MyMedR

Fulltext Cerebral venous sinus thrombosis 2 weeks after the first dose of mRNA SARS-CoV-2 vaccine

Zakaria Z, Sapiai NA, Ghani ARI

Acta Neurochir (Wien), 2021 08;163(8):2359-2362.

PMID: 34101024 DOI: 10.1007/s00701-021-04860-w

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as coronavirus disease 2019 (COVID-19) is a highly transmissible virus and has become pandemic. Part of the prevention of disease spread by the Malaysian government is by getting COVID-19 vaccine. Using the mRNA technology, the Pfizer/BioNTech vaccine is one of the vaccines been approved by the Drug Control Authority in Malaysia. Herein, we report an immediate complication of cerebral VST after the first dose of the Pfizer/BioNTech vaccine.

Septic arthritis of temporomandibular joint

Azmi NS, Mohamad N, Razali NA, Zamli AKT, Sapiai NA

Med J Malaysia, 2021 03;76(2):264-266.

PMID: 33742643

Septic arthritis (SA) occurrence for temporomandibular joint (TMJ) is rare. Pain, fever, swelling or loss of TMJ function are the typical presentation. The more common diagnosis for these presentations is internal derangement, osteoarthritis and rheumatoid arthritis. Therefore, TMJ septic arthritis is a challenging diagnosis and at risk of delayed diagnosis. We present a case of TMJ septic arthritis in a 46 year old Malay female with underlying hypertension and hypercholestrolemia, which was diagnosed as internal derangement in the initial presentation. The initial radiograph was normal. Arthrocentesis procedure had temporarily relieved the symptoms before progressive facial swelling developed after a week. Contrast enhanced computed tomography (CECT) brain revealed left TMJ abscess formation with left condylar erosion. Patient subsequently improved after wound debridement, left condylectomy and antimicrobial therapy.

Fulltext Infected intraperitoneal collection mimicking pneumoperitoneum

Senik NISA, Zon EM, Rahim RA, Sapiai NA

Radiol Case Rep, 2023 Sep;18(9):3101-3104.

PMID: 37404223 DOI: 10.1016/j.radcr.2023.06.016

Acute abdomen is an emergent condition that requires immediate evaluation and prompt treatment. Pneumoperitoneum is defined as the presence of air or gas in the peritoneal cavity. There are various potential causes of pneumoperitoneum, as well as conditions that can mimic or pseudo pneumoperitoneum. We encountered a case of a 26-year-old woman who had a history of postexploratory laparotomy, left ovarian cystectomy, left ovarian reconstruction, right salpingooophorectomy, and infracolic omentectomy for bilateral mucinous cystadenoma and mature cystic teratoma. On the eighth day following her operation, she developed progressive abdominal distension.

Fulltext A case of cerebral toxoplasmosis: "Eccentric and concentric sign" in MRI

Awang Senik NIS, Halim SA, Sapiai NA

IDCases, 2023;33:e01824.

PMID: 37434609 DOI: 10.1016/j.idcr.2023.e01824

Central nervous system (CNS) toxoplasmosis is an opportunistic infection caused by the intracellular protozoan parasite Toxoplasma gondii. This organism typically causes disease in immunocompromised patients with human immunodeficiency virus (HIV). We reported a case of a 52-year-old woman with neurology symptoms and Magnetic resonance imaging (MRI) brain shows both eccentric and concentric target signs, which are typical signs in a patient with cerebral toxoplasmosis but rarely displayed in the same lesion. The MRI played a crucial role in diagnosing the patient and distinguishing CNS diseases commonly found in HIV patients. Our objective is to discuss the imaging findings that aided in the patient's diagnosis.

Fulltext A Case Rarity: Papillary Thyroid Carcinoma with Squamous Metaplasia Complicated with Chronic Discharging Ulcers

Wan Sohaimi WF, Lee YF, Mat Nawi N, Mohd Rohani MF, Sapiai NA

Indian J Surg Oncol, 2019 Dec;10(4):676-678.

PMID: 31857764 DOI: 10.1007/s13193-019-00977-8

We report a unique case of differentiated thyroid carcinoma (DTC) with squamous metaplasia complicated with chronic discharging ulcer. A 76-year-old gentleman was referred to us after defaulted treatment 1 year post-total thyroidectomy. He presented to us with long-standing chronic, non-healing, ulcerative and discharging wound at the anterior neck at previous total thyroidectomy scar. The primary tumour was histologically diagnosed as papillary malignant cells with extensive squamous metaplasia. Squamous metaplasia is a rare finding in thyroid carcinoma that carried a poorer prognostic factor.

Fulltext Reverse Cervical Lordosis Caused by Giant Vertebral Artery Aneurysm in von Recklinghausen Disease

Saleh U, Ismail MI, Sapiai NA, Loh KB, Abd Wahab N, Abdullah JM

Cureus, 2022 Sep;14(9):e29795.

PMID: 36340543 DOI: 10.7759/cureus.29795

Neurofibromatosis type 1 (NF1) is a variable penetrance autosomal dominant condition predominantly involving the peripheral nervous system. NF1 exhibits a wide spectrum of clinical patterns involving the skin, eye, brain, spinal cord, and, to a lesser extent, long bones and arteries. Arterial stenosis or aneurysms have been variously studied, but the association with NF1 has not been firmly established. A 31-year-old gentleman with NF1 experienced progressive neck pain over a five-month period, associated with limited range of motion and dysphagia. Magnetic resonance imaging (MRI) of the cervical spine suggests paraspinal plexiform neurofibromas with excessive reverse cervical lordosis. Further workups revealed a large left vertebral artery fusiform aneurysm and a pseudoaneurysm. The patient made a full recovery following endovascular embolization. It is crucial to maintain a high index of suspicion for vascular malformations in patients with NF1. The pathogenesis of vascular manifestations in NF1 and options for therapeutic management were discussed.

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.

A case of concurrent gastrointestinal, peritoneal and urinary bladder tuberculosis

Ahmad MF, Mohamad N, Sapiai NA, Razali NA, Anuar AH

Indian J Tuberc, 2022 Oct;69(4):706-709.

PMID: 36460413 DOI: 10.1016/j.ijtb.2021.09.004

Tuberculosis is a top 10 leading cause of death worldwide. Lungs are primarily involved organs in tuberculosis. The rest of cases are extrapulmonary tuberculosis (14% reported in 2017). Extrapulmonary tuberculosis always presents with non-specific symptoms, thus at risk of delay diagnosis and management. In genitourinary tuberculosis, kidney alone and kidney with urinary bladder or ureter is affected in more than 70% of cases. The ureter and urinary bladder infections are almost always secondary to tuberculous involvement of the kidney. Bacilli haematogenic spreading is a known transmission pathway to the kidney. In this case, we diagnosed isolated urinary bladder tuberculosis caused by direct gastrointestinal tuberculosis infiltration, a rare occurrence of extrapulmonary tuberculosis. We illustrate the multiorgan involvement in tuberculosis infection including pulmonary, gastrointestinal, peritoneal and urinary bladder.

Multicentric Giant Cell Tumor of Bone: Metachronous Presentation-a Case Report

Sapiai NA, Wan Fatihah WS, Faisham WI, Anani Aila MZ

Indian J Surg Oncol, 2021 Dec;12(Suppl 2):332-337.

PMID: 35035165 DOI: 10.1007/s13193-021-01331-7

Giant cell tumors (GCT) of bone are a benign aggressive tumor with features of frequent local recurrence. It has the potential for metastasis and malignant transformation. GCT of bone represents about 4-9.5% of primary bone tumors. Metachronous GCT happen in less than 1% while metastatic spread in these lesions is very uncommon. Furthermore, reports of multicentric metachronous GCT are very rare in literature. We present a case of a 35-year-old male patient, who suffered from multicentric metachronous GCT, which involved the radius, humerus, femur, and pelvic with pulmonary metastasis. Local control by multiple resections of the tumor and chemotherapy for pulmonary metastases was able to control the disease with long-term survival and good functional outcome. These tumors had a typical radiological appearance and the diagnosis was confirmed on histopathology. Long follow-up needed in this case in view the illness occurs for long period.

Fulltext A Case Report of Bilateral Optic Perineuritis With Idiopathic Intracranial Hypertension: Challenges in Diagnosis and Management

Shahrudin NH, Muhammed J, Wan Hitam WH, Sapiai NA, Abdul Halim S

Cureus, 2024 Feb;16(2):e54692.

PMID: 38523970 DOI: 10.7759/cureus.54692

Optic perineuritis (OPN) refers to the inflammation of the optic nerve sheath and it is a rare form of idiopathic orbital inflammatory disease. We report a rare case of bilateral OPN in an obese female teenager with idiopathic intracranial hypertension (IIH). She was initially presented with painless bilateral blurring of vision that was progressively worsening for three weeks duration. Visual acuity of both eyes was hand movement with no relative afferent pupillary defect detected. The confrontation visual field test showed central scotoma. Both anterior segments were unremarkable. Fundoscopy showed a swollen optic disc bilaterally, with extensive flame-shaped hemorrhages surrounding the disc area and dot blot hemorrhages in the posterior pole. A magnetic resonance imaging scan of the brain and orbit revealed the presence of bilateral optic nerve sheath enhancement with empty sella turcica. The patient was diagnosed with bilateral OPN with IIH. She received an initial high dose of systemic corticosteroid followed by a slow tapering dose. She was monitored by the neuromedical team for her IIH. She was followed up for about a year. The final best corrected visual acuity in the right eye was 6/36 and the left eye was 6/60. In conclusion, OPN poses challenges in diagnosis and management. This case emphasizes the importance of considering OPN in the differential diagnosis of optic nerve-related symptoms, as prompt recognition and intervention are crucial for favorable outcomes.

Fulltext Preparing Malaysia for Population Aging through the Advanced Memory and Cognitive Service in Hospital Universiti Sains Malaysia

Ab Razak A, Rahman NA, Zulkifly MFM, Sapiai NA, Phoa PKA, Mohamed Mustafar MF, et al.

Malays J Med Sci, 2023 Oct;30(5):1-6.

PMID: 37928788 DOI: 10.21315/mjms2023.30.5.1

Improving healthcare and living conditions has led to an increase in life expectancies and challenges of population aging in Malaysia. The Advanced Memory and Cognitive Service builds on integrated healthcare among multidisciplinary specialists to provide holistic and patient-centred healthcare. The service treats older adults experiencing neurocognitive impairment as well as young individuals with complex neurocognitive disorders and thoroughly screens asymptomatic individuals at high risk of developing neurocognitive disorders. This early intervention strategy is a preventive effort in the hope of reducing disease burden and improving quality of life to prepare Malaysia for the forthcoming population aging.

Fulltext The Brain-Gut Clinic in Hospital Universiti Sains Malaysia: Pioneering New Service to Advance Neuro-Gastroenterology and Motility in Malaysia

Lee YY, Izham N, Mohd Zulkifly MF, Mohamed Mustafar MF, Ismail AK, Mohamed Shah NFFN, et al.

Malays J Med Sci, 2023 Jun;30(3):1-7.

PMID: 37425382 DOI: 10.21315/mjms2023.30.3.1

Neurogastroenterology and motility is a new but advanced subspecialty within gasteroenterology that cater to difficult, persistent and refractory gut-brain symptoms. Hospital USM has the country's first and new state-of-the art motility lab that was recently launched on the 25 May 2023, and is covered in nationwide media. Another first is the Brain-Gut Clinic, established on the 16 November 2022. The clinic is a new concept that builds on unique multiple disciplines in relation to the gut-brain axis. It is hoped that there will be more awareness on the existence of neurogastroenterology and motility among doctors and community, and that more research can be forthcoming to reduce the disease burden.

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