Gcy Fong

An epidemiological study of motor neuron disease in Hong Kong

Worldwide, the incidence of motor neuron disease (MND) has been increasing steadily over recent decades. We reported a follow-up epidemiology study of MND in this locality. We identified the subjects from the computer database of the government hospital system between I January 1997 and 31 January 2002 by searching the ICD code starting from 335.xx. Every retrieved case or their records were reviewed and validated by neurologist(s) of the responsible regional hospitals which the patients attended. One hundred and twenty cases from seven regional hospitals (serving 48.05% of the HKSAR population) were identified, validated and confirmed to be MND or related diseases. Ninety-eight new cases were diagnosed during the study period. Average age of onset was 58.76 years; SD 14. 12 (28- 89) years. Male to female ratio was 1.72:1. Peak age of onset was 60-64 years without sex difference. The adjusted incidence rate was 0.60/100,000/year. The adjusted point prevalence at the prevalence date (31 January 200 1) was 3.04/100,000. Despite the incidence and prevalence of MND among Hong Kong Chinese, it remained low compared to worldwide figures, and our data suggested a significant rise of MND or related disease in the last decade. A territory-wide prospective epidemiological study is indicated.

Brainstem tuberculoma mimicking glaucoma

To the Editor: We read with interest the recent article by Drs. Del Brutto and Mosquera.1 They report a case of space-occupying, tumor-like brainstem lesion on MRI that responded dramatically to antituberculous drugs. The authors advocate a trial with antituberculous drugs as a diagnostic tool in the evaluation of enhancing brainstem lesions in patients coming from areas where tuberculosis is endemic. We would like to know the CSF findings or the reason for not performing a lumbar puncture in the patient as the CSF findings may influence the decision on a trial of antituberculous drugs or early biopsy of the lesion. In addition, we wish to respond to their recommendation with an illustrative case. A 39-year-old Chinese woman with good past health developed subacute onset of right sixth nerve palsy as the sole presenting feature. There was no evidence of extraneural tuberculous infection on routine investigations. MRI demonstrated a unifocal 10 mm–diameter rim-enhancing lesion at the right ventrolateral pons. A trial of antituberculous therapy was given, which she only took occasionally. She remained static clinically and radiologically at 7 months after onset. CSF showed elevated protein level, hypoglycorrhachia, and lymphocytic pleocytosis. Microbiologic and cytologic studies were repeatedly negative. She was then hospitalized for supervised antituberculous treatment. Tuberculosis is prevalent in Hong Kong and the incidence of intracranial involvement is higher than that in other developed countries. …