Challenges of diagnosing and treating Charles Bonnet syndrome
Charles Bonnet syndrome (CBS) is characterized by complex visual hallucinations in visually impaired but otherwise psychologically normal individuals.1 CBS is primarily diagnosed in patients with an ophthalmic disease but is also seen in stroke patients with hemianopsia.2 Treatment of these vivid hallucinations is challenging and there is no standard treatment. Here, we present a stroke patient with CBS successfully treated with melperone. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Franke, M., Rauschenberger, L., Fluri, F. Tags: Visual loss, All Cerebrovascular disease/Stroke, Hallucinations Case Source Type: research

Overshunting-associated myelopathy: Flattened spinal cord compressed by epidural venous plexus
A 50-year-old woman presented with a 1-month history of progressive spastic quadriparesis. She had undergone nonprogrammable ventriculoperitoneal (VP) shunt placement after intraventricular hemorrhage due to a ruptured arteriovenous malformation 16 years previously. Neurologically, she had neck extensor weakness (Medical Research Council [MRC] grade 4), symmetrical weakness of her upper extremities (right/left MRC grades 4/4), and weakness of her right proximal lower extremity (MRC grade 4). She also had spasticity and hyperreflexia in all 4 extremities with extensor plantar reflexes. Light touch and vibratory sensation wa...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Koge, J., Nakamura, Y., Hashimoto, T., Tanaka, E., Kawajiri, M., Yamada, T. Tags: MRI, All Spinal Cord, Cerebrospinal Fluid Case Source Type: research

Arc de cercle as a manifestation of focal epileptic seizures
Since its description in 1885 in the Études cliniques sur l'hystéro-épilepsie ou grand hystérie by Raul Richer, the arc de cercle, or circular arc (figure 1A), has become synonymous of psychogenic nonepileptic seizures (PNES) and automatically interpreted as such by physicians. The development of extracranial and intracranial EEG recording has not confirmed the clinical importance of the arc de cercle. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Pestana Knight, E. M., Grinenko, O., Bulacio, J., Bingaman, W., Gupta, A., Chauvel, P. Tags: Intracranial electrodes, Video/ EEG use in epilepsy, SPECT in epilepsy, Partial seizures Case Source Type: research

Rare presentation of essential lingual myoclonus
A 74-year-old woman presented to the Oral Medicine Department with a constant throbbing sensation affecting her entire tongue. She reported sudden onset of constant twitching of the tongue since January 2016. She described it as if "my heart is in my mouth." She had visited both her dentist and her doctor, and was given a multitude of topical agents including Difflam, Nystatin, and Corsodyl, but none was effective. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Patel, K., Tappuni, A. Tags: MRI, Tremor, Myoclonus, EMG, Myoclonus; see Movement Disorders/myoclonus Case Source Type: research

Autoimmune limbic encephalitis in association with acute stroke
A 60-year-old woman with no known medical history presented with acute-onset altered mental status and aphasia. She was in her usual state of health until the time of presentation. She was found to have left middle and posterior cerebral artery (MCA and PCA) acute ischemic strokes and subsequently developed refractory status epilepticus. CT angiography showed moderate stenosis of the proximal left internal carotid artery (ICA), occlusion of the right ICA at its origin, and near-complete occlusion of the left vertebral artery (figure). Strokes were attributed to large-vessel atherosclerotic disease in the setting of multipl...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Kaas, B., Zeiler, S. R., Bahouth, M. N., Llinas, R. H., Probasco, J. C. Tags: All Immunology, All Cerebrovascular disease/Stroke Case Source Type: research

The burnout patient
Physician and patient experiences of health care delivery are inextricably intertwined. Accelerating physician burnout has reached epidemic proportions in the United States. In parallel, health care has become a different experience for our patients. As a practicing neurologist over the last 40 years, I have observed changes in the expectations of colleagues and patients, whose feelings and concerns continually educate me. While I am not alone in advocating for intervention in current health care delivery methodology, not all are convinced. In discussing the repercussion of the "burnout patient," I seek to amplif...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Sergay, S. M. Tags: Commentary Source Type: research

FACETS of health disparities in epilepsy surgery and gaps that need to be addressed
This article explains possible reasons outlined by FACETS for the health disparities in epilepsy surgery that exist in patients of a certain race, socioeconomic status, and language proficiency. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Nathan, C. L., Gutierrez, C. Tags: Epilepsy surgery, All Ethics in Neurology/Legal issues Review Source Type: research

Antiepileptic drugs and suicide-related behavior: Is it the drug or comorbidity?
Conclusions The peak of SRB prior to and rapid reduction in SRB after initiation of AED, and the finding that individuals eventually prescribed a mood-stabilizing AED (vs other AED or levetiracetam) had higher odds of SRB, suggests a strong possibility that the relationship of AED and SRB is one of residual confounding. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Raju Sagiraju, H. K., Wang, C.-P., Amuan, M. E., Van Cott, A. C., Altalib, H. H., Pugh, M. J. V. Tags: All Neuropsychology/Behavior, All Epilepsy/Seizures, Antiepileptic drugs Review Source Type: research

Safety and efficacy of plasma exchange in pediatric transverse myelitis
Conclusions TPE can be a useful treatment for pediatric transverse myelitis. The retrospective nature of this study without a comparator group limits conclusions about efficacy. However, controlled trials would help to validate our results. Classification of evidence This study provides Class IV evidence that plasma exchange is safe and effective in pediatric transverse myelitis. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Noland, D. K., Greenberg, B. M. Tags: All Pediatric, Class IV, All Demyelinating disease (CNS), Transverse myelitis Research Source Type: research

Diagnoses and other predictors of patient absenteeism in an outpatient neurology clinic
Conclusions Certain chronic neurologic diseases, such as medication overuse headache and depression, were associated with a significantly lower odds of honoring scheduled follow-up conditions. As these conditions influence quality of life and productivity, patients with these illnesses may benefit from selective targeting to encourage adherence with scheduled follow-up appointments. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Do, D. H., Siegler, J. E. Tags: Medical care, Administration Research Source Type: research

Traumatic and spontaneous intracranial hemorrhage in atrial fibrillation patients on warfarin
Background Intracranial hemorrhage is the most devastating complication in patients with atrial fibrillation (AF) receiving oral anticoagulation (OAC). It can be either spontaneous or caused by head trauma. We sought to address the prevalence, clinical characteristics, and prognosis of traumatic and spontaneous intracranial hemorrhages in AF patients on OAC. Methods Multicenter FibStroke registry of 5,629 patients identified 592 intracranial hemorrhages during warfarin treatment between 2003 and 2012. Results A large proportion (40%) of intracranial hemorrhages were traumatic. Of these, 64% were subdural hemorrhages (SDH...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Lehtola, H., Palomäki, A., Mustonen, P., Hartikainen, P., Kiviniemi, T., Sallinen, H., Nuotio, I., Ylitalo, A., Airaksinen, K. E. J., Hartikainen, J. Tags: Intracerebral hemorrhage Research Source Type: research

Post-acute care discharge delays for neurology inpatients: Opportunity to improve patient flow
Conclusion Unnecessary hospital days represent a large burden for patients with neurologic illness requiring post-acute care on discharge. These discharge delays present an opportunity to improve hospital-wide patient flow. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Roberts, D. E., Holloway, R. G., George, B. P. Tags: All Health Services Research, All Rehabilitation, Models of care, All Practice Management, Health systems Source Type: research

Discontinuation and comparative effectiveness of dimethyl fumarate and fingolimod in 2 centers
Background Dimethyl fumarate (DMF) and fingolimod (FTY) are approved oral disease-modifying therapies for relapsing multiple sclerosis (MS). Observational studies are valuable when randomized clinical trials cannot be done due to ethical or practical reasons. Two-site studies allow investigators to further ascertain external validity of previously examined treatment effect differences. Limited head-to-head 2-site studies exist comparing DMF and FTY. Methods Patients prescribed DMF (n = 737) and FTY (n = 535) from 2 academic multiple sclerosis (MS) centers (Cleveland Clinic and University of Colorado) were identified. Disc...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Vollmer, B., Ontaneda, D., Bandyopadhyay, A., Cohn, S., Nair, K., Sillau, S., Bermel, R. A., Corboy, J. R., Fox, R. J., Vollmer, T., Cohen, J. A., Alvarez, E., Hersh, C. M. Tags: Multiple sclerosis Research Source Type: research

Increased prevalence of brain tumors classified as T2 hyperintensities in neurofibromatosis 1
Background We sought to define the radiologic features that differentiate neoplastic from non-neoplastic T2 hyperintensities (T2Hs) in neurofibromatosis type 1 (NF1) and identify those lesions most likely to require oncologic surveillance. Methods We conducted a single-center retrospective review of all available brain MRIs from 68 children with NF1 (n = 190) and 46 healthy pediatric controls (n = 104). All T2Hs identified on MRI were characterized based on location, border, shape, degree of T1 hypointensity, and presence of mass effect or contrast enhancement, and subsequently classified using newly established radiologi...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Griffith, J. L., Morris, S. M., Mahdi, J., Goyal, M. S., Hershey, T., Gutmann, D. H. Tags: MRI, Primary brain tumor, Neurofibromatosis Research Source Type: research

"Waiting for placement?": Waiting for solutions
The most humbling aspect of inpatient medicine is often not the severity of the illness treated, the ability to effect diagnosis and treatment where we were previously left to guesswork and acquiescence, or the complex array of psychosocial issues that accompany explaining a loved one's condition to family. Rather, patient placement is the overriding issue in so many cases for inpatient neurology. Neurologists are often confronted with more than half of the neurology ward census, where we have done the good work of making the diagnosis, exhausted the treatment opportunities, and now are waiting for the patient to be accept...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Ney, J. P., Weathers, A. L. Tags: Medical care, Patient safety, Administration Editorial Source Type: research

Patients are harmed by physician burnout
The growing prevalence of physician burnout and its grave harms are now recurring headlines. Among specialists, neurologists have a particularly high risk of burnout.1 In recognition of the seriousness of this problem to American neurology, the American Academy of Neurology (AAN) empaneled a task force to study the problem in all its dimensions, including career satisfaction, work–life balance, and well-being. Their recent reports on the prevalence, causes, consequences, and mitigation of the epidemic of neurologist burnout and the possible strategies to enhance career satisfaction should be studied carefully by all ...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Bernat, J. L., Busis, N. A. Tags: Editorial Source Type: research

What predicts falls in Parkinson disease? Observations from the Parkinson's Foundation Registry
(Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Tags: Correction Source Type: research

A practical approach to detection and treatment of depression in Parkinson disease and dementia
(Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Tags: Correction Source Type: research

Author Response: Uncertainties from a worldwide survey on antiepileptic drug withdrawal after seizure remission
We thank Dr. Sethi for his interest in our article1 and thoughtful comments. We agree that a one-size-fits-all approach to antiepileptic drug (AED) discontinuation would not make sense; as we stated in the Introduction, ultimately this remains an individualized decision. Nevertheless, there are several clinical scenarios that may potentially represent a rather homogeneous population of patients, for example those with juvenile myoclonic epilepsy or those who underwent a successful uncomplicated temporal lobectomy (with all the caveats related to driving status and access to care that were eloquently detailed by Dr. Sethi),...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Bartolini, L. Tags: The Nerve! Readers Speak Source Type: research

Reader Response: Uncertainties from a worldwide survey on antiepileptic drug withdrawal after seizure remission
I read with interest the results of the Bartolini et al.1 worldwide survey on antiepileptic drug (AED) withdrawal after seizure remission. As the authors state, the survey results highlight the pressing need for well-designed studies exploring these issues and the development of standardized guidelines that can guide decision-making when physicians are confronted with the issue of AED withdrawal after seizure remission. In the end, though, every patient is an n of 1 and AED withdrawal decision has to be individualized taking into consideration intrinsic patient factors (type of epilepsy, natural history of that epilepsy/ep...
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Sethi, N. K. Tags: The Nerve! Readers Speak Source Type: research

Author Response: Practice Current: How do you treat neuromyelitis optica?
I thank Dr. Avasarala for responding to the Practice Current on neuromyelitis optica,1 and for highlighting some key unresolved questions in this field. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Ganesh, A. Tags: The Nerve! Readers Speak Source Type: research

Reader Response: Practice Current: How do you treat neuromyelitis optica?
A few lingering questions on this topic.1 (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Avasarala, J. Tags: The Nerve! Readers Speak Source Type: research

Real-world practice
Several articles in this issue of Neurology® Clinical Practice (NCP) address challenges you and your patients face in everyday practice. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - August 13, 2018 Category: Neurology Authors: Corboy, J. R. Tags: From the Editor ' s Desk Source Type: research

Practice Current: When do you order ancillary tests to determine brain death?
Brain death has been accepted as a legal definition of death in most countries, but practices for determining brain death vary widely. One source of variation is in the use of ancillary tests to assist in the diagnosis of brain death. Through case-based discussions with 3 experts from 3 continents, this article discusses selected aspects of brain death, with a focus on the use of ancillary tests. In particular, we explore the following questions: Are ancillary tests necessary, or is the clinical examination sufficient? What ancillary tests are preferred, and under which circumstances? Are ancillary tests required when the ...
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Robbins, N. M., Bernat, J. L. Tags: Practice Current, Brain death Commentary Source Type: research

Exercise for cognitive brain health in aging: A systematic review for an evaluation of dose
Purpose of review We systematically appraised randomized controlled trials proposing exercise to influence cognition in older adults to (1) assess the methodologic quality using Cochrane criteria; (2) describe various exercise dose measures and assess their relationship with improved cognitive performance; and (3) identify consistent patterns of reported effects on cognition. Recent findings There was overall good methodologic quality in all 98 included studies. The assessment of the relationship between improved cognition and various measures of exercise dose (session duration, weekly minutes, frequency, total weeks, and...
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Gomes-Osman, J., Cabral, D. F., Morris, T. P., McInerney, K., Cahalin, L. P., Rundek, T., Oliveira, A., Pascual-Leone, A. Tags: All Neuropsychology/Behavior, Clinical trials Systematic review/meta analysis, All Cognitive Disorders/Dementia, Cognitive aging, MCI (mild cognitive impairment) Source Type: research

Early myoclonus following anoxic brain injury
Conclusions Cortical and subcortical myoclonus are seen in every sixth patient with cardiac arrest and cannot be distinguished using clinical criteria. Either condition may have good functional outcomes. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Reynolds, A. S., Rohaut, B., Holmes, M. G., Robinson, D., Roth, W., Velazquez, A., Couch, C. K., Presciutti, A., Brodie, D., Moitra, V. K., Rabbani, L. E., Agarwal, S., Park, S., Roh, D. J., Claassen, J. Tags: Prognosis, Myoclonus, Cardiac, Critical care, EEG Review Source Type: research

Camptocormia: Etiology, diagnosis, and treatment response
Conclusions An etiology can be identified in almost all cases of camptocormia. Most cases are due to 3 common disorders: Parkinson disease, axial myopathy, and degenerative joint disease. A diagnostic and treatment algorithm is proposed. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Ali, F., Matsumoto, J. Y., Hassan, A. Tags: All Movement Disorders, Gait disorders/ataxia, All Neuromuscular Disease Review Source Type: research

Reflections on translation: Views of participants in a multisite Canadian CCSVI clinical trial
Conclusions There is a strong movement in science today to ensure that research agendas reflect the perspectives of multiple stakeholders, including research participants. While previous work suggests that negative findings adversely affect trust in science, the perspectives of participants in this study demonstrate that good trial design and resilience can prevail over expected tensions. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Benjaminy, S., Lo, C., Illes, J., Traboulsee, A. Tags: Clinical trials Methodology/study design, Multiple sclerosis, All Ethics in Neurology/Legal issues Review Source Type: research

Prevalence of and risk factors for cerebral microbleeds in a general Japanese elderly community
Background We investigated the prevalence of and risk factors for cerebral microbleeds (CMBs) in a cross-sectional study of a general population of Japanese elderly. Methods In 2012, brain MRI scanning at 1.5T and comprehensive health examination were conducted for 1281 residents aged 65 years or older. CMBs were defined as ovoid hypointensity lesions less than 10 mm in diameter on T2*-weighted images and classified into deep/infratentorial or lobar CMBs. Age- and sex-specific and overall prevalence of CMBs were estimated, and the associations of traditional cardiovascular risk factors and APOE polymorphism with the prese...
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Yubi, T., Hata, J., Ohara, T., Mukai, N., Hirakawa, Y., Yoshida, D., Gotoh, S., Hirabayashi, N., Furuta, Y., Ago, T., Kitazono, T., Kiyohara, Y., Ninomiya, T. Tags: MRI, Cohort studies, Prevalence studies, Risk factors in epidemiology, Intracerebral hemorrhage Research Source Type: research

What predicts falls in Parkinson disease?: Observations from the Parkinson's Foundation registry
Background We undertook this study to identify patients with Parkinson disease (PD) with no or rare falls who may progress to frequent falling by their next annual follow-up visit. Methods We analyzed data in the National Parkinson Foundation Quality Improvement Initiative database to identify factors predicting which patients with PD with no or rare falls at the baseline visit will report at least monthly falls at the annual follow-up visit. Multivariable models were constructed using logistic regression. Variables were introduced in 4 blocks: in the 1st block, variables present at or before the baseline visit were enter...
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Parashos, S. A., Bloem, B. R., Browner, N. M., Giladi, N., Gurevich, T., Hausdorff, J. M., He, Y., Lyons, K. E., Mari, Z., Morgan, J. C., Post, B., Schmidt, P. N., Wielinski, C. L., Wu, S. S., On behalf of The National Parkinson Foundation Quality Improve Tags: Gait disorders/ataxia, Parkinson's disease/Parkinsonism, Cohort studies, Natural history studies (prognosis) Research Source Type: research

Neuroimaging abnormalities in patients with Cowden syndrome: Retrospective single-center study
Conclusions It is important to recognize that in addition to Lhermitte-Duclos disease, other intracranial findings such as multiple venous anomalies, meningiomas, greater than expected white matter signal abnormality, prominent perivascular spaces, and cortical malformations may warrant a thorough evaluation for Cowden syndrome in the appropriate clinical setting. We further recommend that this broader spectrum of intracranial abnormalities be considered for addition to the Cowden syndrome diagnostic criteria at the time of next revision. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Dhamija, R., Weindling, S. M., Porter, A. B., Hu, L. S., Wood, C. P., Hoxworth, J. M. Tags: MRI, All Oncology, Primary brain tumor, All Genetics Research Source Type: research

Editor's Note
(Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Tags: Correction Source Type: research

Clinical factors associated with Guillain-Barre syndrome following surgery
Conclusions Surgery antedated GBS in 9.1% of patients. Postsurgical GBS was more common in patients with an active malignancy. A prospective study is needed to determine whether active malignancy represents an independent risk factor for the development of postsurgical GBS. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Hocker, S., Nagarajan, E., Rubin, M., Wijdicks, E. F. M. Tags: Research Source Type: research

Receipt of cardiac screening does not influence 1-year post-cerebrovascular event mortality
Conclusions In this observational cohort study of patients with cerebrovascular disease, cardiac screening was relatively uncommon and was not associated with 1-year mortality. Additional work is needed to understand the utility of CHD screening among high-risk patients with cerebrovascular disease. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Sico, J. J., Baye, F., Myers, L. J., Concato, J., Ferguson, J., Cheng, E. M., Jadbabaie, F., Yu, Z., Arling, G., Zillich, A. J., Reeves, M. J., Williams, L. S., Bravata, D. M. Tags: All Cerebrovascular disease/Stroke Research Source Type: research

Ask a neurologist: What primary care providers ask, and reducing referrals through eConsults
Conclusions We found that an eConsult service provides timely access to neurologists and can divert half of intended face-to-face consultations. The most common questions posed by PCPs regarded diagnosis and drug therapy for headaches, seizures, altered sensation, and CVD. eConsult services could provide guidance for continuing medical education planning in neurology. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Bradi, A. C., Sitwell, L., Liddy, C., Afkham, A., Keely, E. Tags: All Clinical Neurology, All Practice Management, CME, All epidemiology Research Source Type: research

Apathy and functional disability in behavioral variant frontotemporal dementia
(Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Tags: Correction Source Type: research

Identifying priority outcomes that influence selection of disease-modifying therapies in MS
Conclusion Specific outcomes were defined by similar proportions of persons with MS and guideline panelists as priority outcomes influencing MS DMT selection. Several of these priority outcomes were not routinely reported in clinical trials, identifying areas for future evidence development. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Day, G. S., Rae-Grant, A., Armstrong, M. J., Pringsheim, T., Cofield, S. S., Marrie, R. A. Tags: Outcome research, Quality of life, Multiple sclerosis Source Type: research

Curbside consults join the telemedicine era
Probably since the dawn of medicine, physicians have been "curbsiding" their colleagues in the hallways of hospitals, i.e., obtaining quick answers to, hopefully, limited questions about a patient's care. The receiving physician will provide an informal and typically rushed consultation based on limited information, and does so with no compensation for time. More recently, providers have informally consulted their colleagues within the context of their Health Insurance Portability and Accountability Act (HIPAA)–approved electronic health records, or outside these systems in eminently hackable and non-HIPAA-...
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Nuwer, M. R., Corboy, J. R. Tags: All Clinical Neurology, All Practice Management, CME, All epidemiology Editorial Source Type: research

Author response: Pimavanserin: A novel therapeutic option for Parkinson disease psychosis
(Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Berman, B. D., Hawkins, T. Tags: The Nerve! Readers Speak Source Type: research

Reader response: Pimavanserin: A novel therapeutic option for Parkinson disease psychosis
(Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Keys Lawler, A. C., Torres-Yaghi, Y., Amjad, F., Moussa, C., Pagan, F. Tags: The Nerve! Readers Speak Source Type: research

Author response: Incorporating students into clinic may be associated with both improved clinical productivity and educational value
(Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Tanner, J. A., Salas, R. M. E., Gamaldo, C. E. Tags: The Nerve! Readers Speak Source Type: research

Reader response: Incorporating students into clinic may be associated with both improved clinical productivity and educational value
(Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Roy, P. Tags: The Nerve! Readers Speak Source Type: research

Author response: Medical retirement from sport after concussions: A practical guide for a difficult discussion
(Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Noble, J. M. Tags: The Nerve! Readers Speak Source Type: research

Reader response: Medical retirement from sport after concussions: A practical guide for a difficult discussion
(Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Sethi, N. K. Tags: The Nerve! Readers Speak Source Type: research

Providing patient-centered care in the digital era
Several articles in this issue of Neurology® Clinical Practice (NCP) highlight the changing face of medicine in the 21st century. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Corboy, J. R. Tags: From the Editor ' s Desk Source Type: research

Multifocal stroke with proliferation of small cerebral arteries in hepatopulmonary syndrome
Cirrhosis of the liver has been linked to several changes in risk of cerebrovascular disease and may increase the risk of hemorrhage while reducing the risk of ischemic stroke.1,2 The pathophysiology underlying these changes remains unclear, though intracranial hemorrhage and vascular malformations related to liver disease have been described.1,3 Cirrhosis may be complicated by hepatopulmonary syndrome (HPS), in which distal pulmonary arteries dilate, become tortuous, produce shunt physiology, and often produce arteriovenous (AV) malformations.4 (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Younce, J. R., Cross, D. T., Goyal, M. S., Lee, J.-M. Tags: MRI, Other cerebrovascular disease/ Stroke, Gastrointestinal, Arteriovenous malformation Case Source Type: research

Progressive multifocal leukoencephalopathy with extended natalizumab dosing
A 53-year-old man with an 18-year history of multiple sclerosis (MS) was treated with natalizumab for 7 years. Two years prior to presentation, natalizumab treatment interval was increased to every 6 weeks in attempt to reduce the risk of PML. Medical history was notable for cutaneous T-cell lymphoma status-post CHOP chemotherapy. JCV serology was positive (index 2.8). He presented to our tertiary referral center for consultation due to 8 months of progressive left-sided paresthesias, 4 months of right arm clumsiness, and several weeks of expressive aphasia. Neurologic examination was consistent with these symptoms. Serial...
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Baldassari, L. E., Jones, S. E., Clifford, D. B., Fox, R. J. Tags: MRI, Viral infections, Cerebrospinal Fluid, Multiple sclerosis Case Source Type: research

Jack-o-lantern sign in dengue encephalitis
An 18-year-old previously asymptomatic man presented with high-grade fever with holocranial headache and vomiting. On the second day of illness, he became drowsy and subsequently developed altered sensorium. At presentation, he was not opening eyes even on painful stimuli and had decorticate posturing. Pupils were small and sluggishly reacting. Neck rigidity was absent and plantar reflexes were bilaterally extensor. The patient had total leukocyte count 9,700/μL with 76% polymorphs and platelet count of 34,000/μL. Other biochemical measures were normal. Nonstructural 1 (NS1) antigen by ELISA for dengue virus was posi...
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Singh, A. S. Tags: MRI, DWI, Encephalitis Case Source Type: research

EEG registration during ventricular tachycardia and resuscitation
We report a 68-year-old man who developed ventricular tachycardia (VT) during 21-lead EEG monitoring (figure and video). The EEG developed slowing and reduction in amplitude of higher frequency elements after 40 seconds of VT, whereas this is known to occur within 30 seconds in case of asystole.1 EEG activity returned several seconds after initiation of chest compressions, reflecting an increase in cerebral perfusion. A similar observation has previously been reported in a patient with asystole who also underwent chest compressions during EEG registation.2 EEG registration of resuscitation during ventricular tachycardia is...
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Biesbroek, J. M., Hopmans, E. M., Seeber, A. A., Tromp, S. C. Tags: Coma, EEG; see Epilepsy/Seizures, Cardiac; see Cerebrovascular Disease/Cardiac, Syncope Case Source Type: research

Papillary fibroelastoma, an unexpected cause of stroke: Outcomes after acute reperfusion therapy
We present 3 cases of cardiac papillary fibroelastoma (PFE) revealed by acute ischemic stroke (table). (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - June 11, 2018 Category: Neurology Authors: Moreno-Estebanez, A., Luna Rodriguez, A., Ugarriza Serrano, I., Blanco Martin, E., Gonzalez-Pinto, T., Larrazabal Lopez, J., Perez-Concha, T. Tags: All Cerebrovascular disease/Stroke, Cardiac, Embolism Case Source Type: research