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072 The oblique path of a transverse lesion
A 38-year-old man presented in September 2016 with left hand numbness which progressed over 2 days to disabling weakness of his left arm and leg. He initially presented to a stroke unit, stroke being ruled out by brain MRI. An MRI spine showed an intramedullary lesion extending from C2-C7. He was referred to neurosurgery who queried an astrocytoma and performed a biopsy. Biopsy demonstrated a demyelinat- ing lesion leading to referral to neurology. Following a battery of investigations, visual evoked potentials showed left sided delay and positive serum aquaporin-4 antibodies (AQP4-Abs). A diagnosis of Neuromyelitis Optica...
Source: Journal of Neurology, Neurosurgery and Psychiatry - May 27, 2022 Category: Neurosurgery Authors: Kesserwani, J., Cooper, R., Wickremaratchi, M., Palace, J., Fisniku, L. Tags: Poster Presentations Source Type: research

Case presentation: the dancing man from sierra leone
Discussion Making this diagnosis is challenging, as brain imaging often shows non specific changes and blood results are usually normal. CSF may reveal raised proteins and WBCs. A high index of suspicion is required to arrange a brain biopsy as this confirms the diagnosis.
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: Al-Rifai, M. S., Salek-Haddadi, A. Tags: Immunology (including allergy), Neuroimaging, Stroke, Radiology, Drugs: musculoskeletal and joint diseases, Vascularitis, Surgical diagnostic tests ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

Hickam's dictum versus ockham's razor
A 56-year-old man presented with evolving symptoms of left-sided weakness and fatigue over six months. Examination revealed spastic hemiparesis. MR brain imaging revealed confluent, oedematous white matter lesions in the right hemisphere without restricted diffusion or enhancement. Initial CSF analysis was unremarkable, including negative JC virus. Blood screen revealed a mild lymphopaenia. CT scanning of the viscera showed pulmonary changes which revealed, via transbronchial biopsy, non-caseating granulomata suggesting pulmonary sarcoidosis. High dose prednisolone was commenced following which the weakness improved. Metho...
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: Marchant, R., Bunting, E., Barritt, A., Good, C., Adams, N., Merve, A., Wickremaratchi, M. Tags: Immunology (including allergy), Neuroimaging, Stroke, Radiology, Surgical diagnostic tests, Radiology (diagnostics) ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

Just a graze?
In conclusion, when approaching a patient with head injury and one or more cranial nerve palsies, it is important to consider cephalic tetanus. Figure 1 Axial CT head shows a large subcutaneous haematoma overlying the right frontal convexity with locules of gas and a 3mm metallic density at its inferior aspect, possibly representing a foreign body.
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 9, 2013 Category: Neurosurgery Authors: Doshi, A., Dahdalleh, D., Warrell, C., Kullmann, D. Tags: Immunology (including allergy), Cranial nerves, Drugs: CNS (not psychiatric), Neurological injury, Stroke, Trauma CNS / PNS, Hypertension, Trauma, Injury Association of British Neurologists (ABN) joint meeting with the Royal College of Physicians (RCP), 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