1993; 52: 857-861) Polymyositis (PM) is a disorder of unknown aetiology characterised by an inflammatory myopathy involving striated skeletal and less commonly cardiac muscles. A diagnosis of dermatomyositis (DM) is made when characteristic skin lesions accompany the myositis. Available reports on PM/DM is based mainly on studies conducted in white populations. As Singapore has a very different demographic profile, this study was carried out to determine possible similarities and differences in clinical and laboratory features and treatment response of our patients with PM/DM.
Method Case detectionThe database was developed as follows: 1) Case records of adult patients (16 years old and above) referred to the 3 main electromyographic (EMG) laboratories in Singapore between 1 June 1986 and 31 May 1991 were reviewed if the referring diagnosis was myositis or myopathy for investigation regardless of the EMG result. These 3 laboratories (at Tan Tock Seng Hospital, Singapore General Hospital and National University Hospital) serve the 5 major general hospitals and the main dermatology centre in Singapore (referrals were also received from other sources but during the period of study, none of the patients were from these sources).
Hyperhomocyst(e)inemia is an independent risk factor for ischemic strokes in young Asian adults. The relationship between increasing homocyst(e)ine and stroke risk is strong, graded, and significant. The association with large-artery strokes suggests that hyperhomocyst(e)inemia may increase stroke risk via a proatherogenic effect.
It is generally believed that the supranuclear innervation of the hypoglossal nucleus is bilateral and symmetrical. The aim of this work is to study the frequency and clinical characteristics of supranuclear tongue palsy in unilateral stroke. 300 patients with acute unilateral ischaemic motor strokes (excluding those in the lower brainstem) and an equal number of normal controls were studied for the presence of tongue deviation in a standardised manner. 29% of stroke patients and 5% of controls had tongue deviation (p < 0.00001). Deviation was always to the side of the limb weakness. In patients with a history of stroke, it occurred more frequently in those with previous stroke on the contralateral side. Tongue deviation was most common in patients with clinical features of the non-lacunar stroke subtype (56%) or in those with cortical or large subcortical infarctions on brain CT scan (55 and 45%, respectively). All tongue deviations were associated with supranuclear 7th nerve palsy. Dysphagia and dysarthria occurred in 43 and 90% of patients with tongue deviation. Weakness of the arm was significantly associated with presence of tongue deviation. Tongue deviation in unilateral stroke most likely results from asymmetrical supranuclear control of the 12th cranial nerve in many individuals. The finding that it occurs relatively commonly in large (non-lacunar) infarcts and its association with dysphagia may have clinical utility.
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