A man with droopy eyelids (Answers)

(Refer to page 133) Answer: Ocular myasthenia gravis and an ‘ice pack test’, a two minute application of ice (wrapped in a clean towel or other protective covering) to the affected levator muscle. Myasthenia gravis (MG) is an acquired autoimmune disease caused by antibodies to the acetylcholine receptors at the neuromuscular junction of skeletal muscle. The resultant defect in neuromuscular transmission causes muscle fatiguability and weakness. Weakness may localise purely to eye muscles termed ocular myasthenia or may affect other skeletal muscle termed generalised MG. About 50 to 70% of ocular myasthenia will eventually develop generalised MG.

A man with droopy eyelids

A gentleman in his forties presented with drooping of his right eye (Panel A). A test was done and there was improvement (Panel B). What is the diagnosis and what ‘test’ was done? Answer: refer to page 155

Resumption of driving following acquired brain injury amongst Bruneians

Introduction Motor vehicle transport is common everywhere and in our local setting, most travel using their own cars. Resumption of driving after acquired brain injury (ABI) has been shown to affect subsequent community integration. Forty four to 66% of ABI survivors return to driving according to studies elsewhere. This study assesses the number of patients who resumed driving after ABI in Brunei Darussalam. Materials and Methods Brunei Darussalam citizens after ABI who were above 18 years old and had received occupational therapy in RIPAS Hospital, Brunei Darussalam between June 1, 2008 and May 31, 2009 were retrospectively identified and studied. Data was collected from the Department of Occupational Therapy records supplemented by telephone calls to patients or their relatives. Results Of 111 patients included in the study, 43 patients did not drive prior to ABI, since they were either older in age or never had a driving license. Of those with driving licenses (68) prior to ABI, 15 (22%) resumed driving: traumatic brain injury (n=1/5, 20%), brain tumour (n=1/4, 25%), brain infection (n=1/1, 100%) and for stroke (n=12/58, (20.7%). Gender and age groups were not significant predictors of return to driving. Conclusion Only 22% of Bruneians after ABI resumed driving and this is lower than studies elsewhere. Reasons considered include severity of injury and cultural factors which all require further study.