Displaying publications 1 - 20 of 34 in total

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  1. A young lady with thalamic stroke mimicking acute Miller Fisher syndrome
    Hasan S, Stanslas J, Hin LP, Basri HB
    Neurosciences (Riyadh), 2012 Oct;17(4):380-1.
    PMID: 23022907
    Matched MeSH terms: Stroke/diagnosis*
  2. Sudden death during jungle trekking: a case of heat stroke
    Nadesan K, Chan SP, Wong CM
    Malays J Pathol, 1998 Jun;20(1):49-54.
    PMID: 10879265
    Heat stroke, which is also known as "sun stroke," is a medical emergency, and fatalities can occur unless it is diagnosed early and treated efficiently. Heat stroke may manifest quite suddenly, giving little time to differentiate it from extreme physical exhaustion in collapsed subjects. It is also known to lead to serious disseminated intravascular coagulation. Sudden death in a young female is presented who collapsed after trekking in a hilly, jungle area in Malaysia on a warm, humid day. She had joined a weight reduction programme a few weeks earlier. She was found collapsed and in a semiconscious state in the jungle by her groupmates and was taken to hospital. On admission she was unconscious, hyperpyrexic, with rapid, thready pulse and a low blood pressure. Biochemical studies revealed metabolic acidosis, elevated liver and cardiac enzymes and impairment of renal function. Her coagulation profile was found to be impaired and she started bleeding through the mouth and nostrils. She also developed watery diarrhoea and initially a septicaemic condition, including acute enteritis was suspected. Despite active treatment, her condition deteriorated and she died eight hours after admission. Autopsy confirmed a generalised bleeding tendency, with pulmonary, oesophageal and gastrointestinal mucosal haemorrhages. Flame-shaped subendocardial shock haemorrhages were seen in the interventricular septum on the left side of the heart. The findings support a diagnosis of heat stroke. Various aspects related to heat stroke, the autopsy diagnosis and its prevention are discussed.
    Matched MeSH terms: Heat Stroke/diagnosis
  3. Fulltext Zone specific fractal dimension of retinal images as predictor of stroke incidence
    Aliahmad B, Kumar DK, Hao H, Unnikrishnan P, Che Azemin MZ, Kawasaki R, et al.
    ScientificWorldJournal, 2014;2014:467462.
    PMID: 25485298 DOI: 10.1155/2014/467462
    Fractal dimensions (FDs) are frequently used for summarizing the complexity of retinal vascular. However, previous techniques on this topic were not zone specific. A new methodology to measure FD of a specific zone in retinal images has been developed and tested as a marker for stroke prediction. Higuchi's fractal dimension was measured in circumferential direction (FDC) with respect to optic disk (OD), in three concentric regions between OD boundary and 1.5 OD diameter from its margin. The significance of its association with future episode of stroke event was tested using the Blue Mountain Eye Study (BMES) database and compared against spectrum fractal dimension (SFD) and box-counting (BC) dimension. Kruskal-Wallis analysis revealed FDC as a better predictor of stroke (H = 5.80, P = 0.016, α = 0.05) compared with SFD (H = 0.51, P = 0.475, α = 0.05) and BC (H = 0.41, P = 0.520, α = 0.05) with overall lower median value for the cases compared to the control group. This work has shown that there is a significant association between zone specific FDC of eye fundus images with future episode of stroke while this difference is not significant when other FD methods are employed.
    Matched MeSH terms: Stroke/diagnosis*
  4. Fulltext Identifying the ischaemic penumbra using pH-weighted magnetic resonance imaging
    Harston GW, Tee YK, Blockley N, Okell TW, Thandeswaran S, Shaya G, et al.
    Brain, 2015 Jan;138(Pt 1):36-42.
    PMID: 25564491 DOI: 10.1093/brain/awu374
    The original concept of the ischaemic penumbra suggested imaging of regional cerebral blood flow and metabolism would be required to identify tissue that may benefit from intervention. Amide proton transfer magnetic resonance imaging, a chemical exchange saturation transfer technique, has been used to derive cerebral intracellular pH in preclinical stroke models and has been proposed as a metabolic marker of ischaemic penumbra. In this proof of principle clinical study, we explored the potential of this pH-weighted magnetic resonance imaging technique at tissue-level. Detailed voxel-wise analysis was performed on data from a prospective cohort of 12 patients with acute ischaemic stroke. Voxels within ischaemic core had a more severe intracellular acidosis than hypoperfused tissue recruited to the final infarct (P < 0.0001), which in turn was more acidotic than hypoperfused tissue that survived (P < 0.0001). In addition, when confined to the grey matter perfusion deficit, intracellular pH (P < 0.0001), but not cerebral blood flow (P = 0.31), differed between tissue that infarcted and tissue that survived. Within the presenting apparent diffusion coefficient lesion, intracellular pH differed between tissue with early apparent diffusion lesion pseudonormalization and tissue with true radiographic recovery. These findings support the need for further investigation of pH-weighted imaging in patients with acute ischaemic stroke.
    Matched MeSH terms: Stroke/diagnosis*
  5. Acute bilateral medial medullary infarct with hypoplastic vertebral artery
    Tai ML, Katiman E, Rahmat K, Tan CT
    Clin Neurol Neurosurg, 2012 Dec;114(10):1365-7.
    PMID: 22512947 DOI: 10.1016/j.clineuro.2012.03.031
    Matched MeSH terms: Stroke/diagnosis
  6. Antithrombotic treatment for stroke prevention in atrial fibrillation: The Asian agenda
    Chen CH, Chen MC, Gibbs H, Kwon SU, Lo S, On YK, et al.
    Int J Cardiol, 2015 Jul 15;191:244-53.
    PMID: 25978611 DOI: 10.1016/j.ijcard.2015.03.369
    Atrial fibrillation (AF) is the most common heart arrhythmia. Untreated AF incurs a considerable burden of stroke and associated healthcare costs. Asians have AF risk factors similar to Caucasians and a similarly increased risk of AF-related stroke; however, with a vast and rapidly ageing population, Asia bears a disproportionately large disease burden. Urgent action is warranted to avert this potential health crisis. Antithrombotic therapy with oral anticoagulants is the most effective means of preventing stroke in AF and is a particular priority in Asia given the increasing disease burden. However, AF in Asia remains undertreated. Conventional oral anticoagulation with warfarin is problematic in Asia due to suboptimal control and a propensity among Asians to warfarin-induced intracranial haemorrhage. Partly due to concerns about intracranial haemorrhage, there are considerable gaps between AF treatment guidelines and clinical practice in Asia, in particular overuse of antiplatelet agents and underuse of anticoagulants. Compared with warfarin, new direct thrombin inhibitors and Factor Xa inhibitors are non-inferior in preventing stroke and significantly reduce the risk of life-threatening bleeding, particularly intracranial bleeding. These agents may therefore provide an appropriate alternative to warfarin in Asian patients. There is considerable scope to improve stroke prevention in AF in Asia. Key priorities include: early detection of AF and identification of asymptomatic patients; assessment of stroke and bleeding risk for all AF patients; evidence-based pharmacotherapy with direct-acting oral anticoagulant agents or vitamin K antagonists for AF patients at risk of stroke; controlling hypertension; and awareness-raising, education and outreach among both physicians and patients.
    Matched MeSH terms: Stroke/diagnosis
  7. A validation study of the Siriraj Stroke Score
    Kan CH, Lee SK, Low CS, Velusamy SS, Cheong I
    Int J Clin Pract, 2000 Dec;54(10):645-6.
    PMID: 11221275
    A cross-sectional study was conducted on 160 Malaysian patients to validate the usefulness of the Siriraj Stroke Score (SSS) for differentiating intracerebral haemorrhage and infarction following acute strokes. Our results indicate that the score lacks sensitivity and specificity. It should thus not be used in epidemiological studies to determine stroke types in a community. More importantly, in the absence of information from neuroimaging of the brain, it cannot be used safely by physicians to assess the need or otherwise of thrombolytic and/or anticoagulant therapy after an acute stroke.
    Matched MeSH terms: Stroke/diagnosis*
  8. Misdiagnosis leads to Iatrogenesis
    Chin AV
    Med J Malaysia, 2019 08;74(4):359-362.
    PMID: 31424053
    No abstract provided.
    Matched MeSH terms: Stroke/diagnosis*
  9. Erysipelothrix rhusiopathiae endocarditis presenting with stroke
    Tan YA, Ng KC, Cheo SW, Low QJ, Chia YK
    QJM, 2020 07 01;113(7):485-487.
    PMID: 32053172 DOI: 10.1093/qjmed/hcaa025
    Matched MeSH terms: Stroke/diagnosis
  10. The potential of iRest in measuring the hand function performance of stroke patients
    Abdul Rahman H, Khor KX, Yeong CF, Su EL, Narayanan AL
    Biomed Mater Eng, 2017;28(2):105-116.
    PMID: 28372264 DOI: 10.3233/BME-171660
    BACKGROUND: Clinical scales such as Fugl-Meyer Assessment (FMA) and Motor Assessment Scale (MAS) are widely used to evaluate stroke patient's motor performance. However, there are several limitations with these assessment scales such as subjectivity, lack of repeatability, time-consuming and highly depend on the ability of the physiotherapy. In contrast, robot-based assessments are objective, repeatable, and could potentially reduce the assessment time. However, robot-based assessments are not as well established as conventional assessment scale and the correlation to conventional assessment scale is unclear.

    OBJECTIVE: This study was carried out to identify important parameters in designing tasks that efficiently assess hand function of stroke patients and to quantify potential benefits of robotic assessment modules to predict the conventional assessment score with iRest.

    METHODS: Twelve predictive variables were explored, relating to movement time, velocity, strategy, accuracy and smoothness from three robotic assessment modules which are Draw I, Draw Diamond and Draw Circle. Regression models using up to four predictors were developed to describe the MAS.

    RESULTS: Results show that the time given should be not too long and it would affect the trajectory error. Besides, result also shows that it is possible to use iRest in predicting MAS score.

    CONCLUSION: There is a potential of using iRest, a non-motorized device in predicting MAS score.

    Matched MeSH terms: Stroke/diagnosis
  11. Emerging paradigms in treating cerebral infarction with nanotheranostics: opportunities and clinical challenges
    Almalki WH, Alghamdi S, Alzahrani A, Zhang W
    Drug Discov Today, 2021 03;26(3):826-835.
    PMID: 33383212 DOI: 10.1016/j.drudis.2020.12.018
    Interest is increasing in the use of nanotheranostics as diagnosis, imaging and therapeutic tools for stroke management, but movement to the clinic remains challenging.
    Matched MeSH terms: Stroke/diagnosis
  12. Fulltext The prognostic value of tissue factor levels in acute ischaemic stroke
    Halim AG, Hamidon BB, Cheong SK, Raymond AA
    Singapore Med J, 2006 May;47(5):400-3.
    PMID: 16645690
    There is no biological marker that can accurately predict the prognosis after an acute ischaemic stroke. The main objective of this study was to evaluate the prognostic value of tissue factor (thromboplastin) levels in first ischaemic stroke.
    Matched MeSH terms: Stroke/diagnosis*
  13. Fulltext Lower motor neuron facial palsy in a postnatal mother with COVID-19
    Kumar V, Narayanan P, Shetty S, Mohammed AP
    BMJ Case Rep, 2021 Mar 01;14(3).
    PMID: 33649026 DOI: 10.1136/bcr-2020-240267
    COVID-19 is caused by the novel SARS-CoV-2 and is a potentially fatal disease that is of great global public health concern. In addition to respiratory symptoms, neurological manifestations have been associated with COVID-19. This is attributed to the neurotropic nature of coronaviruses. The authors present a case of Bell's palsy associated with COVID-19 in a term primigravida.
    Matched MeSH terms: Stroke/diagnosis*
  14. Zinc: indications in brain disorders
    Prakash A, Bharti K, Majeed AB
    Fundam Clin Pharmacol, 2015 Apr;29(2):131-49.
    PMID: 25659970 DOI: 10.1111/fcp.12110
    Zinc is the authoritative metal which is present in our body, and reactive zinc metal is crucial for neuronal signaling and is largely distributed within presynaptic vesicles. Zinc also plays an important role in synaptic function. At cellular level, zinc is a modulator of synaptic activity and neuronal plasticity in both development and adulthood. Different importers and transporters are involved in zinc homeostasis. ZnT-3 is a main transporter involved in zinc homeostasis in the brain. It has been found that alterations in brain zinc status have been implicated in a wide range of neurological disorders including impaired brain development and many neurodegenerative disorders such as Alzheimer's disease, and mood disorders including depression, Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis, and prion disease. Furthermore, zinc has also been implicated in neuronal damage associated with traumatic brain injury, stroke, and seizure. Understanding the mechanisms that control brain zinc homeostasis is thus critical to the development of preventive and treatment strategies for these and other neurological disorders.
    Matched MeSH terms: Stroke/diagnosis
  15. Assessment of arterial collateralization and its relevance to intra-arterial therapy for acute ischemic stroke
    Ramaiah SS, Mitchell P, Dowling R, Yan B
    J Stroke Cerebrovasc Dis, 2014 Mar;23(3):399-407.
    PMID: 23601372 DOI: 10.1016/j.jstrokecerebrovasdis.2013.03.012
    Evidence from recent randomized controlled studies comparing intra-arterial (IA) therapy with intravenous tissue plasminogen activator highlighted the mismatch between recanalization success and clinical outcomes in patients presenting with acute ischemic stroke. There is emerging interest in the impact of arterial collateralization, as determined by leptomeningeal anastomoses (LMAs), on the treatment outcomes of IA therapy. The system of LMA constitutes the secondary network of cerebral collateral circulation apart from the Circle of Willis. Both anatomic and angiographic studies confirmed significant interindividual variability in LMA. This review aims to outline the current understanding of arterial collateralization and its impact on outcomes after IA therapy for acute ischemic stroke, underpinning the possible role of arterial collateralization assessment as a selection tool for patients most likely to benefit from IA therapy.
    Matched MeSH terms: Stroke/diagnosis
  16. Fulltext The prognostic value of C-reactive protein (CRP) levels in patients with acute ischaemic stroke
    Hamidon BB, Sapiah S, Nawawi H, Raymond AA
    Med J Malaysia, 2004 Dec;59(5):631-7.
    PMID: 15889566 MyJurnal
    Increasing evidence suggests that inflammation plays an important role in the development of both cardiovascular and cerebrovascular events. Recently C-reactive protein (CRP) levels have been reported to be a prognostic factor for cerebrovascular and cardiovascular events. The main objective of the study was to evaluate the prognostic value of CRP levels in a first ever ischaemic stroke at one month. All ischaemic stroke patients who were admitted to Hospital Universiti Kebangsaan Malaysia (HUKM) between May 2002 and July 2002 were eligible for the study. CRP levels were taken within 72 hours after an acute ischaemic stroke. The functional ability was assessed using the Barthel Index (BI) after one month of stroke. During the study period 84 patients were admitted to HUKM with the diagnosis of ischaemic stroke; 49 patients were enrolled and 35 were excluded. Twenty-nine patients (59.2%) had elevated CRP levels (median 1.64+/-3.07 mg/dL, range 0.06 to 16.21 mg/dL). Elevated CRP levels were found to be a predictor of severe functional disability (BI<5) and were also associated with larger infarcts. In conclusion, elevated CRP levels are associated with poorer functional outcome and predict a larger infarct size.
    Matched MeSH terms: Stroke/diagnosis*
  17. Acute Ischemic Stroke and Acute on Chronic Kidney Disease
    Aftab RA, Khan AH, AbdulRazzaq HA, Adnan AS
    JNMA J Nepal Med Assoc, 2016 12 10;54(202):85-87.
    PMID: 27935930
    Ischemic stroke is due to either local thrombus formation or emboli that occlude a cerebral artery, together with chronic kidney disease represent major mortality and morbidity.Here we present a case of 53 years old Malay man, admitted to a hospital in Malaysia complaining of sudden on set of weakness on right sided upper and lower limb associated with slurred speech. Patient was also suffering from uncontrolled hypertension, hyperlipidemia, chronic kidney disease stage 4, and diabetes mellitus (uncontrolled). He was diagnosed with acute ischemic stroke with cranial nerve 7 palsy (with right hemiparesis), acute on chronic kidney disease precipitated by dehydration and ACE inhibitor, and hyperkalemia. Patients with ischemic disease and chronic kidney disaese require constant monitering and careful selected pharmacotherapy. Patient was placed under observation and was prescribed multiple pharamacotherpay to stabalise detoriating condition.
    Matched MeSH terms: Stroke/diagnosis*
  18. Fulltext Knowledge on the action to be taken and recognition of symptoms of stroke in a community: findings from the May Measurement Month 2017 blood pressure screening Programme in Malaysia
    Ching S, Chia YC, Chew BN, Soo MJ, Lim HM, Sulaiman WAW, et al.
    BMC Public Health, 2019 Nov 29;19(1):1602.
    PMID: 31783831 DOI: 10.1186/s12889-019-7922-7
    BACKGROUND: Information regarding the knowledge on the action to be taken during stroke and good recognition of stroke symptoms is mandatory in helping to plan out educational strategies to deliver health education to the community.

    METHODS: This is a cross-sectional study of adults aged 18 and above attending a blood pressure screening program in community in conjunction with May Measurement Month 2017 in Malaysia. A structured self-administered questionnaire was given to the participants who gave verbal consent. Data analysis was done using SPSS v. 23 and multiple logistic regression was used to identify the determinants of knowledge on actions to be taken during stroke and recognition of stroke symptoms.

    RESULTS: Out of 4096 respondents, 82.9-92.1% of them able to recognise the common stroke symptoms. and 74.2% of the study respondents will go to hospital within 4.5 h of stroke onset. According to binomial logistic regression analyses, adults aged 45 years old and above (OR 1.39 95%CI 1.01-1.92), being Malay (OR 1.74, 95% CI 1.27-2.40), being non-smokers (OR = 2.491, 95% CI: 1.64-3.78), hypertensives (OR: 1.57, 95% CI: 1.02-2.42)and diabetics (OR: 2.54, 95% CI:1.38-4.69) are determinants of right actions to be taken during stroke. Meanwhile, respondents aged 45 years old and older (OR = 1.68, 95% CI: 1.39-2.03), being Malay (OR = 1.49, 95% CI: 1.24-1.79), hypertensive (OR = 1.32, 95% CI: 1.04-1.66) and those who had a previous history of stroke (OR = 2.25, 95% CI: 1.01-5.00) are determinants of good recognition of stroke symptoms.

    CONCLUSIONS: The overall knowledge of stroke in our study population was good. Older age, being Malay, non-smokers, hypertensives and diabetics are determinants of right actions to be taken during stroke. Meanwhile, older age, being Malay, hypertensive and those who had a previous history of stroke are determinants of good recognition of stroke symptoms.

    Matched MeSH terms: Stroke/diagnosis
  19. Reliability of Telephone Interview for Assessment of Long-Term Stroke Outcomes: Evidence from Interrater Analysis
    Chen XW, Shafei MN, Abdullah JM, Musa KI
    Neuroepidemiology, 2019;52(3-4):214-219.
    PMID: 30799411 DOI: 10.1159/000497238
    BACKGROUND: A comprehensive evaluation of interrater reliability is crucial when it comes to multiple coders assessing the stroke outcomes using telephone interview. The reliability between telephone raters is important, as it could affect the accuracy of the findings published.

    OBJECTIVE: This study aimed to establish the interrater reliability between multiple telephone interviewers when assessing long-term stroke outcomes.

    METHODS: Patients alive at discharge selected in a retrospective cohort stroke project were recruited in this study. Their contact numbers were obtained from the medical record unit. The patients and/or proxies were interviewed based on a standardized script in Malay or English. Stroke outcomes assessed were modified Rankin Scale (mRS) and Barthel Index (BI) at 1-year post discharge. Fully crossed design was applied and 3 assessors collected the data simultaneously. Data was analysed using the software R version 3.4.4.

    RESULTS: Out of 207 subjects recruited, 132 stroke survivors at the time of interview were analysed. We found a significant excellent interrater reliability between telephone interviewers assessing BI, with intraclass correlation coefficient at 0.996 (95% CI 0.995-0.997). Whereas substantial agreement between the telephone interviewers was revealed in assessing mRS, with Fleiss', Conger's and Light's Kappa statistics reporting 0.719 and the Nelson's model-based κm kappa statistic reporting 0.689 (95% CI 0.667-0.711).

    CONCLUSION: It is reliable to get multiple raters in assessing mRS and BI using the telephone system. It is worthwhile to make use of a telephone interview to update clinicians on their acute clinical management towards long-term stroke prognosis.

    Matched MeSH terms: Stroke/diagnosis*
  20. Fulltext Computed tomography perfusion of ischaemic stroke patients in a rural Malaysian tertiary referral centre
    Man K, Kareem AM, Ahmad Alias NA, Shuaib IL, Tharakan J, Abdullah JM, et al.
    Singapore Med J, 2006 Mar;47(3):194-7.
    PMID: 16518552
    Computed tomography (CT) perfusion is a new method to diagnose ischaemic stroke especially in developing countries. It identifies the area and is useful to predict the size of final infarction. The aim of this study was to assess cerebral ischaemia with CT perfusion (CTP) among patients with acute ischaemic stroke in Hospital Universiti Sains Malaysia, a tertiary referral centre in a rural setting.
    Matched MeSH terms: Stroke/diagnosis*
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