Displaying publications 1 - 20 of 25 in total

  1. Law ZK, Appleton JP, Bath PM, Sprigg N
    Clin Med (Lond), 2017 Apr;17(2):166-172.
    PMID: 28365631 DOI: 10.7861/clinmedicine.17-2-166
    Managing acute intracerebral haemorrhage is a challenging task for physicians. Evidence shows that outcome can be improved with admission to an acute stroke unit and active care, including urgent reversal of anticoagulant effects and, potentially, intensive blood pressure reduction. Nevertheless, many management issues remain controversial, including the use of haemostatic therapy, selection of patients for neurosurgery and neurocritical care, the extent of investigations for underlying causes and the benefit versus risk of restarting antithrombotic therapy after an episode of intracerebral haemorrhage.
  2. Sim BNH, Hui LY, Krishnan D, Joseph JP
    Clin Med (Lond), 2019 03;19(2):133-134.
    PMID: 30872296 DOI: 10.7861/clinmedicine.19-2-133
    Cryptococcosis is an opportunistic fungal infection commonly seen in HIV cases. We present a case of disseminated cryptococcosis with multiple non-continuous infective foci in a non-HIV, non-transplant case.
  3. Payus AO, Jan TH, Raymond AA
    Clin Med (Lond), 2020 11;20(6):e281.
    PMID: 33199345 DOI: 10.7861/clinmed.Let.20.6.6
  4. Shariff RER, Abidin HAZ, Kasim SS
    Clin Med (Lond), 2020 11;20(6):e267-e268.
    PMID: 33199335 DOI: 10.7861/clinmed.2020-0750
    We present a rare case of delayed diagnosis of mitral stenosis, initially presenting with hoarseness in her voice due to left recurrent laryngeal nerve (LRLN) compression. A 60-year-old woman presented to the otorhinolaryngology department following complaints of progressive hoarseness in voice over a 6-month period. There was dysphonia but no additional evidence of a cranial nerve IX or X palsy on examination, with subsequent flexible nasopharyngolaryngoscopy demonstrating left vocal cord palsy. She was referred for a cardiology consult following findings of atrial fibrillation on electrocardiography. Transthoracic echocardiography revealed an enlarged left atrium with evidence of severe mitral stenosis. A diagnosis of Ortner's syndrome was made and the patient underwent mitral valve replacement. Common causes of Ortner's syndrome include mitral stenosis with left atrium compression of the LRLN, but it can occur due to other causes including pulmonary hypertension or aortic aneurysm compression, among others. There are few data at present to conclude that regression of left atrial enlargement and pulmonary arterial hypertension with symptoms are associated with Ortner's syndrome. Therefore, it remains pertinent for clinicians to be aware of clinical features linked to mitral stenosis including its more uncommon presentations, such as in our case, as earlier intervention may improve prognosis.
  5. Chai CS, Kho SS, Chan SK, Tee TT, Tie ST
    Clin Med (Lond), 2021 01;21(1):e114-e115.
    PMID: 33479093 DOI: 10.7861/clinmed.2020-0913
    Percutaneous vertebroplasty (PV) involves injection of polymethylmethacrylate bone cement into vertebral body for relief of pain and strengthening of bone in symptomatic vertebral compression fractures.Passage of bone cement into vertebral venous plexus and then into the lungs is a rare and serious complication of PV. The reported incidence up to 26%.We present an incidental finding of pulmonary cement embolism (PCE) after PV. A 68-year-old woman with history of PV 3 years previously for T11 osteoporotic fracture presented to us with cough for 3 weeks following choking on a fish bone.Chest X-ray showed left lower zone consolidation and a high-density opacity in a tubular branching pattern, corresponding to pulmonary arterial distribution. Contrasted computed tomography of the thorax showed segmental pulmonary cement embolism of both lungs and left lower lobe consolidation.She underwent bronchoscopy with findings of a purulent secretion from the left lower lobe. Her symptoms resolved after 2 weeks of antibiotics. She was managed conservatively for the PCE as she remained asymptomatic.This case highlights the need for a standard post-PV chest X-ray, as patients with cement embolisms can be completely asymptomatic. Measures to minimise the risk of pulmonary cement embolisms during PV need to be taken.
  6. Ismail MNB, Rahim SMA
    Clin Med (Lond), 2021 01;21(1):e108-e109.
    PMID: 33479090 DOI: 10.7861/clinmed.2020-0882
    Tuberculosis is an airborne multisystemic disease which primarily infects the lungs. Isolated tuberculous arthritis is rare. We present a case of a 41-year-old woman with a known case of lupus nephritis class IV who complained of pain and swelling over her left ankle joint for several months. She was treated for rheumatoid arthritis and was started with immunosuppressive agents. However, she did not improve with treatment and was later diagnosed with tuberculous arthritis based on a molecular study from joint aspiration. She was started on antituberculosis medication and showed improvement. We highlight the challenges in reaching the diagnosis and the importance of including tuberculous arthritis in differential diagnoses in cases with persistent ankle swelling.
  7. Sharma A, U V, Dong V, Raut A, Tawfik GM, Ng SJ, et al.
    Clin Med (Lond), 2021 Mar;21(Suppl 2):25-26.
    PMID: 34078684 DOI: 10.7861/clinmed.21-2-s25
  8. Shariff RER, Kasim SS
    Clin Med (Lond), 2020 03;20(2):215-216.
    PMID: 32188662 DOI: 10.7861/clinmed.2019-0501
    A 31-year-old man presented with central chest heaviness. He was a smoker of 15 pack-years, but otherwise had no other comorbidities. He was also a professional footballer. There was no family history of sudden cardiac deaths of note. In view of a low to intermediate pre-test probability for coronary artery disease (CAD), computed tomography coronary angiography (CTCA) was performed, revealing an anomalous, malignant right coronary artery (RCA), originating from the left main coronary stem. Malignant RCAs are rare, and the majority of patients remain asymptomatic. However, malignant RCAs have been associated with both myocardial infarctions and sudden cardiac deaths, which has led to difficulty in deciding on whether a 'watchful waiting' approach or more proactive approach should be adopted. Unfortunately, there remains a lack of evidence to help guide treatment decisions. Furthermore, there are no known guidelines on managing coronary anomalies in athletes, such as the case presented. As the majority of national guidelines have largely recommended CTCA as first-line investigation in patients with low to intermediate risk of CAD with chest pain, incidental finding of coronary anomalies will become more common, urging the need for guidelines to help with directing management in such cases.
  9. Krishnan D, Zaini SS, Latif KA, Joseph JP
    Clin Med (Lond), 2020 01;20(1):95-97.
    PMID: 31941739 DOI: 10.7861/clinmed.2019-0368
    Neurosyphilis is a broad term used to describe an infection caused by Treponema pallidum in the central nervous system. While this was a common cause of stroke in the 19th century, it saw a decline after the introduction of penicillin. However, in the recent past, there has been an increase in the incidence of syphilis, especially with HIV coinfection. Neurosyphilis results from an untreated primary syphilis. Neuropsychiatric disorder appears to be the commonest manifestation followed cerebrovascular accident, myelopathy, ocular disease and seizure. Known as the 'great imitator', this entity, however, may be easily missed if not for a high index of suspicion. This is especially so because of its similar presentation to other more common clinical conditions. We describe the case of a 39-year-old man displaying acute global aphasia and right-sided facial weakness in keeping with a left middle cerebral artery infarct. This was confirmed with computed tomography of the brain, and subsequently, further investigations revealed a diagnosis of neurosyphilis. The patient was treated with intravenous benzylpenicillin and recovered well with treatment.
  10. Cheo SW, Low QJ, Tan YA, Chia YK
    Clin Med (Lond), 2020 05;20(3):e20-e21.
    PMID: 32414735 DOI: 10.7861/clinmed.2020-0019
    Neuromyelitis optica spectrum disorder (NMOSD) is a rare inflammatory disorder of the nervous system which can be potentially debilitating. Its prevalence is estimated to be around 0.5-10 per 100,000 population with predilection towards Asians and females. It can be diagnosed based on core clinical characteristics, serum aquaporin antibodies and neuroimaging features. It is important to pick up the diagnosis of NMOSD as the treatment is different from other demyelinating disease. Here, we illustrate a case of NMOSD presented with intractable vomiting.
  11. Tan YA, Ng KC, Cheo SW, Khoo TT, Low QJ
    Clin Med (Lond), 2020 09;20(5):519-521.
    PMID: 32934050 DOI: 10.7861/clinmed.2020-0364
    Methaemoglobinaemia is an uncommon but potentially serious condition. It can be caused by congenital or acquired cause. Drug-induced methaemoglobinaemia is the commonest cause of acquired methaemoglobinaemia. The clinical signs and symptoms of methaemoglobinaemia include dyspnoea, desaturation, presence of saturation gap, headache, nausea and seizures depending on level of serum methaemoglobinaemia. We illustrate a case of dapsone-induced methaemoglobinaemia and its successful treatment by intravenous methylene blue.
  12. Tong CV
    Clin Med (Lond), 2020 09;20(5):e204-e205.
    PMID: 32934066 DOI: 10.7861/clinmed.2020-0151
    A 34-year-old woman (gravida 4; para 3) at 17 weeks of pregnancy presented with abnormal behaviour for 3 weeks associated with difficulties in walking. She had been admitted 2 months prior with hyperemesis gravidarum and was also diagnosed with thyrotoxicosis. Vomiting and poor oral intake persisted after discharge. She was euthyroid otherwise. Clinical examination revealed a dehydrated and confused patient. She had nystagmus and ataxic gate. Magnetic resonance imaging of the brain showed symmetrical signal changes of posteromedial part of thalamus. A diagnosis of Wernicke's encephalopathy (WE) was made and intravenous thiamine was given leading to gradual improvement of symptoms. Her thyroid function test normalised without any treatment. WE can occur in severe hyperemesis gravidarum. Prompt recognition of WE and replacement with thiamine is important to prevent neurological sequelae and mortality. Gestational transient thyrotoxicosis, which is self-limiting, is more prominent in patients with hyperemesis gravidarum and requires only symptomatic treatment.
  13. Khoo CS, Ali AH, Remli R, Tan HJ
    Clin Med (Lond), 2018 08;18(4):308-310.
    PMID: 30072555 DOI: 10.7861/clinmedicine.18-4-308
    Guillain-Barré syndrome (GBS) is an acute immune-mediated demyelinating disease. Early recognition of this disease is crucial as it can progress to life-threatening conditions such as respiratory failure or autonomic dysfunction. Typical clinical manifestations of GBS include progressive weakness of the limbs, bulbar, facial muscles and ophthalmoplegia. Sensory level and bladder dysfunction are more suggestive of acute myelopathy. We report a case of GBS presenting with acute urinary retention and T6 sensory level, which was successfully treated with plasma exchange.
  14. Tan YY, Tan K
    Clin Med (Lond), 2019 Nov;19(6):511-513.
    PMID: 31732595 DOI: 10.7861/clinmed.2019-0247
    Hypertensive encephalopathy (HE) is a subset of posterior reversible encephalopathy syndrome. It typically involves the posterior supratentorial structures, but variations do occur. However, isolated brainstem involvement in HE is rare, with a few cases reported in the literature. Herein, we report a case of acute hypertensive brainstem encephalopathy in which the patient had mild symptoms with very high blood pressure and normal neurological examination. The computed tomography of the brain showed diffuse hypodensity at brainstem. The patient's symptoms improved drastically after hypertension had been controlled. Marked clinical-radiologic dissociation in this particular case was highly suggestive of hypertensive brainstem encephalopathy. Prompt recognition of the condition and aggressive treatment of hypertension in such patients is crucial to relieve oedema and to prevent life-threatening progression. Nevertheless, there is still a lack of awareness among physicians and radiologists regarding this rare clinical entity.
  15. Khoo CS, Zulkifli NH, Rahman SSA
    Clin Med (Lond), 2017 Oct;17(5):436-438.
    PMID: 28974594 DOI: 10.7861/clinmedicine.17-5-436
    We describe a case of a young lady with anti-NMDA (N-methyl-D-aspartate) receptor encephalitis, who initially presented with status epilepticus. Her seizures and orofacial dyskinesia were refractory to four anticonvulsants. She received intravenous immunoglobulin and a left ovarian tumour (an associated feature) was resected. However, her outcome was poor because of delayed treatment, autonomic dysfunction and complications of prolonged hospitalisation. This case highlights the importance of an early recognition of this rare but increasingly recognised disease.
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