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

Role of CYP2C19 alleles in the management of recurrent ischemic stroke
Purpose of review CYP2C19 is the primary enzyme involved in the activation of clopidogrel, an antiplatelet agent used for secondary stroke prevention. An individual's CYP2C19 alleles are used to understand their CYP2C19-clopidogrel metabolizer phenotype. Single nucleotide polymorphisms of the CYP2C19 gene result in altered metabolism of this prodrug. Recent findings Three ischemic stroke cases were treated with clopidogrel. Despite confirming adequate drug exposure, medication adherence, and ruling out drug-drug interactions, all had recurrent ischemic stroke. Each case had a CYP2C19 *2/*17 genotype, categorizing them as ...
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Lyerly, M. J., Bartlett, K., Albright, K. C. Tags: All Cerebrovascular disease/Stroke, Infarction, All Genetics Review Source Type: research

Poor glycemic control and posterior circulation ischemic stroke
Conclusions Poor glycemic control may be associated with an increased risk of thrombotic infarction that occurs preferentially in the posterior circulation of the brain. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Kuroda, J., Matsuo, R., Yamaguchi, Y., Sato, N., Kamouchi, M., Hata, J., Wakisaka, Y., Ago, T., Kitazono, T., on behalf of the Fukuoka Stroke Registry Investigators Tags: Infarction Research Source Type: research

Three Territory Sign: An MRI marker of malignancy-related ischemic stroke (Trousseau syndrome)
Background Multiple acute cerebral territory infarcts of undetermined origin are typically attributed to cardioembolism, most frequently atrial fibrillation. However, the importance of 3-territory involvement in association with malignancy is under-recognized. We sought to highlight the "Three Territory Sign" (TTS) (bilateral anterior and posterior circulation acute ischemic diffusion-weighted imaging [DWI] lesions), as a radiographic marker of stroke due to malignancy. Methods We conducted a single-center retrospective analysis of patients from January 2014 to January 2016, who suffered an acute ischemic stroke...
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Nouh, A. M., Staff, I., Finelli, P. F. Tags: MRI, DWI, All Cerebrovascular disease/Stroke, All Oncology Research Source Type: research

Mirror therapy for improving motor functions in patients with leprosy with grade 2 disabilities
Background Mirror therapy has been used to treat phantom limb pain and to improve motor function after stroke. We evaluated the efficacy of mirror therapy in patients with leprosy with paresis. Methods Twenty-four patients with leprosy who presented with unilateral grade 2 disabilities were recruited from July 2016 to November 2016 and randomly assigned. Group A, the mirror group, participated in the mirror therapy, and group B, the control group, were treated with a sham therapy. After the interventions, the paretic muscle/limb function, hand coordination abilities, walking, and abilities to perform activities of daily l...
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Singh, M., Pawar, M. Tags: Bacterial infections, All Clinical Neurology, Clinical trials Observational study (Cohort, Case control), Class IV Research Source Type: research

Predictors of dementia misclassification when using brief cognitive assessments
Background Brief cognitive assessments can result in false-positive and false-negative dementia misclassification. We aimed to identify predictors of misclassification by 3 brief cognitive assessments; the Mini-Mental State Examination (MMSE), Memory Impairment Screen (MIS) and animal naming (AN). Methods Participants were 824 older adults in the population-based US Aging, Demographics and Memory Study with adjudicated dementia diagnosis (DSM-III-R and DSM-IV criteria) as the reference standard. Predictors of false-negative, false-positive and overall misclassification by the MMSE (cut-point
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Ranson, J. M., Kuzma, E., Hamilton, W., Muniz-Terrera, G., Langa, K. M., Llewellyn, D. J. Tags: Diagnostic test assessment, All Cognitive Disorders/Dementia, Assessment of cognitive disorders/dementia Research Source Type: research

Montreal Cognitive Assessment as a screening tool: Influence of performance and symptom validity
Background We evaluated Montreal Cognitive Assessment (MoCA) performance in a veteran traumatic brain injury (TBI) population, considering performance validity test (PVT) and symptom validity test (SVT) data, and explored associations of MoCA performance with neuropsychological test performance and self-reported distress. Methods Of 198 consecutively referred veterans to a Veterans Administration TBI/Polytrauma Clinic, 117 were included in the final sample. The MoCA was administered as part of the evaluation. Commonly used measures of neuropsychological functioning and performance and symptom validity were also administer...
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Waldron-Perrine, B., Gabel, N. M., Seagly, K., Kraal, A. Z., Pangilinan, P., Spencer, R. J., Bieliauskas, L. Tags: Neuropsychological assessment, All Cognitive Disorders/Dementia, Brain trauma, Assessment of cognitive disorders/dementia Research Source Type: research

Rebound high-pressure headache after treatment of spontaneous intracranial hypotension: MRV study
Conclusions Rebound high-pressure headache occurs in about one-fourth of patients following treatment of SIH and is more common in those with restriction of cerebral venous outflow. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Schievink, W. I., Maya, M. M., Jean-Pierre, S., Moser, F. G., Nuno, M., Pressman, B. D. Tags: All Headache, Low pressure syndrome, Cerebrospinal Fluid Research Source Type: research

Message from the Editors to our Reviewers
We thank our invaluable reviewers. The reviewers listed below with 1 asterisk have reviewed 5 or more papers. Two asterisks indicate that the reviewer has reviewed 10 or more manuscripts. This list includes those reviewers who returned a review or reviews of initial submissions (re-reviews of the same manuscript are not included) between December 2017 and December 2018. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Corboy, J. R., Powers, L. B., Anderson, D. C., Barbano, R. L. Tags: Acknowledgment to Reviewers Source Type: research

Issue highlights
Schievink et al. (p. 93) report that rebound high-pressure headache occurs in about one-fourth of those treated for spontaneous intracranial hypertension, and the rate is even higher in those with cerebral venous sinus stenosis. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Corboy, J. R. Tags: From the Editor ' s Desk Source Type: research

Amyloid spells
A 66-year-old woman presented with a history of recurrent, transient neurologic symptoms including limb shaking, focal paresthesias, focal weakness, dysphasia, and unresponsiveness. The episodes showed no preference for time of day, lasted less than 6 minutes, and occurred less than monthly in small clusters, increasing in frequency slowly over 2 years. She lived independently, denied cognitive or other complaints, and had no history of smoking, hypertension, hyperlipidemia, coronary atherosclerosis or diabetes mellitus, or family history of stroke. Clinical examination was unremarkable. Cognition was grossly intact but no...
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Cooperman, S. S., Shah, A. K., Rajamani, K. Tags: Intracerebral hemorrhage Case Source Type: research

SWI filtered-phase imaging in calcific cerebral embolism secondary to cardiac myxoma
A 40-year-old man presented with transient weakness and visual field loss following syncope. Head CT showed multiple sulcal calcifications and a chest CT revealed a partially calcified left atrial myxoma (figure 1).1 MRI showed foci of restricted diffusion consistent with embolic infarcts.2 Calcific emboli are usually atheromatous in nature and have been associated with an increased risk of recurrent stroke.1 Susceptibility-weighted imaging (SWI) filtered-phase images have shown value in differentiating between paramagnetic (e.g., methemoglobin, deoxyhemoglobin in veins) and diamagnetic (calcium) substances due to their op...
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Silva, G., Fabris, N., Varvarikos, J., Sills, T., Zamora, C. Tags: Stroke in young adults, MRI, All Cerebrovascular disease/Stroke, Cardiac, Embolism Case Source Type: research

Cerebral microhemorrhages and cerebral fat embolism in hemoglobin S-C disease
A 40-year-old man with a history of ventricular septal defect (VSD) and hemoglobin S-C disease presented with progressively worsening headache, followed by sudden thunderclap headache and encephalopathy. The patient became comatose without any focal neurologic deficits and was intubated for airway protection. Chest X-ray was unremarkable. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Cho, S.-M., Ling, G., Rivera-Lara, L. Tags: Case Source Type: research

Focal myokymia in carpal tunnel syndrome
Localized appendicular myokymia is rarely seen distal to a nerve entrapment. Presence of myokymia, especially in specific muscle groups, should prompt clinicians to consider the differential diagnosis of entrapment neuropathies, e.g., abductor pollicis brevis in carpal tunnel syndrome. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - April 8, 2019 Category: Neurology Authors: Chee, Y. C., Ong, B. H., Mohd Saleh, N. B. Tags: All Clinical Neurology, Clinical neurology examination, All clinical neurophysiology Case Source Type: research

Using EHRs to advance epilepsy care
The improved use of Electronic Health Record (EHR) Systems provides an opportunity to improve the overall efficiency and quality of care of patients with epilepsy. Tools and strategies that may be incorporated into the use of EHRs include utilizing patient generated data, clinical decision support systems and natural language processing systems. Standardization of data from EHR systems may lead to improvement in clinical research through the creation of data collections and multi-center collaborations. Challenges to collaborative use of EHR Systems across centers include costs and the diversity of EHR systems. (Source: Neu...
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Mbwana, J. S., Grinspan, Z. M., Bailey, R., Berl, M., Buchhalter, J., Bumbut, A., Danner, Z., Glauser, T., Glotstein, A., Goodkin, H., Jacobs, B., Jones, L., Kroner, B., Lapham, G., Loddenkemper, T., Maraganore, D. M., Nordli, D., Gaillard, W. D. Tags: Cost effectiveness/economic, Medical care, All Clinical Neurology, Electronic medical records, All Epilepsy/Seizures Commentary Source Type: research

Recent advancements in lateral trunk flexion in Parkinson disease
Conclusion The combination of pharmacologic interventions with nonpharmacologic interventions, such as rehabilitation, might be needed to manage LTF, and the initiation of these treatments should be started as early as possible. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Kataoka, H., Sugie, K. Tags: CT, Clinical neurology examination, Parkinson's disease/Parkinsonism, EMG Review Source Type: research

Management of cervical dystonia with botulinum neurotoxins and EMG/ultrasound guidance
Purpose of review We provide a practical guide on the use of electromyography (EMG) and ultrasound (US) to assist botulinum neurotoxin (BoNT) treatment in patients with cervical dystonia (CD). Recent findings US and EMG guidance improve BoNT treatment in CD. Their use is particularly valuable for targeting deep neck muscles and managing complex cases. There is also evidence that adverse events are reduced when superficial or intermediate layer muscles are injected with assisted guidance. Summary A structured clinical approach, based on functional neck anatomy, guides CD assessment and BoNT treatment. Muscles are selected...
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Castagna, A., Albanese, A. Tags: Dystonia, Botulinum toxin Review Source Type: research

Lymphopenia and DMTs for relapsing forms of MS: Considerations for the treating neurologist
Purpose of review To provide neurologists with an update on the proposed mechanisms of action (MOAs) of disease-modifying therapies (DMTs) for the treatment of relapsing MS, and their effect on peripheral blood leukocytes, in order to inform treatment decisions. Recent findings DMTs have vastly differing MOAs, including effects on peripheral blood leukocyte counts, particularly lymphocytes. The clinical implications of changes in lymphocyte counts need to be understood in the context of the underlying MOAs of each respective DMT, with treatment tailored to individual patient needs. Summary DMTs can alter lymphocyte count...
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Fox, E. J., Buckle, G. J., Singer, B., Singh, V., Boster, A. Tags: Multiple sclerosis Review Source Type: research

Signs heralding appearance of thymomas after extended thymectomy for myasthenia gravis
We describe 2 such cases that highlight potential early warning signs. Recent findings In their 20s, one woman and one man developed EOMG (AChR antibody-positive), requiring extended transsternal removal of hyperplastic thymi at ages 35 and 27, respectively. Their myasthenia gravis was readily controlled for the next 10 and 7 years before deteriorating in both, with appearance of late clinical features and anticytokine autoantibodies suggesting underlying thymomas, namely respiratory infections, genital herpes, chronic candidiasis, and alopecia in the woman and erythroderma and lichen planus in the man, followed by Pseudo...
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Santos, E., Silva, A. M., Stroebel, P., Marinho, A., Willcox, N., Goncalves, G., Lopes, C., Marx, A., Leite, M. I. Tags: Myasthenia, Paraneoplastic syndrome Review Source Type: research

Door in door out and transportation times in 2 telestroke networks
Conclusion In the included telestroke networks, the sDTG time is longer when CTA is conducted at spoke site prior to transportation to TSC. New strategies are urgently needed to decrease sDTG when CTA is done prior to transfer to TSC. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Al Kasab, S., Almallouhi, E., Harvey, J., Turner, N., Debenham, E., Caudill, J., Holmstedt, C. A., Switzer, J. A. Tags: Other cerebrovascular disease/ Stroke, All Cerebrovascular disease/Stroke Research Source Type: research

Quality of life outcomes in patients presenting for evaluation of CNS tumors
We describe patient-reported outcomes (PROs) in adults with CNS tumors and evaluate their correlation with physician-reported functional status. Methods We completed a retrospective cohort study of patients managed at a high-volume CNS tumor institute between September 2013 and September 2014. PROs were measured using 6 domains from the PROs Measurement Information System (PROMIS): anxiety, physical function, pain interference, sleep disturbance, fatigue, and satisfaction with social roles. Physician-reported outcomes were measured using the Eastern Cooperative Oncology Group Scale of Performance Status (ECOG). We compare...
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Chaitoff, A., Sarmey, N., Thompson, N. R., Fan, Y., Ahluwalia, M., Katzan, I. L. Tags: Quality of life, Primary brain tumor, Metastatic tumor Research Source Type: research

Movement disorders in early MS and related diseases: A prospective observational study
Conclusion Movement disorders are more common than previously thought even in early MS. They typically begin a few months after spinal or brainstem/cerebellar relapses but may occasionally be the presenting symptom of a relapse. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Abboud, H., Yu, X. X., Knusel, K., Fernandez, H. H., Cohen, J. A. Tags: All Movement Disorders, Dystonia, All Demyelinating disease (CNS), Multiple sclerosis, Devic's syndrome Research Source Type: research

Ten-year trajectories of health care utilization by Manitobans with MS predict nursing home entry
Conclusion Complex patterns of service use and underlying need contribute to NH entry among people with MS. An increasing number of hospital days is strongly associated with NH entry. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Finlayson, M., Ekuma, O., Finlayson, G., Jiang, D., Marrie, R. A. Tags: All Health Services Research, Multiple sclerosis, Cohort studies Source Type: research

Elbow clonus
A 45-year-old woman presented with a 2-day history of the right upper and lower limb weakness. She had history of craniotomy and blood clot evacuation for hypertensive left basal ganglia hemorrhage in 2014. She had recovered with mRS 2/6 upon discharge. Cranial nerve examination revealed right upper motor neuron facial nerve palsy. Her right upper and lower limbs were hypertonic with positive Hoffman sign. Hyperreflexia was found in the right supinator, biceps, and triceps. Striking the right triceps tendon resulted in sustained right shoulder and elbow clonus (as demonstrated in the video 1). There was also hyperreflexia ...
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Arifin, N. M., Khoo, C. S. Tags: All Clinical Neurology, Clinical neurology examination Case Source Type: research

Devastating neurologic injuries in the Syrian war
Conclusion This study and critical analysis of the devastation in Syria suggests the desperate need for emergency aid. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: El Hajj Abdallah, Y., Beveridge, J., Chan, M., Deeb, T., Mowafi, H., Al-Nuaimi, S., Easa, A. S., Saqqur, M., on behalf of Union of Medical Care and Relief Organizations Tags: All Health Services Research, Spinal cord trauma; see Trauma/spinal cord trauma, All Trauma, All global neurology, All epidemiology Source Type: research

Levodopa-induced dyskinesias in mitochondrial membrane protein-associated neurodegeneration
Parkinsonism may be the presenting feature of neurodegeneration with brain iron accumulation, such as "mitochondrial membrane protein–associated neurodegeneration" (MPAN), caused by mutations in C19orf12. Levodopa therapy may be complicated by development of motor fluctuations and dyskinesias. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Savitt, D., Jankovic, J. Tags: Case Source Type: research

Patients are the best judges: Evaluating quality of life in CNS tumor care
Health-related quality of life (hrQOL) is an often-neglected aspect of care in neurologic disease,1 and all the more so in the management of CNS cancers.2 Knowledge about pathologic grade, extent of tumor burden, and anatomic location may provide little comfort for patients who are coping with diagnoses that cause anxiety, pain, sleep problems, and social isolation. Physician-reported outcomes may focus on physical health with less ability to discern psychosocial dysfunction resulting from the condition. In contrast, patient reported outcomes (PROs) measure quality of life in domains that matter most to patients. (Source: ...
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Ney, J. P., Taylor, L. P. Tags: Quality of life, Primary brain tumor, Metastatic tumor Editorial Source Type: research

Wartime neurology: Serving the neediest in an austere environment
The civil war in Syria has been recognized as possibly the greatest humanitarian crisis of the 21st century.1 According to the British-based Syrian Observatory for Human Rights, 511,000 people (2.33% of Syria's prewar population of 22 million) have been killed in the war from March 2011 to the present,2 and more than 1.9 million have been injured.3 The public health infrastructure has been decimated, partly because hospitals, health workers, and medical supplies have been targeted, which has rendered a large number of health care facilities nonfunctional.4 The magnitude of morbidity and mortality in this region has overwhe...
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Etienne, M., Tsao, J. W. Tags: All Health Services Research, Spinal cord trauma; see Trauma/spinal cord trauma, All Trauma, All global neurology, All epidemiology Editorial Source Type: research

Hemorrhagic stroke complicated by cerebral venous sinus thrombosis with idarucizumab
Idarucizumab can lead to acute thrombosis in a patient with an underlying procoagulant state. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Phua, C. S., Bonura, A., Choong, H. Tags: MRI, Gastrointestinal, Hematologic, Intracerebral hemorrhage, Cerebral venous thrombosis Case Source Type: research

Author response: Traumatic and spontaneous intracranial hemorrhage in atrial fibrillation patients on warfarin
We thank Vilanilam et al. for relevant and interesting comments regarding our article.1 (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Lehtola, H., Palomäki, A., Mustonen, P., Hartikainen, P., Airaksinen, J., Hartikainen, J. Tags: The Nerve! Readers Speak Source Type: research

Reader response: Traumatic and spontaneous intracranial hemorrhage in patients with atrial fibrillation on warfarin
We read with interest the study by Lehtola et al.1 Anticoagulation (AC) in atrial fibrillation (AF) reduces the risk of ischemic stroke, but at the cost of increasing the risk of hemorrhagic stroke. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Vilanilam, G. K., Gopal, N., Agarwal, A., Badi, M. K. Tags: The Nerve! Readers Speak Source Type: research

Author response: The burnout patient
Thank you, Dr. Sethi, for adding your voice to this vital discussion.1 I concur that the mainspring of health caregiver fulfillment and motivation, and of patient well-being, is optimizing the patient-physician relationship while delivering the highest quality cognitive and procedural care. Over the centuries, medicine has bobbed on the ocean of scientific progress, social mores, and economics. Our times are no different. Health care planning, lauded as creative destruction, has made way for disruptive innovation both of which have undoubtedly contributed to care delivery evolution. However, change will neither be free of ...
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Sergay, S. M. Tags: The Nerve! Readers Speak Source Type: research

Reader response: The burnout patient
I read with interest Dr. Sergay's1 commentary on patient burnout. Patients are increasingly becoming disillusioned about their caregivers. The reasons for this disillusionment run deep, but the fundamental reason is the erosion of the physician-patient relationship, a sacred relationship founded on the Hippocratic Oath. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Sethi, N. K. Tags: The Nerve! Readers Speak Source Type: research

Neuromyelitis optica spectrum disorder associated with Zika virus infection
Consider Zika infection in the diagnostic workup of neuromyelitis optica spectrum disorder (NMOSD) in epidemic areas. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Aspahan, M. C., Leonhard, S. E., Gomez, R. S., Rocha, E. d. S., Vilela, M. R. d. S., Alvarenga, P. P. M., Marinho, P. E. S., Kroon, E. G., Meira, F. Tags: Viral infections, Devic's syndrome, Transverse myelitis Case Source Type: research

Giving voice to patients
Articles in this issue of Neurology® Clinical Practice (NCP) reflect a growing emphasis on integrating quality of life measures into clinical practice. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - February 12, 2019 Category: Neurology Authors: Corboy, J. R. Tags: From the Editor ' s Desk Source Type: research

Accelerated emergence from a nontraumatic minimally conscious state with levodopa/carbidopa
A 62-year-old woman was admitted to our hospital in coma following the nontraumatic rupture of a left posterior inferior cerebellar artery aneurysm with subsequent intraventricular hemorrhage and acute hydrocephalus, affecting mainly the fourth ventricle with substantial adjacent edema (figure 1). Her Glasgow Coma Scale score was 3/15 and physical examination showed left hemiparesis, absent corneal and oculovestibular reflexes. Dexamethasone (4 mg q6h) and mannitol (1 g/kg initially, then 0.5 mg/kg q6h) were started, and a frontal bilateral trephination with external ventricular drainage was performed. Initial sedatio...
Source: Neurology Clinical Practice - December 10, 2018 Category: Neurology Authors: Bancalari, E., Rabinstein, A., Machiavello, F., Desmaison, A. Tags: Coma, Critical care, Intracerebral hemorrhage Case Source Type: research

Foix-Chavany-Marie syndrome as the presenting sign of HIV-related PML
In patients with oromandibular palsy, examine both voluntary and automatic movements and consider Foix-Chavany-Marie syndrome, even in the absence of bilateral opercular lesions on MRI. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 10, 2018 Category: Neurology Authors: Dijkstra, F., Guldolf, K., Schotsmans, K., Marechal, E., Hernalsteen, D., Crols, R. Tags: MRI, All Infections, All Clinical Neurology, All Demyelinating disease (CNS) Case Source Type: research

Practice Current: How do you manage patients with a "hot carotid"?
Patients presenting with acutely symptomatic carotid stenosis (a "hot carotid") are known to be at a high up-front risk of recurrent strokes. Uncertainties remain regarding the appropriate management of such patients in the acute period, particularly with respect to anti-thrombotic treatment as they await revascularisation with carotid endarterectomy (CEA) or angioplasty/stenting (CAS). Decision-making is further complicated when intraluminal thrombi are encountered on vessel imaging. Given these uncertainties, and the paucity of high-quality data in the literature, we sought expert opinion from around the globe ...
Source: Neurology Clinical Practice - December 10, 2018 Category: Neurology Authors: Ganesh, A., Wong, J. H., Menon, B. K., Bartolini, L. Tags: Stroke prevention, All Cerebrovascular disease/Stroke, Practice Current Commentary Source Type: research

The COAST stroke advance directive: A novel approach to preserving patient autonomy
This article discusses some of the challenges of preserving patient autonomy in patients presenting with acute stroke and the advent of a stroke advance directive (Coordinating Options for Acute Stroke Therapy [COAST]) aimed to overcome these obstacles. (Source: Neurology Clinical Practice)
Source: Neurology Clinical Practice - December 10, 2018 Category: Neurology Authors: McGehrin, K., Spokoyny, I., Meyer, B. C., Agrawal, K. Tags: All Cerebrovascular disease/Stroke, All Ethics in Neurology/Legal issues, Palliative care Commentary Source Type: research

Consensus-based care recommendations for adults with myotonic dystrophy type 1
Purpose of review Myotonic dystrophy type 1 (DM1) is a severe, progressive genetic disease that affects between 1 in 3,000 and 8,000 individuals globally. No evidence-based guideline exists to inform the care of these patients, and most do not have access to multidisciplinary care centers staffed by experienced professionals, creating a clinical care deficit. Recent findings The Myotonic Dystrophy Foundation (MDF) recruited 66 international clinicians experienced in DM1 patient care to develop consensus-based care recommendations. MDF created a 2-step methodology for the project using elements of the Single Text Procedure...
Source: Neurology Clinical Practice - December 10, 2018 Category: Neurology Authors: Ashizawa, T., Gagnon, C., Groh, W. J., Gutmann, L., Johnson, N. E., Meola, G., Moxley, R., Pandya, S., Rogers, M. T., Simpson, E., Angeard, N., Bassez, G., Berggren, K. N., Bhakta, D., Bozzali, M., Broderick, A., Byrne, J. L. B., Campbell, C., Cup, E., Da Tags: Muscle disease, All Neuropsychology/Behavior, All Cognitive Disorders/Dementia, Trinucleotide repeat diseases Review Source Type: research

Stroke in young adults: Five new things
Purpose of review The incidence of stroke in young adults is increasing, mainly driven by an increasing incidence of ischemic stroke in this population. We provide new information that has been recently presented regarding the risk factor prevalence, some specific etiologic causes, and management strategies in ischemic stroke in this population. Recent findings Recent studies indicate a rapid increase in traditional risk factors in young adults. New information regarding the management of patent foramen ovale in cryptogenic stroke and cervical artery dissection is available. Summary Stroke in young adults is a rapidly gr...
Source: Neurology Clinical Practice - December 10, 2018 Category: Neurology Authors: Bhatt, N., Malik, A. M., Chaturvedi, S. Tags: Stroke in young adults, Stroke prevention, All Cerebrovascular disease/Stroke, Carotid artery dissection Review Source Type: research