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Phua CS, Bhaskar S, Bertram K. Cough as a presenting symptom in Wilson's Disease. J Mov Disord 2024; 17:218-219. [PMID: 38062717 PMCID: PMC11082604 DOI: 10.14802/jmd.23221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 05/12/2024] Open
Affiliation(s)
- Chun Seng Phua
- Department of Neurology, Alfred Health, Melbourne, Australia
- Department of Neurosciences, Monash University, Melbourne, Australia
- Department of Neurology, University Technology Mara, Selangor, Malaysia
| | - Shalini Bhaskar
- Department of Neurology, University Technology Mara, Selangor, Malaysia
| | - Kelly Bertram
- Department of Neurology, Alfred Health, Melbourne, Australia
- Department of Neurosciences, Monash University, Melbourne, Australia
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Phua CS, Moffat B, Paul E, Ang M, Law M, Bertram K, Hutton E. Quantitative analysis of MR T2 relaxation times in neck muscles. Magn Reson Imaging 2023; 103:156-161. [PMID: 37517766 DOI: 10.1016/j.mri.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/01/2023]
Abstract
T2 relaxation times (T2 times) are different between resting and exercised muscles and between muscles of healthy subjects and subjects with muscle pathology. However, studies specifically focusing on neck muscles are lacking. Furthermore, normative neck muscle T2 times are not well defined and methodology used to analyse T2 times in neck muscles is not robust. We analysed T2 times in key neck muscles and explored factors affecting variability between muscles. 20 healthy subjects were recruited. Two circular regions of interest (ROIs) were drawn in two mutually exclusive regions within neck muscles on T2 weighted images and values averaged. ROI measurements were performed by a co-investigator, supervised by a neuro-radiologist. For the first ten subjects, measurements were done from C1-T1. For the remaining subjects, ROIs were drawn at two pre-determined levels. Two MRIs were repeated at 31 degrees acquisition to evaluate the effect of muscle fibre orientation. ROI values were translated into T2 times. Results showed semispinalis capitis had the longest T2 times (range 46.88-51.42 ms), followed by splenius capitis (range 47.37-48.33 ms), trapezius (range 45.27-47.46 ms), levator scapulae (range 43.17-45.63 ms) and sternocleidomastoid (range 38.45-42.91 ms). T2 times did not vary along length of muscles and were unaffected by muscle fibre orientation (P > 0.05). T2 times of splenius capitis correlated significantly with age at C2/C3 and C5/C6 levels and trapezius at C7/T1 level. Gender did not influence relaxation times (P > 0.05). In conclusion, results of normative neck muscle T2 time values and factors influencing the T2 times could serve as a reference for future MR analysis of neck muscles. The methodology used may also be useful for related studies of neck muscles.
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Affiliation(s)
- Chun Seng Phua
- Alfred Health, Department of Neurology, Melbourne, Australia; Monash University, Department of Neurosciences, Melbourne, Australia; Universiti Teknologi Mara, Selangor, Malaysia.
| | - Bradford Moffat
- Melbourne Brain Centre Imaging Unit, University of Melbourne, Melbourne, Australia
| | - Eldho Paul
- Alfred Health, Department of Neurology, Melbourne, Australia; Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia
| | - Megan Ang
- Alfred Health, Department of Radiology, Melbourne, Australia
| | - Meng Law
- Monash University, Department of Neurosciences, Melbourne, Australia; Alfred Health, Department of Radiology, Melbourne, Australia
| | - Kelly Bertram
- Alfred Health, Department of Neurology, Melbourne, Australia; Monash University, Department of Neurosciences, Melbourne, Australia
| | - Elspeth Hutton
- Alfred Health, Department of Neurology, Melbourne, Australia; Monash University, Department of Neurosciences, Melbourne, Australia
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Phua CS, Bhaskar S. Immunological, Physical, and Psychological Interventions in Young-Onset Stiff-Person Syndrome. J Clin Neurol 2022; 18:487-488. [PMID: 35796276 PMCID: PMC9262462 DOI: 10.3988/jcn.2022.18.4.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 04/06/2022] [Accepted: 04/06/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Chun Seng Phua
- Department of Neuroscience, Monash University, Melbourne, Australia.,Department of Neurology, Universiti Teknologi MARA, Selangor, Malaysia.
| | - Shalini Bhaskar
- Department of Neurology, Universiti Teknologi MARA, Selangor, Malaysia
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Brooks CA, Phua CS, Dower A, Bazina R. Pseudochoreoathetosis secondary to progressive spondylotic cervical myelopathy. BMJ Case Rep 2021; 14:e247471. [PMID: 34972784 PMCID: PMC8720953 DOI: 10.1136/bcr-2021-247471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 11/03/2022] Open
Abstract
Pseudochoreoathetosis is a rare movement disorder associated with loss of proprioception. Culprit lesions may occur at any point between the cerebral cortex and the peripheral nerve. Seldom is the underlying cause reversible or prone to improvement. An elderly man presented to our tertiary centre with choreoathetoid movements secondary to spondylotic subaxial cervical myelopathy. His myelopathy fulminated and he was emergently treated with posterior decompressive neurosurgery. Unexpectedly, his choreoathetoid movements improved significantly post-operatively. There are a multitude of reports of pseudochoreoathetosis secondary to lesions of various aetiologies; however, few have reported this disorder secondary to cervical spondylosis. To our knowledge, there is only one other report in the medical literature. Herein, we report a second case, for the purposes of raising awareness of this disorder, and to highlight relevant clinical pearls for clinicians who encounter this rare pathology.
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Affiliation(s)
- Christopher Alan Brooks
- The School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
- Neurosurgery, Concord Repatriation General Hospital, Sydney, New South Wales, Australia
- Neurosurgery, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Chun Seng Phua
- Neurosciences, Monash University, Melbourne, Victoria, Australia
- Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Ashraf Dower
- Neurosurgery, Liverpool Hospital, Sydney, New South Wales, Australia
- Neurosurgery, Westmead Hospital, Sydney, New South Wales, Australia
| | - Renata Bazina
- Neurosurgery, Liverpool Hospital, Sydney, New South Wales, Australia
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Phua CS, Kumar KR, Levy S. Reply to: Neurometabolic causes of dystonia: Sepiapterin reductase-deficient dopamine- and serotonin-responsive dystonia-plus syndrome. J Neurol Sci 2021; 425:117469. [PMID: 33902913 DOI: 10.1016/j.jns.2021.117469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Chun Seng Phua
- Department of Neurosciences, Alfred Hospital, Melbourne, VIC, Australia; Monash School of Medicine, Monash University, Melbourne, VIC, Australia.
| | - Kishore Raj Kumar
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia; Molecular Medicine Laboratory, Concord Repatriation General Hospital, Sydney, NSW, Australia; Neurology Department, Concord Repatriation General Hospital, Sydney, NSW, Australia; Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Stanley Levy
- Department of Neurology, Campbelltown Hospital, NSW, Australia; University of Western Sydney, School of Medicine, NSW, Australia
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Phua CS, Murad A, Fraser C, Bray V, Cappelen-Smith C. Myasthenia gravis and concurrent myositis following PD-L1 checkpoint inhibitor for non-small cell lung cancer. BMJ Neurol Open 2021; 2:e000028. [PMID: 33681778 PMCID: PMC7871726 DOI: 10.1136/bmjno-2019-000028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2020] [Indexed: 11/04/2022] Open
Abstract
Background There are increasing reports of myasthenia gravis (MG) following oncological treatment with immune checkpoint inhibitors (ICIs). Methods and results A 66-year-old man with stage 3A lung adenocarcinoma was treated with second weekly infusions of durvalumab, a programmed cell death ligand-1 inhibitor, at a dose of 10 mg/kg. After the fourth infusion, he developed diplopia, dyspnoea and constitutional symptoms including headache, weakness and anorexia. 1 month later, he developed dysphagia and dysphonia. Examination showed proximal limb weakness with fatigability. An ice pack test was positive. Blood tests revealed a raised creatine kinase and positive PM-Scl75 antibody. Antititin antibody was strongly positive in the serum and cerebrospinal fluid. Antibodies for acetylcholinesterase receptor and antimuscle-specific kinase were negative. Electromyography showed myopathic changes. The patient was treated with steroids, pyridostigmine, mycophenolate mofetil and intravenous immunoglobulin. Eight weeks after treatment initiation ptosis, eye movements and limb strength were markedly improved and repeat creatine kinase was normal. Conclusion Clinicians using ICIs should have a high index of suspicion for ICI-induced MG and concurrent myositis as disease can be severe and is associated with high mortality rates.
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Affiliation(s)
- Chun Seng Phua
- Department of Neurophysiology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Ari Murad
- Department of Immunology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Clare Fraser
- Department of Ophthalmology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Victoria Bray
- Department of Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Cecilia Cappelen-Smith
- Department of Neurophysiology, Liverpool Hospital, Liverpool, New South Wales, Australia
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Phua CS, Ng A, Brooks C, Harrington Z, Vedam H, Huynh T, Seccombe D, Aouad P, Cordato D. Prevalence and factors associated with advanced care directives in a motor neuron disease multidisciplinary clinic in Australia. Postgrad Med J 2020; 97:566-570. [PMID: 32788311 DOI: 10.1136/postgradmedj-2020-138184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/30/2020] [Accepted: 07/04/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Motor neuron disease (MND) is a neurodegenerative disorder leading to functional decline and death. Multidisciplinary MND clinics provide an integrated approach to management and facilitate discussion on advanced care directives (ACDs). The study objectives are to analyse (1) the prevalence of ACD in our MND clinic, (2) the relationship between ACD and patient demographics and (3) the relationship between ACD decision-making and variables such as NIV, PEG, hospital admissions and location of death. METHODS Using clinic records, all patients who attended the MND clinic in Liverpool Hospital between November 2014 and November 2019 were analysed. Data include MND subtypes, symptom onset to time of diagnosis, time of diagnosis to death, location and reason of death. ACD prevalence, non-invasive ventilation (NIV) and percutaneous endoscopic gastrostomy (PEG) requirements were analysed. RESULTS There were 78 patients; M:F=1:1. 44 (56%) patients were limb onset, 28 (36%) bulbar onset, 4 primary lateral sclerosis and 2 flail limb syndrome presentations. 27% patients completed ACDs, while 32% patients declined ACDs. Patients born in Australia or in a majority English-speaking country were more likely to complete ACDs compared to those born in a non-English-speaking country. There was no significant correlation between ACD completion and age, gender, MND subtype, symptom duration, NIV, PEG feeding, location of death. CONCLUSION One-quarter of patients completed ACDs. ACDs did not correlate with patient age, gender, MND subtype and symptom duration or decision-making regarding NIV, PEG feeding or location of death. Further studies are needed to address factors influencing patients' decisions regarding ACDs.
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Affiliation(s)
- Chun Seng Phua
- Department of Neurology and Neurophysiology, Liverpool Hospital, Liverpool, Australia .,School of Medicine, University of New South Wales, Sydney, Australia
| | - Aloysius Ng
- Department of Intensive Care, Lismore Base Hospital, Lismore, Australia
| | - Christopher Brooks
- School of Medicine, University of New South Wales, Sydney, Australia.,Department of Neurosurgery, Liverpool Hospital, Liverpool, Australia
| | - Zinta Harrington
- School of Medicine, University of New South Wales, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Liverpool Hospital, Liverpool, Australia
| | - Hima Vedam
- School of Medicine, University of New South Wales, Sydney, Australia.,Department of Respiratory and Sleep Medicine, Liverpool Hospital, Liverpool, Australia
| | - Thang Huynh
- School of Medicine, University of New South Wales, Sydney, Australia.,Department of Palliative Care, Liverpool Hospital, Liverpool, Australia
| | - Desi Seccombe
- School of Medicine, University of New South Wales, Sydney, Australia.,Department of Palliative Care, Liverpool Hospital, Liverpool, Australia
| | - Patrick Aouad
- Department of Neurology and Neurophysiology, Liverpool Hospital, Liverpool, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
| | - Dennis Cordato
- Department of Neurology and Neurophysiology, Liverpool Hospital, Liverpool, Australia.,School of Medicine, University of New South Wales, Sydney, Australia
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Phua CS, Bonura A, Choong H. Hemorrhagic stroke complicated by cerebral venous sinus thrombosis with idarucizumab. Neurol Clin Pract 2019; 9:e4-e6. [DOI: 10.1212/cpj.0000000000000555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 08/13/2018] [Indexed: 11/15/2022]
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Phua CS, Wijeratne T, Wong C, Jayaram L. Neurological and Sleep Disturbances in Bronchiectasis. J Clin Med 2017; 6:jcm6120114. [PMID: 29189747 PMCID: PMC5742803 DOI: 10.3390/jcm6120114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 11/23/2017] [Accepted: 11/27/2017] [Indexed: 02/07/2023] Open
Abstract
Bronchiectasis unrelated to cystic fibrosis is a chronic lung disease that is increasingly recognised worldwide. While other common chronic lung conditions such as chronic obstructive lung disease have been associated with cardiovascular disease, there is a paucity of data on the relationship between bronchiectasis and cardiovascular risks such as stroke and sleep disturbance. Furthermore, it is unclear whether other neuropsychological aspects are affected, such as cognition, cerebral infection, anxiety and depression. In this review, we aim to highlight neurological and sleep issues in relation to bronchiectasis and their importance to patient care.
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Affiliation(s)
- Chun Seng Phua
- Department of Medicine, Melbourne Clinical School, University of Melbourne, Melbourne, VIC 3010, Australia.
- Department of Neurology, Western Health, St. Albans, VIC 3021, Australia.
| | - Tissa Wijeratne
- Department of Medicine, Melbourne Clinical School, University of Melbourne, Melbourne, VIC 3010, Australia.
- Department of Neurology, Western Health, St. Albans, VIC 3021, Australia.
- Department of Medicine, Faculty of Medicine, University of Rajarata, Saliyapura AD 50008, Sri Lanka.
- Department of Psychology and Counselling, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC 3086, Australia.
| | - Conroy Wong
- Department of Respiratory Medicine, Middlemore Hospital, Auckland 2025, New Zealand.
| | - Lata Jayaram
- Department of Medicine, Melbourne Clinical School, University of Melbourne, Melbourne, VIC 3010, Australia.
- Department of Respiratory and Sleep Medicine, Western Health, St. Albans, VIC 3021, Australia.
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Abstract
Stroke is a leading cause of death and disability worldwide. While various risk factors have been identified, sleep has only been considered a risk factor more recently. Various epidemiologic studies have associated stroke with sleep such as sleep duration, and laboratory and clinical studies have proposed various underlying mechanisms. The pathophysiology is multifactorial, especially considering sleep affects many common risk factors for stroke. This review aims to provide an outline of the effect of sleep duration on common stroke risk factors. Appropriate sleep duration, especially in patients who have stroke risk factors, and increasing awareness and screening for sleep quality may contribute to primary prevention of stroke.
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Affiliation(s)
- Chun Seng Phua
- Department of Medicine, Melbourne Clinical School, University of Melbourne, Melbourne, VIC, Australia.,Department of Neurology, Western Health, St. Albans, VIC, Australia
| | - Lata Jayaram
- Department of Medicine, Melbourne Clinical School, University of Melbourne, Melbourne, VIC, Australia.,Department of Respiratory and Sleep Medicine, Western Health, St. Albans, VIC, Australia
| | - Tissa Wijeratne
- Department of Medicine, Melbourne Clinical School, University of Melbourne, Melbourne, VIC, Australia.,Department of Neurology, Western Health, St. Albans, VIC, Australia.,Department of Medicine, University of Rajarata, Saliyapura, Anuradhapura, Sri Lanka.,Department of Psychology and Counselling, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
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Phua CS, Vejayan J, Ambu S, Ponnudurai G, Gorajana A. Purification and antibacterial activities of an L-amino acid oxidase from king cobra (Ophiophagus hannah) venom. J Venom Anim Toxins Incl Trop Dis 2012. [DOI: 10.1590/s1678-91992012000200010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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