINAL INFECTIONS AND TUMORS: A PROSPECTIVE RANDOMIZED TRIAL
SHE ANN LEE ; CHEE KIDD CHIU ; CHRIS YIN WEI CHAN ; NUR ADURA YAAKUP ; JEANNIE HSIU DING WONG ; KHAIRUL AZMI ABDUL KADIR ; MUN KEONG KWAN
Malaysian Orthopaedic Journal 2018;12(Supplement B):6-
9.Effect of mindfulness meditation on brain-computer interface: fMRI perspective
Norlisah Ramli ; Su Sim Kuok ; Li Kuo Tan ; Yin Qing Tan ; Lee Fan Tan ; Khean Jin Goh ; Khairul Azmi Abd Kadir ; Pohchoo Seow ; Sing Yau Goh
Neurology Asia 2019;24(4):343-353
This study observed the functional changes in brain activity while performing real and imagery
movement using functional MRI (fMRI); and to compare the fMRI changes of motor imagery before
and after mindfulness meditation (MM) training for correlation with actual brain computer interface
(BCI) performance. Thirty-eight participants completed a randomized control trial consisting of 2 groups
(MM and non-intervention control groups) to study the effect of MM on BCI performance. The MM
group participated in a 4-week MM intervention programme. Out of the 38 cohorts, five participants
from the MM group and five from the control group were fMRI scanned for real and imagery movement
of right hand, left hand and both feet, before and after intervention. Statistical parametric mapping was
used for post processing and analysis of fMRI data. The MM group showed a significant improvement
in BCI performance compared to the control group. The fMRI results showed activation of right hand,
left hand and both feet motor imagery at fronto-parietal regions before MM training (p <0.05, family
wise error). After MM training, the fMRI results revealed a focused activation in 3 out of 4 of the
trained subjects during right hand motor imagery, 2 out of 4 of the trained subjects during both feet
motor imagery and 1 out of 4 of the trained subjects during left hand motor imagery, compared to
the control group. This is also correlated with the improvement of BCI accuracy of the intervention
group after MM training. Mindfulness meditation improves BCI performance and is correlated with
focused activation of the fronto-parietal region in fMRI during motor imagery.