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Fulltext Post Stroke Laughter – A Case Report

Amarpreet, K., Nor Zuraida, Z., Ng, C.G., Aida, S.A.

Malaysian Journal of Psychiatry, 2008;17(2):1-5.
MyJurnal

Pathological laughing or crying (PLC) were recognized after the occurrence of stroke, with a prevalence of 15% to 18%. There is no apparent triggering stimulus, and is often misdiagnosed as a mood disorder as it is a disorder of emotional expression rather than a primary disturbance of feeling. We reported a case of a 32 year old lady, who presented with giddiness and altered consciousness progressing to fever and neck stiffness, who’s CT showed a massive left cerebellar infarct. No risk factors were identified. Psychiatrically, she developed sudden crying spells after one month and a diagnosis of Major Depressive Disorder was made with subsequent commencement of anti-depressants. A week later, she developed continuous inappropriate laughter without the feeling of elation, which was beyond her control. There were no symptoms of mania or psychosis.

Matched MeSH terms: Consciousness
Fulltext Malaysian Hybridity: Issues of Kinship Practices and Identity Crisis

ALICIA LOH CHUI YINN, NWANESI PETER KARUBI

Trends in Undergraduate Research, 2018;1(1):0-0.
MyJurnal

This article explores the issues of hybridity and its impacts and bearing to identity crisis in relation to kinship practices among the Euro-Asian families in Malaysia. To demonstrate the empirical and scientific nature of this study, qualitative methods were used whereby respondents were interviewed either face to face interview or through audio interviews. Furthermore, focus Group Discussion and empirical observation were fully utilized to obtain and analyzed for both quality and logical conclusion. Indeed, the data from the field demonstrate that the offspring of mixed marriages had either conscious identity crisis, unconscious or denied identity crisis or no identity crisis due to factors such as religion, socializing, education, and exposure by parents. Thus, the majority of the research respondents identified themselves based on “Others” but there are complexities to this when it comes to formal and informal identification.

Matched MeSH terms: Consciousness; Unconsciousness
Fulltext Necrotizing fasciitis of the head and neck: surgical outcomes in three cases

Shaariyah MM, Marina MB, Mohd Razif MY, Mazita A, Primuharsa Putra SH

Malays J Med Sci, 2010 Apr;17(2):51-5.
PMID: 22135538 MyJurnal

Necrotizing fasciitis of the head and neck is a rare, rapidly progressive infection involving the skin, subcutaneous tissue and fascia. We report three cases of necrotizing fasciitis that differ in their presentation and outcome. The first case involves a patient who presented with progressively enlarging anterior neck swelling that was later complicated by dehydration and reduced consciousness. The second case is a patient with neck swelling and ipsilateral otorrhea. The third case concerns a patient with a buccal ulcer complicated by ipsilateral facial swelling. All of them underwent a fasciotomy with wound debridement with the addition of a cortical mastoidectomy in the second case. Two of these patients recovered well. Unfortunately, the third case succumbed to death due to airway compromise and septicaemia. We advocate the importance of eradicating the source of infection followed by frequent, meticulous wound dressing and strict blood sugar control to obtain better outcomes in managing necrotizing fasciitis of the head and neck. However, involvement of the airway carries a grave prognosis despite aggressive treatment.

Matched MeSH terms: Consciousness
Fulltext Acute Disseminated Encephalomyelitis (ADEM) Presenting with Bilateral Optic Neuritis

Sapuan S, Basri H

Malays J Med Sci, 2007 Jan;14(1):71-4.
PMID: 22593657 MyJurnal

A 43-year old lady presented with progressive loss of vision in both eyes followed by rapid deterioration of consciousness within the next few days. This was preceded by a viral infection one week before her presentation. At presentation she had evidence of meningism and signs of bilateral upper motor neuron lesions and was managed initially as acute meningoencephalitis with antibiotics. The brain CT was within normal limits but subsequent MRI of the brain revealed multiple foci of hyperintense lesions on T2-weighted and FLAIR images. The cerebrospinal fluid examination revealed lymphocytosis, and normal protein and glucose levels. Cultures of the CSF were negative. She was managed as acute disseminated encephalomyelitis (ADEM) with high-dose of intravenous methlyprednisolone one gram/day for three consecutive days followed by oral prednisolone 60 mg/day. Despite the management she lapsed into coma and succumbed to her illness nine days after admission.

Matched MeSH terms: Consciousness
Automation of anaesthesia: a review on multivariable control

Chang JJ, Syafiie S, Kamil R, Lim TA

J Clin Monit Comput, 2015 Apr;29(2):231-9.
PMID: 24961365 DOI: 10.1007/s10877-014-9590-6

Anaesthesia is a multivariable problem where a combination of drugs are used to induce desired hypnotic, analgesia and immobility states. The automation of anaesthesia may improve the safety and cost-effectiveness of anaesthesia. However, the realization of a safe and reliable multivariable closed-loop control of anaesthesia is yet to be achieved due to a manifold of challenges. In this paper, several significant challenges in automation of anaesthesia are discussed, namely model uncertainty, controlled variables, closed-loop application and dependability. The increasingly reliable measurement device, robust and adaptive controller, and better fault tolerance strategy are paving the way for automation of anaesthesia.

Matched MeSH terms: Consciousness/drug effects*
Blood parameters and electroencephalographic responses of goats to slaughter without stunning

Sabow AB, Goh YM, Zulkifli I, Sazili AQ, Kaka U, Kadi MZAA, et al.

Meat Sci, 2016 Nov;121:148-155.
PMID: 27317849 DOI: 10.1016/j.meatsci.2016.05.009

The study compared changes in blood biochemistry, hormonal and electroencephalographic indices associated with possible noxious stimuli following neck cut slaughter in conscious, non-anaesthetized versus minimally-anaesthetized goats. Ten male Boer crossbreed goats were assigned into two groups and subjected to either slaughter conscious without stunning (SWS) or slaughter following minimal anaesthesia (SMA). Hormonal responses and changes in electroencephalographic (EEG) parameters were not influenced by slaughter method. The SWS goats had higher glucose and lactate than did SMA goats. It can be concluded that the noxious stimulus from the neck cut is present in both conscious and minimally anaesthetized goats. The application of slaughter without stunning causes changes in the EEG activities that are consistent with the presence of post slaughter noxious sensory input associated with tissue damage and would be expected to be experienced as pain in goats.

Matched MeSH terms: Consciousness*
Fulltext Fatal Intracranial Hemorrhage in a Patient with Severe Dengue Fever

Sam JE, Gee TS, Wahab NA

Asian J Neurosurg, 2018 3 2;13(1):56-58.
PMID: 29492121 DOI: 10.4103/1793-5482.185056

Dengue fever has been a major cause of morbidity and mortality in subtropical and tropical countries. We report a rare case of severe dengue with spontaneous intracranial hemorrhage. A search of literature through PubMed revealed that the largest series analyzed so far only included five cases. A 47-year-old man presented with 7 days history of fever, headache, myalgia, and vomiting with hematemesis. On the day of presentation, he had reduced consciousness and an episode of generalized tonic-clonic seizure. His Glasgow Coma Scale was E1V1M3 with anisocoria. Postresuscitation computed tomography of the brain revealed a right subdural and left thalamic hemorrhage. His blood investigations revealed thrombocytopenia, dengue virus type 1 nonstructural protein antigen test was positive, dengue IgM negative, and dengue IgG positive. A right decompressive craniectomy was done. Unfortunately, the patient died soon after. Spontaneous intracranial hemorrhage in patients with dengue fever is an uncommon entity but usually carry a grave prognosis. To date, there has been no clear management guideline for such cases, as both operative and nonoperative approaches have their own inherent risks.

Matched MeSH terms: Consciousness
Fulltext Accidental self-injection of Xylazine during work: a rare case

Ganapathy, Ganesh Kumar, Dharmalingam, T. Kumaravadivel, Sathival, Mugunthan M.

Borneo Journal of Medical Sciences, 2018;12(2):47-49.
MyJurnal

Xylazine is an alpha-2agonist often used as a sedative, analgesic and muscle relaxant agent
in animals. Xylazine was not accepted by Food and Drug Administration (FDA) for human use
due to hazardous side effect such as hypotension, bradycardia, respiratory depression and coma.
This is a rare case report of a 64-year-old farmer who accidentally injected himself with Xylazine
which was supposed to be given to a fractious cow. He developed altered conscious level, hypotension, bradycardia and respiratory failure requiring mechanical ventilation. Fortunately, he
recovered and was discharged home after three days. This occurred due to improper handling of
Xylazine without standard operating procedures. Xylazine is regulated for animal use only. Therefore, effects of Xylazine toxicity in human must be emphasized for awareness on proper handling as well as for right management of its poisoning incident in future.

Matched MeSH terms: Consciousness Disorders
Early permanent cerebrospinal fluid diversion in aneurysmal subarachnoid hemorrhage: does a lower rate of nosocomial meningitis outweigh the risk of delayed cerebral vasospasm related morbidity?

Croci DM, Dalolio M, Aghlmandi S, Taub E, Rychen J, Chiappini A, et al.

Neurol Res, 2021 Jan;43(1):40-53.
PMID: 33106124 DOI: 10.1080/01616412.2020.1819091

Objective: Early permanent cerebrospinal fluid (CSF) diversion for hydrocephalus during the first 2 weeks after aneurysmal subarachnoid hemorrhage (aSAH) shortens the duration of external ventricular drainage (EVD) and reduces EVD-associated infections (EVDAI). The objective of this study was to detect any association with symptomatic delayed cerebral vasospasm (DCVS), or delayed cerebral ischemia (DCI) by the time of hospital discharge. Methods: We used a single-center dataset of aSAH patients who had received a permanent CSF diversion. We compared an 'early group' in which the procedure was performed up to 14 days after the ictus, to a 'late group' in which it was performed from the 15th day onward. Results: Among 274 consecutive aSAH patients, 39 (14%) had a permanent CSF diversion procedure with a silver-coated EVD. While the blood clot burden was similarly distributed, patients with early permanent CSF diversion (20 out of 39; 51%) had higher levels of consciousness on admission. Early permanent CSF diversion was associated with less colonized catheter, a shorter duration of extracorporeal CSF diversion (OR 0.73, 95%CI 0.58-0.92 per EVD day), and a lower rate of EVDAI (OR 0.08, 95%CI 0.01-0.80). The occurrence of CSF diversion device obstruction, the rate of symptomatic DCVS or detected DCI on computed tomography and the likelihood of a poor outcome at discharge did not differ between the two groups. Discussion: Early permanent CSF diversion lowers the occurrence of catheter colonization and infectious complication without affecting DCVS-related morbidity in good-grade aSAH patients. These findings need confirmation in larger prospective multicenter cohorts. Abbreviations: aSAH: aneurysmal subarachnoid hemorrhage; BNI: Barrow Neurological Institute Scale; CSF: Cerebrospinal fluid; DCVS: Delayed Cerebral Vasospasm; DCI: Delayed Cortical Ischemia; EKNZ: Ethik-Kommission Nordwest Schweiz; EVD: External ventricular drain; EVDAI: External ventricular drain-associated infections; GCS: Glasgow Coma Scale; IRB: Institutional Review Board; IVH: Inraventricular hemorrhage; mRS: Modified Rankin Scale; SOS: Swiss Study of Subarachnoid Hemorrhage Registry; WFNS: World Federation Neurological-Surgeon Scale.

Matched MeSH terms: Consciousness
Fulltext Paddy, piggy and Japanese encephalitis in Kerian – a case series

Rosilawati A. R., Mohd Zamri M. A.

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):40-40.
MyJurnal

Introduction: Japanese encephalitis (JE) is a vector-borne zoonotic disease caused by the Japanese encephalitis virus (JEV). Paddy fields are high risk area for JEV transmission due the presence of Culex tritaeniorhynchus as vector and wild boar as an amplifier host. Methods: We presented case reports for three patients infected with JEV residing in paddy field area from 2015 to 2018 in Kerian, Perak; illustrating the symptoms and epidemiology trend of the dis-ease. Results: All three cases live next to paddy field and were exposed during peak biting hours. They presented with fever and altered consciousness. IV Acylovir was started as one of the treatments and all had lumbar puncture for CSF testing. Two cases (adult) were confirmed JE after they had passed away. Two cases occurred during fasting month where food wastes were abundance. The source of infection was probably from wild boars that came out at night to hunt for food. Presence of C. tritaeniorhynchus was demonstrated as the main vector in these areas. Conclusion: JE has no cure and human vaccination is the main prevention method. At the moment, vector control, environmental management, chemical control and personal protection are the main mitigation strategies for this area. Further study on JEV and wild board in Kerian will be most beneficial.

Matched MeSH terms: Consciousness
A cross-cultural study of the possession-trance in Singapore

Kua EH, Sim LP, Chee KT

Aust N Z J Psychiatry, 1986 Sep;20(3):361-4.
PMID: 3467715

Possession-trance is a common culture-bound syndrome in Singapore. The characteristic features as seen in 36 young men of the three different ethnic communities are described. At follow-up four to five years later, none of the 26 who could be contacted showed any evidence of mental illness. The psychopathology of the possession-trance is discussed.

Matched MeSH terms: Consciousness
Comparison between effect of desflurane/remifentanil and propofol/remifentanil anesthesia on somatosensory evoked potential monitoring during scoliosis surgery-A randomized controlled trial

Hasan MS, Tan JK, Chan CYW, Kwan MK, Karim FSA, Goh KJ

J Orthop Surg (Hong Kong), 2018 7 31;26(3):2309499018789529.
PMID: 30058437 DOI: 10.1177/2309499018789529

BACKGROUND: Drugs used in anesthesia can affect somatosensory evoked potential (SSEP) monitoring, which is used routinely for intraoperative monitoring of spinal cord integrity during spinal surgery.
OBJECTIVE: The objective of this study was to determine whether combined total intravenous anesthesia (TIVA) technique with propofol/remifentanil is associated with less SSEP suppression when compared to combined volatile agent desflurane/remifentanil anesthesia during corrective scoliosis surgery at a comparable depth of anesthesia.
DESIGN: It is a randomized controlled trial.
SETTING: The study was conducted at the Single tertiary University Hospital during October 2014 to June 2015.
PATIENTS: Patients who required SSEP and had no neurological deficits, and were of American Society of Anesthesiologist I and II physical status, were included. Patients who had sensory or motor deficits preoperatively and significant cardiovascular and respiratory disease were excluded. A total of 72 patients were screened, and 67 patients were randomized and allocated to two groups: 34 in desflurane/remifentanil group and 33 in TIVA group. Four patients from desflurane/remifentanil group and three from TIVA group were withdrawn due to decrease in SSEP amplitude to <0.3 µV after induction of anesthesia. Thirty patients from each group were analyzed.
INTERVENTIONS: Sixty-seven patients were randomized to receive TIVA or desflurane/remifentanil anesthesia.
MAIN OUTCOME MEASURES: The measurements taken were the amplitude and latency of SSEP monitoring at five different time points during surgery: before and after the induction of anesthesia, at skin incision, at pedicle screw insertion, and at rod insertion.
RESULTS: Both anesthesia techniques, TIVA and desflurane/remifentanil, resulted in decreased amplitude and increased latencies of both cervical and cortical peaks. The desflurane/remifentanil group had a significantly greater reduction in the amplitude ( p = 0.004) and an increase in latency ( p = 0.002) of P40 compared with the TIVA group. However, there were no differences in both amplitude ( p = 0.214) and latency ( p = 0.16) in cervical SSEP between the two groups.
CONCLUSIONS: Compared with TIVA technique, desflurane/remifentanil anesthesia caused more suppression in cortical SSEP, but not in cervical SSEP, at a comparable depth of anesthesia.

Matched MeSH terms: Consciousness Monitors

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