1.Aetiology of viral central nervous system infection, a Malaysian study
Yean Kong Yong ; Heng Thay Chong ; Kum Thong Wong ; Chong Tin Tan ; Shamala Devi
Neurology Asia 2008;13(1):65-71
Over 100 viruses are known to cause acute viral encephalitis in human. In order to diagnose a viral
central nervous system infection, various laboratory diagnosis methods have been used. In this study,
we examined 220 cerebrospinal fluid samples that were received at the Diagnostic Virology Laboratory
of University Malaya Medical Centre between year 2004 to 2006, by viral isolation, pathogen specific
antibody ELISA, polymerase chain reaction (PCR) and Real-Time PCR. Majority of the samples
were from patients <10 years old. Out of 220 samples, 3 were positive for viral isolation, 27 for
PCR (inclusive for the 3 positive for viral isolation) and 39 for pathogen specific ELISA. The total
positive detection rate of this study was 30%. Herpes virus was the most important aetiologic agent,
responsible for 58% of infection, followed by paramyxovirus (especially measles virus) in 26% of
infection, and 14% by enterovirus. Parvovirus and flavivirus were the other common viruses. Among
the herpes viruses, herpes simplex and cytomegalovirus were the most common.
3.Treatment of Intracranial Aneurysms with Flow Re-direction Endoluminal Device - A Single Centre Experience with Short-term Follow-up Results.
Neeraj Ramesh MAHBOOBANI ; Wing Ho CHONG ; Samuel Siu Kei LAM ; Jimmy Chi Wai SIU ; Chong Boon TAN ; Yiu Chung WONG
Neurointervention 2017;12(1):11-19
PURPOSE: A flow diverter (FD) is an effective treatment option for intracranial aneurysms. The Flow Re-direction Endoluminal Device (FRED) is a relatively new flow diverter with a unique dual-layer design. We report our experience and short-term results with the FRED. MATERIALS AND METHODS: We did a retrospective review of all consecutive cases in which the FRED was used to treat intracranial aneurysms at a single institution from March 2014 till December 2015. Clinical parameters, aneurysm characteristics, technical results and short-term outcomes were reviewed. RESULTS: Eleven intracranial aneurysms were treated with the FRED in 11 patients. The technical device deployment success rate was 100%. Immediate reduction in intra-aneurysmal flow after deployment was noted in 10 cases. The aneurysm occlusion rate at 6 months was 75%. There was 1 complication of in-stent thrombosis immediately after deployment. There was no side branch occlusion, delayed aneurysm rupture, stroke, or intraparenchymal haemorrhage. There was no neurological deficit, morbidity, or mortality. CONCLUSION: The FRED is a new FD. It has shown to be safe and effective in our series. The unique dual-layer design of the device renders it to have technical advantages over other FDs. The 6-month aneurysm occlusion rate and complication profile of FRED are similar to other FDs.
Aneurysm
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Follow-Up Studies*
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Humans
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Intracranial Aneurysm*
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Mortality
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Retrospective Studies
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Rupture
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Stents
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Stroke
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Thrombosis
4.Role of cytokines in the assessment of clinical outcome and neuroimaging findings in patients with tuberculous meningitis
Mei-Ling Sharon Tai ; Hong-Yien Tan ; Yean-Kong Yong ; Esaki M. Shankar ; Shanthi Viswanathan ; Hazman Mohd Nor ; Kartini Rahmat ; Jun-Fai Yap ; Boon-Seng Ng ; Chong Tin Tan
Neurology Asia 2017;22(3):209-220
Background: Tuberculous meningitis is a life-threatening manifestation resulting from infection
by Mycobacterium tuberculosis, especially in the developing countries. The molecular aspects of
pathogenesis of tuberculous meningitis remain poorly understood. We evaluated the correlation of
cerebrospinal fluid (CSF) and serum cytokine levels with the clinical outcome of 15 HIV-negative
patients with tuberculous meningitis. We also assessed the association of CSF and serum cytokines
with neuroimaging of brain findings in the patients. Methods: The prospective longitudinal study was
conducted at the University Malaya Medical Centre between 2012 and 2014. Neuroimaging of the
brain was performed and the findings of leptomeningeal enhancement, hydrocephalus, tuberculoma,
infarcts and vasculopathy were recorded. The CSF and serum specimens were analyzed for IL-1ß,
IL-8, IL-10, IL-18, IP-10, IFN-γ, MCP-1, TGF-ß, VEGF, TNF- α, IL-18BPa and MMP-9. The clinical
outcome was graded at 3 months based on Modified Rankin scale (mRS). Results: On admission and
at one month of anti-tuberculosis treatment, the CSF levels of IL-8, IL-1β, IP-10, IFN-γ and VEGF
were elevated in all of the patients. Serum IP-10, MCP-1, IL-1β and IL-8 levels were increased on
admission and at one month of anti-tuberculosis treatment. There were statistically significant differences
between good and poor outcome (mRS at 3 months) for CSF IFN-γ (p=0.033), CSF IL-10 (p=0.033)
and serum VEGF (p=0.033) at one month of treatment. None of the patients showed any association
between CSF and serum cytokines on admission and at one month of anti-tuberculosis treatment with
neuro-radiological findings.
Conclusion: The CSF cytokine levels were not related to TBM disease severity on admission, and
changes on MRI/CT scans. CSF levels of IFN-γ and IL-10 at one month of anti-tuberculosis treatment
were associated with clinical outcome at 3 months. CSF cytokine levels on admission were not
associated with the clinical outcome.
Tuberculosis, Meningeal
5.Endovascular Management of Hepatic Artery Pseudoaneurysms: A Case Series
Pui Lam CHEUNG ; Yat Sing LEE ; Chong Boon TAN ; Hin Yue LAU ; Chi Wai SIU ; Chik Xing CHAN ; Wai Tat CHAN ; Cheuk Him HO
Vascular Specialist International 2023;39(1):1-
Although rare, hepatic artery aneurysms are associated with a high morbidity and mortality, necessitating a prompt diagnosis. A significant proportion of hepatic artery aneurysms are pseudoaneurysms, and the major risk factors of which have already been identified in previous literatures. Presentation can be variable, but diagnosis almost relies entirely on computed tomography and digital subtraction angiography. The endovascular approach has progressively become the preferred option due to its better performance when compared to the traditional surgical approach. However, formulation of an endovascular treatment plan for these lesions remains difficult as multiple factors should be considered to identify the best endovascular treatment modality. Five cases of pseudoaneurysm due to recent Whipple operation, hepatobiliary infections, and underlying malignancy are presented in this article to illustrate the effectiveness and complexity of endovascular treatment in this disease entity.
6.Illicit drug use is associated with lower bone mineral density and bone strength
Suhas KRISHNAMOORTHY ; Gloria Hoi-Yee LI ; Kelvin Shun-Cheong HO ; Yin-Pan CHAU ; Constance MAK ; Donna NG ; Albert Kar-Kin CHUNG ; Jody Kwok-Pui CHU ; Kathryn Choon-Beng TAN ; Ruby Lai-Chong HOO ; Ching-Lung CHEUNG
Osteoporosis and Sarcopenia 2023;9(3):88-93
Objectives:
To evaluate the association of illicit drug use with bone mineral density (BMD) and hip geometric parameters at the narrow neck.
Methods:
This is a cross-sectional matched cohort study conducted in the Hong Kong Chinese population. Associations with illicit drug use were estimated using linear regression for BMD (lumbar spine and femoral neck) and hip geometrical parameters (cross-sectional area [CSA], cross-sectional moment of inertia [CSMI], section modulus [SM], average cortical thickness [ACT] and BMD at the narrow neck) after adjusting for age, body mass index (BMI), smoking status, drinking status, physical activity, and history of antipsychotic and antidepressant use. Mean difference and 95% confidence intervals (95% CI) were calculated between 108 illicit drug users and 108 controls using an adjusted linear model and cluster-robust standard errors after matching by age and sex. The false discovery rate was used to correct for multiple testing.
Results:
Illicit drug users had a significantly lower BMD (g/cm2 ) at the lumbar spine (mean difference: -0.062; 95% CI: -0.108 to − 0.015), and femoral neck (mean difference: -0.058; 95% CI: -0.106 to − 0.010) in the fully adjusted model. Illicit drug users also had a significantly lower CSA (mean difference: -0.238 cm2 ; 95% CI: -0.462 to − 0.013), ACT (mean difference: -0.018 cm; 95% CI: -0.030 to − 0.006) and BMD (mean difference: -0.070 g/ cm2 ; 95% CI: -0.128 to − 0.012) at the narrow neck.
Conclusions
Illicit drug use is associated with lower BMD and bone strength. Future studies evaluating the risk of illicit drug use with fragility fracture are warranted.
7.A Rare Case of Neurenteric Cyst of Spinal Cord with Thoracic Vertebra Fusion Successfully Managed with Spinal Cyst Excision and Posterior Instrumentation Surgery
Tan Jih Huei ; Henry Tan Chor Lip ; Chan Chee Kong ; Ariz Chong B. Abdullah@Chong Chee Yong ; Noor Azman Bin A. Rahman
Malaysian Journal of Medicine and Health Sciences 2020;16(No.2):348-350
The incidence of neurenteric cyst (NC) is rare amongst spine tumors. It is most often asymptomatic but may present with sensory and motor symptoms. When associated with thoracic vertebra fusion it is not reported before, this complicates the placement of pedicle screw during posterior instrumentation. Herein, we report a case of thoracic spinal neurenteric cyst in a 40-year-old man that presents with chronic back pain, left lower limb weakness and numbness. Elective excision of NC over T6-T7 with laminectomy and multilevel posterior instrumentation was successfully performed with significant improvement of the symptoms. Neurenteric cyst is a rare spinal cord lesion which may cause permanent neurological sequalae. Complete surgical excision with spine fixation in this case provides good long-term outcome.