Displaying all 6 publications

  1. Benjamin, Ng Han Sim
    Myasthenia gravis, the most common autoimmune
    neuromuscular disorder, is characterised by
    muscle weakness and fatigability. A 23-yearold-lady
    with background history of breathing
    and swallowing difficulty for six months was
    presented with respiratory distress to the hospital
    which is without an in-house neurology service.
    Her diagnosis remained a challenge as patient
    presented as an emergency without detailed
    medical history. She was subjected to bedside ice
    pack testing and subsequently managed along the
    diagnosis of myasthenia crisis. She responded to
    the treatment and survived the critical period. So,
    diagnosis of myasthenia gravis by ice pack test
    and managing a case of myasthenic crisis would
    be possible in limited heath care setting.
  2. Benjamin, Ng Han Sim
    Trimethoprim-Sulfamethoxazole (TMP-SMX)
    or Co-Trimazole is the treatment of choice for
    meliodosis. A 52-year-old man presented with
    generalized body weakness with reduced appetite.
    He had bradycardia on examination. After
    investigations, he was diagnosed as hyperkalaemia.
    He had life-threatening hyperkalaemia treated
    with Trimethoprim-Sulfamethoxazole (TMPSMX)
    as part of the eradication therapy for
    Meliodosis. Urgent haemodialysis was done. There
    were changes done for his meliodosis treatment.
    This case wished to highlight the importance of
    considering hyperkalemia in patient treated with
    Trimethoprim-Sulfamethoxazole especially when
    risk factor for hyperkalaemia is present.
  3. Benjamin Ng Han Sim
    Phasic ECG voltage changes or electrical alternans is a well-described ECG changes seen in the pericardial effusion and cardiac tamponade. Popular as once believed, this ECG features are no longer considered pathognomonic for pericardial effusion and cardiac tamponade. Electric alternans is observed in pneumothorax especially left-sided pneumothorax. This is a case of a 41-year-old man who presented with chest pain and breathlessness to the emergency department. Assessment in the emergency unit revealed an obvious distress man with a respiratory rate of 60 breaths/min with cyanosis There were generalised rhonchi and prolonged expiratory breath sound appreciated. Chest X-ray (CXR) was done and diagnosed to have left tension pneumothorax. Initial electrocardiogram (ECG) showed electrical alternans in all leads. He was intubated for respiratory distress followed by chest tube insertion. His initial ECG findings resolved after treatment of the tension pneumothorax. Doctors need to evaluate the cardiac findings along with respiratory findings.
  4. Benjamin Ng, Han Sim, Lim, Chun Liang, Chow, Siew Kian
    Trigeminal schwannoma is a rare cause of
    cerebellopontine angle tumour. This case report
    of a 65-year-old lady presented with ipsilateral
    facial numbness and instability. She was finally
    diagnosed to have trigeminal schwannoma after
    seeking multiple medical consultations with her
    doctors. This case report highlights a rare cause
    of cerebellopontine angle tumour.
  5. Prakash, Supahiah, Goh, Siew Yuen, Benjamin, Ng Han Sim
    Wegener’s granulomatosis (WG) is a necrotizing
    granulomatous inflammation. A 40-year-old lady
    of Malay descent presented with unresolving
    bilateral painful red eyes for three weeks. Clinical
    examination revealed that best corrected vision
    acuity of 6/9 for both eyes. Slit lamp examination
    revealed diffuse scleritis. Other Investigations
    result like UFEME blood cell: 2+, C-reactive
    protein 70.06 mg/L and ESR of 125 mm/h
    suggestive on acute inflammations. Connective
    tissue screening revealed cytoplasmic ANCA
    was positive and was supported by Anti-Serine
    Protease3 (PR3) 68. All the investigation results
    revealed that she had Wegener’s granulomatosis
    with ophthalmology manifestation in the
    form scleritis. Patient was treated with guttae
    Maxidex QID to reduce cells that present in
    anterior chamber and oral ibuprofen 400 mg
    thrice daily. Subsequently, oral prednisolone
    and oral cyclophosphamide with oral Bactrim
    were commenced. Patient responded well and
    redness resolved. There are many differential
    diagnoses for chronic conjunctivitis but to rule
    out connective tissue disease should be one of the
    primary differential diagnoses in young female.
    Oral immunosuppressive and Trimethoprim/
    Sufmethoxazole (Bactrim) were been found
    beneficial and symptoms were resolved. Wegener’s
    granulomatosis is a great mimicker as exemplified
    in this case. This disease can be misdiagnosed and
    maltreated as conjunctivitis. Thus, the authors
    wish to emphasize that WG is one the differential
    diagnoses that need to be considered in a person
    with bilateral scleritis.
  6. Benjamin NHS, Gin TH, Ling Elora OY, Yung Kelly WK
    J R Coll Physicians Edinb, 2022 Mar;52(1):30-33.
    PMID: 36146975 DOI: 10.1177/14782715221088914
    Bilateral medial medullary stroke is a rare stroke syndrome. The clinical presentation of bilateral medial medullary stroke is heterogenous and often overlaps with other non-stroke neurology emergencies such as Guillain-Barrésyndrome, myasthenic crisis and acute vestibular syndrome, leading to misdiagnosis. We wish to present a case of a young lady with type 1 diabetes mellitus, who had presented with subacute neuromuscular weakness which was erroneously treated as myasthenic crisis. Her case was subsequently diagnosed as bilateral medial medullary stroke, following evolving clinical signs and magnetic resonance imaging (MRI) findings of a heart-shaped abnormality at the rostral medulla. This rare stroke syndrome represented a diagnostic challenge which necessitated a strong clinical suspicion and an urgent MRI scan of the brain for prompt diagnosis to enable appropriate treatment initiation.
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