Fwd: MRI findings in idiopathic intracranial hypertension
From: Djacobs272@aol.comTo: dhj1.neurology@minutiae.comSent: 5/13/2014 2:29:27 P.M. Eastern Daylight TimeSubj: MRI findings in idiopathic intracranial hypertension 1. empty sella 2. flattening of posterior globes3. distension of perioptic subarachnoid spaces4. narrowing of transverse venous sinuses more from Images in Neurology JAMA Neurology 2013; 70:7937-8.5. distended perioptic nerve sheath6. protrusion of the papilla 7. "strangled optic nerve appearance8. optic disc edema and retinal layer edema (Source: neurologyminutiae)
Source: neurologyminutiae - May 14, 2014 Category: Neurologists Source Type: blogs
Uveomeningeal syndromes: ABRA (Amyloid beta related angiitis )
This reported case had uveomeningeal findings clinically and on MRI. Diagnosis by biopsy aND MAY BE AUTOIMMUNE AND RESPOND TO IMMUNOTHERAPY IN THIS CASE PREDNISONE 60/ DAY AND CELLCEPT 1500 BID RESULTED IN IMPROVEMENTSEPARATE ARTICLENeurology 2013; 81: 1596-1603ABRA characteristics of patients: Authors from Mayo compared 78 patients, 40 with CAA (no inflammation) and 28 with granulomatous vasculitis (ABRA) , 10 with CAA related inflammation, and 118 matched patients with PCNSV with AB seen over 25 years. ABRA patients were older, had more altered cognition, seizures and spells, gado positive l...
Source: neurologyminutiae - April 4, 2014 Category: Neurologists Source Type: blogs
CTM v MRI for orthostatic headache with CSF leak
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")); Neurology 2013; 81: 1789-92. Authors did MRI's on 12 patients with CTM proven leaks ("gold standard" test). 11/12 had positive MRI of spine with extradural fluid collections (highly sensitive) and 6/12 having spinal dural enhancement (less sensitive). The dura is seen as a pencil line on sagittal T1 because its displaced by fluid in the dorsal epidural space. Other signs to be expecte...
Source: neurologyminutiae - April 4, 2014 Category: Neurologists Source Type: blogs
Hemosiderin deposition in brain as footprint of high altitude cerebral edema (HACE)
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")); Neurology 2013; 81: 1776-9.Idea- hemosiderin does not go away so patients who experience HACE have hemosiderin seen in corpus callosum-- specifically splenium-- months or years after initial injury. 37 mountaineers were studied, 8 of whom had had HACE, 11 acute mountain sickness, and 8 high clims without injury. Unequivocal microhemorrhages were seen in 8 subjects and equivocal ones in 2 oth...
Source: neurologyminutiae - April 4, 2014 Category: Neurologists Source Type: blogs
Metformin induced B12 deficiency
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")); Arch Int Med 2006 166: 1975-9Retrospective study found B12 deficiency correlated with dose and duration of metformin therapy. B12 deficit defined as less than 150. N was 155 patients. Mechanism is inhibition of calcium dependent ileal absorption of B12-intrinsic factor, which calcium supplementation can reverse. Along with acid inhibitors (PPI's H2 blockers, metformin is most co...
Source: neurologyminutiae - January 20, 2014 Category: Neurologists Source Type: blogs
Statin myopathy 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")); 1. Occurs in fifteen percent of those receiving statins3. Risk factors for include: higher dose statin statin myopathy in a first degree relative older age female small build concurrent systemic disease (renal, he...
Source: neurologyminutiae - December 24, 2013 Category: Neurologists Source Type: blogs
Head drop in neurologic disease: differential and 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")); Clinical: typically occurs in women over age 65neck extensor weakness is usually subacute and associated with proximal arm weaknessEMG abnormal (myopathic or denervating) in cervical or thoracic paraspinal muscles but normal in limb musclesImmunomodulators don't affect prognosisdifferential:polymyositisALS (usually not isolated finding)MG ( three percent have headdrop as initial presentatio...
Source: neurologyminutiae - December 24, 2013 Category: Neurologists Source Type: blogs
Dx of neurologic emergencies in pregnancy/postpartum
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")); Edlow JA, Caplan LR, Obrien K, Tibbles CD. Diagnosis of acute neurological emergencies in pregnant and post-partum women. Lancet Neurology 2013; 12: 175-185This is a review article that is nicely written. I am blogging some of the minutiae of the article, not necessarily the major points, that might escape otherwise. Here are a few pearls from the article:1. There is 8-39 % overlap be...
Source: neurologyminutiae - October 1, 2013 Category: Neurologists Source Type: blogs
Chair for paraplegic
http://www.wimp.com/newdevice/ (Source: neurologyminutiae)
Source: neurologyminutiae - April 26, 2013 Category: Neurologists Source Type: blogs
(no subject)
http://www.wimp.com/newdevice/ (Source: neurologyminutiae)
Source: neurologyminutiae - April 26, 2013 Category: Neurologists Source Type: blogs
Papilledema and obstructive sleep apnea syndrome.
CONCLUSIONS: We propose that PE in SAS is due to episodic nocturnal hypoxemia and hypercarbia resulting in increased ICP secondary to cerebral vasodilation. In these individuals, intermittent ICP elevation is sufficient to cause persistent disc edema. These patients may be at increased risk for developing visual loss secondary to PE compared with patients with obesity-related pseudotumor cerebri because of associated hypoxemia. The diagnosis of SAS PE may not be appreciated because daytime cerebrospinal fluid pressure measurements are normal and because patients tend to present with visual loss rather than ...
Source: neurologyminutiae - April 12, 2013 Category: Neurologists Source Type: blogs
Common pitfalls in management IIH
Management Errors:missing venous sinus thrombosisfailure to address other secondary causes (e.g., anemia, hypoxia)relying on optic disc appearance without monitoring visual fieldsbeing too slow to proceed to surgical intervention (Source: neurologyminutiae)
Source: neurologyminutiae - April 8, 2013 Category: Neurologists Source Type: blogs
Papilledema pearls
1. Cotton wool spots OFF disk may suggest hypertensive syndrome 2. Hemorrhages off disc suggest central retinal vein occlusion 3. New onset pulsatile tinnitus is significant finding indicating need to look for increased ICP, as well as transient obscurations, graying of vision for twenty seconds, with postural change and headache. Field before acuity is affected, disc edema usually affected. 4. MRI findings may include disc enhancement, occassionally, enhanced perioptic space (40 %), flattening of posterior globe (80 %), empty sella Get MRI/M...
Source: neurologyminutiae - April 8, 2013 Category: Neurologists Source Type: blogs
Causes of pappilledema (bilateral) with good optic nerve function
increased intracranial pressure malignant hypertension toxins (amiodarone,cyclosporine) sleep apnea syndrome uveitis, eg. sarcoidosis (Source: neurologyminutiae)
Source: neurologyminutiae - April 8, 2013 Category: Neurologists Source Type: blogs
Fwd: Neurological complications of influenza
Neurological complications of influenza Tsai JP, Baker AJ. Neurocritical Care 18:2013; 118-130 (review article) There are five types of encephalopathy, two benign and three malignant. Typically they occur a mean of two weeks post influenza, and are not associated with CNS inflammation. They include:1) MERS (mild encephalopathy with reversible splenial lesion)- influenza symptoms, then prodrome of decreased level of consciousness, seizures, CSF pleocytosis, EEG abnormal, often within 103 days, and total resolution within one month with or without therapy. Agents incl...
Source: neurologyminutiae - March 6, 2013 Category: Neurologists Source Type: blogs
