ABSTRACT
Background: There is lack of normality data in the literature on the plantar response. Objective: To determine the variability of plantar response in normal population and factors that might contribute to the variability. Methods: We conducted a study of plantar response in healthy subjects aged 19-21 in two phases. First phase was plantar examination with hard strike. Subjects with big toe extension in the fi rst phase were re-examined with light and hard strike in the second phase. Results: 100 subjects recruited in fi rst phase, 19 subjects in second phase. Out of 600 attempts (3 attempts for each foot) with hard strike, responses of the big toe were fl exion (48.3%), extension (11.3%), no movement (39.8%); other toes were fl exion (55.0%), extension (13.0%), no movement (32.0%); ankle was dorsifl exion (30.8%), no movement (59.3%); knee were fl exion (15.7%), no movement (84.3%); hip were fl exion (15.2%), no movement (84.8%). Of those with big toe extension, signifi cantly less had persistent big toe extension with light strike. More (41%) among those with extensor big toe has withdrawal response (with fl exion of the hip and knee) as compared to those with fl exor big toe (18.5%, p<0.05). Interfoot asymmetry was seen in 27% (kappa 0.54). Plantar responses of sequential strikes were mostly consistent, with only 3.5% inter-attempt variability. Conclusion: Plantar response with extensor great toe is seen in about 10% of normal adults, less with lighter strike. Withdrawal response can be a partial explanation to the big toe extensor response in normal adults.
ABSTRACT
Background: Withdrawal response was used to explain extensor plantar response in population without pyramidal dysfunction but there is lack of data characterizing this response in normal population. Objective: To characterize withdrawal response from pain and tickle sensation in population without any neurological defi cit. Methods: The study was carried out using four different stimuli, namely heat-induced pain, cold-induced pain, electric-induced pain using electromyography stimulator and ticklish sensation using superworm (Zophobas morio), applied to normal subjects in University Malaya Medical Centre, Kuala Lumpur. Results: Heat-induced pain resulted in fl exion of the big toe (61.1%), other toes (62.3%), ankle dorsifl exion (82.6%), knee fl exion (83.9%) and hip fl exion (83.9%). Electric-induced pain showed fl exion of the big toe (27.7%), other toes (28.3%), ankle dorsifl exion (51.0%), knee fl exion (76.0%) and hip fl exion (76.0%). Ticklish sensation showed fl exion of the big toe (14.8%), other toes (14.8%), ankle dorsifl exion (22.7%), knee fl exion (21.9%), and hip fl exion (21.9%). There was signifi cant correlation between fear and ticklish sensation induced withdrawal responses and extension of big toe. Cold induced pain resulting in big toe fl exion (6.4%), other toes (6.9%), dorsifl exion of ankle (7.1%), fl exion of knee (6.9%), and hip fl exion (6.9%). Females were more responsive to heat, males to electrical stimulation. The prevalence of big toe extension ranged from 11.0% (electrical), 6.3% (ticklish), 4.8 (heat), to 0% (cold), a mean of 5.2% overall. Conclusion: Withdrawal response caused by nociceptive and ticklish sensation consists mostly of big toe fl exion and of other toes, ankle dorsifl exion and fl exion of the knee and hip. Extension of the big toe is seen in about 5% of all the stimulation.
ABSTRACT
Background and Objective: Nipah virus is an emerging zoonotic virus which caused fatal outbreak among Malaysian pig-farmers in 1998-1999. The Nipah virus outbreak represented one of the batderived paramyxoviruses that have emerged during the last decade to cause severe human and animal disease. Long-term neurological assessments and serological pattern descriptions are limited. We assessed persistent symptoms, neurological and functional outcome of 36 Nipah virus infection survivors after 10 years of the outbreak in Malaysia. Their serological pattern of Nipah virus for both IgM and IgG were studied. Methods: During September 2008 and March 2009, we administered a questionnaire on persistent symptoms and functional disability for all the Nipah virus infection survivors and Nipah infection contacts. Blood were collected for serological test for Nipah virus IgM and IgG. Results: A total of 70 subjects were included in the study, 39 of whom had virus Nipah infection in the past. Among the Nipah virus infection survivors, 31 (79%) were male; mean age was 46 + 1.8 years. Sixteen Nipah infection survivors (41%) were asymptomatic. The most common persistent clinical features were fatigue (12, 31%), daytime somnolence (10, 26%) and focal neurological deficits (8, 21%). Five out of 13 (38%) Nipah encephalitis survivors had significant disability on the modified Rankin scale. Serologically, all subjects were tested negative on the Nipah IgM serology test. IgG were positive for 39 subjects in which 3 had asymptomatic infection during the outbreak. Conclusion: Persistent fatigue and daytime somnolence were common disabling symptoms after 10 years of Nipah virus infection, seen in those with previous encephalitis as well as non-encephalitic infection. Serologically all patients had negative Nipah IgM but positive IgG after 10 years of illness.
ABSTRACT
Background: There are extensive studies indicating that deep venous thrombosis and pulmonary embolism contributes to significant morbidity and mortality after acute ischaemic stroke in the West, with established guidelines for prophylaxis. The situation is less clear in Asia. Accordingly, a literature search was performed to review the available evidence. Methods: A search was performed with all published materials in PubMed, Directory of Open Access Journals and BioMed Central, using the following keywords “venous thromboembolism”, “Asia”, “stroke”, “deep venous thrombosis” and “pulmonary embolism”. Systematic and non-systematic studies, previous review articles with their related references were also reviewed. Results: Wide ranging prevalence of venous thromboembolism has been reported after acute ischaemic stroke in Asia, 1% or less in clinical studies, 4.8% to 45% with imaging studies. The prevalence is lower as compared to Caucasian populations, 1.5% to 5.6% in clinical studies, 11% to 80% with imaging studies. Conclusion: The problem of venous thromboembolism is not negligible in Asia. There is a need for future studies in Asia with larger sample sizes. Antiplatelet drugs should be routinely used as prophylaxis while compression stockings applied for those with significant limb weakness. Prophylactic anticoagulation may be considered in those with additional risk factors.
ABSTRACT
Neuromyelitis optica (NMO) was first described as a severe monophasic syndrome of acute bilateral optic neuritis and transverse myelitis. Whether it is a form of multiple sclerosis (MS) or a separate disease entity has been continually debated since the beginning of last century. The redefinition of NMO as a relapsing disease, the wider use of magnetic resonance imaging showing longer spinal cord lesion, and the recently discovered anti-aquaporin-4 (AQP4) water channel antibody, or NMO-IgG, has rekindled this controversy. The many recent publications including the abstracts published in this issue of Neurology Asia have shown that anti-AQP4 antibody is of variable sensitivity in different populations. It appears to be associated mainly with longitudinal extensive spinal cord lesions and frequent relapses. The site of pathology of NMO also do not co-localize with the widespread expression of AQP4 in the body, throwing doubts on the suggestion that the anti-AQP4 antibody plays primary role in the pathogenesis of NMO. In the day-to-day clinical practice in Asia, anti-AQP4 antibody remains a research investigatory test. As for optic-spinal MS, which is closely similar to NMO based on recently revised criteria, interferon should remain the treatment of first choice.
ABSTRACT
Measles virus causes three distinct neurological syndromes: acute disseminated encephalomyelitis, subacute sclerosing panencephalitis and the rare subacute measles encephalitis, or inclusion body measles encephalitis. There is a current debate of whether subacute measles encephalitis is an opportunistic infection or a subacute infection caused by a mutated measles strain. There is also no report of long term MRI of survivor. We reported a young Chinese girl with a history of relapsed acute lymphoblastic leukaemia and subacute measles encephalitis confirmed by brain biopsy who survived. Serial magnetic resonance imaging of the brain showed cortical and basal ganglial involvement in the initial phase, and generalized cerebral atrophy in the subsequent scan four and a half years later. The patient recovered from subacute measles encephalitis with substantial neurological deficits with the cessation of maintenance chemotherapy without specific antiviral treatment. This suggested that reconstitution of host immunity was adequate in effecting the clearance of the virus, and supporting the hypothesis that subacute measles encephalitis is primarily an opportunistic infection.