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Atypical clinical presentations are common in TIA and minor stroke patients with DWI-MRI confirmed ischaemia
Conclusions Over one-third with DWI-confirmed TIA/minor stroke present atypically. The value of atypical symptoms in excluding ischaemia, particularly in patients with vascular risk factors, appears limited.
Source: Journal of Neurology, Neurosurgery and Psychiatry - August 12, 2022 Category: Neurosurgery Authors: Gallogly, P., Best, J., Werring, D., Hassan, J., Lee, C., Cousins, J., Jäger, R., Chandratheva, A. Tags: Parallel Session 3: Acute/Vascular/Trauma Wed 18 May, 1445 - 1600 2 Source Type: research

Miller fisher syndrome presenting with prodromal thunderclap headache
Conclusions Although not radiographically confirmed, we postulate the headache may have been due to reversible cerebral vasoconstriction syndrome (RCVS), given the characteristics of the headache and dramatic response to nimodipine. Although headache is infrequently observed in Miller Fisher syndrome, the exact aetiology is unclear and there has been no previously reported association with RCVS.
Source: Journal of Neurology, Neurosurgery and Psychiatry - May 8, 2017 Category: Neurosurgery Authors: Waters, M. J., Kiley, M. Tags: Abstracts Source Type: research

Acute hemifield room tilt illusion in cerebral ischaemia
We present 2 cases in the setting of acute vertebrobasilar territory ischaemia. Case 1: A 56-year old man was admitted with acute dyspnoea and new atrial fibrillation. On day two while lying in bed, he developed vomiting and suddenly perceived the curtain to his left was lying horizontal along the floor and felt he was sliding towards the left. MRI brain revealed acute multiterritory infarction (Figure 1). He was commenced on therapeutic anticoagulation and was well on follow-up. Case 2: A 47-year old man awoke with acute vertigo, vomiting and ataxia, exacerbated by head movement with dysarthria and diplopia. The worl...
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: Kinsella, J., Lonergan, R., Killeen, R., McGuigan, C. Tags: Drugs: CNS (not psychiatric), Stroke, Ophthalmology, Ear, nose and throat/otolaryngology ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

Immunocompetent pml--an immunological scotoma?
We describe two cases of progressive multifocal leucoencephalopathy (PML) presenting as stroke in the immunocompetent. A 73-year-old man with a background of treated prostate carcinoma presented in October 2013 with a right hemiplegia; a diagnosis of lacunar infarction was made following CT. However, he progressed with increasing pyramidal weakness, ataxia, dysphasia and dysarthria. MRI in December revealed confluent T2 and FLAIR hyperintense white matter change with normal DWI. Extensive infective, vasculitic and malignancy screen were unremarkable; PCR in serum and CSF demonstrated JC virus DNA. Unfortunately the patient...
Source: Journal of Neurology, Neurosurgery and Psychiatry - September 9, 2014 Category: Neurosurgery Authors: Cooper, R., Doshi, A., Harris, P., Sivagnanasundaram, J., Wells, G., Barritt, A., Aram, J., Giovannoni, G., Gnanapavan, S., Dobson, R. Tags: Abstracts Source Type: research

Cortical susceptibility-weighted imaging hypointensity after stroke-like episode in MELAS
A 49-year-old woman with a known m.3243A>G tRNALeu(UUR) mutation (ie, the most frequent mutation in mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS)) diagnosed in the presence of migraine, diabetes mellitus, neurosensory hearing loss, short stature, cognitive deficit, ataxia and elevated lactate levels, presented with subacute aphasia and right hemiplegia. Brain MRI showed a typical stroke-like lesion in the left temporal and parietal lobe and prerolandic cortex. At this time, gradient-echo T2-weighted imaging showed hyperintensities in the involved regions (also visible on T2-weighted and ...
Source: Journal of Neurology, Neurosurgery and Psychiatry - August 6, 2014 Category: Neurosurgery Authors: Renard, D., Taieb, G. Tags: Immunology (including allergy), Headache (including migraine), Neuroimaging Neurological pictures Source Type: research

Pharyngeal-cervical-brachial variant of Guillain-Barre syndrome
The pharyngeal-cervical-brachial (PCB) variant of Guillain–Barré syndrome is defined by rapidly progressive oropharyngeal and cervicobrachial weakness associated with areflexia in the upper limbs. Serial nerve conduction studies suggest that PCB represents a localised subtype of Guillain–Barré syndrome characterised by axonal rather than demyelinating neuropathy. Many neurologists are unfamiliar with PCB, which is often misdiagnosed as brainstem stroke, myasthenia gravis or botulism. The presence of additional ophthalmoplegia and ataxia indicates overlap with Fisher syndrome. Half of patients with...
Source: Journal of Neurology, Neurosurgery and Psychiatry - February 6, 2014 Category: Neurosurgery Authors: Wakerley, B. R., Yuki, N. Tags: Editor's choice, Immunology (including allergy), Cranial nerves, Drugs: CNS (not psychiatric), Neuromuscular disease, Stroke, Ophthalmology 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

Anti glutamic acid decarboxylase antibody mediated encephalopathy while on etanercept in a patient with multiple autoimmune diseases
A 39 year old lady presented with an altered mental state and unsteadiness of gait. She had a history of juvenile idiopathic arthritis, autoimmune thyroiditis and alopecia, protein S deficiency with vena cava thrombosis, previous excision of ovarian mass and vasculitic rash. There was a previous history of ovarian mass and her immunomodulatory therapy for arthritis over the previous year was Etanercept. She used recreational cannabis but denied any other illicit drug usage. Her affect was variable and at times inappropriate with frequent laughter. She would spit regularly. There was anxiety and a prevailing sensation of do...
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: MacDougall, N., Waddell, B., O'Riordan, J. I. Tags: Immunology (including allergy), Brain stem / cerebellum, Drugs: CNS (not psychiatric), Epilepsy and seizures, Infection (neurology), Stroke, Drugs misuse (including addiction), Connective tissue disease, Musculoskeletal syndromes Association of British Source Type: research

Think outside the box, collapse the box, and take a sharp knife to it!
A 74 year–old woman presented in December 2011 with left sided cerebellar symptoms. She was initially diagnosed as having a posterior circulation infarction and discharged from hospital on appropriate medication. However, over the following month she continued to deteriorate, developing increasing unsteadiness, falls, nausea and vomiting. Following a second admission in January 2012 she had a single seizure and developed focal left sided myoclonus affecting mainly the upper limb. Over the following month the myoclonus spread to affect all four limbs, although it remained more prominent on the left side. There was evi...
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: Dobson, R., McMillan, A., Kung, K., Thom, M., Davis, A., Simister, R., Giovannoni, G., Gnanapavan, S. Tags: Immunology (including allergy), HIV/AIDS, Tropical medicine (infectious diseases), Brain stem / cerebellum, Epilepsy and seizures, Infection (neurology), Multiple sclerosis, Stroke, Ophthalmology, Radiology, Surgical diagnostic tests Association of Brit Source Type: research

Electrolyte imbalance triggering relapse of inflammatory neuropathy
We describe a case of a 71 year old female with a fourteen year history of chronic inflammatory demyelinating polyneuropathy (CIDP) and stable monoclonal gammopathy, normally maintained on three–weekly intravenous immunoglobulin (IVIG) therapy. At her best baseline, she has a normal motor examination and reduced vibration sense only to the ankles. She presented with a four week history of progressive numbness and paresthesiae in all four limbs, reduced balance, a decline in mobility with frequent falls and reduced hand function. The deterioration developed after a week of non–bloody diarrhoea with night sweats ...
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: Keshavan, A., Gandhi, S., Lunn, M., Reilly, M. Tags: Neurogastroenterology, Immunology (including allergy), Drugs: CNS (not psychiatric), Multiple sclerosis, Neuromuscular disease, Peripheral nerve disease, Stroke, Hypertension Association of British Neurologists (ABN) joint meeting with the Royal College Source Type: research