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The tos study control data: how well do neurology in-patients recall being examined and does it matter?
Conclusions Although recall bias is a potential problem for the TOS score, this control data indicates that it should not be seen as a significant issue and does not negate the findings of our previous data collection that large numbers of in–patients with neurological problems are not been appropriately examined. TOS scores provide a method of quantifying the thoroughness of neurological examination and we are at present in the process of organising a multicentre study in six countries using TOS scores to establish how widespread this problem is globally.
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: Mulla, A., Appleton, J., Nicholl, D. Tags: Headache (including migraine), Stroke Association of British Neurologists (ABN) joint meeting with the Royal College of Physicians (RCP), London, 23-24 October 2013 Source Type: research

The medical research council neuromuscular centre for translational research mitochondrial disease patient cohort study uk: from conceptualisation to utilisation
Conclusion For the first time in the UK it is possible to access a large cohort of well–characterised patients with mitochondrial disease. The cohort provides objective data on mitochondrial disease progression, in children and adults, allowing evidence–based guidelines to be developed, and prognostic advice to be provided to patients and families. There is a vast amount of data still to be analysed that will provide systematic evidence and allow the development of disease prevention strategies.
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: Nesbitt, V., Pitceathly, R., Cockell, S., Poulton, J., Rahman, S., Hanna, M., Taylor, R., Chinnery, P., Turnbull, D., McFarland, R. Tags: Genetics, Epilepsy and seizures, Headache (including migraine), Muscle disease, Neuromuscular disease, Stroke, Musculoskeletal syndromes Association of British Neurologists (ABN) joint meeting with the Royal College of Physicians (RCP), London, 23-24 Oc Source Type: research

Sensitivity of transcranial doppler and transoesophageal echocardiography for the detection of patent foramen ovale in cryptogenic stroke
Conclusions TCD with bubble test is sensitive and specific for the detection of right–to–left shunts due to PFO confirmed at right heart catheterisation. In this population, TOE had low sensitivity for RLS. There was no difference in physical PFO size between TOE positive and negative patients.
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: Morhij, D., Dani, K., Stewart Hillis, W., Muir, K. Tags: Headache (including migraine), Neuroimaging, Stroke, Hypertension, Ischaemic heart disease, Radiology, Radiology (diagnostics) Association of British Neurologists (ABN) joint meeting with the Royal College of Physicians (RCP), London, 23-24 October 2013 Source Type: research

Spontaneous intracranial hypotension: clinical features in eight cases
Conclusions SIH is an under–recognised but fairly common disorder. Clinical examination is usually normal, and confirmation of the diagnosis requires investigations and treatment not used routinely in the management of headache. Investigations, including contrast–enhanced neuroimaging, are often normal in the acute or chronic phase. Clinical history taking skills are therefore paramount in recognising this disorder. Characteristic features include a new daily persistent headache in a cranio–cervical distribution, with often bizarre sounding additional symptoms. Our results challenge the prevailing notions...
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: Anderson, J., Corkill, R. Tags: Headache (including migraine), Pain (neurology), Stroke, Ear, nose and throat/otolaryngology Association of British Neurologists (ABN) joint meeting with the Royal College of Physicians (RCP), London, 23-24 October 2013 Source Type: research

A rare cause of headache-the importance of a tissue diagnosis and perseverance
A 64 year old diabetic hypertensive milkman presented in September 2011 with 4 months progressive constant right frontotemporal retro–orbital pain. It was worse at night affecting sleep with slight right field blurring and later vomiting. Full examination including blood pressure was normal with acuities 6/9. Tension type headache was considered. Initial brain CT was reported as normal. With concern about giant cell arteritis steroids were trialled although ESR was 8 and CRP 25 with no other clinical features: pain reduction was short–lived and temporal artery biopsy negative. Symptoms worsened despite analgesi...
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: Defty, H., Cavazza, A., Warner, G. Tags: Immunology (including allergy), Cranial nerves, Headache (including migraine), Neurooncology, Pain (neurology), Stroke, Hypertension, CNS cancer, Ophthalmology, Pain (palliative care), Anxiety disorders (including OCD and PTSD), Radiology, Disability, Dru Source Type: research

Staring you in the face! sturge-weber syndrome is a spectrum disorder and late presentation is possible
A 52 year old man with a four year history of migraine with aura presented to hospital with a severe right sided headache and prolonged episode of left sided sensory and motor disturbance. Examination revealed left homonymous hemianopia, sensory inattention and hemiparesis (3/5). Reflexes were symmetrical and plantars downing. He had a facial port wine stain in a V1 distribution on the right. Unenhanced CT scan was normal. Migrainous infarction was the working diagnosis and he was commenced on aspirin. Two days later he experienced intermittent episodes of left face and arm twitching consistent with focal motor seizures, t...
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: Cosgrove, J., Hassan, A. Tags: Genetics, Drugs: CNS (not psychiatric), Epilepsy and seizures, Headache (including migraine), Pain (neurology), Stroke, Radiology, Radiology (diagnostics) Association of British Neurologists (ABN) joint meeting with the Royal College of Physicians (RCP) Source Type: research

A stroke mimic; focal neurological deficits in benign hereditary chorea?
Conclusion This case highlights the difficulties in assessing patients with new focal neurological symptoms in the presence of known, pre existing, neurological disease. It also serves to highlight how often erroneously progressive weakness is mislabelled as a ‘stroke’. Neurologists working together with acute physicians in liaison posts in MAU, provides a unique opportunity to improve overall recognition of neurological disease, and for patients potentially provides a more timely diagnostic work–up and the opportunity for early treatment.
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: Maw, K., Johnston, J., Rowntree, C., Kalhan, A. Tags: Immunology (including allergy), Headache (including migraine), Movement disorders (other than Parkinsons), Neurooncology, Pain (neurology), Stroke, CNS cancer, Neuropathology, Radiology, Surgical diagnostic tests, Surgical oncology Association of Britis Source Type: research

Trigeminal neuralgia after pontine infarction affecting the ipsilateral trigeminal nerve
A 57-year-old man presented with numbness, paraesthesia and lancinating pain on the left side of the face, which had developed suddenly 10 days previously. He had hypertension and no history of headache. His facial pain was characterised by a brief electric shock-like pain, which was evoked by light stimuli, and also occurred spontaneously. A neurological examination showed a mild decrease in sensation on the left side of the face, mainly with V2 and V3 distribution, and on the left oral cavity, including the tongue and buccal mucosa. Other neurological examinations were normal, including the corneal reflex and the mo...
Source: Journal of Neurology, Neurosurgery and Psychiatry - July 8, 2013 Category: Neurosurgery Authors: Kim, J. B., Yu, S. Tags: Immunology (including allergy), Brain stem / cerebellum, Cranial nerves, Headache (including migraine), Multiple sclerosis, Neuroimaging, Neuromuscular disease, Pain (neurology), Peripheral nerve disease, Stroke, Hypertension, Ophthalmology, Drugs: psychi Source Type: research

Unilateral isolated hypoglossal nerve palsy associated with internal carotid artery dissection
A 54-year-old healthy man was admitted to our hospital with acute dysarthria and mild impairment in swallowing and tongue movements, which he had noticed 2 days before. He was not taking any drugs, and his medical history was unremarkable except for mild hypertension (145/95 mm Hg). He denied prior trauma, fever, facial pain, headache or any other symptoms. Physical examination showed mild dysarthria and left-sided tongue deviation when the patient poked his tongue out, which was consistent with left hypoglossal nerve palsy (figure 1A). Other cranial nerves were preserved. Carotid murmurs were not heard, and...
Source: Journal of Neurology, Neurosurgery and Psychiatry - May 7, 2013 Category: Neurosurgery Authors: Riancho, J., Infante, J., Mateo, J. I., Berciano, J., Agea, L. Tags: Brain stem / cerebellum, Cranial nerves, Drugs: CNS (not psychiatric), Headache (including migraine), Neuroimaging, Neurological injury, Pain (neurology), Stroke, Trauma CNS / PNS, Hypertension, Ophthalmology, Radiology, Radiology (diagnostics), Trauma, I Source Type: research

Clinical risk predictors for cerebral hyperperfusion syndrome after carotid endarterectomy
Conclusions Independent, prospective monitoring of a large cohort of CEA cases identified a brief time interval between ischaemic symptoms and endarterectomy as the clearest risk factor for CHS.
Source: Journal of Neurology, Neurosurgery and Psychiatry - April 8, 2013 Category: Neurosurgery Authors: Maas, M. B., Kwolek, C. J., Hirsch, J. A., Jaff, M. R., Rordorf, G. A. Tags: Epilepsy and seizures, Headache (including migraine), Pain (neurology), Stroke, Hypertension, Ophthalmology, Ischaemic heart disease, Disability Neurosurgery Source Type: research

Idiopathic hypertrophic cranial pachymeningitis: a rare but treatable cause of headache and facial pain
Introduction Idiopathic Hypertrophic Cranial Pachymeningitis (IHCP) is a rare disease with pain and compression related cranial nerve dysfunction as main clinical features. The leading diagnostic finding of IHCP consists of diffuse or localised thickening of the dura, which demands appropriate imaging and image interpretation. This case description aims at increasing the awareness for the clinical symptoms and imaging findings of this rare disease to allow prompt diagnosis and treatment initiation. Case description An 82-year-old man presented with recurrent left sided headache and worsening facial pain, which had begun mo...
Source: Journal of Neurology, Neurosurgery and Psychiatry - February 15, 2013 Category: Neurosurgery Authors: Khalil, M., Ebner, F., Fazekas, F., Enzinger, C. Tags: Immunology (including allergy), Meningitis, Brain stem / cerebellum, Cranial nerves, Headache (including migraine), Infection (neurology), Multiple sclerosis, Pain (neurology), Stroke, Hypertension, Ophthalmology, Radiology, Surgical diagnostic tests, Ear Source Type: research

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