MyMedR

Plasmapheresis to treat Osmotic Demyelination Syndrome from overly rapid plasma sodium correction

Gayathri DK, Dhayalen K, Chia YK, Fung YK

Med J Malaysia, 2019 08;74(4):331-332.

Osmotic demyelination syndrome results from overly rapid serum sodium correction and is often iatrogenic. We report a 50-year-old hypertensive woman on Indapamide presenting with malaise, dizziness and serum sodium less than 100mmol/l who developed osmotic demyelination syndrome after correction of the hyponatremia. Good neurological recovery was seen after plasmapheresis.

Ice pack test-an useful bedside test to diagnose myasthenia gravis

Cheo SW, Low QJ, Mow WC, Chia YK

QJM, 2019 May 01;112(5):381-382.

PMID: 30517761 DOI: 10.1093/qjmed/hcy284

Trident sign in osmotic demyelination syndrome

Cheo SW, Low QJ, Tan YA, Chia YK

QJM, 2020 Feb 01;113(2):131-132.

PMID: 31168610 DOI: 10.1093/qjmed/hcz137

Fulltext Optic Nerve Demyelination in IgG4 Anti-Neurofascin 155 Antibody-Positive Combined Central and Peripheral Demyelination Syndrome

Verghese A, Krishnan D, Chia YK, Querol L, Hiew FL

J Cent Nerv Syst Dis, 2021;13:11795735211039913.

PMID: 34899003 DOI: 10.1177/11795735211039913

Optic nerve demyelination is one of the clinical features of combined central and peripheral demyelination (CCPD), an entity with heterogenous immunopathogenesis and clinical characteristics, overlapping between multiple sclerosis (MS) and chronic inflammatory demyelinating polyneuropathy (CIDP). Of interest, earlier studies among patients with CIDP prior to discovery of antibodies against paranodal protein neurofascin 155 (anti-NF 155) also reported optic nerve dysfunction. We aimed to evaluate optic nerve demyelination among anti-NF 155 CIDP patients. We studied 2 patients with anti-NF 155 CIDP using visual-evoked potentials (VEP) and optical coherence tomography (OCT). Both patients had distal acquired demyelinating symmetric (DADS) subtype CIDP. Other common features were prominent sensory ataxia, hand tremors, significantly elevated cerebral spinal fluid protein, high titre anti-NF 155 antibodies and poor response to corticosteroid and intravenous immunoglobulin (IVIg). No central nervous system neuroradiological abnormality detected. Both had normal visual acuity and colour vision, but one had subclinical right relative afferent pupillary defect (RAPD). VEP of both showed bilateral prolonged P100 latencies. OCT for patient with RAPD demonstrated moderate to severe retinal nerve fibre layer (RNFL) thinning. Identification of optic nerve demyelination among subclinical CIDP with anti-NF 155 antibodies expanded the spectrum of demyelination within the subset of CCPD.

Fulltext Case Series of Osmotic Demyelination Syndrome Treated With Plasmapheresis: Experience From Two Tertiary Hospitals

Lim KY, Chia YK, Khoo CS, Tan HJ

J Clin Neurol, 2022 Jan;18(1):117-119.

PMID: 35021290 DOI: 10.3988/jcn.2022.18.1.117

Isolated bilateral lateral geniculate nuclei T2/FLAIR hyperintensities heralding the development of central pontine myelinolysis in osmotic demyelination syndrome: neuro-images

Ooi JCE, Lee WY, Chia YK

Neurol Sci, 2023 Oct;44(10):3755-3757.

PMID: 37368070 DOI: 10.1007/s10072-023-06925-3

Fulltext Images of the month: Intractable vomiting and neuromyelitis optica spectrum disorder

Cheo SW, Low QJ, Tan YA, Chia YK

Clin Med (Lond), 2020 May;20(3):e20-e21.

PMID: 32414735 DOI: 10.7861/clinmed.2020-0019

Neuromyelitis optica spectrum disorder (NMOSD) is a rare inflammatory disorder of the nervous system which can be potentially debilitating. Its prevalence is estimated to be around 0.5-10 per 100,000 population with predilection towards Asians and females. It can be diagnosed based on core clinical characteristics, serum aquaporin antibodies and neuroimaging features. It is important to pick up the diagnosis of NMOSD as the treatment is different from other demyelinating disease. Here, we illustrate a case of NMOSD presented with intractable vomiting.

Suprasellar lymphoma masquerading as tuberculosis of the central nervous system

Dang YL, Hor JY, Chia YK, Lim TT, Eow GB

Acta Neurol Belg, 2014 Sep;114(3):239-41.

PMID: 23757110 DOI: 10.1007/s13760-013-0217-3

A case of Takayasu Arteritis presenting with young stroke

Cheo SW, Mohd Zamin H, Low QJ, Tan YA, Chia YK

Med J Malaysia, 2020 11;75(6):745-747.

PMID: 33219190

Stroke is a debilitating disease as it carries significant morbidity especially when it affects the younger population. There are various etiologies of young stroke, namely arterial dissection, cardioembolism, thrombophilia, inherited genetic disorder and vasculitis. Young patient with stroke should undergo complete evaluation to identify the underlying etiology in order to prevent recurrence of stroke. Here, we would like to illustrate a case of Takayasu arteritis presenting as young stroke in a 17-years-old lady with no known medical illness.

Fatal subarachnoid haemorrhage in a patient with severe dengue

Cheo SW, Low QJ, Ng EK, Chia YK, Rajahram GS

Med J Malaysia, 2021 Jan;76(1):107-109.

PMID: 33510120

Dengue fever is one of the commonest tropical disease in the tropics. It can present with mild acute febrile illness to severe organ failure. Reported neurological complications of dengue include dengue encephalopathy, encephalitis, transverse myelitis and intracranial haemorrhage. Intracranial haemorrhage in dengue can present as subdural haematoma, extradural haematoma, intracerebral haemorrhage and subarachnoid haemorrhage. We report here a case of subarachnoid haemorrhage in a patient with severe dengue. Our patient was a 30-year-old man who presented with acute febrile illness. He subsequently developed plasma leakage and upper gastrointestinal bleeding. He then had reduced conscious level. Computed tomography of his brain showed subarachnoid haemorrhage. He eventually succumbed to his illness.

Erysipelothrix rhusiopathiae endocarditis presenting with stroke

Tan YA, Ng KC, Cheo SW, Low QJ, Chia YK

QJM, 2020 07 01;113(7):485-487.

PMID: 32053172 DOI: 10.1093/qjmed/hcaa025

Familial neuromyelitis optica spectrum disorder in a pair of sisters

Cheo SW, Ong SAM, Low QJ, Tan YA, Chia YK

QJM, 2020 Oct 01;113(10):743-746.

PMID: 32240316 DOI: 10.1093/qjmed/hcaa107

Response to: Stroke and infective endocarditis

Tan YA, Ng KC, Cheo SW, Low QJ, Chia YK

QJM, 2020 07 01;113(7):517-518.

PMID: 32191336 DOI: 10.1093/qjmed/hcaa099

Acute necrotizing encephalopathy in a child secondary to dengue fever: A case report

Cheo SW, Low QJ, Teh YG, Rajahram GS, Mohd Zain NR, Chia YK

Med J Malaysia, 2021 Sep;76(5):750-752.

PMID: 34508389

Dengue fever (DF) is an important public health problem, and it is now endemic in more than 100 countries worldwide. Dengue associated neurological complication is estimated to be affecting 0.5 to 6.2% of patients. Even though this is rare, neurological manifestation of DF is an increasingly recognized entity in recent years due to significant mortality and morbidity reported/seen. Reported central nervous system manifestations due to dengue include encephalitis, encephalopathy, myelitis, myositis, acute disseminated encephalomyelitis, Guillain-Barré syndrome, stroke and etc. We report here a case of acute necrotizing encephalopathy secondary to DF in a previously healthy 12-year-old girl.

Fulltext Posterior reversible encephalopathy syndrome secondary to dengue fever: a case report

Cheo SW, Wong HJ, Ng EK, Low QJ, Chia YK

Hong Kong Med J, 2021 02;27(1):55-57.

PMID: 33568560 DOI: 10.12809/hkmj208509

Fulltext Immune-mediated neurological syndrome in SARS-CoV-2 infection: a review of literature on autoimmune encephalitis in COVID-19

Payus AO, Jeffree MS, Ohn MH, Tan HJ, Ibrahim A, Chia YK, et al.

Neurol Sci, 2021 Dec 01.

PMID: 34853897 DOI: 10.1007/s10072-021-05785-z

INTRODUCTION: The novel Coronavirus Disease 2019 (COVID-19) is an infection caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which has been spreading rapidly amongst humans and causing a global pandemic. The notorious infection has shown to cause a wide spectrum of neurological syndrome, including autoimmune encephalitis.

OBJECTIVE: Here, we systematically review the literature on autoimmune encephalitis that developed in the background of SARS-CoV-2 infections and also the possible pathophysiological mechanisms of auto-immune mediated damage to the nervous system.

METHODOLOGY: An exhaustive search was made in Medline/PubMed, Embase, Scopus and other medical databases, and 28 relevant published articles were selected according to the strict inclusion criteria.

RESULTS: Autoimmune encephalitis can occur via three possible proposed pathophysiological mechanism and can manifest during or after the acute infection period. It is more common in adult but can also occur in the paediatric patients. There were various spectra of autoantibody panels reported including antineuronal antibody, anti-gangliosides antibody and onconeural antibody. Majority of the patients responded well to the immunomodulating therapy and achieved good recovery.

CONCLUSION: In conclusion, SARSCoV-2 infection can induce various spectrum of autoimmune encephalitis. It is a major concern since there is very limited long-term study on the topic. Hence, this review aims to elucidate on the potential long-term complication of SARS-CoV-2 infection and hopefully to improve the management and prognosis of COVID-19.

Relapsing GABA(A) Receptor Encephalitis After Stem Cell Transplant for Acute Myeloid Leukaemia

Ooi JCE, Pillai P, Lee S, Ong SAM, Koh KL, Chia YK

Can J Neurol Sci, 2024 Jul;51(4):581-584.

PMID: 37434473 DOI: 10.1017/cjn.2023.252

Fulltext Comparing Neuroplasticity Changes Between High and Low Frequency Gait Training in Subacute Stroke: Protocol for a Randomized, Single-Blinded, Controlled Study

Ahmedy F, Mohamad Hashim N, Lago H, Plijoly LP, Ahmedy I, Idna Idris MY, et al.

JMIR Res Protoc, 2022 Jan 28;11(1):e27935.

PMID: 35089146 DOI: 10.2196/27935

BACKGROUND: Walking recovery post stroke can be slow and incomplete. Determining effective stroke rehabilitation frequency requires the assessment of neuroplasticity changes. Neurobiological signals from electroencephalogram (EEG) can measure neuroplasticity through incremental changes of these signals after rehabilitation. However, changes seen with a different frequency of rehabilitation require further investigation. It is hypothesized that the association between the incremental changes from EEG signals and the improved functional outcome measure scores are greater in higher rehabilitation frequency, implying enhanced neuroplasticity changes.

OBJECTIVE: The purpose of this study is to identify the changes in the neurobiological signals from EEG, to associate these with functional outcome measures scores, and to compare their associations in different therapy frequency for gait rehabilitation among subacute stroke individuals.

METHODS: A randomized, single-blinded, controlled study among patients with subacute stroke will be conducted with two groups: an intervention group (IG) and a control group (CG). Each participant in the IG and CG will receive therapy sessions three times a week (high frequency) and once a week (low frequency), respectively, for a total of 12 consecutive weeks. Each session will last for an hour with strengthening, balance, and gait training. The main variables to be assessed are the 6-Minute Walk Test (6MWT), Motor Assessment Scale (MAS), Berg Balance Scale (BBS), Modified Barthel Index (MBI), and quantitative EEG indices in the form of delta to alpha ratio (DAR) and delta-plus-theta to alpha-plus-beta ratio (DTABR). These will be measured at preintervention (R0) and postintervention (R1). Key analyses are to determine the changes in the 6MWT, MAS, BBS, MBI, DAR, and DTABR at R0 and R1 for the CG and IG. The changes in the DAR and DTABR will be analyzed for association with the changes in the 6MWT, MAS, BBS, and MBI to measure neuroplasticity changes for both the CG and IG.

RESULTS: We have recruited 18 participants so far. We expect to publish our results in early 2023.

CONCLUSIONS: These associations are expected to be positive in both groups, with a higher correlation in the IG compared to the CG, reflecting enhanced neuroplasticity changes and objective evaluation on the dose-response relationship.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/27935.

Case-Control Study and Meta-Analysis of the Association Between LIPG rs9958947 SNP and Stroke Risk

Phneh KY, Chong ETJ, Shah SS, Chia YK, Daud DMBA, Jalil E, et al.

J Mol Neurosci, 2021 Oct;71(10):2085-2094.

PMID: 33479916 DOI: 10.1007/s12031-021-01795-w

The rs9958947 single nucleotide polymorphism (SNP) resides in the promoter region of the lipase G (LIPG) gene. This newly discovered SNP increases the risk of stroke in some Asian populations, including Chinese and Korean populations. Stroke is one of the top 5 leading causes of death in Malaysia, so it is of interest to investigate whether this SNP is associated with stroke risk in the Malaysian population. Therefore, this study investigates this association through a case-control study on a Malaysian population along with a comprehensive meta-analysis. Genotyping of LIPG rs9958947 SNP was performed for 241 Malaysians using real-time polymerase chain reaction, and the odds ratios (OR) with 95% confidence intervals were calculated. The meta-analysis was conducted using the software Comprehensive Meta-Analysis ver. 2.2.064. A p value less than 0.05 was considered statistically significant. We observed that the mean age of Malaysian stroke patients was less than that of stroke patients from Korea and China. The meta-analysis showed that the LIPG rs9958947 SNP was significantly associated with an increased risk of ischemic stroke in Asian populations (dominant (CC vs. CT + TT): OR = 1.45, p 0.05) and blood lipid levels.

Progressive ataxia, ophthalmoparesis, and hypogonadotropic hypogonadism in a family with a novel variant in the KIFBP gene

Ooi JCE, Azman A, Chan MY, Toh ESY, Seo GH, Kim JH, et al.

Clin Genet, 2024 Feb;105(2):228-230.

PMID: 37903629 DOI: 10.1111/cge.14448

A novel homozygous variant in KIFBP was identified in a consanguineous family with four sibs affected by Goldberg-Sphrintzen Syndrome (GOSHS). We report for the first time, early-adulthood-onset progressive ataxia, opthalmoparesis, and hypogonadotropic hypogonadism in GOSHS.

Displaying publications 1 - 20 of 27 in total