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Chronic neuropathic pain severity is determined by lesion level in aquaporin 4-antibody-positive myelitis
Conclusions Persistent, caudally located (ie, thoracic) cord lesions in AQP4-Ab-positive patients associate with high postmyelitis chronic pain scores, irrespective of number of myelitis relapses, lesion length and lesion burden. Although disability correlated with pain in isolation, it became an insignificant predictor of pain when analysed alongside craniocaudal location of lesions.
Source: Journal of Neurology, Neurosurgery and Psychiatry - January 12, 2017 Category: Neurosurgery Authors: Tackley, G., Vecchio, D., Hamid, S., Jurynczyk, M., Kong, Y., Gore, R., Mutch, K., Woodhall, M., Waters, P., Vincent, A., Leite, M. I., Tracey, I., Jacob, A., Palace, J. Tags: Immunology (including allergy), Cranial nerves, Infection (neurology), Multiple sclerosis, Pain (neurology), Spinal cord, Ophthalmology Neuro-inflammation Source Type: research

Cll, a rare but treatable cause of longitudinally extensive myelitis
A 65-year-old lady presented with a 1-year history of progressive sensory and motor symptoms in the the legs, back pain, pruritus and night sweats. Neurological examination of the cranial nerves and upper limbs was unremarkable. Lower limb examination revealed mild bilateral spastic paraparesis. Cervical, axillary and inguinal lymphadenopathy was noted. Bloods showed only a mild lymphopenia. MRI revealed symmetrically diffuse nodular enhancement in the brain and longitudinally extensive transverse myelitis in the cervical and thoracic spine with leptomeningeal enhancement. CSF analysis showed a protein of 1888 mg/L, W...
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: Ahmed, W., Coe, J., Carroll, L., Vundavalli, S., Chevassut, T., Saha, R. Tags: Immunology (including allergy), Cranial nerves, Infection (neurology), Multiple sclerosis, Pain (neurology), Spinal cord, Radiology, Surgical diagnostic tests, Radiology (diagnostics) ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

Primary t-cell cns lymphoma mimicking vasculitis
A 29 year old male presented with headache and no neurological signs. MRI brain strongly suggested an aggressive primary brain tumour in the right frontal lobe but histopathology revealed a pleomorphic lymphoid infiltrate, necrosis and vague granulomata and vasculitis was diagnosed. There was aggressive clinico-radiological progression despite two debunking surgeries, corticosteroids and cyclophosphamide. On review the following were noted: areas of necrosis and focal diffuse lymphoid infiltrate showing perivascular cuffing; the presence of granuloma formation and vascular necrosis was less certain; overwhelming predominan...
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: Raheem, B., Khan, H., Scolding, N., Love, S., Al-Sarraj, S., Bhangoo, R., Devereaux, S., Rooney, N., Sutak, J., Moran, N. Tags: Genetics, Immunology (including allergy), Headache (including migraine), Pain (neurology), Drugs: musculoskeletal and joint diseases, Vascularitis, Surgical oncology ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

Case report: pandysautonomia
We present the case of a 25 year old previously healthy female who became unwell with abdominal pain and vomiting a day after taking part in a half marathon and was found to have a pseudo-obstruction requiring laparotomy. Post surgery she developed a dry mouth and urinary retention and was consistently tachycardic with labile blood pressure. She developed one episode of parotitis which resolved with antibiotics. Family history included relatives with Addison's disease, hypothyroidism and Raynaud's phenomenon. Neurological examination was normal. There were no other findings to suggest systemic autoimmune disease. Vasculiti...
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: Al-Ansari, A., Rickards, C., Thomas, L., Bain, S. Tags: Genetics, Immunology (including allergy), HIV/AIDS, Pain (neurology), Hypertension, Ophthalmology, Connective tissue disease, Musculoskeletal syndromes ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

Ebv meningitis as a presenting feature of gata-2 deficiency
We present the case of a 21-year old woman who presented to a district general hospital with headache and meningeal irritation and bilateral abducence nerve palsy and diagnosed with viral meningitis. Her investigation showed positive EBV serology. She represented with signs and symptoms of raised intracranial pressure and then neutropenic sepsis and was found to have persistent EBV viral load. Investigation revealed a mutation in the GATA2 gene [c. 1091_1096dup p.(Ala364_Asn365dup)] which has not been previously reported. She is awaiting haematopoetic stem cell transplant. To our knowledge there have been no previous repor...
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: AlMasri, O., Housheham, E., McLean, B. Tags: Immunology (including allergy), Meningitis, Headache (including migraine), Hydrocephalus, Infection (neurology), Pain (neurology) ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

Peripheral neuropathy associated with whipple's disease
Whipple's Disease (WD) is a chronic multisystem infectious disease caused by the bacterium Tropheryma Whipplei. Neurological manifestations typically involve cognitive impairment and deranged ocular movement with ophthalmoplegia or oculomasticatory myorhythmia. A fifty-five year old Caucasian presented with visual disturbance, patchy lower limb weakness and dysthesia with intermittent abdominal pain and weight loss progressing over several months. He was diagnosed with bilateral uveitis and an axonal motor sensory peripheral neuropathy confirmed with neurophysiology. Blood tests for common metabolic, inflammatory and infec...
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: Kumar, G., Mohamed, M., Redmond, I., Harikrishnan, S. Tags: Immunology (including allergy), Cranial nerves, Pain (neurology), Ophthalmology, Memory disorders (psychiatry), Radiology, Surgical diagnostic tests ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

Brain biopsy in cryptogenic neurologic disease
Conclusions Few biopsies were undertaken for cryptogenic neurological disease in this time period, amounting to approximately 2 cases per year in our centre. However, management was changed in up to two-thirds of cases with no significant complications. Thus, brain biopsy is both safe and helpful in managing difficult neurological cases.
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: Mujong, D. P., Hassan-Smith, G., Woolmore, J. Tags: Immunology (including allergy), Drugs: CNS (not psychiatric), Headache (including migraine), Pain (neurology), Neuropathology, Radiology, Surgical diagnostic tests ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

Foreign material cerebral emboli following endovascular coiling
A 62-year-old lady presented to hospital with thunderclap headache and was found to have a grade 1 subarachnoid haemorrhage due to ruptured anterior communicating artery (ACoA) aneurysm, treated by endovascular coiling. Two small coincidental left middle cerebral artery (MCA) aneurysms were managed conservatively. Follow-up imaging at 6 months showed only minor ischaemic changes. Routine 2 year follow up magnetic resonance angiography (MRA) showed the coiled aneurysm to be secure with unchanged coincidental MCA aneurysms but multiple new right cerebral hemisphere lesions with extensive perilesional oedema. These lesions sh...
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: Boardman, J., Hilditch, C., Roberts, G., Raffalli-Ebezant, H., Sonwalker, H., Wuppalapati, S., Mathur, S., Emsley, H. Tags: Immunology (including allergy), Epilepsy and seizures, Headache (including migraine), Pain (neurology), Radiology, Radiology (diagnostics) ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

Spinal cord infarction due to neurofibromatosis type 1 associated vasculopathy
We report a 28 yr old woman presented with acute onset lower limb weakness, urinary retention and back pain. She has a history of neurofibromatosis type 1, epilepsy, Henoch Schonlein purpura, IgA nephropathy and hypertension. Examination revealed lower limb paraplegia, lower limb areflexia, patchy loss of pain and temperature to knees and preserved proprioception. MR imaging confirmed a T10 spinal cord infarction. CT angiography confirmed stenotic and aneurysmal changes affecting aorta, renal and infrarenal vessels. Similar changes were seen on CT angiography in 2010, when she was investigated for IgA Nephropathy. The...
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: Lavin, T., Murphy, C., Ealing, J., Herwadkar, A. Tags: Genetics, Immunology (including allergy), Epilepsy and seizures, Pain (neurology), Hypertension, Radiology, Radiology (diagnostics) ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

A perplexing plexopathy
Conclusion Acute hepatitis E infection is often subclinical and only associated with mild transient transaminitis. We suggest screening for hepatitis E infection in patients with acute neurology and concurrent liver enzyme derangement.
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: Madi, H., Gall, C., Flegg, P. Tags: Immunology (including allergy), Neuromuscular disease, Pain (neurology), Peripheral nerve disease ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

Cerebral amyloid angiopathy-related inflammation: a complex case
Discussion Despite criteria for non-invasive diagnosis of CAA-I, using clinical features and radiology (Chung criteria), brain biopsy is still sometimes required to make the diagnosis. Successful treatment can be achieved, particularly with corticosteroids. Our case not only highlights how patients can relapse off of treatment but also that spontaneous remission is possible.
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: Cousins, O., Patel, B., Khan, U. Tags: Immunology (including allergy), Headache (including migraine), Pain (neurology), Memory disorders (psychiatry), Radiology, Surgical diagnostic tests ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

'trimming the diagnosis
We report a 52-year old female who initially presented with episodes of vertigo, headache and diplopia. Vestibular migraine or Meniere's disease was diagnosed. Two-years later she reported sensory symptoms in her upper limbs. Normal investigations led to a functional diagnosis being considered. However she worsened with an acute-onset sensorineural hearing loss and diplopia. Examination revealed evidence of brainstem signs and ataxia. MRI showed an enhancing right dorsal pontine lesion, CSF was normal. She was diagnosed with primary CNS angiitis and managed with steroids and mycophenolate. Improvement was noted but on tape...
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: Ahmed, W., Carroll, L. S., Coe, J. S., Rashid, W., Eva, B. Tags: Immunology (including allergy), Drugs: CNS (not psychiatric), Headache (including migraine), Pain (neurology), Ophthalmology, Vascularitis, Ear, nose and throat/otolaryngology ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

Neuromyelitis optica in hiv: a case report and literature review
We present a case and review the literature. A 49 year old lady of African descent with known HIV diagnosed in 2004 – compliant with her antiretroviral medication, Atripla – was admitted with a 3 week history of thoracic back pain, spreading paraesthesia and weakness involving both legs, and constipation. Examination revealed a spastic paraparesis, a sensory level at T3/4 on the right and reduced vibration sense to the iliac crests bilaterally. MRI spine revealed increased signal within the cord from T3–7 in keeping with a longitudinally extensive transverse myelitis. CSF was acellular with normal protein...
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: Appleton, J. P., Kenton, A. Tags: Neurogastroenterology, Immunology (including allergy), HIV/AIDS, Cranial nerves, Multiple sclerosis, Pain (neurology), Spinal cord, Ophthalmology ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

Real world experience of fingolimod in multiple sclerosis: the london audit
Conclusions Our experience of Fingolimod as a treatment for pwRMS closely resembles the data from the original phase III clinical trials and supports the short-term safety and efficacy of Fingolimod in clinical practice. This collaboration between MS centres provides useful insights into the ‘real world’ experience of benefits and risks of DMTs for pwRMS.
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: Stavrou, M., Smith, D., Shaw, P., Raciborska, D., Silber, E., Brex, P., Giovannoni, G., Schmierer, K., Turner, B. Tags: Immunology (including allergy), Headache (including migraine), Multiple sclerosis, Pain (neurology) ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

Tibialis anterior muscle biopsy - a patient reported outcome study
Conclusions This small patient reported outcome study suggests that percutaneous tibialis anterior muscle biopsy is safe and well tolerated.
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: Lilleker, J., Woodall, A., Roberts, M., Chinoy, H. Tags: Drugs: CNS (not psychiatric), Neuromuscular disease, Pain (neurology), Radiology, Surgical diagnostic tests, Ear, nose and throat/otolaryngology, Trauma, Injury ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

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