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Fulltext Ingested Australasian Snapper (Chrysophrys auratus) Bone Migration to C5 Vertebral Body

Mohamed Ramlee FA, Ibrahim N, Hashim MH

Cureus, 2024 Mar;16(3):e56301.
PMID: 38629010 DOI: 10.7759/cureus.56301

Fishbone ingestion has been reported multiple times previously as a cause of oesophageal perforation. This is a surgical emergency that needs to be identified early to ensure immediate medical attention. This report presents the case of a 70-year-old patient with laryngeal perforation and the migration of a Chrysophrys auratus (Australasian snapper) fishbone to the C5 vertebral body. It is hypothesized that the fishbone migrated from the larynx to the visceral fascia and prevertebral fascia before lodging in between the intramuscular substance of the longus coli muscle. Multiple imaging modalities were used to identify and locate the foreign body, including flexible nasopharyngoscopy, esophagogastroduodenoscopy, and a computed tomography (CT) scan of the neck. The exploration of the neck was done by the ENT team and the orthopaedic spine team via the left anterior cervical approach at the level of the C5 and C6 vertebral bodies. The foreign body was identified (15 mm fishbone) at the left lateral of the C5 body, lodged between the intramuscular substance of the longus coli muscle, and was successfully removed.
Fulltext Discal Cyst, a Physical Risk: A Case Report on Endoscopic Resection

Tan EK, Harun MH, Mohd Nasir N, Mohamed Ramlee FA, Lim TS, Mohd Nasir MN

Cureus, 2022 Dec;14(12):e32517.
PMID: 36654588 DOI: 10.7759/cureus.32517

Discal cysts are a rare diagnosis involving the formation of an intraspinal extradural cyst. They are a diagnostic challenge as it is difficult to differentiate discal cysts from other causes of back pain, neurological deficit, and radiculopathy. Due to its rarity, there is a lack of research-based evidence on the optimal management of the discal cyst. This case report aims to increase awareness of this diagnosis and to highlight a possible treatment option for this condition.
Fulltext Navigating Complexity: A Case Report of Concurrent Central Cord Syndrome and Stroke in an Elderly Gentleman

Kee HT, Harun MHB, Mohamed Ramlee FA, Lim TS, Che-Hamzah F

Cureus, 2024 Jan;16(1):e51789.
PMID: 38322071 DOI: 10.7759/cureus.51789

Central cord syndrome (CCS) predominantly manifests in elderly individuals with pre-existing cervical spondylosis resulting from hyperextension mechanisms. However, it is not exclusive to the older population and can occur in younger individuals following traumatic cervical spine injuries or, less frequently, due to nontraumatic causes. The impact of this syndrome is more pronounced in the upper extremities, where motor function experiences greater impairment compared to sensory function. CCS presents itself along a spectrum of severity. At one end, individuals may exhibit weakness confined to the hands and forearms while preserving sensory function. At the other extreme, complete quadriparesis may occur, albeit with sacral sparing being the sole indication of an incomplete spinal cord injury. This spectrum underscores the varied and nuanced clinical presentations within CCS. Moreover, concurrent acute stroke presentations can mimic CCS symptoms, further complicating the diagnostic process. The challenge lies in differentiating these two distinct conditions, particularly in an elderly population with overlapping risk factors. This diagnostic challenge adds a layer of complexity to clinical decision-making and underscores the importance of comprehensive evaluations in patients presenting with neurological symptoms. This case report presents a 73-year-old gentleman with a history of a recent stroke and motor vehicle accidents, highlighting the diagnostic challenges and multidisciplinary management required for concurrent CCS and stroke mimicry. This report is unique, as there are no existing case report publications detailing concurrent CCS and stroke. It emphasizes the necessity for a comprehensive diagnostic approach and coordinated care in managing such intricate cases.
Prevalence and severity of Bertolottis syndrome in Malaysia: A common under diagnosis

Noorman MF, Sofian AA, Kandar MK, Ab Halim AH, Harun MH, Mohamed Ramlee FA, et al.

Malays Fam Physician, 2022 Nov 30;17(3):121-127.
PMID: 36606180 DOI: 10.51866/oa.64

INTRODUCTION: Bertolotti's syndrome (BS) is defined as the presence of low back pain (LBP), radiculopathy or both with a dysplastic transverse process (TP) of the fifth lumbar vertebra that is articulated or fused with the sacral base or iliac crest. This study aimed to investigate the prevalence and severity of BS to promote awareness of this disease.
METHOD: A retrospective review of anteroposterior lumbosacral plain radiographs was conducted between 1 January and 31 December 2017. Patients were recruited via systematic randomised sampling and were then interviewed and examined. The severity of BS was measured objectively using the numerical pain rating scale (NPRS) and Oswestry disability questionnaire (ODQ). Data were analysed using IBM SPSS for Windows version 22.
RESULTS: The prevalence of BS was 9.6% (16/166). Age significantly affected the severity of BS. The older and younger groups had a mean ODQ score of 42.86% and 24.08%, respectively (P=0.006). There was no significant relationship found between the prevalence of BS and age (P=0.126). Only one patient was diagnosed with BS during medical consultation. The mean NPRS score was 5.5. The majority of the BS cases were of moderate severity (43.8%), followed by those of minimal severity (31.2%) and severe disability (25%).
CONCLUSION: Early diagnosis of BS and orthopaedic referral are crucial to halt its progression. BS should be considered in patients presenting with LBP during assessments of lumbosacral radiographs.