1.Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis: A series of ten cases from a university hospital in Malaysia
Suhailah Abdullah ; Shen-Yang Lim ; Khean Jin Goh ; Lucy CS Lum ; Chong Tin Tan
Neurology Asia 2011;16(3):241-246
Objective: To report on the incidence, and the clinical and laboratory features of patients seen at the
University of Malaya Medical Centre with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis.
Methods: The charts of all patients admitted to the adult neurology ward with encephalitis over an 18-
month period from January 2010 to June 2011 were reviewed. Diagnosis of anti-NMDAR encephalitis
was based on the presence of encephalitis plus antibody against the NMDAR. Two other paediatric
patients with anti-NMDAR encephalitis seen over the same period were also included in this report.
Results: There was a total of 10 patients with anti-NMDAR encephalitis seen over the study period.
The mean age was 18.1 years (range 9-29 years). Eight patients were female, two male. Five were
Malay and fi ve were Chinese. All patients had prominent psychiatric symptoms, followed by epileptic
seizures. Nine patients had a movement disorder, orofacial dyskinesia being the commonest, and all
had autonomic involvement. None had an underlying tumour. Treatments consisted of corticosteroid,
plasma exchange and intravenous immunoglobulin (IVIG). The clinical outcome was variable, with
full recovery (2), substantial recovery (3), partial recovery (4), and mortality (1) seen. Remarkably,
the eight adult cases of anti-NMDAR encephalitis accounted for 50% of the 16 cases of encephalitis
seen during the study period.
Conclusion: Anti-NMDAR encephalitis may be a relatively common cause of adult encephalitis among
certain Asian groups. None of our cases was paraneoplastic in origin.
2.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.
3.Bilateral thalamic internal medullary lamina involvement in a case of dengue encephalitis
Sherrini Bazir Ahmad ; Chin Sum Cheong ; Shen-Yang Lim ; Kartini Rahmat ; Faizatul Izza Rozalli ; Shamala Devi Sekaran ; Helmi Sulaiman, Sasheela Ponnampalavanar ; Kheng Seang Lim ; Chong Tin Tan
Neurology Asia 2016;21(4):375-379
There are 50-100 million dengue infections each year, but dengue encephalitis is relatively
uncommon. The aetiology of neuronal injury is proposed to be due to direct viral neurotropism or
host immune response-mediated inflammation causing neuronal damage. We report a case of severe
dengue encephalitis, presenting during the acute viraemic phase of the disease. This was associated
with inflammation and haemorrhage of the internal medullary lamina of both thalami which, to our
knowledge, has not yet been reported in other infections of the central nervous system.
Dengue
4.Purposeless Groaning in Parkinson's Disease
Shen Yang LIM ; Ai Huey TAN ; Jia Lun LIM ; Azlina AHMAD-ANNUAR
Journal of Movement Disorders 2018;11(2):87-88
Purposeless groaning has been reported in advanced progressive supranuclear palsy. We present a case of purposeless groaning occurring as a primary complaint in a patient with advanced Parkinson's disease. Purposeless groaning is thought to be a manifestation of disinhibition and perseveration due to frontal-subcortical dysfunction. Proper recognition of this phenomenon will help clinicians to avoid unnecessary investigations and treatment (e.g., prescription of opioid medications).
Humans
;
Parkinson Disease
;
Prescriptions
;
Supranuclear Palsy, Progressive
6.Development of marked striatal hand with antiparkinsonian medication withdrawal during traditional (Ayurvedic) medicine treatment for Parkinson’s disease
Shen-Yang Lim ; Khean Jin Goh ; Amir Azlan Zain ; Norlisah Ramli ; Yeun-Mun Choo ; Guan Huat Tan
Neurology Asia 2010;15(3):275-277
Ayurveda is a traditional medical system used widely in India and increasingly worldwide. Here,
we report on a patient with Parkinson’s disease (PD) who developed marked striatal hand with
antiparkinsonian medication withdrawal during Ayurvedic medicine treatment for her PD. Although a
direct role for the Ayurvedic medicines in inducing the hand deformity cannot be excluded, we propose
that severe dopaminergic defi ciency (due to prolonged withdrawal of antiparkinsonian medications in
the context of long-standing PD) was probably the main culprit in our patient.
7.Persistent thrombocytopenia following dengue fever: What should we do?
Yang Liang Boo ; Suat Yee Lim ; Hon Shen P&rsquo ; ng ; Christopher Chin Keong Liam ; Nai Chien Huan
Malaysian Family Physician 2019;14(3):71-73
Thrombocytopenia is a common laboratory finding in dengue infection. However, it usually
resolves as the patient recovers from the infection. Persistent thrombocytopenia following dengue
infection requires further investigation. Here, we present a case of immune thrombocytopenic
purpura (ITP) following dengue infection complicated by intracranial bleeding.
8.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.
9.Hyperglycemia-Associated Hemichorea-Hemiballismus with Predominant Ipsilateral Putaminal Abnormality on Neuroimaging
Si Lei FONG ; Ai Huey TAN ; Kar Foo LAU ; Norlisah RAMLI ; Shen Yang LIM
Journal of Movement Disorders 2019;12(3):187-189
No abstract available.
Neuroimaging
10.Glucocerebrosidase genetic variants in Malays with early and late-onset Parkinson’s disease
Nur Fadhlina Mohamad Pakarulrazy ; Saiful Effendi Syafruddin ; Nurul Syakima Ab Mutalib ; Azlina Ahmad Annuar ; Shen-Yang Lim ; Rahman Jamal ; Nor Azian Abdul Murad ; Norlinah Mohamed Ibrahim
Neurology Asia 2020;25(1):39-46
Background: Mutations in glucocerebrosidase (GBA) have been associated with the risk of developing
Parkinson’s disease (PD) in different ethnic populations. The prevalence of GBA mutations among
Malay PD patients is unknown. Thus, the aim of this study was to determine the frequency of GBA
mutations among Malay PD patients, focusing on early (EOPD) and late-onset (LOPD) patients.
Methods:EOPD (n = 50) and LOPD (n = 50) patients along with 50 ethnically and age-matched control wererecruited. The GBA exons of these patients were sequenced using the Ion Torrent PGMTM System.
Results: Five heterozygous mutations exclusive to EOPD patients were identified; c.-203A>G,p.S146L,
p.R159Q, p.L483P and p.L483R+c.-145G>A. In LOPD patients, c.543C>T(p.(F181=)), c.28-10C>A
and p.R202Q were identified in which this p.R202Q was also present in a control subject. In addition,
c.259C>A(p.(R87=)) and c.-145G>A were identified in two control subjects. In summary, we observed
GBA mutations in 8% and 6% of Malay PD cases and control subject, respectively. The prevalence
of GBA mutations was higher in EOPD (10%) than LOPD (6%). However, these differences were
not statistically significant; [PD vs. controls: OR = 1.36, 95%CI 0.35-5.38, p = 0.752] and [EOPD
vs. LOPD: OR = 1.74, 95%CI 0.39-7.71, p = 0.715].
Conclusion: We identified five exclusive heterozygous GBA mutations in EOPD patients which might
predict the increase susceptibility of Malays to develop PD at young age. These findings could add
knowledge into the existing evidences linking genetic alterations in GBA and PD.