Vertebrobasilar Dolichoectasia (VBD) is a condition characterized by abnormal elongation, dilatation and tortuosity of the vertebrobasilar system. It is usually asymptomatic but rarely, it can present with cranial nerve compression symptoms. We present a case of simultaneous trigeminal neuralgia and hypoglossal nerve palsy due to compression by VBD. Neuroimaging plays an important role in diagnosing this condition so that further treatment can be provided.
A 37-year-old woman presented with a short history of fever and bilateral lower limb
weakness. She also had impaired sensory function up to T4 spine level and lax anal tone.
Laboratory investigations confirmed dengue infection with mild thrombocytopenia. MRI of the
spine showed a spinal subarachnoid haemorrhage from the level of T4 till T9. Despite
medical and surgical interventions, her lower limb weakness persists. A high index of
suspicion is needed to recognise dengue-related neurological complications. This diagnosis
should be considered in any patients from dengue endemic areas presenting with acute
febrile illness with atypical neurological manifestations.
Patient satisfaction plays a crucial role in assessing the quality of services provided by healthcare services. The purpose of the present study was to determine the factors influencing patient satisfaction towards services of a specialist medical centre. A cross sectional study was conducted among 300 patients attending a semi-private multidisciplinary specialist centre in Malaysia. They were provided with a set of self-administered questionnaires on patient satisfaction with the services received at the facility. Patient satisfaction was divided into three main components: patient characteristics, delivery of services and hospital characteristics. Additional qualitative comments were also obtained. The mainstay of the analysis was multivariate logistic regression. Altogether, 273 (91.2%) of the patients rated their overall satisfaction as “good” or “very good”. Hospital characteristics (i.e., cleanliness; OR: 30.58 (95% CI: 3.52 – 265.79), hospital appearance; OR: 12.69 (95% CI; 1.51 – 106.53) had the strongest influence on the patient’s overall satisfaction. The findings revealed that the reason a majority of patients liked the hospital was related to good quality of services (18.7%), comfort (21.9%) and the friendly staff (8.8%). Hence, hospital characteristics are the most important determinants of overall patient satisfaction. In addition, the quality of delivery services and a friendly staff should also be considered when improving hospital services in a multidisciplinary specialist centre.
A 37-year-old woman presented with a short history of fever and bilateral lower limb
weakness. She also had impaired sensory function up to T4 spine level and lax anal tone.
Laboratory investigations confirmed dengue infection with mild thrombocytopenia. MRI of the
spine showed a spinal subarachnoid haemorrhage from the level of T4 till T9. Despite
medical and surgical interventions, her lower limb weakness persists. A high index of
suspicion is needed to recognise dengue-related neurological complications. This diagnosis
should be considered in any patients from dengue endemic areas presenting with acute
febrile illness with atypical neurological manifestations.
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.