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Practical Neurology

Grace Petkovic, Elizabeth Rose-Innes, Stana Bojanic, Maria Isabel Leite, Benjamin R Wakerley
No abstract text is available yet for this article.
May 18, 2018: Practical Neurology
Caitlin Adams, Jordan Anderson, Elizabeth N Madva, W Curt LaFrance, David L Perez
Patients with functional neurological disorders (FND)/conversion disorder commonly present to outpatient clinics. FND is now a 'rule in' diagnosis based on neurological examination findings and semiological features. While neurologists may be more comfortable diagnosing patients with FND, there is only limited guidance as to how to conduct follow-up outpatient visits. Using clinical vignettes, we provide practical suggestions that may help guide clinical encounters including how to: (1) explore illness beliefs openly; (2) enquire longitudinally about predisposing vulnerabilities, acute precipitants and perpetuating factors that may be further elucidated over time; (3) facilitate psychotherapy engagement by actively listening for potentially unhelpful or maladaptive patterns of thoughts, behaviours, fears or psychosocial stressors that can be reflected back to the patient and (4) enquire about the fidelity of individual treatments and educate other providers who may be less familiar with FND...
May 15, 2018: Practical Neurology
Caroline N Hahn
No abstract text is available yet for this article.
April 25, 2018: Practical Neurology
Sanjay M Sisodiya
No abstract text is available yet for this article.
April 23, 2018: Practical Neurology
John J Craig
No abstract text is available yet for this article.
April 23, 2018: Practical Neurology
Charlotte Lawthom
Sodium valproate remains the best drug for idiopathic generalised epilepsy. For men with the latter diagnosis, this is the drug of choice. Sodium valproate has an unacceptably high level of major fetal malformation and also causes learning disabilities in many children exposed to the drug in utero. Women of reproductive age should not normally be offered this drug. There are many women with refractory epilepsy who would benefit from this drug and who are not planning pregnancy. Individualised epilepsy care is the gold standard, not blanket bans on drug choice based on gender...
April 23, 2018: Practical Neurology
Jeffrey Lambe, Bernadette Monaghan, Tudor Munteanu, Janice Redmond
Increasing availability of next-generation sequencing technologies has revealed several limitations of diagnosis-driven traditional clinicogenetic disease classifications, particularly among patients with an atypical or mixed phenotype. Hereditary spastic paraplegia (HSP) and spinocerebellar ataxia (SCA) are two such disease entities with an often overlapping presentation, in which next generation exome sequencing has played a key role in identification of genes causing disease along a continuum of ataxia and spasticity...
April 20, 2018: Practical Neurology
Michael Owen Kinney, John J Craig, P W Kaplan
Non-convulsive status epilepticus (NCSE) is an enigmatic condition with protean manifestations. It often goes unrecognised, leading to delays in its diagnosis and treatment. The principal reason for such delay is the failure to consider and request an electroencephalogram (EEG), although occasional presentations have no scalp or surface electroencephalographic correlate. In certain settings with limited EEG availability, particularly out-of-hours, clinicians should consider treating without an EEG. Patients need a careful risk-benefit analysis to assess the risks of neuronal damage and harm versus the risks of adverse effects from various intensities of therapeutic intervention...
April 12, 2018: Practical Neurology
Michal Lubomski, James Dalgliesh, Kenneth Lee, Omprakash Damodaran, Genevieve McKew, Stephen Reddel
A 63-year-old man presented with a 2-month history of progressive right-sided exophthalmos, painful ophthalmoplegia and fevers. As more features developed, he was diagnosed with giant cell arteritis then Tolosa-Hunt syndrome and transiently responded to corticosteroids. A bland cerebrospinal fluid and highly metabolically active brain (18 F)-fluoro-D-glucose-positron emission tomography suggested lymphoma. Biopsy of the mass showed sulphur granules with Gram-positive filamentous bacteria with Actinomyces -like colonies...
April 12, 2018: Practical Neurology
Kathleen Kuh Leander Malgapo, Chinar Osman, Martin Prevett
No abstract text is available yet for this article.
April 12, 2018: Practical Neurology
Jeremy S Stern
The Gilles de la Tourette syndrome (or Tourette's syndrome) has a prevalence of 1% of children with a wide range of severity and associated comorbidities. The last 20 years have seen advances in the understanding of the syndrome's complex genetics and underlying neurobiology. Investigation with imaging and neurophysiology techniques indicate it is a neurodevelopmental condition with dysfunction of basal ganglia-cortical interactions, which are now also being studied in animal models. There is also increasing evidence for treatments although it often remains difficult to manage...
April 10, 2018: Practical Neurology
Sonja Emily Leonhard, Suzannah Lant, Bart C Jacobs, Annelies Wilder-Smith, Maria Lucia Brito Ferreira, Tom Solomon, Hugh John Willison
Zika virus has been associated with a wide range of neurological complications. Neurologists in areas without current active transmission of the virus may be confronted with Zika-associated neurological disease, as a large number of returning travellers with Zika virus infection have been reported and the virus continues to spread to previously unaffected regions. This review provides an overview of Zika virus-associated neurological disease and aims to support neurologists who may encounter patients returning from endemic areas...
April 4, 2018: Practical Neurology
Geraldine Vanderschueren, Katlijn Schotsmans, Emke Maréchal, Roeland Crols
We describe a 16-year-old boy with mild encephalitis with reversible lesions in the white matter and splenium of corpus callosum as a complication of an influenza B virus infection. Although more common in Asiatic children, it can also occur in Caucasian children and adults. There are several possible causes, including metabolic disorders, hypertension and infection, and the prognosis is usually good, even without treatment.
March 29, 2018: Practical Neurology
Anna Randall, Saif Huda, Anu Jacob, Andrew J Larner
Autoimmune encephalitis associated with antibodies (Abs) directed against the synaptic ligand-gated ion channel NMDA receptor (NMDAR) was first described as a paraneoplastic disorder in association with ovarian teratoma. Other forms of neoplasia have subsequently been reported although many patients do not have a tumour. Tumour removal, where applicable, and immunotherapy form the mainstays of treatment. We present a patient who developed NMDAR-Ab encephalitis despite being chronically immunosuppressed following organ transplantation, and who was eventually found to have an occult malignancy in the form of non-Hodgkin's lymphoma...
March 27, 2018: Practical Neurology
Arjune Sen, Sloan Mahone, Taurai Kadzviti, Ingrid Landman, Gwen Kandawasvika, Andrew Mataruse, Gift Ngwende
No abstract text is available yet for this article.
March 27, 2018: Practical Neurology
Foksouna Sakadi, Farrah J Mateen
No abstract text is available yet for this article.
March 23, 2018: Practical Neurology
Itaru Hayakawa, Masaya Kubota
No abstract text is available yet for this article.
March 23, 2018: Practical Neurology
Eoin Mulroy, James Cleland, Nicholas Child, Jennifer Pereira, Neil E Anderson
No abstract text is available yet for this article.
March 22, 2018: Practical Neurology
Matthew D Smith, Tom A T Hughes
No abstract text is available yet for this article.
March 16, 2018: Practical Neurology
Ronan O'Malley, Ganesh Rao, Penelope Stein, Oliver Bandmann
The diagnosis of acute intermittent porphyria (AIP) is often overlooked. We describe a patient with this condition who had all the 'bells and whistles', in whom the diagnosis was only made after considerable delay. Far from an esoteric condition haunting examination candidates, AIP is an important cause of a broad spectrum of neurological symptoms. Its early recognition allows the astute clinician to prevent potentially devastating sequelae. We provide practical guidance on the investigation and management of this complex disorder...
March 14, 2018: Practical Neurology
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