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Chau EMC, Ma ESK, Chan AOO, Tsoi TH, Law WL. Mitochondrial cardiomyopathy due to m.3243A>G mitochondrial DNA mutation presenting in late adulthood: a case report. Hong Kong Med J 2021; 26:240-242. [PMID: 32554818 DOI: 10.12809/hkmj198051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- E M C Chau
- Department of Medicine, Hong Kong Sanatorium & Hospital, Hong Kong
| | - E S K Ma
- Department of Pathology, Hong Kong Sanatorium & Hospital, Hong Kong
| | - A O O Chan
- Department of Medicine, Hong Kong Sanatorium & Hospital, Hong Kong
| | - T H Tsoi
- Department of Medicine, Hong Kong Sanatorium & Hospital, Hong Kong
| | - W L Law
- Department of Surgery, Hong Kong Sanatorium & Hospital, Hong Kong
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Auyeung M, Tsoi TH, Mok V, Cheung CM, Lee CN, Li R, Yeung E. Ten year survival and outcomes in a prospective cohort of new onset Chinese Parkinson's disease patients. J Neurol Neurosurg Psychiatry 2012; 83:607-11. [PMID: 22362919 DOI: 10.1136/jnnp-2011-301590] [Citation(s) in RCA: 130] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The 10 year outcomes and impact of motor and non-motor features on survival of a cohort of new onset Chinese Parkinson's disease (PD) patients were prospectively studied. METHOD A cohort of new onset PD patients from 1995 to 2002 was recruited from a regional hospital based movement disorder clinic. Subjects were classified into postural instability gait disorder (PIGD), tremor predominant type or mixed subtypes at presentation. All were evaluated yearly for development of sensory complaints, first significant fall, hallucinations, dementia, postural hypotension, speech disturbances, dysphagia and postural instability persisted during 'on' medication state (PIPon). Mortality and predictors of death were determined. RESULTS 171 new onset PD patients were recruited. After a mean follow-up of 11.3±2.6 years, 50 (29%) patients died. The standardised mortality ratio was 1.1 (CI 0.8 to 1.5, p=0.34). 83 (49%) developed dementia, 81 (47%) had psychosis and 103 (60%) had sensory complaints. Postural hypotension was found in 58 (34%) patients, 108 (63%) had PIPon, 101 (59%) had falls, 102 (60%) had dysphagia, 148 (87%) had freezing of gait and 117 (68%) had speech disturbances. 46 (27%) were institutionalised whereas 54 (32%) lived independently. Dementia (HR 5.0, 95% CI 2.1 to 13.0), PIPon (HR 2.8, 95% CI 1.2 to 6.8), older onset (HR 1.05, 1 year increase in age, 95% CI 1.0 to 1.1) and PIGD type (HR 2.1, 95% CI 1.2 to 3.7) were independent predictors of death. CONCLUSIONS 10 years into PD, a significant proportion of patients developed dopa resistant motor and non-motor features. Older onset, PIGD type, PIPon and dementia had a negative impact on survival. Standardised mortality ratio was 1.1.
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Affiliation(s)
- Man Auyeung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR China.
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Chan A, Wong S, Chen PP, Tsoi TH, Lam J, Ip WY, Wong CP, Wong L, Mok V. Validation study of the Chinese Identification Pain Questionnaire for neuropathic pain. Hong Kong Med J 2011; 17:297-300. [PMID: 21813898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES For diagnosing neuropathic pain, a simple 6-item patient-completed identification pain questionnaire has been validated among Caucasians. We aimed to study the validity and reliability of this questionnaire among Hong Kong Chinese patients. DESIGN Questionnaire survey. SETTING Two pain clinics and two neurology clinics in Hong Kong. PATIENTS Patients with either neuropathic pain or nociceptive pain were recruited randomly from the four clinics. The patients completed the questionnaire themselves and the diagnosis of neuropathic pain and nociceptive pain was made by the pain specialists. We determined the optimal cutoff, positive and negative predictive values, sensitivity, specificity, the area under the receiver operating characteristic curve, and test-retest reliability of the translated version. RESULTS Among the 92 participants, 60 (65%) had neuropathic pain and 32 (35%) had nociceptive pain. At an optimal cutoff score of 3 or higher, the positive predictive value was 87% while the negative predictive value was 55%, and it correctly classified 71% of cases. The specificity and sensitivity were 81% and 65%, respectively. The area under the curve was 0.78 (P<0.001). Test-retest reliability in the 10 randomly selected patients showed a good intraclass correlation of 0.72. CONCLUSION The Chinese Identification Pain Questionnaire is a valid and reliable scale that may be used as an initial diagnostic tool for neuropathic pain among Hong Kong Chinese patients.
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Affiliation(s)
- A Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Auyeung M, Tsoi TH, Tang WK, Cheung CM, Lee CN, Li R, Yeung E. Impulse control disorders in Chinese Parkinson's disease patients: the effect of ergot derived dopamine agonist. Parkinsonism Relat Disord 2011; 17:635-7. [PMID: 21705258 DOI: 10.1016/j.parkreldis.2011.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 05/25/2011] [Accepted: 06/02/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We studied the prevalence and related risk factors of impulse control disorders in Chinese Parkinson's disease patients. METHOD We screened all non-demented Parkinson's disease patients attending our Parkinson's disease clinic from August 2009 to March 2010. The clinical characteristics of patients with impulse control disorders and those without were compared. RESULTS Of the 213 PD subjects screened, 15 (7.0%) with impulse control disorders were identified. Fourteen of these subjects were on both a dopamine agonist and Levodopa, and one was on Levodopa alone. Of the fourteen subjects on both a dopamine agonist and Levodopa, eleven were on bromocriptine and Levodopa; 10.5% of the subjects exposed to bromocriptine had impulse control disorder. Upon multivariate analysis, dose of dopamine agonist used, young age at onset of Parkinson's disease and a history of anxiety or depression were independent predictors for developing impulse control disorders. CONCLUSIONS 7% of our Chinese PD subjects had impulse control disorders. When young Parkinson's disease patients with a history of anxiety or depression are treated with high dose of DA, they are at risk of developing impulse control disorders.
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Affiliation(s)
- M Auyeung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, 3rd Lok Man Road, Chai Wan, Hong Kong Special Administrative Region, China.
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Cheung RTF, Lyden PD, Tsoi TH, Huang Y, Liu M, Hon SFK, Raman R, Liu L. Production and validation of Putonghua- and Cantonese-Chinese language National Institutes of Health Stroke Scale training and certification videos. Int J Stroke 2010; 5:74-9. [PMID: 20446940 DOI: 10.1111/j.1747-4949.2010.00411.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSES The National Institutes of Health Stroke Scale (NIHSS) is an integral part of acute stroke assessment. We report our experience with new Putonghua- and Cantonese-Chinese language NIHSS (PC-NIHSS and CC-NIHSS) training and certification videos. METHODS A professional video production company was hired to create the training and certification videos for both PC-NIHSS and CC-NIHSS. Two training and certification workshops were held in Chengdu and Beijing, and two workshops in Hong Kong. The instruction, training and group A certification videos were presented to workshop attendees. Unweighted kappa statistics were used to measure the agreement among raters, and the inter-rater agreements for PC-NIHSS and CC-NIHSS videos were compared with those of original English language NIHSS (E-NIHSS) videos. RESULTS The pass rates using PC-NIHSS and CC-NIHSS videos were 79% and 82%, respectively. All possible responses on individual scale items were included. Facial palsy and limb ataxia (13%) showed poor agreement, nine (60%) to 10 (67%) items showed moderate agreement (0.4<kappa<0.75), and three (20%) to four (27%) items showed excellent agreement. When compared with E-NIHSS videos, the agreements on best gaze, visual fields, facial weakness and aphasia were less for PC-NIHSS videos, and the agreements on commands for level of consciousness and visual fields were less for CC-NIHSS videos. Nevertheless, there was no difference between PC-NIHSS or CC-NIHSS and E-NIHSS videos in the agreement on total score. CONCLUSIONS Compared with E-NIHSS videos, PC-NIHSS and CC-NIHSS videos show good content validity and inter-rater reliability. Availability of these videos may facilitate the proper use of NIHSS among physicians and nurses in Putonghua- or Cantonese-speaking communities.
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Affiliation(s)
- R T F Cheung
- Department of Medicine (Neurology), and Research Centre of Heart, Brain, Hormone and Healthy Aging, University of Hong Kong, Hong Kong.
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Chan CK, Li R, Shum HP, Lo SHK, Chan KKC, Wong KS, Tsoi TH, Yan WW. Star fruit intoxication successfully treated by charcoal haemoperfusion and intensive haemofiltration. Hong Kong Med J 2009; 15:149-152. [PMID: 19342744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
We report on a case of an elderly woman with chronic renal impairment, secondary to diabetic nephropathy, who developed a deep coma and seizure shortly after consumption of star fruit. She was managed in the intensive care unit, and her consciousness level improved dramatically after an 8-hour charcoal haemoperfusion and 30 hours of continuous haemofiltration. There were no long-term neurological or renal sequelae 9 months later. Early recognition of this condition, intensive dialytic therapy and supportive measures, as well as early initiation of charcoal haemoperfusion may improve the management of this potentially treatable condition.
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Affiliation(s)
- C K Chan
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
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Cheung CM, Tsoi TH, Hon SFK, Au-Yeung M, Shiu KL, Lee CN, Huang CY. Using the National Institutes of Health Stroke Scale (NIHSS) to predict the mortality and outcome of patients with intracerebral haemorrhage. Hong Kong Med J 2008; 14:367-370. [PMID: 18840907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
OBJECTIVES To investigate whether the National Institutes of Health Stroke Scale (NIHSS) can be used to predict mortality and functional outcome in patients presenting with intracerebral haemorrhage. DESIGN Retrospective study of a prospectively collected cohort. SETTING Regional hospital, Hong Kong. PATIENTS A cohort of 359 patients presented to our hospital from 1996 to 2001 with their first-ever stroke and intracerebral haemorrhage. MAIN OUTCOME MEASURES The sensitivity and specificity of the NIHSS with a cut-off point of 20 in predicting mortality at 30 days and 5 years, and a favourable functional outcome at 5 years. RESULTS A total of 359 patients were available for analysis and were divided into three subgroups according to the site and the size of the haematoma. The NIHSS can predict 30-day mortality with a sensitivity of 81% [corrected] and a specificity of 90% [corrected] The NIHSS can predict 5-year mortality with a sensitivity of 57% [corrected] and a specificity of 92% [corrected] In predicting favourable functional outcomes at 5 years, the NIHSS had a sensitivity of 98% [corrected] and a specificity of 16% [corrected] CONCLUSIONS The NIHSS performed on admission can be used to predict mortality at 30 days and 5 years as well as favourable functional outcome at 5 years, all with an acceptable sensitivity and specificity.
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Affiliation(s)
- C M Cheung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
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Cheung CM, Tsoi TH, Hon SFK, Au-Yeung M, Shiu KL, Lee CN, Huang CY. Outcomes after first-ever stroke. Hong Kong Med J 2007; 13:95-9. [PMID: 17406035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
OBJECTIVES To determine the outcomes after first-ever stroke, including mortality, dependence, and recurrence. DESIGN Retrospective study on a prospectively collected cohort. SETTING Regional hospital, Hong Kong. PATIENTS A cohort of 755 patients presented to our hospital from 1996 to 1998 with their first-ever stroke. MAIN OUTCOME MEASURES Mortality and stroke recurrence rate at 30 days, 1 year, and 5 years from the onset of the stroke. Dependence in activity of daily living at 5 years from the onset of stroke. RESULTS The mortality rate was 15.1% at 30 days, 22.5% at 1 year, and 39.7% at 5 years from the onset of the first-ever stroke. The rate of stroke recurrence was 0.9% at 30 days, 7.0% at 1 year, and 21.2% at 5 years from the onset of first-ever stroke. Among patients presenting with ischaemic strokes, 109 (20.6%) had a recurrence, of which 92 (84%) were ischaemic strokes and 17 (16%) were haemorrhagic. Among patients presenting with intracerebral haemorrhage, 25 (23.1%) had a recurrence, of which 12 (48%) were haemorrhagic strokes and 13 (52%) patients were ischaemic. After 5 years, 11% of the patients were dependent in terms of activity of daily living. CONCLUSIONS The long-term prognosis after first-ever stroke is poor--5 years after their stroke, 39.7% of patients had died and 10.7% were dependent in terms of activity of daily living; 136 (21%) who survived at least 30 days after the initial stroke, had a recurrence within 5 years.
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Affiliation(s)
- C M Cheung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
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Fong GCY, Cheng TS, Lam K, Cheng WK, Mok KY, Cheung CM, Chim CS, Mak W, Chan KH, Tsang KL, Kwan MC, Tsoi TH, Cheung RTF, Ho SL. An epidemiological study of motor neuron disease in Hong Kong. ACTA ACUST UNITED AC 2006; 6:164-8. [PMID: 16247937 DOI: 10.1080/14660820510028412a] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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 1 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 2001) 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.
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Affiliation(s)
- G C Y Fong
- Department of Medicine, Queen Mary Hospital, Hong Kong
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Abstract
Bath-related headache (BRH) is a rare primary headache syndrome. We present our experience over seven years and review all reported cases of BRH. Thirteen patients, including six from our group, are described. BRH occurred exclusively in middle-aged or elderly Oriental women (mean age 51 years, range 32-67. Hong Kong 6 cases, Taiwan 4 cases, Japan 3 cases). The typical presentation was a uniphasic cluster of severe headache recurrently triggered by bathing or other activities involving contact with water. Each attack lasted 30 min to 30 h. Onset was hyperacute, consistent with that of thunderclap headache. Reversible multisegmental cerebral vasoconstriction was found in two patients. No underlying secondary causes were identified. Response to acute treatment was generally unsatisfactory, but headache could be prevented by avoiding the specific trigger(s). BRH runs a self-limiting course; all patients remitted within three months after onset. Nimodipine may shorten the duration of illness.
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Affiliation(s)
- W Mak
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, PR China.
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Lau KK, Lam K, Shiu KL, Au KM, Tsoi TH, Chan AYW, Li HL, Sheng B. Clinical features of hereditary spinocerebellar ataxia diagnosed by molecular genetic analysis. Hong Kong Med J 2004; 10:255-9. [PMID: 15299171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE To assess the frequency and clinical features of different types of hereditary spinocerebellar ataxia in Hong Kong. DESIGN Cross-sectional study using a questionnaire and clinical examination, with the majority of the information retrospectively collected. SETTING Three regional hospitals, Hong Kong. PARTICIPANTS All patients with spinocerebellar ataxia that was confirmed by molecular genetic tests between January 2001 and October 2003. MAIN OUTCOME MEASURES History, latest physical examination results, clinical investigation results, and genetic profiles. RESULTS A total of 16 Chinese patients had received diagnoses of spinocerebellar ataxia. These patients had spinocerebellar ataxia type 1 (n=3), spinocerebellar ataxia type 3 (Machado-Joseph disease; n=12), and dentatorubro-pallidoluysian atrophy (n=1). The most common manifestation was ataxia (15/16), followed by pyramidal signs (12/16). Other features such as bulbar dysfunction, ophthalmoplegia, neuropathy, and cognitive impairment were present but variable. CONCLUSIONS The clinical manifestations of different types of spinocerebellar ataxia overlap, and genetic study is necessary to confirm the diagnosis. The frequency of spinocerebellar ataxia type 3 is greater than that of other types among these Chinese patients. The age of onset of this type may correlate inversely with the number of CAG repeats.
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Affiliation(s)
- K K Lau
- Department of Medicine and Geriatrics, Princess Margaret Hospital, 2-10 Princess Margaret Hospital Road, Laichikok, Hong Kong.
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Abstract
Postictal psychosis is a rare complication of epileptic seizure characterized by reversible psychotic symptoms after flurries of seizure attack. It has been attributed to a phenomenon similar to Todd's paralysis without definitive proof. We studied regional cerebral blood flow (rCBF) of six patients with postictal psychosis by (99m)Tc-HMPAO SPECT scan. Baseline rCBF was compared with the rCBF during postictal psychosis. An asymmetry index (ASI) was calculated as 200 x [(ipsilateral ROI count density - contralateral ROI count density)/(ipsilateral ROI count density + contralateral ROI count density)] %. Significant differences could be found between ASIs during postictal psychosis and interictal state SPECT scan over the lateral temporal neocortex region (P = 0.017). Although hyperperfusion abnormality in SPECT can be found in Todd's paralysis, such findings are more commonly found in cerebral hyperactivity conditions. Taking into account the clinical characteristics of postictal psychosis, namely a preceding lucid interval and crescendo-decrescendo clinical course, these may be an alternative psychopathogenic mechanism for the development of postictal psychosis.
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Affiliation(s)
- G C Y Fong
- Division of Neurology, University Department of Medicine, Universty of Hong Kong, Hong Kong
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Affiliation(s)
- W Mak
- Division of Neurology, University Department of Medicine, Queen Mary Hospital, Hong Kong, China
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Abstract
BACKGROUND Despite doubts about their efficacy and concern about their safety, antithrombotic agents are often used to treat acute ischemic stroke. Recent experience in patients with other thromboembolic disorders suggests that low-molecular-weight heparin, which requires only subcutaneous administration once or twice daily, may be more effective and safer than standard (unfractionated) heparin. METHODS We conducted a randomized, double-blind, placebo-controlled trial comparing two dosages of low-molecular-weight heparin with placebo in the treatment of ischemic stroke. Patients were randomly assigned within 48 hours of the onset of symptoms to receive high-dose nadroparin (4100 anti-factor Xa IU twice daily), low-dose nadroparin (4100 IU once daily), or placebo subcutaneously for 10 days. The primary measure of outcome was death or dependency regarding activities of daily living six months after randomization. Secondary outcomes were death, hemorrhagic transformation of the infarction, and other complications at 10 days, and death or dependency at 3 months. RESULTS A total of 2750 patients were screened for the study. Among 312 patients randomized, 306 had outcomes that were analyzed at six months. Forty-five patients (45 percent) in the high-dose group, 53 patients (52 percent) in the low-dose group, and 68 patients (65 percent) in the placebo group died or became dependent. There was a significant dose-dependent effect among the three study groups in favor of low-molecular-weight heparin (P = 0.005 by the chi-square test for trend). No significant differences among the groups in the occurrence of secondary outcomes were observed at 10 days. CONCLUSIONS For patients with ischemic stroke treated within 48 hours of the onset of symptoms, low-molecular-weight heparin was effective in improving outcomes at six months.
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Affiliation(s)
- R Kay
- Department of Medicine, Prince of Wales Hospital, Shatin, Hong Kong
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