exudates and Brain-Diseases

To review the presenting features, complications and outcome of infants with Salmonella meningitis.. Retrospective review of all cultures of cerebrospinal fluid positive for bacteria in children below 12 years of age, processed at the Department of Medical Microbiology, University of Malaya Medical Centre, Kuala Lumpur from 1973 to 1997. Records of all cases positive for Salmonella species were retrieved and studied.. Thirteen infants aged 3 days to 9 months with Salmonella meningitis were included. The median age of onset of symptoms was 4 months. The clinical and laboratory features were similar to other causes of bacterial meningitis. Salmonella enteritidis was the commonest serotype isolated. Nine infants developed fits, six of which were difficult to control. Other complications noted were hydrocephalus (five), subdural effusions (four), empyema (three), ventriculitis (two), intracranial haemorrhage and cerebral abscess (one each). The use of ampicillin and/or chloramphenicol and inadequate duration of therapy resulted in recrudescence or relapse in five infants. The overall mortality was 18%. The presence of empyema, intracerebral abscess, ventriculitis, hydrocephalus, and intracranial haemorrhage were associated with adverse neurodevelopmental sequelae or death. More than half of those who survived had normal long-term outcome.. Infants who developed neurological complications as a result of Salmonella meningitis had significant mortality and adverse long-term neurodevelopment outcome.

Topics: Anti-Bacterial Agents; Brain Diseases; Female; Humans; Infant; Infant, Newborn; Malaysia; Male; Meningitis, Bacterial; Recurrence; Retrospective Studies; Salmonella Infections; Survival Rate; Treatment Outcome

Dribbling (sialorrhoea) affects about 10 per cent of patients with chronic neurological disease. The variety of treatments currently available is unsatisfactory. This study was a clinical trial of the efficacy of ultrasound-guided, intraglandular injection of botulinum toxin A for dribbling, performed within the otorhinolaryngology department of the National University of Malaysia. Both pairs of parotid and submandibular glands received 25 U each of botulinum toxin A. Twenty patients were enrolled in the study. The median age was 15 years. All 20 patients (or their carers) reported a distinct improvement in symptoms after injection. Using the Wilcoxon signed rank test, there were significant reductions in dribbling rating score, dribbling frequency score, dribbling severity score, dribbling visual analogue score and towel changes score, comparing pre- and post-injection states (p<0.001). There were no complications or adverse effects during or after the injection procedure. Intraglandular, major salivary gland injection of botulinum toxin A is an effective treatment to reduce dribbling. Ultrasound guidance enhances the accuracy of this procedure and minimises the risk of complication.

Topics: Adolescent; Aged; Botulinum Toxins, Type A; Brain Diseases; Child; Female; Humans; Injections; Malaysia; Male; Neurotoxins; Parotid Gland; Patient Satisfaction; Sialorrhea; Statistics, Nonparametric; Submandibular Gland; Treatment Outcome; Ultrasonography, Interventional

This case series compared clinical variables and various combinations of immunotherapy received with outcomes of patients with severe acute necrotizing encephalopathy (ANE). We performed a retrospective review of clinical variables, immunotherapy received, and outcomes (based on the modified Rankin Scale) in Malaysia between February 2019 and January 2020. Twenty-seven children (12 male), aged 7 months to 14 years (mean 4 years) at diagnosis were included. Of these, 23 had an ANE severity score of 5 to 9 out of 9 (high risk). Eleven patients received tocilizumab (four in combination with methylprednisolone [MTP], seven with MTP + intravenous immunoglobulin [IVIG]) and 16 did not (two received MTP alone, 14 received MTP + IVIG). Nine died. Among the survivors, six had good outcomes (modified Rankin Score 0-2) at 6 months follow-up. All patients who received tocilizumab in combination with MTP + IVIG survived. Twenty children received first immunotherapy within 48 hours of admission. No significant association was found between the timing of first immunotherapy with outcomes. Those with brainstem dysfunction (p = 0.016) were observed to have poorer outcomes. This study showed a trend towards better survival when those with severe ANE were treated with tocilizumab in combination with MTP + IVIG. However, larger studies will be needed to determine the effect of this regime on the long-term outcomes.

Topics: Brain Diseases; Child; Humans; Immunoglobulins, Intravenous; Leukoencephalitis, Acute Hemorrhagic; Malaysia; Male; Methylprednisolone; Retrospective Studies

Intracranial complications secondary to chronic otitis media (COM) include otogenic brain abscess and sinus thrombosis. Intravenous antibiotics and imaging have significantly reduced the incidence of intracranial complications secondary to COM. However, the same does not apply to a developing country like Malaysia, which still experiences persisting otogenic complications. This case series describes 3 patients with COM and intracranial complications. All 3 patients had COM with mastoiditis, with 1 of the 3 having a cholesteatoma. Postulated reasons for the continued occurrence include poor access to health care, poor compliance with medication, and the lack of pneumococcal vaccination during childhood. In conclusion, public awareness and a timely specialty referral can reduce the incidence of intracranial complications of COM.

Topics: Adult; Brain Abscess; Brain Diseases; Cholesteatoma, Middle Ear; Chronic Disease; Female; Humans; Malaysia; Male; Mastoiditis; Otitis Media; Young Adult

In 2009, pandemic influenza A H1N1 emerged in Mexico and subsequently spread worldwide. In Malaysia, there were more than a thousand of confirmed cases among children. The general clinical characteristics of these children have been well-published. However, the description of neurologic complications is scarce.. This study aims to describe the characteristics of neurologic manifestations and complications in a national paediatric cohort with pandemic influenza A H1N1.. During the pandemic, children (12 years or less) admitted for novel influenza A H1N1 in 68 Malaysian public hospitals, were prospectively enrolled into national database. The clinical, laboratory and neuro-imaging data for children with neurologic manifestations, hospitalized from 15th June 2009 till 30th November 2009, was reviewed.. Of 1244 children with influenza A H1N1 during the study period, 103 (8.3%) presented with influenza-related neurological manifestations. The mean age of our study cohort was 4.2 years (SD: 3.3 years). Sixty percent of them were males. Sixty-nine (66.9%) were diagnosed as febrile seizures, 16 (15.5%) as breakthrough seizures with underlying epilepsy, 14 (13.6%) as influenza-associated encephalopathy or encephalitis (IAE) and 4 (3.9%) as acute necrotizing encephalopathy of childhood (ANEC). All 4 available CSF specimens were negative for influenza viral PCR. Among 14 children with brain-imaging done, 9 were abnormal (2: cerebral oedema, 4: ANEC and 3: other findings). There were four deaths and three cases with permanent neurological sequelae.. About one-tenth of children with pandemic influenza A H1N1 presented with neurologic complications. The most common diagnosis was febrile seizures. One-fifth of those children with neurologic presentation had IAE or ANEC, which carried higher mortality and morbidity. This large national study provides us useful data to better manage children with neurologic complications in the future pandemic influenza outbreaks.

Topics: Brain Diseases; Child; Child, Preschool; Female; Humans; Influenza A Virus, H1N1 Subtype; Influenza, Human; Malaysia; Male; Pandemics

Molybdenum cofactor deficiency is a rare autosomal recessive disorder with devastating neurological manifestations, characterised by neonatal-onset encephalopathy mimicking hypoxic-ischaemic insult, intractable seizure, and feeding and respiratory difficulties. It is often fatal in the early life. We report an affected 8-year-old boy, who presented with severe neurological manifestations since birth, but without clinically-significant seizure. Molybdenum cofactor deficiency must be included in the differential diagnosis of patients presenting with unexplained encephalopathy in the newborn period, and whose neuroimaging findings are consistent with hypoxic ischaemic encephalopathy. The classic laboratory hallmark of this disorder is low serum uric acid, positive urine sulphite dipstick test, and elevated urinary S-sulphocysteine, hypoxanthine and xanthine.

Topics: Brain Diseases; Child; Coenzymes; Cysteine; Diagnosis, Differential; Humans; Hypoxanthine; Hypoxia; Ischemia; Malaysia; Male; Metalloproteins; Molybdenum Cofactors; Pteridines; Sulfites; Uric Acid; Xanthine

: We present our initial experience using a simple and relatively cost effective system using existing mobile phone network services and conventional handphones with built in cameras to capture carefully selected images from hard copies of scan images and transferring these images from a hospital without neurosurgical services to a university hospital with tertiary neurosurgical service for consultation and management plan.. : A total of 14 patients with acute neurosurgical problems admitted to a general hospital in a 6 months period had their images photographed and transferred in JPEG format to a university neurosurgical unit. This was accompanied by a phone conference to discuss the scan and the patients' condition between the neurosurgeon and the referring physician. All images were also reviewed by a second independent neurosurgeon on a separate occasion to asses the agreement on the diagnosis and the management plan.. : There were nine patients with acute head injury and five patients with acute nontraumatic neurosurgical problems. In all cases both neurosurgeons were in agreement that a diagnosis could be made on the basis of the images that were transferred. With respect to the management advice there were differences in opinion on three of the patients but these were considered to be minor.. : Accurate diagnosis can be made on images of acute neurosurgical problems transferred using a conventional camera phone and meaningful decisions can be made on these images. This method of consultation also proved to be highly convenient and cost effective.

Topics: Acute Disease; Brain Diseases; Cell Phone; Craniocerebral Trauma; Hospitals, General; Hospitals, University; Humans; Malaysia; Multimedia; Neurosurgery; Telemedicine

In a cross-sectional study of 21 children with Systemic Lupus Erythematosus, 15 (71%) were found to have neuropsychiatric manifestations. The most common finding was generalised seizures (42.8%) followed by encephalopathy (19%) and hallucinations (19%). One child (4.76%) had hemichorea. In 3 children neurological manifestations were the first symptom of SLE. Computerised Axial Tomograms (CAT scans) showed cerebral atrophy in 7 of 12 scans available for review. Ten children had abnormal EEGs. Although none of the children had clinical evidence of a peripheral neuropathy, 8 had neurophysiological evidence of a neuropathy. One child died of intracranial haemorrhage. Six children had residual neuropsychiatric sequalae.

Topics: Adolescent; Brain Diseases; Child; Electroencephalography; Female; Hallucinations; Humans; Incidence; Lupus Vasculitis, Central Nervous System; Malaysia; Male; Seizures; Tomography, X-Ray Computed

A prospective study was carried out to determine the incidence, clinical presentation, early outcome, and risk factors associated with periventricular haemorrhage (PVH) in 88 (84 per cent) of the 105 consecutive very low birth weight (VLBW) (< 1500 g) Malaysian neonates born in the Maternity Hospital, Kuala Lumpur. Based on the cranial ultrasound findings, PVH was detected in 86 of the 88 neonates (98 per cent, 95 per cent confidence intervals: 95 to 101). Seventeen (20 per cent) of them had grade I, 52 (61 per cent) had grade II, 7 (8 per cent) had grade III and 10 (12 per cent) had grade IV PVH. PVH was detected in all the affected neonates by the fifth day of life. Sixty-four neonates (74 per cent) were symptomatic when PVH was first detected. Shock (P < 0.01), pallor (P = 0.028), low haematocrit of less than 40 per cent (P < 0.01), convulsion (P < 0.001), and bulging of anterior fontanelle (P = 0.019) were significantly more common in the neonates with severe PVH (grades III or IV). Death occurred in 43/86 (50 per cent, 95 per cent confidence interval: 39-61 per cent) of the neonates with PVH before their first discharge from the hospital. Ventriculomegaly developed in 29/43 (67 per cent, 95 per cent confidence intervals: 54.4-81.4) of the survivors with PVH. Our study suggests that PVH is a common problem in the Malaysian VLBW neonates. To reduce the incidence and severity of this condition, prevention of preterm delivery and improvement in the basic facilities for neonatal care would help.

Topics: Age of Onset; Brain Diseases; Cerebral Ventricles; Female; Health Promotion; Hemorrhage; Humans; Infant, Low Birth Weight; Infant, Newborn; Malaysia; Male; Prospective Studies; Risk Factors; Severity of Illness Index; Ultrasonography

A Danish woman aged 28 years who had travelled in the Far East developed cerebral symptoms with headache and visual disturbances. Migraine was suspected. Subsequent CT scanning revealed multiple processes and metastases were suspected. As the patient had travelled in the Far East 1 1/2 years previously, she was examined for neurocysticercosis. This diagnosis was established and the patient was successfully treated with praziquantel. On account of increased travelling activity, the possibility of neurocysticercosis should be borne in mind when dealing with patients with cerebral symptoms and relevant travelling histories.

Topics: Adult; Brain Diseases; Cysticercosis; Female; Humans; Magnetic Resonance Imaging; Malaysia; Praziquantel; Thailand; Travel; Tropical Climate

Topics: Adult; Aluminum; Brain Diseases; Electroencephalography; Female; Humans; Kidney Failure, Chronic; Malaysia; Male; Middle Aged; Renal Dialysis

Topics: Brain Diseases; Child, Preschool; Female; Humans; Infant; Malaysia; Male; Tuberculosis

A patient with a solitary intracranial cryptococcoma of the occipital lobe of the brain and a concomitant granuloma of similar aetiology in the breast is reported. Despite resistance of the causative fungus to 5-fluorocytosine in vitro, the patient responded well to radical excisional surgery and therapy with 5-fluorocytosine.

Topics: Adolescent; Brain Diseases; Breast Diseases; Cryptococcosis; Female; Granuloma; Humans; Malaysia

Marchiafava-Bignami disease, a rare affliction of alcoholic males, is described in a severely malnourished Malaysian Indian male who took no alcohol. It is the second report of the disease in an Asian and represents one of the few cases which have occurred in non-alcoholics. Besides the pathognomonic demyelination of the central portion of the corpus callosum, there were striking demyelinative plaques in the subcortical white matter. In addition, neuropathological features of Wernicke's disease were found suggesting that severe malnutrition with thiamine deficiency was probably the cause of his demise.

Topics: Alcoholism; Australia; Brain Diseases; Corpus Callosum; Humans; Malaysia; Male; Psychoses, Alcoholic; Syndrome; Wernicke Encephalopathy

Cryptococcal infection of the brain as encountered in a tropical country is reviewed. The meningitic form is not uncommon and there has been, in the last decade, an apparent, if not real, rise in incidence in Malaysia as in Singapore. Only exceptionally was there overt evidence of immunological deficiency. Hydrocephalus was present in about three-quarters of the patients with meningitis and shunts were employed readily. The presence of multiple small intracerebral cysts could be suspected clinically but treatment for this complication was ineffective. The antifungal agent used most frequently was 5-fluorocytosine. Resistance to this drug developed in about one patient in four. There is a need for further epidemiological studies and for a continuing search for new antifungal agents.

Topics: Adolescent; Adult; Brain Diseases; Child; Cryptococcosis; Female; Flucytosine; Humans; Malaysia; Male; Middle Aged

Topics: Brain Diseases; Child; Humans; Malaysia; Reye Syndrome

Topics: Brain Diseases; Humans; Malaysia

Topics: Brain Diseases; Complementary Therapies; Female; Humans; Malaysia; Male; Mental Disorders; Rural Health; Spiritualism; Superstitions