A rare catastrophic cause of muffled voice

@#A 60-year-old diabetic lady presented with a four-day history of sore throat and fever, followed by dysphagia, odynophagia and voice change. It started with a low-grade fever with no chills or rigor, no night sweats and no loss of weight or appetite. There was no other positive history.

Extracranial Carotid Aneurysm Secondary to Takayasu Arteritis (TA): A Rare Complication

Extracranial aneurysms are a rare presentation accounting for only less than 5% of all peripheral artery aneurysms. The left common carotid artery aneurysm is considered even rarer. We present a case of a 46-year-old gentleman who presented to casualty unit with a neck mass, stridor and acute respiratory distress. Prior to this admission patient was being investigated for Takayasu arteritis (TA). Patient was subsequently intubated due to respiratory compromise. A CT angiography of the thorax was done showed a proximal left common carotid artery aneurysm with contained leakage of aneurysm with severe compression of the trachea. Patient was subsequently transferred to the vascular team in National Heart Institute for further management.

MR Volumetry of Hippocampus in Normal Adult Malay of Age 50 Years Old and Above

Background: Hippocampal volume is affected by several psychiatric illnesses of old age, as well as by normal aging. It is important to have a normal data in a population to assist in diagnosis. The aim of this study is to determine hippocampal volume in normal Malay people aged 50 years old and older. Methods: This was a cross-sectional study of the normal Malay population aged 50 to 77 years. We included 43 participants, representing 19 men and 24 women. Magnetic resonance imaging (MRI) was performed using a GE Signa Horizon LX 1.0 Tesla. Oblique coronal images of temporal lobes were obtained and hippocampal volumetry was done manually and normalised with intracranial volume. Results: Mean right and left hippocampal volumes (HCVs) were 3.43 cm3 (SD 0.32) and 3.26 cm3 (SD 0.34), with a significant difference between them (P < 0.001). Total mean HCVs exhibited no significant difference between men and women (P = 0.234). The means of the normalised right and left HCVs were 3.42 cm3 (SD 0.31) and 3.26 cm3 (SD 0.32). Conclusion: The mean right and left hippocampal volumes were significantly different in this study. Men had slightly larger mean HCVs but the difference was not statistically significant. It was found that normalisation further reduces the mean volume difference between the genders.

Normalised MRI Volumetry of the Hippocampus among Normal Malay Children and Adolescents

Background: Magnetic resonance imaging (MRI) is a noninvasive method for determining brain morphology and volumetry. Hippocampal volume changes are observed in conjunction with several diseases. This study aimed to determine the normalised volume of the hippocampus in normal Malay children and adolescents. Methods: This was a cross-sectional study performed from January 2009 to June 2010. Brain and temporal lobe MRI was performed for 81 healthy normal Malay individuals aged 7–18 years. Manual volumetry was performed. The hippocampal volumes were normalised with the total intracranial volume. Results: The original right, left, and total hippocampal volumes (mean and standard deviation) were 3.05 (0.48) cm3, 2.89 (0.44) cm3, and 5.94 (0.90) cm3, respectively. Normalised hippocampal volumes for the right, left, and total volume were 3.05 (0.41) cm3, 2.89 (0.41) cm3, and 5.94 (0.79) cm3, respectively. Pearson’s correlation coefficient for the right and left hippocampal volumes with intracranial volume were 0.514 and 0.413, respectively (P < 0.001). Both the original and normalised hippocampal volumes of the right hippocampus were significantly larger than those of the left (P < 0.001). Conclusion: This is a data set for the local Malay paediatric population. There was no significant difference between the actual and normalised values of hippocampal volume in our study.

Computed Tomography Perfusion Imaging on Traumatic Cerebral Contusion: A Preliminary Report

Background: Brain ischaemia and infarction are the leading factors in morbidity and mortality of traumatic brain injury. This study aimed to determine the perfusion status of pericontusional hypodense areas in traumatic cerebral contusion Methods: Ten patients involved in motor vehicle accidents were enrolled in this study, and contusions were diagnosed from plain computed tomography scans of the brain. Subsequent computed tomography perfusion (CTP) was performed to analyse the perfusion of pericontusional hypodense areas, which were divided into 4 regions of interest (ROI). Results: Most ischaemic perfusion was found in ROI 6 (affecting 60% of patients), although the mean of the perfusion parameters were normal. A significant positive correlation was found between the perfusion status in the pericontusional area nearest to the skull vault (ROI 3) and its distance/thickness to the skull vault (r = 0.698, P = 0.025). Two adjacent pericontusional hypodense areas (ROI 4 and ROI 5) showed a significant positive correlation with each other (r = 0.667, P = 0.035) in terms of perfusion status. The presence of a hypodense pericontusional area is suggestive of oedema and perfusion disturbances. Conclusion: CTP is a useful, fast, and appropriate method in evaluating perfusion of pericontusional hypodensity area that may help the treating physician to provide an appropriate treatment to the patient.

Neuropsychological Assessment In Epilepsy Surgery – Preliminary Experience In A Rural Tertiary Care Hospital In North East Malaysia

We present our preliminary experience in neuropsychological testing in epilepsy surgery patients to demonstrate how these tests contributed to decide the laterality of epileptic focus, and to assess the effect of surgery on patient’s cognitive function and quality of life. Preoperative neuropsychological tests consisting of Wechsler Adult Intelligence Scale-III (WAIS) for IQ, Wechsler Memory Scale-III (WMS) for memory and patients’ quality of life (QOLIE 31) were administered to refractory epilepsy patients under evaluation for surgical treatment. These tests were repeated one year after surgery and we studied any changes in trends. A total of seven patients were recruited in this study between July 2004 and July 2006. The aetiologies of refractory epilepsy were pure mesial temporal sclerosis (MTS) in five patients, dysembryogenic neuroepithelial tumour (DNET) in one and dual lesion of cavernous angioma with ipsilateral MTS in one. The preoperative neuropsychological tests were all in concordance to MRI finding, and showed good contralateral function; five lateralises to the right and two to the left. The post-operative Engel seizure count (median 8.00, IQR 7.00–8.75), general IQ (88 vs. 79), performance IQ (94 vs. 79), verbal memory (89 vs. 71), non-verbal memory (88 vs. 75) and QOLIE (53.14 vs. 44.71) were better compared to preoperative values. The verbal IQ (84 vs. 84) was unchanged. Neuropsychological tests are useful as ancillary investigations to determine the laterality of seizure focus and integrity of function in the contralateral temporal lobe. Following successful surgical treatment, there is a trend towards improvement in memory, IQ and quality of life scores in this small group of patients.

A rare case of paediatric pontine Glioblastoma presenting as a cerebellopontine angle otogenic abscess

We describe rare case of a 9-year old boy who presented with a two- week history of right ear discharge and mild fever. Contrast enhanced CT scan of the brain showed a lesion in the right cerebellopontine angle with mild enhancement mimicking early abscess formation. Involvement of the mastoid air cells pointing towards a radiological diagnosis of mastoiditis reinforced the diagnosis of an abscess. A magnetic resonance imaging (MRI) was planned for the patient but his conscious level deteriorated and patient slipped into coma warranting immediate surgical intervention. Intraoperatively, about 90% of the tumour was removed and the appearance of the tumour resembled that of an acoustic schwannoma but histopathology confirmed the diagnosis of a glioblastoma multiforme (GBM). MRI done post operatively showed lesion in the pons confirming the diagnosis of an exophytic pontine glioblastoma multiforme.

Role of guardians in adolescents'reproductive health behaviors in rural area

A cross-sectional community-based study was undertaken in Taikkyi Township during July 1997, to explore the guardians' attitudes and practices relating to adolescents' reproductive health behavior. Altogether 102 guardians who have adolescents between 10 to 19 years of age involved in the study. Majority of the guardians did not favor their adolescents on choosing their fiancees by themselves and having more than one fiancee. While 52 per cent thought adolescents should know about contraceptives before their marriage, 38.2 per cent thought they should not. Most of the guardians approved that dissemination of messages about sex education for the adolescents through mass media was an appropriate way. It was found that most did not allow their teens to discuss such things either in front of them or with others. But some of them (36.3 per cent) said they would respond about those things willingly if or when they were asked. By knowing sex education and reproductive health, about 48 per cent (46.2 per cent of the mothers and 53.6 per cent of the fathers) said adolescents will gain benefits. Regarding information on Reproductive Health, this study highlights the needs for proper education and counselling for guardians, especially on adolescents.

A comparative study of YGH index and Wayne's index in the diagnosis of thyrotoxicosis

This study was done during 1992 to 1994. the patients were in-patients of Wards 1 & 2 and those referred from the Nuclear Medicine Department of Yangon General Hospital. they all were clinically thyrotoxic patients confirmed by either high uptake of radioactive iodine or high serum T3 and T4 levels. We took proper history taking and did thorough clinical examination for all patients. Then we recorded the findings and counted the scores for each patient according to YGH index and WAYNE index for diagnosis of thyrotoxicosis. The total numberr of patients studied was 138. Mean age was 36.5 years. The sensitivity of YGHindex was 93.47 percent. The sensitivity of WAYNE index was 89.85 percent. The difference between the sensitivities of two scoring systems was not significant statistically. Therefore, both scoring systems can be applied with the nearly same sensitivity in the clinical diagnosis of thyrotoxicosis.

Thyroid dysfunction following irradiation to the neck

Thyroid functions (serum T3, T4 and TSH) were studied among 35 patients who had external radiation of the neck involving the thyroid gland within the past 10 years, and 10 control patients who had radiation else where in the body but not in the thyroid region. Findings were presented, compared with previous reports and discussed. Routine TFTs one year after radiotherapy was recommended and replacement therapy for patients with raised serum TSH is encouraged.