Hui Jan Tan

Post-dengue parkinsonism

BackgroundDengue is a common illness in the tropics. Equally common are neurological complications that stem from dengue infection. However, to date, parkinsonism following dengue has not been reported in medical literature.Case presentationA previously well 18-year old man developed parkinsonism, in addition to other neurological symptoms following serologically confirmed dengue fever. Alternative etiologies were excluded by way of imaging and blood investigations.ConclusionsThe authors detail the first reported case of parkinsonism complicating dengue fever. Keeping rare presentations of common illnesses in mind, it behoves clinicians to consider parkinsonism as a complication following dengue infection. This would prevent injudicious treatment with L-dopa and dopamine agonists. Immunosuppression with steroids has been shown to be helpful in certain cases.

Risk factors and predictors of levodopa-induced dyskinesia among multiethnic Malaysians with Parkinson's disease

Chronic pulsatile levodopa therapy for Parkinsons disease (PD) leads to the development of motor fluctuations and dyskinesia. We studied the prevalence and predictors of levodopa-induced dyskinesia among multiethnic Malaysian patients with PD. Methods: This is a cross-sectional study involving 95 patients with PD on uninterrupted levodopa therapy for at least 6 months. The instrument used was the UPDRS questionnaires. The predictors of dyskinesia were determined using multivariate logistic regression analysis. Results: The mean age was 65.6 ± 8.5 years. The mean onset age was 58.5 ± 9.8 years. The median disease duration was 6 (7) years. Dyskinesia was present in 44% (n = 42) with median levodopa therapy of 3 years. There were 64.3% Chinese, 31% Malays, and 3.7% Indians and other ethnic groups. Eighty-one percent of patients with dyskinesia had clinical fluctuations. Patients with dyskinesia had lower onset age ( p < 0.001), longer duration of levodopa therapy ( p < 0.001), longer disease duration ( p < 0.001), higher total daily levodopa dose ( p < 0.001), and higher total UPDRS scores ( p = 0.005) than patients without dyskinesia. The three significant predictors of dyskinesia were duration of levodopa therapy, onset age, and total daily levodopa dose. Conclusions: The prevalence of levodopa-induced dyskinesia in our patients was 44%. The most significant predictors were duration of levodopa therapy, total daily levodopa dose, and onset age.

A case of Hashimoto encephalopathy in a Malay woman with Graves disease.

Hashimoto encephalopathy (HE) is a poorly recognised steroid-responsive encephalopathy, with prominent neuropsychiatric features. Diagnosis is often difficult due to its heterogeneous clinical presentation, especially since the thyroid status or anti-thyroid antibody titres may not be related to the disease state. Here, the case of a 23-year-old Malay woman with Graves disease who presented with progressive encephalopathy diagnosed as HE is presented. She responded dramatically to high dose intravenous and then oral corticosteroid. A month after the initiation of treatment, she regained full independency.

An unusual neurological complication from a garden-variety organism: post-melioidosis parkinsonism.

A 62-year-old man presented to our tertiary hospital’s emergency department with a 4-week history of fever associated with lethargy and constitutional symptoms. For 9 days before admission, he had been vomiting two to three times per day. He had longstanding diabetes and hypertension and worked for the local city council as a truck driver, transporting water to local gardens and public areas. About 2 months previously, he had sustained an abrasion on his left foot that had healed completely at time of presentation.

A case of Guillain-Barré syndrome (GBS) presenting with acute urinary retention and T6 sensory level

Guillain-Barré syndrome (GBS) is an acute immune-mediated demyelinating disease. Early recognition of this disease is crucial as it can progress to life-threatening conditions such as respiratory failure or autonomic dysfunction. Typical clinical manifestations of GBS include progressive weakness of the limbs, bulbar, facial muscles and ophthalmoplegia. Sensory level and bladder dysfunction are more suggestive of acute myelopathy. We report a case of GBS presenting with acute urinary retention and T6 sensory level, which was successfully treated with plasma exchange.

LP22: The use of blink reflex study in determining the clinical recovery and quality of life in Bell’s palsy patient

oped severe generalized weakness and required mechanical ventilation. At that time, RNST was abnormal in ADQ. Treatment of WM with Rituximab dramatically improved symptoms and led to a progressive and sustained decrease of IgM and anti-MuSK titres. Six years later, patient remains stable without treatment. Discussion: Neurophysiological features studies allowed to rule out a peripheral neuropathy, played a role the diagnosis of MG and, more on, its features correlated with clinical status. Response to rituximab could throw additional light on the role of B cells as therapeutic targets in anti-MuSK positive MG.

1.094 THE PREVALENCE OF NON MOTOR SYMPTOMS AND RESTLESS LEGS SYNDROME IN PARKINSON'S DISEASE: CORRELATION WITH QUALITY OF LIFE

Results: A total of 113 patients consisting of 60 males and 53 females were recruited.The mean age was 64.8 ± 9.0 years. The median duration of illness was 5.0 (2.0-8.0) years.97.3% of patients reported the presence of NMS. The most common symptoms were gastrointestinal symptoms (76.1%), followed by neuropsychiatric symptoms (72.6%), autonomic dysfunction (64.6%) and sleep disorders (58.4%).Eleven patienst (9.7%) had RLS.Patients with PD/RLS had younger age of PD onset (p=0.023) and lower serum ferritin levels (p=0.616).NMS affected the QoL significantly in all dimensions of PDQ-39.Each dimension of PDQ-39 (mobility, activities of daily living, emotional well being, stigma, cognitions, communication and bodily discomfort) correlated strongly with the severity of NMS.