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Md Noh MSF, Abdul Rashid AM, Mohd Zain NR. The Spectrum of Vessel Wall Imaging (VWI) Findings in COVID-19-Associated Neurological Syndromes: A Review. Cureus 2023; 15:e37296. [PMID: 37168192 PMCID: PMC10166570 DOI: 10.7759/cureus.37296] [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] [Accepted: 04/08/2023] [Indexed: 05/13/2023] Open
Abstract
Since the start of the pandemic, there have been extensive studies from all over the world reporting on coronavirus disease 2019 (COVID-19)-associated neurological syndromes. Although initially thought of as primarily a respiratory pathogen, it became increasingly clear that the virus does have other systemic manifestations, including on the neurological system. Since then, the discovery of the many neuroimaging features of COVID-19-associated neurological syndromes have puzzled researchers and physicians in terms of interpretation, and how best to manage these findings to benefit patients. We sought to review the neuroimaging findings of COVID-19-associated neurological syndromes, particularly the vessel wall imaging (VWI) features, in the hope of finding a common feature that would better guide physicians in terms of further management of this group of patients. We will also look into the potential pitfalls of interpreting the VWI findings in these patients.
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Affiliation(s)
- Mohamad Syafeeq Faeez Md Noh
- Department of Radiology, Universiti Putra Malaysia Teaching Hospital, Serdang, MYS
- Department of Radiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
| | - Anna Misyail Abdul Rashid
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
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Abdul Rashid AM, Md Noh MSF, Yusof Khan AHK, Loh WC, Baharin J, Ibrahim A, Ishak FH, Sardi A, Hanapai AF, Mohamad NA, Inche Mat LN, Hoo FK, Wan Sulaiman WA, Basri H. Establishing a hyperacute stroke service during the COVID-19 pandemic: our institution's one year experience. BMC Neurol 2023; 23:72. [PMID: 36792988 PMCID: PMC9929227 DOI: 10.1186/s12883-023-03102-z] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 02/01/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND AND AIMS The corononavirus 2019 (COVID-19) pandemic resulted in modifications in the workflow and redistribution of human resources, causing challenges in setting up of an acute stroke service. We would like to share our preliminary outcome amid this pandemic, to determine if the implementation of COVID-19 standard operating procedures (SOPs) affected the delivery of our hyperacute stroke service. METHODS We retrospectively analyzed one-year data from our stroke registry that began with the establishment of our hyperacute stroke service at Universiti Putra Malaysia Teaching Hospital from April 2020 until May 2021. RESULTS Setting up acute stroke services during the pandemic with constrained manpower and implementation of COVID-19 SOPs, was challenging. There was a significant dip of stroke admission from April to June 2020 due to the Movement Control Order (MCO) implemented by the government to curb the spread of COVID-19. However, the numbers of stroke admission steadily rose approaching 2021, after the implementation of recovery MCO. We managed to treat 75 patients with hyperacute stroke interventions i.e. intravenous thrombolysis (IVT), mechanical thrombectomy (MT) or both. Despite implementing COVID-19 SOPs and using magnetic resonance imaging (MRI) as our first line acute stroke imaging modality, clinical outcomes in our cohort were encouraging; almost 40% of patients who underwent hyperacute stroke treatment had early neurological recovery (ENR), and only 33% of patients had early neurological stability (ENS). In addition, we were able to maintain our door-to-imaging (DTI) and door-to-needle (DTN) time in line with international recommendations. CONCLUSIONS Our data reflects that COVID-19 SOPs did not deter successful delivery of hyperacute stroke services in our center. However, bigger and multi center studies are required to support our findings.
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Affiliation(s)
- Anna Misya’il Abdul Rashid
- grid.11142.370000 0001 2231 800XDepartment of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia ,grid.11142.370000 0001 2231 800XInstitut Penyelidikan Penuaan Malaysia (MyAgeing™), Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Mohamad Syafeeq Faeez Md Noh
- grid.11142.370000 0001 2231 800XDepartment of Radiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Abdul Hanif Khan Yusof Khan
- grid.11142.370000 0001 2231 800XDepartment of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Wei Chao Loh
- grid.11142.370000 0001 2231 800XDepartment of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Janudin Baharin
- grid.11142.370000 0001 2231 800XDepartment of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Azliza Ibrahim
- grid.11142.370000 0001 2231 800XDepartment of Neurology, Universiti Putra Malaysia Teaching Hospital, 43400 Serdang, Selangor Malaysia
| | - Fadhilah Hani Ishak
- grid.11142.370000 0001 2231 800XDepartment of Neurology, Universiti Putra Malaysia Teaching Hospital, 43400 Serdang, Selangor Malaysia
| | - Aminuddin Sardi
- grid.11142.370000 0001 2231 800XDepartment of Neurology, Universiti Putra Malaysia Teaching Hospital, 43400 Serdang, Selangor Malaysia
| | - Ahmad Firdaus Hanapai
- grid.11142.370000 0001 2231 800XDepartment of Neurology, Universiti Putra Malaysia Teaching Hospital, 43400 Serdang, Selangor Malaysia
| | - Nur Afiqah Mohamad
- grid.11142.370000 0001 2231 800XDepartment of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia ,grid.512179.90000 0004 1781 393XCenter for Foundation Studies, Foundation in Science, Lincoln University College, 47301 Petaling Jaya, Selangor Malaysia
| | - Liyana Najwa Inche Mat
- grid.11142.370000 0001 2231 800XDepartment of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Fan Kee Hoo
- grid.11142.370000 0001 2231 800XDepartment of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Wan Aliaa Wan Sulaiman
- grid.11142.370000 0001 2231 800XDepartment of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
| | - Hamidon Basri
- grid.11142.370000 0001 2231 800XDepartment of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor Malaysia
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Abdul Rashid AM, Mohd Yaakob MN, Kamis MFAK, Md Noh MSF. The prominent hypointense vessel sign on susceptibility-weighted imaging (SWI) as a potential imaging biomarker for poor clinical outcome in acute ischemic stroke (AIS). Radiol Case Rep 2022; 17:4268-4271. [PMID: 36120517 PMCID: PMC9478180 DOI: 10.1016/j.radcr.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 11/11/2022] Open
Abstract
Susceptibility-weighted imaging (SWI) is a relatively new magnetic resonance imaging (MRI) technique used in the workup and diagnosis of brain pathologies. In the context of acute ischemic stroke (AIS), it is increasingly becoming useful in the diagnosis, treatment, and further management of these patients. An elderly man with metabolic syndrome presented to us with an acute onset of right sided body weakness and aphasia. Urgent imaging via MRI noted a left middle cerebral artery (MCA) occlusion. Diffusion-weighted imaging (DWI)/fluid attenuated inversion recovery (FLAIR) mismatch was noted with an acute infarct involving the left MCA territory; hence, treatment with intravenous (IV) thrombolysis was administered. On SWI, the prominent hypointense vessel sign was noted. Recanalization of the occluded left MCA was seen on diagnostic cerebral angiography post IV thrombolysis, however, the patient was noted to have early neurological deterioration (END) and poor early stage clinical outcome, despite repeat MRI showing recanalization of the left MCA occlusion and reversal of the prominent hypointense vessel sign on SWI. Presence of the prominent hypointense vessel sign on SWI in AIS patients is associated with poor clinical outcome, unsuccessful recanalization rates, END, poor early stage clinical outcome, and infarct core progression. Some studies have shown an association between this imaging sign and poor collateral circulation status. Therefore, this imaging sign could potentially prove to be a useful imaging biomarker. However, more studies are needed to validate this theory.
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Md Noh MSF, Yusof Khan AHK, Mohd Sabri MN, Kamis MFAK, Mohd Yaakob MN, Rahim EA, Muda AS. Vessel wall imaging in COVID-19 associated carotid atherothrombosis and stroke: a case report and literature review. J Cent Nerv Syst Dis 2022; 14:11795735221112589. [PMID: 35832610 PMCID: PMC9272477 DOI: 10.1177/11795735221112589] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/10/2022] [Indexed: 11/21/2022] Open
Abstract
COVID-19 associated neurological syndromes, including acute ischemic stroke, pose a
challenge to treating physicians. The role of MRI in aiding diagnosis and further
management is indispensable. The advent of new MRI sequences such as vessel wall imaging
(VWI) allows an avenue in which these patients could be better investigated and treated.
We describe our experience in managing a patient with COVID-19 associated atherothrombosis
and stroke, focusing on the VWI imaging findings.
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Affiliation(s)
- Mohamad Syafeeq Faeez Md Noh
- Department of Radiology, Faculty of Medicine and Health Sciences & Universiti Putra Malaysia Teaching Hospital, Selangor, Malaysia
| | - Abdul Hanif Khan Yusof Khan
- Department of Radiology, Faculty of Medicine and Health Sciences & Universiti Putra Malaysia Teaching Hospital, Selangor, Malaysia
| | - Mohd Naqib Mohd Sabri
- Department of Radiology, Faculty of Medicine and Health Sciences & Universiti Putra Malaysia Teaching Hospital, Selangor, Malaysia
| | | | - Mohd Naim Mohd Yaakob
- Department of Radiology, Faculty of Medicine and Health Sciences & Universiti Putra Malaysia Teaching Hospital, Selangor, Malaysia
| | - Ezamin Abdul Rahim
- Department of Radiology, Faculty of Medicine and Health Sciences & Universiti Putra Malaysia Teaching Hospital, Selangor, Malaysia
| | - Ahmad Sobri Muda
- Department of Radiology, Faculty of Medicine and Health Sciences & Universiti Putra Malaysia Teaching Hospital, Selangor, Malaysia
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Abdul Rashid AM, Md Noh MSF, Yusof Khan AHK, Loh WC, Baharin J, Ibrahim A, Inche Mat LN, Wan Sulaiman WA, Hoo FK, Hanapiah FA, Basri H. NeuroAid II (MLC901) and polypharmacy in stroke and the risk of hepatotoxicity: a case report. Egypt J Neurol Psychiatry Neurosurg 2021. [DOI: 10.1186/s41983-021-00397-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
NeuroAid II (MLC901) is a promising therapy for stroke patients who present outside of therapeutic window for reperfusion therapy. Studies have proven its efficacy in ischemic stroke; however, data of drug safety and combination with other medications especially anticoagulants are heterogenous. We report a possible case of hepatotoxicity induced by NeuroAid II in combination with anticoagulants.
Case presentation
We report an elderly patient who developed symptoms of cardioembolic stroke presented outside of time window for reperfusion therapy. He was started on a regiment of statins, anticoagulation, beta blockers and NeuroAid II. One month later he presented with deranged liver enzymes. Cessation of NeuroAid II resulted in rapid improvement of transaminitis within days.
Conclusions
We wish to highlight the potential harmful effect of administering NeuroAid II with an anticoagulant and the importance of routine follow-up and blood monitoring in the elderly patients with stroke.
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Abd Rashid AM, Md Noh MSF, Yusof Khan AHK, Mohd Yaakob MN, Bahari N, Basri H. Unilateral loss of the swallow tail sign in a patient with idiopathic Parkinson’s disease. CVNS 2021; 3:59-62. [DOI: 10.32896/cvns.v3n3.59-62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
A 66-year-old man with underlying hypertension and dyslipidemia presented with left hand tremor for one year. He also noticed difficulty in initiating movement and slowness in activities of daily living. On examination, he was noted to have mask-like facies with reduced blinking and monotonous speech. There was presence of resting pill-rolling tremor, bradykinesia, and cogwheel rigidity which was worst on the left upper limb. Gait assessment revealed difficulty in standing up, shuffling gait with reduced arm swing which was more prominent on the left side, and turning in numbers. No cerebellar signs and supranuclear palsy were present to suggest Parkinson-plus syndrome. Susceptibility weighted imaging (SWI) showed loss of the swallow tail sign on the right side [Figure 1]. The clinical presentation, supplemented by the imaging findings were concluded to be pathognomonic of idiopathic Parkinson’s disease (IPD), Hoehn & Yahr stage 1. He was started on levodopa and benserazide twice daily with improvement of symptoms.The nigrosomes are primary subregions of the substantia nigra where dopaminergic cells are lost in IPD. Within these nigrosomes, maximal cell loss occurs in nigrosome-1; the largest subgroup of nigrosomes. Normally, they appear as a SWI-hyperintense area surrounded by hypointensity within the dorsolateral substantia nigra, akin to a swallow’s tail. In one study, poor visualization of nigrosome-1 was significantly associated with higher motor asymmetry in the contralateral side (sensitivity 98.5%, specificity 93.6%, positive-predictive value 98.3%, negative-predictive value 98.3% and an accuracy of 96%) [1]. Noh et al [2] showed that abnormality involving nigrosome-1 can be detected at 3T MR imaging with an accuracy of 94.6%. Due to the difficulty in diagnosis of early stage IPD, a loss of the swallow tail sign serves as a useful imaging biomarker to supplement the clinical diagnosis, as seen in our patient.
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Kamis MFAK, Yaakob MNM, Rahim EA, Muda AS, Noh MSFM. Spontaneous Middle Cerebral Artery (MCA) dissection and stenosis: Role of vessel wall imaging and 3D-RA endoluminal view as adjunct diagnostic tools in endovascular therapy. Interdisciplinary Neurosurgery 2021. [DOI: 10.1016/j.inat.2021.101170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Md Noh MSF. The middle cerebral artery (MCA) dot sign. Clin Case Rep 2021; 9:CCR33319. [PMID: 34466227 PMCID: PMC8385251 DOI: 10.1002/ccr3.3319] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/08/2020] [Accepted: 08/12/2020] [Indexed: 11/19/2022] Open
Abstract
The middle cerebral artery (MCA) dot sign is an important radiological sign in patients presenting with acute ischemic stroke (AIS). If identified and intervened early, a good clinical outcome may be achieved.
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Affiliation(s)
- Mohamad Syafeeq Faeez Md Noh
- Department of ImagingLevel 3, Faculty of Medicine and Health SciencesUniversiti Putra MalaysiaSerdangMalaysia
- Department of RadiologyUniversiti Putra Malaysia (UPM) Teaching HospitalPersiaran MARDI‐UPMSerdangMalaysia
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Affiliation(s)
- Mohamad Syafeeq Faeez Md Noh
- Department of Imaging, Level 3, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia; Department of Radiology, Universiti Putra Malaysia (UPM) Teaching Hospital, Persiaran MARDI-UPM, 43400 Serdang, Selangor, Malaysia.
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Md Noh MSF. Accidental Puncture of a Dialysis Catheter into the Brachiocephalic Trunk. Aorta (Stamford) 2020; 8:159-160. [PMID: 33368104 PMCID: PMC7758118 DOI: 10.1055/s-0040-1715466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A 22-year-old male with underlying end-stage renal failure was referred to our center for a malpositioned dialysis catheter. Imaging showed the tip of the catheter to be placed in the brachiocephalic trunk; the patient was, however, asymptomatic. Surgical removal of the malpositioned catheter followed, with no postoperative complications.
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Affiliation(s)
- Mohamad Syafeeq Faeez Md Noh
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- Department of Radiology, Universiti Putra Malaysia (UPM) Teaching Hospital, Serdang, Selangor, Malaysia
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Md Noh MSF. Myelin oligodendrocyte glycoprotein-antibody (MOG-IgG) associated disease with centrally located long spinal cord lesion in a 14-month old child. J Cent Nerv Syst Dis 2020; 12:1179573520955008. [PMID: 32973377 PMCID: PMC7495514 DOI: 10.1177/1179573520955008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/01/2020] [Accepted: 08/13/2020] [Indexed: 11/28/2022] Open
Abstract
Myelin oligodendrocyte glycoprotein-antibodies (MOG-IgG) are associated with acquired
inflammatory demyelinating syndromes, seen predominantly in children and young adults. The
overlapping clinical and radiological features of the heterogenous spectrum of
demyelinating central nervous system (CNS) diseases makes the detection of MOG-IgG
antibodies important for prognosis and treatment decisions. Herein, we describe the
occurrence of MOG-IgG associated disease presenting as acute disseminated
encephalomyelitis (ADEM), with spinal MRI findings of centrally located long cord lesion
in a 14-month old child.
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Affiliation(s)
- Mohamad Syafeeq Faeez Md Noh
- Department of Radiology, Universiti Putra Malaysia (UPM) Teaching Hospital, Persiaran MARDI-UPM, Serdang, Selangor, Malaysia.,Department of Imaging, Level 3, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), Serdang, Selangor, Malaysia
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Abdul Rashid AM, Mohamad Mokhtar E, Md Noh MSF. A case of anti- N-methyl-d-aspartate receptor encephalitis. SAGE Open Med Case Rep 2020; 8:2050313X20926431. [PMID: 32547761 PMCID: PMC7273584 DOI: 10.1177/2050313x20926431] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 04/20/2020] [Indexed: 11/19/2022] Open
Abstract
Anti-N-methyl-d-aspartate receptor encephalitis is
characterized by the clinical manifestation of neuropsychiatric symptoms, predominantly
affecting young adults, and frequently associated with neoplasms. It is the second most
common cause of autoimmune and paraneoplastic encephalitis. Early diagnosis is often
missed, as patients are commonly diagnosed with psychiatric illnesses and are treated with
antipsychotics – which rarely gives complete resolution of symptoms. Herein, we discuss a
patient with mixed clinical, imaging, electroencephalogram, and laboratory findings, with
an eventual diagnosis of anti-N-methyl-d-aspartate receptor
encephalitis requiring immunotherapy and operative intervention.
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Affiliation(s)
- Anna Misyail Abdul Rashid
- Department of Medicine, Level 3, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | | | - Mohamad Syafeeq Faeez Md Noh
- Department of Imaging, Level 3, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Affiliation(s)
- Mohamad Syafeeq Faeez Md Noh
- Department of Imaging, Level 3, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia; Department of Radiology, Universiti Putra Malaysia (UPM) Teaching Hospital, Persiaran MARDI-UPM, 43400 Serdang, Selangor, Malaysia.
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Abdul Rashid AM, Bahari N, Md Noh MSF. Pediatric critical illness associated cerebral microhemorrhages. eNeurologicalSci 2020; 18:100221. [PMID: 31909229 PMCID: PMC6938852 DOI: 10.1016/j.ensci.2019.100221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 11/27/2022] Open
Affiliation(s)
- Anna Misyail Abdul Rashid
- Department of Medicine, Level 3, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Norafida Bahari
- Department of Imaging, Level 3, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Mohamad Syafeeq Faeez Md Noh
- Department of Radiology, Universiti Putra Malaysia (UPM) Teaching Hospital, Persiaran MARDI – UPM, 43400 Serdang, Selangor, Malaysia
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Md Noh MSF, Bahari N, Abdul Rashid AM. Tuberculous Myelopathy Associated with Longitudinally Extensive Lesion: A Clinicoradiological Review of Reported Cases. J Clin Neurol 2020; 16:369-375. [PMID: 32657056 PMCID: PMC7354966 DOI: 10.3988/jcn.2020.16.3.369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 10/02/2019] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 12/16/2022] Open
Abstract
Acute transverse myelitis is an inflammatory disorder of the spinal cord in which there is no evidence of spinal cord compression. Longitudinally extensive transverse myelitis (LETM) is a specific subtype of acute transverse myelitis that usually affects three or more vertebral levels and produces marked neurological deficits. While the most-common cause of LETM is neuromyelitis optica or neuromyelitis optica spectrum disorder, there are rare cases of other causes mimicking this condition, including tuberculosis (TB). We sought to review the clinicoradiological features of TB myelopathy associated with longitudinally extensive lesion, which may mimic LETM, in the English literature. We searched the PubMed, Google Scholar, Web of Science, and Scopus databases for relevant articles using search terms including “longitudinally extensive transverse myelitis,” “tuberculosis,” “TB spinal cord,” and various combinations of these expressions. Full-text papers were selected without limiting the publication year. We also examined the reference lists of key papers to identify further articles that are potentially relevant. We found 10 cases in 7 papers describing TB myelopathy associated with longitudinally extensive lesion. The demographics, clinical features, relevant cerebrospinal fluid findings, and radiological findings were compiled and summarized. TB myelopathy associated with longitudinally extensive lesion is very rare, with no documented prevalence. Early and accurate diagnosis is important since the condition is potentially treatable.
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Affiliation(s)
- Mohamad Syafeeq Faeez Md Noh
- Senior Registrar and Interventional Neuroradiologist in-training, Department of Imaging, Level 3, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
| | - Norafida Bahari
- Consultant Radiologist, Department of Imaging, Level 3, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Anna Misyail Abdul Rashid
- Internal Medicine Physician, Department of Imaging, Level 3, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Caunter G, Faeez Md Noh MS, Safri LS, Kumar K, Md Idris MA, Harunarashid H, Yahaya A. Delayed Presentation of Metastatic Renal Cell Carcinoma as an Arteriovenous Malformation Mimicking Vascular Tumour of the Forearm. EJVES Short Rep 2019; 44:19-22. [PMID: 31453386 PMCID: PMC6704251 DOI: 10.1016/j.ejvssr.2019.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 04/17/2019] [Revised: 06/13/2019] [Accepted: 06/19/2019] [Indexed: 10/26/2022] Open
Abstract
Introduction The development of metastatic renal cell carcinoma (RCC) many years after a nephrectomy is not common but has been reported. A metastasis appearing as a hypervascular tumour, mimicking an arteriovenous malformation (AVM), is a highly unusual phenomenon, with a biopsy required for diagnostic confirmation. Surgery is an option for a solitary metastatic lesion amenable to complete excision, with proven survival benefits. However, widespread metastatic disease carries a very poor prognosis, and is best treated with systemic agents such as anti-angiogenic drugs or tyrosine kinase inhibitors. Report A 58 year old man developed an AVM mimicking a vascular tumour within his left brachioradialis muscle 10 years after a nephrectomy for RCC. Ultrasound and magnetic resonance imaging did not reveal any suspicious features of the vascular lesion.The lesion was successfully removed surgically, and was later proven histopathologically to be metastatic RCC. Further imaging showed widespread metastatic disease, and the patient survived only 15 months after receiving tyrosine kinase inhibitor therapy. Discussion This case report aims to highlight a few important points: RCC metastases may be hypervascular, mimicking an AVM. A long disease free interval does not necessarily exclude recurrence or metastasis, as in this case, therefore long term surveillance is recommended. A high index of suspicion must be maintained to avoid delay in treatment, and biopsy of any suspicious lesion for histological examination is mandatory, albeit after many years of cancer remission. Whole body imaging with computed tomography or positron emission tomography computed tomography may detect clinically occult recurrence or metastases, and is important to guide further treatment.
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Affiliation(s)
- Gillian Caunter
- Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | | | - Lenny Suryani Safri
- Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Krishna Kumar
- Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Mohamad Azim Md Idris
- Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Hanafiah Harunarashid
- Department of General Surgery, Faculty of Medicine, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Azyani Yahaya
- Department of Pathology, National University of Malaysia Medical Centre, Kuala Lumpur, Malaysia
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Md Noh MSF, Abdul Rashid AM. Development of pseudo-subarachnoid hemorrhage secondary to hypoxic-ischemic injury due to bleeding pulmonary arterio-venous malformation. BMC Neurol 2018; 18:157. [PMID: 30266082 PMCID: PMC6161445 DOI: 10.1186/s12883-018-1161-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 09/21/2018] [Indexed: 12/03/2022] Open
Abstract
Background The computed tomography (CT) finding of a pseudo-subarachnoid hemorrhage (SAH) may lead the treating physician into a diagnostic dilemma. We present a case of a pseudo-SAH in a patient with post-resuscitative encephalopathy, secondary to a newly diagnosed bleeding pulmonary arterio-venous malformation (AVM). Case presentation A 19-year-old female presented acutely with massive hemoptysis. Cardiopulmonary resuscitation (CPR) followed, and the patient was subsequently intubated for airway protection with intensive care unit (ICU) admission. Urgent CT angiography of the thorax showed a bleeding pulmonary AVM, with evidence of hemothorax. Non-contrasted cranial CT initially revealed cerebral edema. Day 3 post admission, repeat cranial CT showed worsening cerebral edema, with evidence of pseudo-SAH. Patient passed away the next day. Conclusions Pseudo-SAH, if present, carries a poor prognosis. It should be recognized as a potential CT finding in patients with severe cerebral edema, due to various causes. The diagnosis is vital, to avoid wrongful treatment institution, as well as determination of cause of death.
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Md Noh MSF, Bahari N. Massive subdural empyema. Oxf Med Case Reports 2018; 2018:omy065. [PMID: 30159156 PMCID: PMC6109192 DOI: 10.1093/omcr/omy065] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/13/2018] [Accepted: 07/03/2018] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mohamad Syafeeq Faeez Md Noh
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - Norafida Bahari
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
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Safri LS, Md Noh MSF, Hariz Ramli AR, Md Pauzi SH, Md Idris MA, Harunarashid H. A case of metastatic adenocarcinoma from an unknown primary involving the aortic bifurcation. J Vasc Surg Cases Innov Tech 2018; 4:160-162. [PMID: 29942910 PMCID: PMC6012993 DOI: 10.1016/j.jvscit.2018.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/08/2018] [Indexed: 11/26/2022]
Abstract
Aortic malignant neoplasms are rare; these may be primary or secondary (metastatic). Increasing use of cross-sectional imaging has allowed better detection and diagnosis of these conditions. We encountered a young woman presenting with acute abdomen who was found on cross-sectional imaging to have a malignant tumor involving the aortic bifurcation. An en bloc excision of the tumor was performed, with distal aorta reconstruction using an aortoiliac Dacron graft; this was complicated with infection and graft occlusion, necessitating total removal and extra-anatomic bypass. A pathologic diagnosis of metastatic adenocarcinoma involving the aortic bifurcation, with an unknown primary, was made.
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Affiliation(s)
- Lenny Suryani Safri
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Cheras, Malaysia
| | | | - Ahmad Rafizi Hariz Ramli
- Department of Surgery, Faculty of Medicine, Universiti Malaya Medical Center, Petaling Jaya, Malaysia
| | - Suria Hayati Md Pauzi
- Department of Pathology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Cheras, Malaysia
| | - Mohamad Azim Md Idris
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Cheras, Malaysia
| | - Hanafiah Harunarashid
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Center, Cheras, Malaysia
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Abstract
Background Dyke-Davidoff-Masson syndrome is a rare condition of unknown frequency resulting from brain injury due to a multitude of causes; especially in early life. Characteristics include cerebral hemiatrophy/hypoplasia, contralateral hemiparesis, seizures, and compensatory osseous hypertrophy. Case presentation We present a case of a 13-year-old girl who initially presented with headaches, followed by episodic complex-partial seizures; which was controlled via medication. She also had right sided hemiparesis. Computed tomography (CT) showed evidence of left parieto-temporal infarct with cerebral atrophy. Complementary magnetic resonance imaging (MRI) did not reveal additional information. Workup for young stroke was negative. Upon further evaluation by Neuroradiology, features suggesting Dyke-Davidoff-Masson syndrome were confirmed. Patient has been under Neurology follow up since. Conclusions Due to its rarity, Dyke-Davidoff-Masson syndrome may easily be missed by the majority of treating clinicians. Knowledge of its features on imaging enables timely and accurate diagnosis – allowing appropriate management.
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Affiliation(s)
- Anna Misyail Abdul Rashid
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Che Ani MF, Kumar R, Md Noh MSF, Muda AS. Supraclinoid direct carotid-cavernous sinus fistula. BJR Case Rep 2018; 4:20170058. [PMID: 31489208 PMCID: PMC6711273 DOI: 10.1259/bjrcr.20170058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Revised: 02/23/2018] [Accepted: 02/27/2018] [Indexed: 11/06/2022] Open
Abstract
Carotid-cavernous fistulas (CCFs) are vascular shunts between the carotid
arterial system with direct drainage into the cerebral venous system, mainly to
the cavernous sinus. Direct CCF is a well-recognised complication following head
trauma. Classically in direct or traumatic CCF, vessel wall tear occurs at the
cavernous segment of the internal carotid artery, between the fixed and free
segment. Tears at the supraclinoid segment are rare. We report a case of an
internal carotid artery supraclinoid segment pseudoaneurysm, with a direct
communication with the cavernous sinus, draining into the superior ophthalmic
vein.
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Affiliation(s)
- Mohd Firdaus Che Ani
- General Surgery Unit, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Ramesh Kumar
- Neurosurgery Unit, Universiti Kebangsaan Malaysia (UKM) MedicalCentre, Kuala Lumpur, Malaysia
| | - Mohamad Syafeeq Faeez Md Noh
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia
| | - Ahmad Sobri Muda
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia
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Sulaiman N, Othman AZ, Shahril NS, Abdul Rashid AM, Md Noh MSF. Successful febuxostat desensitization in a patient with febuxostat hypersensitivity: A Malaysian experience. SAGE Open Med Case Rep 2018; 5:2050313X17749080. [PMID: 29318019 PMCID: PMC5753890 DOI: 10.1177/2050313x17749080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 05/13/2017] [Accepted: 11/27/2017] [Indexed: 12/02/2022] Open
Abstract
Over the years, allopurinol has been widely used as the preferred choice of urate lowering therapy in patients with gout. However, its role in patients with renal impairment is limited; and adverse reactions are well documented. Febuxostat, a newer oral non-purine xanthine oxidase inhibitor has been proven in several trials to be more effective and tolerable compared to allopurinol and may be used in patients with renal impairment. Here, we describe a case of successful febuxostat desensitization in a patient with a history of allopurinol- and febuxostat-induced adverse cutaneous reaction, as well as the protocol utilized.
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Affiliation(s)
- Narisa Sulaiman
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | | | | | - Anna Misyail Abdul Rashid
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Ahmad Saad FF, Abdul Rashid AM, Md Noh MSF. Incremental Role of Fluorine 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Assessment of Computed Tomography-Inconspicuous Pancreatic Lesions. J Pancreat Cancer 2017; 3:66-70. [PMID: 30631845 PMCID: PMC5933485 DOI: 10.1089/pancan.2017.0014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 12/19/2022] Open
Abstract
Background: Pancreatic malignancies encompass a heterogenous group of disorders, with poor prognosis at diagnosis. Traditionally, conventional computed tomography (CT) has been used for diagnosis, staging, and follow up. However, this technique lacks functional information; and is limited in diagnosis of occult pancreatic disease. Hybrid imaging in the form of positron emission tomography (PET)/CT provides a potential avenue for early detection and subsequent appropriate therapy. Case Presentation: A 60-year-old male, with a history of abdominal aortic aneurysm which was repaired, came with a complaint of 2 months history of back pain, radiating to the front. The pain was relieved on leaning forward, and aggravated by lying on his back. CT angiography of the abdomen was done, which revealed a concealed aortic aneurysm and a significant atrophy of the pancreatic tail. The serum cancer antigen (CA) 19-9 was elevated (50.0 U/mL, reference range 0.0–37.0 U/mL). At this juncture, the PET scan done revealed no discernible abnormalities. Patient was put on close follow-up in view of the rising trend of CA 19-9 levels. Three months following the initial scans, a repeat 18F-FDG (fluorine 18 fluorodeoxyglucose) PET/CT revealed an FDG-avid lesion at the neck of the pancreas on PET without perceptible changes on the correlated CT. A Whipple's procedure ensued, with histopathological examination findings of pancreatic adenocarcinoma. Conclusion: This article discusses the role of PET/CT in the early diagnosis of inconspicuous pancreatic lesions; which could have averted immediate medical therapy.
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Affiliation(s)
| | - Anna Misyail Abdul Rashid
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Abdul Rashid AM, Md Noh MSF. Isolated non-traumatic, non-aneurysmal convexal subarachnoid hemorrhage in a patient with Evans syndrome. BMC Neurol 2017; 17:165. [PMID: 28841841 PMCID: PMC5572068 DOI: 10.1186/s12883-017-0944-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/21/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Non-traumatic, spontaneous subarachnoid hemorrhage occurs in approximately 85% of cases where there is a ruptured saccular aneurysm. An additional 10% of cases arise from non-aneurysmal peri-mesencephalic hemorrhages. CASE PRESENTATION We report a rare case of a young female, with underlying Evans syndrome, who was initially thought to have non-hemorrhagic stroke, eventually diagnosed having isolated non-traumatic, non-aneurysmal convexal subarachnoid haemorrhage. CONCLUSIONS Spontaneous non-traumatic, non-aneurysmal convexal subarachnoid hemorrhage is a rare entity - of which there are multiple possible etiologies.
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Affiliation(s)
- Anna Misyail Abdul Rashid
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra, Serdang, Malaysia
| | - Mohamad Syafeeq Faeez Md Noh
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Level 3, 43400 Serdang, Selangor Malaysia
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Md Noh MSF, Abdul Rashid AM, Ar A, B N, Mohammed Y, A R E. Emphysematous aortitis: report of two cases and CT imaging findings. BJR Case Rep 2017; 3:20170006. [PMID: 30363220 PMCID: PMC6159202 DOI: 10.1259/bjrcr.20170006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/13/2017] [Accepted: 03/09/2017] [Indexed: 01/16/2023] Open
Abstract
Emphysematous aortitis is a rare condition that manifests through the presence of air within or surrounding the inflamed aorta. Aortic inflammation may result from either an infective or a non-infective cause. Recognition of this rare condition is important as the resultant clinical deterioration may be rapid and lead to inevitable death. Cross-sectional imaging, with its relatively wide availability, proves an important tool in the diagnosis and subsequent management of this condition. We report two such cases encountered in our centre, with particular focus on the imaging findings on CT.
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Affiliation(s)
- Mohamad Syafeeq Faeez Md Noh
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Anna Misyail Abdul Rashid
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Aida Ar
- Department of Diagnostic Imaging, Hospital Serdang, Serdang, Malaysia
| | - Norafida B
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Yusri Mohammed
- Department of Diagnostic Imaging, Hospital Serdang, Serdang, Malaysia
| | - Ezamin A R
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Malaysia
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Abstract
Patient: Male, 74 Final Diagnosis: Giant intradiverticular bladder tumor with metastasis Symptoms: Hematuria Medication:— Clinical Procedure: — Specialty: Urology
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Affiliation(s)
| | | | | | - Christopher Lee Kheng Siang
- Urology Unit, Department of Surgery , Faculty of Medicine and Health Sciences, Universiti Putra Malaysia , Serdang, Malaysia
| | - Rosna Yunus
- Department of Pathology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
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Mohd Ibrahim R, Md Noh MSF, Muhammad Nor MA, Md Sari NA, Bahari N, Rahim EA, Mohammed Y. Typical and Atypical Magnetic Resonance Imaging Appearances of Primary Cardiac Lymphoma. Cardiovasc Imaging Asia 2017; 1:248. [DOI: 10.22468/cvia.2017.00080] [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] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 08/10/2017] [Accepted: 09/21/2017] [Indexed: 09/02/2023]
Affiliation(s)
| | | | | | | | - Norafida Bahari
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra, Malaysia
| | - Ezamin Abd Rahim
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra, Malaysia
| | - Yusri Mohammed
- Department of Diagnostic Imaging, Hospital Serdang, Malaysia
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