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Practical Neurology

Claire Rockliffe-Fidler, Mark Willis
Dissociative seizures are common in routine neurological practice and cause considerable morbidity. However, explaining such episodes to patients is rarely straightforward. Taking a neuropsychological perspective, we present a strategy for communicating this diagnosis to both patients and families.
February 12, 2019: Practical Neurology
Mary Angela O'Neal
Neurologists are often consulted to see women postpartum who are having difficulties involving the lower extremities; weakness, numbness and pain. Many of these women have received labour analgesia. Often, there is limited understanding by the neurologist of how these procedures are performed, why a neuraxial technique is chosen and their potential complications. This case-based review will explain the differences in the neuraxial procedures: epidural, spinal and combined spinal epidural; their advantages and disadvantages, why one technique might be chosen over another, contraindications as well as procedural risks...
February 12, 2019: Practical Neurology
Matthew John Harris, Mark Daniel Cossburn, George Pengas
A 52-year-old man experienced a relapse of neurosarcoidosis, characterised by obstructive hydrocephalus and multiple posterior circulation infarcts. He was taking methotrexate, but his prednisolone was being weaned because of adverse effects. Stroke is rare in neurosarcoidosis and typically relates to granulomatous inflammation with a predilection for the perforator arteries. Sarcoidosis generally responds well to corticosteroids; however, patients with leptomeningeal involvement usually require additional immunosuppression as relapses can occur on weaning of corticosteroids...
January 30, 2019: Practical Neurology
Wilson K W Fung, Kelly L Bertram
We present an interesting case of recurrent dystonic crises in dopa-responsive dystonia (DRD) likely induced by excessive consumption of aspartame-containing products, in particular sugar-free energy drinks. This has a strong practical value as acute presentations to the emergency department can be avoided in these susceptible individuals. Usual medical and dietary advice in the treatment of DRD would include the avoidance of high-dose phenylalanine-containing products, and to this we would advocate the avoidance of high-dose aspartame-containing products...
January 30, 2019: Practical Neurology
Lina Nashef, Rinki Singh, Nicholas Moran, Elaine Murphy
This article focuses on investigating adults with early-onset epilepsy and intellectual or physical disability within adult neurology services. We aim to guide general neurologists in the diagnostic reassessment of people with epilepsy and complex neurological problems of unknown cause. Following an overview, we address imaging, electroencephalography, genetic studies and metabolic testing, and give examples where diagnosis directly influences treatment. Aetiological diagnosis serves to inform prognosis, guide treatment and provide a framework for genetic counselling...
January 24, 2019: Practical Neurology
Ruth Dobson, Pooja Dassan, Megan Roberts, Gavin Giovannoni, Catherine Nelson-Piercy, Peter A Brex
Multiple sclerosis (MS) is more common in women than men and is most commonly diagnosed in early adulthood; thus, many patients will not have completed their families at the time of diagnosis. There is increasing awareness of the importance of early treatment in preventing long-term disability in MS. Delaying treatment until women with MS have completed their families can lead to the development of irreversible disability in at least some cases. It is therefore important to discuss family planning and pregnancy proactively...
January 5, 2019: Practical Neurology
Zeid Yasiry, Mahdia S Obeda, Ruth Batty, Basil Sharrack
No abstract text is available yet for this article.
January 5, 2019: Practical Neurology
Mahima Kapoor, Alexander M Rossor, Zane Jaunmuktane, Michael P T Lunn, Mary M Reilly
Systemic amyloidosis can be hereditary or acquired. The autosomal dominant hereditary transthyretin amyloidosis and the acquired light-chain amyloidosis, the result of a plasma cell dyscrasia, are multisystem disorders with cardiovascular, autonomic and peripheral nerve involvement. There are numerous investigational modalities available to diagnose systemic amyloidosis and to assess the extent of organ involvement, but it is frequently misdiagnosed due to its heterogeneous clinical presentations and misleading investigation findings...
December 30, 2018: Practical Neurology
Maciej Juryńczyk, Anu Jacob, Kazuo Fujihara, Jacqueline Palace
The field of central nervous system (CNS) inflammatory diseases has recently broadened to include a new condition associated with pathogenic serum antibodies against myelin oligodendrocyte glycoprotein (MOG). This is distinct from multiple sclerosis (MS) and aquaporin-4 (AQP4) antibody neuromyelitis optica spectrum disorders (NMOSD). MOG antibody-associated disease phenotypes are varied and range from classical neuromyelitis optica to acute demyelinating encephalomyelitis and cortical encephalitis. The diagnosis depends on using a reliable, specific and sensitive assay of the antibody...
December 8, 2018: Practical Neurology
Dafydd Llewelyn, J Gareth Llewelyn
Diabetic lumbosacral radiculoplexus neuropathy is a monophasic syndrome of diffuse pain and weakness that typically affects the lower limbs asymmetrically and is often associated with significant weight loss. Recovery can be prolonged and unpredictable. It is a clinical diagnosis and investigations are performed mainly to exclude other causes. Although it is most likely caused by a microvasculitis, there is no evidence to support using intravenous immunoglobulin or any long-term immunosuppression. Pulsed methylprednisolone may help pain if given within 2-3 months of symptom onset...
December 8, 2018: Practical Neurology
Gowri A Peethambar, Daniel H Whittam, Saif Huda, Sundus Alusi, Mani Puthuran, Arun Chandran, Paul R Eldridge, Anu Jacob
We describe a man with an intracranial dural arteriovenous fistula that presented as a subacute longitudinally extensive cervical myelopathy. The uncommon location of the fistula and the absence of specific radiological signs resulted in initial misdiagnosis as longitudinally extensive transverse myelitis. Neurologists should have a high index of suspicion for dural arteriovenous fistula in older men, especially those with subacute or chronic symptoms, acellular cerebrospinal fluid and, particularly, if there is neurological deterioration soon after corticosteroid treatment...
December 5, 2018: Practical Neurology
Joanne Lawrence, David Joseph Nicholl
No abstract text is available yet for this article.
February 2019: Practical Neurology
Daniel H Whittam, Emma C Tallantyre, Stephen Jolles, Saif Huda, Robert J Moots, Ho Jin Kim, Neil P Robertson, Bruce A C Cree, Anu Jacob
Rituximab is a widely used B-cell-depleting monoclonal antibody. It is unlicensed for use in neurological disorders and there are no treatment guidelines. However, as a rapidly acting, targeted therapy with growing evidence of efficacy and tolerability in several neuroinflammatory disorders, it is an attractive alternative to conventional immunomodulatory medications. This practical review aims to explain the basic principles of B-cell depletion with therapeutic monoclonal antibodies. We present the evidence for using rituximab in neurological diseases, and describe the practical aspects of prescribing, including dosing, monitoring, safety, treatment failure and its use in special circumstances such as coexisting viral hepatitis, pregnancy and lactation...
February 2019: Practical Neurology
Pedro C Brás, Sara P Dias
No abstract text is available yet for this article.
February 2019: Practical Neurology
Marcus V Pinto, Robert J Spinner, Nathan P Staff
No abstract text is available yet for this article.
February 2019: Practical Neurology
Paul Reading
Remarkably and almost invariably, the clinical phenomenon of cataplexy results from the loss of around 40 000 hypocretin-containing neurones in the lateral hypothalamus in the context of narcolepsy type 1. Cataplexy reflects the dysregulation of rapid-eye-movement (REM) sleep, such that REM-sleep atonia intrudes inappropriately into wakefulness as brief episodes of either focal or total paralysis of voluntary muscle. The semiology of cataplexy differs between adults and children. A defining and enigmatic aspect is that certain emotional stimuli usually trigger the episodes...
February 2019: Practical Neurology
Clare M Galtrey, Viva Levee, Jan Arevalo, Damian Wren
The diagnosis of epilepsy is incorrect in up to 20% of cases so should be revisited if attacks are not responding to treatment. We present a case of long QT syndrome that remained undiagnosed in the epilepsy clinic for 15 years until a near-fatal arrhythmia revealed the diagnosis and allowed effective treatment of her attacks. We hope this near miss raises awareness of long QT syndrome as a potentially fatal, rare but treatable condition that neurologists must consider in people with a label of refractory epilepsy...
February 2019: 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...
February 2019: 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...
February 2019: Practical Neurology
Joanne Lawrence, David Joseph Nicholl
No abstract text is available yet for this article.
December 2018: Practical Neurology
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