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Practical Neurology

Floriana De Angelis, Wallace J Brownlee, Declan T Chard, S Anand Trip
No abstract text is available yet for this article.
September 22, 2018: Practical Neurology
Kedar R Mahajan
This case report is of a septuagenarian man on chronic low-dose prednisone who presented with disseminated nocardiosis ( Nocardia cyriacigeorgica ) that was initially mistaken for metastatic brain cancer. Neurologists should be aware of the potential for opportunistic infections with steroid use and to consider a definite tissue diagnosis with culture and histopathology prior to treatment.
September 21, 2018: Practical Neurology
Christopher Kennard
No abstract text is available yet for this article.
September 17, 2018: Practical Neurology
Eric Nieman
No abstract text is available yet for this article.
September 7, 2018: Practical Neurology
Richard John Davenport
The prime purpose of the clinicopathological conference (CPC) is education, delivered ideally in an entertaining and engaging manner. This article tackles both how to organise a CPC (more challenging than it might appear) and how to survive as a CPC discussant (always challenging). The patient at the heart of the CPC will have had a challenging and difficult illness. The reanalysis of the clinical presentation by the discussant, a re-exploration of their clinical journey, is the key to the educational value of the CPC rather than the ultimate diagnosis...
September 6, 2018: Practical Neurology
Jennifer W Lee, Manohar L Bance
Hearing loss affects one in six people in the UK and is a significant disease burden. In addition to communication problems, there is also an association with depression and dementia. Clinical assessment with targeted history and examination can identify the characteristics and cause of hearing loss, and complementary audiological testing can confirm its type and severity. Retrocochlear screening is recommended for sudden, rapidly progressive or asymmetric sensorineural hearing loss. Medical or surgical therapies may be indicated in cases of conductive hearing loss, while hearing assistive devices and hearing aids are the mainstay of rehabilitation for sensorineural hearing loss...
September 5, 2018: Practical Neurology
Ahmed Abbas, Rajdeep Jain
No abstract text is available yet for this article.
September 5, 2018: Practical Neurology
Susan P Mollan, Catherine Hornby, James Mitchell, Alexandra J Sinclair
This paper summarises the first consensus guidelines for idiopathic intracranial hypertension as an infographic. Following a systematic literature review, a multidisciplinary specialist interest group met and established questions relating to population, interventions, controls and outcomes (PICO). A survey was sent to doctors who manage idiopathic intracranial hypertension (IIH) regularly. Statements were reviewed by national professional bodies, specifically the Association of British Neurologists, British Association for the Study of Headache, the Society of British Neurological Surgeons and the Royal College of Ophthalmologists and by international experts...
August 28, 2018: Practical Neurology
Katherine Claire Dodd, Hedley C A Emsley, Michael J R Desborough, Suresh K Chhetri
Lumbar puncture (LP) is an important and frequently performed invasive procedure for the diagnosis and management of neurological conditions. There is little in the neurological literature on the topic of periprocedural management of antithrombotics in patients undergoing LP. Current practice is therefore largely extrapolated from guidelines produced by anaesthetic bodies on neuraxial anaesthesia, haematology groups advising on periprocedural management of antiplatelet agents and anticoagulants, and by neuroradiology on imaging-guided spinal procedures...
August 28, 2018: Practical Neurology
Rob Powell, Robert Elwes, Khalid Hamandi, Nandini Mullatti
The cingulate gyrus is located above the corpus callosum and forms part of the limbic system. Cingulate gyrus epilepsy poses a diagnostic challenge, given its diverse and variable seizure semiology. We present two patients with seizures arising in the cingulate gyrus that highlight the electroclinical and imaging features of this rare form of epilepsy. Cingulate seizures can give a wide range of clinical manifestations, which relate to the underlying neuroanatomy and subdivisions of the cingulate cortex. Here, we review the semiology of cingulate epilepsy and how this relates to the location of seizure onset and patterns of propagation...
August 12, 2018: Practical Neurology
Michal Lubomski, Joanne Sy, Michael Buckland, Andie S Lee, Bethan Richards, Elizabeth Thompson, Michael Fulham, Nora Breen, Kirsty Morris, G Michael Halmagyi
Leptomeningitis is a rare central nervous system manifestation of rheumatoid arthritis, generally in patients with established chronic rheumatoid disease. We report a 41-year-old man without previous rheumatoid arthritis or psychiatric disorder who presented with an acute neuropsychiatric disturbance and polyarthralgia. His MR scan of brain showed asymmetric bifrontal leptomeningitis, confirmed on (18F)-fluoro-D-glucose-positron emission tomography. Other investigations showed highly positive serum and cerebrospinal fluid anti-cyclic citrullinated peptide...
August 10, 2018: Practical Neurology
Laurent M Willems, Natalia Kurka, Ferdinand Bohmann, Peter Rostek, Waltraud Pfeilschifter
Crew-resource management is an approach to work and training that focuses on non-technical skills and strategies to prevent human error in complex procedures. It was initially termed 'cockpit-resource management' and developed for aviation in the 1970s after several severe accidents; it has contributed to a measurable increase in flight safety. In recent years, this approach has been successfully implemented in other high-reliability environments; surgical disciplines have made particular use of crew-resource management strategies and training, with resulting reduced mortality rates...
August 10, 2018: Practical Neurology
Rubens Paulo A Salomão, José Luiz Pedroso, Orlando G P Barsottini
No abstract text is available yet for this article.
August 4, 2018: Practical Neurology
Robert Durcan, Olwen Murphy, Valerie Reid, Tim Lynch
A 42-year-old man, returning to Europe after a 2-month stay in China, reported cough and runny nose. Five days later, he developed neck discomfort and rapidly evolving weakness, spreading from his arms to the facial, bulbar and neck muscles, and then the legs. He developed dysphagia and breathlessness, and was intubated in the emergency department. Cerebrospinal fluid showed mildly elevated protein. On day 2 he had fixed dilated pupils, with absent oculocephalic reflexes, and a flaccid upper limb paralysis...
July 30, 2018: Practical Neurology
Sian K Alexander, Rosemary Chukwulobelu, Sujit Vaidya, Santiago Catania, Raj Ragoowansi, Aleksandar Radunović
No abstract text is available yet for this article.
July 30, 2018: Practical Neurology
Clare M Galtrey, Jessica Styles, Nicholas Gosling, Niran Nirmalananthan, Anthony C Pereira
Acute neurology is the neurological care that a patient receives in an emergency or urgent care situation. This can be adapted successfully to training in a simulation where learners are immersed in realistic scenarios in a safe, controlled and reproducible environment. In addition to teaching important technical skills that improve knowledge of the diagnosis and management of acute neurology, the simulation laboratory provides a valuable setting to improve human factors and non-technical skills, such as teamwork and leadership...
July 25, 2018: Practical Neurology
Naveed Malek, Dominic G O'Donovan, Hadi Manji
An elderly Caucasian man presented with a 10-month history of proximal myopathy and dysphagia. His serum creatine kinase (CK) was elevated at 877 U/L (normal 40-320) and electromyography confirmed a myopathic process. Blood and urine tests suggested myeloma; bone marrow examination showed 30% plasma cells and stained positive for amyloid. The muscle biopsy was initially reported as normal but in the light of the bone marrow report, the biopsy specimen was stained for amyloid, which was positive. We diagnosed systemic amyloidosis causing a myopathy and have started treatment for myeloma...
July 24, 2018: Practical Neurology
Samuel Tribich, Colin J Mahoney, Nicholas W Davies
A 49-year-old man presented with a 1-week history of right facial paraesthesia with blurred vision and diplopia. Examination was normal apart from reduced facial sensation. Following appropriate neuroimaging, we considered a diagnosis of silent sinus syndrome. He underwent a middle meatal antrostomy with complete resolution of symptoms. Silent sinus syndrome results from occlusion of the osteomeatal complex, preventing normal aeration of the maxillary sinus. Maxillary sinus hypoventilation typically causes inferior displacement of the globe in the orbit (unilateral hypoglobus)...
July 20, 2018: Practical Neurology
Derick T Wade
I only realised how much my osteoarthritic hip had altered my life after the operation enabled me to return to activities I did not know I had stopped. Identifying need for and benefit from treatments should focus on relative changes in experience and function, not on a person's absolute state at a particular time.
July 18, 2018: Practical Neurology
Vafa Alakbarzade, Anthony C Pereira
Catheter-based angiography is an important but invasive procedure in vascular neurology. It is used mainly for diagnosis and for planning treatment in patients with a suspected underlying vascular abnormality. It is often performed as a semiurgent, planned investigation or linked to an interventional procedure. Cerebral angiography provides high-resolution, three-dimensional, pathoanatomical data about the cerebral vasculature and also allows real-time analysis of blood flow. Contrast injections can be repeated to identify subtleties...
July 18, 2018: Practical Neurology
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