Displaying publications 1 - 20 of 60 in total

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  1. Kan CH, Saffari M, Khoo TH
    PMID: 22135509 MyJurnal
    Traumatic Brain Injury (TBI) in children has been poorly studied, and the literature is limited. We evaluated 146 children with severe TBI (coma score less than 8) in an attempt to establish the prognostic factors of severe TBI in children.
    Matched MeSH terms: Glasgow Coma Scale
  2. Liong CC, Rahmat K, Mah JS, Lim SY, Tan AH
    Can J Neurol Sci, 2016 Sep;43(5):719-20.
    PMID: 27670213 DOI: 10.1017/cjn.2016.269
    Matched MeSH terms: Glasgow Coma Scale
  3. Seed, H.F., Thong, K.S., Siti-Nor Aizah, A.
    MyJurnal
    Although disturbance of consciousness in delirium patients have been well
    established, but sudden drop of Glasgow Coma Scale (GCS) level to three is
    frightening and mysterious. We are reporting a case of a delirious elderly
    man with multiple medical illnesses presented with acute precipitous
    decrement of GCS with pin point pupils bilaterally after given a course of
    benzodiazepines and regained full consciousness spontaneously 32 hours
    later. We discussed the use of deliriogenic medications in the context of
    delirious elderly gentleman with multiple medical illnesses. We also looked
    into the possible differentials of sudden drop of conscious level with bilateral
    pin point pupils.
    Matched MeSH terms: Glasgow Coma Scale
  4. Idris Z, Zenian MS, Muzaimi M, Hamid WZ
    Asian J Neurosurg, 2014 Jul-Sep;9(3):115-23.
    PMID: 25685201 DOI: 10.4103/1793-5482.142690
    Induced hypothermia for treatment of traumatic brain injury is controversial. Since many pathways involved in the pathophysiology of secondary brain injury are temperature dependent, regional brain hypothermia is thought capable to mitigate those processes. The objectives of this study are to assess the therapeutic effects and complications of regional brain cooling in severe head injury with Glasgow coma scale (GCS) 6-7.
    Matched MeSH terms: Glasgow Coma Scale
  5. Liew BS, Zainab K, Cecilia A, Zarina Y, Clement T
    PMID: 28503270
    Head injury is common and preventable. Assessment of the head injury patient includes airway, cervical spine protection, breathing, circulation, haemorrhage control and the Glasgow Coma Scale. Hypotension, hypoxia, hypocarbia and hypercarbia should be avoided by continuous monitoring of vital signs and hourly head chart to prevent secondary brain injury. This paper aims to assist primary healthcare providers to select the appropriate patient for transfer and imaging for further management of head injury.
    Matched MeSH terms: Glasgow Coma Scale
  6. Sidek MSM, Siregar JA, Ghani ARI, Idris Z
    PMID: 30918459 DOI: 10.21315/mjms2018.25.2.10
    Background: With teleneurosurgery, more patients with head injury are managed in the primary hospital under the care of general surgical unit. Growing concerns regarding the safety and outcome of these patients are valid and need to be addressed.

    Method: This study is to evaluate the outcome of patients with mild head injury which were managed in non-neurosurgical centres with the help of teleneurosurgery. The study recruits samples from five primary hospitals utilising teleneurosurgery for neurosurgical consultations in managing mild head injury cases in Johor state. Two main outcomes were noted; favourable and unfavourable, with a follow up review of the Glasgow Outcome Scale (GOS) at 3 and 6 months.

    Results: Total of 359 samples were recruited with a total of 11 (3.06%) patients have an unfavourable. no significant difference in GOS at 3 and 6 months for patient in the unfavourable group (P = 0.368).

    Conclusion: In this study we have found no significant factors affecting the outcome of mild head injury patients managed in non-neurosurgical centres in Johor state using the help of teleneurosurgery.

    Matched MeSH terms: Glasgow Coma Scale
  7. Law ZK, Meretoja A, Engelter ST, Christensen H, Muresan EM, Glad SB, et al.
    European stroke journal, 2017 Mar;2(1):13-22.
    PMID: 31008298 DOI: 10.1177/2396987316676610
    Purpose: Haematoma expansion is a devastating complication of intracerebral haemorrhage (ICH) with no established treatment. Tranexamic acid had been an effective haemostatic agent in reducing post-operative and traumatic bleeding. We review current evidence examining the efficacy of tranexamic acid in improving clinical outcome after ICH.

    Method: We searched MEDLINE, EMBASE, CENTRAL and clinical trial registers for studies using search strategies incorporating the terms 'intracerebral haemorrhage', 'tranexamic acid' and 'antifibrinolytic'. Authors of ongoing clinical trials were contacted for further details.

    Findings: We screened 268 publications and retrieved 17 articles after screening. Unpublished information from three ongoing clinical trials was obtained. We found five completed studies. Of these, two randomised controlled trials (RCTs) comparing intravenous tranexamic acid to placebo (n = 54) reported no significant difference in death or dependency. Three observational studies (n = 281) suggested less haematoma growth with rapid tranexamic acid infusion. There are six ongoing RCTs (n = 3089) with different clinical exclusions, imaging selection criteria (spot sign and haematoma volume), time window for recruitment and dosing of tranexamic acid.

    Discussion: Despite their heterogeneity, the ongoing trials will provide key evidence on the effects of tranexamic acid on ICH. There are uncertainties of whether patients with negative spot sign, large haematoma, intraventricular haemorrhage, or poor Glasgow Coma Scale should be recruited. The time window for optimal effect of haemostatic therapy in ICH is yet to be established.

    Conclusion: Tranexamic acid is a promising haemostatic agent for ICH. We await the results of the trials before definite conclusions can be drawn.

    Matched MeSH terms: Glasgow Coma Scale
  8. Maheswaran M, Adnan WA, Ahmad R, Ab Rahman NH, Naing NN, Abdullah J
    PMID: 18613557
    Non-traumatic Altered States of Consciousness (ASC) are a non-specific consequence of various etiologies, and are normally monitored by Glasgow Coma Scale (GCS). The GCS gives varriable results among untrained emergency medicine personel in developing countries where English is not the first language. An In House Scoring System (IHSS) scale was made by the first author for the purpose of triaging so as to quickly asses patients when seen by medical personel. This IHSS scale was compared to the GCS to determine it's specificity and sensitivity in the accident and emergency department (ED) of Hospital University Sains Malaysia (HUSM). All patients with non-traumatic ASC were selected by purposive sampling according to pre-determined criteria. Patients were evaluated by the two systems, IHSS and GCS, by emergency physicians who were on call. Patient demographics, clinical features, investigations, treatment given and outcomes were collected and followed for a period of 14 days. A total of 221 patients with non-traumatic ASC were studied, 54.3% were males. The mean age of the patients was 56 years old. The mean overall GCS score on presentation to the ED was 10.3. The mean duration of ASC was 11.6 hours. One hundred thirty patients (58.8%) experienced ASC secondary to general or focal cerebral disorders. The mortality rate was 40.3% 2 weeks after the ED visit. Fifty-four point three percent of the patients were awake and considered to have good outcomes while 45.7% of the patients had poor outcomes (comatose or dead) 2 weeks after the ED visit. The mean overall GCS score, verbal and motor subscores as well as the IHSS had significantly decreased (worsened) after treatment in the ED. A poor IHSS scale, hypertension, current smoking, abnormal pupillary reflexes and acidosis were associated with a worse 2-week outcome. The mean age and WBC count was lower and the mean overall GCS score and eye, verbal and motor subscores were higher as well as those having a lower IHSS scale for the good outcome category. Multivariate analysis revealed that smokers and hypertensives were at higher risk for a poor outcome. Higher eye scores on the GCS were associated fewer poor outcomes. There was significant agreement between the IHSS scale and GCS scores in the assessment of non-traumatic ASC. The sensitivity and specificity of the IHSS score versus GCS were 71.9% and 100.0%, respectively.
    Matched MeSH terms: Glasgow Coma Scale/standards*
  9. Grover CS, Thiagarajah S
    Med J Malaysia, 2014 Dec;69(6):268-72.
    PMID: 25934957 MyJurnal
    Our objective was to study the profile of cerebrovascular accidents and proportion of cerebral haemorrhage (CH) among stroke patients. This project was designed after we observed higher incidence of CH in Miri hospital as compared to conventionally reported data.

    METHODS: This was a prospective observational study conducted from 1st June 2008 to 31st May 2009. All patients admitted in both male and female wards of the Medical Unit with the first incidence of a stroke were recruited for analysis. CT scan brain was done in all patients.

    RESULTS: Total admissions in one year in the medical department were 3204 patients, both male and female together, out of which 215 were due to a first incidence of stroke; Stroke accounted for 6.7% of admissions and 16.8% of deaths in medical unit. 139 (64.7%) were ischaemic strokes and 76 (35.3%) were cerebral haemorrhages. The incidence of CH (35.3%) was high compared to regional data. 71.7% (154) patients had preexisting hypertension. Higher incidence of hypertension, diabetes mellitus and aspirin intake was noted in the ischaemic group. Also compliance to treatment for hypertension was better in the Ischaemic group with more defaults in CH category (P<0.01). Significantly more deaths were noted in patients with higher systolic blood pressure on presentation, poor Glasgow Coma Scale (GCS) and those with dysphagia.

    CONCLUSION: Every third stroke was due to cerebral hemorrhage; CH patients were largely unaware of their hypertension or were altogether treatment naïve or defaulters while compliance was far better in ischaemic stroke category.
    Matched MeSH terms: Glasgow Coma Scale
  10. Raffiq MA, Haspani MS, Kandasamy R, Abdullah JM
    PMID: 25101197 DOI: 10.4103/2152-7806.135342
    BACKGROUND: Malignant middle cerebral artery (MCA) infarction is a devastating clinical entity affecting about 10% of stroke patients. Decompressive craniectomy has been found to reduce mortality rates and improve outcome in patients.

    METHODS: A retrospective case review study was conducted to compare patients treated with medical therapy and decompressive surgery for malignant MCA infarction in Hospital Kuala Lumpur over a period of 5 years (from January 2007 to December 2012). A total of 125 patients were included in this study; 90 (72%) patients were treated with surgery, while 35 (28%) patients were treated with medical therapy. Outcome was assessed in terms of mortality rate at 30 days, Glasgow Outcome Score (GOS) on discharge, and modified Rankin scale (mRS) at 3 and 6 months.

    RESULTS: Decompressive craniectomy resulted in a significant reduction in mortality rate at 30 days (P < 0.05) and favorable GOS outcome at discharge (P < 0.05). Good functional outcome based on mRS was seen in 48.9% of patients at 3 months and in 64.4% of patients at 6 months (P < 0.05). Factors associated with good outcome include infarct volume of less than 250 ml, midline shift of less than 10 mm, absence of additional vascular territory involvement, good preoperative Glasgow Coma Scale (GCS) score, and early surgical intervention (within 24 h) (P < 0.05). Age and dominant hemisphere infarction had no significant association with functional outcome.

    CONCLUSION: Decompressive craniectomy achieves good functional outcome in, young patients with good preoperative GCS score and favorable radiological findings treated with surgery within 24 h of ictus.

    Matched MeSH terms: Glasgow Coma Scale
  11. Johnson JR, Idris Z, Abdullah JM, Alias A, Haspani MS
    PMID: 28381928 DOI: 10.21315/mjms2017.24.1.5
    BACKGROUND: Intraventricular haemorrhage (IVH) causes blockage of ventricular conduits leading to hydrocephalus, increased intracranial pressure (ICP), and a reduced level of consciousness. The current standard management of IVH is insertion of an external ventricular drainage (EVD) catheter. However, this procedure addresses only the problems of acute hydrocephalus and raised ICP. Endoscopic washout allows for a more complete removal of the intraventricular clot. This study compared these two types of treatment in terms of shunt dependency and relevant clinical outcomes.

    METHODS: Patients who were 10-80 years old and presented with a Graeb score of more than six were randomised into endoscopic washout and EVD treatment groups. A CT brain was repeated on each patient within 24 hours after surgery, and if a patient's Graeb score was still more than six, a repeat endoscopic washout was performed to clear the remaining clots. All patients were monitored for shunt dependency at two weeks and three months, and clinical outcomes were measured at six months after the procedure.

    RESULTS: A total of 39 patients were recruited; 19 patients were randomised into the endoscopic washout group, and 20 were randomised into the EVD group. However, three patients in the endoscopic group refused that treatment and opted for EVD insertion. Patients treated with endoscopic washout had significantly less drainage dependency at two weeks (P < 0.005) and at three months (P < 0.004) as compared to patients in the external ventricular drainage group. The reduction in Graeb scores was also significantly greater in the endoscopic washout group (P < 0.001). However, the functional outcome at six months measured via a modified Rankin scale score was no different in the two groups of patients. The difference in the functional outcome of the patients was mainly dependent on the initial pathology, with those presenting with a thalamic bleed with IVH showing a poor functional outcome. This parameter was also influenced by the Glasgow Coma Scale (GCS) score on admission, with those patients with a score of 12 or less having a poor functional outcome (MRS 5-6) at three and six months after the surgery.

    CONCLUSIONS: The use of neuroendoscopy in patients with a massive IVH significantly reduced drainage dependency. However, it did not alter the final functional outcome.

    Matched MeSH terms: Glasgow Coma Scale
  12. Mohamed Ludin S, Abdul Rashid N
    Clin Nurs Res, 2020 Sep;29(7):433-439.
    PMID: 30079766 DOI: 10.1177/1054773818792459
    Throughout recovery, patients with severe traumatic brain injury (TBI) show physical and functional improvement, but continue to have cognitive and psychosocial problems. The aim of this article was to review the literature regarding the functional and health-related quality of life (HRQOL) outcomes in severe TBI. There were 15 articles reviewed, 13 of them were quantitative studies and two were narrative review. Most of the articles showed an improvement occurs rapidly at 6 months post-injury. There were several factors that influence the outcome after TBI, most of it was the Glasgow Coma Scale (GCS) on admission, age, educational level, duration of posttraumatic amnesia (PTA), and length of stay (LOS) in the Intensive Care Unit (ICU). Thus, health care workers should help the survivors of severe TBI in the recovery process to ensure the latter can attain maximum function and quality of life.
    Matched MeSH terms: Glasgow Coma Scale
  13. Wan-Arfah N, Hafiz HM, Naing NN, Muzaimi M, Shetty HGM
    Health Sci Rep, 2018 Feb;1(2):e27.
    PMID: 30623059 DOI: 10.1002/hsr2.27
    Aim: This study aimed to determine the 28-day, 1-year, and 5-year survival probabilities in first-ever stroke patients in a relatively understudied setting: a suburban hospital that serves a predominantly rural population in the east coast of Peninsular Malaysia.

    Methods and results: A retrospective record review was conducted among 432 first-ever stroke patients admitted to the Hospital Universiti Sains Malaysia, Kelantan, Malaysia. Data from between January 1, 2005 and December 31, 2011, were extracted from the medical records. The Kaplan-Meier product limit estimator was applied to determine the 28-day, 1-year, and 5-year survival probabilities. Log-rank test was used to test the equality of survival time between different groups. A total of 101 patients died during the study period. The 28-day, 1-year, and 5-year survival probabilities were 78.0% (95% confidence interval [CI]: 73.5-81.9), 74.2% (95% CI: 69.4-78.4), and 70.9% (95% CI: 65.1-75.9), respectively. There were significant differences in the survival time based on the types of stroke, Glasgow Coma Scale, hyperlipidaemia, atrial fibrillation, fasting blood glucose, and diastolic blood pressure.

    Conclusion: This study, though retrospective, highlights several clinical parameters that influenced the survival probabilities among first-ever stroke patients managed in a suburban setting in Malaysia, and compared them to those reported in more urban regions. Our data emphasise the need for wider establishment of specialized stroke units and teams, as well as for prospective multi-centre studies on first-ever stroke patients to better inform the development of stroke care provision in Malaysia.

    Matched MeSH terms: Glasgow Coma Scale
  14. Nayak C, Nayak D, Raja A, Rao A
    Neurol Res, 2008 Jun;30(5):461-4.
    PMID: 18953735
    Epidemiologic works reveal that moderate head injury (MHI) is more frequent and a substantial number of these patients develop complications resulting in neurological disabilities. Reactive oxygen species (ROS) play a major role in post-traumatic neuronal damage following traumatic head injury. Thus, the current study analysed the post-traumatic changes in the erythrocyte markers of oxidative damage and the relationship between these parameters and Glasgow coma scale (GCS) scores of MHI patients during the 7 day study period.
    Matched MeSH terms: Glasgow Coma Scale*
  15. Nayak CD, Nayak DM, Raja A, Rao A
    Indian J Med Sci, 2007 Jul;61(7):381-9.
    PMID: 17611343
    BACKGROUND: Reactive oxygen species are indicated to play a prime role in the pathophysiology of brain damage following a severe head injury (SHI).

    AIM: The current study was designed to understand the time-relative changes and relationship between erythrocyte antioxidant enzyme activities and Glasgow Coma Scale (GCS) scores of SHI patients in the 21-day posttraumatic study period.

    SETTINGS AND DESIGN: The study included 24 SHI patients and 25 age- and sex-matched normal controls (NC). Activities of superoxide dismutase (SOD), glutathione reductase (GR) and glutathione peroxidase (GSH-Px) were assayed in these patients and controls. The GCS scores of these patients were also recorded for the comparative study.

    MATERIALS AND METHODS: Venous blood samples were collected on day 7 (D7) and D21 from SHI patients and NC for the assay of SOD, GR and GSH-Px activities. These changes were correlated with age and changes in GCS scores of patients.

    STATISTICAL ANALYSIS: A one-way analysis of variance (ANOVA) was used to compare mean values of each parameter between group 1 (NC), group 2 (D7 changes in SHI patients) and group 3 (D21 changes in SHI patients). ANOVA was followed by Bonferroni post hoc tests. The Pearson correlation was applied to correlate between the antioxidant parameters and age and GCS scores of these patients.

    RESULTS: A significant increase in erythrocyte SOD and GSH-Px activities was observed in group 3 as compared to groups 1 and 2. The increase in GSH-Px activity was significant in group 2 as compared to group 1. Although not significant, there was an increase in mean GR activity in groups 2 and 3 as compared to group 1.

    CONCLUSION: These findings indicate that SHI patients have shown significantly enhanced erythrocyte SOD and GSH-Px activities during the 21-day posttraumatic study period.

    Matched MeSH terms: Glasgow Coma Scale*
  16. Ong L, Selladurai BM, Dhillon MK, Atan M, Lye MS
    Pediatr Neurosurg, 1996 Jun;24(6):285-91.
    PMID: 8988493
    The outcome of 151 children less than 15 years of age and admitted within 24 h of head injury was studied in relation to clinical and computed tomography (CT) scan features. Thirty one (20.5%) had a poor outcome (24 died, 6 were severely disabled at 6 months after injury and 1 was in a persistent vegetative state) while 120 (79.5%) had a good outcome (89 recovered well and 31 were moderately disabled). Factors associated with a poor outcome were Glasgow Coma Scale (GCS) score 24 h following injury, presence of hypoxia on admission and CT scan features of subarachnoid haemorrhage, diffuse axonal injury and brain swelling. GCS scores alone, in the absence of other factors, had limited predictive value. The prognostic value of GCS scores < 8 was enhanced two-to fourfold by the presence of hypoxia. The additional presence of the CT scan features mentioned above markedly increased the probability of a poor outcome to > 0.8, modified only by the presence of GCS scores > 12. Correct predictions were made in 90.1% of patients, indicating that it is possible to estimate the severity of a patient's injury based on a small subset of clinical and radiological criteria that are readily available.
    Matched MeSH terms: Glasgow Coma Scale*
  17. Keong LH, Ghani AR, Awang MS, Sayuthi S, Idris B, Abdullah JM
    Acta Neurochir. Suppl., 2011;111:375-9.
    PMID: 21725785 DOI: 10.1007/978-3-7091-0693-8_63
    The aim of the study was to determine the prognostic value of a high augmentation index, which was a surrogate marker of arterial stiffness in patients with spontaneous intracerebral hemorrhage. The outcome was divided into two groups in which the following data were collected in a computer running SphygmoCor CvMS software version 8.2. Logistic regression analysis was carried out among significant variables to identify an independent predictor of 6-month outcome and mortality. Sixty patients were recruited into the study. Admission Glasgow Coma Scale score (OR, 0.7; 95% CI, 0.450-0.971; P=0.035), total white cell count (OR, 1.2; 95% CI, 1.028-1.453; P=0.023) and hematoma volume (OR, 1.1; 95% CI, 1.024-1.204; P=0.011) were found to be statistically significant for identifying poor 6-month outcome in multivariate analysis. Factors independently associated with mortality were a high augmentation index (OR, 8.6; 95% CI, 1.794-40.940; P=0.007) and midline shift (OR, 7.5; 95% CI, 1.809-31.004; P=0.005). Admission Glasgow Coma Scale score, total white cell count and hematoma volume were significant predictors for poor 6-month outcome, and a high augmentation index and midline shift were predictors for 6-month mortality in this study.
    Matched MeSH terms: Glasgow Coma Scale
  18. Ong TZ, Raymond AA
    Singapore medical journal, 2002 Oct;43(10):517-21.
    PMID: 12587706
    Stroke is the third most common cause of death in Malaysia.The prevalence of risk factors and predictors of mortality of stroke in Malaysia are poorly understood.
    Matched MeSH terms: Glasgow Coma Scale
  19. Kumaraswamy N, Naziah A, Abdullah J, Ariff MMed AR, Abdullah MR, Ghazaime G
    J Clin Neurosci, 2002 May;9(3):251-5.
    PMID: 12093129
    Malaysia had the second highest crude accident rate in the world until 1998. Most children who were involved in these road traffic accidents required intensive neurosurgical care management. We report a prospective study on 36 paediatric neurotrauma patients in rural North East West Malaysia who underwent uniform intensive therapy and were subsequently followed up over a period of 2 years. The modified paediatric Glasgow Coma Scale with support of the revised Wechlser Intelligence Scale for children was used to test the outcome of these children over a period of two years. All patients were managed aggressively in our intensive care as well as our high dependency units. Our results indicate that improvement in outcome is seen after a six month period. Midline shift, duration of coma and duration of transport were found to be significant variables associated with bad outcome. Other variables i.e. age, sex, Glasgow Coma Scale on admission and on site, and lesions of the dominant lobe were not found to be associated with good outcome in these patients.
    Matched MeSH terms: Glasgow Coma Scale
  20. Azian AA, Nurulazman AA, Shuaib L, Mahayidin M, Ariff AR, Naing NN, et al.
    Acta Neurochir (Wien), 2001;143(7):711-20.
    PMID: 11534693
    Head injury is a significant economic, social and medical problem all over the world. Road accidents are the most frequent cause of head injury in Malaysia with highest risk in the young (15 to 24 years old). The associated outcomes include good recovery, possibility of death for the severely injured, which may cause disruption of the lives of their family members. It is important to predict the outcome as it will provide sound information to assist clinicians in Malaysia in providing prognostic information to patients and their families, to assess the effectiveness of different modes of treatment in promoting recovery and to document the significance of head injury as a public health problem.

    RESULTS: A total of 103 cases with intracranial haemorrhage i.e. intracerebral haemorrhage, extradural haemorrhage, subdural haemorrhage, intraventricular haemorrhage, haemorrhagic contusion and subarachnoid haemorrhage, following motor vehicle accidents was undertaken to study factors contributing to either good or poor outcome according to the Glasgow Outcome Scale. Patients below 12 years of age were excluded. The end point of the study was taken at 24 months post injury. The selected variables were incorporated into models generated by logistic regression techniques of multivariate analysis to see the significant predictors of outcome as well as the correlation between the CT findings with GCS.

    CONCLUSION: Significant predictors of outcome were GCS on arrival in the accident emergency department, pupillary reflex and the CT scan findings. The CT predictors of outcome include ICH, EDH, IVH, present of SAH, site of ICH, volumes of EDH and SDH as well as midline shift.

    Matched MeSH terms: Glasgow Coma Scale
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