Dermatomyositis with and without anti Mi2 autoantibodies
Pinal-Hernandez I, Mecoli CA, Casal-Dominguez Mvar gaJsHost = (( " https: " == document.location.protocol) ? " https://ssl. " : " http://www. " ); document.write(unescape( " %3Cscript src='" + gaJsHost + " google-analytics.com/ga.js'type='text/javascript'%3E%3C/script%3E " )); .  More prominent muscle involvement with dermatomyositis with anti Mi2 autoantibodies. Neurology; 2019; 93e1768-1777(John Hopkins)58 patients with antiMi2 positive DM143 patient with anti Mi2 negative DM162 patients with antisynthetase syndrome170 patients with immune mediated necrotizing myopat...
Source: neurologyminutiae - November 13, 2019 Category: Neurology Source Type: blogs

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I'm on top of the world because of it! http://better.localknead.comDaniel Jacobs (Source: neurologyminutiae)
Source: neurologyminutiae - November 18, 2018 Category: Neurology Source Type: blogs

Re:
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Source: neurologyminutiae - October 27, 2018 Category: Neurology Source Type: blogs

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Source: neurologyminutiae - September 27, 2018 Category: Neurology Source Type: blogs

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Source: neurologyminutiae - August 18, 2018 Category: Neurology Source Type: blogs

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Source: neurologyminutiae - July 19, 2018 Category: Neurology Source Type: blogs

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http://win.onemillionhealthywomen.com/review3.phpDaniel Jacobs (Source: neurologyminutiae)
Source: neurologyminutiae - April 19, 2018 Category: Neurology Source Type: blogs

Autoimmune meningoencephalitis associated with GFAP IgG antibodies.
var gaJsHost = (( " https: " == document.location.protocol) ? " https://ssl. " : " http://www. " ); document.write(unescape( " %3Cscript src='" + gaJsHost + " google-analytics.com/ga.js'type='text/javascript'%3E%3C/script%3E " ));var pageTracker = _gat._getTracker( " UA-3639768-12 " ); pageTracker._initData(); pageTracker._trackPageview();Fung B et al.  Autoimmune glial fibrillary acidic protein astrocytopathy: a novel meningoencephalomyelitis.  JAMA Neurol 2016; 73: 1297.Mayo labs has 134 cases out of 100,000 evaluated for autoimmune and paraneoplastic ...
Source: neurologyminutiae - February 7, 2017 Category: Neurology Source Type: blogs

Steroid sparing therapy in neurosarcoidosis
var gaJsHost = (( " https: " == document.location.protocol) ? " https://ssl. " : " http://www. " ); document.write(unescape( " %3Cscript src='" + gaJsHost + " google-analytics.com/ga.js'type='text/javascript'%3E%3C/script%3E " ));var pageTracker = _gat._getTracker( " UA-3639768-12 " ); pageTracker._initData(); pageTracker._trackPageview();Neurology 2016; 13:87:2517 Uncontrolled study of 40 patients with neurosarcoidosis, both central and peripheral nerve.  32 got MTX 20 mg per week, 14 got mycophenolate (MMF) at 2 grams per day (median) 6 had both drugs succe...
Source: neurologyminutiae - February 7, 2017 Category: Neurology Source Type: blogs

Biotinidase deficiency mimicking NMO: initiallyexhibiting symptoms in adulthood
Bottin L, Prud'honS, Giannesini C et al. Multiple Sclerosis 21 (12) 1604-07 2015. var gaJsHost = (( " https: " == document.location.protocol) ? " https://ssl. " : " http://www. " ); document.write(unescape( " %3Cscript src='" + gaJsHost + " google-analytics.com/ga.js'type='text/javascript'%3E%3C/script%3E " ));var pageTracker = _gat._getTracker( " UA-3639768-12 " ); pageTracker._initData(); pageTracker._trackPageview();Authors present first case of biotinidase deficiency presenting in young adulthood ; children and adolescents may present with vision los...
Source: neurologyminutiae - November 30, 2016 Category: Neurology Source Type: blogs

Seropositive voltage gated calcium channels, utility
Conclusions:  1.  High VGKC ab levels are found in patients with classic and other autoimmune disorderes,  Low level ab titers are seen in nonspecific and mostly nonautoimmune disorders2.  The presence of VGKC antibodies rather than the level may serve as a marker of malignancyNotes this is bad on a chart review of 6,032 patients who underwent evaluation .The nonclassic group includes PNS and CNS diorders including neuropathy, dementia, ALS, CJD.  Some patietns had nonspecific symptoms such as stutering speech, nausea and vomting and orthostasis without diagnosis of neurologic disease.Cancers were ...
Source: neurologyminutiae - November 8, 2016 Category: Neurology Source Type: blogs

Pearls about GQ1b
var gaJsHost = (( " https: " == document.location.protocol) ? " https://ssl. " : " http://www. " ); document.write(unescape( " %3Cscript src='" + gaJsHost + " google-analytics.com/ga.js'type='text/javascript'%3E%3C/script%3E " ));var pageTracker = _gat._getTracker( " UA-3639768-12 " ); pageTracker._initData(); pageTracker._trackPageview();Serum and CSF GQ1 ab'sin isolated opthalmoplegic syndromes.  Spatola M, Du Pasquier R, Schluep M, et al.  Neurology 2016; 86:1780-1784 pearls about GQ1b from this article 1.  Antibodies are specific for M...
Source: neurologyminutiae - November 8, 2016 Category: Neurology Source Type: blogs

code for chronic management labs
Z79.899var gaJsHost = (( " https: " == document.location.protocol) ? " https://ssl. " : " http://www. " ); document.write(unescape( " %3Cscript src='" + gaJsHost + " google-analytics.com/ga.js'type='text/javascript'%3E%3C/script%3E " ));var pageTracker = _gat._getTracker( " UA-3639768-12 " ); pageTracker._initData(); pageTracker._trackPageview(); (Source: neurologyminutiae)
Source: neurologyminutiae - September 27, 2016 Category: Neurology Source Type: blogs

Froin's syndrome
var gaJsHost = (( " https: " == document.location.protocol) ? " https://ssl. " : " http://www. " ); document.write(unescape( " %3Cscript src='" + gaJsHost + " google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E " )); var pageTracker = _gat._getTracker( " UA-3639768-12 " ); pageTracker._initData(); pageTracker._trackPageview(); CSF showing high protein, xanthochromia and hypercoagulation of CSF is pathognomonic and it can occur with blockage of CSF by a spinal cord mass or meningeal irritation from meningitis. (Source: neurologyminutiae)
Source: neurologyminutiae - June 1, 2016 Category: Neurology Source Type: blogs

Froin's syndrome
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); var pageTracker = _gat._getTracker("UA-3639768-12"); pageTracker._initData(); pageTracker._trackPageview(); CSF showing high protein, xanthochromia and hypercoagulation of CSF is pathognomonic and it can occur with blockage of CSF by a spinal cord mass or meningeal irritation from meningitis. (Source: neurologyminutiae)
Source: neurologyminutiae - June 1, 2016 Category: Neurology Source Type: blogs

Orthostatic tremor - pearls
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); var pageTracker = _gat._getTracker("UA-3639768-12"); pageTracker._initData(); pageTracker._trackPageview(); Hassan A, Ahlskog AE, Matsumotos JY.  Orthostatic tremor: clinical, electrophysiologic and treatment findings in 184 patients.  Neurology 2016; 86: 458-464.The article is a Mayo series of 184 patients seen over 37 years.  Defini...
Source: neurologyminutiae - February 23, 2016 Category: Neurology Source Type: blogs

Scurvy and Neurologic disease
Meisal K, Daggubati S,Josephson SA. .  Scurvy in the 21st century?  Vitamin C deficiency presenting to the neurologist.  Neurol Clin Prac 2015; 5:491-493. Authors present a series of cases with vitamin C deficiency and review some of the neuro manifestations and non neuro manifestations, ; the former are not widely known.   Patients with deficiency were caused by various other causes,including autism, poor status without access to produce, usually rural, were not alcohol users, had measurable low vitamin C levels.  Gingival hyperplasia, rash and bleeding were non neurologic manifestations...
Source: neurologyminutiae - January 4, 2016 Category: Neurology Source Type: blogs

Pellagra and spinal myoclonus
Park K, Oeda T, Sawada H. A case of alcoholic pellegra encephalopathy presenting with spinal myoclonus.  Neurology Clinical Practice 5; 472-3. The authors present a case of alcoholic pellagra  with confusion and myoclonus responding dramatically to administration of niacin1500 mg per day starting 16 days after admission.  Essential points include: 1. Pellagra is rare in US but not in alcoholics2. Dermatitis may be subtle and not appreciated3.  Thiamine and niacin levels may be normal4.  Thiamine may cause worsening due to increased demand for niacin5.  Myoclonus in context is importa...
Source: neurologyminutiae - January 4, 2016 Category: Neurology Source Type: blogs

Malignant subtypes of Parkinsons
JAMA Neurology august 2015 Importance  There is increasing evidence that Parkinson disease (PD) is heterogeneous in its clinical presentation and prognosis. Defining subtypes of PD is needed to better understand underlying mechanisms, predict disease course, and eventually design more efficient personalized management strategies. Objectives  To identify clinical subtypes of PD, compare the prognosis and progression rate between PD phenotypes, and compare the ability to predict prognosis in our subtypes and those from previously published clustering solutions. Design, Setting, and Participants  Prospective co...
Source: neurologyminutiae - January 4, 2016 Category: Neurology Source Type: blogs

Drug choices for juvenile myoclonic epilepsy
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); valproic acidtopiramatelamotriginelevetiracetamzonisamidenote these are the "broad spectrum drugs"also note: valproic acid and topiramate are teratogenicvar pageTracker = _gat._getTracker("UA-3639768-12"); pageTracker._initData(); pageTracker._trackPageview(); (Source: neurologyminutiae)
Source: neurologyminutiae - August 22, 2015 Category: Neurology Source Type: blogs

AED's and psychiatric function
var gaJsHost = (( " https: " == document.location.protocol) ? " https://ssl. " : " http://www. " ); document.write(unescape( " %3Cscript src='" + gaJsHost + " google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E " )); Psychiatric function worse: levetiracetam topiramate zonisamide tiagabine phenobarbital periampanel psychiatric function better carbamazepine valproic acid lamotrigine var pageTracker = _gat._getTracker( " UA-3639768-12 " ); pageTracker._initData(); pageTracker._trackPageview(); pregabalin (Source: neurologyminutiae)
Source: neurologyminutiae - August 22, 2015 Category: Neurology Source Type: blogs

AED's and psychiatric function
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); Psychiatric function worse:levetiracetamtopiramatezonisamidetiagabinephenobarbitalperiampanelpsychiatric function bettercarbamazepinevalproic acidlamotriginevar pageTracker = _gat._getTracker("UA-3639768-12"); pageTracker._initData(); pageTracker._trackPageview(); pregabalin (Source: neurologyminutiae)
Source: neurologyminutiae - August 22, 2015 Category: Neurology Source Type: blogs

AED's compared head to head to standard therapy eg. carbamazepine
var gaJsHost = (( " https: " == document.location.protocol) ? " https://ssl. " : " http://www. " ); document.write(unescape( " %3Cscript src='" + gaJsHost + " google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E " )); note this is a test done by EU & gt; & gt; FDA favorably compare:   oxcarbazepine eslicarbazepine lamotrigine gabapentin topiramate levetiracetam zonisamide unfavorably compare (are inferior) pregabalin vigabatrin test not done tiagabine lacosamide ezogabine perampanel var pageTracker = _gat._getTracker( " UA-3639768-1...
Source: neurologyminutiae - August 22, 2015 Category: Neurology Source Type: blogs

AED's compared head to head to standard therapy eg. carbamazepine
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); note this is a test done by EU>> FDAfavorably compare:  oxcarbazepineeslicarbazepinelamotriginegabapentintopiramatelevetiracetamzonisamideunfavorably compare (are inferior)pregabalinvigabatrintest not donetiagabinelacosamideezogabineperampanelvar pageTracker = _gat._getTracker("UA-3639768-12"); pageTracker._initData(); pageTracker._trackP...
Source: neurologyminutiae - August 22, 2015 Category: Neurology Source Type: blogs

Enzyme inducers-- pearls
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); enzyme inducers adverse effects (partial) include1.  decrease efficacy of oral contraception2.  osteomalacia3.  halve dose of many drugs, rendering them ineffective; this includes chemotherapeutic agents for children having CLL who have greater mortality on these drugs4.  increase cholesterol5.  Decrease testicular sizevar pageTracker...
Source: neurologyminutiae - August 22, 2015 Category: Neurology Source Type: blogs

Narrow and broad spectrum antiepileptic drugs
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); Narrow spectrumcarbamazepineoxcarbazepinetiagabinegabapentinpregabalinBroad spectrumvalproic acidtopiramatelamotriginelevetiracetamzonisamideparampanelvar pageTracker = _gat._getTracker("UA-3639768-12"); pageTracker._initData(); pageTracker._trackPageview(); (Source: neurologyminutiae)
Source: neurologyminutiae - August 21, 2015 Category: Neurology Source Type: blogs

New Epilepsy classification
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); I  GeneticII Focal    a. Aware    b  UnawareIII MixedIV UnknownV Secondary generalizedvar pageTracker = _gat._getTracker("UA-3639768-12"); pageTracker._initData(); pageTracker._trackPageview(); (Source: neurologyminutiae)
Source: neurologyminutiae - August 21, 2015 Category: Neurology Source Type: blogs

IV valproate inferior for acute migraine
Friedman BW, Garber L, Yoon A, et al.  Randomized trial of iv valproate vs.metoclopramide v. ketorolac for acute migraine.  Neurology 2014; 82:976-983.   Authors randomized 330 patients in ER to get 1000 mg, 10 mg, or 30 mg of respective drugs above over an iv drip over 15 minutes in a double blind trial.  On the primary measure of pain relief, valproate lost big to the other two drugs.  On secondary measures of needing a rescue medication, iv valproate also lost.   Comment-- great to have this knowledge but the two winning drugs each had relatively low sustained headache relief, 4 v. 1...
Source: neurologyminutiae - April 19, 2015 Category: Neurology Source Type: blogs

GPDS and NCSE
Foreman BM, Chassen J, Abou Khaled K, et al. Generalized periodic discharges in the critically ill:  a case control study of 200 patients.  Neurology 2012; 79:1951-1960   and editorial Jette N, Mosely BD. Generalized periodic discharges : More light shed on the old GPEDs Neurology 2012; 79: 1940-1.   Authors found GPD's in 4.5 % of 3000 patients undergoing cEEG.  These 200 patients  had brain injury (44%), acute systemic illness (38%), cardiac arrest (15%) and epilepsy (3%).    27 % of GPD's had NCSE v. 8 % of controls.  However, GPD's were not associated with convul...
Source: neurologyminutiae - April 1, 2015 Category: Neurology Source Type: blogs

code for tpa
If you physically administer tpa; code 37195 If you are present evaluating a acute stroke, bill as highest level code (if you meet all the 'bullet points'). Add a statment "patient is critical and unstable'; document time spent; if it is 30-74 min; add 99291 (Source: neurologyminutiae)
Source: neurologyminutiae - March 25, 2015 Category: Neurology Source Type: blogs

Idiopathic hypertrophic pachymeningitis
    Dumont AS, Clark AWm Sevick RJ, Myles ST. Idiopathic hypertrophic pachymeningitis:  A report of two cases and review of the literature.   Background-- Authors note entity was described by Charcot and Joffroy, and that there are three forms:  spinal, intracranial and craniospinal (latter is rarer).    Past cases were often attributed to specific etiologies but most recent cases are idiopathic after investigation.  Authors case 1 underwent 2 surgeries for biopsy/decompression , had persistent pain and numbness, but was non progressive for 15 years after one early relapse.&n...
Source: neurologyminutiae - March 25, 2015 Category: Neurology Source Type: blogs

Encephalitis serological evaluation
Hsve Cmv Hiv 1 and 2 Vzv Ebv Toxo Lyme Mycoplasma pn Leptospirosis Legionella Brucellosis Chlamydia Syphilis Aspergillosis (Source: neurologyminutiae)
Source: neurologyminutiae - February 1, 2015 Category: Neurologists Source Type: blogs

Definite central fourth nerve palsy
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); per Neil MillerAn ipsilateral or contralateral relative afferent pupillary defect (RAPD) unassociated with any decrease in visual acuity, reduced color vision, or visual defect, but with setting of an isolated fourth nerve palsy, RAPD indicated localization to brachium of superior colliculus and almost always indicates the fourth nerve paresis is central in o...
Source: neurologyminutiae - November 4, 2014 Category: Neurologists Source Type: blogs

Smartvest SQL
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); Chest wall oscillation approved for neuromuscular disease, 80 % paid by Medicare with assistance for rest.originally for bronchiectasisuse for thirty minutes twice dailywww.smartvest.comwww.ICD9data.com var pageTracker = _gat._getTracker("UA-3639768-12"); pageTracker._initData(); pageTracker._trackPageview(); (Source: neurologyminutiae)
Source: neurologyminutiae - October 18, 2014 Category: Neurologists Source Type: blogs

Galaxy portfolio for aed's-- low priced drugs
var gaJsHost = (( " https: " == document.location.protocol) ? " https://ssl. " : " http://www. " ); document.write(unescape( " %3Cscript src='" + gaJsHost + " google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E " )); UPSHER SMITH PORTFOLIO INCLUDES TOPIRAMATE ER (QUDEXY) 25,50,100, 150 , 200 MG TABS (NOT DISCOUNTED) Discounted: topiramate tablets divalproex delayed release tbalets valproic acid capsules, USP lamotrigine tablets carbamazepine tablets phenytoin extended release.   advantages receive a consistent product use a specialty pharmacy form ...
Source: neurologyminutiae - October 18, 2014 Category: Neurology Source Type: blogs

Galaxy portfolio for aed's-- low priced drugs
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); UPSHER SMITH PORTFOLIO INCLUDES TOPIRAMATE ER (QUDEXY) 25,50,100, 150 , 200 MG TABS (NOT DISCOUNTED)Discounted:topiramate tabletsdivalproex delayed release tbaletsvalproic acid capsules, USPlamotrigine tabletscarbamazepine tabletsphenytoin extended release.  advantagesreceive a consistent productuse a specialty pharmacy formMOBE referral kit available fr...
Source: neurologyminutiae - October 18, 2014 Category: Neurologists Source Type: blogs

Charging for items outside the traditional billing codes.
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); based on summary article by Orly Avitzur, Neurology Today based ona presentation by health care lawyer Daniel Brown.New CPT codes for telephone/internet assessment when provided doctor to doctor by a consultant-- codes 99446-99449.  May be used for complex and urgent situations when face to face is not practical.  These are time based only codes and...
Source: neurologyminutiae - October 18, 2014 Category: Neurologists Source Type: blogs

Concise of brain antigens commonly tested
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); 1.  NMDAR NR1  anti NMDAR encephalitis2.  amphiphysin-- stiff person syndrome, encephalomyelitis,limbic encephalomyelitis, sensorimotor neuropathy3.  ARHGAP 25, GRAF -- subacute inflammatory cerebellar ataxia4. CASPR2 (contactin associated protein 2)-  Morvan syndrome, neuromyotonia, limbic encephalitis5.  MOG  -- ADEM, MS, ...
Source: neurologyminutiae - October 17, 2014 Category: Neurologists Source Type: blogs

Hydroxyurea and HbF in sickle cell disease
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); Steinberg MH et al. Effect of hydroxyurea on mortality and morbidity in adult sickle cell anemia.    Risks and benefits up to 9 years of treatment. JAMA 1003; 289: 1645-51.  Weiner DL, et al. editorial: hydroxyurea and sickle cell disease. A chance for every patient.HbF is inversely related to mortality in SCD, and can be increased with hy...
Source: neurologyminutiae - October 9, 2014 Category: Neurologists Source Type: blogs

Machado Joseph disease
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); aka MJD, spinocerebellar ataxia type 3features adult onset, autosomal dominantUMN and LMN signs resembling ALS may include tongue fasciculations, dystonia, rigidity, progressive external opthalmoplegia, and peripheral neuropathy.Due to CAG triplicate repeat on chromosome 14q32.1Cramping is far more common than in PN or SMA but not ALS and is relieved almost c...
Source: neurologyminutiae - October 9, 2014 Category: Neurologists Source Type: blogs

Cocaine related hallunications
var pageTracker = _gat._getTracker("UA-3639768-12"); pageTracker._initData(); pageTracker._trackPageview(); Classically is the sensation of animal, bugs or insects moving under the skin (cocaine bugs or parasitosis). Other purely visual hallucinations that can occur include "snow lights" or the sensation of sunlight reflecting off snow crystals. Vibrating and pulsating geometric shapes, polyopia, and dysmorphia occur and resemble visual aura. Olfactory, tactile and gustatory hallucinations may occur. Photophobia, halos around lights, and gtrouble focusing may be due instead to pupillary mydriasis due to...
Source: neurologyminutiae - October 9, 2014 Category: Neurologists Source Type: blogs

Vienna conference return to play recommendations
1.   Remove from game if any signs of concussion- any items missed on sideline exam2.   No return to play in current game3.   Medical evaluation after injury   a. rule out serious focal injury     b. neuropsychologic evaluation4.   Stepwise return to play    a.  rest till asymptomatic      b.   light aerobic      c.  sport specific training     d.  noncontact practice      e. full contact practice     f. return to play1 var gaJsHos...
Source: neurologyminutiae - October 9, 2014 Category: Neurologists Source Type: blogs

Parkinsonism in cirrhotics
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www."); document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js' type='text/javascript'%3E%3C/script%3E")); Burkhard PR et al. Arch Neurol 2003;60:521-528 Authors studied cirrhotics prospectively and found a unique Parkinsonian syndrome in 20 %.  Among 51 consecutive patients evaluated for liver transplant, 11 had Parkinsonism esp. stereotypical onset with generalized bradykinesia, dysarthira, postural instability, and prominent ACTION tremor.  Six h...
Source: neurologyminutiae - October 9, 2014 Category: Neurologists Source Type: blogs

Shingles pearls
var pageTracker = _gat._getTracker("UA-3639768-12"); pageTracker._initData(); pageTracker._trackPageview(); 1. 1 in 3 people will develop HZ during their lifetimes.2. The preeruption pain may be confused with MI , pleurisy, appendicitis, dental pain and many others.3. Shell vial viral culture is most common test, but PCR is rapid, more sensitive and specific4. (Source: neurologyminutiae)
Source: neurologyminutiae - October 9, 2014 Category: Neurologists Source Type: blogs

LEMS review paper
http://ac.els-cdn.com/S1474442211702459/1-s2.0-S1474442211702459-main.pdf?_tid=82414656-f231-11e3-9c91-00000aacb360&acdnat=1402578200_ed42d2f0e8da41b0e292941e0f16ebd3 (Source: neurologyminutiae)
Source: neurologyminutiae - June 12, 2014 Category: Neurologists Source Type: blogs

ADEM pearls
old paper, useful insights Menge T, Hemmer B, Nessler S et al  Acute disseminated encephalomyelitis: an update. Arch Neurol 2005; 62: 1673-1680   1.  Consider a temporal relationship to a vaccine or infection.  If vaccine, especially MMR, also polioand European tick borne encephalitis vaccination (Source: neurologyminutiae)
Source: neurologyminutiae - June 5, 2014 Category: Neurologists Source Type: blogs

antiMOG seronegative NMO
Kitley J, Waters P, Woodhall M, et al. Neuromyelitis optica spectrum disorders with aquaphorin-4 and Myelin-oligodendrocyte glycoprotein antibodies: a comparative study.   see Levy M. Does aquaphorin-4-seronegative neuromyelitis optica exist? (editorial) JAMA Neurology 2014; 71:271-2.   Authors of both studies ferret out a subtype of seronegative NMO that is actually yet another disease.   Anti MOG positve patients with clinical features of NMO have a slightly different phenotype with features of ADEM also.  This group encompasses young males with severe episodes with better recoveries that ...
Source: neurologyminutiae - June 2, 2014 Category: Neurologists Source Type: blogs

CJD and non CJD with neuronal markers
Grau-Rivera O, Sanchez-Valle R, Saiz A et al. Determination of neuronal antibodies in suspected and definite Creutzfeld-Jakob disease . JAMA Neurol 2014;71:74-78. Take home points 1. A small but definite number of 346 patients with suspected CJD had anti neuronal antibody mimics but these six did not fulfil criteria for CJD. Found were NMDAR,LGI1 , CASPR2, aquaphorin 4, Tr(DNER alpha notch 4 epgf and unknown protein. 2. No patients among 46 with definite CJD had these neuronal markers. These all were studied in CSF (Source: neurologyminutiae)
Source: neurologyminutiae - May 28, 2014 Category: Neurologists Source Type: blogs

Faciobrachial systolic seizures , correlate with anti VGKC and not CJD
Yoo J and Hirsch LJ. Limbic encephalitis associated with anti voltage gated potassium channel complex antibodies mimicking CJD. Jama Neurol 2014;71:79-82. Case with following take home points: FBDS are highly associated with ant VGKCC and not CJD and are treated with normal AED's The two disorders otherwise may mimic each other Anti VGKCC responds robustly to steroids Both disorders can have elevated 14,3,3 in CSF Absent restricted diffusion is a "red flag" against CJD MRI of anti VGKCC is usually high T2 signal in uni or bilateral temporal lobes but they can also show cortical ribbon and basal ganglia changes mi...
Source: neurologyminutiae - May 28, 2014 Category: Neurologists Source Type: blogs

RA meningitis as stroke mimic
Bourgeois P et al.  Rheumatoid arthritis presenting with stroke like episodes. Neurology 2014; 82: 1564-5.    70 yo male presented with series of TIA like events over ten days consisting of right leg more than arm weakness.  He had poorly controlled RA.  MRI was negative for brain parenchyma but there was enhancement of meninges and pachymeningitis.  Meningeal biopsy was positive and patient was successfully treated by Solumedrol 1 gram per day followed by 1 mg/kg/day prednisone, tapered over months with no recurrence.    Other reported presentations of RA meningitis include ...
Source: neurologyminutiae - May 18, 2014 Category: Neurologists Source Type: blogs