Development of a Delayed Cerebral Infarction Load Scoring System (DCI Score).

Delayed cerebral infarction (DCI) is related to unfavorable outcome after aneurysmal subarachnoid hemorrhage (SAH). There lacks a clear understanding how the DCI load affects cognitive function after SAH. We conducted a literature review on the clinical classification systems on brain hemorrhages and cerebral infarction and devised a Delayed Cerebral Infarction Load Scoring System (DCI Score).

Prevalence of neutralising antibodies to interferon-beta and clinical response in Chinese patients with relapsing multiple sclerosis.

Background: There are no data on neutralising antibodies to interferon-beta and its clinical implications in Chinese patients with multiple sclerosis (MS).

Objectives: The objectives of this study were to investigate the prevalence of neutralising antibodies among Chinese patients with relapsing MS receiving interferon-beta (1a or 1b) and to study the association between neutralising antibodies and the clinical-radiological response.

Methods: We performed a cross-sectional study on MS patients who received interferon-beta for 9 months or more, and evaluated the clinical response by relapses and magnetic resonance imaging lesions.

Clinically important difference of Stroke-Specific Quality of Life Scale for aneurysmal subarachnoid hemorrhage.

Health-related quality of life measurements, are commonly used to quantify burden of disease, to evaluate treatment method, and to facilitate benchmarking. The aim of the current study was to determine the Clinically Important Difference (CID) for a Chinese version of Stroke-specific Quality of Life (SS-QOL) in an aneurysmal subarachnoid hemorrhage (SAH) patient cohort. The study recruited SAH patients in a neurosurgical unit in Hong Kong.

Screening for intracranial aneurysms? Prevalence of unruptured intracranial aneurysms in Hong Kong Chinese.

OBJECT The objective of this study was to generate data on the local prevalence of unruptured intracranial aneurysms (UIAs) in asymptomatic Hong Kong Chinese individuals. First-degree relatives of patients with aneurysmal subarachnoid hemorrhage (aSAH) were recruited as surrogates of the general population and to explore the potential role of screening in this locality. METHODS The authors identified first-degree relatives of consecutive patients with subarachnoid hemorrhage from a ruptured aneurysm who were admitted to a university hospital in Hong Kong from June 2008 to December 2010.

Early Cerebral Infarction after Aneurysmal Subarachnoid Hemorrhage.

Aneurysmal subarachnoid hemorrhage (SAH) is a serious disease with high case fatality and morbidity. Early cerebral infarction has been suggested as a risk factor for poor outcome. We aimed to assess the pattern of early and delayed cerebral infarction after aneurysmal subarachnoid hemorrhage.

Location, Infarct Load, and 3-Month Outcomes of Delayed Cerebral Infarction After Aneurysmal Subarachnoid Hemorrhage.

Background And Purpose: Aneurysmal subarachnoid hemorrhage is a serious disease with high case fatality and morbidity. Delayed cerebral infarction (DCI) is an important surrogate marker. How location and infarct load affected outcomes was unclear.

Cognitive outcome in acute simvastatin treatment for aneurysmal subarachnoid hemorrhage: A propensity matched analysis.

Objectives: Experimental evidence has indicated the benefit of simvastatin in the treatment of subarachnoid hemorrhage (SAH). Recently, acute simvastatin treatment was not shown to be beneficial in neurological outcome using modified Rankin Scale. Cognitive function is another important dimension of outcome assessment and yet had not been investigated in statin studies for aneurysmal subarachnoid hemorrhage.

Moyamoya disease in a patient with neuromyelitis optica.

Moyamoya disease can be associated with autoimmune disease such as thyrotoxicosis, but there has been only one report of association with neuromyelitis optica (NMO). We report another case of this combination with the presence of anti-SSA antibody in addition to the NMO-immunoglobulin G. The patient presented limb weakness along with unsteady gait and numbness.

Atypical intracranial epidermoid cysts: rare anomalies with unique radiological features.

Epidermoid cysts are benign slow growing extra-axial tumours that insinuate between brain structures, while their occurrences in intra-axial or intradiploic locations are exceptionally rare. We present the clinical, imaging, and pathological findings in two patients with atypical epidermoid cysts. CT and MRI findings for the first case revealed an intraparenchymal epidermoid cyst that demonstrated no restricted diffusion.

High-dose simvastatin for aneurysmal subarachnoid hemorrhage: multicenter randomized controlled double-blinded clinical trial.

Background And Purpose: Experimental evidence has indicated the benefits of simvastatin for the treatment of subarachnoid hemorrhage. Two randomized placebo-controlled pilot trials that used the highest clinically approved dose of simvastatin (80 mg daily) gave positive results despite the fact that a lower dose of simvastatin (40 mg daily) did not improve clinical outcomes. We hypothesized that a high dose of 80 mg of simvastatin daily for 3 weeks would reduce the incidence of delayed ischemic deficits after subarachnoid hemorrhage compared with a lower dose (40 mg of simvastatin daily) and lead to improved clinical outcomes.

Spontaneous intracranial hypotension: improving recognition and treatment strategies in the local setting.

We report a case of spontaneous intracranial hypotension with classic symptoms of orthostatic headache and acute presentation of subdural haematoma on computed tomographic scan. Conventional approach with conservative treatment was initially adopted. The patient's condition, however, deteriorated after 2 weeks, requiring surgical evacuation of the intracranial haemorrhage.

Spinal nerve root haemangioblastoma associated with reactive polycythemia.

Haemangioblastomas are uncommon tumours that usually occur in the cerebellum and, less commonly, in the intramedullary spinal cord. The extramedullary spinal canal is an uncommon location for these tumours. Also haemangioblastoma at this site is not known to be associated with polycythemia.

A sequential comparison on the risk of haemorrhage with different sizes of biopsy needles for stereotactic brain biopsy.

Aim: To compare the risk of postoperative haemorrhage with different sizes of brain biopsy needles.

Patients And Method: A cohort of patients using a 2.5-mm outer diameter side-cutting biopsy needle was compared to a subsequent cohort using a 1.

Early MoCA-assessed cognitive impairment after aneurysmal subarachnoid hemorrhage and relationship to 1-year functional outcome.

Recent clinical research into aneurysmal subarachnoid hemorrhage (aSAH) has confirmed the long-term effect of cognitive dysfunction on functional outcomes. We hypothesized that early cognitive impairment was a marker of permanent brain injury and hence predicted long-term functional outcome. Hong Kong Chinese patients with aneurysmal subarachnoid hemorrhage were evaluated prospectively by means of the Montreal Cognitive Assessment (MoCA) in the subacute phase (2-4 weeks after aSAH) and by neuropsychological evaluation of functional outcomes in the chronic phase (1 year after aSAH).

Performance of serum α-fetoprotein levels in the diagnosis of hepatocellular carcinoma in patients with a hepatic mass.

Objectives: The role of serum α-fetoprotein (AFP) measurements in the diagnosis of hepatocellular carcinoma (HCC) remains controversial. Some guidelines have advised against the use of AFP in the diagnosis of HCC. This study was conducted to evaluate the performance of AFP in the diagnosis of HCC, and to identify the optimal cut-off value of serum AFP in the diagnosis of HCC in patients with a hepatic mass.

Cognitive domain deficits in patients with aneurysmal subarachnoid haemorrhage at 1 year.

Background: Cognitive domain deficits can occur after aneurysmal subarachnoid haemorrhage (aSAH) though few studies systemically evaluate its impact on 1-year outcomes.

Objective: We aimed to evaluate the pattern and functional outcome impact of cognitive domain deficits in aSAH patients at 1 year.

Methods: We carried out a prospective observational study in Hong Kong, during which, 168 aSAH patients (aged 21-75 years and had been admitted within 96 h of ictus) were recruited over a 26-month period.

Intra-arterial revascularisation therapy for acute ischaemic stroke: initial experience in a Hong Kong hospital.

Objectives: To assess the outcome of acute ischaemic stroke patients who received intra-arterial therapy in our unit.

Design: Case series.

Setting: A tertiary hospital in Hong Kong.

An uncommon mimic of spontaneous subarachnoid haemorrhage.

We here presented a rare disease entity with a clinical presentation mimicking aneurysmal subarachnoid haemorrhage. A 43-year-old woman presented with a 1-week history of neck pain and dizziness. Computed tomography of brain showed communicating hydrocephalus and subarachnoid hyperintensity suspicious of previous subarachnoid haemorrhage.

A 45-year-old woman with reversible bilateral hearing loss.

A 45-year-old woman complained of a progressive 2-month history of bilateral hearing impairment and diplopia on upward gaze. She had a history of a recurrent pineal region ganglioglioma with repeated tumor excision, adjuvant radiotherapy, and a ventriculo-peritoneal shunt performed 12 years prior. Subsequent imaging studies 6 years ago showed a pineal region cyst with progressive increase in size and a Rickham reservoir (Codman; Johnson & Johnson, Raynham, MA) was placed for percutaneous cyst fluid aspiration.

Angiographic features, collaterals, and infarct topography of symptomatic occlusive radiation vasculopathy: a case-referent study.

Background And Purpose: Occlusive radiation vasculopathy (ORV) predisposes head-and-neck cancer survivors to ischemic strokes.

Methods: We analyzed the digital subtraction angiography acquired in 96 patients who had first-ever transient ischemic attack or ischemic strokes attributed to ORV. Another age-matched 115 patients who had no radiotherapy but symptomatic high-grade (>70%) carotid stenoses were enrolled as referent subjects.

Pseudoprogression of malignant glioma in Chinese patients receiving concomitant chemoradiotherapy.

Objectives: To investigate the frequency of pseudoprogression of glioblastoma in Chinese patients receiving concomitant chemoradiotherapy and investigate its association with pseudoprogression and tumour molecular marker O(6)-methylguanine-DNA methyltransferase promoter methylation status.

Design: Case series with internal comparisons.

Setting: University teaching hospital, Hong Kong.

Risk of intracerebral hemorrhage in patients with cerebral microbleeds undergoing endovascular intervention.

Background And Purpose: Cerebral microbleeds (CMBs) on MRI gradient echo images are hemosiderin deposits, which may predict intracerebral hemorrhage (ICH). The risk of ICH in patients with CMBs could be exacerbated by the use of antithrombotics. The purpose of our study is to prospectively evaluate the risk of ICH in patients with ischemic stroke who receive dual antiplatelet therapy for endovascular intervention.

Is stroke thrombolysis safe and efficacious in Hong Kong?

Objective: To investigate the safety and efficacy of stroke thrombolysis in a local hospital.

Design: Historical cohort study.

Setting: A tertiary hospital in Hong Kong.

Computed tomographic angiography for patients with acute spontaneous intracerebral hemorrhage.

With the advanced technology of multi-slice CT scans, we explored the effectiveness of CT angiography (CTA) in place of digital subtraction angiography (DSA) in patients with acute spontaneous intracerebral hemorrhage (ICH). We performed a computerized PubMed search of the literature from inception to 27 July 2011 to find reports of similar comparative studies and performed a meta-analysis of diagnostic accuracy. The pooled sensitivity was 97.