Myopathies in the adult patient
General clinicians manage patients with muscle conditions presenting in isolation or as part of a multisystem disorder. It is important to recognize acquired myopathies, particularly inflammatory muscle disease and rhabdomyolysis, and be able to identify common genetic myopathies, such as myotonic dystrophy. Many of these patients require specialist assessment. Major translational therapies are now available for dystrophinopathies, spinal muscular atrophy and some other muscle conditions. Early recognition and treatment of medical complications of myopathies, particularly cardiac, respiratory and swallowing/nutritional iss...
Source: Medicine - July 24, 2023 Category: Internal Medicine Authors: Andria F.A. Merrison Tags: Neuromuscular disorders in neurology Source Type: research
Acute neurological infections
This article briefly outlines the common acute neuroinfection syndromes. (Source: Medicine)
Source: Medicine - July 24, 2023 Category: Internal Medicine Authors: Varun Sethi, Nicholas WS. Davies Tags: Acute neurology Source Type: research
Clinical aspects of motor neurone disease
Motor neurone disease (MND), or amyotrophic lateral sclerosis (ALS), is a progressive, fatal neurodegenerative disease affecting the upper and lower motor neurones. It eventually causes widespread weakness and wasting, spasticity, dysarthria, dysphonia, dysphagia and respiratory failure. The diagnosis is clinical, and it is important for management to establish this early. It presents with upper and lower motor neurone signs affecting the bulbar, cervicothoracic and lumbosacral regions (ALS), only lower motor neurone signs affecting one or more limbs (progressive muscular atrophy), purely bulbar region symptoms and signs (...
Source: Medicine - July 24, 2023 Category: Internal Medicine Authors: Richard W. Orrell, Roberto J. Guiloff Tags: Neuromuscular disorders in neurology Source Type: research
Functional neurological disorders
Functional neurological disorder (FND) causes genuine, involuntary and disabling symptoms. FND is a rule-in diagnosis based on positive examination findings and typical features. Despite the significant prevalence of FND and improved understanding of disease mechanisms, many clinicians feel ill-equipped to diagnose and manage this condition. This review provides a practical overview of FND focusing on the initial assessment, diagnostic challenges and multidisciplinary treatment strategies. Dissociative seizures and functional movement, sensory, cognitive and speech disorders are discussed. (Source: Medicine)
Source: Medicine - July 24, 2023 Category: Internal Medicine Authors: Gauri K Saxena, Mahinda Yogarajah Tags: Acute neurology Source Type: research
Acute back pain and cauda equina syndrome
This article focuses on cauda equina syndrome with an overview of the differential diagnoses. (Source: Medicine)
Source: Medicine - July 24, 2023 Category: Internal Medicine Authors: Ingrid Hoeritzauer, Julie Woodfield Tags: Acute neurology Source Type: research
Acute and chronic neuropathies
A detailed history, examination, nerve conduction tests and appropriate laboratory investigations will be diagnostic in most peripheral neuropathies. It is important to identify treatable causes. Guillain –Barré syndrome, vasculitic neuropathy, chronic inflammatory demyelinating polyradiculoneuropathy and multifocal motor neuropathy can have good outcomes with immunomodulation. In addition, hereditary transthyretin amyloidosis neuropathy is now a treatable disorder. (Source: Medicine)
Source: Medicine - July 24, 2023 Category: Internal Medicine Authors: Simeona Jacinto, Hadi Manji Tags: Neuromuscular disorders in neurology Source Type: research
Self-assessment/CPD answers
Question 1 (Source: Medicine)
Source: Medicine - July 24, 2023 Category: Internal Medicine Tags: Self-assessment/CPD answers Source Type: research
Contents
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Source: Medicine - June 28, 2023 Category: Internal Medicine Source Type: research
Editorial Board
(Source: Medicine)
Source: Medicine - June 28, 2023 Category: Internal Medicine Source Type: research
Autoantibody-mediated neurological diseases
In 1672 Thomas Willis first described a patient with fatiguable muscle weakness, which is likely to have been myasthenia gravis (MG), a prototypic antibody-mediated neuroimmunological condition. However, the linking between MG and anti-acetylcholine receptor antibody only began 3 centuries later in the 1970s, a few years after discovering the antibody structure.Several clinical syndromes and autoantibodies of neuroimmunological disorders have been identified since, especially in the past two decades. (Source: Medicine)
Source: Medicine - June 28, 2023 Category: Internal Medicine Authors: Pyae Phyo San, Saiju Jacob Tags: Clinical assessment in neurology Source Type: research
Persistent symptoms after a mild traumatic brain injury: assessment and management
Mild traumatic brain injuries are common. Most patients make a quick and complete recovery but a proportion report persistent symptoms that can have a major impact on work and social functioning. The cause of persistent symptoms is complex, with numerous interacting biological, psychological and social factors implicated in their generation. Detailed assessment to determine the cause(s) for an individual patient is important to allow the tailoring of an appropriate treatment plan. (Source: Medicine)
Source: Medicine - June 28, 2023 Category: Internal Medicine Authors: Peter O. Jenkins Tags: Cognitive neurology Source Type: research
Epilepsy update: diagnosis, classification and management
Careful clinical evaluation differentiates epileptic seizures from syncope (vasovagal or cardiogenic), dissociative seizures (non-epileptic attack disorder) and other rarer paroxysmal events. The initial diagnosis of epilepsy is incorrect in 20 –30% of patients. Investigations can include blood tests, electrocardiograms, electroencephalograms and neuro-imaging. Patients should be informed and counselled about the diagnosis. Anti-seizure medications (ASMs) are the first-line treatment for epilepsy, the choice depending on the epilepsy syn drome, seizure type, patient and their co-morbidities. (Source: Medicine)
Source: Medicine - June 28, 2023 Category: Internal Medicine Authors: Lauren Harris, Heather Angus-Leppan Tags: Clinical assessment in neurology Source Type: research
Lumbar punctures and cerebrospinal fluid analysis
We describe how, with adequate preparation and correct patient positioning, the procedure can be performed quickly and safely. The range of investigations that can be performed on CSF and their interpretation are discussed. (Source: Medicine)
Source: Medicine - June 27, 2023 Category: Internal Medicine Authors: Catherine Morgan, Justin Pearson, Geraint Fuller Tags: Investigations in neurology Source Type: research
Dementia and disorders of cognition
Dementia is a progressive deterioration in cognitive function caused by degenerative brain disease. It is one of the most common presentations encountered in general medical practice, especially in elderly individuals. Dementia is a syndrome that can be caused by different types of brain pathology including, commonly, Alzheimer's disease and brain vascular disease. Different pathologies have different ‘signatures', especially at an early stage, based on combinations of cognitive, behavioural and neurological features. (Source: Medicine)
Source: Medicine - June 27, 2023 Category: Internal Medicine Authors: Meher Lad, Timothy D. Griffiths Tags: Cognitive neurology Source Type: research
Assessment of dizziness in neurology
Dizziness and vertigo are common symptoms. In acute vertigo, expert clinical assessment is critically important in discerning stroke from non-stroke causes because the results of stroke-protocol brain magnetic resonance imaging, including diffusion-weighted imaging, can be falsely negative in the first 24 hours. It follows that acute medical services must have access to clinicians expert in assessing acute vertigo. Expertise in clinical examination and interpretation of the findings requires appropriate training, but here we outline the basic diagnostic and therapeutic approach to patients with dizziness. (Source: Medicine)
Source: Medicine - June 27, 2023 Category: Internal Medicine Authors: Louisa Murdin, Barry M. Seemungal, Adolfo M. Bronstein Tags: Clinical assessment in neurology Source Type: research