Displaying publications 1 - 20 of 67 in total

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  1. Md Isa IA, Halim SA, Chuan CY
    Neurology, 2021 04 06;96(14):e1921-e1924.
    PMID: 33441459 DOI: 10.1212/WNL.0000000000011493
    Matched MeSH terms: Brain Stem Infarctions/complications*; Brain Stem Infarctions/diagnosis
  2. Dzulkarnain AAA, Shahrudin FA, Jamal FN, Marzuki MN, Mazlan MNS
    Am J Audiol, 2020 Dec 09;29(4):838-850.
    PMID: 32966099 DOI: 10.1044/2020_AJA-20-00049
    Purpose The purpose of this study is to investigate the influence of stimulus repetition rates on the auditory brainstem response (ABR) to Level-Specific (LS) CE-Chirp and click stimuli at multiple intensity levels in normal-hearing adults. Method A repeated-measure study design was used on 13 normal-hearing adults. ABRs were acquired from the study participants using LS CE-Chirp and click stimuli at four stimulus repetition rates (19.1, 33.3, 61.1, and 81.1 Hz) and four intensity levels (80, 60, 40, and 20 dB nHL). The ABR test was stopped at 40-nV residual noise level. Results High-stimulus repetition rates caused the ABR latencies to be longer and have reduced amplitudes in both ABR to LS CE-Chirp and click stimuli. The ABR to LS CE-Chirp Wave I, III, and V amplitudes were larger than ABR to click in almost all the stimulus repetition rates. However, there were no differences in the number of averages required to reach the stopping criterion between ABR to LS CE-Chirp and click stimulus, and between high-stimulus repetition rates and low-stimulus repetition rates. Conclusion The LS CE-Chirp at standard low-stimulus repetition rates can be used to elicit ABR for both neurodiagnostic and threshold seeking procedure.
    Matched MeSH terms: Evoked Potentials, Auditory, Brain Stem*
  3. Ramli NM, Bae YJ
    Neuroimaging Clin N Am, 2023 Feb;33(1):43-56.
    PMID: 36404046 DOI: 10.1016/j.nic.2022.07.002
    MR imaging is essential in diagnosing viral encephalitis. Clinical features, cerebrospinal fluid analysis and pathogen confirmation by polymerase chain reaction can be supported by assessing imaging features. MR imaging patterns with typical locations can identify pathogens such as temporal lobe for herpes simplex virus type 1; bilateral thalami for Japanese encephalitis and influenza virus ; and brainstem for enterovirus and rabies. In this article, we have reviewed representative viral encephalitis and its MR imaging patterns. In addition, we also presented acute viral encephalitis without typical MR imaging patterns, such as dengue and varicella-zoster virus encephalitis.
    Matched MeSH terms: Brain Stem
  4. Yong SJ
    ACS Chem Neurosci, 2021 Feb 17;12(4):573-580.
    PMID: 33538586 DOI: 10.1021/acschemneuro.0c00793
    Long-COVID is a postviral illness that can affect survivors of COVID-19, regardless of initial disease severity or age. Symptoms of long-COVID include fatigue, dyspnea, gastrointestinal and cardiac problems, cognitive impairments, myalgia, and others. While the possible causes of long-COVID include long-term tissue damage, viral persistence, and chronic inflammation, the review proposes, perhaps for the first time, that persistent brainstem dysfunction may also be involved. This hypothesis can be split into two parts. The first is the brainstem tropism and damage in COVID-19. As the brainstem has a relatively high expression of ACE2 receptor compared with other brain regions, SARS-CoV-2 may exhibit tropism therein. Evidence also exists that neuropilin-1, a co-receptor of SARS-CoV-2, may be expressed in the brainstem. Indeed, autopsy studies have found SARS-CoV-2 RNA and proteins in the brainstem. The brainstem is also highly prone to damage from pathological immune or vascular activation, which has also been observed in autopsy of COVID-19 cases. The second part concerns functions of the brainstem that overlap with symptoms of long-COVID. The brainstem contains numerous distinct nuclei and subparts that regulate the respiratory, cardiovascular, gastrointestinal, and neurological processes, which can be linked to long-COVID. As neurons do not readily regenerate, brainstem dysfunction may be long-lasting and, thus, is long-COVID. Indeed, brainstem dysfunction has been implicated in other similar disorders, such as chronic pain and migraine and myalgic encephalomyelitis or chronic fatigue syndrome.
    Matched MeSH terms: Brain Stem/blood supply; Brain Stem/metabolism; Brain Stem/physiopathology*; Brain Stem/virology
  5. Dzulkarnain AA, Wan Mhd Pandi WM, Wilson WJ, Bradley AP, Sapian F
    Int J Audiol, 2014 Aug;53(8):514-21.
    PMID: 24702636 DOI: 10.3109/14992027.2014.897763
    To determine if a computer simulation can be used to improve the ability of audiology students to analyse ABR waveforms.
    Matched MeSH terms: Evoked Potentials, Auditory, Brain Stem*
  6. Noorhassim I, Kaga K, Nishimura K
    Am J Otolaryngol, 1996 1 1;17(1):31-5.
    PMID: 8801813
    PURPOSE: The objective of this study is to find the relationship between pure-tone audiometry results and the auditory brainstem response wave abnormalities.

    SUBJECTS AND METHODS: The pure-tone audiometry (PTA) and auditory brainstem responses (ABRs) from 22 patients (44 ears) with diagnosed noise-induced permanent hearing loss were studied. Three indices of PTA were average thresholds of 0.5 kHz/, /1 kHz, and 2 kHz (PTA1); 2 kHz and 4 kHz (PTA2); and 4 kHz (PTA3) were subdivided into 3 thresholds of hearing. Their relationships with ABR results were analysed. The patterns of PTA from various groups of ABR wave patterns were studied.

    RESULTS: In this study, the abnormal ABR wave patterns were detected in 72.7% of the ears. The ears with prolonged ABR wave latency, absent early waves, prolong interpeak wave I-V latency was 20.5%, 18.2%, and 21.1%, respectively. Normal ABRs were recorded in 27.3% of the ears despite marked thresholds elevation of the PTA at high frequencies. Other relationships between PTA results and ABR wave results were discussed.

    CONCLUSION: There were relationships between severity of noise-induced hearing loss indicated by PTA and the patterns of ABR wave abnormalities among workers with noise-induced permanent hearing loss.

    Matched MeSH terms: Evoked Potentials, Auditory, Brain Stem*
  7. Jalaei B, Zakaria MN, Sidek D
    Iran J Otorhinolaryngol, 2017 Jan;29(90):53-57.
    PMID: 28229064
    INTRODUCTION: Noonan syndrome (NS) is a heterogeneous genetic disease that affects many parts of the body. It was named after Dr. Jacqueline Anne Noonan, a paediatric cardiologist.

    CASE REPORT: We report audiological tests and auditory brainstem response (ABR) findings in a 5-year old Malay boy with NS. Despite showing the marked signs of NS, the child could only produce a few meaningful words. Audiological tests found him to have bilateral mild conductive hearing loss at low frequencies. In ABR testing, despite having good waveform morphology, the results were atypical. Absolute latency of wave V was normal but interpeak latencies of wave's I-V, I-II, II-III were prolonged. Interestingly, interpeak latency of waves III-V was abnormally shorter.

    CONCLUSION: Abnormal ABR results are possibly due to abnormal anatomical condition of brainstem and might contribute to speech delay.

    Matched MeSH terms: Brain Stem; Evoked Potentials, Auditory, Brain Stem
  8. Boo NY
    Ann Acad Med Singap, 2008 Dec;37(12 Suppl):60-3.
    PMID: 19904452
    Auditory neuropathy is defined by the presence of normal evoked otoacoustic emissions (OAE) and absent or abnormal auditory brainstem responses (ABR). The sites of lesion could be at the cochlear inner hair cells, spiral ganglion cells of the cochlea, synapse between the inner hair cells and auditory nerve, or the auditory nerve itself. Genetic, infectious or neonatal/perinatal insults are the 3 most commonly identified underlying causes. Children usually present with delay in speech and language development while adult patients present with hearing loss and disproportionately poor speech discrimination for the degree of hearing loss. Although cochlear implant is the treatment of choice, current evidence show that it benefits only those patients with endocochlear lesions, but not those with cochlear nerve deficiency or central nervous system disorders. As auditory neuropathy is a disorder with potential long-term impact on a child's development, early hearing screen using both OAE and ABR should be carried out on all newborns and infants to allow early detection and intervention.
    Matched MeSH terms: Evoked Potentials, Auditory, Brain Stem
  9. Lim XY, Wai YZ, Yong YX, Lim LT
    J Med Case Rep, 2023 Mar 06;17(1):99.
    PMID: 36879252 DOI: 10.1186/s13256-022-03699-8
    BACKGROUND: Multiple sclerosis is a diffuse chronic demyelinating disease of the central nervous system. It is relatively uncommon in the Asian population and even more so in males. Despite the usual involvement of the brainstem, eight-and-a-half syndrome remains a rare first presentation in multiple sclerosis. Only a few cases have been reported previously, but none involving the Asian population. Eight-and-a-half syndrome, a neuro-ophthalmological condition, is characterized by one-and-a-half syndrome with ipsilateral lower facial nerve palsy, which localizes lesions to the pontine tegmentum. This case report demonstrates the first case of eight-and-a-half syndrome as the first presentation of multiple sclerosis in an Asian male.

    CASE PRESENTATION: A healthy 23-year-old Asian man presented with sudden onset of diplopia followed by left-sided facial asymmetry for 3 days. Assessment of extraocular movement revealed left conjugate horizontal gaze palsy. On right gaze, there was limited left eye adduction and horizontal nystagmus of the right eye. These findings were consistent with a left-sided one-and-a-half syndrome. Prism cover test revealed left esotropia of 30 prism diopters. Cranial nerve examination showed left lower motor neuron facial nerve palsy, while other neurological examination was normal. Magnetic resonance imaging brain showed multifocal T2 fluid attenuated inversion recovery hyperintense lesions, involving bilateral periventricular, juxtacortical, and infratentorial regions. A focal gadolinium contrast-enhanced lesion with open ring sign on T1 sequence was seen at the left frontal juxtacortical region. Multiple sclerosis was diagnosed on the basis of the clinical and radiological evidence, which fulfilled the 2017 McDonald criteria. Positive oligoclonal bands in cerebrospinal fluid analysis further confirmed our diagnosis. He had a complete resolution of symptoms 1 month after a course of pulsed corticosteroid therapy, and was subsequently placed on maintenance therapy with interferon beta-1a.

    CONCLUSION: This case illustrates eight-and-a-half syndrome as the first presentation of a diffuse central nervous system pathology. A wide range of differential diagnoses needs to be considered in such a presentation as based on the patient's demographics and risk factors.

    Matched MeSH terms: Brain Stem
  10. Tan SH, Ong KC, Wong KT
    J. Neuropathol. Exp. Neurol., 2014 Nov;73(11):999-1008.
    PMID: 25289894 DOI: 10.1097/NEN.0000000000000122
    Enterovirus 71 (EV71)-associated hand, foot, and mouth disease may be complicated by encephalomyelitis. We investigated EV71 brainstem infection and whether this infection could be ameliorated by passive immunization in a mouse model. Enterovirus 71 was injected into unilateral jaw/facial muscles of 2-week-old mice, and hyperimmune sera were given before or after infection. Harvested tissues were studied by light microscopy, immunohistochemistry, in situ hybridization, and viral titration. In unimmunized mice, viral antigen and RNA were detected within 24 hours after infection only in ipsilateral cranial nerves, motor trigeminal nucleus, reticular formation, and facial nucleus; viral titers were significantly higher in the brainstem than in the spinal cord samples. Mice given preinfection hyperimmune serum showed a marked reduction of ipsilateral viral antigen/RNA and viral titers in the brainstem in a dose-dependent manner. With optimum hyperimmune serum given after infection, brainstem infection was significantly reduced in a time-dependent manner. A delay in disease onset and a reduction of disease severity and mortality were also observed. Thus, EV71 can directly infect the brainstem, including the medulla, via cranial nerves, most likely by retrograde axonal transport. This may explain the sudden cardiorespiratory collapse in human patients with fatal encephalomyelitis. Moreover, our results suggest that passive immunization may still benefit EV71-infected patients who have neurologic complications.
    Matched MeSH terms: Brain Stem/metabolism; Brain Stem/virology*
  11. Lau KF, Tan KS, Goh KJ, Ramli N, Tai SM
    Ann Acad Med Singap, 2019 Mar;48(3):109-111.
    PMID: 30997481
    Matched MeSH terms: Brain Stem Infarctions/complications; Brain Stem Infarctions/physiopathology*
  12. Kartikasalwah A, Lh N
    Biomed Imaging Interv J, 2010 Jan-Mar;6(1):e6.
    PMID: 21611066 MyJurnal DOI: 10.2349/biij.6.1.e6
    Leigh syndrome is a progressive neurodegenerative disorder of childhood. The symmetrical necrotic lesions in the basal ganglia and/or brainstem which appear as hyperintense lesions on T2-weighted MRI is characteristic and one of the essential diagnostic criteria. Recognising this MR imaging pattern in a child with neurological problems should prompt the clinician to investigate for Leigh syndrome. We present here two cases of Leigh syndrome due to different biochemical/genetic defects, and discuss the subtle differences in their MR neuroimaging features.
    Matched MeSH terms: Brain Stem
  13. Oo KT, Tay KS, Law WC, Shatriah I
    Taiwan J Ophthalmol, 2019 12 05;10(3):235-238.
    PMID: 33110759 DOI: 10.4103/tjo.tjo_69_19
    Over the past decade, the discovery of disease-specific aquaporin-4 antibodies has led to a better understanding of the diverse spectrum of disorders that are associated with neuromyelitis optica. Brainstem manifestations have been increasingly recognized in this disease. However, multiple cranial nerve palsies as an initial presentation of neuromyelitis optica are uncommon. We report a rare case of anti-aquaporin-4 antibody-positive neuromyelitis optica that presented with unilateral abducens and facial nerve palsies. Notably, this case did not involve the optic nerve or the spinal cord. Diagnosing neuromyelitis optica that presents as an isolated acute brainstem syndrome is challenging, but the outcome may be devastating if the diagnosis is delayed.
    Matched MeSH terms: Brain Stem
  14. Dzulkarnain AAA, Azizi AK, Sulaiman NH
    J Taibah Univ Med Sci, 2020 Dec;15(6):495-501.
    PMID: 33318741 DOI: 10.1016/j.jtumed.2020.08.007
    Objective: This study aims to investigate the auditory sensory gating capacity in Huffaz using an auditory brainstem response (ABR) test with and without psychological tasks.

    Methods: Twenty-three participants were recruited for this study. The participants were comprised of 11 Huffaz who memorized 30 chapters of the Islamic Scripture (from the Quran) and 12 non-Huffaz as the control group. All participants had normal hearing perception and underwent an ABR test with and without psychological tasks. The ABR was elicited at 70 dB nHL using a 3000 Hz tone burst stimulus with a 2-0-2 cycle at a stimulus repetition rate of 40 Hz. The ABR wave V amplitude and latencies were measured and statistically compared. A forward digit span test was also conducted to determine participants' working memory capacity.

    Results: There were no significant differences in the ABR wave V amplitudes and latencies between Huffaz and non-Huffaz in ABR with and without psychological tasks. There were also no significant differences in the ABR wave V amplitudes and latencies in both groups of ABR with and without psychological tasks. In addition, no significant differences were identified in the digit span working memory score between both groups.

    Conclusions: In this study, based on the ABR findings, Huffaz showed the same auditory sensory gating capacity as the non-Huffaz group. The ABR result was consistent with the digit span working memory test score. This finding implies that both groups have similar working memory performance. However, the conclusion is limited to the specific assessment method that we used in this study.

    Matched MeSH terms: Evoked Potentials, Auditory, Brain Stem
  15. Jamal FN, Arafat Dzulkarnain AA, Shahrudin FA, Marzuki MN
    J Audiol Otol, 2021 Jan;25(1):14-21.
    PMID: 32575950 DOI: 10.7874/jao.2020.00073
    BACKGROUND AND OBJECTIVES: There is growing interest in the use of the Level-specific (LS) CE-Chirp® stimulus in auditory brainstem response (ABR) due to its ability to produce prominent ABR waves with robust amplitudes. There are no known studies that investigate the test-retest reliability of the ABR to the LS CE-Chirp® stimulus. The present study aims to investigate the test-retest reliability of the ABR to the LS CE-Chirp® stimulus and compare its reliability with the ABR to standard click stimulus at multiple intensity levels in normal-hearing adults.

    SUBJECTS AND METHODS: Eleven normal-hearing adults participated. The ABR test was repeated twice in the same clinical session and conducted again in another session. The ABR was acquired using both the click and LS CE-Chirp® stimuli at 4 presentation levels (80, 60, 40, and 20 dBnHL). Only the right ear was tested using the ipsilateral electrode montage. The reliability of the ABR findings (amplitudes and latencies) to the click and LS CE-Chirp® stimuli within the same clinical session and between the two clinical sessions was calculated using an intra-class correlation coefficient analysis (ICC).

    RESULTS: The results showed a significant correlation of the ABR findings (amplitude and latencies) to both stimuli within the same session and between the clinical sessions. The ICC values ranged from moderate to excellent.

    CONCLUSIONS: The ABR results from both the LS CE-Chirp® and click stimuli were consistent and reliable over the two clinical sessions suggesting that both stimuli can be used for neurological diagnoses with the same reliability.

    Matched MeSH terms: Evoked Potentials, Auditory, Brain Stem
  16. Zakaria MN, Abdul Wahab NA, Awang MA
    Noise Health, 2017 12 2;19(87):112-113.
    PMID: 29192621 DOI: 10.4103/nah.NAH_2_17
    Matched MeSH terms: Evoked Potentials, Auditory, Brain Stem
  17. Dewey RS, Francis ST, Guest H, Prendergast G, Millman RE, Plack CJ, et al.
    Neuroimage, 2020 Jan 01;204:116239.
    PMID: 31586673 DOI: 10.1016/j.neuroimage.2019.116239
    In animal models, exposure to high noise levels can cause permanent damage to hair-cell synapses (cochlear synaptopathy) for high-threshold auditory nerve fibers without affecting sensitivity to quiet sounds. This has been confirmed in several mammalian species, but the hypothesis that lifetime noise exposure affects auditory function in humans with normal audiometric thresholds remains unconfirmed and current evidence from human electrophysiology is contradictory. Here we report the auditory brainstem response (ABR), and both transient (stimulus onset and offset) and sustained functional magnetic resonance imaging (fMRI) responses throughout the human central auditory pathway across lifetime noise exposure. Healthy young individuals aged 25-40 years were recruited into high (n = 32) and low (n = 30) lifetime noise exposure groups, stratified for age, and balanced for audiometric threshold up to 16 kHz fMRI demonstrated robust broadband noise-related activity throughout the auditory pathway (cochlear nucleus, superior olivary complex, nucleus of the lateral lemniscus, inferior colliculus, medial geniculate body and auditory cortex). fMRI responses in the auditory pathway to broadband noise onset were significantly enhanced in the high noise exposure group relative to the low exposure group, differences in sustained fMRI responses did not reach significance, and no significant group differences were found in the click-evoked ABR. Exploratory analyses found no significant relationships between the neural responses and self-reported tinnitus or reduced sound-level tolerance (symptoms associated with synaptopathy). In summary, although a small effect, these fMRI results suggest that lifetime noise exposure may be associated with central hyperactivity in young adults with normal hearing thresholds.
    Matched MeSH terms: Brain Stem/physiology*; Evoked Potentials, Auditory, Brain Stem/physiology*
  18. Zakaria MN, Jalaei B, Wahab NA
    Eur Arch Otorhinolaryngol, 2016 Feb;273(2):349-54.
    PMID: 25682179 DOI: 10.1007/s00405-015-3555-3
    For estimating behavioral hearing thresholds, auditory steady state response (ASSR) can be reliably evoked by stimuli at low and high modulation frequencies (MFs). In this regard, little is known regarding ASSR thresholds evoked by stimuli at different MFs in female and male participants. In fact, recent data suggest that 40-Hz ASSR is influenced by estrogen level in females. Hence, the aim of the present study was to determine the effect of gender and MF on ASSR thresholds in young adults. Twenty-eight normally hearing participants (14 males and 14 females) were enrolled in this study. For each subject, ASSR thresholds were recorded with narrow-band chirps at 500, 1,000, 2,000, and 4,000 Hz carrier frequencies (CFs) and at 40 and 90 Hz MFs. Two-way mixed ANOVA (with gender and MF as the factors) revealed no significant interaction effect between factors at all CFs (p > 0.05). The gender effect was only significant at 500 Hz CF (p < 0.05). At 500 and 1,000 Hz CFs, mean ASSR thresholds were significantly lower at 40 Hz MF than at 90 Hz MF (p < 0.05). Interestingly, at 2,000 and 4,000 Hz CFs, mean ASSR thresholds were significantly lower at 90 Hz MF than at 40 Hz MF (p < 0.05). The lower ASSR thresholds in females might be due to hormonal influence. When recording ASSR thresholds at low MF, we suggest the use of gender-specific normative data so that more valid comparisons can be made, particularly at 500 Hz CF.
    Matched MeSH terms: Evoked Potentials, Auditory, Brain Stem/physiology*
  19. Abdul Wahid SN, Md Daud MK, Sidek D, Abd Rahman N, Mansor S, Zakaria MN
    Int J Pediatr Otorhinolaryngol, 2012 Sep;76(9):1366-9.
    PMID: 22770594 DOI: 10.1016/j.ijporl.2012.06.008
    OBJECTIVE: To identify the outcomes of hearing screening using different protocols of both Distortion Product Otoacoustic Emissions (DPOAE) and Automated Auditory Brainstem Response (AABR) tests in the same ear of the babies in a neonatal unit population.
    METHODS: A cross-sectional study was carried out on babies who were admitted into a neonatal unit. By using a formula of single proportion and considering 20% drop out, the number of sample required was 114. The subjects were chosen by using a systematic random sampling. The infants selected were subjected to DPOAE followed by AABR tests screening at the same setting before discharge.
    RESULTS: There were 73 newborns (61.6% male and 38.4% female) participated in this study with a total of 146 ears screened. Ototoxic medication was the most common risk factor followed by hyperbilirubinaemia and low birth weight. AABR had higher passing rate (82.9%) as compared to DPOAE (77.4%). The highest passing rate was achieved if the protocol of either passed DPOAE or AABR was used (90.4%). The rate was lower when auditory neuropathy spectrum disorder (ANSD) has been considered (82.9%). Hyperbilirubinaemia, prematurity, craniofacial malformation and ototoxic drugs seem to be the high risk factors for auditory neuropathy.
    CONCLUSION: AABR has a higher passing rate as compared to DPOAE. However, the use of both instruments in the screening process especially in NICU will be useful to determine the infants with ANSD who may need different approach to management. Therefore, a protocol in which newborns are tested with AABR first and then followed by DPOAE on those who fail the AABR is recommended.
    Matched MeSH terms: Evoked Potentials, Auditory, Brain Stem/physiology*
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