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Clinical examination neurologist

Sita Jayalakshmi, Sudhindra Vooturi
Clinical neuroscience has made tremendous advances over the last century. Neurology as a discipline is still considered challenging and at times risky due to the natural history and progressive course of few of the neurological diseases. Encouragingly, the patient and their caregivers are now increasingly willing to be actively involved in making decisions. The patients' relationship with the doctor is a reflection of the society. A society that is orienting itself toward "rating" and "feedback" has made this doctor-patient relationship, a consumer-service provider relationship...
October 2016: Annals of Indian Academy of Neurology
Alyssa R Espinera, Jay Gavvala, Irena Bellinski, Jeffrey Kennedy, Micheal P Macken, Aditi Narechania, Jessica Templer, Stephen VanHaerents, Stephan U Schuele, Elizabeth E Gerard
INTRODUCTION: There are several important interactions between antiepileptic drugs (AEDs) and hormonal contraception that need to be carefully considered by women with epilepsy (WWE) and their practitioners. Many AEDs induce hepatic enzymes and decrease the efficacy of hormonal contraception. In addition, estrogen-containing hormonal contraception can increase the metabolism of lamotrigine, the most commonly prescribed AED in women of childbearing age. The intrauterine device (IUD) is a highly effective form of reversible contraception without AED drug interactions that is considered by many to be the contraceptive of choice for WWE...
October 29, 2016: Epilepsy & Behavior: E&B
Mark M Stecker, Huiying Yu, Renee Barlev, Michael Marmor, Marc Wilkenfeld
OBJECTIVE: The aim of this study was to describe the clinical phenotype of a limited group of responders and survivors of the World Trade Center (WTC) disaster who were referred for the evaluation of neuropathic symptoms. METHODS: Sixteen patients with WTC exposure were referred to a neurologist for evaluation. All had a neurologic examination. Most had electromyogram and nerve conduction testing/nerve conduction studies as well as appropriate imaging and blood tests...
November 2016: Journal of Occupational and Environmental Medicine
M Dattilo, V Biousse, B B Bruce, N J Newman
Nonorganic visual loss (NOVL) is the cause of a large number of referrals to neurologists and ophthalmologists and is a frequent area of overlap between neurologists, ophthalmologists, and psychiatrists. NOVL is the presence of visual impairment without an organic cause for disease despite a thorough and comprehensive investigation. A diagnosis of NOVL requires both the absence of any findings on examination and proof of the integrity and functioning of the visual system. Although sometimes a challenging diagnosis to make, there are a number of techniques and maneuvers which can be utilized fairly easily, either at the bedside or in the clinic, to help determine if a patient has NOVL...
2017: Handbook of Clinical Neurology
Michail Vikelis, Alan M Rapoport
BACKGROUND: Cluster headache (CH) is considered the most excruciating primary headache syndrome; although much less prevalent than migraine, it is not rare as it affects more than 1/1000 people. While its clinical presentation is considered stereotypic, atypical features are often encountered. Internationally, cluster headache is often misdiagnosed, undertreated and mistreated. METHODS: We prospectively studied 302 CH patients, all examined by the same headache specialist...
December 2016: Journal of Headache and Pain
Sara Nader Marta, Roberto Yoshio Kawakami, Claudia Almeida Prado Piccino Sgavioli, Ana Eliza Correa, Guaniara D'Árk de Oliveira El Kadre, Ricardo Sandri Carvalho
Waardenburg syndrome (WS) is an inherited autosomal dominant genetic disorder presenting variable penetrance and expressivity, with an estimated prevalence of 1:42,000. Clinical characteristics of WS include lateral displacement of the internal eye canthus, hyperplasia of the medial portion of the eyebrows, prominent and broad nasal base, congenital deafness, pigmentation of the iris and skin, and white forelock. A 24-year-old male patient, previously diagnosed with WS, was referred to the Special Needs Dental Clinic of Sacred Heart University, Bauru, Brazil...
2016: Journal of Contemporary Dental Practice
Rüdiger Lange, Frank Erbguth
"Disturbances of consciousness of unknown origin" require an interdisciplinary approach due to the broad variety of possibly underlying causes. Primary neurological pathologies account for about half of the cases, which emphasizes the key role of the neurologist in the primary assessment and planning of the diagnostic and therapeutic strategy. The most important goal is to quickly identify patients with extremely time-critical conditions like ischemic stroke, bacterial meningitis or space occupying intracranial hemorrhage...
September 2016: Deutsche Medizinische Wochenschrift
Oren S Cohen, Joab Chapman, Amos D Korczyn, Oliver L Siaw, Naama Warman-Alaluf, Zeev Nitsan, Shmuel Appel, Esther Kahana, Hanna Rosenmann, Chen Hoffmann
The use of diffusion MRI improved the accuracy of diagnosis in Creutzfeldt-Jakob disease (CJD) and expanded our knowledge of the changes occurring in the brain during the disease. The aim of this study was to test whether in patients with E200K familial CJD (fCJD) the clinical severity correlates with the disease burden as reflected by the extent of cortical involvement in DWI MRI. Consecutive fCJD patients were examined by a neurologist who performed several tests including the CJD neurological scale (CJD-NS), MiniMental status examination (MMSE), Frontal Assessment Battery (FAB), NIH Stroke Scale (NIHSS), and the expanded disability status scale (EDSS)...
December 2016: Journal of Neural Transmission
In-Young Choi, Phil Lee, Abbey J Hughes, Douglas R Denney, Sharon G Lynch
BACKGROUND: Increased oxidative stress leads to loss of glutathione (GSH). We have reported lower cerebral GSH in patients with secondary progressive multiple sclerosis (SPMS), indicating the involvement of oxidative stress in multiple sclerosis (MS) pathophysiology. OBJECTIVE: This study expanded upon our earlier work by examining longitudinal changes in cerebral GSH in patients with SPMS in relation to their clinical status. METHODS: A total of 13 patients with SPMS (Expanded Disability Status Scale (EDSS) = 4...
September 12, 2016: Multiple Sclerosis: Clinical and Laboratory Research
Allison K Graebner, Daniel Tarsy, Ludy C Shih, Veronique Vanderhorst, Omesh Kulkarni, Scott Kaplan, David K Simon
BACKGROUND/AIMS: The clinical diagnosis of degenerative forms of parkinsonism is imperfect, with past studies reporting a high rate of misdiagnosis by neurologists and movement disorder specialists, particularly early in the disease course. 123I-ioflupane SPECT (DaTscan) is a diagnostic neuroimaging tool used to distinguish essential tremor from tremor due to degenerative parkinsonisms. The present study expands upon prior studies of the clinical impact of DaTscan imaging in movement disorder centers by assessing quantitative estimates of diagnostic certainty, the impact on subsequent clinical decisions, and the degree to which the asymmetry in the results corresponds to laterality by clinical history and examination...
September 10, 2016: Neuro-degenerative Diseases
Christopher W Hess, Michael S Okun
PURPOSE OF REVIEW: While establishing the diagnosis of Parkinson disease (PD) can be straightforward, it can be challenging in some patients, even for the experienced neurologist. The misdiagnosis rate ranges from 10% to 20% or greater depending on clinician experience. RECENT FINDINGS: Despite promise in the search for a biomarker that can establish the presence of PD and act as a marker of its progression, the diagnosis of PD continues to be based on clinical examination...
August 2016: Continuum: Lifelong Learning in Neurology
Israel Contador, Teodoro Del Ser, Sara Llamas, Alberto Villarejo, Julián Benito-León, Félix Bermejo-Pareja
BACKGROUND: The effect of different educational indices on clinical diagnosis of dementia requires more investigation. OBJECTIVE: We compared the differential influence of two educational indices (EIs): years of schooling and level of education (i.e., null/low literacy, can read and write, primary school, and secondary school) on global cognition, functional performance, and the probability of having a dementia diagnosis. METHOD: A total of 3,816 participants were selected from the population-based study of older adults "Neurological Disorders in Central Spain" (NEDICES)...
August 2, 2016: Journal of Clinical and Experimental Neuropsychology
Myoung Jin Cha, Heui Soo Moon, Jong Hee Sohn, Byung Su Kim, Tae Jin Song, Jae Moon Kim, Jeong Wook Park, Kwang Yeol Park, Soo Kyoung Kim, Byung Kun Kim, Soo Jin Cho
BACKGROUND AND PURPOSE: Chronic daily headache (CDH) is defined as a headache disorder in which headaches occur on a daily or near-daily basis (at least 15 days/month) for more than 3 months. Chronic migraine (CM) and medication overuse headache (MOH) are very disabling headaches that remain underdiagnosed. The aim of this study was to establish the frequency of CDH and its various subtypes, and examine the associations with MOH among first-visit headache patients presenting at neurology outpatient clinics in Korea...
July 2016: Journal of Clinical Neurology
Ana Nikolic, Zorica Stevic, Stojan Peric, Vidosava Rakocevic Stojanovic, Dragana Lavrnic
OBJECTIVE: Diagnostic procedures are often overused in the attempt to substitute for the good clinical examination. The aim of this study was to evaluate the type and the accuracy of the referral diagnosis to our EMG lab, as well as the impact of electrodiagnostic (EDX) examination on the diagnosis of our patients. METHODS: In this prospective study all patients examined in the six months period in a single tertiary referral EMG lab were analyzed. All patients were tested in a uniform fashion and by the same neurologist, according to the referral diagnosis...
September 2016: Clinical Neurology and Neurosurgery
Deb K Pal, Colin Ferrie, Laura Addis, Tomoyuki Akiyama, Giuseppe Capovilla, Roberto Caraballo, Anne de Saint-Martin, Natalio Fejerman, Renzo Guerrini, Khalid Hamandi, Ingo Helbig, Andreas A Ioannides, Katsuhiro Kobayashi, Dennis Lal, Gaetan Lesca, Hiltrud Muhle, Bernd A Neubauer, Tiziana Pisano, Gabrielle Rudolf, Caroline Seegmuller, Takashi Shibata, Anna Smith, Pasquale Striano, Lisa J Strug, Pierre Szepetowski, Thalia Valeta, Harumi Yoshinaga, Michalis Koutroumanidis
The term idiopathic focal epilepsies of childhood (IFE) is not formally recognised by the ILAE in its 2010 revision (Berg et al., 2010), nor are its members and boundaries precisely delineated. The IFEs are amongst the most commonly encountered epilepsy syndromes affecting children. They are fascinating disorders that hold many "treats" for both clinicians and researchers. For example, the IFEs pose many of the most interesting questions central to epileptology: how are functional brain networks involved in the manifestation of epilepsy? What are the shared mechanisms of comorbidity between epilepsy and neurodevelopmental disorders? How do focal EEG discharges impact cognitive functioning? What explains the age-related expression of these syndromes? Why are EEG discharges and seizures so tightly locked to slow-wave sleep? In the last few decades, the clinical symptomatology and the respective courses of many IFEs have been described, although they are still not widely appreciated beyond the specialist community...
September 1, 2016: Epileptic Disorders: International Epilepsy Journal with Videotape
Devin D Mackay, Beau B Bruce
Declining proficiency in direct ophthalmoscopy by non-ophthalmologists has spurred a search for alternative methods of ocular fundus examination. Recent technological advances have improved the ease of use and quality of non-mydriatic fundus photography, increasing its suitability for clinical care. As the availability of this technology continues to improve, neurologists will need to be familiar with its advantages, limitations and potential applications in the clinical care of patients with neurological conditions...
October 2016: Practical Neurology
Kevin Hargrave, Blaine Hoppe, Joan Wojak, Paula Sharkey, James Godchaux, Orlando Diaz
The authors present an unusual case of a transorbital penetrating injury of the internal carotid artery and brainstem. A young man accidentally ran into a 10-foot long citizens band (CB) antenna, and presented to the emergency department with nausea, dizziness and right periorbital ecchymosis. The nature and full extent of the injury were not appreciated at the time of initial examination and computed tomography scan. Magnetic resonance imaging subsequently demonstrated an unusual brainstem lesion. Neurology consultation was obtained...
May 2016: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
Annemiek Dols, Saskia van Liempt, Flora Gossink, Welmoed A Krudop, Sietske Sikkes, Yolande A L Pijnenburg, Max L Stek
OBJECTIVE: Early differentiation between psychiatric disorders and behavioral variant frontotemporal dementia (bvFTD) is of paramount importance in patients with the late-onset frontal lobe syndrome. As bvFTD in patients will deteriorate, psychiatric disorders are treatable. To date, misdiagnosis often occurs due to an overlap of symptoms and lack of specific biomarkers. The aim of our study was to investigate whether specific symptoms could separate bvFTD from psychiatric disorders. METHODS: In a naturalistic, prospective, multicenter study, 137 patients (aged 45-75 years, 72% male) with a late-onset frontal lobe syndrome were included based on their scores on the Frontal Behavioral Inventory (FBI) and the Stereotypy Rating Inventory (SRI) from April 2011 to June 2013...
July 5, 2016: Journal of Clinical Psychiatry
Kapetanakis Stylianos, Giatroudakis Konstantinos, Pavlidis Pavlos, Fiska Aliki
The medial antebrachial cutaneous nerve (MACN) is a branch of the brachial plexus with a great variation within its branches. Knowledge of these variations is critical to neurologists, hand surgeons, plastic surgeons, and vascular surgeons. The aim of this study was to search for variations of the MACN and to discuss their clinical significance. For this study, six arm cadavers from three fresh cadavers were dissected and examined to find and study possible anatomical variations of the MACN. The authors report a rare case of a variation of the MACN, in which there are four brachial cutaneous branches, before the separation to anterior (volar) and posterior (ulnar) branch, that provide sensory innervation to the medial, inferior half of the arm, in the area that is commonly innervated from the medial brachial cutaneous nerve...
July 2016: Journal of Neurosciences in Rural Practice
Michel C F Shamy, Michael Pugliese, Karl Meisel, Rosendo Rodriguez, Anthony S Kim, Frank W Stahnisch, Eric E Smith
BACKGROUND AND PURPOSE: Understanding physician decision making is increasingly recognized as an important topic of study, especially in stroke care. We sought to characterize the process of acute stroke decision making among neurologists in the United States and Canada from clinical and epistemological perspectives. METHODS: Using a factorial design online survey, respondents were presented with clinical data to mimic an acute stroke encounter. The history, examination, computed tomographic (CT) scan, CT angiogram, and CT perfusion were presented in sequence, and respondents rated their diagnostic confidence and likelihood of treatment with tissue-type plasminogen activator after each element...
August 2016: Stroke; a Journal of Cerebral Circulation
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