Tuck Loong, Derek Soon

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mdcstld@nus.edu.sg


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MEDICINE
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2016 - 20182
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    Outpatient management of transient ischaemic attack
    (SINGAPORE MEDICAL ASSOC, 2016-12-01) LOH WENG KEONG VICTOR; SOON TUCK LOONG, DEREK; YEO LEONG LITT,LEONARD; Dr Loh Weng Keong Victor; MEDICINE
    © 2016, Singapore Medical Association. All right reserved. Mr Chong, a 63-year-old retired, right-handed Chinese man, hurriedly walked over to your clinic after feeling a sudden, transient episode of weakness in his left arm and face. He had noticed the weakness on waking that morning. At first, he could hardly raise his shoulder, and was only able to move his fingers with great difficulty. About 15 minutes later, while trying to get dressed, he noticed the strength in his arm returning and his face returning to normal. He had been on amlodipine for hypertension and simvastatin for hyperlipidaemia over the past two years, and had been smoking for the past ten years. He apologetically admitted that he had run out of medication two weeks ago. His blood pressure was 170/100 mmHg and his heart rate was regular at 88 beats/min. You noted that his speech was clear and gait normal. On further neurological examination, neither upper or lower limb weakness nor numbness was detected bilaterally, and there were no signs of cerebellar dysfunction.
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    The adult patient with headache
    (SINGAPORE MEDICAL ASSOC, 2018-08-01) Lee, Vivien Min Er; ANG LAI LAI; SOON TUCK LOONG, DEREK; ONG JIA YUAN, JONATHAN; LOH WENG KEONG VICTOR; Dr Loh Weng Keong Victor; MEDICINE
    © 2018, Singapore Medical Association. All rights reserved. Headaches are common in primary care. For safe assessment and management of the patient with headache, a focused history and physical examination are important to identify secondary headache, and find out whether an immediate referral to the emergency department or a non-emergent referral to the neurologist is warranted. The majority of patients with primary headache may be safely managed in the outpatient setting. Key steps include proper categorisation of the primary headache, attention to lifestyle and psychosocial factors, prescription of analgesics for acute pain relief, and the use of preventive medication when indicated. The patient with a cluster headache, a headache of uncertain diagnosis and/or poor response to preventive strategies or a migraine with persistent aura, or a headache with associated motor weakness, should be referred to a neurologist. Secondary headache and the diagnosis of medication overuse headache should be considered in a patient on long-term analgesics with unremitting headache.