MyMedR

Fulltext Oesophageal intubation and ventilation as initial airway support of newborn infant with tracheal agenesis

Wong AC, Khoo CS, Ee YS, Sidhu JK, Chan LG

Med J Malaysia, 2014 Aug;69(4):189-90.

Tracheal agenesis is a rare congenital airway anomaly which presents as an airway emergency at birth. We report a case of late premature Chinese infant with tracheal agenesis type II (by Floyd's classification) who presented with severe respiratory distress at birth. He had multiple failed attempts at intubations with accidental oesophageal intubation and ventilation. Tracheal agenesis with tracheo-oesophageal fistula was suspected from an emergency optical laryngoesophagoscopy done. The infant was subsequently stabilized on oesophageal ventilation. The diagnosis was confirmed on CT scan and parents were counseled regarding the poor outcome and decided for withdrawal at day 7 of life.

Fulltext An unusual case of refractory status epilepticus in a young lady: anti-NMDA receptor encephalitis

Khoo CS, Zulkifli NH, Rahman SSA

Clin Med (Lond), 2017 Oct;17(5):436-438.

PMID: 28974594 DOI: 10.7861/clinmedicine.17-5-436

We describe a case of a young lady with anti-NMDA (N-methyl-D-aspartate) receptor encephalitis, who initially presented with status epilepticus. Her seizures and orofacial dyskinesia were refractory to four anticonvulsants. She received intravenous immunoglobulin and a left ovarian tumour (an associated feature) was resected. However, her outcome was poor because of delayed treatment, autonomic dysfunction and complications of prolonged hospitalisation. This case highlights the importance of an early recognition of this rare but increasingly recognised disease.

Spontaneous pneumomediastinum

Khoo CS, Ab Rahman SS

Med J Aust, 2017 11 20;207(10):421.

PMID: 29129168

Fulltext Abdominal Distension-An Unexpected Gift

Khoo CS

Perm J, 2017;21:17-026.

PMID: 28746027 DOI: 10.7812/TPP/17-026

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 Dengue Cerebellitis: A Case Report and Literature Review

Khoo CS

Am J Case Rep, 2018 Jul 24;19:864-867.

PMID: 30038209 DOI: 10.12659/AJCR.909884

BACKGROUND Dengue-associated neurological manifestations have recently been on the rise. Cerebellar syndrome complicating dengue fever has rarely been reported in the literature. We present a case report of dengue-associated cerebellar syndrome and performed a literature review to draw attention to this rare neurological complication. CASE REPORT A 60-year-old man presented with 4 days of fever, myalgia, arthralgia, headaches, and warning symptoms (persistent diarrhea and vomiting). He was admitted with serologically-confirmed dengue fever. He had been well until day 8 of illness, when he developed cerebellar signs and symptoms. The temporal relationship with the recent dengue fever suggested that he had dengue cerebellitis. He recovered well, with no neurological sequelae upon our clinic visit. CONCLUSIONS Dengue cerebellitis is a rare but recognized manifestation, which should be considered in patients from endemic areas of dengue fever who develop cerebellar syndrome.

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 The predictive and diagnostic accuracy of vascular endothelial growth factor and pentraxin-3 in severe dengue

Low GKK, Gan SC, Zainal N, Naidu KD, Amin-Nordin S, Khoo CS, et al.

Pathog Glob Health, 2018 09;112(6):334-341.

PMID: 30246621 DOI: 10.1080/20477724.2018.1516417

This study aimed to evaluate vascular endothelial growth factor (VEGF) and pentraxin 3 (PTX-3) as predictive and diagnostic markers in differentiating severe dengue from non-severe dengue. The study was conducted in Ampang Health Clinic, Ampang Hospital and Serdang Hospital. The plasma levels of VEGF and PTX-3 were compared between severe dengue and non-severe dengue by ELISA from the day of presentation until discharged. Multiple logistic regression was used to develop predictive and diagnostic models by incorporating other clinical parameters. The receiver operating characteristics (ROC) analysis was used to assess the accuracy of the biomarkers and the developed models. Eighty-two patients were recruited, 29 with severe dengue and four died. The Area Under the Curve (AUC) was statistically significant in VEGF as diagnostic marker at Day 2 and 3 of illness with sensitivity of 80.00%-100.00% and specificity of 76.47%-80.00%. The predictive model with AUC of 0.84 (p

Successful intravenous thrombolysis of a wake-up stroke with underlying valvular atrial fibrillation

Shahedah KK, Khoo CS, Wan Nur Nafisah WY, Ng CF, Noor Ashikin I, Mohd Naim MY, et al.

J R Coll Physicians Edinb, 2018 Sep;48(3):239-241.

PMID: 30191912 DOI: 10.4997/JRCPE.2018.308

A 42-year-old female admitted with new-onset atrial fibrillation had a wake-up stroke on the high-dependency unit and the time last seen well (TLSW) was 6.5 h. She suffered left-sided body weakness and her National Institutes of Health Stroke Scale (NIHSS) score was 17. An emergency CT perfusion showed right M1 segment occlusion with more than 50% penumbra. She was given recombinant tissue plasminogen activator (r-tPA) at 9 h from TLSW. An immediate diagnostic angiogram with intention to treat, owing to the presence of large vessel occlusion, showed complete reperfusion after intravenous r-tPA. She was discharged with NIHSS of 2, and at 3-month follow up her Modified Rankin Scale was 0. We demonstrated a successful reperfusion and excellent clinical recovery with intravenous thrombolysis in a patient who presented with a wake-up stroke with underlying valvular atrial fibrillation despite evidence of large vessel occlusion.

Fulltext PLPBP mutations cause variable phenotypes of developmental and epileptic encephalopathy

Shiraku H, Nakashima M, Takeshita S, Khoo CS, Haniffa M, Ch'ng GS, et al.

Epilepsia Open, 2018 Dec;3(4):495-502.

PMID: 30525118 DOI: 10.1002/epi4.12272

Objective: Vitamin B6-dependent epilepsies are treatable disorders caused by variants in several genes, such as ALDH7A1,PNPO, and others. Recently, biallelic variants in PLPBP, formerly known as PROSC, were identified as a novel cause of vitamin B6-dependent epilepsies. Our objective was to further delineate the phenotype of PLPBP mutation.

Methods: We identified 4 unrelated patients harboring a total of 4 variants in PLPBP, including 3 novel variants, in a cohort of 700 patients with developmental and epileptic encephalopathies. Clinical information in each case was collected.

Results: Each patient had a different clinical course of epilepsy, with seizure onset from the first day of life to 3 months of age. Generalized tonic-clonic seizures were commonly noted. Myoclonic seizures or focal seizures were also observed in 2 patients. Interictal electroencephalography showed variable findings, such as suppression burst, focal or multifocal discharges, and diffuse slow activity. Unlike previous reports, all the patients had some degree of intellectual disability, although some of them had received early treatment with vitamin B6, suggesting that different mutation types influence the severity and outcome of the seizures.

Significance: PLPBP variants should be regarded as among the causative genes of developmental and epileptic encephalopathy, even when it occurs after the neonatal period. Early diagnosis and proper treatment with pyridoxine or pyridoxal phosphate is essential to improve the neurologic prognosis in neonates or young children with poorly controlled seizures.

Fulltext First Reported Case of Neuroleptospirosis Complicated With Anton's Syndrome

Saeed N, Khoo CS, Remli R, Law ZK, Periyasamy P, Osman SS, et al.

Front Neurol, 2018;9:966.

PMID: 30564184 DOI: 10.3389/fneur.2018.00966

Leptospirosis is a spirochetal zoonotic disease with a wide clinical spectrum, often underdiagnosed especially when presented as an acute neurological manifestation. We report a case of a 24-year-old man with serologically positive leptospirosis, who presented with altered sensorium, seizures and subsequently developed cortical blindness. His brain MRI revealed bilateral occipital and later parietal lobe cerebritis.

Fulltext To Pace or Not To Pace? A Narrative Review of VIP Syndrome

Khoo CS

Perm J, 2018;22:18-081.

PMID: 30227913 DOI: 10.7812/TPP/18-081

Elbow clonus

Arifin NM, Khoo CS

Neurol Clin Pract, 2019 Feb;9(1):e10.

PMID: 30859015 DOI: 10.1212/CPJ.0000000000000558

Fulltext A rare extrapyramidal manifestation in a patient with primary central nervous system lymphoma

Tee TY, Khoo CS, Ibrahim NM, Osman SS

Neurol India, 2019 3 13;67(1):297-299.

PMID: 30860142 DOI: 10.4103/0028-3886.253620

Fulltext Prominent Oromandibular Dystonia as Levodopa-induced Dyskinesia in Idiopathic Parkinson's Disease

Tee TY, Khoo CS, Norlinah MI

Mov Disord Clin Pract, 2019 Apr;6(4):330-331.

PMID: 31061844 DOI: 10.1002/mdc3.12759

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.

Modified French Osteotomy for Humeroradial Synostosis in a Child with Multiple Synostoses Syndrome: A Case Report

Sahdi H, Rasit AH, Khoo CS, Bojeng A, Nur-Alyana BA

Malays Orthop J, 2019 Jul;13(2):52-55.

PMID: 31467654 DOI: 10.5704/MOJ.1907.011

Congenital humeroradial synostosis can occur as an isolated clinical entity or as part of a syndrome. Bilateral elbow fixed flexion deformity is very incapacitating and challenging to treat. Here we present the case of a boy with fixed flexion deformity of both elbows due bilateral humeroradial synostosis. Other characteristic features of multiple synostoses syndrome were also present in this child, his elder brother and mother. We elected to improve the position of the right elbow by adapting the modified French osteotomy described by Bellemore et al.

Teaching NeuroImages: Neuroimaging in hemiplegic migraine

Tee TY, Khoo CS, Raymond AA, Syazarina SO

Neurology, 2019 08 06;93(6):e626-e627.

PMID: 31383811 DOI: 10.1212/WNL.0000000000007905

Fulltext A case series of fetal valproate syndrome in the Republic of Crimea

Rybalko ON, Kaladze NN, Sukhareva IA, Khoo CS

J Neurosci Rural Pract, 2019 Oct;10(4):700-702.

PMID: 31831992 DOI: 10.1055/s-0039-1700599

Valproic acid or valproate is a well-recognized potent teratogen. Antenatal exposure to this drug can cause fetal valproate syndrome (FVS), which is a constellation of distinctive dysmorphic features and congenital malformations. Despite an abundance of reports and registries about this syndrome, there is lack of information from Russia, in particular, the Republic of Crimea. We herein describe two cases of FVS from our registry.

Fulltext A rare but treatable cause of recurrent chest pain - Ictal chest pain

Khoo CS, Lee D, Park KM, In Lee B, Kim SE

BMC Neurol, 2019 Dec 30;19(1):348.

PMID: 31888520 DOI: 10.1186/s12883-019-1575-0

BACKGROUND: Chest pain as the primary manifestation of epilepsy is extremely rare and has only been reported once to date.

CASE PRESENTATION: We herein describe a 47-year-old woman with recurrent chest pain for 3 years. The cause of her chest pain remained elusive despite extensive investigations including comprehensive cardiac work-up. She was referred to the neurology clinic for one episode of confusion. Video-electroencephalographic monitoring detected unequivocal ictal changes during her habitual chest pain events. She has remained chest pain (seizure) free with a single antiseizure drug.

CONCLUSIONS: This case underlines the importance of epilepsy as a rare yet treatable cause of recurrent chest pain. Further studies are required to determine the pathophysiology of ictal chest pain.

Displaying publications 1 - 20 of 54 in total