Moyamoya disease in Malaysia: two documented cases.

Moyamoya disease is a rare cause of young strokes. The definitive diagnosis of moyamayo disease is made by cerebral angiography. We report two cases of moyamoya disease in Malaysia.

Neuroleptic malignant syndrome in Malaysia: a university hospital experience.

The neuroleptic malignant syndrome (NMS) is a potentially fatal complication of antipsychotic therapy. A retrospective study of nine patients seen over six years at the University Hospital, Kuala Lumpur (UHKL), is described. The estimated annualised incidence was 1.2 per 1000 in-patients with psychosis. No ethnic difference was detected. Clinical features were similar to experiences elsewhere, with wide variability seen in the severity of illness. The neuroleptic drugs implicated were haloperidol, trifluoperazine, chlorpromazine, fluphenazine and clopenthixol. Treatment consisted of withdrawal of offending drugs and supportive measures. Specific therapy was given to five patients. There was one death. At follow-up no deterioration was detected. A different neuroleptic drug was successfully re-introduced in four patients. In view of the wide usage of major tranquillizers, a high degree of clinical awareness of this serious complication is necessary for early diagnosis to reduce morbidity and mortality.

Vitamin B12 neuropathy in the absence of anaemia--case report.

A 70-year old man with neurological manifestations of vitamin B12 deficiency in the absence of anaemia is reported. The clue to the correct diagnosis is a raised mean corpuscular volume.

Inhibitory epilepsy.

Unlike post-epileptic paralysis, inhibitory epilepsy is rare and not well known. Differentiation between the two phenomena is usually difficult because both may have associated seizures. A satisfactory physiological explanation has yet to be advanced to account for the paraplysis. The present is a report of such a case together with the results of electroencephalographic, electromyographic and nerve conduction studies both during and after an attack of paralysis. The results suggest that inhibitory impulses originating from higher centres acting on the upper motor neurone itself leaving the anterior horn cell and possibly the upper motor neurone input to the gamma efferents switched off, are probably responsible for the paralysis.

Clinical and electroencephalographic data indicative of brain tumours in a seizure population.

One hundred and two patients suffering from seizures, with focal EEG signs (101 cases) and focal seizures but generalized EEG abnormalities (one case) were divided into tumour (twenty-one cases) and non-tumour (eighty-one cases) groups on the basis of contrast radiological studies. Retrospective analysis of various clinical data and EEG abnormalities, determined before the contrast radiological examinations, showed that the following were statistically significantly different between the two groups in favour of a tumoral aetiology for the seizures: age at onset of fits (greater than 20 years), presence of focal neurological signs and increased intracranial pressure, presence of focal unilateral delta waves without accompanying epileptic discharges, beta asymmetry between the cerebral hemispheres and hyperventilation-induced electrical seizures. A brain scan was a very useful screening test for the detection of a tumoral aetiology for seizures.

Occlusive cerebrovascular disease in young adults.

13 patients under 40 years of age had cerebral infarction and angiographic evidence of arterial stenosis or occlusion. None of them had cardiac disorders prone to cerebral embolism. Five patients had occlusion at the origin of the internal carotid artery, one had occlusion of the common carotid artery and one each had stenosis at the origin of the internal carotid and common carotid arteries, respectively. Two patients had unilateral occlusion of the supraclinoid portion of the carotid artery with basal collaterals that had some resemblance to the Moyamoya disease. Three patients demonstrated stenosis or occlusion of the middle and/or anterior cerebral arteries. Three patients had hypercholesterolemia, one of whom was hypertensive. None had confirmed diabetes mellitus. One female, who died, had taken oral contraceptives for 3 years. A male, with internal carotid artery occlusion, had serological evidence for syphilis.

Clinical value of nerve conduction studies.

No abstract available.

Herpes Zoster with severe neurological complication.

No abstract available.