MyMedR

Fulltext Finger drop sign-Characteristic pattern of distal weakness in Guillain-Barré Syndrome: A case report and review of the literature

Chee YC, Ong BH

SAGE Open Med Case Rep, 2018;6:2050313X18773649.

PMID: 29760923 DOI: 10.1177/2050313X18773649

Guillain-Barré Syndrome is an acquired acute autoimmune polyradiculoneuropathy that commonly presents with limb weakness and occasional cranial nerve, respiratory and autonomic involvement. Although the classic description of Guillain-Barré Syndrome is that of a demyelinating neuropathy with ascending weakness, predominant bilateral finger drop as presenting feature has rarely been reported. A characteristic pattern of weakness involving the extensor components of the fingers known as "finger drop sign" has been first described to be specific in acute motor axonal neuropathy form of Guillain-Barré Syndrome in the literature. We report a case of acute motor-sensory axonal neuropathy, which showed characteristic pattern of predominant finger extensor weakness, and provide a summary of all reported cases to date. While previous reports suggested that this is a sign that carries good prognosis, our case report suggested otherwise as the patient succumbed to respiratory and autonomic complications. Further studies are needed to evaluate the clinical significance of this peculiar sign.

Fulltext Recurrent transient heading disorientation heralding acute posterior cerebral artery (PCA) infarction

Chee YC, Ong BH

BMJ Neurol Open, 2019;1(1):e000009.

PMID: 33681769 DOI: 10.1136/bmjno-2019-000009

Objective: Heading disorientation is a type of pure topographical disorientation. Reported cases have been very few and its underlying mechanism remains unclear. We report an unusual presentation of a 60-year-old man with recurrent transient heading disorientation heralding an acute posterior cerebral artery infarction.

Design: Case report.

Conclusion: Acquired injury to the right retro-splenial region can result in a specific variant of topographical disorientation known as heading disorientation that may present as an atypical transient ischaemic attack-like symptom heralding acute cerebral infarction.

Fulltext Klebsiella pneumoniae sacroiliac septic arthritis: First case report

Chee YC, Lim CH

IDCases, 2018;14:e00459.

PMID: 30386726 DOI: 10.1016/j.idcr.2018.e00459

Infective sacroiliitis is a rare disease with misleading clinical signs that often delay diagnosis. We report a case of pyogenic sacroiliac joint septic arthritis caused by Klebsiella pneumoniae that has not been reported in the literature highlighting it as one of the important etiologies of infective sacroiliitis especially among diabetics.

Fulltext Mumps encephalitis with bilateral hippocampal lesions preceding parotitis

Chee YC, Ong BH

Neurol Clin Pract, 2019 Dec;9(6):475-477.

PMID: 32042482 DOI: 10.1212/CPJ.0000000000000665

Fulltext An unusual case of primary melioidotic prostatic abscess complicated by perianal abscess

Chee YC, Chee YN

IDCases, 2018;11:51-52.

PMID: 29349040 DOI: 10.1016/j.idcr.2018.01.001

Burkholderia pseudomallei is recognized to cause severe and fatal infections. Most of the infections caused by this facultative intracellular gram-negative bacterium are pneumonia, soft tissue, genito-urinary and central nervous system infection. We report an unusual case of primary prostatic abscess complicated by perianal abscess caused by Burkholderia pseudomallei. Melioidosis related anorectal infections have not been previously reported in the literature.

Fulltext Cerebral venous sinus thrombosis in a patient with concomitant Graves' disease and squamous cell carcinoma of the cervix

Chee YC, Abdul Halim S

BMJ Case Rep, 2020 Dec 09;13(12).

PMID: 33298481 DOI: 10.1136/bcr-2020-236730

Cerebral venous sinus thrombosis (CVST) is caused by either acquired or inherited pro-thrombotic states. Hyperthyroidism is a less recognised predisposing factor of CVST, and the causality has been debated. We report a case of a life-threatening CVST in a 40-year-old woman, with uncommon dual risk factors: hyperthyroidism and advanced squamous cell carcinoma of the cervix. CVST should be considered as a differential diagnosis when a patient with hyperthyroidism presents with new-onset headache or other neurological symptoms. Further assessment to elucidate other covert risk factors may need to be continuously carried out, when the causal relationship of one apparent cause has not been well established.

Hyperthyroidism and autoimmune hemolytic anemia--a case report

Chee YC, Gill DS, Poh SC

Med J Malaysia, 1978 Dec;33(2):154-5.

PMID: 755168

Fulltext Adult-Onset Satoyoshi Syndrome and Axial Spondyloarthritis

Chee YC, Lim TT, Ong BH

J Clin Neurol, 2021 Oct;17(4):593-595.

PMID: 34595874 DOI: 10.3988/jcn.2021.17.4.593

Fulltext Transient hyperthyroidism of hyperemesis gravidarum

Tan JYL, Loh KC, Yeo GSH, Chee YC

BJOG, 2002 Jun;109(6):683-8.

PMID: 12118648

OBJECTIVE: To characterise the clinical, biochemical and thyroid antibody profile in women with transient hyperthyroidism of hyperemesis gravidarum.
DESIGN: Prospective observational study.
SETTING: Hospital inpatient gynaecological ward.
POPULATION: Women admitted with hyperemesis gravidarum and found to have hyperthyroidism.
METHODS: Fifty-three women were admitted with hyperemesis gravidarum and were found to have hyperthyroidism. Each woman was examined for clinical signs of thyroid disease and underwent investigations including urea, creatinine, electrolytes, liver function test, thyroid antibody profile and serial thyroid function test until normalisation.
MAIN OUTCOME MEASURES: Gestation at which thyroid function normalised, clinical and thyroid antibody profile and pregnancy outcome (birthweight, gestation at delivery and Apgar score at 5 minutes).
RESULTS: Full data were available for 44 women. Free T4 levels normalised by 15 weeks of gestation in the 39 women with transient hyperthyroidism while TSH remained suppressed until 19 weeks of gestation. None of these women were clinically hyperthyroid. Thyroid antibodies were not found in most of them. Median birthweight in the infants of mothers who experienced weight loss of > 5% of their pre-pregnancy weight was lower compared with those of women who did not (P = 0.093). Five women were diagnosed with Graves' disease based on clinical features and thyroid antibody profile.
CONCLUSIONS: In transient hyperthyroidism of hyperemesis gravidarum, thyroid function normalises by the middle of the second trimester without anti-thyroid treatment. Clinically overt hyperthyroidism and thyroid antibodies are usually absent. Apart from a non-significant trend towards lower birthweights in the infants of mothers who experienced significant weight loss, pregnancy outcome was generally good. Routine assessment of thyroid function is unnecessary for women with hyperemesis gravidarum in the absence of any clinical features of hyperthyroidism.

Fulltext Focal myokymia in carpal tunnel syndrome

Chee YC, Ong BH, Mohd Saleh NB

Neurol Clin Pract, 2019 Apr;9(2):e11-e12.

PMID: 31041139 DOI: 10.1212/CPJ.0000000000000581

Seizures among young adults consuming kratom beverages in Malaysia: A case series

Halim SA, Low JH, Chee YC, Alias MR

Epilepsy Behav, 2021 08;121(Pt A):108057.

PMID: 34052638 DOI: 10.1016/j.yebeh.2021.108057

We report a case series of young adults who were admitted to hospital with seizures after regular kratom beverage consumption. This study aimed to determine kratom consumption habits and seizure characteristics and to explore whether chronic kratom ingestion without concomitant drug abuse leads to recurrent seizure or epilepsy. All patients underwent blood investigations, a brain computed tomography (CT) scan, electroencephalography, and urine testing for mitragynine and drug toxicology. Eleven participants who had a positive urine mitragynine test were included in the study. The longest duration of kratom consumption was 84 months: - most drank more than eight times per month (>200 mL/drink). Seizure developed within 10 minutes or up to 72 hours post-ingestion. Seizure occurred one to three times per year in most cases. Four patients had a focal to bilateral tonic-clonic seizure whereas the remaining participants had a generalized tonic-clonic seizure. Four patients mixed kratom with diphenhydramine syrup, and one patient took methamphetamine. Two patients had positive urine results for recreational drugs (opioid and amphetamine). This study provided indirect evidence that chronic kratom use with or without concomitant drug abuse can cause recurrent seizures in susceptible individuals, which may progress to epilepsy or require antiepileptic medication.

Outcome of acute ischaemic stroke patients after intravenous alteplase in Hospital Universiti Sains Malaysia

Wong KY, Baharuddin KA, Masykurin MM, Abdul Halim S, Chee YC, Sapiai NA, et al.

Med J Malaysia, 2021 Nov;76(6):870-875.

PMID: 34806675

INTRODUCTION: Intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (rt-PA) is effective in treating acute ischaemic stroke. Our primary objective is to assess the outcome of these acute ischaemic stroke (AIS) patients after IV alteplase with the modified Rankin scale (mRS).

METHODS: This is a cross-sectional study in which patients receiving IV alteplase in Hospital Universiti Sains Malaysia, from January 2017 to April 2020 were recruited. Demographical data, National Institutes of Health Stroke Scale (NIHSS) scores, door-to-needle time were recorded. Modified Rankin scale (mRS) scores were evaluated at 90 days after initial therapy. Good and poor functional outcomes were defined as 0-2 and 3-6, respectively.

RESULTS: A total of 30 patients were included in the study with a mean age of 59±11.47 years old. 76.7% of them were male and the rest were female. From the study, onset-toneedle time was 197.47±51.74 minutes, whereas door-toneedle time was 120.93±53.63 minutes. Seventeen (56.3%) patients achieved a favourable score of 0-2 on the mRS at 90 days after treatment. Haemorrhagic transformation occurred in eight (26.7%) of the patients with a mortality rate of 13.3%.

CONCLUSION: 56.7% of our patients showed improvement in the mRS at 90 days post thrombolysis for AIS. Higher baseline NIHSS scores and diabetes mellitus were associated with poorer functional outcomes after thrombolysis.

Fulltext COVID-19 in the elderly: A Malaysian perspective

Mustaffa N, Lee SY, Mohd Nawi SN, Che Rahim MJ, Chee YC, Muhd Besari A, et al.

J Glob Health, 2020 Dec;10(2):020370.

PMID: 33214887 DOI: 10.7189/jogh.10.020370

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