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MELAS: A Case Report

A 6-year-old Chinese boy presented at the Oral and Maxillofacial Surgery clinic with gingival bleeding due to poor oral hygiene, odontogenic pain due to...

Case Reports of Two Biopsy-proven Patients with Creutzfeldt-Jakob Disease in Singapore

Creutzfeldt-Jakob disease (CJD) is the commonest human transmissible subacute spongiform encephalopathy. It has a worldwide distribution with an estimated annual incidence of 0.5 to...

Axoglial Interaction via the Notch Receptor in Oligodendrocyte Differentiation

Oligodendrocytes (OLs) derived from the common neural progenitor cells in the central nervous system (CNS) ensheathe the nude axon to form the myelin that...

Hemifacial Spasm in Singapore: Clinical Characteristics and Patients’ Perceptions

Hemifacial spasm (HFS) is a movement disorder characterised by intermittent involuntary contractions of the facial muscles. It begins with contractions of the orbicularis oculi,...

Characteristics and Acute Rehabilitation of Guillain-Barré Syndrome in Singapore

The Guillain-Barré syndrome (GBS) is an acute, frequently severe evolution of a demyelinating inflammatory polyradiculopathy with an autoimmune pathogenesis. In developed countries, GBS is...

Clinical Indications for Positron Emission Tomography (PET) Scanning

The purpose of these guidelines is to provide a broad framework for clinicians considering the use of positron emission tomography (PET) scanning for their...

Positron Emission Tomography – A Vital Component of Molecular Imaging

Contemporary medical imaging is progressing towards quantification of tissue function in addition to merely providing anatomical information, as illustrated by the rising use of...

Spinocerebellar Ataxia Type 2 with Focal Epilepsy – An Unusual Association

The spinocerebellar ataxias (SCAs) are a rare group of neurodegenerative disorders that are clinically and genetically heterogeneous. Almost all SCAs are due to trinucleotide...

Identification of a Common Genetic Risk Variant (LRRK2 Gly2385Arg) in Parkinson’s Disease

For diseases with complex inheritance, the age-old debate regarding the relative contribution of gene-environment interaction never fails to generate interest, discussion and hypothesis within...

Neural Progenitor and Stem Cells in the Adult Central Nervous System

Seminal studies in the 1960s, using -thymidine autoradiography, reported that neurogenesis occurs in discrete areas of the adult mammalian brain, in rodents. Studies in...

Concurrent Intermediate Uveitis and an Enhancing Intracranial Lesion as the Initial Manifestation of Sarcoidosis

Sarcoidosis remains an enigmatic disease with protean manifestations. It is a multi-system disorder of unknown cause characterised by an accumulation of T-lymphocytes, mononuclear phagocytes...

Re-defining Neurological Syndromes: The Genotype Meets the Phenotype

Since time immemorial, generations of medical students and physicians have always been taught that a thorough and detailed history and examination is the foundation...

The Evolution of Teaching and Learning Medical Microbiology and Infectious Diseases at NUS

The Straits and Federated Malay States Government Medical School was founded in 1905. Dr Chen Su Lan, 1 of the 7 graduates in the...

Ultrasound Assisted Thrombolysis in Acute Ischaemic Stroke: Preliminary Experience in Singapore

Most patients with acute ischaemic stroke have arterial thrombi that occlude extra- or intracranial vessels. Intravenously administered tissue plasminogen activator (IV-TPA) induces thrombolysis and...

Functional Neuroimaging of Sleep Deprived Healthy Volunteers and Persons with Sleep Disorders: A Brief Review

Most adults have experienced sleep deprivation at some stage of their lives, be it in the context of work, illness or play. Sleep deprivation...

Treatment of Circadian Rhythm Sleep Disorders with Light

In humans, the daily pattern of consolidated sleep and wake is strongly influenced by the timing of exposure to light and darkness. In the...

Basic Science Review on Circadian Rhythm Biology and Circadian Sleep Disorders

The sleep-wake cycle, with its characteristic intervals of activity alternating with restfulness that recur with a periodicity approximating the 24-hour day-night cycle, is the...

Delayed and Extra-pontine Myelinolysis after Osmotic Dysregulation

A 58-year-old Chinese man was admitted because of increasing lethargy and confusion over 4 days. He had been taking hydrochlorthiazide for hypertension and regularly...

Limb-Shaking Transient Ischemic Attack with Distal Micro-Embolic Signals and Impaired Cerebrovascular Reactivity Using Transcranial Doppler

We present a patient with limb-shaking transient ischaemic attack (TIA) associated with extracranial carotid occlusion and suggest that the pathophysiological mechanism is hypoperfusion, as...

Neuropsychiatry – An Emerging Field

Neuropsychiatry can be described as the interface between neurology and psychiatry – the intersecting field of enquiry for both the brain and the mind....

Alzheimer’s Disease – Towards More Patient-centred and Meaningful Clinical Outcomes

More than 100 years ago Alois Alzheimer first presented the clinical and pathological features of an unusual brain disease at his seminal lecture in...

Sir Gordon Arthur Ransome (1910-1978) – His Teaching Style and His Legacy

Sir Gordon Arthur Ransome was born in Salop, England, in 1910.1 He came to Singapore in 1938, where he taught and practised medicine for...

Corticospinal Tract Degeneration in Amyotrophic Lateral Sclerosis: A Diffusion Tensor Imaging and Fibre Tractography Study

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder characterised by spinal and cortical motor neuron degeneration. Although electro myography, muscle biopsy and motor...

Biomarkers of Mild Cognitive Impairment and Alzheimer’s Disease

Alzheimer’s disease (AD) is the most prevalent form of age-related dementia in the modern society. Other than symptomatic treatment with acetylcholinesterase inhibitors at its...

Validation of Transcranial Doppler with CT Angiography in Cerebral Ischaemia: A Preliminary Pilot Study in Singapore

Transcranial Doppler (TCD) is routinely performed to assess the blood flow in patients with cerebral ischaemia and provides important real-time information about cerebral haemodynamics....

Superior Sagittal Sinus Thrombosis: Subtle Signs on Neuroimaging

Cerebral venous thrombosis (CVT) is an infrequent but potentially deadly disease. The mortality rate of CVT is 10% to 20%, and surviving patients may...

Embryonic Stem Cells and Parkinson’s Disease: Cell Transplantation to Cell Therapy

Although levodopa is currently a well-endorsed form of treatment for Parkinson’s Disease (PD), the search for a safe, long-term and dyskinesia-free treatment remains an...

Bridging the Gap Between Primary and Specialist Care – An Integrative Model for Stroke

Cerebrovascular disease (CVD) is Singapore’s fourth leading cause of death, comprising 9% of all deaths, a crude death rate of 40.4/100,000, an age- and...

Malignant Syndrome of Two Parkinson Patients due to Withdrawal of Drugs

Neuroleptic malignant syndrome (NMS) is characterised by the impairment of consciousness, high fever, rigidity and autonomic instability. Although originally described in patients taking neuroleptic...

Multimodal Therapeutic Approach in Acute Ischaemic Stroke with Real-time Neurovascular Monitoring

Intravenously administered tissue plasminogen activator (IV-TPA) induces thrombolysis and remains the only FDA-approved therapy for acute ischaemic stroke (IS) within the therapeutic time-window according...

Chewing-induced Facial Dystonia

Dystonia is a movement disorder characterised by sustained muscle contractions, repetitive twisting movements, and abnormal postures of the trunk, neck, face, or arms and...

Timing of Arrival to a Tertiary Hospital after Acute Ischaemic Stroke – A Follow-up Survey 5 Years Later

Intravenous tPA is a proven treatment for acute ischaemic stroke. However as it has to be given in a narrow time window from symptom...

Alzheimer’s disease–The Inexorable Epidemic

Alzheimer's disease (AD) is the most common form of dementia which refers collectively to syndromes of progressive deterioration of memory along with other cognitive...

Unusual Cause for Unilateral Headache: A Quadrigeminal Cistern Arachnoid Cyst

Young adults are frequently presented with headaches due to various causes. Atypical facial pain, renamed as persistent idiopathic facial pain (PIFP) is a poorly...

Genome-wide Association Studies: Promises and Pitfalls

Genetic testing is an important means to confirm the diagnosis of an inheritable disease. For this to be feasible, genes that are associated with...

Epilepsy: Looking Beyond Seizures

World Epilepsy Day falls on 26 March 2013. As we observe this important date in Singapore, it is perhaps instructive to take a step...

Sleep, Public Health and Wellness: The Elephant in the Room

The rising cost of health care and the burden of chronic illness are perennial concerns. Remarkably, there exists a measure that around 30% of...

Single-level Anterior Corpectomy with Fusion versus 2-level Anterior Cervical Decompression with Fusion: A Prospective Controlled Study with 2-year Follow-up Using Cages for Fusion

Anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF) are performed for decompression of the spine when the primary compressive...

Immunomodulator use in paediatric severe sepsis and septic shock

Paediatric sepsis is one of the main causes of childhood mortality.1 Globally, paediatric severe sepsis and septic shock accounts for 6.2% to 23.1% of...

Cost of inpatient rehabilitation for children with moderate to severe traumatic brain injury

The cost of rehabilitation for children post-traumatic brain injury (TBI) is significant. The annual total healthcare cost of TBI had been estimated to range...

Long-term outcomes of ischaemic stroke patients with diabetes in a multi-ethnic cohort in Singapore

Asia faces an epidemic of diabetes. The prevalence of diabetes in Asia is projected to grow from 114 million in 2007 to 180 million...

Recurrent vascular events in ischaemic stroke patients with diabetes

Stroke is a major cause of death and disability globally, with 6.55 million deaths (95% uncertainty interval 6.00–7.02 million), 101 million prevalent cases...