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  1. Molecular genetic analysis of anaplastic pleomorphic xanthoastrocytoma
    Nasuha NA, Daud AH, Ghazali MM, Yusoff AA, Zainuddin N, Abdullah JM, et al.
    Asian J Surg, 2003 Apr;26(2):120-5.
    PMID: 12732498
    A case of pleomorphic xanthoastrocytoma in a 10-year-old Malay boy is reported. The patient presented with headache and epilepsy. On computed tomography, a ring-enhancing low-density lesion was observed in the left fronto-temporal area. During surgery, a cystic tumour containing serous fluid was found and almost totally removed. Histologically, the tumour exhibited marked pleomorphism of oval and spindle-shaped cells intermixed with uni- and multinucleated giant cells, and xanthomatous cells with foamy cytoplasm. The tumour displayed pericellular reticulin and periodic acid-Schiff positive granules. Focally, six mitotic characters per 10 high-power fields were seen, and necrosis was confined only to the inner lining of the cyst. Mutational analysis showed that a frameshift mutation (a 4-bp deletion) in the p53 gene had occurred in codons 273 and 274 of exon 8. No mutation was detected in the p16 gene. No allelic loss and/or loss of heterozygosity were observed on chromosome 10 using microsatellite marker D105532. The patient was treated with postoperative radiotherapy because of histological anaplasia and the presence of residual tumour. The patient showed marked neurological recovery after a follow-up period of 2 years.
    Matched MeSH terms: Frontal Lobe*
  2. Fulltext Frontal Electroencephalogram Alpha Asymmetry during Mental Stress Related to Workplace Noise
    Alyan E, Saad NM, Kamel N, Yusoff MZ, Zakariya MA, Rahman MA, et al.
    Sensors (Basel), 2021 Mar 11;21(6).
    PMID: 33799722 DOI: 10.3390/s21061968
    This study aims to investigate the effects of workplace noise on neural activity and alpha asymmetries of the prefrontal cortex (PFC) during mental stress conditions. Workplace noise exposure is a pervasive environmental pollutant and is negatively linked to cognitive effects and selective attention. Generally, the stress theory is assumed to underlie the impact of noise on health. Evidence for the impacts of workplace noise on mental stress is lacking. Fifteen healthy volunteer subjects performed the Montreal imaging stress task in quiet and noisy workplaces while their brain activity was recorded using electroencephalography. The salivary alpha-amylase (sAA) was measured before and immediately after each tested workplace to evaluate the stress level. The results showed a decrease in alpha rhythms, or an increase in cortical activity, of the PFC for all participants at the noisy workplace. Further analysis of alpha asymmetry revealed a greater significant relative right frontal activation of the noisy workplace group at electrode pairs F4-F3 but not F8-F7. Furthermore, a significant increase in sAA activity was observed in all participants at the noisy workplace, demonstrating the presence of stress. The findings provide critical information on the effects of workplace noise-related stress that might be neglected during mental stress evaluations.
    Matched MeSH terms: Frontal Lobe
  3. The impact of cognitive load on reward evaluation
    Krigolson OE, Hassall CD, Satel J, Klein RM
    Brain Res, 2015 Nov 19;1627:225-32.
    PMID: 26431993 DOI: 10.1016/j.brainres.2015.09.028
    The neural systems that afford our ability to evaluate rewards and punishments are impacted by a variety of external factors. Here, we demonstrate that increased cognitive load reduces the functional efficacy of a reward processing system within the human medial-frontal cortex. In our paradigm, two groups of participants used performance feedback to estimate the exact duration of one second while electroencephalographic (EEG) data was recorded. Prior to performing the time estimation task, both groups were instructed to keep their eyes still and avoid blinking in line with well established EEG protocol. However, during performance of the time-estimation task, one of the two groups was provided with trial-to-trial-feedback about their performance on the time-estimation task and their eye movements to induce a higher level of cognitive load relative to participants in the other group who were solely provided with feedback about the accuracy of their temporal estimates. In line with previous work, we found that the higher level of cognitive load reduced the amplitude of the feedback-related negativity, a component of the human event-related brain potential associated with reward evaluation within the medial-frontal cortex. Importantly, our results provide further support that increased cognitive load reduces the functional efficacy of a neural system associated with reward processing.
    Matched MeSH terms: Frontal Lobe
  4. Fulltext Brain activations evoked by passive and active listening: a preliminary study on multiple subjects
    Ahmad Nazlim Yusoff, Mazlyfarina Mohamad, Mohd Mahadir Ayob, Mohd Harith Hashim
    Jurnal Sains Kesihatan Malaysia, 2008;6(1):35-60.
    MyJurnal
    A functional magnetic resonance imaging (fMRI) study was conducted on 4 healthy male and female subjects to investigate brain activation during passive and active listening. Two different experimental conditions were separately used in this study. The first condition requires the subjects to listen to a simple arithmetic instruction (e.g. one-plus-two-plus-three-plus-four) - passive listening. In the second condition, the subjects were given the same series of arithmetic instruction and were required to listen and perform the calculation - active listening. The data were then analysed using the Statistical Parametric Mapping (SPM5) and the MATLAB 7.4 (R2007a) programming softwares. The results obtained from the fixed (FFX) and random effects analyses (RFX) show that the active-state signal intensity was significantly higher (p < 0.05) than the resting-state signal intensity for both conditions. The results also indicate significant differences (p < 0.001) in brain activation between passive and active listening. The activated cortical regions during passive listening, as obtained from the FFX of the first condition is symmetrical in the left and right temporal and frontal lobes covering the cortical auditory areas. However, for the second condition, which was active listening, more activation occurs in the left hemisphere with a reduction in the number of activated voxels and their signal intensity in the right hemisphere. Activation mainly occurs in the middle temporal gyrus, precentral gyrus, middle frontal gyrus, superior temporal gyrus and several other areas in the frontal lobes. The point of maximum signal intensity has been shifted to a new coordinates during active listening. It is also observed that the magnetic resonance signal intensity and the number of activated voxel in the right and left superior temporal lobes for the second condition have been reduced as compared to that of the first condition. The results obtained strongly suggest the existence of functional specialisation. The results also indicate different networks for the two conditions. These networks clearly pertain to the existence of functional connectivity between activation areas during listening and listening while performing a simple arithmetic task.
    Matched MeSH terms: Frontal Lobe
  5. Real time monitoring of dopamine release evoked by mitragynine (Kratom): An insight through electrochemical sensor
    Effendy MA, Yunusa S, Zain ZM, Hassan Z
    Neurosci Lett, 2021 10 15;763:136183.
    PMID: 34418508 DOI: 10.1016/j.neulet.2021.136183
    BACKGROUND: Mitragynine, the major indole alkaloid from Mitragyna speciosa has been reported previously to possess abuse liability. However, there are insufficient data suggesting the mechanism through which this pharmacological agent causes addiction.

    AIMS: In this study, we investigated the effects of mitragynine on dopamine (DA) level and dopamine transporter (DAT) expression from the rat's frontal cortex.

    METHODS: DA level was recorded in the brain samples of animals treated with acute or repeated exposure for 4 consecutive days with either vehicle or mitragynine (1 and 30 mg/kg) using electrochemical sensor. Animals were then decapitated and the brain regions were removed, snap-frozen in liquid nitrogen and immediately stored at -80 °C. DA level was quantified using Enzyme linked immunosorbent assay (ELISA) kits and DAT gene expression was determined using quantitative real time polymerase chain reaction (RT-qPCR).

    RESULTS/OUTCOME: Mitragynine (1 and 30 mg/kg) did not increase DA release following acute treatment, however, after repeated exposure at day 4, mitragynine significantly and dose dependently increased DA release in the frontal cortex. In this study, we also observed a significant increase in DAT mRNA expression at day 4 in group treated with mitragynine (30 mg/kg).

    CONCLUSION/INTERPRETATION: Data from this study indicates that mitragynine significantly increased DA release when administered repeatedly, increased in DAT mRNA expression with the highest tested dose (30 mg/kg). Therefore, the rewarding effects observed after mitragynine administration could be due to its ability to increase DA content in certain areas of the brain especially the frontal cortex.

    Matched MeSH terms: Frontal Lobe/drug effects; Frontal Lobe/metabolism; Frontal Lobe/pathology
  6. The speech evoked potential in normal subjects and patients with cerebral hemispheric lesions
    Pratap RC
    Clin Neurol Neurosurg, 1987;89(4):237-42.
    PMID: 3690926
    The present study deals with observations on the "speech evoked potential"-a late positive potential evoked by word repetition. These potentials, evoked by "silent" repetition of polysyllabic words, were averaged and recorded from the scalp overlying the inferior frontal regions on both sides in 20 normal healthy subjects of ages ranging from 13-58 years. The potential had a triphasic negative, positive, negative morphology and was present over both hemispheres in left as well as right handed subjects. The main positive deflection and mean latencies of 219.2 msec and 221.6 msec and mean amplitude of 6.2 muv and 6.5 muv respectively on the left and right sides. Though there were interindividual variations in latency, amplitude and morphology, there was a high degree of intraindividual similarity and reproducibility in subjects. The variations in these parameters with age, sex and handedness are discussed. In 10 patients with cerebral lesions, the evoked potential was normal in 5 cases with right frontal lesions and showed abnormalities in 3 of 5 cases with left frontal lesions. The speech evoked potential may be useful in the further study of electrical correlates of speech output in speech disorders.
    Matched MeSH terms: Frontal Lobe/physiopathology*
  7. Chlorogenic acid may improve memory function and decrease inflamation of frontal lobe in diabetic rat
    Munawaroh F, Arfian N, Saputri LAAWS, Kencana SMS, Sari DCR
    Med J Malaysia, 2023 Jul;78(4):476-483.
    PMID: 37518915
    INTRODUCTION: Diabetes Mellitus (DM) is a chronic disease with many complications, one of which is diabetic encephalopathy which is characterised by memory dysfunction. Hyperglycaemia that occurs in DM will activate inflammatory pathways in neurons, including NF-κB pathway. Activation of this pathway produce proinflammatory agents such as MCP-1 and IL-6, which activate glial cells. Activation of glial cells is characterised by Glial Fibrillary Acid Protein (GFAP). Chlorogenic acid (CGA) has been reported to have anti-inflammatory effects and can improve memory function. This research aimed to determine the effect of CGA as anti-inflammation, its effect on memory function, mRNA expression of NF-κB, MCP-1, IL- 6, and GFAP of frontal lobe.

    MATERIALS AND METHODS: A total of 24 male rats were randomly divided into six groups: control, DM 1.5 month (DM1.5), DM 2 months (DM2) and the group with three different doses of CGA 12.5 (CGA1), 25 (CGA2), and 50 (CGA3) mg/KgBW. Frontal lobe tissue is taken for analysis of mRNA expression for NF-κB, MCP-1, IL-6, and GFAP using Reverse Transcriptase PCR (RT-PCR). Samples were also taken for histopathology preparation and stained by immunohistochemistry method using anti-GFAP antibodies to observe glial cell activation in frontal lobe tissue.

    RESULTS: The group that was given CGA at all doses have statistically significant better memory function, i.e. DM2 versus CGA1 (p = 0.036), CGA2 (p = 0.040), and CGA3 (p = 0.021). The result of mRNA expression in NF-κB was lower in the group given CGA, i.e. DM2 compared to CGA2 (p = 0.007). mRNA expression of MCP-1 was significantly lower in all CGA treatment groups compared to the non-CGA group (p = 0.000). IL-6 mRNA expression was lower than the group not given CGA, DM compared to CGA2 (p = 0.028). GFAP mRNA expression was lower than the group given CGA in DM, DM2 group compared to CGA1 (p = 0.04) and CGA3 (p = 0.004).

    CONCLUSION: Administration of CGA can improve memory function at all doses given, and can reduce brain inflammatory activity, especially in the CGA2 group.

    Matched MeSH terms: Frontal Lobe/metabolism
  8. Comparison of effect of sex hormone manipulation during neonatal period, on mRNA expression of Slc9a4, Nr3c2, Htr5b and Mas1 in hippocampus and frontal cortex of male and female rats
    Karimi B, Hafidzi MN, Panandam JM, Fuzina NH
    J Biol Regul Homeost Agents, 2013 Jul-Sep;27(3):869-74.
    PMID: 24152851
    It has long been known that spatial memory and the ability to navigate through space are sexually dimorphic traits among mammals, and numerous studies have shown that these traits can be altered by means of sex hormone manipulation. Hippocampus, the main organ involved in this kind of memory, has specific signature genes with high expression level compared to other regions of the brain. Based on their expression levels and the role that products of these genes can play in processes like signal transduction, mediation of hormone effects and long term potentiation, these genes can be considered as genes necessary for routine tasks of hippocampus. Male and female rat pups were injected with estradiol and testosterone respectively. at early stage of their lives to examine the effect of sex hormone manipulation on mRNA expression of Slc9a4, Nr3c2, Htr5b and Mas1 using comparative quantitative real-time polymerase chain reaction. The results showed that expressions of these genes are strongly influenced by sex hormones in both the frontal cortex and hippocampus, especially in male hippocampus, in which expression of all genes were up-regulated. Htr5b was the only gene that was affected only in the males. Expression of Mas1 was contrary to expectations, showed stronger changes in its expression in cortex than in hippocampus. Nr3c2 was down regulated in all samples but up regulated in male hippocampus, and Slc9a4 also showed a huge up-regulation in male hippocampus compared to other samples.
    Matched MeSH terms: Frontal Lobe/drug effects; Frontal Lobe/metabolism*
  9. Effects of edible bird's nest on hippocampal and cortical neurodegeneration in ovariectomized rats
    Zhiping H, Imam MU, Ismail M, Ismail N, Yida Z, Ideris A, et al.
    Food Funct, 2015 May;6(5):1701-11.
    PMID: 25920003 DOI: 10.1039/c5fo00226e
    The aim of this research is to investigate whether edible bird's nest (EBN) attenuates cortical and hippocampal neurodegeneration in ovariectomized rats. Ovariectomized rats were randomly divided into seven experimental groups (n = 6): the ovariectomy (OVX) group had their ovaries surgically removed; the sham group underwent surgical procedure similar to OVX group, but ovaries were left intact; estrogen group had OVX and received estrogen therapy (0.2 mg kg(-1) per day); EBN treatment groups received 6%, 3%, and 1.5% EBN, respectively. Control group was not ovariectomized. After 12 weeks of intervention, biochemical assays were performed for markers of neurodegeneration, and messenger ribonucleic acid (mRNA) levels of oxidative stress-related genes in the hippocampus and frontal cortex of the brain were analysed. Caspase 3 (cysteine-aspartic proteases 3) protein levels in the hippocampus and frontal cortex were also determined using western blotting. The results show that EBNs significantly decreased estrogen deficiency-associated serum elevation of advanced glycation end-products (AGEs), and they changed redox status as evidenced by oxidative damage (malondialdehyde content) and enzymatic antioxidant defense (superoxide dismutase and catalase) markers. Furthermore, genes associated with neurodegeneration and apoptosis were downregulated in the hippocampus and frontal cortex by EBN supplementation. Taken together, the results suggest that EBN has potential for neuroprotection against estrogen deficiency-associated senescence, at least in part via modification of the redox system and attenuation of AGEs.
    Matched MeSH terms: Frontal Lobe/enzymology; Frontal Lobe/metabolism*
  10. Fulltext Unilateral neglect or alien hand syndrome? A diagnostic challenge
    Wan Yusoff WR, Hanafi MH, Ibrahim AH, Kassim NK, Suhaimi A
    J Taibah Univ Med Sci, 2021 Apr;16(2):288-291.
    PMID: 33897336 DOI: 10.1016/j.jtumed.2020.12.003
    Alien hand syndrome (AHS) is a rare post-stroke complication. Although the occurrence of AHS after stroke is rare, it can have a disabling impact on the lifestyle and career of the patients post stroke. It is difficult to distinguish AHS from the non-dominant hemispheric infarction with symptoms of hemianopia and left hemineglect, as patients with AHS can also have neglect as well as behaviour symptoms if the frontal lobe is involved. We report the case of a 62-year-old gentleman who was admitted to the rehabilitation ward and was treated for neglect and apraxia following right middle cerebral artery stroke. After further re-evaluation, the patient was diagnosed with AHS. Functionally, he improved and the symptoms disappeared four months after the stroke. In this case report, we highlight the features of AHS and provide a unique management approach.
    Matched MeSH terms: Frontal Lobe
  11. Fulltext Frontal meningioma with psychiatric symptoms
    Hussin S, Yusoff SSM, Zin FM, Ghani ARI
    J Family Med Prim Care, 2018 6 20;7(1):252-254.
    PMID: 29915770 DOI: 10.4103/jfmpc.jfmpc_157_17
    Frontal meningioma is often asymptomatic and patient may present with psychiatric symptoms. We report a case of 45- year-old female patient with no premorbid medical illness presented with 6 months history of depressive symptoms and changes in personality. Her worsening cognitive impairment brought her to psychiatry clinic and led to further investigation with contrast-enhanced computed tomography (CECT) Brain. The result showed well defined markedly enhancing lesion in the frontal region measuring 5.5 cm X5.2 cm X 4.4 cm with mass effect to the adjacent brain parenchyma and associated surrounding edema. Diagnosis of bifrontal tumour-olfactory Groove Meningioma was made. Patient underwent bifrontal craniotomy and tumour excision. The quality of life improved after surgical excision.
    Matched MeSH terms: Frontal Lobe
  12. Fulltext Proximal migration of the Hakim's valve into a porencephalic cyst
    Chee Pin Chee
    Med J Malaysia, 1987 Dec;42(4):309-13.
    PMID: 3331410
    An unusual case of proximal migration of a Hakim's valve intracranially into a porencephalic cyst two years after insertion of the ventriculo-peritoneal shunt in a neonate is reported. The underlying cause is discussed. It is recommended that all shunt should be anchored with nonabsorbable suture material properly on to the pericranium.
    Matched MeSH terms: Frontal Lobe*
  13. 47 XYY and morning glory syndrome--a unique association
    Chew FL, Visvaraja S
    J AAPOS, 2009 Aug;13(4):406-7.
    PMID: 19487143 DOI: 10.1016/j.jaapos.2009.02.007
    47 XYY syndrome is a sporadic condition in which the human male receives an extra Y chromosome. Few ocular associations have been documented. The authors report the first case of 47 XYY associated with morning glory syndrome, frontonasal meningoencephalocele, and midfacial defects.
    Matched MeSH terms: Frontal Lobe/abnormalities
  14. Fulltext Validating a functional near-infrared spectroscopy diagnostic paradigm for Major Depressive Disorder
    Husain SF, Yu R, Tang TB, Tam WW, Tran B, Quek TT, et al.
    Sci Rep, 2020 06 16;10(1):9740.
    PMID: 32546704 DOI: 10.1038/s41598-020-66784-2
    Reduced haemodynamic response in the frontotemporal cortices of patients with major depressive disorder (MDD) has been demonstrated using functional near-infrared spectroscopy (fNIRS). Most notably, changes in cortical oxy-haemoglobin during a Japanese phonetic fluency task can differentiate psychiatric patients from healthy controls (HC). However, this paradigm has not been validated in the English language. Therefore, the present work aimed to distinguish patients with MDD from HCs, using haemodynamic response measured during an English letter fluency task. One hundred and five HCs and 105 patients with MDD took part in this study. NIRS signals during the verbal fluency task (VFT) was acquired using a 52-channel system, and changes in oxy-haemoglobin in the frontal and temporal regions were quantified. Depression severity, psychosocial functioning, pharmacotherapy and psychiatric history were noted. Patients with MDD had smaller changes in oxy-haemoglobin in the frontal and temporal cortices than HCs. In both regions of interest, oxy-haemoglobin was not associated with any of the clinical variables studied. 75.2% and 76.5% of patients with MDD were correctly classified using frontal and temporal region oxy-haemoglobin, respectively. Haemodynamic response measured by fNIRS during an English letter fluency task is a promising biomarker for MDD.
    Matched MeSH terms: Frontal Lobe/physiopathology
  15. Fulltext Aphagia in frontal lobe syndrome following traumatic brain injury: Delightful lessons from olanzapine treatment
    Ahmedy F, Loo JL, Mazlan M
    Indian J Psychiatry, 2020 12 12;62(6):732-733.
    PMID: 33896983 DOI: 10.4103/psychiatry.IndianJPsychiatry_334_19
    A case of persistent aphagia in frontal lobe syndrome after traumatic brain injury (TBI) with successful use of olanzapine to improve the eating disorder is presented. A 20-year-old man suffered a severe TBI with right frontal intracerebral haemorrhage At four-month post-TBI, he had agitation, concurrent apathy with constant refusal for oral swallow despite gustatory sensory stimulation, hence the needs for nasogastric tube (NGT) feeding. He was diagnosed with frontal lobe syndrome and prescribed olanzapine 5mg daily that was optimised to 10mg due to worsened aggression. One month later, the aggression reduced with gradual improvement in oral intake. Percutaneous enterogastrostomy (PEG) tube insertion was cancelled and the NGT was sucessfully removed. Olanzapine prescription in this case improved aggression and aphagia simultaneously. Although olanzapine is proven beneficial and surgical intervention for long-term enteral feeding was avoided in this case, its usage requires judicious judgement.
    Matched MeSH terms: Frontal Lobe
  16. Fulltext Changes in white matter fiber density and morphology across the adult lifespan: A cross-sectional fixel-based analysis
    Choy SW, Bagarinao E, Watanabe H, Ho ETW, Maesawa S, Mori D, et al.
    Hum Brain Mapp, 2020 08 15;41(12):3198-3211.
    PMID: 32304267 DOI: 10.1002/hbm.25008
    White matter (WM) fiber bundles change dynamically with age. These changes could be driven by alterations in axonal diameter, axonal density, and myelin content. In this study, we applied a novel fixel-based analysis (FBA) framework to examine these changes throughout the adult lifespan. Using diffusion-weighted images from a cohort of 293 healthy volunteers (89 males/204 females) from ages 21 to 86 years old, we performed FBA to analyze age-related changes in microscopic fiber density (FD) and macroscopic fiber morphology (fiber cross section [FC]). Our results showed significant and widespread age-related alterations in FD and FC across the whole brain. Interestingly, some fiber bundles such as the anterior thalamic radiation, corpus callosum, and superior longitudinal fasciculus only showed significant negative relationship with age in FD values, but not in FC. On the other hand, some segments of the cerebello-thalamo-cortical pathway only showed significant negative relationship with age in FC, but not in FD. Analysis at the tract-level also showed that major fiber tract groups predominantly distributed in the frontal lobe (cingulum, forceps minor) exhibited greater vulnerability to the aging process than the others. Differences in FC and the combined measure of FD and cross section values observed between sexes were mostly driven by differences in brain sizes although male participants tended to exhibit steeper negative linear relationship with age in FD as compared to female participants. Overall, these findings provide further insights into the structural changes the brain's WM undergoes due to the aging process.
    Matched MeSH terms: Frontal Lobe
  17. Fulltext Memantine augmentation in the treatment of frontal lobe syndrome in patients with end-stage renal disease: a case report
    Aida Abdul Razak, Maniam, T., Hatta Sidi, Shalisah Sharip, Suriati Mohamed Saini
    ASEAN Journal of Psychiatry, 2014;15(1):93-96.
    MyJurnal
    Objective: This case report highlights the challenges in managing Frontal Lobe Syndrome (FLS) in a patient with end-stage renal disease. Methods: This is a case description of a 58 year-old gentleman who presented with behavioural changes: irritability, mood lability, aggression, psychosis, and overfamiliarity. His presenting symptoms were in keeping with (FLS) with positive findings on Computed Tomography (CT) scan of the brain and also neuropsychological assessments. Difficulties arose in attempts to control his aggression without further compromising his renal function. Results: The usage of the commonly used antipsychotics in controlling aggression was restricted in view of the patient’s renal impairment. Augmentation with low dose memantine proved to be beneficial in this case, without causing further deterioration in renal function. Conclusion: The use of memantine to augment the effect of risperidone was observed to be safe and successful in managing the behavioural changes associated with FLS in adults with end-stage renal disease. ASEAN Journal of Psychiatry, Vol. 15 (1): January - June 2014: 93-96.
    Matched MeSH terms: Frontal Lobe
  18. Fulltext Ischaemic haemorrhagic stroke in a child with new onset type 1 diabetes mellitus
    Mohd Nor NS, Fong CY, Rahmat K, Vanessa Lee WM, Zaini AA, Jalaludin MY
    Eur Endocrinol, 2018 Apr;14(1):59-61.
    PMID: 29922355 DOI: 10.17925/EE.2018.14.1.59
    Cerebral oedema is the most common neurological complication of diabetic ketoacidosis (DKA). However, ischaemic and haemorrhagic brain injury has been reported infrequently. A 10-year old girl who was previously well presented with severe DKA. She was tachycardic with poor peripheral perfusion but normotensive. However, two fast boluses totalling 40 ml/kg normal saline were given. She was transferred to another hospital where she was intubated due to drowsiness. Rehydration fluid (maintenance and 48-hour correction for 7.5% dehydration) was started followed by insulin infusion. She was extubated within 24 hours of admission. Her ketosis resolved soon after and subcutaneous insulin was started. However, about 48 hours after admission, her Glasgow Coma Scale score dropped to 11/15 (E4M5V2) with expressive aphasia and upper motor neuron signs. One dose of mannitol was given. Her symptoms improved gradually and at 26-month follow-up she had a near-complete recovery with only minimal left lower limb weakness. Serial magnetic resonance imaging brain scans showed vascular ischaemic injury at the frontal-parietal watershed regions with haemorrhagic transformation. This case reiterates the importance of monitoring the neurological status of patient's with DKA closely for possible neurological complications including an ischaemic and haemorrhagic stroke.
    Matched MeSH terms: Frontal Lobe
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