MyMedR

Fulltext Embolization of brain arteriovenous malformations with squid co-polymer embolic material: Initial experience

Ch'ng LS, Zaki Z, Sobri Muda A

J Interv Med, 2023 Nov;6(4):176-179.

PMID: 38312133 DOI: 10.1016/j.jimed.2023.09.003

OBJECTIVE: To analyze the safety and effectiveness of the ethylene-vinyl alcohol copolymer (EVOH) liquid embolic agent Squid (Emboflu, Switzerland) for the treatment of brain arteriovenous malformations.

MATERIALS AND PROCEDURES: Between April 2015 and July 2017, 46 embolization treatments for brain arteriovenous malformations (BAVM) were performed in 25 patients using two Squid formulations (18 and 12). Six female and 19 male patients with a mean age of 34 years (range, 9-62 years) were included. A total of 46 procedures were performed. The BAVMs were classified as Spetzler-Martin grade II in 4 procedures, III in 27 procedures, and 1V in 15 procedures. Among the 25 patients, 15 presented with hemorrhage, 5 with seizures, and 5 with headache and neurology. The BAVMs were located in the temporal lobe in 5 patients, parietal lobe in 7 patients, frontal lobe in 3 patients, posterior fossa in 6 patients, basal ganglia in 3 patients, and parasagittal lobe in 1 patient.

RESULTS: The obliteration rate of the BAVMs ranged from 10% to 100%, with a mean of 33%. Most patients underwent their first or second embolization procedure. Four patients (8%) developed intracranial bleeding post-procedure, with one death (2%). One patient (2%) experienced a seizure during the procedure; however, no intracranial bleeding was observed. Seven patients (15%) experienced perforations during catheter manipulation. One case (2%) of a fractured catheter was recorded, but no significant complications were observed. The average volume of copolymer injected was 0.6 ml per nidus. Thirteen procedures used the Squid-12 formulation, 29 procedures used the Squid-18 formulation, and 3 procedures used a combination of Squid-12 and -18 formulations.

CONCLUSION: Squid is a safe and effective embolic agent for treating BAVMs.

Fulltext Tricks to do a quick successful Bronchial Artery Embolization (BAE) in massive Haemoptysis

Ezamin Abdul Rahim, Ahmad Sobri Muda, Hariati Jamil

Malaysian Journal of Medicine and Health Sciences, 2018;14(3):46-50.

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Bronchial artery embolization (BAE) is the mainstay treatment for massive haemoptysis. Herein we briefly discuss the tips and tricks of super-selective embolization of bronchial artery using N-butyl-2 cyanoacrylate (NBCA). Based on our experience, this technique produces a better resolution and exhibit high non- recurrence rate in the treatment of massive haemoptysis.

Fulltext Pre-operative spine embolisation for spinal tumors and metastases: 6 years experience at Pusat Perubatan Universiti Kebangsaan Malaysia

Mohd Naim Mohd Yaakob, , Nik Azuan Nik Ismail, Ahmad Sobri Muda

Journal of Cardiovascular, Neurovascular and Stroke, 2020;2(1):5-12.

MyJurnal

Objective: Our aim is to determine the average intraoperative blood loss in patients who underwent pre-operative spinal tumour embolisation in PPUKM from 2010 until 2016 and to compare with other centres from literature review.Material And Methodology: 15 patients in PPUKM with spinal tumour and spinal metastatic disease underwent pre-operative embolisation before palliative spinal surgery between 2010 and 2016 in PPUKM. Intraoperative blood loss during palliative spinal surgery was documented obtaining the average and median blood loss. Secondary analyses were made on the amount of intraoperative blood loss in comparison to the embolisation materials, degree of embolisation completion, primary malignancy, level of spinal metastatic involvement and total operating time.Result: The average and median intraoperative blood loss during palliative spinal surgery were 1480mls and 1000mls respectively, which is comparable with other centre from literature review. Significant difference is noted in intraoperative blood loss between the different embolisation materials used (P

Fulltext Collateral score on CT angiography in patients with acute ischemic stroke: A retrospective study

Mathan Raj, Shahizon Azura Mukari, Wan Asyraf Wan Zaidi, Ahmad Sobri Muda

Journal of Cardiovascular, Neurovascular and Stroke, 2019;1(1):1-7.

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Objective: Clinically assessing the status of cerebral collaterals is thought to provide invaluable diagnostic and prognostic data in managing acute ischemic stroke (AIS) patients. In this study we present a report, based on commonly used collateral grading system, assessing the correlation between the collateral status seen on CT angiography and patients’ functional outcome at Day 90 in our institution.Method: Patients presenting to the Emergency Department within 6 hours of onset of stroke from January 2010 until December 2014 were chosen for the study. CT angiography source images were retrospectively reviewed and given a “collateral score” (CS) by a radiologist who was blinded to the patient’s clinical information on presentation, as well as theclinical outcomes at 90 days. Patients’ mRS score at 90 days was obtained retrospectively and compared against the “collateral score”. Results: 87 patients were enrolled into this study, of which 60 (69%) were male and 27 (31%) were female with a mean age of 60.3 years. In this study, 56 (64.4%) patients had a collateral score (CS) ≥ 2 and 31 (35.6%) patients had a CS < 2. Out of 56 patientswho had a CS ≥ 2, 51 of them (91%) had good clinical outcome with a mRS ≤ 2. All the patients who had CS < 2 showed poor clinical outcome with a mRS > 2. The collateral score predicts accurately the clinical outcome with an area under the curve (ROC) of 0.75 (95% CI, 0.675-0.871, P=0.001). There is significant Spearman correlation between CS and the clinical outcome at Day 90, in patients with AIS during CTA analysis.Conclusion: Our data supports the potential use of CS analysis in predicting clinical outcome of patients with AIS. Nevertheless, further study on a larger scale is strongly suggested to verify the reliability and reproducibility of CS assessment in CTA analysis prior to reperfusion in AIS patients.

Fulltext Evaluation of the clot burden score (CBS) for acute ischemic stroke (AIS) in intent-to-treat patients

Sarah Yaziz, Ahmad Sobri Muda, Wan Asyraf Wan Zaidi, Nik Azuan Nik Ismail

Journal of Cardiovascular, Neurovascular and Stroke, 2019;1(1):11-15.

MyJurnal

Background : The clot burden score (CBS) is a scoring system used in acute ischemic stroke (AIS) to predict patient outcome and guide treatment decision. However, CBS is not routinely practiced in many institutions. This study aimed to investigate the feasibility of CBS as a relevant predictor of good clinical outcome in AIS cases.Methods: A retrospective data collection and review of AIS patients in a teaching hospital was done from June 2010 until June 2015. Patients were selected following the inclusion and exclusion criteria. These patients were followed up after 90 days of discharge. The Modified Rankin scale (mRS) was used to assess their outcome (functional status). Linear regression Spearman Rank correlation was performed between the CBS and mRS. The quality performance of the correlations was evaluated using Receiver operating characteristic (ROC) curves.Results: A total of 89 patients with AIS were analysed, 67.4% (n=60) male and 32.6% (n=29) female. Twenty-nine (29) patients (33.7%) had a CBS ≥6, 6 patients (6.7%) had CBS

Fulltext Value of cone beam computed tomography to evaluate complication of intracranial haemorrhage in endovascular treatment (EVT): A case report

Norafida Bahari, Nik Azuan Nik Ismail, Jegan Thanabalan, Ahmad Sobri Muda

Journal of Cardiovascular, Neurovascular and Stroke, 2019;1(1):16-18.

MyJurnal

In this article, we evaluate the effectiveness of Cone Beam Computed Tomography, through a case study, in assessing the complication of intracranial bleeding during an endovascular treatment of brain arteriovenous malformation when compared to Multislice-Detector Computed Tomography performed immediately after the procedure. The image quality of Cone Beam Computed Tomography has enough diagnostic value in differentiating between haemorrhage, embolic materials and the arteriovenous malformation nidus to facilitate physicians to decide for further management of the patient.

Tuberculous meningitis: neuroimaging features, clinical staging and outcome

Al-Edrus SA, Sobri Muda, Nordiyana M, Merican JS

Neuroradiol J, 2007 Oct 31;20(5):517-24.

PMID: 24299940

Forty-two patients diagnosed with tuberculous meningitis in Kuala Lumpur Hospital based on clinical criteria, cerebrospinal fluid analysis and response to antituberculous treatment over a seven year period were included in this study. Relevant information was obtained from patients' medical case notes and neuroimaging findings were evaluated. The clinical presentation of patients was staged according to Medical Research Council for tuberculous meningitis. Fisher's Exact Test was used to determine the correlation between the neuroimaging features, clinical staging and outcome of patients. 52.4% of patients had stage 2 disease, 28.6% stage 3 and the remainder stage 1 disease. 95.2% of patients had various neuroimaging abnormalities and only 4.8% had normal neuroimaging findings. The commonest neuroimaging findings were hydrocephalus and meningeal enhancement. 47.6% of patients survived without any complication. 23.8% developed morbidity either with minor or major neurological deficit and 28.6% had died at the end of the study period. Among patients with negative neuroimaging findings, one died and another one survived without any complication. Among patients with abnormal neuroimaging findings, 25% developed morbidity, 27.5% died and 47.5% survived without complication. The only neuroimaging feature significantly correlated with clinical outcome was the presence of hydrocephalus. Therefore, hydrocephalus is important in the prognosis of the disease and should be considered an indicator of poor clinical outcome. There was no significant correlation between clinical staging and clinical outcome, nor was there a significant correlation between clinical staging and individual neuroimaging features.

Fulltext 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, et al.

Neurology Asia, 2013;18(4):355-360.

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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.

An unusual cause of blepharospasm

Sobri Muda A, Kwah YG, Al-Edrus SA, Wong SL, Norzaini MZ, Viswanathan S

Neuroradiol J, 2010 Nov;23(4):443-6.

PMID: 24148636

We describe a rare case of multiple dilated Virchow-Robin spaces in the brainstem in a patient presenting initially with blepharospasm with subsequent spread to involve the face and neck. On magnetic resonance imaging (MRI), these lesions demonstrated an isointense signal to cerebrospinal fluid on all sequences with no mass effect or enhancement. Although rare, this condition should be considered part of the differential diagnosis when evaluating cystic abnormalities in the brainstem. This is the first reported case of blepharospasm with subsequent orofacial and neck dystonia caused by dilated Virchow-Robin spaces. The imaging findings and differential diagnoses are discussed.

Fulltext Starting mechanical thrombectomy service during covid-19 pandemic: Our early institution experience

Ezamin Abdul Rahim, Ahmad Sobri Muda, Mohd Naim Mohd Yaakob, Mohd Fandi Al Khafiz Kamis, Aizad Azahar, Chong Kok Wah, et al.

Journal of Cardiovascular, Neurovascular and Stroke, 2020;2(1):18-21.

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Fulltext Regional emergency stroke quick-response (RESQ) network: a proposed paradigm of Malaysia stroke care services

Peck Kee Chia, Nur Afiqah Mohamad, Liyana Najwa Inche Mat, Iskasymar Itam@Ismail, Abdul Hanif Khan Yusof Khan, Wei Chao Loh, et al.

Malaysian Journal of Medicine and Health Sciences, 2020;16(4):353-361.

MyJurnal

Stroke care service in Malaysia is suboptimal despite the fact that it is one of the commonest cause of death. This is due to several limitations, including lack of resources and funding for the stroke care establishment and the man- agement itself. Alternatively, other regions have come up with numerous ways to combat the difficulties in order to provide better stroke care services. We have identified the overwhelming benefits of creating stroke care units, thrombolysis services, and endovascular thrombectomy. For this reason, we designed a Regional Emergency Stroke Quick Response Network (RESQ) based on the needs of the current situation in Malaysia. With a standardised RESQ training, we hope to achieve close-knitted cooperation in between the emergency medical services, emergency de- partment team and the RESQ, which subsequently will create an ideal improvised stroke care units.

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