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  • Craniectomy for acute disseminated encephalomyelitis
    Pract. Neurol. Pub Date : 2020-09-25
    David Bourke; Kelvin Woon

    A 17-year-old girl underwent emergency bifrontal craniectomy for severely raised intracranial pressure with brainstem compression, having developed acute disseminated encephalomyelitis (ADEM) following Epstein-Barr virus infection. We discuss the current evidence for craniectomy in both ADEM and infective encephalitis and propose an approach to management.

    更新日期:2020-09-25
  • Memory complaints in the epiltify clinic.
    Pract. Neurol. Pub Date : 2020-09-25
    Sallie Baxendale,Dominic Heaney

    Cognitive complaints in people with epilepsy are usually multifactorial in their nature and origin. While antiepileptic medications are an important consideration, we explore other ways in which neurologists can address cognitive problems in this population. It is never too early to ask about cognitive impairment, and the answers can have diagnostic significance. Understanding and accepting that cognitive

    更新日期:2020-09-25
  • Amyloid PET imaging in clinical practice
    Pract. Neurol. Pub Date : 2020-09-24
    Magdalena A Kolanko; Zarni Win; Flavia Loreto; Neva Patel; Christopher Carswell; Anastassia Gontsarova; Richard J Perry; Paresh A Malhotra

    Amyloid positron emission tomography (PET) imaging enables in vivo detection of brain Aβ deposition, one of the neuropathological hallmarks of Alzheimer’s disease. There is increasing evidence to support its clinical utility, with major studies showing that amyloid PET imaging improves diagnostic accuracy, increases diagnostic certainty and results in therapeutic changes. The Amyloid Imaging Taskforce

    更新日期:2020-09-24
  • Myotonic dystrophy: a cause of acute breathlessness not to be missed
    Pract. Neurol. Pub Date : 2020-09-24
    Caroline Kramarz; Abigail Turner; Vafa Alakbarzade; Brendan Mclean

    Myotonic dystrophy type 1 (DM1), the most common muscular dystrophy in adults, is an autosomal dominant disorder with a wide phenotypic spectrum ranging from oligosymptomatic forms to a life-threatening, multisystem disease. People with DM1 overall have a reduced life expectancy, mainly due to respiratory or cardiac causes. There is no cure but prompt, appropriate symptom management is essential to

    更新日期:2020-09-24
  • Highlights from this issue.
    Pract. Neurol. Pub Date : 2020-10-01
    Phil E M Smith,Geraint N Fuller

    The COVID-19 pandemic has changed so much that it is easy to forget what life was like before it began. We already experience a slight shock on seeing pictures of large groups of people standing close to or even touching one another, before realising it is an old photo. We are also becoming accustomed to being ignored by colleagues because of a low-level mask-induced prosopagnosia. Too much change;

    更新日期:2020-09-21
  • Grand rounds: a precious resource to be nurtured.
    Pract. Neurol. Pub Date : 2020-10-01
    Amy L Ross Russell,Mary M Reilly,Martin R Turner

    With the sad news of the death of neurologist Gerald Stern, it is a fitting time to recall his treatise in praise of Grand Rounds.1 This traditional style of learning has long been cherished by neurologists as the optimal way to teach both the clinical method and deductive reasoning.2 Medical education has significantly evolved, with the recognition of varying learning styles, availability of simulations

    更新日期:2020-09-21
  • Simple visual hallucinations and epilepsy.
    Pract. Neurol. Pub Date : 2020-10-01
    Mark Manford

    Jasvir Virdee and Susan Mollan describe a patient presenting with photopsia who had an unusual ophthalmological diagnosis. Positive and/or negative visual phenomena may relate to pathology anywhere from the eye to the visual association cortex; thus, neurologists and ophthalmologists share responsibility for diagnosing and treating these symptoms. The authors describe how they arrived at an ophthalmological

    更新日期:2020-09-21
  • Management of incidental unruptured intracranial aneurysms.
    Pract. Neurol. Pub Date : 2020-10-01
    Shelley Renowden,Richard Nelson

    The widespread use of MR has led to the increasingly frequent diagnosis of unruptured incidental intracranial aneurysms. Most are small (<7 mm diameter) and will never rupture. Yet, their recognition causes much anxiety, and their optimal management remains controversial. This review addresses the difficulties in managing incidental unruptured saccular intracranial aneurysms. Note that our conclusions

    更新日期:2020-09-21
  • Cerebral venous thrombosis: a practical guide.
    Pract. Neurol. Pub Date : 2020-10-01
    Leonardo Ulivi,Martina Squitieri,Hannah Cohen,Peter Cowley,David J Werring

    All neurologists need to be able to recognise and treat cerebral venous thrombosis (CVT). It is difficult to diagnose, partly due to its relative rarity, its multiple and various clinical manifestations (different from ‘conventional’ stroke, and often mimicking other acute neurological conditions), and because it is often challenging to obtain and interpret optimal and timely brain imaging. Although

    更新日期:2020-09-21
  • Tardive syndromes.
    Pract. Neurol. Pub Date : 2020-10-01
    Eoin Mulroy,Bettina Balint,Kailash P Bhatia

    Dopamine receptor-blocking antipsychotics, first introduced into clinical practice in 1952, were hailed as a panacea in the treatment of a number of psychiatric disorders. However, within 5 years, this notion was to be shattered by the recognition of both acute and chronic drug-induced movement disorders which can accompany their administration. Tardive syndromes, denoting the delayed onset of movement

    更新日期:2020-09-21
  • Stop testing for autoantibodies to the VGKC-complex: only request LGI1 and CASPR2.
    Pract. Neurol. Pub Date : 2020-10-01
    Sophia Michael,Patrick Waters,Sarosh R Irani

    Autoantibodies to leucine-rich glioma-inactivated 1 (LGI1) and contactin-associated protein like-2 (CASPR2) are associated with clinically distinctive syndromes that are highly immunotherapy responsive, such as limbic encephalitis, faciobrachial dystonic seizures, Morvan’s syndrome and neuromyotonia. These autoantibodies target surface-exposed domains of LGI1 or CASPR2, and appear to be directly pathogenic

    更新日期:2020-09-21
  • Muscle biopsy: what and why and when?
    Pract. Neurol. Pub Date : 2020-10-01
    Jon Walters,Atik Baborie

    Skeletal muscle biopsy remains an important investigative tool in the diagnosis of a variety of muscle disorders. Traditionally, someone with a limb-girdle muscle weakness, myopathic changes on electrophysiology and raised serum creatine kinase (CK) would have a muscle biopsy. However, we are living through a genetics revolution, and so do all such patients still need a biopsy? When should we undertake

    更新日期:2020-09-21
  • Video consultations in ordinary and extraordinary times.
    Pract. Neurol. Pub Date : 2020-10-01
    Callum Duncan,Angus D Macleod

    Tele-neurology is a neurological consultation at a distance, or not in person, using various technologies to achieve connectivity, including the telephone and the internet. The telephone is ubiquitous and is a standard part of how we manage patients. Video consulting has been used for a long time in some centres, particularly in those where the geography means that patients have to travel long distances

    更新日期:2020-09-21
  • Ataxia telangiectasia: what the neurologist needs to know.
    Pract. Neurol. Pub Date : 2020-10-01
    May Yung Tiet,Rita Horvath,Anke E Hensiek

    Ataxia telangiectasia is an autosomal recessive DNA repair disorder characterised by complex neurological symptoms, with an elevated risk of malignancy, immunodeficiency and other systemic complications. Patients with variant ataxia telangiectasia—with some preserved ataxia telangiectasia-mutated (ATM) kinase activity—have a milder and often atypical phenotype, which can lead to long delays in diagnosis

    更新日期:2020-09-21
  • Photopsia.
    Pract. Neurol. Pub Date : 2020-10-01
    Jasvir Virdee,Susan P Mollan

    ‘Photopsia’ describes the symptom of visual disturbances that are typically flash-like, sudden in onset and brief, and occurring without light entering the eye. Patients reporting photopsia often pose a diagnostic challenge, given the wide range of possible neurological and ophthalmological causes. We review the common causes of photopsia, discuss the assessment and workup of this symptom, and stress

    更新日期:2020-09-21
  • Mesial bifrontal stroke presenting as isolated spontaneous confabulations.
    Pract. Neurol. Pub Date : 2020-10-01
    Vardan Nersesjan,Henrik Gutte Bogwardt,Daniel Kondziella

    A 52-year-old man with paroxysmal atrial fibrillation presented with spontaneous confabulation, working memory deficits, and frontal release signs. MR scan of brain showed bifrontal mesial ischaemic strokes and angiography demonstrated that both anterior cerebral arteries were supplied by the left internal carotid artery. Isolated spontaneous confabulation is a rare presentation of stroke and may be

    更新日期:2020-09-21
  • A neurologist with Parkinson's disease.
    Pract. Neurol. Pub Date : 2020-10-01
    David Blacker

    I could feel Parkinson’s disease creeping up on me, so when I finally summoned up the courage to have a colleague assess me and make the diagnosis, it was of no surprise; in fact, it was almost a relief. In my mid-30s, I had taken up long-distance running, mainly to shed the weight I’d stacked on during training and fellowship years. About 10 years later, I developed a gait disturbance, manifesting

    更新日期:2020-09-21
  • Ophthalmoscopy in COVID-19 low-risk patients.
    Pract. Neurol. Pub Date : 2020-10-01
    André Jorge,Ana Inês Martins,Margarida Prata,Cláudia Nazareth,João Cardoso,Pedro Guilherme Vaz,João Lemos

    Since the start of the COVID-19 pandemic, there has been an urgent need to develop protective measures to ensure patient and healthcare worker safety in clinical situations. Direct/monocular ophthalmoscopy is particularly difficult to perform safely, given the very close proximity of the patient and the clinician. However, ophthalmoscopy is an important and on occasion an irreplaceable element of the

    更新日期:2020-09-21
  • Hypoglossal palsy from an atlanto-axial synovial cyst.
    Pract. Neurol. Pub Date : 2020-10-01
    David Vaughan,Sinead M Murphy,Michael D Alexander,Richard A Walsh

    A 63-year-old man had a 5-week history of a constant right-sided pulsating headache that was initially temporo-parietal but migrated to the suboccipital area. This was associated with new-onset of dysarthria. On examination, there was deviation of the tongue to the right, and the right-side had a wasted surface appearance, despite what he described as ‘wave-like’ prominence when looking at his tongue

    更新日期:2020-09-21
  • Acute leukoencephalopathy in an adult.
    Pract. Neurol. Pub Date : 2020-10-01
    Chulika Makawita,Sudath Ravindra,Ishani Rajapakshe,Bimsara Senanayake

    A 35-year-old unmarried man living alone was brought to the emergency department with acute abdominal pain mainly in the epigastric region. He could not provide any detailed history regarding his presenting complaint but had no fever or other constitutional symptoms. He was known to have diabetes mellitus, but we had no information on any other medical history. Following admission to hospital, his

    更新日期:2020-09-21
  • Epileptic: David B.
    Pract. Neurol. Pub Date : 2020-10-01
    Neil Watson

    The Edinburgh Neurology Book Club recently read cartoonist David B’s Epileptic , a graphic novel and memoir about a childhood hijacked by his brother JC’s epilepsy and his parents’ search for an effective treatment. It is an odyssey through conventional and complementary medicine and a searing critique of both. The family repeatedly uproots as JC is subjected to a host of treatments, including novel

    更新日期:2020-09-21
  • Carphology
    Pract. Neurol. Pub Date : 2020-10-01
    A Fo Ben

    What may be the societal implications of legalising cannabis? The state-by-state variation in the legal status of cannabis in the USA allows for comparison. Using the 2018 roadway fatality data, researchers were able to identify an increase 2.1 (95% CI 1.2 to 2.9; p<0.001) in traffic fatalities in the first four states to legalise the herb. Confounders may abound, but try as they might to correct for

    更新日期:2020-09-21
  • ABN news.
    Pract. Neurol. Pub Date : 2020-10-01
    Joanne Lawrence,Jon Sussman

    ![Graphic][1] Following the July publication of the Cumberlege review, the ABN met with Dr June Raine (Chief Executive of the MHRA) and colleagues to discuss next steps including the possibility of developing a valproate register. The MHRA team were very well briefed on the topic. ABN explained the need for research to better understand the information given to women who become pregnant while taking

    更新日期:2020-09-21
  • Nepal: the pain of stroke treatment.
    Pract. Neurol. Pub Date : 2020-09-18
    Bikram Prasad Gajurel

    Nepal, a small country in the southern part of Asia (figures 1 and 2), is well known over the world for its magnificent natural beauty. Roughly about half the size of the United Kingdom (about 150 000 square kilometres), its rich geography ranges from the hot and humid tropics of the Southern Terai plains (figure 3) adjoining Northern India, to the high mountain range in the north adjoining Tibet,

    更新日期:2020-09-20
  • Concussion: Neurology Film Club with pandemic adaptation.
    Pract. Neurol. Pub Date : 2020-09-16
    Katherine M Sawicka,Neha Patel,Priscilla Kwan,Jeffrey Wang,Felix Tyndel

    The University of Toronto Neurology Film Club has run for 4 years and meets in the 101-year-old Hart House in the campus centre. In light of the ongoing pandemic, the residents, who organise the meetings, arranged for the latest film, Concussion , to be shown on an online social platform with a simultaneous real-time text chat feature.1 We held our customary postfilm discussion on a video-conferencing

    更新日期:2020-09-16
  • The medial hamstring (L5) reflex.
    Pract. Neurol. Pub Date : 2020-09-14
    Euripedes Gomes de Carvalho Neto,Matheus Ferreira Gomes,Mateus Damiani Monteiro,Barbara Maldotti Dalla Corte,Ana Maria Hoppe,Francisco Tellechea Rotta

    A 41-year-old man gave a 1-week history of very intense lower back pain, which radiated down the right posterolateral thigh, to the anterior tibia and the dorsum of the foot. He had previously undergone a renal transplantation. On examination, Lasègue’s sign was positive on the right. The medial hamstring reflex was absent on the right but normal on the left (figure 1 and online supplemental video)

    更新日期:2020-09-14
  • Improving liaison neurology services.
    Pract. Neurol. Pub Date : 2020-09-02
    Geraint N Fuller

    Liaison neurology (consulting with inpatient ward referrals) is the main way that most patients admitted with neurological disease will access neurology services. Most liaison neurology services are responsive, seeing referrals on request, but they also can be proactive, with a regular neurology presence in the acute medical unit. Fewer than half of hospitals in England have electronic systems, yet

    更新日期:2020-09-02
  • Bilateral visual loss in a 60-year-old woman.
    Pract. Neurol. Pub Date : 2020-09-02
    Edward Margolin

    A 60-year-old woman noticed gradually worsening blurred vision in the right eye for several weeks. The patient had history of anxiety and depression. She had never smoked cigarettes and drank alcohol only socially. An optometrist had assessed her vision 2 weeks after the symptoms had begun and recorded visual acuity of 6/60 right and 6/6 left, with a mild right relative afferent pupillary defect, but

    更新日期:2020-09-02
  • Superficial siderosis treated with dural tear repair and deferiprone.
    Pract. Neurol. Pub Date : 2020-08-29
    Nabeela Nathoo,Sandeep Naik,Jeremy Rempel,Emmanuel Gibon,Houssam Bouloussa,Andrew Nataraj,Ken Makus

    A 74-year-old man presented with a 2-year history of gait ataxia, bilateral sensorineural hearing loss, cognitive impairment, vertigo, falls and urinary retention. His mobility had worsened, with several falls over 3 months. Two and half years before, he had been thrown from his quad bike while 3 000 feet up a mountain, hitting his head without a helmet. He had also sustained multiple mild traumatic

    更新日期:2020-08-29
  • Cerebral venous thrombosis: a practical guide.
    Pract. Neurol. Pub Date : 2020-08-29
    Leonardo Ulivi,Martina Squitieri,Hannah Cohen,Peter Cowley,David J Werring

    All neurologists need to be able to recognise and treat cerebral venous thrombosis (CVT). It is difficult to diagnose, partly due to its relative rarity, its multiple and various clinical manifestations (different from ‘conventional’ stroke, and often mimicking other acute neurological conditions), and because it is often challenging to obtain and interpret optimal and timely brain imaging. Although

    更新日期:2020-08-29
  • Neurological letter from Bangladesh.
    Pract. Neurol. Pub Date : 2020-08-28
    Mohammad Selim Shahi,Tauhidul Islam Chowdhury,Oliver Bandmann,Thomas Jenkins

    MSS and TI: Dhaka is the capital of Bangladesh (figure 1) and the fifth largest city by population in the world. It is home to more than 14 million people and to the National Institute of Neurosciences & Hospital (NINS), a government-run neurological centre of excellence, recognised with the health minister’s best performance award for the past 3 consecutive years, since inauguration in 2012. Patients

    更新日期:2020-08-28
  • Contrast-induced encephalopathy: a complication of coronary angiography.
    Pract. Neurol. Pub Date : 2020-08-28
    Tharanga Geethapriya Fernando,Shanika Nandasiri,Sepalika Mendis,Sunethra Senanayake,Inuka Kishara Gooneratne,Rayno Navinan,Ambiga Kadiragamanathan,Sumudu Wickramasinghe,Tharuka Herath,Narmathey Thambirajah,Romesh Markus

    Contrast-induced encephalopathy is a rare idiosyncratic reaction to contrast material. A 56-year-old woman with hypertension developed a hemiparesis with confusion and disorientation 3 hours after routine coronary angiography. The procedure had been prolonged, and during it she had received 130 mL of iopromide contrast. A metabolic screen was negative, and cerebral angiography and MR scan of brain

    更新日期:2020-08-28
  • Cortical foot.
    Pract. Neurol. Pub Date : 2020-08-28
    Robin Fox,Laszlo Sztriha

    An 83-year-old woman presented with an acute onset of foot drop. Whilst the pattern of weakness initially appeared to be most likely due to a peripheral cause, an MR scan of the brain showed a small cortical stroke. This rare phenomenon appears similar to the more widely described ‘cortical hand’.

    更新日期:2020-08-28
  • Scleromyxoedema, blistering lesions and progressive sensorimotor neuropathy in Waldenström's macroglobulinaemia.
    Pract. Neurol. Pub Date : 2020-08-27
    Poornima Jayadev Menon,Michael D Alexander,Lisa Costelloe,Julie MacMahon,Anne-Marie Tobin,Ronan Desmond,Sinéad M Murphy

    A 62-year-old man reported tingling and numbness in his hands over 8 months that had progressed to his wrists, and with hand weakness. Two years previously he had developed thickening of the skin on his face and blistering skin lesions on his hands. He also reported erectile dysfunction. On examination, his facial skin was visibly thickened (figure 1). There was an ulcer overlying the second right

    更新日期:2020-08-28
  • Descriptive neuroradiology: beyond the hummingbird.
    Pract. Neurol. Pub Date : 2020-08-27
    Inna Page,Frank Gaillard

    Radiology signs have long been described in ways that communicate the imagery around us to enhance our cognitive perception. Here, we describe the use and limitations of 10 such signs in neuroradiology, divided into three groups. The first are signs that are reliable for a specific diagnosis, such as the Medusa head sign indicating a developmental venous anomaly, or a racing car sign in agenesis of

    更新日期:2020-08-28
  • Fluorosis causing spinal cord compression.
    Pract. Neurol. Pub Date : 2020-08-07
    Varsha Ambwani,Nikhil Dongre,Vivek Singh,Vimal Kumar Paliwal

    A 40-year-old woman, resident of Eastern Uttar Pradesh, India, reported 3 years of low back pain experiencing difficulty walking and 2 years of numbness in legs. On examination, there was dark brown pigmentation on the surface of all her teeth and horizontal brown lines on most of her teeth (figure 1A). She had spastic tetraparesis (strength at shoulder 4/5, legs 4/5) with generally brisk deep tendon

    更新日期:2020-08-08
  • Highlights from this issue.
    Pract. Neurol. Pub Date : 2020-08-01
    Phil E M Smith,Geraint N Fuller

    ‘The people of this country have had enough of experts…’ This extraordinary quotation is from a British politician who most definitely is not a neurologist, and certainly not a reader of Practical Neurology . Readers of this journal love experts, and particularly those who think critically about what they do, and can distil their knowledge so that we, the jobbing neurologists, can make this expertise

    更新日期:2020-07-28
  • When to think about mitochondrial disease.
    Pract. Neurol. Pub Date : 2020-08-01
    Yi Shiau Ng,Doug M Turnbull

    Mitochondrial diseases are one of the most common groups of neurogenetic disease, with an estimated prevalence of 1 in 4300.1 There have been many syndromic presentations of mitochondrial disease described over the last few decades, such as chronic progressive external ophthalmoplegia, Leigh syndrome, mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) and neurogenic weakness

    更新日期:2020-07-28
  • Primary lateral sclerosis: diagnosis and management.
    Pract. Neurol. Pub Date : 2020-08-01
    Martin R Turner,Kevin Talbot

    Primary lateral sclerosis (PLS) is a rare neurodegenerative disorder at the upper motor neurone extreme of the spectrum of motor neurone disease. The diagnosis is clinical and based on the characteristic features of slowly progressive spasticity beginning in the lower limbs, or more rarely with spastic dysarthria, typically presenting around 50 years of age. The absence of lower motor neurone involvement

    更新日期:2020-07-28
  • Emergency presentations of movement disorders.
    Pract. Neurol. Pub Date : 2020-08-01
    Sacha E Gandhi,Edward J Newman,Vicky L Marshall

    Movement disorders are typically perceived as being gradually progressive conditions that are managed in outpatient settings. However, they may manifest de novo with an acute severe phenotype or an acute decompensation. A movement disorder becomes an emergency when it evolves acutely or subacutely over hours to days; delays in its diagnosis and treatment may cause significant morbidity and mortality

    更新日期:2020-07-28
  • How to diagnose difficult white matter disorders.
    Pract. Neurol. Pub Date : 2020-08-01
    Thomas Williams,Henry Houlden,Elaine Murphy,Nevin John,Nick C Fox,Jonathan M Schott,Matthew Adams,Indran Davagananam,Jeremy Chataway,David S Lynch

    Genetic and acquired disorders of white matter comprise a diverse group of conditions, with often overlapping clinical and radiological findings. Patients present with a variable combination of cognitive impairment, ataxia, spasticity or movement disorders, among others. There are many genetic causes, and the route to diagnosis involves comprehensive clinical assessment, radiological expertise, metabolic

    更新日期:2020-07-28
  • Neurotoxicity-CAR T-cell therapy: what the neurologist needs to know.
    Pract. Neurol. Pub Date : 2020-08-01
    Lorna Neill,Jeremy Rees,Claire Roddie

    Chimeric antigen receptor (CAR) T-cell therapy is one of the most innovative therapies for haematological malignancies to emerge in a generation. Clinical studies have shown that a single dose of CAR T-cells can deliver durable clinical remissions for some patients with B-cell cancers where conventional therapies have failed. A significant complication of CAR therapy is the immune effector cell-associated

    更新日期:2020-07-28
  • Next steps after diagnosing dementia: interventions to help patients and families.
    Pract. Neurol. Pub Date : 2020-08-01
    Antony Bayer

    The way that a diagnosis of dementia is delivered to patients, what information is provided and what practical advice and support is arranged has a lasting impact and deserves at least as much attention as the process of assessment and investigation. Individuals and their families require an honest yet sensitive discussion about the nature and cause of their problems, using non-technical language and

    更新日期:2020-07-28
  • Diagnosis and management of acute ischaemic stroke.
    Pract. Neurol. Pub Date : 2020-08-01
    Robert Hurford,Alakendu Sekhar,Tom A T Hughes,Keith W Muir

    Acute ischaemic stroke is a major public health priority and will become increasingly relevant to neurologists of the future. The cornerstone of effective stroke care continues to be timely reperfusion treatment. This requires early recognition of symptoms by the public and first responders, triage to an appropriate stroke centre and efficient assessment and investigation by the attending stroke team

    更新日期:2020-07-28
  • DCTN1-related Parkinson-plus disorder (Perry syndrome).
    Pract. Neurol. Pub Date : 2020-08-01
    Daniel Richardson,Meriel M McEntagart,Jeremy D Isaacs

    Dynactin-1 (DCTN1)-related Parkinson-plus disorder (Perry syndrome) is an autosomal dominant neurodegenerative disorder characterised by levodopa-resistant parkinsonism, weight loss, mood change and central hypoventilation. Ventilatory insufficiency is the predominant cause of death. It has been previously described in 87 people from 20 families with a worldwide distribution. It is now recognised as

    更新日期:2020-07-28
  • CSF lactate.
    Pract. Neurol. Pub Date : 2020-08-01
    Aravindhan Baheerathan,Robert Ds Pitceathly,Carmel Curtis,Nicholas Ws Davies

    Lactate is produced from anaerobic glycolysis, which occurs in most tissues in the human body. Blood lactate is tested in most physiologically unwell patients in the Emergency Department and helps to guide treatment and prognosis. Cerebrospinal fluid (CSF) lactate, however, is not often measured. Various central nervous system (CNS) conditions lead to a rise in CSF lactate, including acute neurological

    更新日期:2020-07-28
  • Clinicopathological case: headache and systemic inflammatory illness—Occam vs Hickam
    Pract. Neurol. Pub Date : 2020-08-01
    James D Bridson; Edward J Newman; Helen E Harris; Derek AJ Smith; Richard J Davenport

    A 63-year-old woman presented with a sudden headache, which persisted and subsequently changed in character. Over time, constitutional features developed, leading to an unexpected diagnosis. This report documents the clinicopathological conference at the Association of British Neurologists Annual Meeting 2019.

    更新日期:2020-07-28
  • Contralateral hyperhidrosis following lateral medullary infarction.
    Pract. Neurol. Pub Date : 2020-08-01
    Tharani Thirugnanachandran,Henry Ma,Thanh Phan

    A 39-year-old woman presented with vertigo and difficulty controlling her right side. She had a right-sided Horner’s syndrome, gaze-evoked horizontal nystagmus with the fast-beating phase to the left, and right upper and lower limb ataxia with reduced temperature sensation to the left side of her face, arm and leg. MR scan of brain showed a right lateral medullary infarct secondary to a dissection

    更新日期:2020-07-28
  • Sphenoid sinus aspergilloma with sixth nerve palsy.
    Pract. Neurol. Pub Date : 2020-08-01
    Eleftherios Agorogiannis,Christos Korais,Athanasios Saratziotis,Jiannis Hajiioannou,John Bizakis

    A 58-year-old immunocompetent woman gave a 2-week history of headache, facial pain and fever, without photophobia, nausea or vomiting. Initially, the pain was left-sided retrobulbar and radiated to the vertex. It was dull and intermittent without postural variation but progressively intensified, becoming more constant with nocturnal interference. The pain gradually extended bilaterally to the cheeks

    更新日期:2020-07-28
  • Horner's syndrome and apraclonidine eye drops.
    Pract. Neurol. Pub Date : 2020-08-01
    Edward Margolin,Trishal Jeeva-Patel,Nicolin Hainc

    A 62-year-old woman had noticed a droopy right eyelid for 2 weeks. She had a history of stage 2 breast cancer, treated 10 years before with mastectomy, radiotherapy and chemotherapy. She was otherwise healthy and took no medications. On examination, there was mild right upper eyelid ptosis and anisocoria, more pronounced in the dark, with the right pupil smaller than the left. Testing with 0.5% apraclonidine

    更新日期:2020-07-28
  • Fatal cerebellar oedema in adult Leigh syndrome.
    Pract. Neurol. Pub Date : 2020-08-01
    Leon S Edwards,Gabor M Halmagyi,Amali Mallawaarachchi,Elizabeth O Thompson,Matthew C Kiernan

    A 19-year-old female university student presented with a 5-week history of generalised weakness, unsteady gait and breathlessness. There were no symptoms of recent infection. Her only medical history was long-standing symmetrical 40 dB sensorineural hearing loss. On neurological examination, she had hyperpnoea, mild non-fatigable global weakness, bilateral ptosis, soft speech and absent lower limb

    更新日期:2020-07-28
  • A treatable cause of vertigo.
    Pract. Neurol. Pub Date : 2020-08-01
    Benjamin Nham,Allison S Young,Roger Garsia,G Michael Halmagyi,Miriam S Welgampola

    ### Key points A 69-year-old man presented to the Emergency Department with 1 day of acute spontaneous vertigo, left-sided tinnitus and hearing loss. He had no otalgia, previous vertigo or hearing problems but did have a background of diabetes and hypertension. On examination, with fixation, there was no nystagmus, but without visual fixation (using Frenzel’s goggles), there was primary position left-beating

    更新日期:2020-07-28
  • Acute anosmia from COVID-19 infection.
    Pract. Neurol. Pub Date : 2020-08-01
    Sofia Mermelstein

    I am a 27-year-old neurology registrar working on the wards in a teaching hospital, Pedro Ernesto University Hospital. As a public health reference centre in Rio, we had prepared to receive coronavirus-infected patients, and I worried that sooner rather than later, I would contract the infection myself. I began to feel ill on Sunday, 21 March, just 1 week after the quarantine measures had started,

    更新日期:2020-07-28
  • Why We Sleep by Matthew Walker.
    Pract. Neurol. Pub Date : 2020-08-01
    Jonathan Hawken

    Matthew Walker (University of California, Berkeley) is a neuroscientist rather than a clinician. His book begins with an explanation of the physiology and function of sleep and dreaming, starting in utero and progressing through an individual’s lifetime. It explores the short-term and long-term consequences that result from insufficient sleep and concludes with personal and public health measures that

    更新日期:2020-07-28
  • Carphology
    Pract. Neurol. Pub Date : 2020-08-01
    A Fo Ben

    Time is brain when it comes to door-to-needle times for acute ischaemic stroke, right? A retrospective study of 61 426 people aged over 65 treated with intravenous tissue plasminogen activator shows that long delays before therapy are significantly associated with higher all-cause mortality at a year and higher likelihood of all-cause readmission at a year. With every increase in 15 min, the hazard-ratio

    更新日期:2020-07-28
  • ABN news.
    Pract. Neurol. Pub Date : 2020-08-01
    Joanne Lawrence,Jon Sussman

    From the early days of the COVID-19 crisis, it was clear that 2020 would be no ordinary year for the ABN. Its committees and advisory groups moved swiftly to develop and update guidance for people with neurological conditions, their doctors and carers. Hosted on a website restructured to accommodate an expanding COVID-19 section, this was supplemented by the best of inhouse and external guidance on

    更新日期:2020-07-28
  • Protecting people with multiple sclerosis through vaccination.
    Pract. Neurol. Pub Date : 2020-07-06
    Saúl Reyes,Mary Ramsay,Shamez Ladhani,Gayatri Amirthalingam,Neena Singh,Carlos Cores,Joela Mathews,Jonathan Lambourne,Monica Marta,Benjamin Turner,Sharmilee Gnanapavan,Ruth Dobson,Klaus Schmierer,Gavin Giovannoni

    Vaccines are key to preventing contagious, or serious, infections. However, their use in people with multiple sclerosis (pwMS) has often been problematic because of misguided concerns that vaccinations may exacerbate the disease and also because some disease-modifying therapies (DMTs) may influence the immune response to immunisations and/or their safety. PwMS may have higher morbidity and mortality

    更新日期:2020-07-06
  • Moyamoya disease.
    Pract. Neurol. Pub Date : 2020-07-03
    Andrea Gioppo,Francesco Acerbi,Anna Bersano,Giuseppe Faragò

    A 36-year-old woman presented with transient diplopia and right-sided paresthesia. MR scan of the brain showed multiple chronic ischaemic lesions in the white matter, linear hyperdensities along sulci and reduced visibility of the middle cerebral arteries (figure 1A– B). Angiography identified progressive narrowing of the internal carotid arteries, with tiny and tortuous lenticulostriate arteries giving

    更新日期:2020-07-03
  • British Society for Rheumatology guideline for diagnosis and treatment of giant cell arteritis.
    Pract. Neurol. Pub Date : 2020-07-01
    Susan P Mollan,Sarah L Mackie

    Giant cell arteritis (GCA) presents to all specialties due to its early non-specific initial symptoms. As new-onset headache is one of the principal symptoms of cranial GCA, neurologists often assess (and indeed may manage) people with this condition, in isolation from rheumatology. The British Society of Rheumatology, which has been accredited by the National Institute for Health and Care Excellence

    更新日期:2020-07-01
  • Non-traumatic CSF rhinorrhoea.
    Pract. Neurol. Pub Date : 2020-06-25
    Geoffrey Ronan,Rachel Barry,Noel Fanning,Áine Merwick

    A 53-year-old woman presented with acute onset of bifrontal headache with fever and vomiting, and a 6-week history of unilateral, left-sided, clear, salty rhinorrhoea. She worked as a veterinary pathologist. On examination, her neck movements were painful, but there were no localising neurological signs. She was obese with a body mass index of 36.5 kg/m2(height 162 cm, weight 96 kg). Cerebrospinal

    更新日期:2020-06-25
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