Background and objectives: Radiation treatment in nasopharyngeal carcinoma (NPC) is known to be associated with increased prevalence of carotid stenosis. The objectives of the study was to determine the prevalence of radiation-induced extracranial carotid stenosis, plaque, carotid intima thickness (CIMT) in NPC patients; to explore whether the stenosis is due to direct effect of radiation rather than general tendency to atherosclerosis. Methods: This was a cross-sectional study conducted in the University Malaya Medical Centre from July 2011 to February 2012. The study subjects consisted of 47 NPC patients who were treated with radiation, and 47 healthy control. The patients and control had carotid duplex ultrasound and transcranial Doppler (TCD). Results: The mean age of the patients was 55.1 years, the time lapse from radiation was 76.7 ± 95.3 months. Internal carotid artery (ICA) and common carotid artery (CCA) stenosis of ≥50% was seen in 17.0% of patients vs 2.1 % of controls (p = 0.031), with 61.7% of patients and 19.1% of controls having plaque in ICA and CCA (p=0.004). CIMT was increased in 70.2% of patients and 44.7% of controls (p =0.022). Both the patient group and control had similar rate of intracranial stenosis of 12.8% in TCD.
Conclusion: Extracranial internal carotid artery is the most common site of stenosis following radiotherapy in NPC. This suggests that local trauma from irradiation is the most important factor in predisposition to atherosclerosis following radiation therapy.
Glioblastoma multiforme (GBM) is the commonest primary cerebral malignancy consisting of 12- 20% of intracranial brain tumours.1 We report here a patient with GBM with very unusual marked and widespread leptomeningeal GBM.
Primary angiitis of the central nervous system (PACNS) is a rare vasculitis restricted to the central nervous system without systemic involvement. Delay in diagnosis and treatment is common due to its non-specific symptoms and lack of non-invasive diagnostic tests. Myelopathy can occur in PACNS, during the clinical course of the illness, with or without cerebral symptoms. We describe here a 51 year-old ethnic Chinese woman who presented initially with paraparesis without cerebral symptoms. The diagnosis of PACNS was eventually made from brain biopsy when she subsequently developed cerebral involvement. Despite aggressive treatment, the patient developed progressive neurological deterioration and died. This patient demonstrates the rare occurrence of myelopathy as the sole initial presentation of PACNS.
Background: Tuberculous disease of spine (spinal TB) is under-recognized in tuberculous (TB) meningitis.
The objective of the study was to evaluate the frequency, clinical and neuroimaging changes, and
outcome in the patients with spinal TB.
Methods: All the patients with spinal TB admitted in the two
largest tertiary hospitals in Kuala Lumpur from 2009 to 2017 were recruited, the clinical features were
documented, the magnetic resonance imaging (MRI) of the spine was performed. Clinical outcome was
assessed with Modified Rankin scale (MRS).
Results: Twenty two patients were recruited. This was
out of 70 TB meningitis patients (31.4%) seen over the same period. Eighteen (81.8%) patients had
concomitant TB meningitis. The clinical features consisted of systemic symptoms with fever (63.6%),
meningitis symptoms with altered sensorium (45.5%), myelopathy with paraparesis (36.4%). The
findings on spinal MRI were discitis (36.4%), spinal meningeal enhancement (31.8%), spinal cord
compression (31.8%), psoas abscess (27.3%), osteomyelitis (22.7%), and cord oedema (22.7%). All
except two patients (90.9%) had involvement in psoas muscle, bone or leptomeningeal enhancement,
features that can be used to differentiate from myelopathy that affect the parenchyma only, such as
demyelination. Unusual manifestations were syringomyelia and paradoxical manifestations seen in 3
patients each. The outcome were overall poor, with 68% having MRS 3 or more.
Conclusion: Spinal TB is common in TB meningitis. The outcome is overall poor. A heightened
awareness is crucial to enable early diagnosis and treatment.
Streptococcus pneumoniae are Gram-positive bacteria that are responsible for many types of illnesses including pneumonia, sinus infections, and community-acquired meningitis. One important complication of bacterial meningitis is intracranial vasculopathy. Possible etiologies include vasculitis, vasospasm, endocarditis, or intra-arterial thrombosis. We present a case report of S. pneumoniae meningitis treated with antibiotics in which clinical improvement correlated with serial transcranial Doppler ultrasonography (TCD) improvement, suggesting vasospasm or vasculitis as a possible mechanism for intracranial vasculopathy.
Background: Tuberculous meningitis is a life-threatening manifestation resulting from infection
by Mycobacterium tuberculosis, especially in the developing countries. The molecular aspects of
pathogenesis of tuberculous meningitis remain poorly understood. We evaluated the correlation of
cerebrospinal fluid (CSF) and serum cytokine levels with the clinical outcome of 15 HIV-negative
patients with tuberculous meningitis. We also assessed the association of CSF and serum cytokines
with neuroimaging of brain findings in the patients.
Methods: The prospective longitudinal study was
conducted at the University Malaya Medical Centre between 2012 and 2014. Neuroimaging of the
brain was performed and the findings of leptomeningeal enhancement, hydrocephalus, tuberculoma,
infarcts and vasculopathy were recorded. The CSF and serum specimens were analyzed for IL-1ß,
IL-8, IL-10, IL-18, IP-10, IFN-γ, MCP-1, TGF-ß, VEGF, TNF- α, IL-18BPa and MMP-9. The clinical
outcome was graded at 3 months based on Modified Rankin scale (mRS).
Results: On admission and
at one month of anti-tuberculosis treatment, the CSF levels of IL-8, IL-1β, IP-10, IFN-γ and VEGF
were elevated in all of the patients. Serum IP-10, MCP-1, IL-1β and IL-8 levels were increased on
admission and at one month of anti-tuberculosis treatment. There were statistically significant differences
between good and poor outcome (mRS at 3 months) for CSF IFN-γ (p=0.033), CSF IL-10 (p=0.033)
and serum VEGF (p=0.033) at one month of treatment. None of the patients showed any association
between CSF and serum cytokines on admission and at one month of anti-tuberculosis treatment with
neuro-radiological findings.
Conclusion: The CSF cytokine levels were not related to TBM disease severity on admission, and
changes on MRI/CT scans. CSF levels of IFN-γ and IL-10 at one month of anti-tuberculosis treatment
were associated with clinical outcome at 3 months. CSF cytokine levels on admission were not
associated with the clinical outcome.