ORCID Profile
0000-0002-0570-5398
Current Organisations
Austin Health
,
Eastern Health
,
Royal Melbourne Hospital
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Publisher: Springer Science and Business Media LLC
Date: 18-02-2021
DOI: 10.1186/S12883-021-02110-1
Abstract: Chronic lymphocytic infiltration with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a neuro-inflammatory syndrome first described in 2010. It has a relationship with lymphoproliferative disorders that has not been fully elucidated. This case represents an unusual progression of CLIPPERS to Epstein-Barr Virus (EBV)-related lymphomatoid granulomatosis (LYG). The exact connection between CLIPPERS and LYG remains poorly understood. We present a case of a 75-year-old man who was diagnosed with CLIPPERS with initial response to immunosuppression but later progressed to EBV-related LYG. EBV polymerase chain reaction (PCR) was detected in his cerebrospinal fluid (CSF), and repeat imaging revealed findings that were uncharacteristic for CLIPPERS thereby prompting a brain biopsy which led to a diagnosis of EBV-related LYG. This case highlights the following learning points: 1) CLIPPERS cases are often part of a spectrum of lymphomatous disease, 2) CLIPPERS can be associated with EBV-related lymphoproliferative disorders such as LYG, and 3) EBV detection in CSF should prompt earlier consideration for brain biopsy in patients. Our case highlights the difficulty in distinguishing CLIPPERS from other steroid-responsive conditions such as neoplastic and granulomatous diseases. Given the association of CLIPPERS with EBV-related LYG as demonstrated in this case, we recommend testing for EBV in CSF for all patients with suspected CLIPPERS. An early referral for brain biopsy and treatment with rituximab should be considered for patients with suspected CLIPPERS who test positive for EBV in their CSF.
Publisher: BMJ
Date: 11-2021
Abstract: We describe a patient who developed bilateral oculomotor nerve palsy, ataxia, facial diplegia and lower limb weakness 2 weeks post-Oxford-AstraZeneca SARS-CoV2 vaccination, consistent with Miller-Fisher syndrome (MFS) and Guillain-Barre syndrome (GBS) overlap syndrome. Although some features of the patient’s presentation were typical of recently reported cases of a rare GBS variant post-Oxford-AstraZeneca vaccination, including severe facial weakness and a lack of respiratory involvement, to our knowledge this is the first reported case of MFS associated with SARS-CoV2 vaccination. While postvaccination GBS remains rare, it appears to have a favourable prognosis, and recognising this entity is therefore important for patient counselling and monitoring for potential complications.
Publisher: Wiley
Date: 12-2022
DOI: 10.1002/CCR3.6725
Abstract: The diagnosis of antineutrophil cytoplasmic autoantibody‐associated vasculitis in first‐episode strokes is particularly challenging, especially in patients lacking features of systemic vasculitis. We present the case of a 71‐year‐old woman with positive myeloperoxidase antineutrophil cytoplasmic antibodies and negative proteinase 3 autoantibodies. The patient presented with 1 week history of pyramidal weakness in both upper and lower limbs, hyperreflexia, and clonus. Magnetic resonance imaging of the brain demonstrated widespread bihemispheric cortical and deep white matter acute infarcts, which are consistent with features of stroke secondary to vasculitis. Myeloperoxidase antineutrophilic cytoplasmic autoantibody‐positive vasculitis diseases are more commonly associated with renal, pulmonary, and cutaneous manifestations however, in our patient, the central nervous system features predominated. This case highlights the challenges of diagnosing primary central nervous system vasculitis, in this case, an atypical myeloperoxidase antineutrophilic cytoplasmic autoantibody‐positive disease without the classical disease course and clinical signs.
Publisher: Wiley
Date: 27-12-2022
DOI: 10.5694/MJA2.51814
Publisher: Springer Science and Business Media LLC
Date: 12-06-2014
Publisher: Wiley
Date: 08-07-2023
DOI: 10.1002/EPD2.20093
Abstract: The pharmacological treatment of epilepsy entails several critical decisions that need to be based on an in idual careful risk–benefit analysis. These include when to initiate treatment and with which antiseizure medication (ASM). With more than 25 ASMs on the market, physicians have opportunities to tailor the treatment to in idual patients´ needs. ASM selection is primarily based on the patient's type of epilepsy and spectrum of ASM efficacy, but several other factors must be considered. These include age, sex, comorbidities, and concomitant medications to mention the most important. In idual susceptibility to adverse drug effects, ease of use, costs, and personal preferences should also be taken into account. Once an ASM has been selected, the next step is to decide on an in idual target maintenance dose and a titration scheme to reach this dose. When the clinical circumstances permit, a slow titration is generally preferred since it is associated with improved tolerability. The maintenance dose is adjusted based on the clinical response aiming at the lowest effective dose. Therapeutic drug monitoring can be of value in efforts to establish the optimal dose. If the first monotherapy fails to control seizures without significant adverse effects, the next step will be to gradually switch to an alternative monotherapy, or sometimes to add another ASM. If an add‐on is considered, combining ASMs with different modes of action is usually recommended. Misdiagnosis of epilepsy, non‐adherence and suboptimal dosing are frequent causes of treatment failure and should be excluded before a patient is regarded as drug‐resistant. Other treatment modalities, including epilepsy surgery, neuromodulation, and dietary therapies, should be considered for truly drug‐resistant patients. After some years of seizure freedom, the question of ASM withdrawal often arises. Although successful in many, withdrawal is also associated with risks and the decision needs to be based on careful risk–benefit analysis.
Publisher: SAGE Publications
Date: 19-02-2023
DOI: 10.1177/13524585231151400
Abstract: Multiple sclerosis patients experience 3–6 times more seizures than the general population, but observations vary among studies. Seizure risk in disease-modifying therapy recipients remains unknown. The objective of this study was to compare seizure risk in multiple sclerosis patients receiving disease-modifying therapy versus placebo. MEDLINE(OVID), Embase, CINAHL, and ClinicalTrials.gov were searched from database inception until August 2021. Phase 2–3 randomized, placebo-controlled trials reporting efficacy and safety data for disease-modifying therapies were included. Network meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using Bayesian random effects model for in idual and pooled (by drug target) therapies. Main outcome was log e seizure risk ratios [95% credible intervals]. Sensitivity analysis included meta-analysis of non-zero-event studies. A total of 1993 citations and 331 full-texts were screened. Fifty-six included studies (29,388 patients—disease-modifying therapy = 18,909 placebo = 10,479) reported 60 seizures (therapy = 41 placebo = 19). No in idual therapy was associated with altered seizure risk ratio. Exceptions were daclizumab (−17.90 [−65.31 −0.65]) and rituximab (−24.86 [−82.71 −1.37]) trending toward lower risk ratio cladribine (25.78 [0.94 4.65]) and pegylated interferon-beta-1a (25.40 [0.78 85.47]) trended toward higher risk ratio. Observations had wide credible intervals. Sensitivity analysis of 16 non-zero-event studies revealed no difference in risk ratio for pooled therapies (l0.32 [−0.94 0.29]) No evidence of association was found between disease-modifying therapy and seizure risk—this informs seizure management in multiple sclerosis patients.
Publisher: Springer Science and Business Media LLC
Date: 26-10-2021
Publisher: Elsevier BV
Date: 02-2021
No related grants have been discovered for Yew Li Dang.