British Society for Rheumatology guideline for diagnosis and treatment of giant cell arteritis.
PMID: 32611764 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - July 1, 2020 Category: Neurology Authors: Mollan SP, Mackie SL Tags: Pract Neurol Source Type: research

Stop testing for autoantibodies to the VGKC-complex: only request LGI1 and CASPR2.
Abstract Autoantibodies to leucine-rich glioma-inactivated 1 (LGI1) and contactin-associated protein like-2 (CASPR2) are associated with clinically distinctive syndromes that are highly immunotherapy responsive, such as limbic encephalitis, faciobrachial dystonic seizures, Morvan's syndrome and neuromyotonia. These autoantibodies target surface-exposed domains of LGI1 or CASPR2, and appear to be directly pathogenic. In contrast, voltage-gated potassium channel (VGKC) antibodies that lack LGI1 or CASPR2 reactivities ('double-negative') are common in healthy controls and have no consistent associations with distinct...
Source: Practical Neurology - June 28, 2020 Category: Neurology Authors: Michael S, Waters P, Irani SR Tags: Pract Neurol Source Type: research

Non-traumatic CSF rhinorrhoea.
cute; PMID: 32586830 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - June 25, 2020 Category: Neurology Authors: Ronan G, Barry R, Fanning N, Merwick Á Tags: Pract Neurol Source Type: research

Correction: The Waiting Room: neurological observations made outside the movement disorder specialist's consulting office.
Authors: PMID: 32581142 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - June 24, 2020 Category: Neurology Tags: Pract Neurol Source Type: research

Acute leukoencephalopathy in an adult.
PMID: 32563997 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - June 21, 2020 Category: Neurology Authors: Makawita C, Ravindra S, Rajapakshe I, Senanayake B Tags: Pract Neurol Source Type: research

A neurologist with Parkinson's disease.
PMID: 32554438 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - June 17, 2020 Category: Neurology Authors: Blacker D Tags: Pract Neurol Source Type: research

Acute intermittent porphyria presenting with posterior reversible encephalopathy syndrome (PRES) and abdominal pain.
We describe a patient with acute intermittent porphyria who presented with seizures and PRES, and who had previous unexplained severe abdominal pain. Acute intermittent porphyria should be considered as a possible cause of PRES, especially in those with unexplained abdominal pain, since delays in its diagnosis can result in permanent complications. PMID: 32554439 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - June 17, 2020 Category: Neurology Authors: Swart G, Lim SS, Jude M Tags: Pract Neurol Source Type: research

Neuroretinitis: a tricky mimic.
PMID: 32546515 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - June 16, 2020 Category: Neurology Authors: Lueck CJ Tags: Pract Neurol Source Type: research

The World I Fell Out Of by Melanie Reid.
PMID: 32546516 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - June 16, 2020 Category: Neurology Authors: Scott N, Leighton DJ, Newman EJ Tags: Pract Neurol Source Type: research

Bartonella neuroretinitis (cat-scratch disease).
We report a patient with cat-scratch disease presenting with meningitis and neuroretinitis. This condition, caused by Bartonella henselae, has a worldwide distribution and is among the most common infective causes of neuroretinitis. Bartonella neuroretinitis is a rare but under-recognised mimic of optic neuritis; it should be suspected in a patient with an infective prodrome whose fundus shows optic disc oedema and a macular star. A low-positive initial serological test for Bartonella henselae does not exclude cat-scratch disease if there is high clinical suspicion, and repeat testing is recommended to look for titre rise....
Source: Practical Neurology - June 16, 2020 Category: Neurology Authors: Yap SM, Saeed M, Logan P, Healy DG Tags: Pract Neurol Source Type: research

Photopsia.
Abstract 'Photopsia' describes the symptom of visual disturbances that are typically flash-like, sudden in onset and brief, and occurring without light entering the eye. Patients reporting photopsia often pose a diagnostic challenge, given the wide range of possible neurological and ophthalmological causes. We review the common causes of photopsia, discuss the assessment and workup of this symptom, and stress the importance of close interdisciplinary liaison to help with its diagnosis and management. We discuss a patient with acute zonal occult outer retinopathy to illustrate these points. PMID: 32536606 [Pub...
Source: Practical Neurology - June 14, 2020 Category: Neurology Authors: Virdee J, Mollan SP Tags: Pract Neurol Source Type: research

Charcot in the ICU: functional tetraplegia after surgery.
We report a patient with no psychiatric history or prior abnormal examination who developed sudden-onset functional tetraplegia and sensory disturbances immediately after elective surgery, and who was subsequently discharged home several days later after nearly complete resolution of neurologic deficits. We highlight the features of this syndrome, including its unique postoperative presentation, unusual resolution and absence of any identifiable psycho-dynamic mechanism. We also introduce the tripod sign as a useful clinical tool in identifying functional tetraplegia. PMID: 32532808 [PubMed - as supplied by publisher]...
Source: Practical Neurology - June 12, 2020 Category: Neurology Authors: Scheitler KM, Robin CR, Wijdicks EFM Tags: Pract Neurol Source Type: research

Diagnosis and management of acute ischaemic stroke.
Abstract Acute ischaemic stroke is a major public health priority and will become increasingly relevant to neurologists of the future. The cornerstone of effective stroke care continues to be timely reperfusion treatment. This requires early recognition of symptoms by the public and first responders, triage to an appropriate stroke centre and efficient assessment and investigation by the attending stroke team. The aim of treatment is to achieve recanalisation and reperfusion of the ischaemic penumbra with intravenous thrombolysis and/or endovascular thrombectomy in appropriately selected patients. All patients sho...
Source: Practical Neurology - June 7, 2020 Category: Neurology Authors: Hurford R, Sekhar A, Hughes TAT, Muir KW Tags: Pract Neurol Source Type: research

Neurotoxicity-CAR T-cell therapy: what the neurologist needs to know.
Abstract Chimeric antigen receptor (CAR) T-cell therapy is one of the most innovative therapies for haematological malignancies to emerge in a generation. Clinical studies have shown that a single dose of CAR T-cells can deliver durable clinical remissions for some patients with B-cell cancers where conventional therapies have failed.A significant complication of CAR therapy is the immune effector cell-associated neurotoxicity syndrome (ICANS). This syndrome presents a continuum from mild tremor to cerebral oedema and in a minority of cases, death. Management of ICANS is mainly supportive, with a focus on seizure ...
Source: Practical Neurology - June 5, 2020 Category: Neurology Authors: Neill L, Rees J, Roddie C Tags: Pract Neurol Source Type: research

Grand rounds: a precious resource to be nurtured.
PMID: 32503898 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - June 5, 2020 Category: Neurology Authors: Ross Russell AL, Reilly MM, Turner MR Tags: Pract Neurol Source Type: research

Muscle biopsy: what and why and when?
Abstract Skeletal muscle biopsy remains an important investigative tool in the diagnosis of a variety of muscle disorders. Traditionally, someone with a limb-girdle muscle weakness, myopathic changes on electrophysiology and raised serum creatine kinase (CK) would have a muscle biopsy. However, we are living through a genetics revolution, and so do all such patients still need a biopsy? When should we undertake a muscle biopsy in patients with a distal, scapuloperoneal or other patterns of muscle weakness? When should patients with myositis, rhabdomyolysis, myalgia, hyperCKaemia or a drug-related myopathy have a m...
Source: Practical Neurology - June 5, 2020 Category: Neurology Authors: Walters J, Barborie A Tags: Pract Neurol Source Type: research

A confused patient with deranged liver function tests.
PMID: 32487721 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - June 2, 2020 Category: Neurology Authors: Tucker H, Masood Z, Chhetri SK Tags: Pract Neurol Source Type: research

Tardive syndromes.
Abstract Dopamine receptor-blocking antipsychotics, first introduced into clinical practice in 1952, were hailed as a panacea in the treatment of a number of psychiatric disorders. However, within 5 years, this notion was to be shattered by the recognition of both acute and chronic drug-induced movement disorders which can accompany their administration. Tardive syndromes, denoting the delayed onset of movement disorders following administration of dopamine receptor-blocking (and also other) drugs, have diverse manifestations ranging from the classic oro-bucco-lingual dyskinesia, through dystonic craniocervic...
Source: Practical Neurology - June 2, 2020 Category: Neurology Authors: Mulroy E, Balint B, Bhatia KP Tags: Pract Neurol Source Type: research

Next steps after diagnosing dementia: interventions to help patients and families.
Abstract The way that a diagnosis of dementia is delivered to patients, what information is provided and what practical advice and support is arranged has a lasting impact and deserves at least as much attention as the process of assessment and investigation. Individuals and their families require an honest yet sensitive discussion about the nature and cause of their problems, using non-technical language and tailored to their priorities and needs. This should lead on to the provision of good-quality information in an accessible format. Priorities for intervention include medication review, attention to sensory de...
Source: Practical Neurology - May 22, 2020 Category: Neurology Authors: Bayer A Tags: Pract Neurol Source Type: research

Simple visual hallucinations and epilepsy.
PMID: 32444478 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - May 22, 2020 Category: Neurology Authors: Manford M Tags: Pract Neurol Source Type: research

DCTN1-related Parkinson-plus disorder (Perry syndrome).
We report a patient with DCTN1-related Parkinson-plus disorder, in whom genetic confirmation came only after death. PMID: 32434902 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - May 20, 2020 Category: Neurology Authors: Richardson D, McEntagart MM, Isaacs JD Tags: Pract Neurol Source Type: research

How to diagnose difficult white matter disorders.
We present a guide for clinicians, including pitfalls of testing, clinical pearls and where to seek advice. PMID: 32434903 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - May 20, 2020 Category: Neurology Authors: Williams T, Houlden H, Murphy E, John N, Fox NC, Schott JM, Adams M, Davagananam I, Chataway J, Lynch DS Tags: Pract Neurol Source Type: research

Neurosarcoidosis: clinical manifestations, investigation and treatment.
Abstract Sarcoidosis affects the nervous system in 10% of cases. When it does so it can affect any part of the nervous system and with all degrees of severity. It forms part of the differential diagnosis in inflammatory, infective, neoplastic and degenerative neurological diseases and may be very difficult to diagnose without histological confirmation. Recent clinical studies and the increasing availability of new biological treatments allow a much clearer understanding of the disease. This review summarises its clinical features, imaging and laboratory characteristics, treatment and outcome. PMID: 32424017 [...
Source: Practical Neurology - May 17, 2020 Category: Neurology Authors: Kidd DP Tags: Pract Neurol Source Type: research

Targeting sedentary behaviour in neurological disease.
PMID: 32404405 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - May 13, 2020 Category: Neurology Authors: Busse M, Ramdharry G Tags: Pract Neurol Source Type: research

CSF lactate.
This article discusses the utility and limitations of CSF lactate, highlighting specific clinical situations where it can help in the diagnosis of CNS infections and unexplained encephalopathy. PMID: 32404406 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - May 13, 2020 Category: Neurology Authors: Baheerathan A, Pitceathly RDS, Curtis C, Davies NWS Tags: Pract Neurol Source Type: research

A treatable cause of vertigo.
PMID: 32376683 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - May 6, 2020 Category: Neurology Authors: Nham B, Young AS, Garsia R, Halmagyi GM, Welgampola MS Tags: Pract Neurol Source Type: research

Hypoglossal palsy from an atlanto-axial synovial cyst.
PMID: 32366594 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - May 4, 2020 Category: Neurology Authors: Vaughan D, Murphy SM, Alexander MD, Walsh RA Tags: Pract Neurol Source Type: research

Acute anosmia from COVID-19 infection.
PMID: 32366595 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - May 4, 2020 Category: Neurology Authors: Mermelstein S Tags: Pract Neurol Source Type: research

COVID-19: switching to remote neurology outpatient consultations.
PMID: 32366596 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - May 4, 2020 Category: Neurology Authors: Nitkunan A, Paviour D, Nitkunan T Tags: Pract Neurol Source Type: research

'Fasciculations': linguistic slip or judicious advance?
PMID: 32345767 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - April 28, 2020 Category: Neurology Authors: Bashford J Tags: Pract Neurol Source Type: research

Frenzel glasses: an affordable alternative.
PMID: 32332155 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - April 24, 2020 Category: Neurology Authors: Dhonde P, Khadilkar S Tags: Pract Neurol Source Type: research

Autoimmune encephalitis associated with Ma2 antibodies and immune checkpoint inhibitor therapy.
Abstract Immune checkpoint inhibitors have transformed the treatment of advanced malignancy, while increasing the risk of immune-related adverse events. A 56-year-old woman who had received nivolumab for stage 4 renal cell carcinoma subsequently developed altered behaviour, memory deficits and worsening of previously stable epilepsy. MR scan of the brain showed bilateral FLAIR (fluid-attenuated inversion recovery) hyperintensity of the mesial temporal lobes, and there were anti-Ma2 antibodies in both serum and cerebrospinal fluid. She was treated with corticosteroids but developed further clinical relapses requiri...
Source: Practical Neurology - April 17, 2020 Category: Neurology Authors: Lyons S, Joyce R, Moynagh P, O'Donnell L, Blazkova S, Counihan TJ Tags: Pract Neurol Source Type: research

Patent foramen ovale.
Abstract Patent foramen ovale (PFO) is the most common anatomical cause of an interatrial shunt. It is usually asymptomatic but may cause paradoxical embolism, manifesting as stroke, myocardial infarction or visceral/peripheral ischaemia. PFO is a risk factor for stroke and may be associated with migraine with aura. New evidence suggests PFO closure reduces the risk of recurrent ischaemic stroke in a highly selected population of stroke survivors: those aged 60 years or younger with a cryptogenic stroke syndrome, a large right-to-left shunt, an atrial septal aneurysm and no evidence of atrial fibrillation. They be...
Source: Practical Neurology - April 16, 2020 Category: Neurology Authors: Alakbarzade V, Keteepe-Arachi T, Karsan N, Ray R, Pereira AC Tags: Pract Neurol Source Type: research

Emergency presentations of movement disorders.
Abstract Movement disorders are typically perceived as being gradually progressive conditions that are managed in outpatient settings. However, they may manifest de novo with an acute severe phenotype or an acute decompensation. A movement disorder becomes an emergency when it evolves acutely or subacutely over hours to days; delays in its diagnosis and treatment may cause significant morbidity and mortality. Here we address the clinical presentation, diagnosis and management of those movement disorder emergencies that are principally encountered in emergency departments, in acute receiving units or in intensive c...
Source: Practical Neurology - April 16, 2020 Category: Neurology Authors: Gandhi SE, Newman EJ, Marshall VL Tags: Pract Neurol Source Type: research

Epileptic: David B.
PMID: 32273393 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - April 9, 2020 Category: Neurology Authors: Watson N Tags: Pract Neurol Source Type: research

Management of mild traumatic brain injury.
Abstract Mild traumatic brain injury (TBI) is common and associated with a range of diffuse, non-specific symptoms including headache, nausea, dizziness, fatigue, hypersomnolence, attentional difficulties, photosensitivity and phonosensitivity, irritability and depersonalisation. Although these symptoms usually resolve within 3 months, 5%-15% of patients are left with chronic symptoms. We argue that simply labelling such symptoms as 'postconcussional' is of little benefit to patients. Instead, we suggest that detailed assessment, including investigation, both of the severity of the 'mild' injury and of the ...
Source: Practical Neurology - April 9, 2020 Category: Neurology Authors: van Gils A, Stone J, Welch K, Davidson LR, Kerslake D, Caesar D, McWhirter L, Carson A Tags: Pract Neurol Source Type: research

ABN news.
PMID: 32184293 [PubMed - in process] (Source: Practical Neurology)
Source: Practical Neurology - March 20, 2020 Category: Neurology Authors: Lawrence J, Sussman J Tags: Pract Neurol Source Type: research

Facial myokymia in inherited peripheral nerve hyperexcitability syndrome.
We report a woman with marked facial myokymia and distal upper limb contractures whose mother also had subtle facial myokymia; both had the c.G620A (p.R207Q) variant in the KCNQ2 gene. Patients with familial myokymia and peripheral nerve hyperexcitability syndrome should be investigated for KCNQ2 variants. This autosomal dominant condition may respond to antiepileptic medications acting at potassium channels. PMID: 32184343 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - March 17, 2020 Category: Neurology Authors: Camelo CG, Silva AMS, Moreno CAM, Matsui-Júnior C, Heise CO, Pedroso JL, Zanoteli E Tags: Pract Neurol Source Type: research

Horner's syndrome and apraclonidine eye drops.
PMID: 32184344 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - March 17, 2020 Category: Neurology Authors: Margolin E, Jeeva-Patel T, Hainc N Tags: Pract Neurol Source Type: research

Two sisters with myoclonus and ataxia.
ute;rio MDC PMID: 32161095 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - March 11, 2020 Category: Neurology Authors: Pereira M, Durães J, Macário MDC Tags: Pract Neurol Source Type: research

Why We Sleep by Matthew Walker.
PMID: 32139582 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - March 5, 2020 Category: Neurology Authors: Hawken J Tags: Pract Neurol Source Type: research

Sphenoid sinus aspergilloma with sixth nerve palsy.
PMID: 32075878 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - February 19, 2020 Category: Neurology Authors: Agorogiannis E, Korais C, Saratziotis A, Hajiioannou J, Bizakis J Tags: Pract Neurol Source Type: research

Vagus nerve stimulation for epilepsy.
PMID: 32054789 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - February 13, 2020 Category: Neurology Authors: Duncan J Tags: Pract Neurol Source Type: research

Prison epilepsy clinic.
PMID: 32033993 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - February 7, 2020 Category: Neurology Authors: Esposito M, Pierri M, Strinati M, Smith PEM Tags: Pract Neurol Source Type: research

My dad and progressive supranuclear palsy (PSP).
PMID: 32033994 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - February 7, 2020 Category: Neurology Authors: Angus-Leppan H Tags: Pract Neurol Source Type: research

ABN news.
PMID: 31937686 [PubMed - in process] (Source: Practical Neurology)
Source: Practical Neurology - January 17, 2020 Category: Neurology Authors: Lawrence J, Sussman J Tags: Pract Neurol Source Type: research

Extending boundaries for thrombectomy in stroke.
PMID: 31911479 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - January 7, 2020 Category: Neurology Authors: Bosnell R Tags: Pract Neurol Source Type: research

Endovascular thrombectomy: 31 hours from symptom onset.
We describe a young woman managed with endovascular thrombectomy beyond 24 hours. PMID: 31911480 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - January 7, 2020 Category: Neurology Authors: Beharry J, Duncan R, Krauss M, Colgan F, Lim JY, Wu T Tags: Pract Neurol Source Type: research

Vagus nerve stimulation for drug-resistant epilepsy.
ner G Abstract Vagus nerve stimulation (VNS) is a neuromodulatory therapeutic option for drug-resistant epilepsy. In randomised controlled trials, VNS implantation has resulted in over 50% reduction in seizure frequency in 26%-40% of patients within 1 year. Long-term uncontrolled studies suggest better responses to VNS over time; however, the assessment of other potential predictive factors has led to contradictory results. Although initially designed for managing focal seizures, its use has been extended to other forms of drug-resistant epilepsy. In this review, we discuss the evidence supporting the use o...
Source: Practical Neurology - December 31, 2019 Category: Neurology Authors: Pérez-Carbonell L, Faulkner H, Higgins S, Koutroumanidis M, Leschziner G Tags: Pract Neurol Source Type: research

Giant intracranial aneurysm water-hammer effect.
PMID: 31822505 [PubMed - as supplied by publisher] (Source: Practical Neurology)
Source: Practical Neurology - December 10, 2019 Category: Neurology Authors: Dmytriw AA, Alrashed A, Yang VX Tags: Pract Neurol Source Type: research