MyMedR

Corpus callosum infarction in uncontrolled diabetes mellitus

Ng CF, Tan HJ

Acta Neurol Belg, 2021 Oct;121(5):1335-1337.

PMID: 34184193 DOI: 10.1007/s13760-021-01729-8

Fulltext Parietal Hand Weakness in a Patient with Astrocytoma

Ng CF, Tan HJ

J Neurosci Rural Pract, 2022 Jan;13(1):164-166.

PMID: 35110942 DOI: 10.1055/s-0041-1741568

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.

MyJurnal

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.

Fulltext Preeruptive Unilateral Cerebellar Ataxia in an Immunocompetent Adult: A Rare Case of Varicella

Ng CF, Ong BH, Tan HJ

J Neurosci Rural Pract, 2018 5 5;9(2):281-283.

PMID: 29725187 DOI: 10.4103/jnrp.jnrp_461_17

Fulltext A Case of Herpes Simplex Virus Type 1 (HSV-1) Encephalitis as a Possible Complication of Cosmetic Nasal Dermal Filler Injection

Khoo CS, Tan HJ, Sharis Osman S

Am J Case Rep, 2018 Jul 13;19:825-828.

PMID: 30002360 DOI: 10.12659/AJCR.909883

BACKGROUND Dermal fillers are increasingly used for medical and aesthetic purposes in clinical practice. Common complications following filler injections include bruising, itching, infections, allergic reactions, and tissue necrosis. This case is the first report of Herpes simplex virus type 1 (HSV-1) encephalitis as a possible complication of dermal filler injection. CASE REPORT A 27-year-old woman with no past medical history presented with altered mental state, headaches, and seizures. She had a nasal dermal filler injection for aesthetic purpose five weeks before her acute presentation. A diagnosis of HSV-1 encephalitis was made based on brain imaging with computed tomography and magnetic resonance imaging (MRI) findings that showed bilateral frontotemporal lobe hyperintensity. Analysis of her cerebrospinal fluid (CSF) confirmed the presence of HSV-1 DNA. Despite anti-viral treatment with acyclovir, she developed postencephalitic syndrome. CONCLUSIONS This case report highlights the possibility that among the complications of the use of cosmetic dermal fillers, the transmission of HSV-1 and the development of HSV-1 encephalitis should be recognized.

Fulltext Longitudinally Extensive Transverse Myelitis in Highly Active Relapsing-remitting Multiple Sclerosis

Ng CF, Remli R, Tan HJ

Neurol India, 2021 11 9;69(5):1412-1413.

PMID: 34747827 DOI: 10.4103/0028-3886.329533

Transverse myelitis in multiple sclerosis is typically a short cord lesion with patchy distribution. Rarely, longitudinally extensive transverse myelitis can be seen in those with highly active disease or frequent relapses. The recognition of this uncommon phenotype in multiple sclerosis is important as the treatment is largely different from other demyelinating diseases. We describe a patient with highly active relapsing-remitting multiple sclerosis on interferon beta-1a who developed LETM after multiple relapses.

Fulltext Chemotherapy-induced transverse melanonychia

Ng CF, Tan HJ, Remli R

BMJ Case Rep, 2021 Aug 17;14(8).

PMID: 34404676 DOI: 10.1136/bcr-2021-245878

Fulltext Stroke care in Pusat Perubatan UKM; the actual picture

Sahathevan R, Wan Yahya WNN, Tan HJ, Mohd Ibrahim N

Med J Malaysia, 2013 Apr;68(2):187-8.

PMID: 23629577

Fulltext A Treatable Encephalopathy in a Peritoneal Dialysis Patient - Cefepime-Induced Encephalopathy

Khoo CS, Tee TY, Tan HJ, Ali RA

J Neurosci Rural Pract, 2019 4 20;10(2):324-326.

PMID: 31001027 DOI: 10.4103/jnrp.jnrp_315_18

We report a patient with end-stage renal disease on peritoneal dialysis, who developed encephalopathy after receiving a few doses of cefepime. He recovered clinically and electroencephalographically after having discontinued the culprit agent and undergone hemodialysis. This case highlights the importance of promptly recognizing this reversible encephalopathy, which can lead to the avoidance of unnecessary workup, reduce the length of hospital stay, and thereby improve the patients' outcome.

Fulltext Impulse control behaviours in a Malaysian Parkinson’s disease population

Shahrul Azmin, Tan, Eng Liang, Law, Zhe Kang, Remli Rabani, Wan Yahya Nafisah, Sahathevan, Ramesh, et al.

Neurology Asia, 2016;21(2):137-143.

MyJurnal

Background: Impulse control behaviours are repetitive and excessive activities that may be sub-syndromal and not fulfil the criteria for impulse control disorder. These activities have potential to negatively impact on the daily lives of sufferers. We conducted a study to investigate the prevalence of impulse control behaviours and its associated features in Parkinson’s disease in our population. Methods: We conducted a prospective cross-sectional study on consecutive patients attending neurology clinic. Inclusion criteria include idiopathic Parkinson’s disease patients with Hoehn & Yahr stage I-IV. Eighty patients were enrolled and screened for impulse control behaviours using the Questionnaire for Impulsive-Compulsive Disorder for Parkinson’s disease (QUIP). Results: Prevalence of impulse control behaviours among our cohort was 11.3%; the features significantly associated with it were higher level of education (p=0.02), advanced stage of disease (p=0.03) and higher levodopa dosage (p= 0.01). The commonest impulse control behaviour in our cohort was compulsive medication use (7.5%), followed by hobbyism (6.3%), hypersexuality (5%), compulsive buying (3.75%), punding (2.5%), walkabout (2.5%), compulsive eating (1.25%) and pathological gambling (1.3%).
Conclusions: There is an association between impulse control behaviour and higher levodopa dosage in a study on patients with Parkinson’s disease in Malaysia. We also found a low prevalence of pathological gambling as compared to studies performed in the West.
Study site: Neurology clinic, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia

Fulltext Use of complementary and alternative medicine and adherence to antiepileptic drug therapy among epilepsy patients: a systematic review

Farrukh MJ, Makmor-Bakry M, Hatah E, Tan HJ

Patient Prefer Adherence, 2018;12:2111-2121.

PMID: 30349205 DOI: 10.2147/PPA.S179031

Purpose: To identify the use pattern of complementary and alternative medicine (CAM) and its impact on antiepileptic drug (AED) adherence among patients with epilepsy.

Method: Potential studies were identified through a systematic search of Scopus, Science Direct, Google Scholar, and PubMed. The keywords used to identify relevant articles were "adherence," "AED," "epilepsy," "non-adherence," and "complementary and alternative medicine." An article was included in the review if the study met the following criteria: 1) conducted in epilepsy patients, 2) conducted in patients aged 18 years and above, 3) conducted in patients prescribed AEDs, and 4) patients' adherence to AEDs.

Results: A total of 3,330 studies were identified and 30 were included in the final analysis. The review found that the AED non-adherence rate reported in the studies was between 25% and 66%. The percentage of CAM use was found to be between 7.5% and 73.3%. The most common reason for inadequate AED therapy and higher dependence on CAM was the patients' belief that epilepsy had a spiritual or psychological cause, rather than primarily being a disease of the brain. Other factors for AED non-adherence were forgetfulness, specific beliefs about medications, depression, uncontrolled recent seizures, and frequent medication dosage.

Conclusion: The review found a high prevalence of CAM use and non-adherence to AEDs among epilepsy patients. However, a limited number of studies have investigated the association between CAM usage and AED adherence. Future studies may wish to explore the influence of CAM use on AED medication adherence.

Fulltext A validation study of the Bahasa Malaysia version of the National Institute of Health Stroke Scale

Najma Kori, Wan Asyraf Wan Zaidi, Rabani Remli, Azman Ali Raymond, Norlinah Mohamed Ibrahim, Tan, Hui Jan, et al.

Neurology Asia, 2018;23(3):225-232.

MyJurnal

Background & Objectives: The National Institute of Health Stroke Scale (NIHSS) provides a valid and quick assessment of stroke severity in hyperacute stroke management. Stroke patients who are eligible for reperfusion therapy require prompt assessment. There is no validated Bahasa Malaysia (BM) version of the NIHSS that allows easier assessment by BM-speaking health professionals. This study aimed to translate and validate a BM version of the NIHSS.
Methods: The English NIHSS was translated to BM, then back translated to ensure linguistic accuracy. We also adapted the language assessment of the NIHSS to be more culturally appropriate. Training and certification videos were downloaded from the NIH website and dubbed into BM. We determined intra-class correlation and unweighted kappa as the best measure of reliability. Median scores were used in the analysis for language items.
Results: One hundred and one raters participated in the test-retest reliability study. Agreement between the original NIHSS and our translated version of the BM-NIHSS was good (ICC = 0.738, 95% CI: 0.611 to 0.823). Fair to moderate agreement was found on item-by-item analysis (unweighted κ=0.20-0.50) despite high observed agreement. Fifty patients participated in the language assessment arm. Scores were better in BM for reading, naming objects and repetition (Mdn = 100, p < 0.001). There was no difference in the median scores for the description component.
Conclusions: The BM-NIHSS is a valid translation of the NIHSS, and may be used in clinical practice by BM-speaking healthcare professionals.

Levodopa-induced myocardial infarction in a patient with Parkinson's disease and severe coronary artery disease

Ng CF, Tiau PW, Tan HJ, Norlinah MI

J R Coll Physicians Edinb, 2019 Mar;49(1):37-39.

PMID: 30838990 DOI: 10.4997/JRCPE.2019.108

Levodopa is the most effective medical treatment for Parkinson's disease (PD) to date. As dopamine is known to increase cardiac inotropism and vasomotor tone, peripheral dopamine decarboxylase inhibitor is coadministered to suppress the peripheral conversion of levodopa to dopamine. Levodopa poses potential cardiovascular risks, thus its use in patients with existing coronary artery disease needs to be carefully monitored. We report a case of an elderly male with newly diagnosed PD who developed non-ST-elevation myocardial infarction following levodopa (Madopar) initiation.

Fulltext Acute Thoracolumbar Myelitis Secondary To Intrathecal Chemotherapy

Cheong XK, Ng CF, Tan HJ, Remli R

J Neurosci Rural Pract, 2021 Oct;12(4):815-816.

PMID: 34737525 DOI: 10.1055/s-0041-1735246

Reply letter to "Are the self-administered questionnaires appropriate to uncover undiagnosed depression among people with epilepsy?"

Tan JK, Khoo CS, Baharudin A, Tan HJ

Epilepsy Res, 2022 Feb 15;181:106889.

PMID: 35182826 DOI: 10.1016/j.eplepsyres.2022.106889

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

Lithium neurotoxicity with electroencephalogram changes

Tan HJ, Lim KY, Rajah R, Ng CF

BMJ Case Rep, 2021 Nov 17;14(11).

PMID: 34789530 DOI: 10.1136/bcr-2021-246499

Lithium is a medication with a variety of medical usage for various diseases including bipolar mood disorder. As the therapeutic window of lithium is narrow, its usage is commonly associated with toxicity. Lithium toxicity affects multiple systems especially the central nervous system, leading to neuropsychiatric complications. Haemodialysis is an effective method for lithium removal especially in severe lithium toxicity such as neurotoxicity with electroencephalogram changes. We describe a case of lithium neurotoxicity with electroencephalographic abnormalities which was reversed following haemodialysis.

Fulltext Bickerstaff brainstem encephalitis with Guillain-Barré syndrome overlap following chlamydia infection

Wong CK, Ng CF, Tan HJ, Mukari SAM

BMJ Case Rep, 2021 May 24;14(5).

PMID: 34031085 DOI: 10.1136/bcr-2021-242090

Bickerstaff brainstem encephalitis (BBE) is a rare autoimmune encephalitis characterised by ataxia, ophthalmoplegia and altered consciousness. An overlap between BBE with Guillain-Barré syndrome (GBS) shows similar clinical and immunological features. We report a case of BBE with GBS overlap secondary to Chlamydia pneumoniae infection. The triad of altered consciousness, ataxia and ophthalmoplegia were present in the patient. The investigations included cerebrospinal fluid cytoalbuminological dissociation, nerve conduction test that showed prolonged or absent F wave latencies, hyperintensity in the left occipital region on brain MRI and diffuse slow activity on the electroencephalogram. The chlamydia serology was positive indicating a postinfectious cause of BBE syndrome. He required artificial ventilation as his consciousness level deteriorated with tetraparesis, oropharyngeal and respiratory muscle weakness. Immunotherapy with intravenous immunoglobulin and methylprednisolone was commenced. He made good recovery with the treatment. Prompt recognition of this rare condition following chlamydia infection is important to guide the management.

Fulltext A case of Guillain-Barré syndrome (GBS) presenting with acute urinary retention and T6 sensory level

Khoo CS, Ali AH, Remli R, Tan HJ

Clin Med (Lond), 2018 Aug;18(4):308-310.

PMID: 30072555 DOI: 10.7861/clinmedicine.18-4-308

Guillain-Barré syndrome (GBS) is an acute immune-mediated demyelinating disease. Early recognition of this disease is crucial as it can progress to life-threatening conditions such as respiratory failure or autonomic dysfunction. Typical clinical manifestations of GBS include progressive weakness of the limbs, bulbar, facial muscles and ophthalmoplegia. Sensory level and bladder dysfunction are more suggestive of acute myelopathy. We report a case of GBS presenting with acute urinary retention and T6 sensory level, which was successfully treated with plasma exchange.

Fulltext Post-dengue parkinsonism

Azmin S, Sahathevan R, Suehazlyn Z, Law ZK, Rabani R, Nafisah WY, et al.

BMC Infect Dis, 2013;13:179.

PMID: 23594500 DOI: 10.1186/1471-2334-13-179

BACKGROUND: Dengue is a common illness in the tropics. Equally common are neurological complications that stem from dengue infection. However, to date, parkinsonism following dengue has not been reported in medical literature.
CASE PRESENTATION: A previously well 18-year old man developed parkinsonism, in addition to other neurological symptoms following serologically confirmed dengue fever. Alternative etiologies were excluded by way of imaging and blood investigations.
CONCLUSIONS: The authors detail the first reported case of parkinsonism complicating dengue fever. Keeping rare presentations of common illnesses in mind, it behoves clinicians to consider parkinsonism as a complication following dengue infection. This would prevent injudicious treatment with L-dopa and dopamine agonists. Immunosuppression with steroids has been shown to be helpful in certain cases.

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