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  1. Ng, V.H., Wan Nor Aida, W.M.S., Ahmad Khaldun, I.
    Medicine & Health, 2018;13(2):246-251.
    MyJurnal
    Hyperdensity of basal ganglia in computed tomography (CT) of brain is always recognised as hemorrhagic stroke or calcification. Features of hyperglycemia include muscle weakness, hypotonia, pyramidal tract signs and hemichorea-hemiballismus (HC-HB), which mimic the symptoms of stroke. Hyperdensity of the basal ganglia was reported in patient with non-ketotic hyperglycemia (NKH). Inability to recognize the hyperdensity in CT brain as a feature of NKH may lead to failure of treatment. Early recognition and reversal of hyperglycemia will improve the outcome. This was a case of an atypical presentation of stroke-like symptoms with the neuroimaging finding showing asymmetric hyperdensity of basal ganglia. Neurological examination failed to elicit any sign of HC-HB. Laboratory test showed hyperglycemia with absence of acidosis and ketonaemia. The patient was diagnosed having basal ganglia hemorrhage and referred to the Neurosurgical team. However, the stroke-like symptoms completely resolved following the normalization of glucose level. This is the only other reported case of NKH with typical neuroimaging features not associated with HC-HB. One should be aware of the possibility of NKH in the absence of movement disorder with asymmetric basal ganglia hyperdensity in CT brain. Misinterpretation as acute intracranial bleeding may result in suboptimal management of the true underlying cause.
  2. Wan Nor Aida, W.M.S., Aaina Iryani, M., Ahmad Khaldun, I.
    Medicine & Health, 2020;15(1):288-293.
    MyJurnal
    Fraktur avulsi tulang belakang iliac anterior (ASIS) jarang terjadi, dan lebih lumrah berlaku di kalangan remaja muda semasa bersukan. Ini disebabkan oleh rawan apophyseal yang lemah semasa remaja, apabila kontraksi otot yang kuat mengatasi ASIS semasa aktiviti olahraga. Seorang lelaki berusia 15 tahun dibawa ke Jabatan Kecemasan (ED) mengadu sakit pinggul kanan selepas perlumbaan semasa Hari Sukan sekolahnya. Ketika dia melintasi garisan penamat dan menang, dia tiba-tiba rasa sensasi “pop” di pinggul kanannya dan jatuh ke tanah dengan kesakitan. Di ED, dia baring meniarap dengan skor sakit 6/10. Intravena Ketorolac diberikan untuk melegakan kesakitannya. Pemeriksaan fizikal menunjukkan kesakitan setempat di kawasan hadapan pelvis kanan, tanpa bengkak atau kecacatan pada sendi pinggul kanan. Tiada perbezaan antara kepanjangan kaki kanan berbanding kaki kiri. Pergerakan pinggul kanan terhad akibat kesakitan. Pemeriksaan neurovaskular adalah normal. Radiografi pelvis menunjukkan fraktur avulsi ASIS kanan. Beliau telah dirujuk kepada pasukan Ortopedik dan telah dirancang untuk rawatan konservatif rehat di katil, analgesik, dan ambulansi tanpa berat. Dia dibenarkan pulang dan dirancang untuk temujanji di Klinik Ortopedik. Pemeriksaan semula selepas 2 bulan kecederaan menunjukkan pesakit sihat dan bebas kesakitan. ASIS mudah terdedah kepada kecederaan avulsi semasa menjalankan aktiviti sukan kerana otot sartorius menarik anteroinferior ASIS semasa lekukan maksimum pinggul dan lanjutan lutut. Walaupun fraktur avulsi apophyses pelvis jarang berlaku, ia harus dipertimbangkan di kalangan atlet remaja jika mekanisma kecederaan adalah sangat sugestif.

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