Displaying publications 41 - 60 of 71 in total

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  1. Introduction: Nipah virus--discovery and origin
    Chua KB
    Curr. Top. Microbiol. Immunol., 2012;359:1-9.
    PMID: 22782307 DOI: 10.1007/82_2012_218
    Until the Nipah outbreak in Malaysia in 1999, knowledge of human infections with the henipaviruses was limited to the small number of cases associated with the emergence of Hendra virus in Australia in 1994. The Nipah outbreak in Malaysia alerted the global public health community to the severe pathogenic potential and widespread distribution of these unique paramyxoviruses. This chapter briefly describes the initial discovery of Nipah virus and the challenges encountered during the initial identification and characterisation of the aetiological agent responsible for the outbreak of febrile encephalitis. The initial attempts to isolate Nipah virus from the bat reservoir host are also described.
    Matched MeSH terms: Encephalitis, Viral/cerebrospinal fluid; Henipavirus Infections/cerebrospinal fluid
  2. Fulltext Pneumocranium secondary to halo vest pin penetration through an enlarged frontal sinus
    Cheong ML, Chan CY, Saw LB, Kwan MK
    Eur Spine J, 2009 Jul;18 Suppl 2:269-71.
    PMID: 19390875 DOI: 10.1007/s00586-009-1004-y
    We present a case report of a patient with pneumocranium secondary to halo vest pin penetration and a review of literature. The objectives of this study are to report a rare complication of halo vest pin insertion and to discuss methods of prevention of this complication. Halo vest orthosis is a commonly used and well-tolerated upper cervical spinal stabilizing device. Reports of complications related to pin penetration is rare and from our review, there has been no reports of pneumocranium occurring from insertion of pins following standard anatomical landmarks. A 57-year-old male sustained a type 1 traumatic spondylolisthesis of C2/C3 following a motor vehicle accident. During application of the halo vest, penetration of the left anterior pin through the abnormally enlarged frontal sinus occurred. The patient developed headache, vomiting and CSF rhinorrhoea over his left nostril. He was treated with intravenous Ceftriaxone for 1 week. This resulted in resolution of his symptoms as well as the pneumocranium. In conclusion, complications of halo vest pin penetration are rare and need immediate recognition. Despite the use of anatomical landmarks, pin penetration is still possible due to aberrant anatomy. All patients should have a skull X-ray with a radio-opaque marker done prior to placement of the halo vest pins and halo vest pins have to be inserted by experienced personnel to enable early detection of pin penetration.
    Matched MeSH terms: Cerebrospinal Fluid Rhinorrhea/drug therapy; Cerebrospinal Fluid Rhinorrhea/etiology*
  3. Endoscopic transpterygoidal repair of a large cranial defect with cerebrospinal fluid leak in a patient with extensive osteoradionecrosis of the skull base: case report and technical note
    Brand Y, Lim E, Waran V, Prepageran N
    J Laryngol Otol, 2015 Dec;129(12):1243-7.
    PMID: 26412297 DOI: 10.1017/S0022215115002601
    Endoscopic endonasal techniques have recently become the method of choice in dealing with cerebrospinal fluid leak involving the anterior cranial fossa. However, most surgeons prefer an intracranial approach when leaks involve the middle cranial fossa. This case report illustrates the possibilities of using endoscopic techniques for cerebrospinal fluid leaks involving the middle fossa.
    Matched MeSH terms: Cerebrospinal Fluid Leak/etiology; Cerebrospinal Fluid Leak/surgery*
  4. Diagnosis of Guillain-Barré syndrome and validation of the Brighton criteria in Malaysia
    Tan CY, Razali SNO, Goh KJ, Shahrizaila N
    J Peripher Nerv Syst, 2020 09;25(3):256-264.
    PMID: 32511817 DOI: 10.1111/jns.12398
    We aimed to evaluate the key diagnostic features of Guillain-Barré syndrome (GBS) in Malaysian patients and validate the Brighton criteria. This was a retrospective study of patients presenting with GBS and Miller Fisher syndrome (MFS) between 2010 and 2019. The sensitivity of the Brighton criteria was evaluated. A total of 128 patients (95 GBS, 33 MFS) were included. In the GBS cohort, 92 (97%) patients presented with symmetrical limb weakness. Reflexes were depressed or absent in 90 (95%) patients. Almost all patients (94, 99%) followed a monophasic disease course, with 5 (5%) patients experiencing treatment-related fluctuations. Cerebrospinal fluid (CSF) albuminocytological dissociation was seen in 62/84 (73%) patients. Nerve conduction study (NCS) revealed neuropathy in 90/94 (96%) patients. In GBS patients with complete dataset (84), 56 (67%) patients reached level 1 of the Brighton criteria, 21 (25%) reached level 2, 3 (4%) reached level 3, and 4 (5%) reached level 4. In MFS, the clinical triad was present in 25 (76%) patients. All patients had a monophasic course. CSF albuminocytological dissociation was present in 10/25 (40%) patients. NCS was normal or showed sensory neuropathy in 25/33 (76%) patients. In MFS patients with complete dataset (25), 5 (20%) patients reached level 1 of the Brighton criteria, 14 (56%) reached level 2, 2 (8%) reached level 3, and 4 (16%) reached level 4. Inclusion of antiganglioside antibodies improved the sensitivity of the Brighton criteria in both cohorts. In the Malaysian cohort, the Brighton criteria showed a moderate to high sensitivity in reaching the highest diagnostic certainty of GBS, but the sensitivity was lower in MFS.
    Matched MeSH terms: Miller Fisher Syndrome/cerebrospinal fluid; Guillain-Barre Syndrome/cerebrospinal fluid
  5. Fulltext Activation of the kynurenine pathway and increased production of the excitotoxin quinolinic acid following traumatic brain injury in humans
    Yan EB, Frugier T, Lim CK, Heng B, Sundaram G, Tan M, et al.
    J Neuroinflammation, 2015 May 30;12:110.
    PMID: 26025142 DOI: 10.1186/s12974-015-0328-2
    During inflammation, the kynurenine pathway (KP) metabolises the essential amino acid tryptophan (TRP) potentially contributing to excitotoxicity via the release of quinolinic acid (QUIN) and 3-hydroxykynurenine (3HK). Despite the importance of excitotoxicity in the development of secondary brain damage, investigations on the KP in TBI are scarce. In this study, we comprehensively characterised changes in KP activation by measuring numerous metabolites in cerebrospinal fluid (CSF) from TBI patients and assessing the expression of key KP enzymes in brain tissue from TBI victims. Acute QUIN levels were further correlated with outcome scores to explore its prognostic value in TBI recovery.

    METHODS: Twenty-eight patients with severe TBI (GCS ≤ 8, three patients had initial GCS = 9-10, but rapidly deteriorated to ≤8) were recruited. CSF was collected from admission to day 5 post-injury. TRP, kynurenine (KYN), kynurenic acid (KYNA), QUIN, anthranilic acid (AA) and 3-hydroxyanthranilic acid (3HAA) were measured in CSF. The Glasgow Outcome Scale Extended (GOSE) score was assessed at 6 months post-TBI. Post-mortem brains were obtained from the Australian Neurotrauma Tissue and Fluid Bank and used in qPCR for quantitating expression of KP enzymes (indoleamine 2,3-dioxygenase-1 (IDO1), kynurenase (KYNase), kynurenine amino transferase-II (KAT-II), kynurenine 3-monooxygenase (KMO), 3-hydroxyanthranilic acid oxygenase (3HAO) and quinolinic acid phosphoribosyl transferase (QPRTase) and IDO1 immunohistochemistry.

    RESULTS: In CSF, KYN, KYNA and QUIN were elevated whereas TRP, AA and 3HAA remained unchanged. The ratios of QUIN:KYN, QUIN:KYNA, KYNA:KYN and 3HAA:AA revealed that QUIN levels were significantly higher than KYN and KYNA, supporting increased neurotoxicity. Amplified IDO1 and KYNase mRNA expression was demonstrated on post-mortem brains, and enhanced IDO1 protein coincided with overt tissue damage. QUIN levels in CSF were significantly higher in patients with unfavourable outcome and inversely correlated with GOSE scores.

    CONCLUSION: TBI induced a striking activation of the KP pathway with sustained increase of QUIN. The exceeding production of QUIN together with increased IDO1 activation and mRNA expression in brain-injured areas suggests that TBI selectively induces a robust stimulation of the neurotoxic branch of the KP pathway. QUIN's detrimental roles are supported by its association to adverse outcome potentially becoming an early prognostic factor post-TBI.

    Matched MeSH terms: Neurotoxins/cerebrospinal fluid*; Quinolinic Acid/cerebrospinal fluid*
  6. Fulltext Syndrome of inappropriate antidiuretic hormone caused by continuous lumbar spinal fluid drainage after transphenoidal surgery
    Norlela S, Azmi KN, Khalid BA
    Singapore Med J, 2006 Jan;47(1):75-6.
    PMID: 16397727
    A 53-year-old acromegalic woman had cerebrospinal fluid rhinorrhoea following transphenoidal surgery for a pituitary microadenoma. A continuous lumbar spinal fluid drainage catheter was inserted and on the sixth postoperative day, she developed hyponatremia with features of syndrome of inappropriate antidiuretic hormone (SIADH) requiring hypertonic saline administration. Over-drainage is potentially hazardous and close biochemical monitoring is required. To our knowledge, this is the first reported case of SIADH caused by continuous lumbar drainage in an adult.
    Matched MeSH terms: Cerebrospinal Fluid Rhinorrhea/etiology; Cerebrospinal Fluid Rhinorrhea/therapy
  7. Fulltext Complete genome analysis and characterization of neurotropic dengue virus 2 cosmopolitan genotype isolated from the cerebrospinal fluid of encephalitis patients
    Ngwe Tun MM, Muthugala R, Nabeshima T, Soe AM, Dumre SP, Rajamanthri L, et al.
    PLoS One, 2020;15(6):e0234508.
    PMID: 32555732 DOI: 10.1371/journal.pone.0234508
    Dengue virus (DENV) infection remains a major public health concern in many parts of the world, including Southeast Asia and the Americas. Sri Lanka experienced its largest dengue outbreak in 2017. Neurological symptoms associated with DENV infection have increasingly been reported in both children and adults. Here, we characterize DENV type 2 (DENV-2) strains, which were isolated from cerebrospinal fluid (CSF) and/or serum of patients with dengue encephalitis. Acute serum and CSF samples from each patient were subjected to dengue-specific non-structural protein 1 (NS1) antigen test, IgM and IgG enzyme-linked immunosorbent assay (ELISA), virus isolation, conventional and real-time polymerase chain reaction (PCR), and next-generation sequencing (NGS). Among the 5 dengue encephalitis patients examined, 4 recovered and 1 died. DENV-2 strains were isolated from serum and/or CSF samples of 3 patients. The highest viral genome levels were detected in the CSF and serum of the patient who succumbed to the illness. A phylogenetic tree revealed that the DENV-2 isolates belonged to a new clade of cosmopolitan genotype and were genetically close to strains identified in China, South Korea, Singapore, Malaysia, Thailand, and the Philippines. According to the NGS analysis, greater frequencies of nonsynonymous and synonymous mutations per gene were identified in the nonstructural genes. The full genomes of serum- and CSF-derived DENV-2 from the same patient shared 99.7% similarity, indicating that the virus spread across the blood-brain barrier. This is the first report to describe neurotropic DENV-2 using whole-genome analysis and to provide the clinical, immunological, and virological characteristics of dengue encephalitis patients during a severe dengue outbreak in Sri Lanka in 2017.
    Matched MeSH terms: Dengue/cerebrospinal fluid; Encephalitis/cerebrospinal fluid
  8. Endonasal endoscopic repair of anterior skull-base fistulas: the Kuala Lumpur experience
    Gendeh BS, Mazita A, Selladurai BM, Jegan T, Jeevanan J, Misiran K
    J Laryngol Otol, 2005 Nov;119(11):866-74.
    PMID: 16354338
    The purpose of this retrospective study is to determine the pattern of cerebrospinal fluid (CSF) rhinorrhoea presenting to our tertiary referral centre in Kuala Lumpur and to assess the clinical outcomes of endonasal endoscopic surgery for repair of anterior skull base fistulas. Sixteen patients were treated between 1998 and 2004. The aetiology of the condition was spontaneous in seven and acquired in nine patients. In the acquired category, three patients had accidental trauma and this was iatrogenic in six patients (five post pituitary surgery), with one post endoscopic sinus surgery (ESS). Imaging included computed tomography (CT) scan and magnetic resonance imaging (MRI). Endoscopic repair is less suited for defects in the frontal sinuses with prominent lateral extension and defects greater than 1.5 cm in diameter involving the skull base. Fascia lata, middle turbinate mucosa, nasal perichondrium and ear fat ('bath plug') were the preferred repair materials in the anterior skull base, whereas fascia lata, cartilage and abdominal fat obliteration was preferentially used in the sphenoid leak repair. Intrathecal sodium flourescein helped to confirm the site of CSF fistula in 81.3 per cent of the patients. Ninety per cent of the patients who underwent 'bath plug' repair were successful. The overall success rate for a primary endoscopic procedure was 87.5 per cent, although in two cases a second endoscopic procedure was required for closure. In the majority of cases endoscopic repair was successful, and this avoids many of the complications associated with craniotomy, particularly in a young population. Therefore it is our preferred option, but an alternative procedure should be utilized should this prove necessary.
    Matched MeSH terms: Cerebrospinal Fluid Rhinorrhea/diagnosis; Cerebrospinal Fluid Rhinorrhea/etiology; Cerebrospinal Fluid Rhinorrhea/surgery*
  9. Fulltext A rare case of idiopathic intracranial hypertension in prepubertal age
    Nurul Najieha Amir, Nor Fadhilah Mohamad, Mimiwati Zahari, Choo May May
    Malaysian Journal of Medicine and Health Sciences, 2020;16(3):331-333.
    MyJurnal
    A 2-year-old girl who was under genetic follow up for developmental delay and dysmorphism was accidentally found to have bilateral optic disc swelling during screening examination. She showed response to optokinetic drum examination and the anterior segment examination was unremarkable. Optic disc swellings were seen in both eyes. Lumbar puncture shows high opening pressure of 50 cm H2O with unremarkable CSF analysis. MRI of brain was done and showed features in keeping with mild cerebral atrophy, with no evidence of hydrocephalus or space oc- cupying lesion. She was diagnosed with idiopathic intracranial hypertension and oral acetazolamide 125mg bd was commenced. However, papilloedema persist despite medical therapy. Ventriculoperitonel shunt was inserted to re- duce the csf pressure. This case report highlights the importance of considering idiopathic intracranial hypertension as a cause of optic disc swelling in pre-pubertal children because delay in diagnosis and treatment may permanently affect visual function especially in children.
    Matched MeSH terms: Cerebrospinal Fluid Pressure
  10. Prophylactic antibiotics in children
    Sinniah D
    Med J Malaya, 1971 Dec;26(2):84-9.
    PMID: 4260865
    Matched MeSH terms: Cerebrospinal Fluid Otorrhea/drug therapy; Cerebrospinal Fluid Rhinorrhea/drug therapy
  11. Fulltext Comparison between Ventriculosubgaleal Shunt and Extraventricular Drainage to Treat Acute Hydrocephalus in Adults
    Nee LS, Harun R, Sellamuthu P, Idris Z
    Asian J Neurosurg, 2017 Oct-Dec;12(4):659-663.
    PMID: 29114279 DOI: 10.4103/ajns.AJNS_122_16
    Context: Hydrocephalus, due to subarachnoid or intraventricular hemorrhage (IVH), meningitis, or tumor compression, is usually transient and may resolve after treatment. There are several temporary methods of cerebrospinal fluid (CSF) diversion, none of it is superior to the other, and the decision is based on its various etiologies and factors. Ventriculosubgaleal shunt (VSGS) is one of those temporary measures, which is a simple and rapid CSF decompression method without causing electrolyte and nutritional losses.

    Aims: The aim is to study the efficacy of VSGS for temporary CSF diversion, compared to extraventricular drainage (EVD) in adult hydrocephalus patients; to evaluate the outcome in terms of avoiding a permanent shunt, and to look for incidences of their complications.

    Settings and Design: This was a retrospective observational study.

    Subjects and Methods: The data were acquired from case notes of fifty patients with acute hydrocephalus: 26 secondary to IVH, 10 from aneurysm rupture, 8 posttrauma, and 6 from infection. All these patients had undergone CSF diversion in Hospital Queen Elizabeth II, Sabah, Malaysia, between 2013 and 2015. The patients were followed up from the date of treatment until the resolution of hydrocephalus, where parameters such as shunt dependency and complications were documented.

    Statistical Analysis Used: All analyses were carried out using Statistical Packages for the Social Sciences Version 22.0. Chi-squared test or Fisher's exact test is used for univariate analysis of categorical variables.

    Results: A total of 21 (42%) patients underwent EVD insertion and 29 (58%) underwent VSGS insertion. Thirty-seven (74%) patients did not require a permanent shunt; 24 (64.8%) of them were from the VSGS group (P = 0.097). EVD had more intracranial complications (44.1%) compared with VSGS (23.5%), with a statistically significant P = 0.026.

    Conclusions: VSGS is a safe and viable option for adult hydrocephalus patients, with the possibility of continuation of the treatment for such patients in nonneurosurgical centers, as opposed to patients with EVDs. Furthermore, even though this method had no statistical difference in avoiding a permanent ventriculoperitoneal shunt, VSGS has statistically significant less intracranial complications compared with EVD.
    Matched MeSH terms: Cerebrospinal Fluid Shunts
  12. Fulltext Paradoxical Manifestation is Common in HIV-negative Tuberculous Meningitis
    Tai ML, Nor HM, Kadir KA, Viswanathan S, Rahmat K, Zain NR, et al.
    Medicine (Baltimore), 2016 Jan;95(1):e1997.
    PMID: 26735523 DOI: 10.1097/MD.0000000000001997
    Paradoxical manifestation is worsening of pre-existing tuberculous lesion or appearance of new lesions in patients whose condition initially improved with antituberculous treatment. Our hypothesis was that paradoxical manifestation in non-HIV tuberculous meningitis (TBM) patients was underestimated and this could contribute to patients' prognosis. This was the first systemic study of paradoxical manifestation in HIV-negative TBM patients. Between 2009 and 2014, TBM patients were studied prospectively in 2 hospitals. Clinical features, cerebrospinal fluid, and radiological findings were monitored. Paradoxical manifestation was divided into definite (4 weeks or more) and probable (between 14 and 27 d) after commencement of antituberculous treatment. Forty-one non-HIV TBM patients were recruited. Definite paradoxical manifestation occurred in 23/41 (56%) of the patients. Time to onset of paradoxical manifestation was between 28 days and 9 months, and majority was between 28 and 50 days. Neuroimaging manifestation in the brain (22/41 patients, 54%) and clinical manifestation (22/41 patients, 54%) were most commonly seen, followed by cerebrospinal fluid manifestation (7/41 patients, 17%). Neuroimaging changes most commonly seen were worsening of leptomeningeal enhancement, new infarcts, new tuberculomas, and enlargement of tuberculoma. Initial Computed Tomography Angiography/magnetic resonance angiography brain showed vasculitis in 14 patients, with 2 (12.5%) showing paradoxical vasculitis during follow-up. Recurrence of the paradoxical manifestation was seen in 7/23 (30%) of the patients. More than half (14/23, 61%) of the patients improved, 6 (26%) patients died, and 3 (13%) patients had persistent neurological deficit. Paradoxical manifestation was very common in non-HIV TBM patients. Neuroimaging paradoxical manifestation of 2-4 weeks may not be paradoxical manifestation but could be delayed treatment response.
    Matched MeSH terms: Tuberculosis, Meningeal/cerebrospinal fluid
  13. Meningitis Caused by Rhodotorula mucilaginosa in HIV-Infected Patient: A Case Report and Review of the Literature
    Mohd Nor F, Tan LH, Na SL, Ng KP
    Mycopathologia, 2015 Aug;180(1-2):95-8.
    PMID: 25739670 DOI: 10.1007/s11046-015-9879-0
    Rhodotorula species are increasingly being identified as a cause of fungal infection in the central nervous system, especially in patients with compromised immunity. The diagnosis could easily be missed due to low index of suspicion, as cryptococcus meningitis and cerebral toxoplasmosis are more common amongst immunocompromised hosts. To date, there are six cases of Rhodotorula-related meningitis reported, and three are associated with human immunodeficiency virus infection. In this report, a case of a Malaysian male with underlying human immunodeficiency virus infection who developed Rhodotorula mucilaginosa meningitis is presented. High-grade fever and severe headaches were the complaints presented in three previous case reports. India ink and nigrosin stainings were performed in the two previous reports and both revealed positive results. R. mucilaginosa were isolated from the culture of the patient's cerebrospinal fluid in all three previous reports. Predominant lymphocyte infiltration in the cerebrospinal fluid examination was documented in two reports. CD4 counts were above 100/µl in two previously published reports, while another report documented CD4 count as 56/µl. Amphotericin B and itraconazole are identified to be the first line of antifungal used and as the maintenance therapy, respectively. The possibility of relapse cannot be excluded as it was reported in the first report. It was also revealed that the current case has almost similar clinical presentation and therapeutic outcome as compared to the published reports, but some differences in diagnostic details were to be highlighted.
    Matched MeSH terms: Cerebrospinal Fluid/microbiology
  14. Fulltext Comparative profile of circulating antigenic peptides in CSF, serum & urine from patients with neurocysticercosis diagnosed by immunoblotting
    Sahu PS, Parija S, Kumar D, Jayachandran S, Narayan S
    Parasite Immunol., 2014 Oct;36(10):509-21.
    PMID: 24965663 DOI: 10.1111/pim.12124
    Traditionally serum and/or CSF specimens have been used for detection of either specific antibodies or antigens as a supportive diagnosis of NCC. However, in recent days, much interest has been shown employing noninvasive specimens such as urine. In our study, we identified and compared a profile of circulating antigenic peptides of parasite origin in three different body fluids (CSF, serum and urine) obtained from confirmed NCC cases and control subjects. The circulating antigenic peptides were resolved by SDS-PAGE and subjected to immunoblotting. For confirmation of their origin as parasite somatic or excretory secretory (ES) material, immunoreactivity was tested employing affinity purified polyclonal Taenia solium metacestode anti-somatic or ES antibodies, respectively. Only lower molecular weight antigenic peptides were found circulating in urine in contrast to serum and CSF specimens. Few somatic peptides were identified to be 100% specific for NCC (19·5 kDa in all three specimens; 131, 70 kDa in CSF and serum only; 128 kDa in CSF only). Similarly, the specific ES peptides detected were 32 kDa (in all three specimens), 16·5 kDa (in serum and CSF only), and 15 kDa (urine only). A test format detecting either one or more of these specific peptides would enhance the sensitivity in diagnosis of NCC.
    Matched MeSH terms: Antigens, Helminth/cerebrospinal fluid
  15. Fatal encephalitis due to Nipah virus among pig-farmers in Malaysia
    Chua KB, Goh KJ, Wong KT, Kamarulzaman A, Tan PS, Ksiazek TG, et al.
    Lancet, 1999 Oct 9;354(9186):1257-9.
    PMID: 10520635
    Between February and April, 1999, an outbreak of viral encephalitis occurred among pig-farmers in Malaysia. We report findings for the first three patients who died.
    Matched MeSH terms: Antibodies, Viral/cerebrospinal fluid
  16. Diagnosis of nipah virus encephalitis by electron microscopy of cerebrospinal fluid
    Chow VT, Tambyah PA, Yeo WM, Phoon MC, Howe J
    J Clin Virol, 2000 Dec;19(3):143-7.
    PMID: 11090749
    BACKGROUND: between 1998 and 1999, an outbreak of potentially fatal viral encephalitis erupted among pig farm workers in West Malaysia, and later spread to Singapore where abattoir workers were afflicted. Although Japanese encephalitis virus was initially suspected, the predominant aetiologic agent was subsequently confirmed to be Nipah virus, a novel paramyxovirus related to but distinct from Hendra virus.

    OBJECTIVE: to describe a case of Nipah virus encephalitis in a pig farm worker from Malaysia.

    STUDY DESIGN: the clinical, laboratory and radiological findings of this patient were scrutinized. Special emphasis was placed on the electron microscopic analysis of the cerebrospinal fluid (CSF) specimen from this patient.

    RESULTS: the neurological deficits indicative of cerebellar involvement were supported by the magnetic resonance imaging that showed prominent cerebellar and brainstem lesions. CSF examination provided further evidence of viral encephalitis. Complement fixation and/or RT-PCR assays were negative for Japanese encephalitis, herpes simplex, measles and mumps viruses. ELISA for detecting IgM and IgG antibodies against Hendra viral antigens were equivocal for the CSF specimen, and tested initially negative for the first serum sample but subsequently positive for the repeat serum sample. Transmission electron microscopy of negatively-stained preparations of CSF revealed enveloped virus-like structures fringed with surface projections as well as nucleocapsids with distinctive helical and herringbone patterns, features consistent with those of other paramyxoviruses, including Hendra virus.

    CONCLUSION: this case report reiterates the relevant and feasible role of diagnostic electron microscopy for identifying and/or classifying novel or emerging viral pathogens for which sufficiently specific and sensitive tests are lacking.

    Matched MeSH terms: Cerebrospinal Fluid/virology*
  17. Comparison of the complete nucleotide sequences of echovirus 7 strain UMMC and the prototype (Wallace) strain demonstrates significant genetic drift over time
    Chua BH, McMinn PC, Lam SK, Chua KB
    J Gen Virol, 2001 Nov;82(Pt 11):2629-39.
    PMID: 11602774
    The complete nucleotide sequences are reported of two strains of echovirus 7, the prototype Wallace strain (Eo7-Wallace) and a recent Malaysian strain isolated from the cerebrospinal fluid of a child with fatal encephalomyelitis (Eo7-UMMC strain). The molecular findings corroborate the serological placement of the UMMC strain as echovirus 7. Both Eo7-Wallace and Eo7-UMMC belong to the species human enterovirus B and are most closely related to echovirus 11. Eo7-UMMC has undergone significant genetic drift from the prototype strain in the 47 years that separate the isolation of the two viruses. Phylogenetic analysis revealed that Eo7-UMMC did not arise from recombination with another enterovirus serotype. The molecular basis for the severely neurovirulent phenotype of Eo7-UMMC remains unknown. However, it is shown that mutations in the nucleotide sequence of the 5' untranslated region (UTR) of Eo7-UMMC result in changes to the putative structure of the 5' UTR. It is possible that these changes contribute to the neurovirulence of Eo7-UMMC.
    Matched MeSH terms: Cerebrospinal Fluid/virology
  18. Fulltext Experience with sublabial transseptal transsphenoidal hypophysectomy at the Universiti Kebangsaan Malaysia
    Said H, Cheah F, Mohamed AS, Hadi AR
    Med J Malaysia, 1993 Jun;48(2):222-4.
    PMID: 8350800
    The transseptal transsphenoidal hypophysectomy has become a relatively frequent procedure in recent years. We performed 20 such procedures between January 1984 and December 1987 for various pituitary disorders. Significant complications such as CSF rhinorrhea, meningitis, diabetes insipidus, haemorrhage and septal perforation are discussed. The mortality rate for the series was 5%. In analysing the data, we feel that this technique of hypophysectomy is a safe procedure.
    Matched MeSH terms: Cerebrospinal Fluid Rhinorrhea/etiology
  19. Basal skull fractures. A prospective study of 100 consecutive admissions
    Chee CP, Ali A
    Aust N Z J Surg, 1991 Aug;61(8):597-602.
    PMID: 1867613
    A prospective study of 100 consecutive patients with basal skull fracture admitted to the University Hospital, Kuala Lumpur between July 1986 and October 1988 was carried out to study its epidemiological pattern, clinical and radiological presentations, mechanisms of injury, time interval between accidents and neurosurgical referrals, complications and outcomes. Two-thirds of the patients were between 20 and 50 years old and 79% were male. Half of the injured were motorcyclists and 22% were pedestrians. Three-quarters of the patients were seen within an hour after injury. Thirty-two patients had intracranial haematomas: 14 subdural, 9 extradural and 9 intracerebral. Three patients developed meningitis (two after operations) and six developed epilepsy. Eighteen patients died, but good recovery resulted in 70 patients at follow-up of 1 to 28 months. A small subgroup of 15 patients with severe ear and nose bleeding as a result of basal venous sinus tear died within a few hours despite aggressive resuscitation, probably due to underlying severe brain stem injury. The implication of the high incidence of basal skull fractures in motorcyclists, despite the enforcement of crash helmets is discussed, with possible mechanisms proposed.
    Matched MeSH terms: Cerebrospinal Fluid Otorrhea/epidemiology
  20. Hydrocephalic children presenting to a Malaysian community-based university hospital over an 8-year period
    Abdullah J, Naing NN
    Pediatr Neurosurg, 2001 Jan;34(1):13-9.
    PMID: 11275782
    There are few local statistics on the incidence of hydrocephalus and the outcome of hydrocephalic shunts in the South East Asian region. We report a retrospective study on 285 hydrocephalic patients who underwent shunting procedures between 1990 and 1998 at the University Hospital Science Malaysia, a regional referral center. Multiple logistic regression analysis was applied to predict determinants of outcome in relation to the timing of diagnosis, other congenital abnormalities associated with the hydrocephalus, timing of surgery and cortical thickness from CT scan. The relationship of shunt infection was correlated to the age of the patient and surgical procedure. The predictors for developmental outcome reported by this study were age at diagnosis, type of brain abnormalities and gender. Time of operation and cortical thickness did not contribute to the outcome.
    Matched MeSH terms: Cerebrospinal Fluid Shunts*
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