Teaching Video NeuroImages: Bilateral abducens ocular neuromyotonia
A 44-year-old woman with a history of resolved nasopharyngeal carcinoma presented with an 8-month history of transient binocular horizontal diplopia. She received complete concurrent chemoradiotherapy 7 years ago. Following prolonged eccentric gaze to the right, she developed involuntary contraction of right lateral rectus, which resulted in 60 seconds of right exotropia. These events also occurred following prolonged eccentric gaze to the left, which resulted in left exotropia (video 1 at Neurology.org). Treatment with carbamazepine improved her symptoms (video 2). Ocular neuromyotonia should be included as a differential...
Source: Neurology - September 4, 2017 Category: Neurology Authors: Vanikieti, K., Rizzo, J. F. Tags: All Neuro-ophthalmology, Diplopia (double vision) RESIDENT AND FELLOW SECTION Source Type: research
Teaching NeuroImages: Central neurocytoma
A woman in her mid-20s presented with a 6-month history of worsening headaches, amenorrhea, and nausea. Neurologic examination demonstrated word-finding difficulties, mild right-sided weakness of the upper and lower extremities, and mild right-sided neglect. Imaging revealed a complex, cystic, heterogeneously enhancing mass in the left lateral ventricle extending to the foramen of Monro (figure). Pathology after surgical resection was consistent with a central neurocytoma. This benign tumor, comprising 0.25%–0.5% of all brain tumors, typically affects young adults and arises from subependymal neural progenitor cells....
Source: Neurology - September 4, 2017 Category: Neurology Authors: Smith-Cohn, M., House, P. A., Anzai, Y. Tags: All Headache, All Imaging, All Oncology, Primary brain tumor, Surgical therapy-tumor RESIDENT AND FELLOW SECTION Source Type: research
Pearls & Oy-sters: Frontal lobe epilepsy presenting as complex stereotyped movements
A 14-year-old boy presented to the University of Rochester Pediatric Movement Disorder clinic for abnormal movements of 1 year’s duration. He was referred to the Movement Disorder clinic for evaluation of complex tics. His movements were stereotyped and often preceded by a blank stare, sometimes associated with a "guttural sound." He also reported having a "numb" sensation prior to the movements. He denied volitional control of the movements or ability to suppress them. He reported movements only occurring during the day although parents recalled a period of nightly episodes witnessed while sharin...
Source: Neurology - September 4, 2017 Category: Neurology Authors: Vermilion, J., Mink, J. W. Tags: All Pediatric, Adolescence, All Epilepsy/Seizures, Complex partial seizures RESIDENT AND FELLOW SECTION Source Type: research
Clinical Reasoning: A 27-year-old man with unsteady gait
A 27-year-old man presented to our hospital's emergency department (ED) with an abnormal gait, paresthesias of the lower extremities, and lower back pain that had progressed over 2 weeks. He reported no medical history and a family history notable only for poor folic acid absorption in his father (etiology unknown). (Source: Neurology)
Source: Neurology - September 4, 2017 Category: Neurology Authors: Fernandez, D., Fara, M. G., Biary, R., Hoffman, R. S., Vassallo, S., Balcer, L., Torres, D. Tags: MRI, All Spinal Cord, Other toxicology RESIDENT AND FELLOW SECTION Source Type: research
Short-term clinical outcomes for stages of NIA-AA preclinical Alzheimer disease
Source: Neurology - August 28, 2017 Category: Neurology Tags: CORRECTIONS Source Type: research
Author response: Clinical Reasoning: A young woman with respiratory failure, hearing loss, and paraplegia
We thank Drs. Bhatt and Adams for the thoughtful comment on our article.1 Hypoxia affects cochlear function in many ways,2–5 including a rapid decline in both endocochlear and other cochlear potentials (i.e., cochlear microphonic, distortion-product otoacoustic emission, and compound action potential),6,7 as well as inducing histologic and cellular changes.8 Moreover, hypoxia, in the form of apneic spells, is a significant clinical predictor of newborn sensorineural hearing loss.9 (Source: Neurology)
Source: Neurology - August 28, 2017 Category: Neurology Authors: Ntranos, A., Shoirah, H., Dhamoon, M. S., Hahn, D., Naidich, T. P., Shin, S. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Letter re: Clinical Reasoning: A young woman with respiratory failure, hearing loss, and paraplegia
Ntranos et al.1 presented a case of a 35-year-old woman with acute respiratory failure, hearing loss, and paraplegia. After discussing the differential diagnosis, they concluded that the likely cause of her symptoms was diffuse hypoxic injury of the involved structures. (Source: Neurology)
Source: Neurology - August 28, 2017 Category: Neurology Authors: Bhatt, N., Adams, D. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Author response: Clinical Reasoning: A young woman with respiratory failure, hearing loss, and paraplegia
I thank Dr. Berg for the thoughtful comments on our article.1 Methylmalonic acidemia is indeed an important consideration for this case. We included a methylmalonic acid serum level in our initial workup, which was undetectable. (Source: Neurology)
Source: Neurology - August 28, 2017 Category: Neurology Authors: Ntranos, A. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Letter re: Clinical Reasoning: A young woman with respiratory failure, hearing loss, and paraplegia
I read with interest the case presented by Ntranos et al.1 of acute-onset bilateral lesions in the globus pallidi, hearing loss (possible cochlear dysfunction), and upper thoracic anterior spinal cord lesion in a patient with an opioid/acetaminophen overdose and possible transient hypoxia. Did the authors consider the possibility of methylmalonic acidemia (MMA) as a potential underlying susceptibility factor? The lesions on the patient's MRI in the globus pallidi are characteristic of MMA. There are several possibilities, including an unrecognized minor mutation in the MMA pathway resulting in partial loss of function that...
Source: Neurology - August 28, 2017 Category: Neurology Authors: Berg, M. J. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
: In "Clinical Reasoning: A young woman with respiratory failure, hearing loss, and paraplegia," Ntranos et al. discussed the case of a patient with lesions in the globus pallidi, spinal cord, and cochleae in the setting of opioid overdose and respiratory failure. They concluded that the patient's neurologic syndrome was related to hypoxia. (Source: Neurology)
Source: Neurology - August 28, 2017 Category: Neurology Authors: Karam, C., Griggs, R. C. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Right Brain: The fragile sense of self in neurodegenerative disease: A brief philosophical examination
This essay was selected as the winner of the American Academy of Neurology's CNRF Essay Contest. (Source: Neurology)
Source: Neurology - August 28, 2017 Category: Neurology Authors: Powell, A. C. Tags: Executive function, All Cognitive Disorders/Dementia, Delirium RESIDENT AND FELLOW SECTION Source Type: research
Ultrasound examination of the pupil suggestive for carotid dissection
A 51-year-old man presented to our emergency department with persistent right cervical pain. Neurologic examination was unremarkable, and no anisocoria was reported. Using a linear ultrasound probe, the pupillary diameters were measured at rest, under direct/consensual light stimulus, and after elicitation of the ipsilateral ciliospinal reflex (CR), evoked by applying a painful stimulation (pinching) at the base of the neck on the trapezius muscle.1,2 (Source: Neurology)
Source: Neurology - August 28, 2017 Category: Neurology Authors: Farina, F., Brunner, C., Schreiber, S. J., Palmieri, A., Struhal, W., Baracchini, C., Vosko, M. R. Tags: Ultrasound, Clinical neurology examination, Pupils, Carotid artery dissection NEUROIMAGES Source Type: research
Five cases of malignant melanoma during fingolimod treatment in Dutch patients with MS
Several case reports suggest an association between the use of fingolimod in multiple sclerosis (MS) and the occurrence of malignant melanoma.1–4 There are also data, however, to suggest a role of fingolimod in eliminating melanoma cells.5,6 The most recent European Medicines Agency report on melanoma (among other skin cancers) in patients with MS using fingolimod states that "the number of skin cancer (potential risk) to date and the duration of follow-up, remain relatively limited and do not permit to draw definitive conclusions on any potential long-term risk for this type of malignancy."7 (Source: Neurology)
Source: Neurology - August 28, 2017 Category: Neurology Authors: Killestein, J., Leurs, C. E., Hoogervorst, E. L. J., van Eijk, J., Mostert, J. P., van den Eertwegh, A. J. M., Uitdehaag, B. M. J. Tags: All Oncology, Patient safety, Multiple sclerosis CLINICAL/SCIENTIFIC NOTES Source Type: research
Brain imaging in myotonic dystrophy type 1: A systematic review
Conclusions: DM1 brains show widespread white and gray matter involvement throughout the brain, which is supported by abnormal resting-state network, PET/SPECT, and MRS parameters. Longitudinal studies evaluating spatiotemporal imaging changes are essential. (Source: Neurology)
Source: Neurology - August 28, 2017 Category: Neurology Authors: Okkersen, K., Monckton, D. G., Le, N., Tuladhar, A. M., Raaphorst, J., van Engelen, B. G. M. Tags: All Imaging, Muscle disease, Trinucleotide repeat diseases VIEWS & amp;amp; REVIEWS Source Type: research
Developing an outline for teleneurology curriculum: AAN Telemedicine Work Group recommendations
The emerging field of teleneurology is delivering quality care to neurologic patients in increasingly numerous technologies and configurations. Teleneurology is well-positioned to address many of the logistical issues neurologists and their patients encounter today. However, formalized medical training has not caught up with this developing field, and there is a lack of formal education concentrating on the specific opportunities and challenges of teleneurology. Considering this, the American Academy of Neurology Telemedicine Work Group identified equivalencies with which any practitioner of teleneurology should be familia...
Source: Neurology - August 28, 2017 Category: Neurology Authors: Govindarajan, R., Anderson, E. R., Hesselbrock, R. R., Madhavan, R., Moo, L. R., Mowzoon, N., Otis, J., Rubin, M. N., Soni, M., Tsao, J. W., Vota, S., Planalp, H. Tags: Computer use in education, Other Education, Professional conduct and ethics CONTEMPORARY ISSUES Source Type: research
Activity limitations and subjective well-being after stroke
Conclusions: Activity limitations were not associated with stroke survivors' subjective well-being after adjustment for other factors. While some predictors of well-being after stroke were identified, the determinants of well-being remained largely unexplained. (Source: Neurology)
Source: Neurology - August 28, 2017 Category: Neurology Authors: Zahuranec, D. B., Skolarus, L. E., Feng, C., Freedman, V. A., Burke, J. F. Tags: Quality of life, All Cerebrovascular disease/Stroke, All Rehabilitation ARTICLE Source Type: research
Predicting major bleeding in patients with noncardioembolic stroke on antiplatelets: S2TOP-BLEED
Conclusions: The S2TOP-BLEED score can be used to estimate 3-year major bleeding risk in patients with a TIA or ischemic stroke who use antiplatelet agents, based on readily available characteristics. The discriminatory performance may be improved by identifying stronger predictors of major bleeding. (Source: Neurology)
Source: Neurology - August 28, 2017 Category: Neurology Authors: Hilkens, N. A., Algra, A., Diener, H.-C., Reitsma, J. B., Bath, P. M., Csiba, L., Hacke, W., Kappelle, L. J., Koudstaal, P. J., Leys, D., Mas, J.-L., Sacco, R. L., Amarenco, P., Sissani, L., Greving, J. P., For the Cerebrovascular Antiplatelet Trialists' Tags: Stroke prevention, All Cerebrovascular disease/Stroke, Risk factors in epidemiology, Infarction ARTICLE Source Type: research
Cross-sectional analysis of a large cohort with X-linked Charcot-Marie-Tooth disease (CMTX1)
Conclusions: In the absence of a phenotypic correlation with specific GJB1 mutations, sex-specific distinctions and clinically relevant attributes need to be incorporated into the measurements for clinical trials in people with CMTX1. ClinicalTrials.gov identifier: NCT01193075. (Source: Neurology)
Source: Neurology - August 28, 2017 Category: Neurology Authors: Panosyan, F. B., Laura, M., Rossor, A. M., Pisciotta, C., Piscosquito, G., Burns, J., Li, J., Yum, S. W., Lewis, R. A., Day, J., Horvath, R., Herrmann, D. N., Shy, M. E., Pareyson, D., Reilly, M. M., Scherer, S. S., For the Inherited Neuropathies Consorti Tags: All Neuromuscular Disease, Peripheral neuropathy, EMG, Association studies in genetics ARTICLE Source Type: research
Association of parathyroid hormone with 20-year cognitive decline: The ARIC study
Conclusions: Our work does not support an independent influence of PTH on cognitive decline in this population-based cohort study. (Source: Neurology)
Source: Neurology - August 28, 2017 Category: Neurology Authors: Kim, S. M., Zhao, D., Schneider, A. L. C., Korada, S. K., Lutsey, P. L., Guallar, E., Alonso, A., Windham, B. G., Gottesman, R. F., Michos, E. D. Tags: Endocrine, Cognitive aging, Cohort studies, Risk factors in epidemiology ARTICLE Source Type: research
Clinical phenotype and outcome of hepatitis E virus-associated neuralgic amyotrophy
Objective: To determine the clinical phenotype and outcome in hepatitis E virus–associated neuralgic amyotrophy (HEV-NA). Methods: Cases of NA were identified in 11 centers from 7 European countries, with retrospective analysis of demographics, clinical/laboratory findings, and treatment and outcome. Cases of HEV-NA were compared with NA cases without evidence of HEV infection. Results: Fifty-seven cases of HEV-NA and 61 NA cases without HEV were studied. Fifty-six of 57 HEV-NA cases were anti-HEV IgM positive; 53/57 were IgG positive. In 38 cases, HEV RNA was recovered from the serum and in 1 from the CSF (all gen...
Source: Neurology - August 28, 2017 Category: Neurology Authors: van Eijk, J. J. J., Dalton, H. R., Ripellino, P., Madden, R. G., Jones, C., Fritz, M., Gobbi, C., Melli, G., Pasi, E., Herrod, J., Lissmann, R. F., Ashraf, H. H., Abdelrahim, M., Masri, O. A. B. A. L., Fraga, M., Benninger, D., Kuntzer, T., Aubert, V., Sa Tags: Outcome research, Viral infections, All epidemiology, Natural history studies (prognosis) ARTICLE Source Type: research
Prognostic relevance of MOG antibodies in children with an acquired demyelinating syndrome
Objective: To assess the prognostic value of MOG antibodies (abs) in the differential diagnosis of acquired demyelinating syndromes (ADS). Methods: Clinical course, MRI, MOG-abs, AQP4-abs, and CSF cells and oligoclonal bands (OCB) in children with ADS and 24 months of follow-up were reviewed in this observational prospective multicenter hospital-based study. Results: Two hundred ten children with ADS were included and diagnosed with acute disseminated encephalomyelitis (ADEM) (n = 60), neuromyelitis optica spectrum disorder (NMOSD) (n = 12), clinically isolated syndrome (CIS) (n = 101), and multiple sclerosis (MS) (n = 3...
Source: Neurology - August 28, 2017 Category: Neurology Authors: Hennes, E.-M., Baumann, M., Schanda, K., Anlar, B., Bajer-Kornek, B., Blaschek, A., Brantner-Inthaler, S., Diepold, K., Eisenkölbl, A., Gotwald, T., Kuchukhidze, G., Gruber-Sedlmayr, U., Häusler, M., Höftberger, R., Karenfort, M., Tags: All Pediatric ARTICLE Source Type: research
Profile of neonatal epilepsies: Characteristics of a prospective US cohort
Conclusions: Neonatal epilepsy is often due to identifiable genetic causes. Genetic testing is now warranted for newborns with epilepsy in order to guide management and inform discussions of prognosis. (Source: Neurology)
Source: Neurology - August 28, 2017 Category: Neurology Authors: Shellhaas, R. A., Wusthoff, C. J., Tsuchida, T. N., Glass, H. C., Chu, C. J., Massey, S. L., Soul, J. S., Wiwattanadittakun, N., Abend, N. S., Cilio, M. R., For the Neonatal Seizure Registry Tags: Neonatal, Cohort studies, EEG, Neonatal seizures ARTICLE Source Type: research
Underestimation of sudden deaths among patients with seizures and epilepsy
Conclusions: Among the 25 patients identified with epilepsy by the epileptologists, they found definite or possible SUDEP in 72% (18/25) vs 24% (6/25) by the multidisciplinary group (6/15 cases they identified with epilepsy). The epileptologists identified acute symptomatic seizures as a potential COD in 5/14 patients with alcohol-related seizures. Epilepsy is underdiagnosed among decedents. Among patients with seizures and epilepsy who die suddenly, seizures and SUDEP often go unrecognized as a potential or definite COD. (Source: Neurology)
Source: Neurology - August 28, 2017 Category: Neurology Authors: Devinsky, O., Friedman, D., Cheng, J. Y., Moffatt, E., Kim, A., Tseng, Z. H. Tags: All Epilepsy/Seizures ARTICLE Source Type: research
Isabelle Rapin, MD (1927-2017)
On May 24, 2017, academic neurology lost one of its legendary pioneers who shattered our preconceptions of developmental disorders and created entirely new paradigms of thought, realms of nosology, pathogenic mechanisms, and interdisciplinary studies. Isabelle Rapin, MD, professor emerita in the Saul R. Korey Department of Neurology and the Department of Pediatrics, died after a bout with pneumonia. She was 89. A lifelong faculty member at Einstein and founding member of both the Child Neurology Society and the International Child Neurology Association, Rapin's many accomplishments in the scientific realm reflected her lif...
Source: Neurology - August 28, 2017 Category: Neurology Authors: Moshe, S. L., Mehler, M. F. Tags: IN MEMORIAM Source Type: research
Individualized risk prediction of major bleeding in secondary stroke prevention: Are we there yet?
In most patients diagnosed with a TIA or ischemic stroke, secondary stroke prevention relies on antiplatelet therapy unless anticoagulation is indicated. Aspirin has the largest evidence base and reduces the risk of early recurrent ischemic stroke without a major risk of early hemorrhagic complications.1 Because antiplatelet therapy typically continues for many years, clinicians and patients need an estimation of the annual bleeding risk to accurately assess future risk. In a meta-analysis of 25 randomized trials of antiplatelet therapy in primary or secondary prevention of cardiovascular disease, aspirin increased the abs...
Source: Neurology - August 28, 2017 Category: Neurology Authors: Lemmens, R., Al-Shahi Salman, R. Tags: Stroke prevention, All Cerebrovascular disease/Stroke, Risk factors in epidemiology, Infarction EDITORIALS Source Type: research
Early genetic testing for neonatal epilepsy: When, why, and how?
The incidence of seizures is greatest during the neonatal period, with an estimated rate of 2–4 per 1,000 live births. Although the majority of seizures in the newborn are due to acquired brain disorders, a substantial proportion are due to metabolic and genetic disorders causing neonatal- and infantile-onset epilepsies. For decades, genetics has played a critical role in identification and treatment of seizures in the newborn and infantile period.1,2 With newborn screening, disorders such as phenylketonuria and biotinidase deficiency can be identified before patients develop seizures. Early identification and treatm...
Source: Neurology - August 28, 2017 Category: Neurology Authors: Novotny, E. J. Tags: EEG, Video/ EEG use in epilepsy, Neonatal seizures, All Genetics, Ion channel gene defects EDITORIALS Source Type: research
Sudden unexpected death in epilepsy patients is often misdiagnosed as sudden cardiac death
Sudden unexpected death in epilepsy patients (SUDEP) represents the second main neurologic cause of years of potential life lost, following stroke, with a cumulative lifetime risk reaching 8% for childhood-onset epilepsy.1 In light of these worrying figures, the American Academy of Neurology (AAN) has recently published practice guidelines on the risk of SUDEP. These guidelines emphasize the "considerable uncertainty"of SUDEP incidence in adults with epilepsy, currently estimated at 1.2/1,000 patient-years (95% CI 0.64–2.32).2 Difficulties in assessing the epidemiology of SUDEP are several, including large ...
Source: Neurology - August 28, 2017 Category: Neurology Authors: Ryvlin, P., Cascino, G. D. Tags: All Epilepsy/Seizures EDITORIALS Source Type: research
Sudden unexpected death in epilepsy: Taking another look
The researchers set out to understand more about the condition of sudden death that can happen in people who have epilepsy (sudden unexpected death in epilepsy [SUDEP]).1 Epilepsy is a disorder of the brain. People who have had 2 seizures without a clear trigger or one seizure and a high risk of more seizures in the future have epilepsy.2 See the "About epilepsy" page for more information about epilepsy. (Source: Neurology)
Source: Neurology - August 28, 2017 Category: Neurology Authors: Schuele, S. U. Tags: All Epilepsy/Seizures, Epilepsy monitoring, Epilepsy semiology PATIENT PAGES Source Type: research
Teaching Video NeuroImages: Macrosaccadic oscillations induced by horizontal head impulses
A 33-year-old woman experienced chronic dizziness for 2 years. Examination disclosed gaze-evoked nystagmus and hypermetric saccades. Macrosaccadic oscillations (MSOs) were induced by a gaze shift and horizontal head impulses (video at Neurology.org). Brain MRI demonstrated a large (3.8 x 3.9 x 5.3 cm3) epidermoid cyst at the fourth ventricle that compresses the brainstem and cerebellum (figure). (Source: Neurology)
Source: Neurology - August 28, 2017 Category: Neurology Authors: Choi, S.-Y., Choi, Y. J., Choi, J.-H., Choi, K.-D. Tags: MRI, Clinical neurology examination, Ocular motility, Vertigo, Primary brain tumor RESIDENT AND FELLOW SECTION Source Type: research
Teaching NeuroImages: Reversible brain MRI lesions in adult-onset type II citrullinemia
An 18-year-old man presented with recurrent lethargy without triggers for 6 months. Neurologic examinations showed bilateral pyramidal signs. Brain MRI showed bilateral symmetric lesions in the cingulate cortex (figure, A and B). Adult-onset type II citrullinemia was confirmed by hyperammonemia, citrullinemia, and the mutation of the SLC25A13 gene.1 He was treated with low-carbohydrate diets, arginine, and sodium pyruvate but the treatment failed. Finally, the patient underwent liver transplantation, and the symptoms and signs recovered dramatically 2 weeks later. A repeat brain MRI showed the previous lesions nearly resol...
Source: Neurology - August 28, 2017 Category: Neurology Authors: Chen, L., Zhao, B., Shang, H. Tags: MRI, Metabolic disease (inherited), Coma RESIDENT AND FELLOW SECTION Source Type: research
Mystery Case: A case of fulminant encephalopathy in a 69-year-old woman
A 69-year-old right-handed woman was admitted to the medical intensive care unit for acute encephalopathy. Her medical history included sickle cell disease (hemoglobin sickle cell [HbSC]) with bone involvement (bilateral femoral head osteonecrosis) and rare sickle cell crises with joint pain and hemolytic anemia requiring red blood cell transfusions, sarcoidosis, diabetes, hypertension, and hypothyroidism. She never smoked cigarettes and never used recreational drugs or alcohol, and there was no history of recent travel. The patient's daughter reported that the patient was found unresponsive lying on the floor in the morni...
Source: Neurology - August 28, 2017 Category: Neurology Authors: Lamotte, G., Williams, C. Tags: MRI, Other cerebrovascular disease/ Stroke, Coma, Critical care, Embolism RESIDENT AND FELLOW SECTION Source Type: research
Clinical Reasoning: A 61-year-old man with conjugate gaze deviation, hemiparesis, and asymmetric reflexes
A 61-year-old man with a history of alcoholic cirrhosis was transferred from an outside hospital for spontaneous bacterial peritonitis, septic shock, and respiratory failure after intubation. The patient was initially on sedation; however, more than 48 hours after the sedative was discontinued, his mental status remained depressed and he also developed new onset of conjugate rightward gaze deviation. On neurologic examination, the patient was unresponsive to verbal stimuli and sternal rub. He could not follow any command, including closing or opening eyes and squeezing hands. He had remarkable conjugate, forced eye deviati...
Source: Neurology - August 28, 2017 Category: Neurology Authors: Lin, C.-Y., Yoo, J. Y., Doshi, A., Colman, R. Tags: MRI, Clinical neurology examination, All Cerebrovascular disease/Stroke, Critical care, Video/ EEG use in epilepsy RESIDENT AND FELLOW SECTION Source Type: research
Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: A systematic review
Source: Neurology - August 21, 2017 Category: Neurology Tags: CORRECTIONS Source Type: research
Author response: How can neurologists avoid burnout?
I thank Dr. Goldenberg for the comment on my editorial.1 He explains how he, as a busy clinical neurologist, found meaning by representing colleagues in a series of professional medical societies. It is a wonderful testimony of the point made in the article by Busis et al.2 that achieving personal engagement is a powerful preventive to burnout. (Source: Neurology)
Source: Neurology - August 21, 2017 Category: Neurology Authors: Bernat, J. L. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Letter re: How can neurologists avoid burnout?
We read with interest the article by Dr. Bernat,1 which gave an overview on how to avoid or reduce burnout for neurologists. It is a good approach to recreate workflows and give space to meet the most demanding individual requirements. A great way to expand the interventions to promote mental well-being would be by adding mindfulness-based interventions. Goodman and Schorling2 published a pre–post observational study on mindfulness-based stress reduction for health care providers, with impressive results. The intervention was for a period of 8 weeks,2 which is a good index that rapid improvement of individual well-be...
Source: Neurology - August 21, 2017 Category: Neurology Authors: Czempisz, A. M., Kunte, H. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Letter re: How can neurologists avoid burnout?
I read Dr. Bernat's editorial with interest.1 It is an excellent summary of the current health of our profession. An additional mitigation strategy, proven successful for me, is engagement with organized medicine. My professional journey took me from a county medical society to a state medical society and on to the American Academy of Neurology (AAN). In each venue, I find thoughtful, engaged physicians and dedicated, intelligent support staff. Clinical practice neurologists often spend their career in a rather isolated setting. When physicians do get together, the current practice environment fosters criticism. My dialogu...
Source: Neurology - August 21, 2017 Category: Neurology Authors: Goldenberg, J. N. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
: In the February 21, 2017, issue of Neurology®, the American Academy of Neurology Burnout Task Force reported that 60% of American neurologists surveyed experienced at least one symptom of burnout. In the accompanying editorial, Dr. Bernat hypothesizes as to why neurologists are more prone to burnout than other similar specialties and suggests several actions to reverse the trend, including increasing patient care time and decreasing clerical work. (Source: Neurology)
Source: Neurology - August 21, 2017 Category: Neurology Authors: Alcauskas, M., Griggs, R. C. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Listeria rhomboencephalomyelitis complicated by hemorrhagic transformation
A 53-year-old woman presented with a 2-week history of diplopia, ataxia, and fevers. Blood cultures and CSF PCR were positive for Listeria monocytogenes. MRI demonstrated hyperintensity in the cerebellum, brainstem, and cervical cord (figure 1) with interval hemorrhagic transformation (figure 2). While a recognized cause of rhomboencephalitis, Listeria rarely involves the spinal cord concurrently.1 Hemorrhagic transformation is a novel finding, possibly secondary to bacterial invasion with localized inflammation and necrosis of brain parenchyma and surrounding blood vessels leading to exudation of blood products. Correlati...
Source: Neurology - August 21, 2017 Category: Neurology Authors: Nham, B., Baskin, J., Choong, H. Tags: MRI, Meningitis, Bacterial infections, Spinal cord infection NEUROIMAGES Source Type: research
Thiamine-responsive disease due to mutation of tpk1: Importance of avoiding misdiagnosis
A first child of unrelated healthy parents was the product of an uneventful pregnancy and delivery. Initial psychomotor development proceeded regularly. At 21 months of age, during an episode of otitis media, she started presenting recurrent vomiting, global hyporeactivity, ataxia, dysmetria, pyramidal signs, and loss of postural control. Cerebral MRI showed bilateral signal abnormalities of putamina (figure). (Source: Neurology)
Source: Neurology - August 21, 2017 Category: Neurology Authors: Invernizzi, F., Panteghini, C., Chiapparini, L., Moroni, I., Nardocci, N., Garavaglia, B., Tonduti, D. Tags: Mitochondrial disorders; see Genetics/Mitochondrial disorders CLINICAL/SCIENTIFIC NOTES Source Type: research
Chemotherapy-induced peripheral neuropathy clinical trials: Review and recommendations
Conclusions: These data identify reporting practices that could be improved in order to enhance readers' ability to critically evaluate RCTs of CIPN treatments and use the findings to inform the design of future studies and clinical practice. Reporting recommendations are provided. (Source: Neurology)
Source: Neurology - August 21, 2017 Category: Neurology Authors: Gewandter, J. S., Freeman, R., Kitt, R. A., Cavaletti, G., Gauthier, L. R., McDermott, M. P., Mohile, N. A., Mohlie, S. G., Smith, A. G., Tejani, M. A., Turk, D. C., Dworkin, R. H. Tags: Clinical trials Methodology/study design, Clinical trials Systematic review/meta analysis, Neuropathic pain VIEWS & amp;amp; REVIEWS Source Type: research
Penfield's ceiling: Seeing brain injury through Galen's eyes
The cathedral ceiling located in the entrance hall of the Montreal Neurological Institute, planned by its founder Wilder Penfield, has intrigued visitors since it was erected in 1934. Central to its charm is a cryptic comment by the ancient physician Galen of Pergamum, which refutes a dire Hippocratic aphorism about prognosis in brain injury. Galen's optimism, shared by Penfield, is curious from a fellow ancient. In this article, we use primary sources in Ancient Greek as well as secondary sources to not only examine the origins of Galen's epistemology but also, using a methodology in classics scholarship known as receptio...
Source: Neurology - August 21, 2017 Category: Neurology Authors: Adams, Z. M., Fins, J. J. Tags: HISTORICAL NEUROLOGY Source Type: research
In vivo retention of 18F-AV-1451 in corticobasal syndrome
Conclusions: Patients with CBS without typical AD pathology exhibited AV-1451 retention in the motor cortex, corticospinal tract, and basal ganglia contralateral to the affected body side, clearly different from controls and patients with AD dementia or PSP. However, cortical atrophy measured with MRI and decreased 18F-fluorodeoxyglucose uptake were more widespread than 18F-AV-1451 uptake and probably represent earlier, yet less specific, markers of CBS. Classification of evidence: This study provides Class III evidence that 18F-AV-1451 PET distinguishes between CBS and AD or PSP. (Source: Neurology)
Source: Neurology - August 21, 2017 Category: Neurology Authors: Smith, R., Schöll, M., Widner, H., van Westen, D., Svenningsson, P., Hägerström, D., Ohlsson, T., Jögi, J., Nilsson, C., Hansson, O. Tags: PET, Progressive supranuclear palsy, Alzheimer's disease, Corticobasal degeneration, Basal ganglia ARTICLE Source Type: research
Motor speech signature of behavioral variant frontotemporal dementia: Refining the phenotype
Conclusions: One in 8 patients presented with moderate speech timing deficits with a further two-thirds rated as mild or subclinical. Subtle but measurable deficits in prosody are common in bvFTD and should be considered during disease management. Language function correlated with speech timing measures derived from the unprepared monologue only. (Source: Neurology)
Source: Neurology - August 21, 2017 Category: Neurology Authors: Vogel, A. P., Poole, M. L., Pemberton, H., Caverle, M. W. J., Boonstra, F. M. C., Low, E., Darby, D., Brodtmann, A. Tags: Clinical neurology examination, Apraxia, Frontotemporal dementia ARTICLE Source Type: research
Biological age is better than chronological as predictor of 3-month outcome in ischemic stroke
Conclusions: B-age, estimated by DNA methylation, is an independent predictor of ischemic stroke outcome regardless of chronological years. (Source: Neurology)
Source: Neurology - August 21, 2017 Category: Neurology Authors: Soriano-Tarraga, C., Mola-Caminal, M., Giralt-Steinhauer, E., Ois, A., Rodriguez-Campello, A., Cuadrado-Godia, E., Gomez-Gonzalez, A., Vivanco-Hidalgo, R. M., Fernandez-Cadenas, I., Cullell, N., Roquer, J., Jimenez-Conde, J. Tags: All Cerebrovascular disease/Stroke, Cohort studies, Risk factors in epidemiology, All Genetics ARTICLE Source Type: research
Brain hemorrhage recurrence, small vessel disease type, and cerebral microbleeds: A meta-analysis
Conclusions: CMB burden and distribution on MRI identify subgroups of ICH survivors with higher ICH recurrence risk, which may help to predict ICH prognosis with relevance for clinical practice and treatment trials. (Source: Neurology)
Source: Neurology - August 21, 2017 Category: Neurology Authors: Charidimou, A., Imaizumi, T., Moulin, S., Biffi, A., Samarasekera, N., Yakushiji, Y., Peeters, A., Vandermeeren, Y., Laloux, P., Baron, J.-C., Hernandez-Guillamon, M., Montaner, J., Casolla, B., Gregoire, S. M., Kang, D.-W., Kim, J. S., Naka, H., Smith, E Tags: MRI, Intracerebral hemorrhage ARTICLE Source Type: research
Magnesium, hemostasis, and outcomes in patients with intracerebral hemorrhage
Conclusions: These data support the hypothesis that magnesium exerts a clinically meaningful influence on hemostasis in patients with ICH. (Source: Neurology)
Source: Neurology - August 21, 2017 Category: Neurology Authors: Liotta, E. M., Prabhakaran, S., Sangha, R. S., Bush, R. A., Long, A. E., Trevick, S. A., Potts, M. B., Jahromi, B. S., Kim, M., Manno, E. M., Sorond, F. A., Naidech, A. M., Maas, M. B. Tags: All Cerebrovascular disease/Stroke, Critical care, Intracerebral hemorrhage ARTICLE Source Type: research
Serum matrix metalloproteinase-9 levels and prognosis of acute ischemic stroke
Conclusions: Higher serum MMP-9 levels in the acute phase of ischemic stroke were associated with increased risk of mortality and major disability, suggesting that serum MMP-9 could be an important prognostic factor for ischemic stroke. (Source: Neurology)
Source: Neurology - August 21, 2017 Category: Neurology Authors: Zhong, C., Yang, J., Xu, T., Xu, T., Peng, Y., Wang, A., Wang, J., Peng, H., Li, Q., Ju, Z., Geng, D., Zhang, Y., He, J., For the CATIS Investigators Tags: Stroke prevention, Prognosis, All Cerebrovascular disease/Stroke, Clinical trials Observational study (Cohort, Case control), Cohort studies ARTICLE Source Type: research
Long-term AIDS-related PCNSL outcomes with HD-MTX and combined antiretroviral therapy
Conclusions: Combined short-term HD-MTX monochemotherapy and optimal cART simply and effectively treat AR-PCNSL, achieving long-term survival with few relapses. Classification of evidence: This study provides Class IV evidence that short-term HD-MTX monochemotherapy improves long-term survival of patients with AIDS with primary CNS lymphoma receiving cARTs. (Source: Neurology)
Source: Neurology - August 21, 2017 Category: Neurology Authors: Moulignier, A., Lamirel, C., Picard, H., Lebrette, M.-G., Amiel, C., Hamidi, M., Polivka, M., Mikol, J., Cochereau, I., Pialoux, G. Tags: Viral infections, HIV, All Oncology, Primary brain tumor ARTICLE Source Type: research
Oral fluoroquinolones and risk of secondary pseudotumor cerebri syndrome: Nested case-control study
Conclusion: Our study suggests an increase in the risk of PTCS with current users of fluoroquinolones. Although this adverse event is rare, patients who experience symptoms of raised intracranial pressure including headaches, tinnitus, and double vision while taking fluoroquinolones should seek medical attention. (Source: Neurology)
Source: Neurology - August 21, 2017 Category: Neurology Authors: Sodhi, M., Sheldon, C. A., Carleton, B., Etminan, M. Tags: Idiopathic intracranial hypertension, Case control studies ARTICLE Source Type: research