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  1. Fulltext Recurrent bilateral occipital infarct with cortical blindness and anton syndrome
    Kwong Yew K, Abdul Halim S, Liza-Sharmini AT, Tharakan J
    Case Rep Ophthalmol Med, 2014;2014:795837.
    PMID: 24744933 DOI: 10.1155/2014/795837
    Bilateral cortical blindness and Anton syndrome, are most commonly caused by ischaemic stroke. In this condition, patients have loss of vision but deny their blindness despite objective evidence of visual loss. We report a case of a patient with multiple cardiovascular risk factors who developed recurrent bilateral occipital lobe infarct with Anton syndrome. A suspicion of this condition should be raised when the patient has denial of blindness in the presence of clinical and radiological evidence of occipital lobe injury. Management of this condition should focus on the underlying cause, in which our patient requires secondary stroke prevention and rehabilitation.
  2. Fulltext Prevalence of aspirin resistance in diabetic patients and its associated factors
    Habizal NH, Abdul Halim S, Bhaskar S, Wan Bebakar WM, Abdullah JM
    Malays J Med Sci, 2015 Jan-Feb;22(1):50-7.
    PMID: 25892950 MyJurnal
    BACKGROUND: Aspirin resistance has posed a major dilemma in the prevention of cardiovascular disease and stroke. There have been many factors that have been associated with aspirin resistance. Among these factors, the inflammatory processes of diabetes and glycaemic control have been significantly associated with aspirin resistance. Our study evaluated the prevalence of aspirin resistance and its associated factors.
    METHODS: This was a cross-sectional, interventional study, which was implemented from October to November 2012 at the Hospital Universiti Sains Malaysia (HUSM). Sixty-nine patients with diabetes who were taking aspirin were enrolled. The glycosylated haemoglobin (HbA1c) and C-reactive protein (CRP) levels were measured in these patients. The thromboelastography (TEG) level was measured using a TEG machine by a trained technician employing standard methods. The variables obtained were analysed for prevalence of aspirin resistance, HbA1c, CRP, and TEG level. The Chi-square test (and Fisher exact test where applicable) were used to evaluate the associations between aspirin resistance with glycaemic control (HbA1c) and inflammatory markers (CRP).
    RESULTS: The prevalence of aspirin resistance was 17.4% (95%; CI 9.3, 28.4). Glycaemic control (HbA1c) and inflammatory markers (CRP) were not associated with aspirin resistance. Aspirin resistance was prevalent in our study population and was comparable to other studies. The mean HbA1c in the aspirin-resistant group was 8.9%, whereas the mean HbA1c in the aspirin-sensitive group was 8.6%.
    CONCLUSION: There was no significant difference in HbA1c between the two groups. There was no significant association between CRP levels and aspirin resistance.
    KEYWORDS: aspirin resistance; diabetes mellitus; thromboelastography
    Study site: NeuroMedical Specialist Clinic, Hospital Universiti Sains Malaysia (HUSM), Kelantan, Malaysia
  3. Fulltext Damage control resuscitation: A case of thoraco-abdominal impalement
    Nur AK, Mohd Mokhtar MA, Izzat I, Abdul Halim S, Nor Elayni B
    Med J Malaysia, 2016 04;71(2):77-8.
    PMID: 27326948 MyJurnal
    Damage Control Resuscitation and Surgery is the concept of controlled hypotension, haemostatic resuscitation and abbreviated surgical procedures following severe trauma; the practice of which has resulted in improved mortality and morbidity. We describe a rare case of thoraco-abdominal impalement successfully managed based on the concept of Damage Control Resuscitation.
  4. Fulltext Status epilepticus as the initial presentation of antibody-negative Goodpasture's syndrome
    Ting IP, Abdul Halim S, Adnan A, Jaafar H
    BMJ Case Rep, 2017 Aug 01;2017.
    PMID: 28765179 DOI: 10.1136/bcr-2017-219628
    Goodpasture's syndrome is a rare pulmonary-renal disease. It is characterised by presence of auto-antibodies directed against the glomerular basement membrane (GBM) antigen. These antibodies that bind to the GBM antigens cause rapidly progressive glomerulonephritis. The alveolar basement membrane also contains similar antigen, leading to pulmonary haemorrhage in active disease. We report a case of a young man who initially presented with status epilepticus and later was found to have rapidly progressive glomerulonephritis with pulmonary haemorrhage. Serum anti-GBM antibody was negative but the renal biopsy confirmed the diagnosis by showing typical linear IgG along the GBM on immunofluorescent study. He was treated with plasmapheresis and high-dose steroid in combination with oral cyclophosphamide. His renal function normalised after treatment.
  5. Fulltext Intracranial bleeding (ICB) as a catastrophic complication of Streptococcus gordonii infective endocarditis (IE) in an immunocompetent patient
    Pairan MS, Mohammad N, Abdul Halim S, Wan Ghazali WS
    BMJ Case Rep, 2018 Sep 10;2018.
    PMID: 30206067 DOI: 10.1136/bcr-2018-225265
    We present an interesting case of late-onset intracranial bleeding (ICB) as a complication of Streptococcus gordonii causing infective endocarditis. A previously healthy young woman was diagnosed with infective endocarditis. While she was already on treatment for 2 weeks, she had developed seizures with a localising neurological sign. An urgent non-contrasted CT brain showed massive left frontoparietal intraparenchymal bleeding. Although CT angiogram showed no evidence of active bleeding or contrast blush, massive ICB secondary to vascular complication of infective endocarditis was very likely. An urgent decompressive craniectomy with clot evacuation was done immediately to release the mass effect. She completed total 6 weeks of antibiotics and had postoperative uneventful hospital stay despite having a permanent global aphasia as a sequel of the ICB.
  6. Fulltext Treatment response in osmotic demyelination syndrome presenting as severe parkinsonism, ptosis and gaze palsy
    Abdul Halim S, Mohd Amin NA
    BMJ Case Rep, 2018 Oct 21;2018.
    PMID: 30344146 DOI: 10.1136/bcr-2018-225751
    Osmotic demyelination syndrome commonly affects the pons and infrequently involves the extrapontine region. We report a patient with severe hyponatraemia who developed osmotic demyelination syndrome as a consequence of rapid sodium correction. The condition manifested as acute severe parkinsonism, bilateral ptosis and gaze impairment. MRI revealed typical features of central pontine and extrapontine myelinolysis. The patient improved gradually after treatment with a combination of levodopa, intravenous immunoglobulin and dexamethasone. However, it is important to emphasise that the improvement of neurological symptoms is not necessarily causal with these experimental therapies.
  7. Anterior spinal cord syndrome as a rare complication of acute bacterial meningitis in an adult
    Ng KS, Abdul Halim S
    BMJ Case Rep, 2018 Oct 24;2018.
    PMID: 30361450 DOI: 10.1136/bcr-2018-226082
    Acute bacterial meningitis is not an uncommon central nervous system infection. In severe cases, it can be associated with various neurological or systemic complications. However, acute spinal cord dysfunction rarely occurs. We report a case of bacterial meningitis complicated with spinal cord infarction despite adequate treatment with antibiotics and corticosteroid therapy. He had residual paraplegia and was fully dependent in the activity of daily living.
  8. Drivers of food waste generation: Case study of island-based hotels in Langkawi, Malaysia
    Kasavan S, Mohamed AF, Abdul Halim S
    Waste Manag, 2019 May 15;91:72-79.
    PMID: 31203944 DOI: 10.1016/j.wasman.2019.04.055
    Food waste (FW) generation from hotel operations have a significant negative impact on the environment, society and economy. Hence, the urgent need to introduce sustainable food management to reduce both FW and operational costs in hotels. The aim of this paper is to identify the drivers of FW generation and barriers to sustainable food waste management (SFWM) in island based hotels. The data were collected using in-depth interview coupled with the observations conducted at 23 selected hoteliers in Langkawi Island, Malaysia. Based on the analysis, using qualitative content analysis (QCA), eight FW drivers were identified and the drivers were classified into three categories of factors, mainly internal, external and intermediate influence. There are four FW drivers identified as internal factors that influenced the implementation of food waste management namely (1) poor hotel management and policies, (2) lack of skills in food preparation, (3) lack of facilities and FW technology and (4) non-implementation of waste audit and waste separation. For external factors, there are two FW drivers, including (5) unsustainable food consumption patterns of the customers and (6) risk of food ingredients spoilage. As for intermediate factors, two FW drivers were identified, which are (7) ineffective communication and (8) inadequate education and awareness. Findings from this study contribute towards a better understanding on the complexity of FW issues, particularly for island-based hotel sector. It was also suggested that a holistic approach with multi-stakeholders is crucial to reduce food wastage towards achieving SFWM.
  9. Fulltext Biomechanical System Versus Observational Rating Scale for Parkinson's Disease Tremor Assessment
    Chan PY, Mohd Ripin Z, Abdul Halim S, Kamarudin MI, Ng KS, Eow GB, et al.
    Sci Rep, 2019 05 31;9(1):8117.
    PMID: 31148550 DOI: 10.1038/s41598-019-44142-1
    There is a lack of evidence that either conventional observational rating scale or biomechanical system is a better tremor assessment tool. This work focuses on comparing a biomechanical system and the Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale in terms of test-retest reliability. The Parkinson's disease tremors were quantified by biomechanical system in joint angular displacement and predicted rating, as well as assessed by three raters using observational ratings. Qualitative comparisons of the validity and function are made also. The observational rating captures the overall severity of body parts, whereas the biomechanical system provides motion- and joint-specific tremor severity. The tremor readings of the biomechanical system were previously validated against encoders' readings and doctors' ratings; the observational ratings were validated with previous ratings on assessing the disease and combined motor symptoms rather than on tremor specifically. Analyses show that the predicted rating is significantly more reliable than the average clinical ratings by three raters. The comparison work removes some of the inconsistent impressions of the tools and serves as guideline for selecting a tool that can improve tremor assessment. Nevertheless, further work is required to consider more variabilities that influence the overall judgement.
  10. Fulltext Big Brain Data Initiative in Universiti Sains Malaysia: Challenges in Brain Mapping for Malaysia
    Shekh Ibrahim SA, Hamzah N, Abdul Wahab AR, Abdullah JM, Nurul Hashimah Ahamed Hassain Malim, Sumari P, et al.
    Malays J Med Sci, 2020 Jul;27(4):1-8.
    PMID: 32863741 DOI: 10.21315/mjms2020.27.4.1
    Universiti Sains Malaysia has started the Big Brain Data Initiative project since the last two years as brain mapping techniques have proven to be important in understanding the molecular, cellular and functional mechanisms of the brain. This Big Brain Data Initiative can be a platform for neurophysicians and neurosurgeons, psychiatrists, psychologists, cognitive neuroscientists, neurotechnologists and other researchers to improve brain mapping techniques. Data collection from a cohort of multiracial population in Malaysia is important for present and future research and finding cure for neurological and mental illness. Malaysia is one of the participant of the Global Brain Consortium (GBC) supported by the World Health Organization. This project is a part of its contribution via the third GBC goal which is influencing the policy process within and between high-income countries and low- and middle-income countries, such as pathways for fair data-sharing of multi-modal imaging data, starting with electroencephalographic data.
  11. Neurological Examination Techniques of Speech in Bahasa Malaysia for Adults: Simple Approach Practiced in Hospital Universiti Sains Malaysia
    Noorsham AH, Abdullah MM, Abdul Halim S, Ghani ARI, Idris Z, Abdullah JM
    Malays J Med Sci, 2020 Dec;27(6):148-182.
    PMID: 33447142 DOI: 10.21315/mjms2020.27.6.14
    There are four classification levels for speech disorders namely dysphonia, dysarthria, dysprosody and dysphasia. In general, speech examination mainly focuses on three main components that are spontaneous speech, auditory comprehension, and oral motor examination. Quick bedside assessment on speech in Bahasa Malaysia is essential to assist the speech language therapist (SLT) and other physicians to determine the disorders. Speech therapy is also essential in monitoring and continuous assessment for patients with speech and language disorders such as dysphasia and dysarthria. Speech clinicians in Hospital Universiti Sains Malaysia (HUSM) have been adapting two most widely used batteries of speech assessment tools namely Western aphasia battery-revised (WAB-R) by Andrew Kertesz and Boston diagnostic aphasia examination (BDAE). These tools have been modified into simple and validated speech assessments in Bahasa Malaysia. This video manuscript will demonstrate the use of both tools in performing bedside speech assessment for patients with speech disorders. The Bahasa Malaysia speech examination should not be difficult when WAB-R and BDAE speech assessment tools are applied. The aim of this simple approach using the adapted version of BDAE and WAB-R is to assist the clinician to achieve quick and accurate diagnosis with a validated scoring system.
  12. Examination Approach to the Dizzy and Swaying Patient
    Said Mogutham NN, Abdullah JM, Idris Z, Ghani ARI, Abdul Halim S, Naesarajoo JJJ, et al.
    Malays J Med Sci, 2020 Dec;27(6):89-101.
    PMID: 33447137 DOI: 10.21315/mjms2020.27.6.9
    Background: Dizziness is a common presenting complaint among patients in Malaysia. It is a vague term which could be associated with vertigo, imbalance, ataxia or syncope. In order to deal with this overwhelming complaint, a detailed history-taking is essential in confirming aetiology of disease and this should be followed by a meticulous clinical examination. The purpose of the video manuscript it to provide a step-by-step approach to a dizzy and swaying patient, specially catered for Malaysian medical students and trainees.

    Methods: A series of videos were shot, which involved the eye, ear, vestibular system, cerebellar, proprioceptive sense and gait examination. These videos, conducted in Universiti Sains Malaysia (USM) School of Medical Sciences, will be first in Malaysia and will highlight the proper technique and rapport with patients and essential points of each examination. There will be summary at the end of each examination on how to report findings which is a common weakness among students.

    Conclusion: We hope that students and junior doctors could be apply these methods in their daily assessment of dizzy patients and ultimately, reach an accurate diagnosis.

  13. Fulltext Cerebral venous sinus thrombosis in a patient with concomitant Graves' disease and squamous cell carcinoma of the cervix
    Chee YC, Abdul Halim S
    BMJ Case Rep, 2020 Dec 09;13(12).
    PMID: 33298481 DOI: 10.1136/bcr-2020-236730
    Cerebral venous sinus thrombosis (CVST) is caused by either acquired or inherited pro-thrombotic states. Hyperthyroidism is a less recognised predisposing factor of CVST, and the causality has been debated. We report a case of a life-threatening CVST in a 40-year-old woman, with uncommon dual risk factors: hyperthyroidism and advanced squamous cell carcinoma of the cervix. CVST should be considered as a differential diagnosis when a patient with hyperthyroidism presents with new-onset headache or other neurological symptoms. Further assessment to elucidate other covert risk factors may need to be continuously carried out, when the causal relationship of one apparent cause has not been well established.
  14. Paraneoplastic optic neuropathy secondary to adenocarcinoma of the lung
    Yap JY, Wan HItam WH, Abdul Halim S, Masnon NA
    BMJ Case Rep, 2021 May 12;14(5).
    PMID: 33980562 DOI: 10.1136/bcr-2021-242082
    We describe an uncommon cause of paraneoplastic optic neuropathy in adenocarcinoma of the lung. A 45-year-old healthy woman presented with seizure and encephalitis, followed by an acute visual loss in both eyes for 1 week. Her visual acuity was no perception of light in the right eye and hand movement in the left eye. There was a generalised restriction of extraocular muscle movements in both eyes. Funduscopy showed a bilateral pale optic disc. A paraneoplastic antigen autoimmune profile showed a positive anti-CV2/CRMP-5 antibody. CT of the thorax revealed the presence of right apical lung mass, confirmed to be adenocarcinoma through a biopsy. She was scheduled for lung lobectomy and chemotherapy. Unfortunately, her health deteriorated and she passed away eventually.
  15. Fulltext COVID-19 Infection and Circulating Microparticles-Reviewing Evidence as Microthrombogenic Risk Factor for Cerebral Small Vessel Disease
    Che Mohd Nassir CMN, Hashim S, Wong KK, Abdul Halim S, Idris NS, Jayabalan N, et al.
    Mol Neurobiol, 2021 Aug;58(8):4188-4215.
    PMID: 34176095 DOI: 10.1007/s12035-021-02457-z
    Severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) due to novel coronavirus disease 2019 (COVID-19) has affected the global society in numerous unprecedented ways, with considerable morbidity and mortality. Both direct and indirect consequences from COVID-19 infection are recognized to give rise to cardio- and cerebrovascular complications. Despite current limited knowledge on COVID-19 pathogenesis, inflammation, endothelial dysfunction, and coagulopathy appear to play critical roles in COVID-19-associated cerebrovascular disease (CVD). One of the major subtypes of CVD is cerebral small vessel disease (CSVD) which represents a spectrum of pathological processes of various etiologies affecting the brain microcirculation that can trigger subsequent neuroinflammation and neurodegeneration. Prevalent with aging, CSVD is a recognized risk factor for stroke, vascular dementia, and Alzheimer's disease. In the background of COVID-19 infection, the heightened cellular activations from inflammations and oxidative stress may result in elevated levels of microthrombogenic extracellular-derived circulating microparticles (MPs). Consequently, MPs could act as pro-coagulant risk factor that may serve as microthrombi for the vulnerable microcirculation in the brain leading to CSVD manifestations. This review aims to appraise the accumulating body of evidence on the plausible impact of COVID-19 infection on the formation of microthrombogenic MPs that could lead to microthrombosis in CSVD manifestations, including occult CSVD which may last well beyond the pandemic era.
  16. What are Your Eyes Revealing? The Contemporary Bedside Neuro-Ophthalmological Examination
    Ng PM, Abdullah JM, Idris Z, Ghani ARI, Abdul Halim S
    Malays J Med Sci, 2021 Oct;28(5):142-148.
    PMID: 35115897 DOI: 10.21315/mjms2021.28.5.15
    The neuro-ophthalmological evaluation is done to assess the integrity of cranial nerves II, III, IV, VI. This work does not intend to substitute the examination in a fully equipped ophthalmology suite. The aim of this manuscript is to describe bedside examination of the eye by using simple apparatus that are easily available. This work incorporates the usage of smartphone application, as smartphone is deemed an accessory in almost every resident's pocket during review of patients as a consult in the emergency department. However, the essence of traditional physical examination remains the fundamental. Understanding of neuroanatomy and neurophysiology of the eye and the central nervous system can enhance the clinician's performance at the bedside.
  17. Outcome of acute ischaemic stroke patients after intravenous alteplase in Hospital Universiti Sains Malaysia
    Wong KY, Baharuddin KA, Masykurin MM, Abdul Halim S, Chee YC, Sapiai NA, et al.
    Med J Malaysia, 2021 Nov;76(6):870-875.
    PMID: 34806675
    INTRODUCTION: Intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA) is effective in treating acute ischaemic stroke. Our primary objective is to assess the outcome of these acute ischaemic stroke (AIS) patients after IV alteplase with the modified Rankin scale (mRS).

    METHODS: This is a cross-sectional study in which patients receiving IV alteplase in Hospital Universiti Sains Malaysia, from January 2017 to April 2020 were recruited. Demographical data, National Institutes of Health Stroke Scale (NIHSS) scores, door-to-needle time were recorded. Modified Rankin scale (mRS) scores were evaluated at 90 days after initial therapy. Good and poor functional outcomes were defined as 0-2 and 3-6, respectively.

    RESULTS: A total of 30 patients were included in the study with a mean age of 59±11.47 years old. 76.7% of them were male and the rest were female. From the study, onset-toneedle time was 197.47±51.74 minutes, whereas door-toneedle time was 120.93±53.63 minutes. Seventeen (56.3%) patients achieved a favourable score of 0-2 on the mRS at 90 days after treatment. Haemorrhagic transformation occurred in eight (26.7%) of the patients with a mortality rate of 13.3%.

    CONCLUSION: 56.7% of our patients showed improvement in the mRS at 90 days post thrombolysis for AIS. Higher baseline NIHSS scores and diabetes mellitus were associated with poorer functional outcomes after thrombolysis.

  18. Calcaneal Reconstruction With Free Deep Circumflex Iliac Artery Osseocutaneous Flap Following Aggressive Benign Bone Tumor Resection
    Rosli MA, Wan Ismail WF, Wan Sulaiman WA, Mat Zin NA, Abdul Halim S, Mat Johar F, et al.
    Foot Ankle Int, 2021 Dec;42(12):1570-1578.
    PMID: 34286617 DOI: 10.1177/10711007211025280
    BACKGROUND: Advances in limb-salvage techniques have made total calcanectomy and primary reconstruction possible in managing calcaneal aggressive benign tumors and selected cases of intraosseous malignant tumors. However, there is still no consensus on the operative approach, oncologic margin, and the best reconstruction method to date. These 2 cases describe our experience in calcaneal reconstruction with the free deep circumflex iliac artery (DCIA) osseocutaneous flap in benign aggressive calcaneal tumors.

    METHODS: We reported 2 consecutive male and female patients, with an average age of 25 years (age 19 and 31, respectively), who underwent total calcanectomy and primary calcaneal reconstruction with the free DCIA osseocutaneous flaps for calcaneal chondroblastoma and giant cell tumor. A marginal resection of the entire calcaneus through the subtalar and calcaneocuboid joints (intra-articular approach) was performed in the first case and a wide local resection leaving 1 cm normal calcaneal bone margin anterosuperiorly (intraosseous approach) was performed in the second case.

    RESULTS: The follow-up period averaged 48 months. Negative oncologic margins were achieved in both cases. The first case was complicated with venous thrombosis; however, the graft remained viable after emergency reexploration. Normal foot function was restored with good solid osseous union and bony hypertrophy observed. Both patients achieved good short-term functional and aesthetic outcomes with no donor site pain or disability. No local recurrence was reported either.

    CONCLUSION: Primary calcaneal reconstruction with the free DCIA osseocutaneous flap can lead to good short-term functional and aesthetic outcomes.

    LEVEL OF EVIDENCE: Level IV, case series.

  19. Fulltext Subthalamic Nucleus (STN)-Deep Brain Stimulation Reduces the Power of Mu and Beta Rhythms and Enhances Synchrony at the Motor Cortices in Parkinson's Disease: A Report of Two Cases
    Zakaria Z, Idris Z, Abdul Halim S, Ghani ARI, Abdullah JM
    Cureus, 2023 Feb;15(2):e35057.
    PMID: 36942168 DOI: 10.7759/cureus.35057
    The motor circuit in Parkinson's disease (PD) involves the basal ganglia, thalamus, motor cortex, and cerebellum. Hence, subthalamic nucleus (STN) or globus pallidus internus deep brain stimulation is commonly used in treating refractory Parkinson's patients. During the procedure, the local field potential (LPF) is commonly made along the trajectory of the STN. Two cases were assessed, where an electroencephalographic recording at the sensorimotor cortices was also performed with and without stimulation at the optimal STN electrode site. The 'on' stimulation state associated with clinical improvement correlated with a marked reduction in the late theta (7.5 Hz), alpha (10.5 Hz) (Mu wave), and beta (20 Hz) wave power. Besides, more synchronized and coherent brainwaves were noted when the stimulation was 'on'.
  20. Fulltext Manual Muscle Testing of the Scapula and the Upper Limb through Bedside Examination
    Vijian K, Cheng YT, Idris Z, Izaini Ghani AR, Abdul Halim S, Abdullah JM
    Malays J Med Sci, 2023 Feb;30(1):198-212.
    PMID: 36875200 DOI: 10.21315/mjms2023.30.1.17
    Neurological examination is an important tool in diagnosing patients with neurological and neurosurgical conditions. As the complexity and knowledge of neurological and neurosurgical conditions increases, we are now required to learn and indoctrinate our peers and students with the correct skills and methods of examination. Emphasis on the correct techniques of testing muscle strength is essential to avoid errors in recording muscle power and in testing specific muscles which may have overlapping functions. The manual muscle testing of muscles of scapula and upper limbs was performed as to mimic a bedside clinical examination and involved an examiner, a patient and a videographer. The manual muscle testing has been performed in rostrocaudal manner starting from the scapula and ending with the thumbs. A reliable and consistent method of manual muscle testing is lacking among students and clinicians. By adhering to the methods delineated in our text and accompanying video, we hope to reduce inter-examiner variability and increase the reliability and validity of this important examination.
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