Paraparesis can occur as a primary presentation of brain pathology at the motor strip along the parasagittal region. It could also occur as a neurological complication especially following resection of parasagittal meningioma with infiltration of the superior sagittal sinus (SSS). We report a case of a complete paraparesis immediately following resection of bilateral parasagittal meningioma with infiltration of the middle third of the SSS. A gradual improvement in neurological recovery and functional outcome was observed over a period of one year after undergoing an intensive neurorehabilitation program beginning from the acute inpatient phase post surgery.

Objective: To determine the incidence and predictors of early ankle contracture in adults with acquired brain injury. Methods: A prospective cohort study of patients admitted to Neurosurgical Intensive Care Unit (NICU), University Malaya Medical Centre and referred for rehabilitation within a period of 12 months. Adult patients with newly diagnosed acquired brain injury with no prior deformity to lower limbs, Glasgow Coma Scale ≤ 12, no concomitant spinal or lower limb injuries, medical stability at inclusion into the study and agreed to participate for the total duration of assessment (3 months) were recruited. We conducted weekly review of ankle muscle tone and measurement of ankle maximum passive dorsiflexion motion. The end point is reached if ankle contracture developed or completed 3 months post injury assessment. Results: The cohort included 70 patients, of which only 46 patients completed the study. Twenty-eight patients suffered from severe brain injury whilst 18 from moderate brain injury. Out of the 46 patients, 13 (28%) developed ankle contracture at the end of the study period. Abnormal motor pattern was significantly associated with incidence of ankle contracture, which included spasticity (p<0.001), spastic dystonia (p=0.001) and clonus (p=0.015). Using univariate analysis, the predictors for ankle contracture were spasticity (OR 51.67, CI 7.53-354.52, p<0.001), spastic dystonia (OR 27.43 CI 2.84-265.35, p=0.004) and clonus (OR 4.18 CI 1.33-13.19, p =0.015). Conclusion: Abnormal motor patterns are strongly associated with early incidence of ankle contracture amongst adult with new diagnosis of moderate to severe acquired brain injury despite a regular standard therapy program. This is an important clinical finding towards early prevention of ankle contracture.
Contracture ; Ankle

Background: The clinical presentation of horses with back pain (BP) vary considerably with most horse's willingness to take part in athletic or riding purpose becoming impossible.However, there are some clinical features that are directly responsible for the loss or failure of performance. Objectives: To investigate the clinical features of the thoracolumbar region associated with BP in horses and to use some of the clinical features to classify equine BP. Methods: Twenty-four horses comprised of 14 with BP and 10 apparently healthy horses were assessed for clinical abnormality that best differentiate BP from normal horses. The horses were then graded (0–5) using the degree of pain response, muscular hypertonicity, thoracolumbar joint stiffness and overall physical dysfunction of the horse. Results: The common clinical features that significantly differentiate horses with BP from non-BP were longissimus dorsi spasm at palpation (78.6%), paravertebral muscle stiffness (64.3%), resist lateral bending (64.3%), and poor hindlimb impulsion (85.7%). There were significantly (p < 0.05) higher scores for pain response to palpation, muscular hypertonicity, thoracolumbar joint stiffness and physical dysfunction among horses with BP in relation to non-BP. A significant relationship exists between all the graded abnormalities. Based on the cumulative score, horses with BP were categorized into mild, mild-moderate, moderate and severe cases. Conclusions BP in horse can be differentiated by severity of pain response to back palpation, back muscle hypertonicity, thoracolumbar joint stiffness, physical dysfunctions and their cumulative grading score is useful in the assessment and categorization of BP in horses.

INTRODUCTIONThis study aimed to investigate the direct cost of outpatient care for patients with stroke, as well as the relationship between the aforementioned cost and the sociodemographic and stroke characteristics of the patients.

METHODSThis was a cross-sectional study involving patients with first-ever stroke who were attending outpatient stroke rehabilitation, and their family members. Participants were interviewed using a structured questionnaire designed to obtain information regarding the cost of outpatient care. Stroke severity was measured using the National Institute of Health Stroke Scale.

RESULTSThis study comprised 49 patients (28 men, 21 women) with a mean age of 60.2 (range 35-80) years. The mean total cost incurred was USD 547.10 (range USD 53.50-4,591.60), of which 36.6% was spent on attendant care, 25.5% on medical aids, 15.1% on travel expenses, 14.1% on medical fees and 8.5% on out-of-pocket expenses. Stroke severity, age > 70 years and haemorrhagic stroke were associated with increased cost. The mean cost of attending outpatient therapy per patient was USD 17.50 per session (range USD 6.60-30.60), with travelling expenses (41.8%) forming the bulk of the cost, followed by medical fees (38.1%) and out-of-pocket expenses (10.9%). Multiple regression analysis showed that stroke severity was the main determinant of post-stroke outpatient care cost (p < 0.001).

CONCLUSIONPost-stroke outpatient care costs are significantly influenced by stroke severity. The cost of attendant care was the main cost incurred during the first three months after hospital discharge, while travelling expenses was the main cost incurred when attending outpatient stroke rehabilitation therapy.

Adult ; Aged ; Aged, 80 and over ; Ambulatory Care ; economics ; Cross-Sectional Studies ; Female ; Health Care Costs ; Humans ; Malaysia ; Male ; Middle Aged ; Neurology ; economics ; Outpatients ; Rehabilitation ; economics ; Severity of Illness Index ; Social Class ; Stroke ; economics ; Stroke Rehabilitation ; Surveys and Questionnaires

It is common to have vision problems after neurological insults such as traumatic brain injury, stroke or brain tumours. While these neurological insults can affect patients’ daily functioning to different extents, vision problems can be the main obstacle to the dysfunction. A 19-year-old boy with pontine cavernoma presented to the clinic with multiple visual problems at ten months after surgical removal of the tumour. He has left 6th cranial nerve palsy with persistent diplopia and nystagmus. These were associated with giddiness, imbalance, cerebellar impairments, right hemiparesis and hemisensory loss. This case illustrates the importance of adding the neuro-optometric vision rehabilitation, which include visual information processing therapy and other substitutive interventions, into the existing multidisciplinary rehabilitation program to achieve the greatest functional benefit.
Brain Injuries

Fluoxetine is a common selective serotonin reuptake inhibitor (SSRI) used as a pharmacological neuromodulationagent for post-stroke motor recovery and treatment for post-stroke mood disorder. Although some SSRIs are known to cause bilateral symmetrical peripheral oedema, to datethere are no reported cases of oedemacaused by fluoxetine or reported cases of a unilateral peripheral oedema. We report a case of fluoxetine-induced unilateral facial and limb oedema in a patient with haemorrhagic stroke. The peripheral oedema was noted on the hemiparetic side within 48 hours after theinitiation of fluoxetine.The medication was then tapered off over two weeks, which resulted in gradual resolution of the oedema.
Fluoxetine

his is a short-term longitudinal study of physical, cognitive, psychological and functional outcomes following mild traumatic brain injury (mTBI) in adults, caused by road traffic accident (RTA). Outcome measures were the Montreal Cognitive Assessment (MoCA), the Neuropsychological Assessment Battery Screening Module (S-NAB), the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 7 (GAD-7) scale. Functional outcomes included returning to working/academia and driving, lifestyle changes, financial claims and litigation status. A total of 285 individuals were diagnosed with mTBI, involving young male motorcyclists (90%): uncomplicated mTBI, n=201; complicated mTBI, n=84. Ethnic distribution consisted of 204 Malays, 58 Indians and 23 Chinese. MoCA detected cognitive deficits (mean=23.11, SD=3.41) within 72 hours of injury. At two weeks, somatic manifestations, physical injuries, cognitive deficits and psychological symptoms were detected. At three months of injury, the language domain was persistently impaired, with a lower score on most cognitive domains in the complicated mTBI category than the uncomplicated mTBI. Psychological and somatic symptoms had improved. Almost 50% of patients had returned to a functional baseline within two weeks of injury and a further 24% within three months. A small proportion of patients made active lifestyle changes (<25%), financial injury claims (38%) and were involved in litigation (11%). In conclusion, mTBI in multi-ethnic Malaysia has multifaceted deficits and outcomes. Early management of symptoms may promote maximum recovery.
Brain Concussion