Neurology steering board effects change for a major electronic health record vendor
We describe the advocacy of the American Academy of Neurology for improved EHR usability and the resultant formation and subsequent accomplishments of a Neurology Subspecialty Steering Board at 1 major EHR vendor (Epic). (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 12, 2019 Category: Neurology Authors: Weathers, A. L., Haq, I. U., Ficker, D. M., Ney, J. P., Meyers, S. L. Tags: All Clinical Neurology, Electronic medical records Commentary Source Type: research

"Pseudo-syndromes" associated with Parkinson disease, dementia, apathy, anxiety, and depression
Purpose of review Physicians treating patients with Parkinson disease must evaluate not only motor symptoms but also acquire expertise in assessing the complex behavioral features that often accompany the disease, such as dementia, apathy, anxiety, and depression. Recent findings There is a risk of diagnostic confusion and error because many of the behavioral and motor symptoms accentuate, overlap, or mimic each other. Summary Awareness of potential diagnostic pitfalls and "pseudo-syndromes" should lead to more accurate clinical assessment and better care for our patients. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 12, 2019 Category: Neurology Authors: Weiss, H. D., Pontone, G. M. Tags: Clinical neurology examination, Parkinson's disease/Parkinsonism, All Neuropsychology/Behavior, Parkinson's disease with dementia, Assessment of cognitive disorders/dementia Review Source Type: research

Consensus-based care recommendations for adults with myotonic dystrophy type 2
Purpose of review Myotonic dystrophy type 2 (DM2) is a rare, progressive multisystem disease particularly affecting the skeletal muscle. A causal therapy is not yet available; however, prompt, appropriate symptomatic treatments are essential to limit disease-related complications. Evidence-based guidelines to assist medical practitioners in the care of DM2 patients do not exist. Recent findings The Myotonic Dystrophy Foundation (MDF) previously worked with an international group of 66 clinicians to develop consensus-based care recommendations for myotonic dystrophy type 1. Following a similar approach, the MDF recruited 1...
Source: Neurology Clinical Practice - August 12, 2019 Category: Neurology Authors: Schoser, B., Montagnese, F., Bassez, G., Fossati, B., Gamez, J., Heatwole, C., Hilbert, J., Kornblum, C., Kostera-Pruszczyk, A., Krahe, R., Lusakowska, A., Meola, G., Moxley, R., Thornton, C., Udd, B., Formaker, P., on behalf of the Myotonic Dystrophy Fou Tags: All Neuromuscular Disease, Genetic linkage Review Source Type: research

Therapy for acute nerve agent poisoning: An update
Purpose of review Acute nerve agent poisoning was last reviewed in the neurology literature in 2004. As neurologists may expect to be called upon by non-neurologist colleagues as local experts, it is timely to update the 2004 review. Recent findings Acute antidotal therapy for nerve agent poisoning has been rendered simpler and faster by the FDA approval and introduction of the dual-dose autoinjector. Although there are no truly new fielded antidotes, midazolam recently received FDA approval for treatment against seizures, and will replace diazepam in most acute situations when the FDA approves it in the autoinjector form...
Source: Neurology Clinical Practice - August 12, 2019 Category: Neurology Authors: Newmark, J. Tags: All Clinical Neurology, Other toxicology, Bioterrorism Review Source Type: research

Distribution of ischemic strokes in patients with atrial fibrillation: The FibStroke Study
Conclusions The timing of AF diagnosis, use of OAC drugs, or the CHA2DS2-VASc score did not affect the distribution of ischemic strokes. Anterior territory strokes were slightly more often located within the left hemisphere. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 12, 2019 Category: Neurology Authors: Jaakkola, J., Hartikainen, P., Kiviniemi, T. O., Nuotio, I., Palomäki, A., Hartikainen, J. E. K., Ylitalo, A., Mustonen, P., Airaksinen, K. E. J. Tags: All Cerebrovascular disease/Stroke, Cardiac, Embolism, Infarction Research Source Type: research

Association between patient-reported outcomes and objective disease indices in people with NF2
Objective The association between patient-reported outcomes and currently used clinical trial endpoints, including total vestibular schwannoma (VS) volume and word recognition score (WRS) in neurofibromatosis type 2 (NF2), is not known. Methods A prospective observational study enrolling adult patients with NF2 was conducted at a single specialty center. Measures included: NF2 impact on quality of life (NFTI-QOL), short form (SF)-36; total VS volume, WRS; provider- and patient-reported disease severity (ProvSev, PatSev) measured with an institutionally derived multi-item (e.g., symptom burden, age-of-onset, and fatality-r...
Source: Neurology Clinical Practice - August 12, 2019 Category: Neurology Authors: Shukla, A., Hsu, F.-C., Slobogean, B., Langmead, S., Lu, Y., Blakeley, J. O., Strowd, R. E. Tags: Quality of life, Spinal cord tumor, Nerve tumor, Clinical trials Observational study (Cohort, Case control), Neurofibromatosis Research Source Type: research

Appointment completion in pediatric neurology telemedicine clinics serving underserved patients
Conclusions The use of telemedicine for outpatient pediatric neurology visits has high odds of completion and can serve as an equal adjunct to in-person clinic visits. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 12, 2019 Category: Neurology Authors: Dayal, P., Chang, C. H., Benko, W. S., Ulmer, A. M., Crossen, S. S., Pollock, B. H., Hoch, J. S., Kissee, J. L., Warner, L., Marcin, J. P. Tags: Outcome research, All Pediatric, Models of care, Access to care, Cohort studies Source Type: research

Carpal tunnel syndrome and associated symptoms as first manifestation of hATTR amyloidosis
Conclusion CTS occurs in most patients with hATTR amyloidosis and frequently precedes the hATTR diagnosis. Most patients with CTS preceding hATTR diagnosis have systemic features. Recognizing systemic features at the time of CTS presentation may help in early diagnosis of hATTR amyloidosis. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 12, 2019 Category: Neurology Authors: Karam, C., Dimitrova, D., Christ, M., Heitner, S. B. Tags: All Neuromuscular Disease, Peripheral neuropathy, Carpal tunnel syndrome Research Source Type: research

Timing of symptomatic intracerebral hemorrhage after rt-PA treatment in ischemic stroke
Conclusions Our findings suggest that rt-PA patients have the highest risk of post rt-PA sICH within the first 24 hours after treatment. This supports monitoring of rt-PA-treated patients in specialized settings such as neuro-intensive care units or stroke units. Our findings suggest that the probability of sICH is low 36 hours post rt-PA. Future larger studies are warranted to identify the patterns of bleeding after rt-PA administration. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 12, 2019 Category: Neurology Authors: Chen, P. M., Lehmann, B., Meyer, B. C., Rapp, K., Hemmen, T., Modir, R., Agrawal, K., Hailey, L., Mortin, M., Meyer, D. M. Tags: All Cerebrovascular disease/Stroke, Intracerebral hemorrhage Research Source Type: research

Referral trends for temporal lobe epilepsy surgery between 2000 and 2014 in India
Conclusion There is evidence for delayed referral of patients with refractory TLE to a surgical epilepsy center in this study. Renewed efforts to confront challenges beholding epilepsy surgery and steps to ensure timely referral are desirable. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 12, 2019 Category: Neurology Authors: Asranna, A., Menon, R., Radhakrishnan, A. Tags: EEG; see Epilepsy/Seizures, Antiepileptic drugs, Epilepsy monitoring, Epilepsy surgery, Hippocampal sclerosis Research Source Type: research

Comment: Epilepsy surgery programs in resource-limited settings: When less is more
In this issue of Neurology® Clinical Practice, Habibabadi et al.1 provide an overview of their experience establishing an epilepsy surgery program in Iran. Their approach has focused on surgical treatment of lesional, refractory epilepsy—primarily temporal lobe epilepsy and mesial temporal lobe sclerosis (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 12, 2019 Category: Neurology Authors: Birbeck, G. L. Tags: All Epilepsy/Seizures Research Source Type: research

Outcome of lesional epilepsy surgery: Report of the first comprehensive epilepsy program in Iran
Conclusions We found high rates of seizure freedom after surgery in lesional epilepsy patients despite limited facilities and infrastructure; antiepileptic medications were successfully tapered in almost half of the patients. Considering the favorable outcome of epilepsy surgery in our series, we believe that it is a major treatment option, even in less resource-intensive settings, and should be encouraged. Strategies to allow larger scale utility of epilepsy surgery in such settings in the developing world and dissemination of such knowledge may be considered an urgent clinical need, given the established mortality and mo...
Source: Neurology Clinical Practice - August 12, 2019 Category: Neurology Authors: Mehvari Habibabadi, J., Moein, H., Basiratnia, R., Badihian, S., Zaki, B., Manouchehri, N., Zare, M., Barekatain, M., Rahimian, E., Mehvari Habibabadi, A., Moein, P., Aghakhani, Y., Amina, S., Lhatoo, S. Tags: All Clinical Neurology, Access to care, Underserved populations, All Epilepsy/Seizures, Epilepsy surgery Research Source Type: research

The next level of care in epilepsy: Delays, more delays, delays everywhere
Surgical treatment for drug-resistant epilepsy remains underused in the industrialized world; it is estimated that, in the United States, less than 1% of patients with drug-resistant epilepsy, defined as failure of 2 appropriate trials of antiseizure drugs,1 are referred to an epilepsy center.2 Furthermore, when patients are referred, the delay from onset of epilepsy is 18–22 years,2,3 often too late to prevent irreversible social and psychological disabilities. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 12, 2019 Category: Neurology Authors: Benbadis, S. R., Engel, J. Tags: Editorial Source Type: research

Issue highlights
In an authoritative review, Jonathan Newmark (p. 337), one of the nation's experts on nerve warfare agents and the only neurologist in the chemical/biological defense program, provides an update on the latest therapies for acute nerve agent poisoning. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 12, 2019 Category: Neurology Authors: Corboy, J. R. Tags: From the Editor ' s Desk Source Type: research

Resting-state fMRI in disorders of consciousness to facilitate early therapeutic intervention
Whole-brain analysis of resting-state functional MRI by independent component analysis may aid in accurate diagnosis of disorders of consciousness, prognosis of coma following an acute brain injury, as well as provide an opportunity for early therapeutic intervention of subclinical seizures. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 12, 2019 Category: Neurology Authors: Boerwinkle, V. L., Torrisi, S. J., Foldes, S. T., Marku, I., Ranjan, M., Wilfong, A. A., Adelson, P. D. Tags: fMRI, Prognosis, Coma, All Pediatric Case Source Type: research

Palatal tremor and hypertrophic olivary degeneration as sequelae of basilar artery occlusion
Basilar artery occlusion can present with both positive and negative neurologic signs. A thorough neurologic examination is crucial for timely recognition and urgent intervention when applicable. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 12, 2019 Category: Neurology Authors: Bulwa, Z., Biller, J. Tags: Stroke in young adults, MRI, Tremor, All Cerebrovascular disease/Stroke Case Source Type: research

Multiple recurrent intracerebral hemorrhages and hepatopulmonary syndrome
Patients with liver cirrhosis complicated by hepatopulmonary syndrome may show vascular changes in cerebral angiography, which may predispose them to spontaneous intracerebral hemorrhage. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 12, 2019 Category: Neurology Authors: Carvalho, A., Rodrigues, M., Rocha, M., Nunes, J., Cunha, A., Costa, H., Barros, P. Tags: All Cerebrovascular disease/Stroke, Intracerebral hemorrhage Case Source Type: research

Severe left MCA syndrome with an occluded accessory MCA
In patients presenting with acute ischemic stroke, when the clinical presentation cannot be explained by findings seen on imaging, consider the presence of rare anatomical variations. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Khrlobyan, M., Olivas, E., Feng, L., Czar Taon, M., Sangha, N. Tags: All Clinical Neurology, All Cerebrovascular disease/Stroke, Infarction Case Source Type: research

Treating chronic migraine in CADASIL with calcitonin gene-related peptide receptor antagonism
CGRP receptor monoclonal antibodies may be safe for preventing migraine therapy in those with CADASIL; systematic study of safety and efficacy are needed before this approach to migraine prevention can be recommended. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Goldstein, E. D., Badi, M. K., Meschia, J. F. Tags: Migraine, All Clinical Neurology, All Cerebrovascular disease/Stroke, CADASIL Case Source Type: research

CNS atypical T-cell lymphoproliferative disease following treatment with alemtuzumab
Autoimmune disease is a well-recognized complication of alemtuzumab therapy in MS; however, the risk of subsequent malignancy is another important consideration in this highly efficacious therapy. Here, we report a fatal atypical T-cell hematologic disorder. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Khan, M., Ney, D. E., Kleinschmidt-DeMasters, B. K., Horton, L., Alvarez, E., Piquet, A. L. Tags: All Immunology, Primary brain tumor, All Demyelinating disease (CNS), Multiple sclerosis Case Source Type: research

Headache: Illustrating the patient experience
A new headache clinic in a Canadian downtown quaternary neurological center aimed at supporting clinicians in the community was opened in March 2017. As a means to help appreciate a patient’s unique experience of pain, an initially therapeutic history-taking tool has blossomed into a visual tool to advocate, educate, and communicate their headache experience. Over a 10-month period, we asked 375 patients the question, what is the one word you use to describe your headache pain or experience? From this question, we derived 171 unique words with many recurring word themes showing shared experience (table). These words ...
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Robblee, J., Kelly, S. Tags: Migraine, Cluster headache, Tension headache, Clinical neurology history, Trigeminal neuralgia Hypotheses and Musings Source Type: research

Practice Current: How do you diagnose and treat post-concussive headache?
A common complaint after concussion is the development of new or worsening headaches which can make it difficult or even impossible for patients to work or function in their day-to-day lives. Uncertainties associated with the complaints and a wide variety of approaches exist regarding the appropriate work-up and management of these patients. Areas of ongoing debate include the need for neuroimaging; optimal, acute, and preventative treatment; and proper counseling and expectation management. Given the wide variety of potential approaches and the lack of consensus, we sought expert opinion from around the globe on how to ev...
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Bartolini, L., Dave, A., Ganesh, A., Adil, M. M., Tsao, J. W. Tags: Migraine, Secondary headache disorders, Pediatric headache, Brain trauma, Practice Current Commentary Source Type: research

Are some ophthalmoplegias migrainous in origin?
The 3rd edition of the International Classification of Headache Disorders replaced the term ophthalmoplegic migraine (OM) with Recurrent Painful Ophthalmoplegic Neuropathy (RPON) based on the presence of contrast enhancement of the involved cranial nerves on Gadolinium-enhanced magnetic resonance imaging. We review our experience and publications concerning ophthalmoplegia, migraine, and RPON. Majority of cases of acute ophthalmoplegia are associated with severe migrainous headaches. A positive history of migraine, increased severity of migraine headaches before the onset of ophthalmoplegia, and the close temporal associat...
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Lal, V., Caplan, L. Tags: Migraine, Ocular motility, Diplopia (double vision) Commentary Source Type: research

Acute middle cerebral artery stroke in a patient with a patent middle cerebral artery
Purpose of review Knowledge of cerebrovascular anatomical variants is vital for clinicians working with patients presenting with signs and symptoms of cerebral infarction, particularly in the era of endovascular clot retrieval. Recent findings We provide an overview of a cerebrovascular anatomical variation and detail a patient presenting with cerebral infarction secondary to occlusion of their anomalous vessel who underwent successful endovascular clot retrieval with excellent functional outcome. We also include technical descriptions. Summary Given the clinical importance of the areas supplied by the accessory middle c...
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Cooke, J., Maingard, J., Chandra, R. V., Slater, L.-A., Brooks, M., Asadi, H. Tags: All Cerebrovascular disease/Stroke, Infarction Review Source Type: research

CDC's guideline on pediatric mild traumatic brain injury: Recommendations for neurologists
Purpose of review In September 2018, the Centers for Disease Control and Prevention (CDC) published an evidence-based guideline on the diagnosis and management of mild traumatic brain injury (mTBI) among children. Recent findings Based on a systematic review of the evidence that covers research published over a 25-year span (1990–2015), the CDC Pediatric mTBI Guideline strives to optimize the care of pediatric patients with mTBI. The guideline was developed using a rigorous methodology developed by the American Academy of Neurology. Summary Clinical practice recommendations in the CDC Pediatric mTBI Guideline can h...
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Weissman, B., Joseph, M., Gronseth, G., Sarmiento, K., Giza, C. C. Tags: Pediatric headache, CT, Clinical neurology examination, Brain trauma Review Source Type: research

Primary headache disorders: Five new things
Purpose of review To review 5 new areas in primary headache disorders, especially migraine and cluster headache. Recent findings Calcitonin gene-related peptide (CGRP) receptor antagonists (gepants—rimegepant and ubrogepant) and serotonin 5-HT1F receptor agonists (ditans—lasmiditan) have completed phase 3 clinical trials and will soon offer novel, effective, well-tolerated nonvasoconstrictor options to treat acute migraine. CGRP preventive treatment is being revolutionized after the licensing of 3 monoclonal antibodies (MABs), erenumab, fremanezumab, and galcanezumab, with eptinezumab to follow, especially des...
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Goadsby, P. J. Tags: All Headache, All Clinical trials Review Source Type: research

Patient-perceived value of a specialty-specific welcome letter: What you say and how you say it
Conclusions Preparing patients for their neurology visits is important and affects visits' value. Sensitivity to literacy levels is an essential component of person-centered care among neurologic patients. Carefully created and assessed welcome letters help to achieve these goals by improving readiness for outpatient appointments and increases perceived overall value significantly. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Busl, K. M., Alongi, J., Anderson, A., Jaffee, M., Baron-Lee, J. Tags: Outcome research, Patient safety, Administration, Methods of education Source Type: research

Multiple sclerosis and sarcoidosis: A case for coexistence
Conclusions We propose a rational diagnostic approach to patients with sarcoidosis who may have comorbid MS. When the clinical picture is equivocal, the presence of multiple "MS-typical lesions" and the absence of any "NS-typical lesions" on MRI favor diagnosis of MS. Close follow-up is required to ascertain whether clinical and radiologic disease evolution and response to MS therapies conform to the proposed diagnosis of MS. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Tyshkov, C., Pawate, S., Bradshaw, M. J., Kimbrough, D. J., Chitnis, T., Gelfand, J. M., Ryerson, L. Z., Kister, I. Tags: Multiple sclerosis Research Source Type: research

Challenges and opportunities caring for neurology outpatients across language differences
Conclusions More than 70% of outpatient neurology clinicians and patient services coordinators were satisfied with PMI. However, their perceived barriers and reported practices suggest a need for updated policies and education to improve the use of PMI services. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Tran, J. H., Luan Erfe, B. M., Kirwan, C. J., Mejia, N. I. Tags: All Health Services Research, All Clinical Neurology, All global neurology, Risk factors in epidemiology, All Ethics in Neurology/Legal issues Source Type: research

Differences in treatment of epilepsy in pregnancy: A worldwide survey
Conclusion This survey highlights several areas where further research would be helpful in guiding practice. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: George, I. C., Bartolini, L., Ney, J., Singhal, D. Tags: All global neurology, Practice Current, All Epilepsy/Seizures, Antiepileptic drugs Research Source Type: research

Remote poststroke headache in children: Characteristics and association with stroke recurrence
Conclusions Remote poststroke headache is a common morbidity among pediatric stroke survivors, particularly in older children. Headaches may increase health care utilization, including neuroimaging and hospital admissions. We identified a possible association between poststroke headache and stroke recurrence. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Chelse, A. B., Kurz, J. E., Gorman, K. M., Epstein, L. G., Balmert, L. C., Ciolino, J. D., Wainwright, M. S. Tags: Childhood stroke, Secondary headache disorders, Pediatric headache, Pediatric stroke; see Cerebrovascular Disease/ Childhood stroke, Risk factors in epidemiology Research Source Type: research

Minding the gap in pediatric headache care: Can a focus on quality measures improve outcomes?
Background The American Academy of Neurology Headache Quality Measures seek to improve care delivery and outcomes by addressing gaps in care. Our practice identified underperformance in 3 of the 7 measures that apply to children and adolescents. We expected that improved performance on these measures would lead to a reduction in emergency department (ED) visits and improvement in the average disability grade of established patients. Methods An interdisciplinary workgroup used the Institute for Healthcare Improvement's Model for Improvement. Quality improvement (QI) interventions focused on the use of Pediatric Migraine Di...
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Turner, S., Foss-Barratt, A., Malmberg, J., Disabato, J. Tags: Pediatric headache, Cost effectiveness/economic, Health systems Research Source Type: research

Vascular variants and the evaluation of patients with acute stroke
Variations in the cerebral vasculature that arise during embryogenesis can predispose to stroke or lead to atypical stroke syndromes, and neurologists assessing patients with acute stroke must be aware of some of the most common variations. During fetal development, the cerebral vasculature forms through a process of sprouting, driven by target tissue growth factors induced by ischemia. The process starts when the embryo is around 1.3 mm in length with the development of 6 branchial arch arteries. Subsequent remodeling and appearance of new vessels leads to the formation of the extracranial and intracranial vasculatur...
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Merino, J. G., Tavarez, T. Tags: All Cerebrovascular disease/Stroke Editorial Source Type: research

Lymphopenia and DMTs for relapsing forms of MS: Considerations for the treating neurologist
(Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Tags: Correction Source Type: research

Message from the Editors to our Reviewers
In the article "Message from the Editors to our Reviewers" by Corboy et al.,1 first published online April 8, 2019, the penultimate sentence in Dr. John Corboy’s disclosures should have read ‘He is a consultant to Novartis, participating on a steering committee, and Mylan, on a legal issue.’ The author regrets the error. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Tags: Correction Source Type: research

Spotlight on headache
The current issue of Neurology® Clinical Practice reflects many of the exciting changes in headache medicine that are transforming the field and setting the stage for a new chapter in the diagnosis and treatment of the broad range of conditions that cause headache. This editorial will address 3 major themes that cut across the articles in this issue: secondary headaches, emerging treatments for primary headaches, and improving outcomes in neurologic practice for people with migraine. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Lipton, R. B. Tags: All Headache, Migraine, Secondary headache disorders, Pediatric headache Editorial Source Type: research

Issue highlights
This issue of Neurology® Clinical Practice features a spotlight on headache with an introductory editorial by Richard Lipton (p. 182) and fascinating articles on a variety of important aspects of headache care. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Corboy, J. R. Tags: From the Editor ' s Desk Source Type: research

Immune checkpoint inhibitor-related myositis associated with atezolizumab therapy
Immune checkpoint inhibitor-related myositis should be considered in the differential diagnosis of patients presenting with acute weakness even if atezolizumab had been commenced many weeks beforehand. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Khoo, A., Zhuang, Y., Boundy, K., Frasca, J. Tags: Autoimmune diseases, Muscle disease, Metastatic tumor Case Source Type: research

13-year diagnostic delay as cerebral palsy of an Iraqi patient with NBIA type 4
Consider neurodegenerative disorders in the differential diagnosis of cerebral palsy in the presence of progressive pattern of illness and positive family history. Abnormal MRI signals in the basal ganglia may help distinguish NBIA in patients with cerebral palsy. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Hadi, A. S., Saadi, N. W., Fahad, Q. A. Tags: MRI, Dystonia, All Cognitive Disorders/Dementia, Basal ganglia, All Genetics Case Source Type: research

Bilateral optic neuritis from acute HIV infection
HIV should be considered in the differential diagnosis of optic neuritis associated with systemic symptoms. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 10, 2019 Category: Neurology Authors: Fortin, E., Heller, H. M., Lyons, J., Prasad, S. Tags: HIV, Optic nerve, Visual loss Case Source Type: research

Psychosis of dual origin in HIV infection: Viral escape syndrome and autoimmune encephalitis
Consider anti-NMDA encephalitis and viral escape syndrome (low HIV load in serum and high in CSF) in patients with HIV with neuropsychiatric disturbances because both require specific therapy measures. Anti-NMDA encephalitis requires immunotherapy; viral escape syndrome requires an antiretroviral regimen. CD8 encephalitis may coexist with viral escape syndrome and may respond to steroids. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Anguizola-Tamayo, D., Bocos-Portillo, J., Pardina-Vilella, L., Rodriguez-Sainz, A., Vicente-Olabarria, I., Martinez, E., Gomez-Beldarrain, M., Garcia-Monco, J. C. Tags: Autoimmune diseases, All Infections, HIV Case Source Type: research

Spinal segmental myoclonus in both legs associated with antibodies to glycine receptors
Antibodies to glycine receptors were associated with synchronized myoclonus in both legs and the myoclonus derived from not only the brainstem but also the spine. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Nanaura, H., Kataoka, H., Kiriyama, T., Eura, N., Iwasa, N., Shobatake, R., Horikawa, H., Sugie, K. Tags: Autoimmune diseases, Encephalitis, Meningitis, Myoclonus, Paraneoplastic syndrome Case Source Type: research

Neuromyelitis optica spectrum disorder with area postrema syndrome
Cardiac arrest may be accompanied with intractable hiccups and nausea or appear independently in patients with neuromyelitis optica spectrum disorder. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Okada, K., Kobata, M., Naruke, S. Tags: Autoimmune diseases, Paraneoplastic syndrome, Syncope Case Source Type: research

Saturday night retinopathy and anterograde amnesia due to fentanyl overdose
Early identification of Saturday night retinopathy and anterograde amnestic syndrome secondary to the opioid epidemic can prevent unnecessary treatments including antibiotics, anticoagulation, and antithrombotic therapy. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Budhu, J., Tolokh, I., Bouffard, M., Wray, S. H., Matiello, M. Tags: Ocular motility, Optic nerve, Visual loss, Memory, Opiates Case Source Type: research

Torsional internuclear ophthalmoplegia in acute ischemic stroke
A 45-year-old man with no medical history woke up with acute binocular diplopia. Clinical examination revealed disturbances in eye movements (video 1). MRI showed a recent infarction in the left posteromedial mesencephalon (figures 1 and 2). Lesions of this type can result in inactivation of the interstitial nucleus of Cajal which causes an ipsilateral torsional quick phase nystagmus,1 as well as inactivation of the left medial longitudinal fascicle, which causes a left-sided internuclear ophthalmoplegia.2 Within 24 hours, symptoms had resolved completely. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Vynckier, J., Lemmens, R. Tags: Stroke in young adults, DWI, Clinical neurology examination, All Cerebrovascular disease/Stroke Case Source Type: research

Should neurologists diagnose and manage functional neurologic disorders? It is complicated
Whereas only neurologists can "rule in" functional neurologic disorders (FNDs)—using physical signs and semiologic features—their role in follow-up care remains debated. We outlined the arguments for and against a neurologist's primary role in both assessing and managing FNDs. Favorable arguments include the following: (1) FND presents neurologically, and thus, only neurologists can ascertain the etiology of new neurologic deficits appearing on follow-up, and (2) neurologic encounters facilitate acceptance of diagnosis and enhance treatment engagement. Counter arguments include the following: (1) FND ...
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Perez, D. L., Haller, A. L., Espay, A. J. Tags: All Clinical Neurology, All Movement Disorders, Conversion Commentary Source Type: research

Shared decision making in mild cognitive impairment
Shared decision making (SDM) occurs when patients and clinicians consider patients' values and preferences while discussing medical evidence to inform healthcare decisions. SDM enables patients with mild cognitive impairment (MCI) to express values and preferences when making current healthcare decisions and presents a unique opportunity to inform future decision making in the case of further cognitive decline. However, clinicians often fail to facilitate SDM with patients with MCI. This review describes research pertaining to value solicitation, weighing of the medical evidence, and medical decision making for individuals...
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Mejia, A. M., Smith, G. E., Wicklund, M., Armstrong, M. J. Tags: Medical care, All Clinical Neurology, MCI (mild cognitive impairment), Professional conduct and ethics Commentary Source Type: research

Tackling the imposter phenomenon to advance women in neurology
Recent literature documents that women comprise an increasing proportion of the neurology workforce but still lag behind male counterparts in publications and promotion. There are many reasons for gender disparities in neurology including family responsibilities, different career goals, lack of mentorship, cultural stereotypes, lack of institutional funding, biases, and professional isolation. Another contributing factor receiving relatively little recognition is the imposter phenomenon. This review highlights recent literature on gender differences in neurology, the definition of the imposter phenomenon, and research on t...
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Armstrong, M. J., Shulman, L. M. Tags: All Clinical Neurology, Other Education, Professional conduct and ethics Commentary Source Type: research

Tuberculous meningitis: A neglected tropical disease?
Tuberculosis (TB) surpassed HIV as the world's leading infectious cause of death in 2014. Although billions of dollars have been invested to reduce the global burden of pulmonary TB, tuberculous meningitis (TBM), the most lethal manifestation of the disease, has remained largely neglected with a paucity of evidence-based guidelines. Research is urgently needed to obtain reliable estimates of the global incidence of TBM, develop high performance technologies to detect TBM in CSF, and evaluate drug regimens with greater penetration of the CNS. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Chin, J. H. Tags: Meningitis, Cerebrospinal Fluid, All global neurology, Burden of disease, Poverty-related disease Commentary Source Type: research

Variably protease-sensitive prionopathy: A differential diagnostic consideration for dementia
Purpose of review Prion diseases are rare neurodegenerative diseases that are caused by abnormal pathogenic agents and can affect both humans and animals. These diseases are categorized as sporadic, inherited, or acquired by infection. Clinical manifestations include psychiatric symptoms, cognitive impairment, and parkinsonism, which are similar to those of other prion diseases and frontotemporal dementia variants. Recent findings More recently, scientists discovered a new sporadic prion disease called variably protease-sensitive prionopathy. Summary The following case discusses a patient presenting with sudden onset and...
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Kim, S. H., Yu, M. M., Strutt, A. M. Tags: Medical care, Prion, Prion disease; see Infections/prion, Cognitive neuropsychology in dementia, Assessment of cognitive disorders/dementia Review Source Type: research