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Clinical examination neurologist

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https://www.readbyqxmd.com/read/29157405/common-clinical-and-imaging-conditions-misdiagnosed-as-multiple-sclerosis-a-current-approach-to-the-differential-diagnosis-of-multiple-sclerosis
#1
REVIEW
Aksel Siva
Multiple Sclerosis is increasing, so is the number of misdiagnosed cases as MS. One major source of misdiagnosis is misinterpretation of nonspecific clinical and imaging findings and misapplication of MS diagnostic criteria resulting in an overdiagnosis of MS! Since nonspecific white matter abnormalities on brain MRI and other imaging findings that may mimic MS, as well as MS-nonspecific lesions that are seen in people with MS, neurologists should be aware of all possibilities and should be able to interpret the clinical and MRI findings well and by their selves! The differential diagnosis of MS includes MS variants and inflammatory astrocytopathies and other atypical inflammatory-demyelinating syndromes, as well as a number of systemic diseases with CNS involvement...
February 2018: Neurologic Clinics
https://www.readbyqxmd.com/read/29132700/early-operation-in-patients-with-mitral-valve-infective-endocarditis-and-acute-stroke-is-safe
#2
Mehrdad Ghoreishi, Nate Foster, Chetan Pasrija, Aakash Shah, A Claire Watkins, Charlie F Evans, Sam Maghami, Rachael Quinn, Brody Wehman, Bradley S Taylor, Murtaza Y Dawood, Bartley P Griffith, James S Gammie
BACKGROUND: To determine if preoperative embolic stroke is associated with an increased risk of postoperative stroke among patients undergoing early operation for mitral valve (MV) infective endocarditis (IE), we compared outcomes among patients presenting with and without acute stroke. METHODS: From 2003 to 2015, 243 consecutive patients underwent surgery for active MV IE. Patients were categorized into 2 groups: 72% (174 of 243 patients) with no preoperative acute stroke (clinical, radiographic or both) and 28% (69 of 243 patients) with stroke...
November 11, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29117603/-clinical-tests-for-symptom-validity-assessment
#3
Bernhard Widder
Assessing symptom validity is essential both in the clinical and medicolegal contexts. If neurological symptoms are demonstrated and/or a patient complains of pain that is not or cannot be fully explained by an underlying disease, it is necessary to recognize reliably a possible psychological cause in order to avoid further unnecessary examinations. In the medicolegal context, malingering or exaggeration of complaints for obtaining financial benefit is to be differentiated in a further step. The present overview contains a summary of clinical observations and tests for neurologists and psychiatrists used for symptom validity assessment of sensorimotor symptoms, tremor, gait, equilibrium and visual disturbances as well as pain...
November 8, 2017: Fortschritte der Neurologie-Psychiatrie
https://www.readbyqxmd.com/read/29112517/use-of-antidementia-drugs-in-german-patients-with-alzheimer-s-disease
#4
Philipp Hessmann, Richard Dodel, Erika Baum, Matthias J Müller, Greta Paschke, Bernhard Kis, Jan Zeidler, Mike Klora, Jens-Peter Reese, Monika Balzer-Geldsetzer
The objective of this study was to evaluate the use of antidementia drugs (ADDs) in patients with Alzheimer's disease (AD) regarding German guideline recommendations and to assess correlations between the use of ADDs and the patients' characteristics. A total of 395 community-dwelling and institutionalized patients with AD across all severity stages of dementia were recruited in this cross-sectional study. Associations between the prescription of ADDs and patients' sociodemographic and clinical parameters (neuropsychiatric symptoms, cognitive capacity, daily activities, and health-related quality of life) were analyzed in multiple logistic regression analyses...
November 6, 2017: International Clinical Psychopharmacology
https://www.readbyqxmd.com/read/29103052/increasing-efficiency-of-recruitment-in-early-parkinson-s-disease-trials-a-case-study-examination-of-the-steady-pd-iii-trial
#5
Sarah Berk, Brittany L Greco, Kevin Biglan, Catherine M Kopil, Robert G Holloway, Claire Meunier, Tanya Simuni
BACKGROUND: Challenges in clinical trial recruitment threaten the successful development of improved therapies. This is particularly true in Parkinson's disease (PD) studies of disease modification where the population of interest is difficult to find and study design is more complex. OBJECTIVE: This paper seeks to understand how STEADY PD III, a National Institute of Neurological Disorders and Stroke (NINDS) funded phase 3 trial evaluating the efficacy of isradipine as a disease modifying agent for PD, was able to recruit their full target population 6 months ahead of schedule...
2017: Journal of Parkinson's Disease
https://www.readbyqxmd.com/read/29095389/paroxysmal-tonic-upgaze-in-children-three-case-reports-and-a-review-of-the-literature
#6
Ayse Kartal
BACKGROUND: In clinical practice, nonepileptic paroxysmal events during infancy and childhood are common reasons for parents and caregivers to seek for medical advice. These events are mostly unrecognized and considered as an epileptic seizure because of the clinical features resembling an epileptic seizure. Paroxysmal tonic upgaze, which consists of recurrent episodes of sustained upward deviation of the eyes and incomplete downward saccades, and normal horizontal eye movements without impairment of consciousness, is a diagnostic challenge for the pediatrician and pediatric neurologist...
October 31, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29083975/factors-associated-with-direct-health-care-costs-among-patients-with-migraine
#7
Machaon Bonafede, Qian Cai, Katherine Cappell, Gilwan Kim, Sandhya J Sapra, Neel Shah, Katherine Widnell, Paul Winner, Pooja Desai
BACKGROUND: Migraine imposes substantial economic burden on patients and the health care system. Approximately 18% of women and 6% of men suffer from migraine in the United States. This is a heterogeneous group, and little data are available to evaluate factors associated with migraine costs. OBJECTIVE: To evaluate characteristics associated with high costs among commercially insured patients with migraine. METHODS: This retrospective analysis identified patients with migraine in the Truven Health MarketScan Research Databases between January 2008 and June 2013...
November 2017: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29081427/clinical-and-video-head-impulse-test-in-the-diagnosis-of-posterior-circulation-stroke-presenting-as-acute-vestibular-syndrome-in%C3%A2-the-emergency-department
#8
Ayse Guler, Funda Karbek Akarca, Cenk Eraslan, Ceyda Tarhan, Cem Bilgen, Tayfun Kirazli, Nese Celebisoy
INTRODUCTION: Head impulse test (HIT) is the critical bedside examination which differentiates vestibular neuritis (VN) from posterior circulation stroke (PCS) in acute vestibular syndrome (AVS). Video-oculography based HIT (vHIT) may have aadditional strength in making the differentiation. METHODS: Patients admitted to the emergency department of a tertiary-care medical center with AVS were studied. An emergency specialist and a neurologist performed HIT. vHIT was conducted by an neuro-otology research fellow...
2017: Journal of Vestibular Research: Equilibrium & Orientation
https://www.readbyqxmd.com/read/29042521/-transition-of-children-with-epilepsy-to-adult-care-current-status-and-challenge
#9
Hidemoto Kubota
Thirty percent of the patients consulting a pediatric neurologist have already reached adulthood as patients and their families do not like transfer to the adult clinics; moreover, there are no suitable clinics. Pediatric neurologists find it difficult to examine adult patients with childhood-onset epilepsy as they are unfamiliar with the psychiatric and psychological symptoms manifested in adulthood, and the common diseases of adulthood. On the other hand, adult neurologists have difficulty obtaining a complete picture of the patient's clinical history since childhood, and are unfamiliar with childhood-specific epilepsy syndrome...
October 2017: Brain and Nerve, Shinkei Kenkyū No Shinpo
https://www.readbyqxmd.com/read/29042180/idiopathic-rem-sleep-behavior-disorder-in-the-elderly-spanish-community-a-primary-care-center-study-with-a-two-stage-design-using-video-polysomnography
#10
Montserrat Pujol, Jesús Pujol, Tomás Alonso, Araceli Fuentes, Mercè Pallerola, Jovita Freixenet, Ferran Barbé, Manel Salamero, Joan Santamaría, Alex Iranzo
OBJECTIVE: To examine the presence and characteristics of idiopathic REM sleep behavior disorder (IRBD) in a representative Caucasian sample from the elderly community of Lleida, Spain, attending primary care centers. METHODS: Participants were individuals aged 60 years or older who underwent routine visits in two primary care centers. They underwent a two-stage study; a validated screening single question for IRBD diagnosis (RBD1Q) followed by, in those who endorsed positive answer, clinical assessment by a neurologist plus video-polysomnography (V-PSG)...
August 24, 2017: Sleep Medicine
https://www.readbyqxmd.com/read/29026691/accuracy-of-crescent-sign-on-ocular-ultrasound-in-diagnosing-papilledema
#11
Ananth Bhosale, Virna M Shah, Parag K Shah
AIM: To study the usefulness of orbital ultrasonography in the diagnosis of papilledema. METHODS: Fifty patients who were referred to the neurophthalmology clinic and clinically suspected to have papilledema were selected. Thorough, clinical examination with slitlamp biomicroscopy and visual acuity assessment was done. These patients underwent ultrasonography to demonstrate the crescent sign. The patients were further evaluated with the neurologist and magnetic resonance imaging (MRI) thus confirming the diagnosis of papilledema...
September 26, 2017: World Journal of Methodology
https://www.readbyqxmd.com/read/29018767/optical-coherence-tomography-features-in-a-case-of-type-i-sialidosis
#12
I-Hua Wang, Ting-Yu Lin, Shu-Ting Kao
A 15-year-old boy presented with progressive myoclonic epilepsy and unbalance gaits for 4 years. Slit lamp examination showed a punctate cataract and funduscopic examination revealed bilateral macular cherry-red spots. Macular scan of spectral domain optical coherence tomography (SD-OCT) showed hyperreflectivity of the inner retinal layer and apparent hyperreflectivity of the photoreceptor layers in the foveal region. The clinical presentations were consistent with a Type I sialidosis which led to genetic analysis and revealed NEU1 mutation in this patient...
April 2017: Taiwan Journal of Ophthalmology
https://www.readbyqxmd.com/read/28991677/hurst-revisited-are-symptoms-and-signs-of-functional-motor-and-sensory-disorders-dependent-on-idea
#13
Jon Stone, Jennifer Mutch, Denis Giannokous, Ingrid Hoeritzauer, Alan Carson
INTRODUCTION: Symptoms and signs of functional (psychogenic) motor and sensory disorder are often said to be dependent on the patients' idea of what symptoms should be, rather than anatomy and physiology. This hypothesis has however rarely been tested. MATERIALS AND METHODS: Inspired by a brief experiment carried out in 1919 by neurologist Arthur Hurst we aimed to assess the views of healthy non-medical adults towards paralysis and numbness and their response to tests for functional disorders when asked to pretend to have motor and sensory symptoms...
October 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28986620/-imaging-of-primary-muscular-diseases-what-do-neurologists-expect-from-radiologists
#14
REVIEW
M P Wattjes, A Fischmann, D Fischer
Imaging, in particular magnetic resonance imaging (MRI), has in recent years increasingly become a crucial tool for the diagnostics of inherited and acquired muscular diseases. The aim of imaging in neuromuscular disorders goes beyond the detection and quantification of degenerative muscular changes, such as fatty degeneration and includes recognition of very early signs of muscular pathologies presenting as muscular edema. Therefore, imaging is a valuable diagnostic method to support the clinical diagnosis and to narrow down the differential diagnoses, leading to specific additional diagnostic tests in order to establish the correct diagnosis...
October 6, 2017: Der Radiologe
https://www.readbyqxmd.com/read/28973176/association-between-poor-cognitive-functioning-and-risk-of-incident-parkinsonism-the-rotterdam-study
#15
Sirwan K L Darweesh, Frank J Wolters, Ronald B Postuma, Bruno H Stricker, Albert Hofman, Peter J Koudstaal, M Kamran Ikram, M Arfan Ikram
Importance: Cognitive dysfunction is a common feature among patients with parkinsonism, including Parkinson disease (PD). However, there is a scarcity of data on cognitive functioning before parkinsonism diagnosis, a stage at which patients may still respond to putative disease-modifying interventions. Objective: To assess whether poor cognitive functioning is associated with an increased risk of parkinsonism. Design, Setting, and Participants: Between January 8, 2002, and December 14, 2008, baseline cognitive function was assessed in 7386 participants of the Rotterdam Study who were free of parkinsonism and dementia...
September 25, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28967492/multimorbidity-care-model-recommendations-from-the-consensus-meeting-of-the-joint-action-on-chronic-diseases-and-promoting-healthy-ageing-across-the-life-cycle-ja-chrodis
#16
Katie Palmer, Alessandra Marengoni, Maria João Forjaz, Elena Jureviciene, Tiina Laatikainen, Federica Mammarella, Christiane Muth, Rokas Navickas, Alexandra Prados-Torres, Mieke Rijken, Ulrike Rothe, Laurène Souchet, Jose Valderas, Theodore Vontetsianos, Jelka Zaletel, Graziano Onder
Patients with multimorbidity have complex health needs but, due to the current traditional disease-oriented approach, they face a highly fragmented form of care that leads to inefficient, ineffective, and possibly harmful clinical interventions. There is limited evidence on available integrated and multidimensional care pathways for multimorbid patients. An expert consensus meeting was held to develop a framework for care of multimorbid patients that can be applied across Europe, within a project funded by the European Union; the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS)...
September 14, 2017: Health Policy
https://www.readbyqxmd.com/read/28966876/the-inter-rater-variability-of-clinical-assessment-in-post-anoxic-myoclonus
#17
Jonathan C van Zijl, Martijn Beudel, Jan-Willem J Elting, Bauke M de Jong, Joukje van der Naalt, Walter M van den Bergh, Andrea O Rossetti, Marina A J Tijssen, Janneke Horn
BACKGROUND: Acute post-anoxic myoclonus (PAM) can be divided into an unfavorable (generalized/subcortical) and more favorable ((multi)focal/cortical) outcome group that could support prognostication in post-anoxic encephalopathy; however, the inter-rater variability of clinically assessing these PAM subtypes is unknown. METHODS: We prospectively examined PAM patients using a standardized video protocol. Videos were rated by three neurologists who classified PAM phenotype (generalized/(multi)focal), stimulus sensitivity, localization (proximal/distal/both), and severity (Clinical Global Impression-Severity Scale (CGI-S) and Unified Myoclonus Rating Scale (UMRS))...
2017: Tremor and Other Hyperkinetic Movements
https://www.readbyqxmd.com/read/28959202/a-58-year-old-male-with-cognitive-deteriorations-caused-by-septum-pellucidum-cyst-a-case-report
#18
Li-Ming Chen, Ming-Xin Zhu, Yu-Fen Zhang, Se-Hui Ma, Yao Yi, Lie-Xin Xia, Yan Wu, Lei Pei
Dementia is known to be induced by vascular dementia and certain neurodegenerative diseases. The presenting features of disordered memory, intellect and personality often result in referral to a neurologist initially. Septum pellucidum cyst (SPC) is a rare clinical finding and defined as a cystic structure between the lateral ventricles. SPC induced memory disorder and dementia has been seldom reported in which the clinical features are atypical and can be misdiagnosed. The main difficulty is to establish a correlation between symptoms and the cyst...
2017: Frontiers in Aging Neuroscience
https://www.readbyqxmd.com/read/28952326/education-on-the-brain-a-partnership-between-a-pediatric-primary-care-center-and-neurology-residency
#19
Eric Zwemer, Miya Bernson-Leung, Corinna Rea, Archana A Patel, Rejean Guerriero, David K Urion, Sara L Toomey
The national shortage of pediatric neurologists is worsening, yet referral rates by pediatricians are high. Suboptimal training of pediatric residents in care of patients with neurologic disease may be a contributing factor. We formed a partnership between the Boston Children's Primary Care at Longwood clinic and Child Neurology Residency Training Program. The educational intervention included lectures, observed neurologic examinations, in-person and virtual triage, and an electronic medical record-based consult system...
February 1, 2017: Clinical Pediatrics
https://www.readbyqxmd.com/read/28898914/-neuroanatomy-of-the-oculomotor-system
#20
Stephan Heermann
After just a clinical examination, the experienced neurologist can assign specific symptoms quite precisely to distinct lesions within the brain and other parts of the nervous system, on the basis of his neuroanatomical knowledge. This also holds true for lesions affecting the oculomotor system. The aim of this article is to give a comprehensive overview of the neuroanatomical basis of the oculomotor system, in order to facilitate the precise spatial assignment of potential lesions affecting the control of eye movements...
September 12, 2017: Klinische Monatsblätter Für Augenheilkunde
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