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  • Highlights from this issue
    Pract. Neurol. Pub Date : 2021-02-01
    Phil E M Smith; Geraint N Fuller

    This first edition of 2021 arrives along with signs that the world is beginning to get to grips with COVID-19. Several vaccines have proven effective, strategies to reduce transmission are helping to varying degrees and we have a better understanding of how to manage the disorder. This has all happened at extraordinary speed, moving from a general approach using basic principles with interventions

    更新日期:2021-01-19
  • Vertebrobasilar insufficiency: an insufficient term that should be retired
    Pract. Neurol. Pub Date : 2021-02-01
    Arvind Chandratheva; David Werring; Diego Kaski

    The concept of vertebrobasilar insufficiency was introduced by Silversides in 1954. Milliken and Siekert coined the term in 1955 when describing eight patients with symptoms suggesting episodic ‘insufficiency’ of blood flow in the vertebrobasilar arterial territory supplying the brainstem with—in four cases—basilar artery thrombosis found at postmortem. This followed Denny-Brown’s descriptions of ‘cerebrovascular

    更新日期:2021-01-19
  • Big data, machine learning and artificial intelligence: a neurologist’s guide
    Pract. Neurol. Pub Date : 2021-02-01
    Stephen D Auger; Benjamin M Jacobs; Ruth Dobson; Charles R Marshall; Alastair J Noyce

    Modern clinical practice requires the integration and interpretation of ever-expanding volumes of clinical data. There is, therefore, an imperative to develop efficient ways to process and understand these large amounts of data. Neurologists work to understand the function of biological neural networks, but artificial neural networks and other forms of machine learning algorithm are likely to be increasingly

    更新日期:2021-01-19
  • Anaesthesia and neuromuscular disorders: what a neurologist needs to know
    Pract. Neurol. Pub Date : 2021-02-01
    Luuk R van den Bersselaar; Marc M J Snoeck; Madelief Gubbels; Sheila Riazi; Erik-Jan Kamsteeg; Heinz Jungbluth; Nicol C Voermans

    Neurologists are often asked for specific advice regarding patients with neuromuscular disease who require general anaesthesia. However, guidelines on specific neuromuscular disorders do not usually include specific guidelines or pragmatic advice regarding (regional and/or general) anaesthesia or procedural sedation. Furthermore, the medical literature on this subject is mostly limited to publications

    更新日期:2021-01-19
  • Memory complaints in the epilepsy clinic.
    Pract. Neurol. Pub Date : 2021-02-01
    Sallie Baxendale,Dominic Heaney

    Cognitive complaints in people with epiltify 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:2021-01-19
  • Peripheral nerve blocks for headache disorders
    Pract. Neurol. Pub Date : 2021-02-01
    Linford Fernandes; Marc Randall; Luis Idrovo

    Headache is a common neurological referral and a frequent cause for acute hospital admissions. Despite peripheral nerve blocks being widely used in headache and pain services to treat patients with headache disorders, there is no readily accessible resource with instructions for the delivery of peripheral nerve blocks. Here we provide a practical approach for administering peripheral nerve blocks and

    更新日期:2021-01-19
  • Ammonia: what adult neurologists need to know
    Pract. Neurol. Pub Date : 2021-02-01
    Rick Meijer; Umesh Vivekananda; Simona Balestrini; Matthew Walker; Robin Lachmann; Johannes Haeberle; Elaine Murphy

    Hyperammonaemia is often encountered in acute neurology and can be the cause of acute or chronic neurological symptoms. Patients with hyperammonaemia may present with seizures or encephalopathy, or may be entirely asymptomatic. The underlying causes are diverse but often straightforward to diagnose, although sometimes require specialist investigations. Haemodialysis or haemo(dia)filtration is the first-line

    更新日期:2021-01-19
  • Mitochondrial neurogastrointestinal encephalopathy disease (MNGIE).
    Pract. Neurol. Pub Date : 2021-02-01
    Simon R Hammans

    Mitochondrial neurogastrointestinal encephalopathy (MNGIE) is a rare autosomal recessive condition. Deficiency of thymidine phosphorylase disrupts the nucleoside pool, with progressive secondary mitochondrial DNA damage. MNGIE is clinically diagnosable because of a distinctive tetrad of gastrointestinal dysmotility, progressive external ophthalmoplegia, demyelinating neuropathy and asymptomatic leucoencephalopathy

    更新日期:2021-01-19
  • Myotonic dystrophy: a cause of acute breathlessness not to be missed.
    Pract. Neurol. Pub Date : 2021-02-01
    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:2021-01-19
  • Craniectomy for acute disseminated encephalomyelitis.
    Pract. Neurol. Pub Date : 2021-02-01
    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:2021-01-19
  • Oophorectomy in NMDA receptor encephalitis and negative pelvic imaging
    Pract. Neurol. Pub Date : 2021-02-01
    Dustin Anderson; Nabeela Nathoo; Monica Henry; George Wood; Penelope Smyth; Jennifer McCombe

    Ovarian teratomas are found in one-third of females presenting with anti- N -methyl-D-aspartate receptor (NMDAR) encephalitis. When a teratoma is detected on imaging, its removal is first-line therapy. Even with multiple imaging modalities, occasionally, the teratoma is found only on subsequent imaging, long after initial presentation. Very rarely, patients have undergone oophorectomy despite negative

    更新日期:2021-01-19
  • Orthostatic hearing loss: audiovestibular manifestations of spontaneous intracranial hypotension
    Pract. Neurol. Pub Date : 2021-02-01
    Frederick Schon; Arun Karunakaran; Sarah Shanmuganathan; Arani Nitkunan

    A 36-year-old woman with severe postural headaches caused by spontaneous intracranial hypotension developed bilateral hearing loss. Her hearing loss varied in severity and also at times affected one ear more than the other. She noticed her hearing returned to normal on lying flat, and this was confirmed on audiometry. Her hearing fully recovered after treatment with blood patches. Audiovestibular symptoms

    更新日期:2021-01-19
  • Bobble-head doll syndrome with supra-sellar arachnoid cyst
    Pract. Neurol. Pub Date : 2021-02-01
    Done Indira Priya; Ramkumar Sugumaran; Narayan Sunil K; Chauhan Supriya

    A 19-year-old woman reported progressively worsening involuntary head movements since the age of 7. She had visited multiple hospitals and been labelled as having a functional disorder. Detailed evaluation identified a large supra-sellar arachnoid cyst with hydrocephalus. We made a diagnosis of bobble-head doll syndrome, which is only very rarely associated with suprasellar arachnoid cyst. Her symptoms

    更新日期:2021-01-19
  • Fluorosis causing spinal cord compression.
    Pract. Neurol. Pub Date : 2021-02-01
    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:2021-01-19
  • Superficial siderosis treated with dural tear repair and deferiprone.
    Pract. Neurol. Pub Date : 2021-02-01
    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:2021-01-19
  • Cortical foot.
    Pract. Neurol. Pub Date : 2021-02-01
    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:2021-01-19
  • Cerebral venous sinus thrombosis associated with COVID-19
    Pract. Neurol. Pub Date : 2021-02-01
    Ameeka Thompson; Catherine Morgan; Paul Smith; Christopher Jones; Harriet Ball; Elizabeth J Coulthard; Ed Moran; Konrad Szewczyk-Krolikowski; Claire M Rice

    Coronavirus disease of 2019 (COVID-19) is well known to increase the risk of developing venous thromboembolism; thus, patients with COVID-19 may present to neurologists with cerebral venous sinus thrombosis. We present a patient presenting acutely with delirium, who after initial negative viral testing, was diagnosed with cerebral venous sinus thrombosis in association with COVID-19. A 50-year-old

    更新日期:2021-01-19
  • Bilateral visual loss in a 60-year-old woman.
    Pract. Neurol. Pub Date : 2021-02-01
    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:2021-01-19
  • Nepal: the pain of stroke treatment.
    Pract. Neurol. Pub Date : 2021-02-01
    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:2021-01-19
  • How Proust can change your life
    Pract. Neurol. Pub Date : 2021-02-01
    Harsh Bhatt; Tom A T Hughes

    Marcel Proust was arguably the greatest 20th-century French novelist. He also had a deep connection with neurological diseases and with neurologists. Through his physician father, he knew Brissaud (Charcot’s pupil), considered treatment by Dejerine and consulted Babinski when his health failed in later years.1 Alain de Botton’s commentary entitled ‘How Proust can change your life’2 therefore made for

    更新日期:2021-01-19
  • Concussion: Neurology Film Club with pandemic adaptation.
    Pract. Neurol. Pub Date : 2021-02-01
    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:2021-01-19
  • Carphology
    Pract. Neurol. Pub Date : 2021-02-01
    A Fo Ben

    The transition from mild cognitive impairment (MCI) to dementia can only be understood backwards; but it must be lived forwards. Group-wise risk factors are known—but for trials and prognostication, individual risk prediction is needed. Using plasma biomarkers, researchers created models using 573 patients with MCI. The model that combines tau phosphorylated at threonine 181 (P-tau181) and neurofilament

    更新日期:2021-01-19
  • ABN News
    Pract. Neurol. Pub Date : 2021-02-01
    Joanne Lawrence; Jon Sussman

    ![Graphic][1] 20, 21 May 2021 plus evening sessions 29 April, 6 May and 13 May. Registration for the ABN 2021 annual scientific meeting opened in December 2020. The meeting will again be virtual; however, the second day will feature a live-streamed programme plus small, socially distanced audience. Following the success of the ABN’s first virtual Annual meeting in 2020, we have worked to improve opportunities

    更新日期:2021-01-19
  • Nerve root enhancement in Guillain-Barré syndrome
    Pract. Neurol. Pub Date : 2021-01-18
    Waqar Waheed; Rup Tandan; Michael Bazylewicz

    A 26-year-old woman presented with low back pain, perineal numbness, double incontinence and numbness involving her distal upper and lower limbs, with mild weakness of both legs. These symptoms followed a 3-week history of gastrointestinal illness. On neurological examination, there was weakness (Medical Research Council grade 4/5) of finger abduction and in proximal and distal leg muscles. Deep tendon

    更新日期:2021-01-18
  • Levels of Life by Julian Barnes
    Pract. Neurol. Pub Date : 2021-01-17
    Hamish Duncan Morrison; Roswell Martin

    Gloucester Neurology Book Club convened over Zoom for its first meeting in the COVID-19 era to discuss Levels of Life,1 Barnes’ grief memoir. Despite some attendees bemoaning the need to pour their own drinks and failing to unmute microphones, the virtual format was a successful platform for open dialogue on an important and deeply personal topic. In 2008, Barnes’s wife Pat Kavanagh was diagnosed with

    更新日期:2021-01-18
  • Black blood imaging of intracranial vessel walls
    Pract. Neurol. Pub Date : 2021-01-07
    Joga Chaganti; Hannah Woodford; Susan Tomlinson; Sophie Dunkerton; Bruce Brew

    Traditional vascular imaging focuses on non-invasive cross-sectional imaging to assess luminal morphology; however, the vessel wall itself may be specifically involved in many diseases. Newer pulse sequences, and particularly black blood MRI of intracranial vessels, have brought a paradigm shift in understanding the pathophysiology of many vasculopathies. Black blood MRI of intracranial vessel walls

    更新日期:2021-01-07
  • CLIPPERS
    Pract. Neurol. Pub Date : 2020-12-29
    Aniello Iovino; Walter Del Vecchio; Francesco Aruta; Rosa Iodice

    We present the clinical case of a woman suffering from CLIPPERS syndrome (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids). The images obtained from the brain magnetic resonance show the lesions typical of the disease.

    更新日期:2020-12-29
  • Refractory CIDP with chronic lymphocytic leukaemia responding to chemoimmunotherapy
    Pract. Neurol. Pub Date : 2020-12-29
    Dana Lewis; Chinar Osman; David Allen; Ashwin Arnold Pinto; Andrew Duncombe; Haider A Katifi

    Chronic inflammatory demyelinating polyneuropathy (CIDP) has a variable clinical course with 15% remaining refractory to treatment. We report a woman with severe refractory CIDP and coexisting chronic lymphocytic leukaemia (CLL) who improved dramatically after chemoimmunotherapy appropriate for the CLL, including rituximab. A subsequent CIDP relapse after 15 months responded again to similar treatment

    更新日期:2020-12-29
  • Anti-GFAP neuroinflammation with synchronous bilateral papillitis and characteristic imaging
    Pract. Neurol. Pub Date : 2020-12-17
    William John Utley; Adam El-Dieb; Andrew Martin Chancellor

    A 50-year-old female marine ecologist presented to the emergency department following 3 weeks of persistent headache, nausea, vomiting, disturbed vision, intermittent aural pulsations, unsteady gait and acroparesthesias. She had previously been healthy, specifically with no history of autoimmune disease. Mental status, vital signs and general medical examination were normal. Corrected visual acuity

    更新日期:2020-12-17
  • Hyper-religiosity in frontotemporal dementia with predominant atrophy of the right temporal lobe
    Pract. Neurol. Pub Date : 2020-12-15
    Maria Karatzikou; Theodora Afrantou; Dimitrios Parissis; Panagiotis Ioannidis

    A 56-year-old Greek woman developed personality changes, presenting first with prominent hyper-religiosity alternating with periods of retardation, together with social disinhibition. For 10 months before, she had expressed extravagant religiosity, having previously been religiously indifferent. She had begun praying at home, reading Christian magazines and attending church frequently. She had also

    更新日期:2020-12-15
  • Young-onset frontotemporal dementia with FUS pathology
    Pract. Neurol. Pub Date : 2020-12-11
    Matthew Gowell; Ian Baker; Olaf Ansorge; Masud Husain

    Frontotemporal dementia (FTD) is an uncommon cause of behavioural change in adults under the age of 50. A 44-year-old man presented with progressive neuropsychiatric disturbance characterised by social withdrawal, apathy, loss of empathy, motor stereotypies and hyperorality. Cognitive testing identified severe impairment, including executive dysfunction. MR scan of the brain showed bilateral symmetrical

    更新日期:2020-12-11
  • Rhomboencephalitis
    Pract. Neurol. Pub Date : 2020-12-08
    Jonathan Cleaver; Richard James; Claire M Rice

    Rhomboencephalitis—inflammation of the brainstem and cerebellum—has myriad clinical presentations including encephalopathy, cranial neuropathies, long tract signs and cerebellar dysfunction and is associated with significant morbidity and mortality. There are a variety of potential underlying causes that respond variably to treatment, including infections, parainfective syndromes, inflammatory disorders

    更新日期:2020-12-08
  • Acute intracerebral haemorrhage: diagnosis and management
    Pract. Neurol. Pub Date : 2020-12-07
    Iain J McGurgan; Wendy C Ziai; David J Werring; Rustam Al-Shahi Salman; Adrian R Parry-Jones

    Intracerebral haemorrhage (ICH) accounts for half of the disability-adjusted life years lost due to stroke worldwide. Care pathways for acute stroke result in the rapid identification of ICH, but its acute management can prove challenging because no individual treatment has been shown definitively to improve its outcome. Nonetheless, acute stroke unit care improves outcome after ICH, patients benefit

    更新日期:2020-12-08
  • Axial muscle weakness
    Pract. Neurol. Pub Date : 2020-12-01
    Waqar Waheed; James Brian Allison; John Dewitt; Sharon Hallman; Rup Tandan

    Axial myopathy is a rare neuromuscular disorder characterised by selective involvement of the paraspinal muscles, and presenting either as a bent spine and/or dropped head syndrome. The axial muscles can be involved in various conditions, including neuromuscular disease, movement disorders, spinal disease and metabolic disorders. There have been recent descriptions of disorders with selective axial

    更新日期:2020-12-01
  • Dysarthria and ptosis
    Pract. Neurol. Pub Date : 2020-11-28
    Rachael Matthews; Farhat Mirza; Rekha Siripurapu; Ranjit Ramdass; Anoop Ranjan Varma; Rajiv Mohanraj

    A 56-year-old man attended the emergency department with his wife, who reported that his speech had become slurred (he denied this) and that he may be having a stroke. The patient described only occasional swallowing difficulty. He had a 10-year history of progressive hearing loss requiring bilateral hearing aids. When aged 11 years, he had undergone resection and radiotherapy for a posterior fossa

    更新日期:2020-12-01
  • Unilateral meningitis: unusual central nervous system involvement in rheumatoid arthritis
    Pract. Neurol. Pub Date : 2020-11-28
    Carla Tortorella; Luca Prosperini; Giandomenico Sebastiani; Claudio Gasperini

    A 40-year-old woman developed acute onset of right-sided weakness with ipsilateral partial motor seizures. She had a 6-month history of well-controlled rheumatoid arthritis treated with certolizumab (a biological pegylated tumour necrosis factor (TNF)-α inhibitors). MR scan of brain showed diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) hyperintensity of the left fronto-parietal

    更新日期:2020-12-01
  • Menière’s disease
    Pract. Neurol. Pub Date : 2020-11-28
    Mansur Amirovich Kutlubaev; Ilmari Pyykko; Todd A Hardy; Robert Gürkov

    Menière’s disease causes paroxysmal rotatory vertigo, due to endolymphatic hydrops, an accumulation of endolymph in the endolymphatic space of the labyrinth. Its major symptoms are attacks of rotatory vertigo lasting minutes to hours, with unilateral hearing loss, tinnitus and aural fullness. As the disease progresses, attacks happen less often, but hearing loss and tinnitus gradually become permanent

    更新日期:2020-12-01
  • Highlights from this issue
    Pract. Neurol. Pub Date : 2020-12-01
    Phil E M Smith; Geraint N Fuller

    At this time of the year, editorials traditionally reflect on the year’s highlights and note whether last year’s predictions have come to pass, before making further forecasts. Were our predictions correct? Sadly no, we certainly did not anticipate what 2020 would bring. Who can predict what will happen next? A vaccine may soon be here. Perhaps only now we are appreciating the true value of the vaccines

    更新日期:2020-11-23
  • Don’t do the blood* test!!
    Pract. Neurol. Pub Date : 2020-12-01
    Jacqueline Palace; Geraint Fuller

    Classical neurology teaching highlighted that investigations make a very small contribution to the diagnosis; we were therefore encouraged to focus on our clinical skills, and particularly the history. However, the development of increasingly sophisticated diagnostic techniques, particularly in imaging and genetics, has made us rely more on investigations in coming to a diagnosis. Several factors encourage

    更新日期:2020-11-23
  • Neuroretinitis: a tricky mimic.
    Pract. Neurol. Pub Date : 2020-12-01
    Christian J Lueck

    Neuroretinitis is relatively rare. It refers to the triad of subacute visual loss, optic disc swelling and a macular star (figure 1), often in association with cells in the vitreous.1–4 An illustrative case is presented in this issue of Practical Neurology .5 The macular star typically takes 1–2 weeks to develop, meaning that it is usually not possible to make the diagnosis when the patient first presents

    更新日期:2020-11-23
  • Fasciculation anxiety syndrome in clinicians: FASICS
    Pract. Neurol. Pub Date : 2020-12-01
    Matthew C Kiernan

    It is the phone call that every neurologist dreads. A colleague, diagnosed with motor neurone disease (MND), looking for a confirmatory opinion. From personal experience over the last 25 years, these calls have become all too regular. My early reactions were fear and apprehension. How could I possibly confirm such a life-changing diagnosis for a friend or fellow clinician and remain positive when we

    更新日期:2020-11-23
  • Protecting people with multiple sclerosis through vaccination.
    Pract. Neurol. Pub Date : 2020-12-01
    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

    Vaccination is one of the most effective and cost-efficient methods for protecting people with multiple sclerosis (MS) from infections. However, use of vaccines has often been problematic because of misguided concerns that they may exacerbate the disease and/or that some disease-modifying therapies may influence the immune response to immunisations and/or their safety. People with MS risk higher morbidity

    更新日期:2020-11-23
  • Nystagmus goggles: how to use them, what you find and what it means
    Pract. Neurol. Pub Date : 2020-12-01
    G Michael Halmagyi; Leigh A McGarvie; Michael Strupp

    A fundamental characteristic of peripheral vestibular nystagmus, in particular horizontal nystagmus, is that it is suppressed by visual fixation. This means that a patient with a vertigo attack of peripheral vestibular origin might have no obvious spontaneous nystagmus on clinical examination. Goggles that reduce or remove visual fixation allow the cliniican to observe nystagmus in this situation.

    更新日期:2020-11-23
  • Amyloid PET imaging in clinical practice.
    Pract. Neurol. Pub Date : 2020-12-01
    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:2020-11-23
  • Descriptive neuroradiology: beyond the hummingbird.
    Pract. Neurol. Pub Date : 2020-12-01
    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:2020-11-23
  • The medial hamstring (L5) reflex.
    Pract. Neurol. Pub Date : 2020-12-01
    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:2020-11-23
  • British Society for Rheumatology guideline for diagnosis and treatment of giant cell arteritis.
    Pract. Neurol. Pub Date : 2020-12-01
    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:2020-11-23
  • Charcot in the ICU: functional tetraplegia after surgery.
    Pract. Neurol. Pub Date : 2020-12-01
    Kristen M Scheitler,Cynthia R Robin,E F M Wijdicks

    Functional neurological disorder is a condition in which a patient has physical findings that are not compatible with anatomical boundaries, have no structural substrate and are not representable of an established disease. General anaesthesia and surgery have been previously reported as precipitating factors for functional disorders and mostly involve dissociative (non-epileptic) seizures. We report

    更新日期:2020-11-23
  • Huntington’s disease-like 2: a phenocopy not to miss
    Pract. Neurol. Pub Date : 2020-12-01
    Daniel Sabino De Oliveira; Daniela Pereira Santos; Daniel Oliveira Araujo; Pedro José Tomaselli; WIlson Marques Júnior; Thiago Cardoso Vale

    A 67-year-old Brazilian man of African ancestry and his 60-year-old sister both presented with choreiform movements, although in the man these were significantly overshadowed by additional parkinsonism. The man also had a history of four epileptic seizures. Neurological examination in each also found slow saccades and a dysexecutive syndrome. Genetic tests for Huntington’s disease were negative but

    更新日期:2020-11-23
  • Contrast-induced encephalopathy: a complication of coronary angiography.
    Pract. Neurol. Pub Date : 2020-12-01
    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:2020-11-23
  • Acute intermittent porphyria presenting with posterior reversible encephalopathy syndrome (PRES) and abdominal pain.
    Pract. Neurol. Pub Date : 2020-12-01
    Grace Swart,Su San Lim,Martin Jude

    Acute intermittent porphyria is a rare genetic condition in which disrupted haem synthesis causes overproduction of porphyrin precursors. Occasionally, it is associated with posterior reversible encephalopathy syndrome (PRES), presenting with headache, confusion, seizures and visual disturbance. We describe a patient with acute intermittent porphyria who presented with seizures and PRES, and who had

    更新日期:2020-11-23
  • Tips for trainees: some practical tips on clinical examination
    Pract. Neurol. Pub Date : 2020-12-01
    Richard James Stark

    The following tips are designed to help trainees or inexperienced neurologists to reach the right answer in a time-efficient manner. The tools required are easily carried. The list is personal and idiosyncratic; other experienced neurologists may feel they can improve on it. Some tips are very simple and most trainees will know them already, but experience shows that not all do. Expert clinicians use

    更新日期:2020-11-23
  • Improving liaison neurology services.
    Pract. Neurol. Pub Date : 2020-12-01
    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:2020-11-23
  • A confused patient with deranged liver function tests.
    Pract. Neurol. Pub Date : 2020-12-01
    Harry Tucker,Zain Masood,Suresh K Chhetri

    ### Clinical case A 31-year-old right-handed man was transferred by ambulance after falling out of bed. His wife reported that he was agitated, not moving his left side, appeared ‘blue in the face’ and complained that he could not see properly. He had a history of seronegative inflammatory arthritis and keratitis. On arrival at the emergency department, he was significantly agitated and required anaesthetic

    更新日期:2020-11-23
  • Non-traumatic CSF rhinorrhoea.
    Pract. Neurol. Pub Date : 2020-12-01
    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:2020-11-23
  • Frenzel glasses: an affordable alternative.
    Pract. Neurol. Pub Date : 2020-12-01
    Pramod Dhonde,Satish Khadilkar

    Neurologists commonly see patients with vertigo or dizziness. Frenzel goggles, which remove visual fixation as well as magnifying and illuminating the patient’s eyes, can increase the diagnostic accuracy in various vestibular disorders.1 Takeaway Frenzel glasses or M glasses offer an alternative to the Frenzel goggles, being …

    更新日期:2020-11-23
  • Bartonella neuroretinitis (cat-scratch disease).
    Pract. Neurol. Pub Date : 2020-12-01
    Siew Mei Yap,Mamoun Saeed,Patricia Logan,Daniel G Healy

    We report a patient with cat-scratch disease presenting with meningitis and neuroretinitis. This condition, caused by Bartonella henselae, has a worldwide distribution and is among the most common infective causes of neuroretinitis. Bartonella neuroretinitis is a rare but under-recognised mimic of optic neuritis; it should be suspected in a patient with an infective prodrome whose fundus shows optic

    更新日期:2020-11-23
  • Moyamoya disease.
    Pract. Neurol. Pub Date : 2020-12-01
    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:2020-11-23
  • Neurological letter from Bangladesh.
    Pract. Neurol. Pub Date : 2020-12-01
    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:2020-11-23
  • Letter from our virtually neurological world
    Pract. Neurol. Pub Date : 2020-12-01
    Stephen Krieger; Neha Vijayvargiya Safi

    The virtual realm of the internet has connected individuals regardless of the physical distance between them. During the COVID-19 pandemic, when maintaining a physical distance is of the utmost importance, clinicians in all neurological subspecialties have quickly adopted teleneurology via the internet. Clinicians have found inventive ways to examine their patients remotely, and there are now various

    更新日期:2020-11-23
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