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Practical Neurology
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#1James Beharry (Christchurch Hospital)
#2Roderick Duncan (Christchurch Hospital)H-Index: 28
Last.Teddy Y. Wu (Christchurch Hospital)H-Index: 10
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Endovascular thrombectomy is an effective intervention for symptomatic intracranial large-vessel occlusion. This treatment has proven benefit up to 24 hours following onset in selected patients with prestroke functional independence. Limited case reports suggest that thrombectomy beyond 24 hours may also be effective. We describe a young woman managed with endovascular thrombectomy beyond 24 hours.
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In the modern era of stroke care, the clock is always ticking. We are all aware of the need to act ‘FAST’ to maximise the chance of a patient having a good outcome. ‘Time is brain’ is the mantra for delivery of thrombolysis and time to puncture is a nationally audited marker for thrombectomy care. However, for a variety of reasons, there can be delays in a patient reaching an interventional stroke centre. Some are outside of our control, for example, patients with an unknown onset time of their ...
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#1Charis Wong (Edin.: University of Edinburgh)
#2Adrian J. WillsH-Index: 8
Last.Richard DavenportH-Index: 15
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A 74-year-old woman developed bilateral leg weakness, with fluctuating cognitive and systemic symptoms that progressed despite treatment. Her diagnosis was confirmed at autopsy. Her case was discussed at the Edinburgh Clinical Neurology Course 2019 Clinicopathological Conference.
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A 39-year-old woman presented with vertigo and difficulty controlling her right side. She had a right-sided Horner’s syndrome, gaze-evoked horizontal nystagmus with the fast-beating phase to the left, and right upper and lower limb ataxia with reduced temperature sensation to the left side of her face, arm and leg. MR scan of brain showed a right lateral medullary infarct secondary to a dissection of the right vertebral artery (figure 1). A week after her stroke, she noticed increased sweating o...
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#1Soon Tjin Lim (Royal Free London NHS Foundation Trust)
#2Timothy Yates (Royal Free London NHS Foundation Trust)
Last.Heather Angus-LeppanH-Index: 8
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A 76-year-old man developed recurrent encephalopathy, visual disturbance, myoclonus, generalised seizures and atonic drop attacks on a background of a gastrectomy for adenocarcinoma and stable chronic lymphocytic leukaemia. He presented to three different hospitals and was admitted twice, with normal investigations. His symptoms transiently improved during each admission (and with starting levetiracetam) but recurred each time on hospital discharge. Subsequent careful inspection of his medicatio...
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#1Mark R. BakerH-Index: 17
#2Tim Williams (RVI: Royal Victoria Infirmary)H-Index: 17
There is a vocal section of the regular audience attending the neurology grand rounds at the Royal Victoria Infirmary, Newcastle upon Tyne, who proudly occupy what might be termed ‘Pedants’ Corner’. Of late, these consultants, for that is what they are, have become increasingly concerned by the widespread misuse of the word ‘fasciculations’ for what Charcot referred to as ‘fibrillar twitches of muscles’ in his original description of the disease he named sclerose laterale amyotrophique . Fascicu...
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#1Jane Alty (Centre College)
#2Maree Farrow (Centre College)
Last.Katherine Lawler (Centre College)
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Ageing, genetic, medical and lifestyle factors contribute to the risk of Alzheimer’s disease and other dementias. Around a third of dementia cases are attributable to modifiable risk factors such as physical inactivity, smoking and hypertension. With the rising prevalence and lack of neuroprotective drugs, there is renewed focus on dementia prevention strategies across the lifespan. Neurologists encounter many people with risk factors for dementia and are frequently asked whether lifestyle chang...
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#2Fiona Moreton (Western General Hospital)H-Index: 1
Last.Peter FoleyH-Index: 7
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A 75-year-old woman, who was recovering from a recent episode of urosepsis, presented with 3 days of recurrent focal motor seizures affecting the right arm. She was aware and orientated throughout each episode but experienced confusion and weakness afterwards. On examination, she had mild pyramidal weakness of the right arm. CT scan of head showed no acute abnormality. She was started on levetiracetam. Her history included type 2 diabetes mellitus, posterior circulation stroke, and known asympto...
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#1Laura Pérez-Carbonell (Guy's and St Thomas' NHS Foundation Trust)H-Index: 1
#2Howard Faulkner (Southmead Hospital)H-Index: 1
Last.Guy D. Leschziner (Guy's and St Thomas' NHS Foundation Trust)H-Index: 17
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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 o...
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A middle-aged man presented with new-onset vertigo and truncal imbalance. MR scan of brain showed an incidental giant partially thrombosed anterior communicating artery aneurysm with concentric blood products of varying age (figure 1). Subsequent catheter angiography showed the ‘water-hammer’ effect (video 1). Figure 1 MR scan of brain with intravenous gadolinium, showing an enhancing partially thrombosed anterior communicating artery aneurysm with concentric blood products of varying …
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