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  • Clinicopathological case: headache and systemic inflammatory illness—Occam vs Hickam
    Pract. Neurol. Pub Date : 2020-07-09
    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.

  • Mesial bifrontal stroke presenting as isolated spontaneous confabulations
    Pract. Neurol. Pub Date : 2020-07-07
    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

  • 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

  • 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

  • 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

  • Stop testing for autoantibodies to the VGKC-complex: only request LGI1 and CASPR2
    Pract. Neurol. Pub Date : 2020-06-28
    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

  • 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

  • Correction: The Waiting Room: neurological observations made outside the movement disorder specialist’s consulting office
    Pract. Neurol. Pub Date : 2020-06-24
    BMJ Publishing Group Ltd

    Araújo R, van de Warrenburg B, Lang A, et alThe Waiting …

  • Epileptic: David B
    Pract. Neurol. Pub Date : 2020-06-24
    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

  • Acute leukoencephalopathy in an adult.
    Pract. Neurol. Pub Date : 2020-06-21
    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

  • A neurologist with Parkinson's disease.
    Pract. Neurol. Pub Date : 2020-06-17
    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

  • Acute intermittent porphyria presenting with posterior reversible encephalopathy syndrome (PRES) and abdominal pain.
    Pract. Neurol. Pub Date : 2020-06-17
    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

  • Bartonella neuroretinitis (cat-scratch disease).
    Pract. Neurol. Pub Date : 2020-06-16
    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

  • The World I Fell Out Of by Melanie Reid.
    Pract. Neurol. Pub Date : 2020-06-16
    Nicholas Scott,Danielle J Leighton,Edward J Newman

    Melanie Reid’s chronicle of her life-changing spinal injury in The World I Fell Out Of was discussed at the second meeting of the Glasgow Neurology Book Club. Reid has previously documented her ‘adapt or die’ approach to post-injury life within her column in The Times magazine. From the immediate recognition that her life was forever changed when her chestnut mare refused a jump, to the practicalities

  • Neuroretinitis: a tricky mimic.
    Pract. Neurol. Pub Date : 2020-06-16
    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

  • Photopsia.
    Pract. Neurol. Pub Date : 2020-06-14
    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

  • Charcot in the ICU: functional tetraplegia after surgery.
    Pract. Neurol. Pub Date : 2020-06-12
    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

  • Muscle biopsy: what and why and when?
    Pract. Neurol. Pub Date : 2020-06-11
    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

  • Diagnosis and management of acute ischaemic stroke.
    Pract. Neurol. Pub Date : 2020-06-07
    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

  • Grand rounds: a precious resource to be nurtured.
    Pract. Neurol. Pub Date : 2020-06-05
    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

  • Neurotoxicity-CAR T-cell therapy: what the neurologist needs to know.
    Pract. Neurol. Pub Date : 2020-06-05
    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

  • A confused patient with deranged liver function tests.
    Pract. Neurol. Pub Date : 2020-06-02
    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

  • Tardive syndromes.
    Pract. Neurol. Pub Date : 2020-06-02
    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

  • Simple visual hallucinations and epilepsy.
    Pract. Neurol. Pub Date : 2020-05-22
    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

  • Next steps after diagnosing dementia: interventions to help patients and families.
    Pract. Neurol. Pub Date : 2020-05-22
    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

  • How to diagnose difficult white matter disorders.
    Pract. Neurol. Pub Date : 2020-05-20
    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

  • DCTN1-related Parkinson-plus disorder (Perry syndrome).
    Pract. Neurol. Pub Date : 2020-05-20
    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

  • CSF lactate.
    Pract. Neurol. Pub Date : 2020-05-13
    Aravindhan Baheerathan,Robert D S Pitceathly,Carmel Curtis,Nicholas W S 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

  • A treatable cause of vertigo.
    Pract. Neurol. Pub Date : 2020-05-06
    Benjamin Nham,Allison S Young,Roger Garsia,G Michael Halmagyi,Miriam S Welgampola

    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 nystagmus

  • Acute anosmia from COVID-19 infection.
    Pract. Neurol. Pub Date : 2020-05-04
    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,

  • Hypoglossal palsy from an atlanto-axial synovial cyst.
    Pract. Neurol. Pub Date : 2020-05-04
    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

  • Highlights from this issue.
    Pract. Neurol. Pub Date : 2020-05-01
    Phil E M Smith,Geraint N Fuller

    COVID-19 has profoundly disrupted the normal rhythms of life. It is hard to anticipate the full impact of the pandemic as we write this in March 2020, with almost daily changes in advice for both the population and medical staff. The disease is flooding normal acute medical services. From a neurological perspective, there is concern for the collateral damage caused to patients with neurological disorders

  • Carphology
    Pract. Neurol. Pub Date : 2020-05-01
    A Fo Ben

    A Fo Ben appreciates that the world will have significantly moved on by the time this edition of PN hits the printers, but in an attempt to move with the times, this is a report from medRxiv (and comes with all the caveats for pre-peer-reviewed papers)—but it is highly pertinent. A study of 214 hospitlaised patients with COVID-19 from Wuhan, China, looked at the neurological features of severe and

  • ABN News.
    Pract. Neurol. Pub Date : 2020-05-01
    Joanne Lawrence,Jon Sussman

    Following the decision to postpone the planned annual conference in Bournemouth from May to October, work has continued to restructure the programme to fit within the available 2 days. The new programme combines sessions from both the original May meeting and the 1-day autumn meeting it will replace. Although, sadly, this means we have had to lose some of the planned sessions, we do now have wealth

  • Patent foramen ovale.
    Pract. Neurol. Pub Date : 2020-05-01
    Vafa Alakbarzade,Tracey Keteepe-Arachi,Nazia Karsan,Robin Ray,Anthony C Pereira

    Patent foramen ovale (PFO) is the most common anatomical cause of an interatrial shunt. It is usually asymptomatic but may cause paradoxical embolism, manifesting as stroke, myocardial infarction or visceral/peripheral ischaemia. PFO is a risk factor for stroke and may be associated with migraine with aura. New evidence suggests PFO closure reduces the risk of recurrent ischaemic stroke in a highly

  • Management of mild traumatic brain injury.
    Pract. Neurol. Pub Date : 2020-05-01
    Anne van Gils,Jon Stone,Killian Welch,Louise R Davidson,Dean Kerslake,Dave Caesar,Laura McWhirter,Alan Carson

    Mild traumatic brain injury (TBI) is common and associated with a range of diffuse, non-specific symptoms including headache, nausea, dizziness, fatigue, hypersomnolence, attentional difficulties, photosensitivity and phonosensitivity, irritability and depersonalisation. Although these symptoms usually resolve within 3 months, 5%–15% of patients are left with chronic symptoms. We argue that simply

  • Facial myokymia in inherited peripheral nerve hyperexcitability syndrome.
    Pract. Neurol. Pub Date : 2020-05-01
    Clara Gontijo Camelo,André Macedo Serafim Silva,Cristiane Araújo Martins Moreno,Ciro Matsui-Júnior,Carlos Otto Heise,José Luiz Pedroso,Edmar Zanoteli

    Peripheral nerve hyperexcitability syndrome comprises a heterogeneous group of diseases, clinically characterised by myokymia, fasciculation, muscle cramps and stiffness. The causes are either immune mediated or non-immune mediated. Non-immune-mediated forms are mostly genetic, relating to two main genes: KCNQ2 and KCNA1 . Patients with KCNQ2 gene mutations typically present with epileptic encephalopathy

  • Two sisters with myoclonus and ataxia.
    Pract. Neurol. Pub Date : 2020-05-01
    Miguel Pereira,João Durães,Maria do Carmo Macário

    A 26-year-old woman (patient 1 on the family tree—figure 1) gave a 6-year history of dysarthria, occasional jerks and progressive gait unsteadiness with frequent falls, and had become bedridden. On examination, she had dorsal kyphosis and pes cavus. There was severe truncal and appendicular ataxia, generalised action myoclonus, hyporeflexia, hypotonia and bilateral extensor plantar reflexes. Electromyography

  • Neurosarcoidosis: clinical manifestations, investigation and treatment.
    Pract. Neurol. Pub Date : 2020-05-01
    Desmond P Kidd

    Sarcoidosis affects the nervous system in 10% of cases. When it does so it can affect any part of the nervous system and with all degrees of severity. It forms part of the differential diagnosis in inflammatory, infective, neoplastic and degenerative neurological diseases and may be very difficult to diagnose without histological confirmation. Recent clinical studies and the increasing availability

  • Targeting sedentary behaviour in neurological disease.
    Pract. Neurol. Pub Date : 2020-05-01
    Monica Busse,Gita Ramdharry

    Lack of physical activity is a major risk factor in non-communicable diseases, increasing the all-cause mortality risk by 20–30%. It is also an important risk factor for dementia. While it can be difficult in any individual to ascertain the relevant contribution of lifestyle factors, interventions that target physical activity behaviours are important primary and secondary prevention strategies. We

  • COVID-19: switching to remote neurology outpatient consultations.
    Pract. Neurol. Pub Date : 2020-05-01
    Arani Nitkunan,Dominic Paviour,Tharani Nitkunan

    Teleneurology and telephone consultations have long been used in neurology.1 2 There is a lack of research data on using remote consultations for new neurology outpatients and only low-level evidence for their use in general practice. Remote consultations provide a mechanism for neurology care during the COVID-19 pandemic. Switching from face-to-face new appointments to remote (telephone or video)

  • 'Fasciculations': linguistic slip or judicious advance?
    Pract. Neurol. Pub Date : 2020-05-01
    J Bashford

    It was with great interest that I read Baker & Williams’ persuasive account outlining the correct use of the term ‘fasciculation’.1 The plural ‘fasciculations’, they argue, has erroneously slipped into the medical vernacular since Denny-Brown and Pennybacker coined the singular term in 1938.2 Fasciculation, they emphasise, represents a ‘state of being’ and therefore is a binary entity; fasciculation

  • Autoimmune encephalitis associated with Ma2 antibodies and immune checkpoint inhibitor therapy.
    Pract. Neurol. Pub Date : 2020-05-01
    Shane Lyons,Ronan Joyce,Patrick Moynagh,Luke O'Donnell,Silive Blazkova,Timothy J Counihan

    Immune checkpoint inhibitors have transformed the treatment of advanced malignancy, while increasing the risk of immune-related adverse events. A 56-year-old woman who had received nivolumab for stage 4 renal cell carcinoma subsequently developed altered behaviour, memory deficits and worsening of previously stable epilepsy. MR scan of the brain showed bilateral FLAIR (fluid-attenuated inversion recovery)

  • Vagus nerve stimulation for epilepsy.
    Pract. Neurol. Pub Date : 2020-05-01
    John Duncan

    Refractory epilepsy causes physical, psychological, psychiatric and social morbidities and carries an increased risk of premature mortality. Resective neurosurgery brings the possibility of long-term seizure remission in those with focal epilepsy, but is only suitable in approximately half of the patients who undergo presurgical evaluation,1 either because a single epileptogenic zone is not definable

  • My dad and progressive supranuclear palsy (PSP).
    Pract. Neurol. Pub Date : 2020-05-01
    Heather Angus-Leppan

    Dad aged 60 years was a powerhouse—energetic, handsome, tall and powerful. I thought he would live forever. He and mum were mountaineers, opening a treacherous climb in the Drakensberg, South Africa, which bears their name (figure 1), fleeing apartheid and starting a new life in Australia. He was a pioneering academic in his field after a terrible childhood. An exceptional marriage, three children

  • Prison epilepsy clinic.
    Pract. Neurol. Pub Date : 2020-05-01
    Michelle Esposito,Malisa Pierri,Mair Strinati,Phil E M Smith

    Cardiff Prison is a Victorian city centre establishment that opened in 1832. It has the operational capacity for up to 820 adult men (Wales has no women’s prisons) and is a category B local remand prison with training and resettlement functions. There is an on-site healthcare facility, with an outpatient clinic area and inpatient beds. Providing healthcare to an imprisoned population presents unique

  • Out of sight: a lesson in drug errors.
    Pract. Neurol. Pub Date : 2020-05-01
    Soon Tjin Lim,Timothy Yates,Di Liang,Heather Angus-Leppan

    A 76-year-old man developed recurrent encephalopathy, visual disturbance, myoclonus, generalised seizures and atonic drop attacks on a background of a gastrectomy for adenocarcinoma and stable chronic lymphocytic leukaemia. He presented to three different hospitals and was admitted twice, with normal investigations. His symptoms transiently improved during each admission (and with starting levetiracetam)

  • Exercise and dementia prevention.
    Pract. Neurol. Pub Date : 2020-05-01
    Jane Alty,Maree Farrow,Katherine Lawler

    Ageing, genetic, medical and lifestyle factors contribute to the risk of Alzheimer’s disease and other dementias. Around a third of dementia cases are attributable to modifiable risk factors such as physical inactivity, smoking and hypertension. With the rising prevalence and lack of neuroprotective drugs, there is renewed focus on dementia prevention strategies across the lifespan. Neurologists encounter

  • Twitchy about fasciculation.
    Pract. Neurol. Pub Date : 2020-05-01
    Mark R Baker,Timothy L Williams

    There is a vocal section of the regular audience attending the neurology grand rounds at the Royal Victoria Infirmary, Newcastle upon Tyne, who proudly occupy what might be termed ‘Pedants’ Corner’. Of late, these consultants, for that is what they are, have become increasingly concerned by the widespread misuse of the word ‘fasciculations’ for what Charcot referred to as ‘fibrillar twitches of muscles’

  • Seeding of infection in previously asymptomatic meningioma.
    Pract. Neurol. Pub Date : 2020-05-01
    Edward Christopher,Fiona C Moreton,Antonia Torgersen,Peter Foley

    A 75-year-old woman, who was recovering from a recent episode of urosepsis, presented with 3 days of recurrent focal motor seizures affecting the right arm. She was aware and orientated throughout each episode but experienced confusion and weakness afterwards. On examination, she had mild pyramidal weakness of the right arm. CT scan of head showed no acute abnormality. She was started on levetiracetam

  • Giant intracranial aneurysm water-hammer effect.
    Pract. Neurol. Pub Date : 2020-05-01
    Adam A Dmytriw,Abdullah Alrashed,Victor Xd Yang

    A middle-aged man presented with new-onset vertigo and truncal imbalance. MR scan of brain showed an incidental giant partially thrombosed anterior communicating artery aneurysm with concentric blood products of varying age (figure 1). Subsequent catheter angiography showed the ‘water-hammer’ effect (video 1). Figure 1 MR scan of brain with intravenous gadolinium, showing an enhancing partially thrombosed

  • Vagus nerve stimulation for drug-resistant epilepsy.
    Pract. Neurol. Pub Date : 2020-05-01
    Laura Pérez-Carbonell,Howard Faulkner,Sean Higgins,Michalis Koutroumanidis,Guy Leschziner

    Vagus nerve stimulation (VNS) is a neuromodulatory therapeutic option for drug-resistant epilepsy. In randomised controlled trials, VNS implantation has resulted in over 50% reduction in seizure frequency in 26%–40% of patients within 1 year. Long-term uncontrolled studies suggest better responses to VNS over time; however, the assessment of other potential predictive factors has led to contradictory

  • Hirayama disease causing hand tremor on neck flexion.
    Pract. Neurol. Pub Date : 2020-05-01
    Tun Hing Lui

    A 21-year-old man presented with right-hand intrinsic muscle wasting and right-hand tremor on neck flexion. MR scan of cervical spine was normal in the neutral position, but on neck flexion showed anterior shift and flattening of the cervical cord, with prominent posterior epidural space and engorged epidural venous plexus. We diagnosed Hirayama disease and his condition stabilised with a neck collar

  • 'Educated' by Tara Westover.
    Pract. Neurol. Pub Date : 2020-05-01
    Jessica Ellis

    ‘Educated’ is Tara Westover’s critically acclaimed memoir chronicling her life from her upbringing in rural Idaho to her scholarship and eventual doctorate at Cambridge University. The Gloucester neurology book group universally liked this book, finding it well written and eminently readable, adroitly recording Westover’s challenging and sometimes harrowing upbringing, without her resorting to the

  • Frenzel glasses: an affordable alternative.
    Pract. Neurol. Pub Date : 2020-04-24
    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, …

  • Emergency presentations of movement disorders
    Pract. Neurol. Pub Date : 2020-04-16
    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

  • Highlights from this issue
    Pract. Neurol. Pub Date : 2020-04-01
    Phil E M Smith; Geraint N Fuller

    ‘No man is an island entire of itself…’.1 We can be certain that John Donne was not thinking about the inter-relationships between medical specialties when he wrote those lines in 1642 but such is the resonance of the ideas that we can easily see their relevance to our practice. A recurring issue in neurological training is the extent and depth of neurology’s links with other general medical specialties

  • Carphology
    Pract. Neurol. Pub Date : 2020-04-01
    BMJ Publishing Group Ltd

    We know that the standard diagnostic EEG can be obliterated by artefact (here’s looking at you, chewing), and we must familiarise ourselves with natural distracting rhythms that occur when drowsing, asleep and sedated. A report will comment on the patient’s level of arousal and their cooperativeness, perhaps. How many of our top-notch electrophysiologists comment on the pose and poise of the technologists

  • ABN news
    Pract. Neurol. Pub Date : 2020-04-01
    Joanne Lawrence; Jon Sussman

    ![][1] Our 2020 annual scientific meeting will be in Bournemouth. The ABN has, in March 2020, with regret taken the decision to postpone the meeting from May to October. This decision has been taken after careful analysis of all factors impacting upon the meeting in light of the spread of Covid 19. We acknowledge the WHO statement regarding the role of robust containment and control activities in slowing

  • 2019 Thank you to our reviewers.
    Pract. Neurol. Pub Date : 2020-04-01

    The editors would like to publicly acknowledge the people listed below who served as reviewers on the journal during 2019. Without their efforts, the quality of the journal could not be sustained. Holger Allroggen Neil Anderson Richard Appleton Oliver Bandmann Sallie Baxendale Bastiaan Bloem Jerry Brown Monica Busse Nauman Butt Aisling Carr …

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