Advances in neuroimaging techniques, particularly Magnetic Resonance Imaging (MRI), have proved invaluable in detecting structural brain lesions in patients with epilepsy in developed countries. In Malaysia, a few electroencephalography facilities available in rural district hospitals run by trained physician assistants have Internet connections to a government neurological center in Kuala Lumpur. These facilities are more commonly available than MRI machines, which require radiological expertise and helium replacement, which may problematic in Southeast Asian countries where radiologists are found in mainly big cities or towns. We conducted a cross-sectional study over a two year period begining January 2001 on rural patients, correlating EEG reports and MRI images with a clinical diagnosis of epilepsy to set guidelines for which rural patients need to be referred to a hospital with MRI facilities. The patients referred by different hospitals without neurological services were classified as having generalized, partial or unclassified seizures based on the International Classification of Epileptic Seizures proposed by the International League Against Epilepsy (ILAE). The clinical parameters studied were seizure type, seizure frequency, status epilepticus and duration of seizure. EEG reports were reviewed for localized and generalized abnormalities and epileptiform changes. Statistical analysis was performed using logistic regression and area under the curve. The association between clinical and radiological abnormalities was evaluated for sensitivity and specificity. Twenty-six males and 18 females were evaluated. The mean age was 20.7 +/- 13.3 years. Nineteen (43.2%) had generalized seizures, 22 (50.0%) had partial seizures and 3 (6.8%) presented with unclassified seizures. The EEG was abnormal in 30 patients (20 with generalized abnormalities and 10 localized abnormalities). The MRI was abnormal in 17 patients (38.6%); the abnormalities observed were cerebral atrophy (5), hippocampal sclerosis (4), infarct/gliosis (3), cortical dysgenesis (2) and tumors (2). One patient had an arachnoid cyst in the right occipital region. Of the 17 patients with an abnormal MRI, 14 had an abnormal EEG, this difference was not statistically significant. There was no significant associaton between epileptographic changes and MRI findings (p = 0.078). EEG findings were associated with MRI findings (p = 0.004). The association between an abnormal EEG and an abnormal MRI had a specificity of 82.4%, while epileptogenic changes had a specificity of 64.7% in relation to abnormal MRI findings. This meants that those patients in rural hospitals with abnormal EEGs should be referred to a neurology center for further workup and an MRI to detect causes with an epileptic focus.
Matched MeSH terms: Magnetic Resonance Imaging/instrumentation; Magnetic Resonance Imaging/utilization*
This is a report of a case of peroneal subluxation caused by peroneus quartus, a supernumerary muscle in the peroneal muscle group. Peroneus quartus' anatomy and its clinical relevance in lateral ankle pain, swelling and peroneal subluxation are described. It may be accurately diagnosed by peroneal tendoscopy. The technical note of this procedure is also described.
Posterolateral corner (PLC) laxity of the knee results in rotatory instability, in association with posterior cruciate ligament (PCL) laxity led to a grossly unstable knee. This is a series of eight patients with chronic PLC and PCL laxity treated with arthroscopic quadriceps tendon PCL reconstruction and extraarticular hamstring PLC reconstruction. Seven cases had high tibial osteotomy to address associated genu varus deformity. With prospective pre- and post-operative assessments, there was a significant improvement in the 2000 International Knee Documentation Committee (IKDC) subjective assessment and knee examination, Lysholm-Gillquist and Tegner activity scores, as well as KT-1000 arthrometry measurement after one year in all knees. Surgical treatment of PLC laxity must address coexisting problems of the PCL and mechanical alignment for a successful outcome.
Sensorineural hearing loss (SNHL) due to internal auditory canal (IAC) stenosis with hypoplasia of the cochleovestibular nerve is a rare disorder. The diagnosis of the IAC stenosis requires both high resolution computed tomography scan (HRCT) and magnetic resonance imaging (MRI).
Transesophageal echocardiography (TEE) is a trusted method of sizing atrial septal defect (ASD) prior to percutaneous closure but is invasive, uncomfortable, and may carry a small risk of morbidity and mortality. Magnetic resonance imaging (MRI) may be useful non-invasive alternative in such patients who refuse or are unable to tolerate TEE and may provide additional information on the shape of the A0SD.
Matched MeSH terms: Magnetic Resonance Imaging/methods*
Kajian garis pangkal pengimejan resonans magnet kefungsian (fMRI) telah dijalankan ke atas 2 orang subjek lelaki sihat (kidal dan tidak kidal) masing-masing berumur 22 dan 25 tahun. Imbasan fMRI dijalankan menggunakan sistem pengimejan resonans magnet (MRI) 1.5 T di Jabatan Radiologi, Hospital Universiti Kebangsaan Malaysia. Kajian ini menggunakan gerakanjari tangan kanan dan kiri untuk merangsang aktiviti neuron di dalam korteks serebrum. Paradigma 5 kitar aktifIrehat digunakan dengan setiap kitar mengandungi satu blok aktif dan satu blok rehat yang masing-masing mengandungi 10 siri pengukuran. Imej fMRI dianalisis menggunakan pekej perisian MatLab dan pemetaan statistik berparameter 2 (sPM2). Proses pendaftaran jasad tegar menggunakan penjelmaan afin 6 parameter dilakukan ke atas kesemua imej kefungsian berwajaran T2*. Keputusan menunjukkan bahawa pergerakan subjek adalah minimum sama ada dalam arah translasi (< 1 mm) atau putaran (< 1 ). Kesemua imej dinormalkan melalui proses peledingan tak linear menggunakan penjelmaan afin 12 parameter dan didapati sepadan dengan pencontoh yang telahpun mematuhi ruang anatomi piawai. Walau bagaimanapun, bentuk, resolusi dan kontras imej kefungsian telah berubah sedikit berbanding dengan imej asal. Pelicinan imej menggunakan kernel Gaussian isotropik 6 mm menyebabkan data imej lebih bersifat parametrik dengan kehilangan yang ketara dalam resolusi dan kontras. Pengasingan struktur yang dilakukan ke atas imej berwajaran T1 mengklaskan tisu otak kepadajirim kelabu, jirim putih dan bendalir serebrospina. Pasca pemprosesan ruang bagi imej kefungsian dan struktur menjadikan data imej bersifat parametrik dengan taburan jenis Gaussian dan sedia untuk dianalisis menggunakan model linear am dan teori medan rawak Gaussian.
Objective: A baseline functional magnetic resonance imaging (fMRI) study was carried out on a healthy right-handed male subject to attain further insights into the basic neuronal control mechanisms of bimanual and unimanual movements of hand fingers, an area that is still not fully understood. Methods : The study used the basic unimanual and bimanual movements of the left- and right-hand fingers to stimulate neuronal activity in the cerebral cortices. The subject was instructed to sequentially press his fingers either unimanually (UNI) or bimanually (BIM), against the thumb in a consistent alternative manner during the functional scans. The data were analysed using the MATLAB and SPM2 software packages. Results : Brain activations obtained via the F-test indicate a larger activation area as compared to that obtained from the T-test. The results showed that, the activated brain regions due to the self-paced finger movements are the precentral and postcentral gyrii covering the primary motor, premotor and somatosensory primer areas. The activestate signal intensity was found to be significantly (p < 0.05) higher than that of the resting-state. For UNI, brain activation showed contra-laterality with a larger activation area and a higher signal intensity at the point of maximum intensity for the left-hand finger
movement (UNIleft) compared to the right-hand finger movement (UNIright). Small ipsilateral activations were observed during UNIright and UNIleft. For BIM, the activation was observed in both hemispheres with the right hemisphere showing a higher signal intensity and coverage. The results support the fact that for a right-handed person performing either UNI or BIM type of movement, the activated motor area on the right hemisphere of the brain (movement of the left hand fingers) experience a higher intensity and larger coverage of hemodynamic response compared to the left hemisphere of the brain (movement of the right hand fingers). Analyses performed on the activated regions of interest (ROI) by
comparing the unimanual and bimanual types of activations revealed that during BIM, there are voxels in the left hemisphere controlling the movement of the left hand fingers (BIMleft) and voxels in the right hemisphere controlling the movement of the right hand fingers (BIMright). The interactions observed in this study resemble the existence of interhemispheric connection between both hemispheres during BIM. Conclusion : Although this is a single subject study, the hemodynamic response and the neuronal control mechanism in the cerebral cortices based on the BOLD mechanism can be studied and evaluated using fMRI and SPM.
Kajian garis pangkal pengimejan resonans magnet kefungsian (fMRI) telah dijalankan ke atas 2 orang subjek lelaki sihat dominan tangan kanan dan kiri. Kajian ini menggunakan gerakan jari tangan kanan dan kiri untuk merangsang aktiviti neuron di dalam korteks serebrum. Subjek diarahkan supaya menekan jari-jari pada ibu jari secara bergilir-gilir semasa imbasan fMRI dilakukan. Paradigma 5 kitar aktif-rehat digunakan dengan setiap kitar mengandungi satu blok aktif dan satu blok rehat dengan 10 siri pengukuran untuk setiap blok. Seratus isipadu imej fMRI bagi setiap subjek dianalisis menggunakan pekej perisian MatLab dan SPM2. Model linear am (GLM) digunakan untuk menganggar secara statistik parameter yang mencirikan model rangsangan hemodinamik bagi gerakan jari. Kesimpulan mengenai pengaktifan otak yang diperhatikan dijana secara statistik berasaskan teori medan rawak (RFT) Gaussian. Keputusan menunjukkan bahawa rantau otak yang aktif akibat gerakan jari adalah pada girus presentral merangkumi kawasan motor primer. Pengaktifan otak adalah secara kontralateral terhadap gerakan jari tangan kanan dan kiri. Keamatan isyarat keadaan aktif didapati lebih tinggi secara bererti (p < 0.001) daripada keamatan isyarat keadaan rehat. Bilangan voksel yang aktif didapati lebih tinggi pada hemisfera otak yang mengawal gerakan jari bagi tangan yang tidak dominan untuk kedua-dua subjek. Keputusan ini menyokong fakta bahawa kawasan pengaktifan motor pada hemisfera otak semasa gerakan jari tangan yang tidak dominan mengalami rangsangan hemodinamik yang lebih tinggi dan kawasan pengaktifan yang lebih luas berbanding dengan kawasan pengaktifan pada hemisfera otak yang mengawal gerakan jari bagi tangan yang dominan.
In football there are established age-related tournaments for males and females to guarantee equal chances within the game for all the different age groups. To prevent participation in the incorrect age group, and owing to the fact that in some Asian and African countries registration at birth is not compulsory, other methods of age determination need to be available. Standard radiographs of the left wrist have been used for assessment of skeletal age for many years. This is, however, not ethical in the sporting environment.
Cerebral angioinvasive aspergillosis is a rare manifestation of disseminated aspergillosis which may result in stroke in immunocompromised individuals. Reports of such disease in patients with diabetes mellitus are rare. We describe a 45-year-old man with diabetes mellitus who presented with a three-day history of right-sided limb weakness and aphasia. Cerebral computed tomography showed features of an acute infarct involving the left anterior and middle cerebral arteries. He was initially treated for an acute ischaemic stroke. Further history revealed that he was investigated for a growth in the sphenoid sinus two months earlier. Culture of the biopsied material from the sphenoid sinus grew Aspergillus fumigatus. Magnetic resonance imaging showed an extension of the growth to the brain, causing the acute ischaemic stroke. He was subsequently diagnosed with angioinvasive cerebral aspergillosis and was commenced on intravenous amphotericin B. Unfortunately, he succumbed to his illness despite treatment.
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.
This study assessed the sensitivities of preoperative localisation modalities such as computed tomography (CT), magnetic resonance imaging (MRI), arteriography and arterial stimulation venous sampling (ASVS) using serum insulin and C-peptide gradients to intraoperative techniques in localising insulin-secreting tumours in our institution.
We report the case of a 25-year-old Malay woman, admitted for preterm delivery at 35 weeks' gestation. Vaginal swab did not isolate any organism. She delivered a baby girl who developed respiratory distress syndrome, requiring ventilation. Although chest radiograph showed hyaline membrane disease with pneumonia, septic workout was negative. The mother was discharged on the next day. Seven days postpartum, the mother presented with fever and fits and was diagnosed to have meningo-encephalitis. Lumbar puncture isolated group B Streptococcus (GBS) and MRI revealed a superior cerebellar abscess. She was treated and survived the episode. This case illustrates the uncommon situation where GBS infection was confirmed via maternal septic workout rather than neonatal, although both presented with severe disease.
Pre-natal diagnosis of intra-abdominal pregnancy is difficult. Ultrasound has been the frontline modality to date; however, it gives a diagnostic error of 50-90% and its use is disappointing. In recent years, MRI has emerged as an appealing imaging modality. With its good soft tissue contrast and non-ionizing property, it acts as a means of definitive non-invasive assessment before surgical intervention when ultrasound is inconclusive.
A 43 year-old man presented with pain on the right tooth for three days duration. Computed tomography showed left orbital cellulitis and right parapharyngeal abscess. There was also evidence suggestive of a dental abscess over right upper alveolar region. Magnetic resonance imaging revealed left superior ophthalmic vein thrombosis. Emergency drainage of the right parapharyngeal abscess was performed. Right maxillary molar extraction revealed periapical abscess. Left eye proptosis markedly reduced after initiating heparin.
We report a case of 50-year-old man who was presented with recurrent episodes of left sided hemiparesis. CT scan and MRI brain revealed a large intraventricular fatty lesion. Histopathological examination showed a picture of angiolipoma.
Gartner duct cysts are the remnants of the Wolffian duct and they are rarely seen in adulthood. We present a case of a pregnant patient with a prolapsing vaginal mass. A diagnosis of Gartner duct cyst was made after MRI was performed. The Gartner duct cyst was drained when the patient went into labour allowing vaginal delivery to be performed.
A 20 year old male presented to the emergency department with generalized tonic clonic convulsions and up rolling of eye balls. He had history of seizure disorder for three years and on regular medical treatment and is compliant to medication. A non-contrast CT scan of the head was only done on 14th day of admission which showed hypodense areas in the right and left cerebellar hemisphere. MR imaging was performed four days later revealed high signal intensity in the both cerebellar hemispheres, both external capsules, both occipital and right parietal regions on fluid-attenuated inversion recovery (FLAIR). The post contrast MR imaging revealed diffuse cerebral and cerebellar hypervascularity in the similar region. This change of diffuse hypervascularity of both cerebral and cerebellar associated with seizure activity on post-contrast magnetic resonance imaging (MRI) has not been reported in any literature.
Burkholderia pseudomallei infection of the central nervous system (CNS) is rare with less than 50 cases reported over the last 30 years. The retrospective melioidosis study at University Malaya Medical Centre has documented three cases of CNS melioidosis out of more than 160 cases of melioidosis since 1978. There were two patients with brain abscess and one with spinal epidural abscess. The predisposing factors were: one patient was an aboriginal farmer and the other two were diabetic. Their age ranged from 17 to 45 years. Prominent neurological features were limb weakness, cranial nerve palsy (6th and 7th) and visual disturbance. CT brain scan and MRI spine showed abscess formation, subdural collection, and spinal epidural collection, osteomyelitis of vertebra and occipital bone and also sagital sinus thrombosis. All these patients underwent surgical drainage leading to bacteriological diagnosis as well as appropriate long-term antibiotic therapy. All had good recovery at 6 months after completion of treatment.