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 completely by mexilitene, supporting notion that is...
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 increased sympa...
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 had dystonia especially of face or feet. ...
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 recov...
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 mimicking C...
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 meningiti...
Source: neurologyminutiae - May 17, 2014 Category: Neurologists Source Type: blogs
Management of hepatic encephalopathy in hospital
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")); Review ArticleLeise MD, Poterucha J, Kamath PS et. al. Management of hepatic encephalopathy in the hospital. Mayo Clin Proc 2014; 89(2) 241-253.Working Party for hepatic encephalopathy nomenclature:Type A HE-- secondary to liver failureType B HE enteric hyperammonemia without liver diseasevar pageTracker = _gat._getTracker("UA-3639768-12"); pageTracker._initData(); pageTracker._trackPageview(); T...
Source: neurologyminutiae - May 16, 2014 Category: Neurologists Source Type: blogs
Fwd: Diagnostic criteria for pseudotumore cerebri
From: Djacobs272@aol.comTo: dhj1.neurology@blogger.comSent: 5/13/2014 2:29:29 P.M. Eastern Daylight TimeSubj: Diagnostic criteria for pseudotumore cerebri Neurology 2013; 81:1161 A. Required 1. Papilledema 2. normal neuro exam except cranial neuropathy eg abducens palsy 3. Neuroimaging-- normal MRI with and without contrast 4. Normal CSF composition ...
Source: neurologyminutiae - May 14, 2014 Category: Neurologists Source Type: blogs
Fwd: Secondary causes of pseudotumor cerebri syndrome
From: Djacobs272@aol.comTo: dhj1.neurology@blogger.comSent: 5/13/2014 2:29:28 P.M. Eastern Daylight TimeSubj: Secondary causes of pseudotumore cerebri syndrome (from Neurology, 2013; 81:1159-1165 cerebrovenous abnormalities:cerebral venous thrombosis (CVT)bilateral jugular thrombosis or surgical ligationmiddle ear or mastoid infectionincreased right heart pressuresuperior vena cava syndromeAV fistulashypercoagulable statesMedications and exposures:Antibiotics: tetracycline, minocycline, doxycycline, nalidixic acid, sulfa drugsVitamin A and retinoidshypervitaminosis A, isotretinoin, all trans retinoic acid...
Source: neurologyminutiae - May 14, 2014 Category: Neurologists Source Type: blogs
Fwd: presentations of chronic traumatic encephalopathy
From: Djacobs272@aol.comTo: dhj1.neurology@minutiae.comSent: 5/13/2014 2:29:28 P.M. Eastern Daylight TimeSubj: presentations of chronic traumatic encephalopathy Stern et al. Neurology; 2013: 81:1122-1129 Clinical review of 36 patients, all male athletes. They were based on autopsy studies at Boston University Center for CTAE. 11 patients had episodic memory impairment and executive dysfunction (cognition group) initially, only later behavioral and mood disturbances. Nine patients initially had depression and thi...
Source: neurologyminutiae - May 14, 2014 Category: Neurologists Source Type: blogs
