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  1. Gayathri DK, Dhayalen K, Chia YK, Fung YK
    Med J Malaysia, 2019 08;74(4):331-332.
    PMID: 31424043
    Osmotic demyelination syndrome results from overly rapid serum sodium correction and is often iatrogenic. We report a 50-year-old hypertensive woman on Indapamide presenting with malaise, dizziness and serum sodium less than 100mmol/l who developed osmotic demyelination syndrome after correction of the hyponatremia. Good neurological recovery was seen after plasmapheresis.
    Matched MeSH terms: Demyelinating Diseases/blood; Demyelinating Diseases/diagnosis; Demyelinating Diseases/etiology; Demyelinating Diseases/therapy*
  2. Nur, A.S., Jemaima, C.H., Fuad Ismail, Safinaz, M.K.
    MyJurnal
    In children, most cases of optic neuritis are immune-related. Less frequently, it may also be due to
    demyelinating disorders. Other secondary causes such as infection of adjacent structures or infiltration are
    even rarer. The occurrence of optic neuritis in children on chemotherapy also has not being extensively
    reported. We report a case of bilateral optic neuritis in a young girl with subacute visual loss after receiving
    systemic chemotherapy for embryonal ovarian carcinoma.
    Matched MeSH terms: Demyelinating Diseases
  3. Michael NDB, Tuan Jaffar TN, Hussein A, Wan Hitam WH
    Cureus, 2018 Sep 24;10(9):e3352.
    PMID: 30510863 DOI: 10.7759/cureus.3352
    Vaccination-induced optic neuritis is not common. The development of optic neuritis following various vaccinations have been reported, suggesting a possible association between optic neuritis and vaccination. Of those reported cases, influenza vaccines have been the most common. Although rare, those patients who developed optic neuritis following HPV vaccination also presented with other central nervous system (CNS) demyelinating syndromes, especially following a booster dose. We present a rare case of simultaneous isolated bilateral optic neuritis following the first dose of an HPV vaccination in a young child. She received treatment with a systemic corticosteroid that resulted in a good clinical outcome without developing any demyelinating disease.
    Matched MeSH terms: Demyelinating Diseases
  4. Tan AH, Lim SY, Ng RX
    JAMA Neurol, 2018 07 01;75(7):888-889.
    PMID: 29799978 DOI: 10.1001/jamaneurol.2018.0983
    Matched MeSH terms: Demyelinating Diseases/drug therapy; Demyelinating Diseases/etiology
  5. Sim Mervyn Ian, Nor Zuraida Zainal, Aili Hanim
    MyJurnal
    Osmotic demyelination syndrome (ODS) may occur as a consequence of a
    rapid change in serum osmolality. We report a case of a 32-year-old woman
    who presented to the hospital with symptoms suggestive of severe
    hyperemesis gravidarum. Blood investigation results showed that patient had
    severe hyponatraemia (serum sodium 109 mmol/L) and hypokalaemia
    (serum potassium 1.7 mmol/L). Active and vigorous corrections to these
    electrolyte imbalances had led to an overly increased of serum sodium levels
    within a short duration of time. Four days after the rapid correction, patient
    started exhibiting neuropsychiatric manifestations. Radiological findings
    were consistent with the diagnosis of ODS. The neuropsychiatric symptoms
    experienced by patient gradually worsened with time. Subsequently,
    intravenous methylprednisolone was administered to patient. Patient showed
    marked response to the steroid given. At the time of discharge, twenty-seven
    days later, patient had recovered from most of the neuropsychiatric sequelae;
    but still required assistance during ambulation. In conclusion, correction of
    electrolyte imbalances should be done in a more judicious manner. Prudent
    corrections of electrolyte alterations could have possibly prevented the onset
    of ODS and its’ devastating neuropsychiatric sequelae in this patient.
    Matched MeSH terms: Demyelinating Diseases
  6. Alturkustani M, Bahakeem B, Zhang Q, Ang LC
    Malays J Pathol, 2020 Aug;42(2):187-194.
    PMID: 32860370
    INTRODUCTION: Multiple sclerosis (MS) has variable clinical presentations, prognoses, pathogeneses, and pathological patterns. We conducted a pathological review of acute MS-associated lesions that focused on the degree of axonal injury, myelin loss, and glial reaction to determine whether the observed demyelination was of the primary or secondary type.

    MATERIALS AND METHODS: After searching the records for a 15-year period at the London Health Sciences Centre Pathology Department, we identified 8 cases of surgical acute lesion biopsies in which clinical MS diagnoses were made before or after the biopsy.

    RESULTS: The white matter pathologies in these cases could be sorted into 3 morphological patterns. The first pattern, which represents typical demyelinated plaques, was observed in 4 cases and was characterised by nearly complete demyelination accompanied by variable degrees of axon preservation and axonal swelling. The second pattern was observed in 3 cases and was characterised by demyelinating lesions containing variable numbers of myelinated axons mixed with a few demyelinated axons and variable numbers of axonal swellings. The myelinated axons ranged from scattered fibres to bands of variable thickness, and the demyelination was a mixture of primary and secondary demyelination. The third pattern was observed in 1 case and was characterised by well-demarcated areas of reduced myelin staining and numerous apoptotic nuclei. Axonal staining revealed many fragmented axons with reduced myelin staining but no definitely demyelinated axons.

    CONCLUSIONS: This report shows that the predominant pathology underlying acute MS-related lesions is not limited to demyelination but can include axonal degeneration alone or in combination with primary demyelination which reflect different pathogenesis for these acute lesions.

    Matched MeSH terms: Demyelinating Diseases
  7. Tai, Sharon Mei-Ling, Hazman Mohd Nor, Kartini Rahmat, Pow, Zhen Yuan, Ong, Lay Sim, Tan, Chong Tin, et al.
    Neurology Asia, 2017;22(4):313-323.
    MyJurnal
    Background: Tuberculous disease of spine (spinal TB) is under-recognized in tuberculous (TB) meningitis.
    The objective of the study was to evaluate the frequency, clinical and neuroimaging changes, and
    outcome in the patients with spinal TB.

    Methods: All the patients with spinal TB admitted in the two
    largest tertiary hospitals in Kuala Lumpur from 2009 to 2017 were recruited, the clinical features were
    documented, the magnetic resonance imaging (MRI) of the spine was performed. Clinical outcome was
    assessed with Modified Rankin scale (MRS).

    Results: Twenty two patients were recruited. This was
    out of 70 TB meningitis patients (31.4%) seen over the same period. Eighteen (81.8%) patients had
    concomitant TB meningitis. The clinical features consisted of systemic symptoms with fever (63.6%),
    meningitis symptoms with altered sensorium (45.5%), myelopathy with paraparesis (36.4%). The
    findings on spinal MRI were discitis (36.4%), spinal meningeal enhancement (31.8%), spinal cord
    compression (31.8%), psoas abscess (27.3%), osteomyelitis (22.7%), and cord oedema (22.7%). All
    except two patients (90.9%) had involvement in psoas muscle, bone or leptomeningeal enhancement,
    features that can be used to differentiate from myelopathy that affect the parenchyma only, such as
    demyelination. Unusual manifestations were syringomyelia and paradoxical manifestations seen in 3
    patients each. The outcome were overall poor, with 68% having MRS 3 or more.

    Conclusion: Spinal TB is common in TB meningitis. The outcome is overall poor. A heightened
    awareness is crucial to enable early diagnosis and treatment.
    Matched MeSH terms: Demyelinating Diseases
  8. Suryaningtyas W, Parenrengi MA, Bajamal AH, Rantam FA
    Malays J Med Sci, 2020 May;27(3):34-42.
    PMID: 32684804 DOI: 10.21315/mjms2020.27.3.4
    Background: Hydrocephalus induces mechanical and biochemical changes in neural cells of the brain. Astrogliosis, as the hallmark of cellular changes in white matter, is involved in demyelination process, re-myelination inhibitory effect, and inhibition of axonal elongation and regeneration. The pathophysiology of this process is not well understood. The purpose of the present study is to elucidate the effect of lipid peroxidation product on astrogliosis through WNT/ β-catenin in kaolin-induced hydrocephalic rats.

    Methods: The study used kaolin-induced hydrocephalic rats. Obstructive hydrocephalus was expected to develop within seven days after induction. The hydrocephalus animals were killed at day 7, 14 and 21 after induction. One group of the saline-injected animals was used for sham-treatment.

    Results: We demonstrated that the hydrocephalic rats exhibited a high expression of 4-hydroxynonenal (4-HNE) in the periventricular area. The expression of β-catenin also increased, following the pattern of 4-HNE. Reactive astrocyte, expressed by positive glial fibrillary acidic protein (GFAP), was upregulated in an incremental fashion as well as the microglia.

    Conclusion: This work suggests that lipid peroxidation product, 4-HNE, activated the WNT/β-catenin pathway, leading to the development of reactive astrocyte and microglia activation in hydrocephalus.

    Matched MeSH terms: Demyelinating Diseases
  9. Shahrizaila N, Yuki N
    J Neurol Neurosurg Psychiatry, 2013 May;84(5):576-83.
    PMID: 22984203 DOI: 10.1136/jnnp-2012-302824
    In the 1950s, Bickerstaff and Fisher independently described cases with a unique presentation of ophthalmoplegia and ataxia. The neurological features were typically preceded by an antecedent infection and the majority of patients made a spontaneous recovery. In the cases with Bickerstaff brainstem encephalitis, there was associated altered consciousness and in some, hyperreflexia, in support of a central pathology whereas in Fisher syndrome, patients were areflexic in keeping with a peripheral aetiology. However, both authors recognised certain similarities to Guillain-Barré syndrome such as the presence of peripheral neuropathy and cerebrospinal fluid albuminocytological dissociation. The discovery of immunoglobulin G anti-GQ1b antibodies in patients with Fisher syndrome and later in Bickerstaff brainstem encephalitis was crucial in providing the necessary evidence to conclude that both conditions were in fact part of the same spectrum of disease by virtue of their common clinical and immunological profiles. Following this, other neurological presentations that share anti-GQ1b antibodies emerged in the literature. These include acute ophthalmoparesis and acute ataxic neuropathy, which represent the less extensive spectrum of the disease whereas pharyngeal-cervical-brachial weakness and Fisher syndrome overlap with Guillain-Barré syndrome represent the more extensive end of the spectrum. The conditions can be referred to as the 'anti-GQ1b antibody syndrome'. In this review, we look back at the historical descriptions and describe how our understanding of Fisher syndrome and Bickerstaff brainstem encephalitis has evolved from their initial descriptions more than half a century ago.
    Matched MeSH terms: Demyelinating Diseases/pathology
  10. Anandakrishnan P, Khoo TB
    BMJ Case Rep, 2018 May 30;2018.
    PMID: 29848532 DOI: 10.1136/bcr-2018-224496
    Cerebral demyelination and optic neuritis are often seen in children with acute disseminated encephalomyelitis following various infections and immunisations. An eight month old girl presented with a left axillary lymph node swelling and an erythematous lace-like rash over her cheeks and trunk. She then developed acute encephalopathy, bilateral nystagmus, right hemiparesis and left facial nerve palsy. Her electroencephalogram showed an encephalopathic process and visual evoked response study were grossly abnormal. Her MRI brain showed hyperintensities in the midbrain, pons and bilateral cerebellar peduncles. She was treated as postinfectious cerebral demyelination with intravenous antibiotics, methylprednisolone and immunoglobulin. Left axillary lymph node excision biopsy and GeneXpert test detected Mycobacterium tuberculosis complex that prompted initiation of antituberculous therapy. Her chest X-ray and cerebrospinal fluid examinations for tuberculosis were normal. She showed significant recovery after 2 weeks. This case illustrates a rare presentation of cerebral demyelination and bilateral optic neuritis following suppurative BCG lymphadenitis.
    Matched MeSH terms: Demyelinating Diseases/drug therapy
  11. Nurul-Ain M, Khairul Kamal ZN, Wan Hitam WH, Abd Munaaim M, Mohd Zaki F
    Cureus, 2021 Apr 13;13(4):e14452.
    PMID: 33996312 DOI: 10.7759/cureus.14452
    Myelin oligodendrocyte glycoprotein (MOG) antibody disease has been recognised as a distinct demyelinating disorder. Optic neuritis has been reported as the most common presentation and manifestation of this spectrum disorder. This is a case series of three MOG optic neuritis patients. Patients involved are female with disease onset ranging between 7- and 37-year-old. Most of these patients experienced symptoms of profound reduced visual acuity with eye pain. All three patients had optic disc swelling upon first presentation and they experienced at least one episode of bilateral simultaneous optic neuritis. Only one patient had demonstrable optic nerve enhancement on magnetic resonance imaging (MRI). Disease was confirmed through positive MOG antibody. Patients typically responded well to intravenous methylprednisolone (IVMP) during acute attack of optic neuritis. However, one patient had suboptimal response to IVMP after multiple relapses. We noted multiple relapses of optic neuritis are common in MOG patients. MOG optic neuritis is a devastating, but treatable condition. Aggressive treatment during acute optic neuritis attack and relapse prevention may favour a good visual prognosis in MOG antibody disease.
    Matched MeSH terms: Demyelinating Diseases
  12. Viswanathan S, Hung SKY, Goyal V, Apiwattanakul M, Thirugnanam UN, Abdullah S, et al.
    J Clin Apher, 2018 Oct;33(5):559-568.
    PMID: 29626354 DOI: 10.1002/jca.21630
    In December 2017, 79 delegates attended the 2nd regional plasmapheresis conference and workshop for Southeast Asia (SEA) on the immunomodulatory role of plasma exchange in central and peripheral nervous system disorders in Kuala Lumpur, Malaysia. This meeting featured 6 plenary lectures, interactive sessions dedicated for experience sharing, case presentations, and a practical session for paramedics. Clinical experts and researchers from 7 SEA countries and India shared experience and challenges in treating autoimmune neurological disorders. While the spectrum of diseases and neurology practice remained largely similar, there was great disparities in accessibility of therapeutic plasma exchange (TPE) within SEA countries and between urban or rural settings. Costs, human resources, and healthcare policies are common challenges in providing sustainable TPE services. Novel techniques and innovative ideas in performing TPE were explored. A working consortium comprising of key opinion leaders was proposed to improve standards of TPE and enhance future research.
    Matched MeSH terms: Demyelinating Diseases
  13. Omotoso GO, Olajide OJ, Gbadamosi IT, Rasheed MA, Izuogu CT
    Malays J Med Sci, 2018 Mar;25(2):50-63.
    PMID: 30918455 DOI: 10.21315/mjms2018.25.2.6
    Background: This study explored the efficacy of kolaviron-a biflavonoid complex isolated from the seeds of Garcinia kola-in protecting against cuprizone (CPZ)-induced demyelination in both the prefrontal cortex and the hippocampus of Wistar rats.

    Methodology: Thirty rats were treated to receive 0.5 mL phosphate-buffered saline (group A, control), 0.5 mL corn oil (group B), 0.2% CPZ (group C), for 6 weeks, 0.2% CPZ for 3 weeks and then 200 mg/kg of Kv for 3 weeks (group D), or 200 mg/kg of Kv for 3 weeks followed by 0.2% CPZ for 3 weeks (group E). Rats were assessed for exploratory functions and anxiety-like behaviour before being euthanised and perfused transcardially with 4% paraformaldehyde. Prefrontal and hippocampal thin sections were stained in hematoxylin and eosin and cresyl fast violet stains.

    Results: CPZ-induced demyelination resulted in behavioural impairment as seen by reduced exploratory activities, rearing behaviour, stretch attend posture, center square entry, and anxiogenic characteristics. Degenerative changes including pyknosis, karyorrhexis, neuronal hypertrophy, and reduced Nissl integrity were also seen. Animals treated with Kv showed significant improvement in behavioural outcomes and a comparatively normal cytoarchitectural profile.

    Conclusion: Kv provides protective roles against CPZ-induced neurotoxicity through prevention of ribosomal protein degradation.

    Matched MeSH terms: Demyelinating Diseases
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