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Papers by chesda udommongkol

Research paper thumbnail of Prevalence of Carotid Artery Disease and Risk Factors in Asymptomatic Thai Population using Carotid Duplex Ultrasonography at the Check-up Clinic, Health Promotion Center at Bangkok Hospital

The Bangkok Medical Journal, 2014

To examine the prevalence of carotid artery disease and to determine risk factors for carotid dup... more To examine the prevalence of carotid artery disease and to determine risk factors for carotid duplex abnormalities among asymptomatic Thai subjects. MATERIALS AND METHODS: The cross-sectional observation study was conducted in a sample of patients (Thai population) who took an annual health checkup at the Bangkok Medical Center (BMC) over a 10 month period from June 1, 2011 to March 31, 2012. A total of 2,105 subjects were enrolled and underwent a carotid duplex examination using the standard procedure. The results from the carotid duplex ultrasonography and risk factors that contribute to carotid artery abnormalities were recorded and analyzed using a multiple logistic regression method and a prevalence rate ratio. RESULTS: The study enrolled 2,105 Thai participants aged 25-79 years old with a mean of age of 54 ± 10.4 years. The population was equally divided by gender, and 44% of subjects were current smokers and 25% of the patients were overweight. Approximately 30.5% of participants had hypertension (HT) and 9.3% had diabetes mellitus (DM). Abnormal carotid duplex examinations were found in 912 cases accounting for 45.7% of the participants. Atheromatous plaque and thickening of the intimal media thickness was observed in 784 cases (37.2%) and 314 cases (14.9%) respectively. Internal carotid stenosis results were detected including 11 mild, 9 moderate and 2 severe stenotic cases; however, no carotid occlusion reported. Underlying HT and DM were related to abnormal duplex results. Factors including increasing age (p < 0.001), male gender (odds ratio (OR) 1.5, 95% confidence interval (CI) 1.2-2.0), and HT associated (OR 2.4, 95% CI 1.8-3.1) were associated with carotid atherosclerotic disease observed by the duplex examination. CONCLUSION: The prevalence of atherosclerotic carotid arteries detected by duplex ultrasonography was approximately 45% among asymptomatic Thai population who took an annual health check at the BMC. Atheromatous plaque is the most common finding and significant (moderate to severe) internal carotid artery (ICA) stenosis was observed in 0.5% of participants. Factors including age, male gender, DM, and HT were associated with atherosclerotic carotid disease. High fasting plasma glucose (FPG) and low-density lipoprotein (LDL) were also related to abnormal carotid duplex results. The carotid duplex examination provided health information to the participants to help control risk factors and to raise awareness of cerebrovascular disease.

Research paper thumbnail of Cut Off Value of Good Pronostic Factor Outcomes in Large Territory Ischemic Stroke Undergoing Early Decompressive Craniectomy

Journal of Southeast Asian Medical Research, 2022

Background: Decompressive craniectomy (DC) significantly reduces mortality in large territory isc... more Background: Decompressive craniectomy (DC) significantly reduces mortality in large territory ischemic strokes that develop intractable cerebral edema. However, evidence for functional benefit remains sparse and contradictory. Objective: This study aimed to assess cut-off value for predictor outcomes of early DC. Methods: We conducted a prospective, observational cohort study from December 2016 to June 2021. Patients were screened for ischemic stroke involving the middle cerebral, internal carotid artery or both using the National Institutes of Health Stroke Scale score. All patients underwent DC. Multivariate analysis was performed for an array of clinical variables in relation to functional outcomes according to the modified Rankin Scale (mRS) and Pearson’s correlation coefficient analysis. Clinical outcome was assessed after 3- and 6-month follow-up. Results: In total, 243 patients were included in this study. Age ≤71 years (AUC=0.955, p <0.001 accuracy 89.7%), onset to DC ≤9 ...

Research paper thumbnail of Low Serum Vitamin B12 in Alzheimerûs Patients as Detected by a Solid Phase

Objective: To determine the relationship between serum levels of vitamin B12 and folate in AD and... more Objective: To determine the relationship between serum levels of vitamin B12 and folate in AD and other types of dementia in Thai patients. Methods: One hundred and eleven Thai subjects were classified into 3 groups: 32 AD patients, 43 non-AD dementia patients and 36 age-matched controls. Serum concentrations of vitamin B12 and folate were measured using a solid phase radioimmunoassay. Results: Serum vitamin B12 levels were found to be significantly lower in AD and non-AD dementia patients than in age-matched controls. There is a significant relationship between Mini-Mental State Examination score and vitamin B12 level in AD and non-AD dementia groups. However, there is no significant difference in serum folate in AD and non-AD dementia groups when compared to age-matched controls. Conclusion: These findings suggest the need for vitamin B12 supplementation in AD and non-AD dementia patients.

Research paper thumbnail of Prevalence of Carotid Artery Disease and Risk Factors in Asymptomatic Thai Population using Carotid Duplex Ultrasonography at the Check-up Clinic, Health Promotion Center at Bangkok Hospital

THE BANGKOK MEDICAL JOURNAL, 2014

OBJECTIVE: To examine the prevalence of carotid artery disease and to determine risk factors for ... more OBJECTIVE: To examine the prevalence of carotid artery disease and to determine risk factors for carotid duplex abnormalities among asymptomatic Thai subjects. MATERIALS AND METHODS: The cross-sectional observation study was conducted in a sample of patients (Thai population) who took an annual health check-up at the Bangkok Medical Center (BMC) over a 10 month period from June 1, 2011 to March 31, 2012. A total of 2,105 subjects were enrolled and underwent a carotid duplex examination using the standard procedure. The results from the carotid duplex ultrasonography and risk factors that contribute to carotid artery abnormalities were recorded and analyzed using a multiple logistic regression method and a prevalence rate ratio. RESULTS: The study enrolled 2,105 Thai participants aged 25-79 years old with a mean of age of 54 ± 10.4 years. The population was equally divided by gender, and 44% of subjects were current smokers and 25% of the patients were overweight. Approximately 30.5%...

Research paper thumbnail of Top of the Basilar Syndrome with Painful Palmar Reticulated Erythematous Patches Complicating Cardiac Atrial Myxoma : A Case Report

Corresponding Author: E-mail: chesda_udommongkol@yahoo.com Abstract The authors reported an uncom... more Corresponding Author: E-mail: chesda_udommongkol@yahoo.com Abstract The authors reported an uncommon ischemic stroke in a young patient with an unusual dermatologic manifestation. A 28-year-old Thai woman presented with acute vertigo, ataxia, vertical diplopia, and impaired vertical gazes. Multiple painful, ill defined-border, reticulated, erythematous, and non-blanchable patches were formerly presented in both palms one day before the stroke onset. MRI showed hypersignals in bilateral thalami and left paramedian midbrain region on DWI with corresponding ADC map. Hyperechoic lobulated mass was detected at interatrial septum by transthoracic echocardiography. Top of the basilar syndrome with a rare skin sign were diagnosed and etiology was hypothesized as embolic phenomena caused by cardiac myxoma embolism. The dermatologic sign was exceptionally rare but the lesion can be a diagnostic clue for embolic mechanism caused by atrial myxoma. (J Thai Stroke Soc 2015; 14 (3): 166-171.)

Research paper thumbnail of In-vitro Doppler study of fluid flow in a cerebral small vessel occlusion model

Research paper thumbnail of Recurrent stroke from paradoxical embolism in a case with hereditary hemorrhagic telangiectasia

CHESDA UDOMMONGKOL, MD PhD Head of Neurology, Phramongkutklao Army Hospital Rajvithee Road, Rajth... more CHESDA UDOMMONGKOL, MD PhD Head of Neurology, Phramongkutklao Army Hospital Rajvithee Road, Rajthewee, Bangkok Thailand 10400 Tel. +66-2-3547600 ext. 93027 Fax. +66-2-6444635 Email: chesda_udommongkol@yahoo.com Rendu Osler Weber or Hereditary Hemorrhagic Telangiectesia (HHT) is an autosomal dominant genetic disorder causing abnormal development of vasculature characterized by telangiectases and arteriovenous malformations of specific organs. The most common presentation of HHT is epistaxis; however ischemic stroke occasionally occurs due to paradoxical shunt such as pulmonary ateriovenous malformation (PAVM). We reported a 37-year-old woman presenting with recurrent ischemic stroke as a result of paradoxical emboli from PAVMs. The patient was brought to emergency department and the examination revealed left facial palsy and left hemiplegia. The CT angiography demonstrated complete occlusion of the distal right M1 MCA. Transcranial Doppler showed positive microbubble examination with...

Research paper thumbnail of Efficacy and Safety of Ticagrelor and Aspirin in Patients With Moderate Ischemic Stroke

JAMA Neurology

Prior trials of dual antiplatelet therapy excluded patients with moderate ischemic stroke. These ... more Prior trials of dual antiplatelet therapy excluded patients with moderate ischemic stroke. These patients were included in the Acute Stroke or Transient Ischaemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death (THALES) trial, but results have not been reported separately, raising concerns about safety and efficacy in this subgroup. OBJECTIVE To evaluate the efficacy and safety of ticagrelor plus aspirin in patients with moderate ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score of 4 to 5). DESIGN, SETTING, AND PARTICIPANTS The THALES trial was a randomized trial conducted at 414 hospitals in 28 countries in January 2018 and December 2019. This exploratory analysis compared patients with moderate stroke (baseline NIHSS score of 4 to 5) with patients with less severe stroke (NIHSS score of 0 to 3). A total of 9983 patients with stroke were included in the present analysis, after excluding 2 patients with NIHSS scores greater than 5 and 1031 patients with transient ischemic attack. Data were analyzed from March to April 2021. INTERVENTIONS Ticagrelor (180-mg loading dose on day 1 followed by 90 mg twice daily on days 2 to 30) or placebo within 24 hours after symptom onset. All patients received aspirin, 300 to 325 mg, on day 1 followed by aspirin, 75 to 100 mg, daily on days 2 to 30. Patients were observed for 30 additional days. MAIN OUTCOMES AND MEASURES The primary outcome was time to stroke or death within 30 days. The primary safety outcome was time to severe bleeding. RESULTS In total, 3312 patients presented with moderate stroke and 6671 presented with less severe stroke. Of those in the moderate stroke group, 1293 (39.0%) were female, and the mean (SD) age was 64.5 (10.8) years; of those in the less severe stroke group, 2518 (37.7%) were female, and the mean (SD) age was 64.8 (11.2) years. The observed primary outcome event rate in patients with moderate stroke was 7.6% (129 of 1671) for those in the ticagrelor group and 9.1% (150 of 1641) for those in the placebo group (hazard ratio, 0.84; 95% CI, 0.66-1.06); the primary outcome event rate in patients with less severe stroke was 4.7% (158 of 3359) for those in the ticagrelor group and 5.7% (190 of 3312) for those in the placebo group (hazard ratio, 0.82; 95% CI, 0.66-1.01) (P for interaction = .88). Severe bleeding occurred in 8 patients (0.5%) in the ticagrelor group and in 4 patients (0.2%) in the placebo group in those with moderate stroke compared with 16 patients (0.5%) and 3 patients (0.1%), respectively, with less severe stroke (P for interaction = .26). CONCLUSIONS AND RELEVANCE In this study, patients with a moderate ischemic stroke had consistent benefit from ticagrelor plus aspirin vs aspirin alone compared with patients with less severe ischemic stroke, with no further increase in the risk of intracranial bleeding or other severe bleeding events. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03354429

Research paper thumbnail of Ticagrelor Added to Aspirin in Acute Nonsevere Ischemic Stroke or Transient Ischemic Attack of Atherosclerotic Origin

Stroke

Background and Purpose: Among patients with a transient ischemic attack or minor ischemic strokes... more Background and Purpose: Among patients with a transient ischemic attack or minor ischemic strokes, those with ipsilateral atherosclerotic stenosis of cervicocranial vasculature have the highest risk of recurrent vascular events. Methods: In the double-blind THALES (The Acute Stroke or Transient Ischemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death) trial, we randomized patients with a noncardioembolic, nonsevere ischemic stroke, or high-risk transient ischemic attack to ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2–30) or placebo added to aspirin (300–325 mg on day 1 followed by 75–100 mg daily for days 2–30) within 24 hours of symptom onset. The present paper reports a prespecified analysis in patients with and without ipsilateral, potentially causal atherosclerotic stenosis ≥30% of cervicocranial vasculature. The primary end point was time to the occurrence of stroke or death within 30 days. Results: Of 11 016 random...

Research paper thumbnail of Beyond symptomatic effects: Donepezil's potential for neuroprotection and disease modification in Alzheimer's disease

British Journal of Pharmacology

Alzheimer's disease (AD) is associated with neurodegenerative changes resulting clinically in pro... more Alzheimer's disease (AD) is associated with neurodegenerative changes resulting clinically in progressive cognitive and functional deficits. The only therapies are the cholinesterase inhibitors donepezil, galantamine and rivastigmine and the N-methyl-Daspartate-receptor antagonist memantine. Donepezil acts primarily on the cholinergic system as a symptomatic treatment, but it also has potential for disease modification and may reduce the rate of progression of AD. This review explores the potential for disease modifying effects of donepezil. Several neuroprotective mechanisms that are independent of cholinesterase inhibition, are suggested. Donepezil has demonstrated a range of effects, including protecting against amyloid β, ischaemia and glutamate toxicity; slowing of progression of hippocampal atrophy; and up-regulation of nicotinic acetylcholine receptors. Clinically, early and continuous treatment with donepezil is considered to preserve cognitive function more effectively than delayed treatment. The possible neuroprotective effects of donepezil and the potential for disease pathway modification highlight the importance of early diagnosis and treatment initiation in AD.

Research paper thumbnail of Orthostatic hypotension: a non-motor complication assessment in 82 patients with idiopathic Parkinson's disease in Phramongkutklao Hospital

Journal of the Medical Association of Thailand Chotmaihet Thangphaet, Nov 1, 2010

Objective: Parkinson's disease (PD) is one of the neurogenic etiologies of orthostatic hypotensio... more Objective: Parkinson's disease (PD) is one of the neurogenic etiologies of orthostatic hypotension, a non-motor symptoms complex, that tends to be under-recognized and under-treated leading to a major cause of disability for PD patients. This complication is associated with one or recurrent falls causing mortality and morbidity. To the authors' knowledge, there is no study about this condition in Thai PD population. The authors therefore aimed to determine the frequency, clinical and risk factors of orthostatic hypotension in PD patients treated in Phramongkutklao Hospital. Material and Method: The authors enrolled consecutive patients with idiopathic PD over a 10-month period. Supine and standing blood pressure (BP) were measured sequentially as the standard techniques. Orthostatic hypotension (OH) was diagnosed if there was a reduction in systolic or diastolic BP of at least 20 or 10 mmHg respectively within 3 minutes after standing. The authors analyzed for the frequency of this condition as well as determined the risk factors between the OH and non-OH groups. Results: The number of patients enrolled was 82 with the mean age of 69 years. The median duration of PD was 4 years. Eighty-five percent were in Hoehn & Yahr stage 1-3. Thirty-three patients (40.2%) had orthostatic hypotension and 70% of them were asymptomatic. By univariate and multivariate analysis, the risk factors for this condition were the longer duration of PD diagnosis, the more advanced staging and the use of selegiline. Conclusions: The frequency of orthostatic hypotension among the present PD was 40.2%. The longer duration of disease, the more advanced stage of Parkinson's disease and selegiline usage were the factors associated with this non-motor condition.

Research paper thumbnail of Detection of small vessel knock signals by Doppler ultrasound in a laboratory model simulating a penetrating branch occlusion

Research paper thumbnail of Spinal cord compression and bilateral sensory neural hearing loss: an unusual manifestation of neurocysticercosis

Journal of the Medical Association of Thailand Chotmaihet Thangphaet, Oct 1, 2004

Neurocysticercosis is the most common parasitic infestation involving the central nervous system ... more Neurocysticercosis is the most common parasitic infestation involving the central nervous system in tropical countries. Common presentations are seizure, meningitis and increased intracranial pressure. The authors report a case of a 52-year-old woman with racemose neurocysticercosis in the subarachnoid space at the cistern of the brain through the lumbar cistern. She presented with progressive paraparesis due to spinal cord compression and finally had progressive bilateral sensori-neural hearing loss. MRI brain and the whole spinal cord revealed numerous rim-enhancing cystic lesions at the basal cistern, prepontine cistern, bilateral cerebellopontine angle, internal acoustic canals, intramedullary lesion at the 5th cervical spinal level, lumbar cistern lesions and secondary syringomyelia at the thoracic spinal cord. The histopathologic examination confirmed cysticercosis. After treatment by albendazole and surgical removal, she still developed recurrent spinal compression at a higher level and obstructive hydrocephalus. Finally, she died from status epilepticus and septic shock.

Research paper thumbnail of Comparison between aspirin combined with dipyridamole versus aspirin alone within 48 hours after ischemic stroke event for prevention of recurrent stroke and improvement of neurological function: a preliminary study

Journal of the Medical Association of Thailand Chotmaihet Thangphaet, Dec 1, 2005

To determine efficacy and tolerability of aspirin plus dipyridamole (combination) versus aspirin ... more To determine efficacy and tolerability of aspirin plus dipyridamole (combination) versus aspirin alone in acute intervention treatment after acute ischemic stoke among Thai patients. Material and Method: This pilot study enrolled ischemic stroke patients within 48 hours and randomized to aspirin 300 mg/d or combination (aspirin 300 mg/d+ standard release dipyridamole 75 mg thrice a day) and followed up for 6 months. End points were recurrent ischemic stroke, transient ischemic attack and vascular death. Side effects were recorded. National Institutes of Health Stroke Scale was assessed at entry and at 6 months period for determining neurological functions. Results: Of 38 patients, mean age was 64.3 years. Male and female were 52.6% and 47.4% respectively. There were 18 patients in the aspirin group and 20 patients in the combination group. No patient developed end point events or no significant adverse event in both groups. The combination group showed more improvement in neurological function than the aspirin group (p-value 0.009). Conclusion: This pilot study showed equal efficacy and tolerability of the combination group and aspirin alone in acute intervention treatment for prevention of recurrent stroke or vascular death within 6 months.

Research paper thumbnail of The Changes in Mean Platelet Volume after Using of Antiplatelet Drugs in Acute Ischemic Stroke: A Randomized Controlled Trial

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2015

To measure the changes of mean platelet volume (MPV) after using four antiplatelet drugs in acute... more To measure the changes of mean platelet volume (MPV) after using four antiplatelet drugs in acute non-cardioembolic ischemic stroke patients and assess the association of antiplatelets and MPV and stroke outcome. Ischemic stroke survivors with National Institute of Health Stroke Scale (NIHSS) 8 were randomly allocated intofour groups, receiving aspirin, clopidogrel, combined aspirin and dipyridamole, and cilostazol. The change of MPV NIHSS, and modified Rankin Scale (mRS) were recorded at baseline and week 4 in all studied groups. MPV was measured using the standard automated blood test for complete blood count. Twenty-one subjects were included in this study. They comprised of five cases in each antiplatelet group, except for aspirin, which had six subjects. Male was 57%, and hypertension was the most common risk factor (61.9%). Most of participants (76%) had small vessel disease. At 4-week, MPVwas reduced and NIHSS, mRS were improved in every studied group. Clopidogrel sign ficant...

Research paper thumbnail of Prevalence of depression among epileptic patients at Phramongkutklao Hospital

Journal of the Medical Association of Thailand = Chotmaihet thangphaet

To determine the prevalence of depression among epileptic patients in Phramongkutklao Hospital an... more To determine the prevalence of depression among epileptic patients in Phramongkutklao Hospital and to find the factors associated with depression. One hundred and ten epileptic patients were enrolled and 60 patients met the inclusion criteria. These subjects were screened with Thai Geriatric Depressive Scale (TGDS) and were interviewed. Demographic data that effect depression were evaluated. During the 1-year study period, 60 of 110 patients diagnosed epilepsy were eligible. Prevalence of depression was 38.3%, which is similar to previous studies. Mild depression was found in 65.2% and moderate 34.8%, without severe depression. Comparing between male and female, there was no statistical significant difference (p = 0.75). The age group that compared between age equal or less than 25 years and more than 25 years had no statistical significant difference (p = 0.77). Other variables were not found to be significant risk factors of depression among epileptic patients including duration o...

Research paper thumbnail of Excessive daytime sleepiness and obstructive sleep apnea in Thai epileptic patients

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014

Sleepiness is a common complaint in epilepsy. Also obstructive sleep apnea (OSA) is increasingly ... more Sleepiness is a common complaint in epilepsy. Also obstructive sleep apnea (OSA) is increasingly detected and would affect the epilepsy prognosis. We aimed to determine the frequency and predictors of sleepiness and OSA in epileptic patients. This was a cross-sectional descriptive study using Epworth Sleepiness Scale questionnaire (ESS) and Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ) to identify excessive daytime sleepiness and OSA in our consecutive epileptic patients in Neurology out-patient clinic. Overall 113 patients (male 55%) answered a personal survey and completed ESS and SA-SDQ. Mean age was 47 years (range 15-93). Average body mass index (BMI) was 24. Excessive daytime sleepiness (ESS 10) was demonstrated in 37%, and the prevalence of OSA diagnosed by using SA-SDQ was 20% (male 18%, female 22%). OSA were identified 68% among individuals whose BMI of more than 25, which was significant higherfi-equency than in the nomnnal BMI group (32%). The predictors...

Research paper thumbnail of Non-motor symptoms in Thai patients with Parkinson's disease studied at Phramongkutklao Hospital

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014

Non-motor symptoms (NMS) ofParkinson's disease (PD) have been recently recognized to be as di... more Non-motor symptoms (NMS) ofParkinson's disease (PD) have been recently recognized to be as disabling as motor symptoms in PD. However these symptoms are still under recognized causing delay in treatment and inadequate management. This study aimed to identify NMS in Thai PD patients using the NMS screening questionnaire (NMSQuest). Patients with idiopathic Parkinson's disease visiting the neurology clinic in 2008 were enrolled. NMSQuest-Thai version (NMSQ-T) was applied to patients to identify NMS. Collected data from questionnaires completed by 165 probable idiopathic PD was analyzed. The demographic profiles showed mean age of 68.6 years with mean disease duration 5.4 years, and male 56.4%. Patients had Hoehn & Yahrstaging, stage-2: 43%, stage-3: 24.8%, stage-I: 24.2% and stage-4: 7.9%. The average dosage oflevodopa was 456.4 mg/d. Mean total NMSQ-T score was 9.5. Most prevalent of non-motor symptom was nocturia (64.2%). The domains which gained most positive answers were u...

Research paper thumbnail of Orthostatic hypotension: a non-motor complication assessment in 82 patients with idiopathic Parkinson's disease in Phramongkutklao Hospital

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2010

Parkinson's disease (PD) is one of the neurogenic etiologies of orthostatic hypotension, a no... more Parkinson's disease (PD) is one of the neurogenic etiologies of orthostatic hypotension, a non-motor symptoms complex, that tends to be under-recognized and under-treated leading to a major cause of disability for PD patients. This complication is associated with one or recurrent falls causing mortality and morbidity. To the authors' knowledge, there is no study about this condition in Thai PD population. The authors therefore aimed to determine the frequency, clinical and risk factors of orthostatic hypotension in PD patients treated in Phramongkutklao Hospital. The authors enrolled consecutive patients with idiopathic PD over a 10-month period. Supine and standing blood pressure (BP) were measured sequentially as the standard techniques. Orthostatic hypotension (OH) was diagnosed if there was a reduction in systolic or diastolic BP of at least 20 or 10 mmHg respectively within 3 minutes after standing. The authors analyzed for the frequency of this condition as well as det...

Research paper thumbnail of Spinal cord compression and bilateral sensory neural hearing loss: an unusual manifestation of neurocysticercosis

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2004

Neurocysticercosis is the most common parasitic infestation involving the central nervous system ... more Neurocysticercosis is the most common parasitic infestation involving the central nervous system in tropical countries. Common presentations are seizure, meningitis and increased intracranial pressure. The authors report a case of a 52-year-old woman with racemose neurocysticercosis in the subarachnoid space at the cistern of the brain through the lumbar cistern. She presented with progressive paraparesis due to spinal cord compression and finally had progressive bilateral sensori-neural hearing loss. MRI brain and the whole spinal cord revealed numerous rim-enhancing cystic lesions at the basal cistern, prepontine cistern, bilateral cerebellopontine angle, internal acoustic canals, intramedullary lesion at the 5th cervical spinal level, lumbar cistern lesions and secondary syringomyelia at the thoracic spinal cord. The histopathologic examination confirmed cysticercosis. After treatment by albendazole and surgical removal, she still developed recurrent spinal compression at a highe...

Research paper thumbnail of Prevalence of Carotid Artery Disease and Risk Factors in Asymptomatic Thai Population using Carotid Duplex Ultrasonography at the Check-up Clinic, Health Promotion Center at Bangkok Hospital

The Bangkok Medical Journal, 2014

To examine the prevalence of carotid artery disease and to determine risk factors for carotid dup... more To examine the prevalence of carotid artery disease and to determine risk factors for carotid duplex abnormalities among asymptomatic Thai subjects. MATERIALS AND METHODS: The cross-sectional observation study was conducted in a sample of patients (Thai population) who took an annual health checkup at the Bangkok Medical Center (BMC) over a 10 month period from June 1, 2011 to March 31, 2012. A total of 2,105 subjects were enrolled and underwent a carotid duplex examination using the standard procedure. The results from the carotid duplex ultrasonography and risk factors that contribute to carotid artery abnormalities were recorded and analyzed using a multiple logistic regression method and a prevalence rate ratio. RESULTS: The study enrolled 2,105 Thai participants aged 25-79 years old with a mean of age of 54 ± 10.4 years. The population was equally divided by gender, and 44% of subjects were current smokers and 25% of the patients were overweight. Approximately 30.5% of participants had hypertension (HT) and 9.3% had diabetes mellitus (DM). Abnormal carotid duplex examinations were found in 912 cases accounting for 45.7% of the participants. Atheromatous plaque and thickening of the intimal media thickness was observed in 784 cases (37.2%) and 314 cases (14.9%) respectively. Internal carotid stenosis results were detected including 11 mild, 9 moderate and 2 severe stenotic cases; however, no carotid occlusion reported. Underlying HT and DM were related to abnormal duplex results. Factors including increasing age (p < 0.001), male gender (odds ratio (OR) 1.5, 95% confidence interval (CI) 1.2-2.0), and HT associated (OR 2.4, 95% CI 1.8-3.1) were associated with carotid atherosclerotic disease observed by the duplex examination. CONCLUSION: The prevalence of atherosclerotic carotid arteries detected by duplex ultrasonography was approximately 45% among asymptomatic Thai population who took an annual health check at the BMC. Atheromatous plaque is the most common finding and significant (moderate to severe) internal carotid artery (ICA) stenosis was observed in 0.5% of participants. Factors including age, male gender, DM, and HT were associated with atherosclerotic carotid disease. High fasting plasma glucose (FPG) and low-density lipoprotein (LDL) were also related to abnormal carotid duplex results. The carotid duplex examination provided health information to the participants to help control risk factors and to raise awareness of cerebrovascular disease.

Research paper thumbnail of Cut Off Value of Good Pronostic Factor Outcomes in Large Territory Ischemic Stroke Undergoing Early Decompressive Craniectomy

Journal of Southeast Asian Medical Research, 2022

Background: Decompressive craniectomy (DC) significantly reduces mortality in large territory isc... more Background: Decompressive craniectomy (DC) significantly reduces mortality in large territory ischemic strokes that develop intractable cerebral edema. However, evidence for functional benefit remains sparse and contradictory. Objective: This study aimed to assess cut-off value for predictor outcomes of early DC. Methods: We conducted a prospective, observational cohort study from December 2016 to June 2021. Patients were screened for ischemic stroke involving the middle cerebral, internal carotid artery or both using the National Institutes of Health Stroke Scale score. All patients underwent DC. Multivariate analysis was performed for an array of clinical variables in relation to functional outcomes according to the modified Rankin Scale (mRS) and Pearson’s correlation coefficient analysis. Clinical outcome was assessed after 3- and 6-month follow-up. Results: In total, 243 patients were included in this study. Age ≤71 years (AUC=0.955, p <0.001 accuracy 89.7%), onset to DC ≤9 ...

Research paper thumbnail of Low Serum Vitamin B12 in Alzheimerûs Patients as Detected by a Solid Phase

Objective: To determine the relationship between serum levels of vitamin B12 and folate in AD and... more Objective: To determine the relationship between serum levels of vitamin B12 and folate in AD and other types of dementia in Thai patients. Methods: One hundred and eleven Thai subjects were classified into 3 groups: 32 AD patients, 43 non-AD dementia patients and 36 age-matched controls. Serum concentrations of vitamin B12 and folate were measured using a solid phase radioimmunoassay. Results: Serum vitamin B12 levels were found to be significantly lower in AD and non-AD dementia patients than in age-matched controls. There is a significant relationship between Mini-Mental State Examination score and vitamin B12 level in AD and non-AD dementia groups. However, there is no significant difference in serum folate in AD and non-AD dementia groups when compared to age-matched controls. Conclusion: These findings suggest the need for vitamin B12 supplementation in AD and non-AD dementia patients.

Research paper thumbnail of Prevalence of Carotid Artery Disease and Risk Factors in Asymptomatic Thai Population using Carotid Duplex Ultrasonography at the Check-up Clinic, Health Promotion Center at Bangkok Hospital

THE BANGKOK MEDICAL JOURNAL, 2014

OBJECTIVE: To examine the prevalence of carotid artery disease and to determine risk factors for ... more OBJECTIVE: To examine the prevalence of carotid artery disease and to determine risk factors for carotid duplex abnormalities among asymptomatic Thai subjects. MATERIALS AND METHODS: The cross-sectional observation study was conducted in a sample of patients (Thai population) who took an annual health check-up at the Bangkok Medical Center (BMC) over a 10 month period from June 1, 2011 to March 31, 2012. A total of 2,105 subjects were enrolled and underwent a carotid duplex examination using the standard procedure. The results from the carotid duplex ultrasonography and risk factors that contribute to carotid artery abnormalities were recorded and analyzed using a multiple logistic regression method and a prevalence rate ratio. RESULTS: The study enrolled 2,105 Thai participants aged 25-79 years old with a mean of age of 54 ± 10.4 years. The population was equally divided by gender, and 44% of subjects were current smokers and 25% of the patients were overweight. Approximately 30.5%...

Research paper thumbnail of Top of the Basilar Syndrome with Painful Palmar Reticulated Erythematous Patches Complicating Cardiac Atrial Myxoma : A Case Report

Corresponding Author: E-mail: chesda_udommongkol@yahoo.com Abstract The authors reported an uncom... more Corresponding Author: E-mail: chesda_udommongkol@yahoo.com Abstract The authors reported an uncommon ischemic stroke in a young patient with an unusual dermatologic manifestation. A 28-year-old Thai woman presented with acute vertigo, ataxia, vertical diplopia, and impaired vertical gazes. Multiple painful, ill defined-border, reticulated, erythematous, and non-blanchable patches were formerly presented in both palms one day before the stroke onset. MRI showed hypersignals in bilateral thalami and left paramedian midbrain region on DWI with corresponding ADC map. Hyperechoic lobulated mass was detected at interatrial septum by transthoracic echocardiography. Top of the basilar syndrome with a rare skin sign were diagnosed and etiology was hypothesized as embolic phenomena caused by cardiac myxoma embolism. The dermatologic sign was exceptionally rare but the lesion can be a diagnostic clue for embolic mechanism caused by atrial myxoma. (J Thai Stroke Soc 2015; 14 (3): 166-171.)

Research paper thumbnail of In-vitro Doppler study of fluid flow in a cerebral small vessel occlusion model

Research paper thumbnail of Recurrent stroke from paradoxical embolism in a case with hereditary hemorrhagic telangiectasia

CHESDA UDOMMONGKOL, MD PhD Head of Neurology, Phramongkutklao Army Hospital Rajvithee Road, Rajth... more CHESDA UDOMMONGKOL, MD PhD Head of Neurology, Phramongkutklao Army Hospital Rajvithee Road, Rajthewee, Bangkok Thailand 10400 Tel. +66-2-3547600 ext. 93027 Fax. +66-2-6444635 Email: chesda_udommongkol@yahoo.com Rendu Osler Weber or Hereditary Hemorrhagic Telangiectesia (HHT) is an autosomal dominant genetic disorder causing abnormal development of vasculature characterized by telangiectases and arteriovenous malformations of specific organs. The most common presentation of HHT is epistaxis; however ischemic stroke occasionally occurs due to paradoxical shunt such as pulmonary ateriovenous malformation (PAVM). We reported a 37-year-old woman presenting with recurrent ischemic stroke as a result of paradoxical emboli from PAVMs. The patient was brought to emergency department and the examination revealed left facial palsy and left hemiplegia. The CT angiography demonstrated complete occlusion of the distal right M1 MCA. Transcranial Doppler showed positive microbubble examination with...

Research paper thumbnail of Efficacy and Safety of Ticagrelor and Aspirin in Patients With Moderate Ischemic Stroke

JAMA Neurology

Prior trials of dual antiplatelet therapy excluded patients with moderate ischemic stroke. These ... more Prior trials of dual antiplatelet therapy excluded patients with moderate ischemic stroke. These patients were included in the Acute Stroke or Transient Ischaemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death (THALES) trial, but results have not been reported separately, raising concerns about safety and efficacy in this subgroup. OBJECTIVE To evaluate the efficacy and safety of ticagrelor plus aspirin in patients with moderate ischemic stroke (National Institutes of Health Stroke Scale [NIHSS] score of 4 to 5). DESIGN, SETTING, AND PARTICIPANTS The THALES trial was a randomized trial conducted at 414 hospitals in 28 countries in January 2018 and December 2019. This exploratory analysis compared patients with moderate stroke (baseline NIHSS score of 4 to 5) with patients with less severe stroke (NIHSS score of 0 to 3). A total of 9983 patients with stroke were included in the present analysis, after excluding 2 patients with NIHSS scores greater than 5 and 1031 patients with transient ischemic attack. Data were analyzed from March to April 2021. INTERVENTIONS Ticagrelor (180-mg loading dose on day 1 followed by 90 mg twice daily on days 2 to 30) or placebo within 24 hours after symptom onset. All patients received aspirin, 300 to 325 mg, on day 1 followed by aspirin, 75 to 100 mg, daily on days 2 to 30. Patients were observed for 30 additional days. MAIN OUTCOMES AND MEASURES The primary outcome was time to stroke or death within 30 days. The primary safety outcome was time to severe bleeding. RESULTS In total, 3312 patients presented with moderate stroke and 6671 presented with less severe stroke. Of those in the moderate stroke group, 1293 (39.0%) were female, and the mean (SD) age was 64.5 (10.8) years; of those in the less severe stroke group, 2518 (37.7%) were female, and the mean (SD) age was 64.8 (11.2) years. The observed primary outcome event rate in patients with moderate stroke was 7.6% (129 of 1671) for those in the ticagrelor group and 9.1% (150 of 1641) for those in the placebo group (hazard ratio, 0.84; 95% CI, 0.66-1.06); the primary outcome event rate in patients with less severe stroke was 4.7% (158 of 3359) for those in the ticagrelor group and 5.7% (190 of 3312) for those in the placebo group (hazard ratio, 0.82; 95% CI, 0.66-1.01) (P for interaction = .88). Severe bleeding occurred in 8 patients (0.5%) in the ticagrelor group and in 4 patients (0.2%) in the placebo group in those with moderate stroke compared with 16 patients (0.5%) and 3 patients (0.1%), respectively, with less severe stroke (P for interaction = .26). CONCLUSIONS AND RELEVANCE In this study, patients with a moderate ischemic stroke had consistent benefit from ticagrelor plus aspirin vs aspirin alone compared with patients with less severe ischemic stroke, with no further increase in the risk of intracranial bleeding or other severe bleeding events. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03354429

Research paper thumbnail of Ticagrelor Added to Aspirin in Acute Nonsevere Ischemic Stroke or Transient Ischemic Attack of Atherosclerotic Origin

Stroke

Background and Purpose: Among patients with a transient ischemic attack or minor ischemic strokes... more Background and Purpose: Among patients with a transient ischemic attack or minor ischemic strokes, those with ipsilateral atherosclerotic stenosis of cervicocranial vasculature have the highest risk of recurrent vascular events. Methods: In the double-blind THALES (The Acute Stroke or Transient Ischemic Attack Treated With Ticagrelor and ASA for Prevention of Stroke and Death) trial, we randomized patients with a noncardioembolic, nonsevere ischemic stroke, or high-risk transient ischemic attack to ticagrelor (180 mg loading dose on day 1 followed by 90 mg twice daily for days 2–30) or placebo added to aspirin (300–325 mg on day 1 followed by 75–100 mg daily for days 2–30) within 24 hours of symptom onset. The present paper reports a prespecified analysis in patients with and without ipsilateral, potentially causal atherosclerotic stenosis ≥30% of cervicocranial vasculature. The primary end point was time to the occurrence of stroke or death within 30 days. Results: Of 11 016 random...

Research paper thumbnail of Beyond symptomatic effects: Donepezil's potential for neuroprotection and disease modification in Alzheimer's disease

British Journal of Pharmacology

Alzheimer's disease (AD) is associated with neurodegenerative changes resulting clinically in pro... more Alzheimer's disease (AD) is associated with neurodegenerative changes resulting clinically in progressive cognitive and functional deficits. The only therapies are the cholinesterase inhibitors donepezil, galantamine and rivastigmine and the N-methyl-Daspartate-receptor antagonist memantine. Donepezil acts primarily on the cholinergic system as a symptomatic treatment, but it also has potential for disease modification and may reduce the rate of progression of AD. This review explores the potential for disease modifying effects of donepezil. Several neuroprotective mechanisms that are independent of cholinesterase inhibition, are suggested. Donepezil has demonstrated a range of effects, including protecting against amyloid β, ischaemia and glutamate toxicity; slowing of progression of hippocampal atrophy; and up-regulation of nicotinic acetylcholine receptors. Clinically, early and continuous treatment with donepezil is considered to preserve cognitive function more effectively than delayed treatment. The possible neuroprotective effects of donepezil and the potential for disease pathway modification highlight the importance of early diagnosis and treatment initiation in AD.

Research paper thumbnail of Orthostatic hypotension: a non-motor complication assessment in 82 patients with idiopathic Parkinson's disease in Phramongkutklao Hospital

Journal of the Medical Association of Thailand Chotmaihet Thangphaet, Nov 1, 2010

Objective: Parkinson's disease (PD) is one of the neurogenic etiologies of orthostatic hypotensio... more Objective: Parkinson's disease (PD) is one of the neurogenic etiologies of orthostatic hypotension, a non-motor symptoms complex, that tends to be under-recognized and under-treated leading to a major cause of disability for PD patients. This complication is associated with one or recurrent falls causing mortality and morbidity. To the authors' knowledge, there is no study about this condition in Thai PD population. The authors therefore aimed to determine the frequency, clinical and risk factors of orthostatic hypotension in PD patients treated in Phramongkutklao Hospital. Material and Method: The authors enrolled consecutive patients with idiopathic PD over a 10-month period. Supine and standing blood pressure (BP) were measured sequentially as the standard techniques. Orthostatic hypotension (OH) was diagnosed if there was a reduction in systolic or diastolic BP of at least 20 or 10 mmHg respectively within 3 minutes after standing. The authors analyzed for the frequency of this condition as well as determined the risk factors between the OH and non-OH groups. Results: The number of patients enrolled was 82 with the mean age of 69 years. The median duration of PD was 4 years. Eighty-five percent were in Hoehn & Yahr stage 1-3. Thirty-three patients (40.2%) had orthostatic hypotension and 70% of them were asymptomatic. By univariate and multivariate analysis, the risk factors for this condition were the longer duration of PD diagnosis, the more advanced staging and the use of selegiline. Conclusions: The frequency of orthostatic hypotension among the present PD was 40.2%. The longer duration of disease, the more advanced stage of Parkinson's disease and selegiline usage were the factors associated with this non-motor condition.

Research paper thumbnail of Detection of small vessel knock signals by Doppler ultrasound in a laboratory model simulating a penetrating branch occlusion

Research paper thumbnail of Spinal cord compression and bilateral sensory neural hearing loss: an unusual manifestation of neurocysticercosis

Journal of the Medical Association of Thailand Chotmaihet Thangphaet, Oct 1, 2004

Neurocysticercosis is the most common parasitic infestation involving the central nervous system ... more Neurocysticercosis is the most common parasitic infestation involving the central nervous system in tropical countries. Common presentations are seizure, meningitis and increased intracranial pressure. The authors report a case of a 52-year-old woman with racemose neurocysticercosis in the subarachnoid space at the cistern of the brain through the lumbar cistern. She presented with progressive paraparesis due to spinal cord compression and finally had progressive bilateral sensori-neural hearing loss. MRI brain and the whole spinal cord revealed numerous rim-enhancing cystic lesions at the basal cistern, prepontine cistern, bilateral cerebellopontine angle, internal acoustic canals, intramedullary lesion at the 5th cervical spinal level, lumbar cistern lesions and secondary syringomyelia at the thoracic spinal cord. The histopathologic examination confirmed cysticercosis. After treatment by albendazole and surgical removal, she still developed recurrent spinal compression at a higher level and obstructive hydrocephalus. Finally, she died from status epilepticus and septic shock.

Research paper thumbnail of Comparison between aspirin combined with dipyridamole versus aspirin alone within 48 hours after ischemic stroke event for prevention of recurrent stroke and improvement of neurological function: a preliminary study

Journal of the Medical Association of Thailand Chotmaihet Thangphaet, Dec 1, 2005

To determine efficacy and tolerability of aspirin plus dipyridamole (combination) versus aspirin ... more To determine efficacy and tolerability of aspirin plus dipyridamole (combination) versus aspirin alone in acute intervention treatment after acute ischemic stoke among Thai patients. Material and Method: This pilot study enrolled ischemic stroke patients within 48 hours and randomized to aspirin 300 mg/d or combination (aspirin 300 mg/d+ standard release dipyridamole 75 mg thrice a day) and followed up for 6 months. End points were recurrent ischemic stroke, transient ischemic attack and vascular death. Side effects were recorded. National Institutes of Health Stroke Scale was assessed at entry and at 6 months period for determining neurological functions. Results: Of 38 patients, mean age was 64.3 years. Male and female were 52.6% and 47.4% respectively. There were 18 patients in the aspirin group and 20 patients in the combination group. No patient developed end point events or no significant adverse event in both groups. The combination group showed more improvement in neurological function than the aspirin group (p-value 0.009). Conclusion: This pilot study showed equal efficacy and tolerability of the combination group and aspirin alone in acute intervention treatment for prevention of recurrent stroke or vascular death within 6 months.

Research paper thumbnail of The Changes in Mean Platelet Volume after Using of Antiplatelet Drugs in Acute Ischemic Stroke: A Randomized Controlled Trial

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2015

To measure the changes of mean platelet volume (MPV) after using four antiplatelet drugs in acute... more To measure the changes of mean platelet volume (MPV) after using four antiplatelet drugs in acute non-cardioembolic ischemic stroke patients and assess the association of antiplatelets and MPV and stroke outcome. Ischemic stroke survivors with National Institute of Health Stroke Scale (NIHSS) 8 were randomly allocated intofour groups, receiving aspirin, clopidogrel, combined aspirin and dipyridamole, and cilostazol. The change of MPV NIHSS, and modified Rankin Scale (mRS) were recorded at baseline and week 4 in all studied groups. MPV was measured using the standard automated blood test for complete blood count. Twenty-one subjects were included in this study. They comprised of five cases in each antiplatelet group, except for aspirin, which had six subjects. Male was 57%, and hypertension was the most common risk factor (61.9%). Most of participants (76%) had small vessel disease. At 4-week, MPVwas reduced and NIHSS, mRS were improved in every studied group. Clopidogrel sign ficant...

Research paper thumbnail of Prevalence of depression among epileptic patients at Phramongkutklao Hospital

Journal of the Medical Association of Thailand = Chotmaihet thangphaet

To determine the prevalence of depression among epileptic patients in Phramongkutklao Hospital an... more To determine the prevalence of depression among epileptic patients in Phramongkutklao Hospital and to find the factors associated with depression. One hundred and ten epileptic patients were enrolled and 60 patients met the inclusion criteria. These subjects were screened with Thai Geriatric Depressive Scale (TGDS) and were interviewed. Demographic data that effect depression were evaluated. During the 1-year study period, 60 of 110 patients diagnosed epilepsy were eligible. Prevalence of depression was 38.3%, which is similar to previous studies. Mild depression was found in 65.2% and moderate 34.8%, without severe depression. Comparing between male and female, there was no statistical significant difference (p = 0.75). The age group that compared between age equal or less than 25 years and more than 25 years had no statistical significant difference (p = 0.77). Other variables were not found to be significant risk factors of depression among epileptic patients including duration o...

Research paper thumbnail of Excessive daytime sleepiness and obstructive sleep apnea in Thai epileptic patients

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014

Sleepiness is a common complaint in epilepsy. Also obstructive sleep apnea (OSA) is increasingly ... more Sleepiness is a common complaint in epilepsy. Also obstructive sleep apnea (OSA) is increasingly detected and would affect the epilepsy prognosis. We aimed to determine the frequency and predictors of sleepiness and OSA in epileptic patients. This was a cross-sectional descriptive study using Epworth Sleepiness Scale questionnaire (ESS) and Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ) to identify excessive daytime sleepiness and OSA in our consecutive epileptic patients in Neurology out-patient clinic. Overall 113 patients (male 55%) answered a personal survey and completed ESS and SA-SDQ. Mean age was 47 years (range 15-93). Average body mass index (BMI) was 24. Excessive daytime sleepiness (ESS 10) was demonstrated in 37%, and the prevalence of OSA diagnosed by using SA-SDQ was 20% (male 18%, female 22%). OSA were identified 68% among individuals whose BMI of more than 25, which was significant higherfi-equency than in the nomnnal BMI group (32%). The predictors...

Research paper thumbnail of Non-motor symptoms in Thai patients with Parkinson's disease studied at Phramongkutklao Hospital

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014

Non-motor symptoms (NMS) ofParkinson's disease (PD) have been recently recognized to be as di... more Non-motor symptoms (NMS) ofParkinson's disease (PD) have been recently recognized to be as disabling as motor symptoms in PD. However these symptoms are still under recognized causing delay in treatment and inadequate management. This study aimed to identify NMS in Thai PD patients using the NMS screening questionnaire (NMSQuest). Patients with idiopathic Parkinson's disease visiting the neurology clinic in 2008 were enrolled. NMSQuest-Thai version (NMSQ-T) was applied to patients to identify NMS. Collected data from questionnaires completed by 165 probable idiopathic PD was analyzed. The demographic profiles showed mean age of 68.6 years with mean disease duration 5.4 years, and male 56.4%. Patients had Hoehn & Yahrstaging, stage-2: 43%, stage-3: 24.8%, stage-I: 24.2% and stage-4: 7.9%. The average dosage oflevodopa was 456.4 mg/d. Mean total NMSQ-T score was 9.5. Most prevalent of non-motor symptom was nocturia (64.2%). The domains which gained most positive answers were u...

Research paper thumbnail of Orthostatic hypotension: a non-motor complication assessment in 82 patients with idiopathic Parkinson's disease in Phramongkutklao Hospital

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2010

Parkinson's disease (PD) is one of the neurogenic etiologies of orthostatic hypotension, a no... more Parkinson's disease (PD) is one of the neurogenic etiologies of orthostatic hypotension, a non-motor symptoms complex, that tends to be under-recognized and under-treated leading to a major cause of disability for PD patients. This complication is associated with one or recurrent falls causing mortality and morbidity. To the authors' knowledge, there is no study about this condition in Thai PD population. The authors therefore aimed to determine the frequency, clinical and risk factors of orthostatic hypotension in PD patients treated in Phramongkutklao Hospital. The authors enrolled consecutive patients with idiopathic PD over a 10-month period. Supine and standing blood pressure (BP) were measured sequentially as the standard techniques. Orthostatic hypotension (OH) was diagnosed if there was a reduction in systolic or diastolic BP of at least 20 or 10 mmHg respectively within 3 minutes after standing. The authors analyzed for the frequency of this condition as well as det...

Research paper thumbnail of Spinal cord compression and bilateral sensory neural hearing loss: an unusual manifestation of neurocysticercosis

Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2004

Neurocysticercosis is the most common parasitic infestation involving the central nervous system ... more Neurocysticercosis is the most common parasitic infestation involving the central nervous system in tropical countries. Common presentations are seizure, meningitis and increased intracranial pressure. The authors report a case of a 52-year-old woman with racemose neurocysticercosis in the subarachnoid space at the cistern of the brain through the lumbar cistern. She presented with progressive paraparesis due to spinal cord compression and finally had progressive bilateral sensori-neural hearing loss. MRI brain and the whole spinal cord revealed numerous rim-enhancing cystic lesions at the basal cistern, prepontine cistern, bilateral cerebellopontine angle, internal acoustic canals, intramedullary lesion at the 5th cervical spinal level, lumbar cistern lesions and secondary syringomyelia at the thoracic spinal cord. The histopathologic examination confirmed cysticercosis. After treatment by albendazole and surgical removal, she still developed recurrent spinal compression at a highe...