1.Uterine Arteriovenous Malformation
Hilwati Hashim ; Ouzreiah Nawawi
Malaysian Journal of Medical Sciences 2013;20(2):76-80
Uterine arteriovenous malformation (AVM) is a rare condition, with fewer than 100 cases reported in the literature. Despite it being rare, it is a potentially life-threatening condition. This case report describes a 33-year-old woman who presented with secondary post-partum hemorrhage. Transabdominal ultrasound (US) of the pelvis showed increased vascularity with multidirectional flow of the uterus and a prominent vessel, located on the left lateral wall. She also had retained product of conception, which complicated the diagnosis. A uterine artery angiogram confirmed an AVM in the fundal region with an early draining vein. Embolisation of the AVM was performed successfully.
2.Onyx In Brain Arteriovenous Malformation Embolization
Hilwati Hashim ; A Sobri Muda ; Aida Abdul Aziz ; Zuhanis Abdul Hamid
Malaysian Journal of Medical Sciences 2016;23(4):59-64
Introduction: Embolisation has long been used as an adjunct to surgical resection
in the treatment of brain arteriovenous malformation (bAVM). The most commonly used
embolic material, n-butylcyanoacrylate glue, requires experience and skill to handle its quick
and unpredictable flow and polymerisation. A new liquid embolic agent, ethylene vinyl alcohol
copolymer (Onyx), is less adhesive and polymerises slowly, which provides better control for
radiologists performing embolisation.
Objective: To report our experience in embolisation using Onyx alone or in combination
with histoacryl for bAVM embolisation in our tertiary referral centre.
Methods: We retrospectively reviewed the anatomy, technical conditions, complications
and clinical outcome of all bAVM patients embolised at our centre using Onyx alone or in
combination with n-butylcyanoacrylate glue.
Results: Between 2010 and 2013, 13 patients [6 (46.2%) male; 7 (53.8%) female; aged, 14–
57 years] were included, and a total of 31 embolisations were performed. Clinical presentation
included hemorrhage [9 (69.2%)], seizures [2 (15.4%)], and headache [2 (15.4%)]. Most AVMs
were located in the brain hemispheres [12 (92.3%)] and measured <3 cm [7 (53.8%]. Complete
occlusion of the AVM was obtained in 2 (15.4%) patients; 11 (84.6%) patients had partial occlusion
[6 (54.5%) had <50% nidus occlusion]. Complications occurred in four procedures involving 3
patients (morbidity, 23.1%). This resulted in the death of 1 patient (mortality, 7.7%) and complete
recovery with no disability in 2 patients.
Conclusion: The total nidal occlusion achieved herein is comparable to other similar
studies. Our morbidity and mortality were higher compared to other studies which may be
attributed to the small number of patients. More data is being collected which may better reflect
on our experience.
3.Atypical Clival Chordoma in an Adolescent without Imaging Evidence of Bone Involvement
Hilwati Hashim ; Azmin Kass Rosman ; Aida Abdul Aziz ; Abdul Kadir Roqiah ; Nor Salmah Bakar
Malaysian Journal of Medical Sciences 2014;21(5):78-82
Clival chordoma is a rare primary bone tumour that arises from the remnant of the notochord and typically occurs in older adults. Upon imaging, the tumour can be seen arising from the clivus and causes clival destruction. This usually provides insight for a diagnosis. Here we present a case of a non-enhancing, pre-pontine mass that was hypointense on T1W and hyperintense on T2W in an adolescent. No clival bone erosion was observed. Based on the age group, imaging findings, and lack of clival erosion, a provisional diagnosis of epidermoid cyst was made and the tumour was resected. This patient was eventually diagnosed with a clival chordoma based on histopathological examination.
4.Pleuritic chest pain and fever: An unusual presentation of aortic dissection
Mohamed Syarif Mohamed Yassin ; Noorhida Baharudin ; Anis Safura Ramli ; Hilwati Hashim
Malaysian Family Physician 2019;14(1):47-52
It remains a challenge to diagnose aortic dissection in primary care, as classic clinical features are not
always present. This case describes an atypical presentation of aortic dissection, in which the patient
walked in with pleuritic central chest pain associated with a fever and elevated C-reactive protein.
Classic features of tearing pain, pulse differentials, and a widened mediastinum on chest X-ray were
absent. This unusual presentation highlights the need for a heightened level of clinical suspicion for
aortic dissection in the absence of classic features. The case is discussed with reference to the literature
on the sensitivity and specificity of the classic signs and symptoms of aortic dissection. A combination
of the aortic dissection detection risk score (ADD-RS) and D-dimer test is helpful in ruling out this
frequently lethal condition.
5.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.
6.Clival Chordoma in an Adolescent: A Perspective from Primary Care
Hayatul Najaa MIPTAH ; Siti Fatimah BADLISHAH-SHAM ; Hilwati HASHIM ; Anis Safura RAMLI
Korean Journal of Family Medicine 2020;41(6):427-430
Clival chordoma is a rare malignant tumor of the brain that typically occurs in older adults. It has a high local recurrence rate and is hence associated with poor prognosis. Here, we report a case of an adolescent who presented with a 1-month history of worsening headache and blurring of vision, as well as a 6-month history of left-sided facial and body numbness. Clinical findings were consistent with left upper motor neuron lesion of the seventh cranial nerve with involvement of the fifth cranial nerve. He was also found to have a sixth cranial nerve palsy demonstrated by diplopia upon lateral gaze with no evidence of papilledema. Magnetic resonance imaging of the brain suggested clival chordoma. He was subsequently referred to the neurosurgical team, and he successfully underwent an endoscopic trans-sphenoidal surgery to excise the lesion. He recovered well, continued his follow-ups with the neurosurgical team, and showed good progress. He also attended regular follow-ups with his primary care physician to ensure ongoing psychosocial support and monitoring of his overall health status. This case demonstrates the importance of prompt identification and treatment of clival chordoma in an adolescent. Long-term follow-ups and shared care between primary and secondary care physicians are essential to monitor recurrence of tumor and to provide psychosocial support.