PRACTICAL NEUROLOGY最新文献

Humans interact with aquatic environments through recreational and occupational activities, and through consumption of both fresh and salt water inhabitants. While these activities may be associated with health benefits, there are various accompanying acute and chronic risks to the nervous system through varied pathological mechanisms, including the effects of toxins and infections, and the adverse physiology of diving. This comprehensive review highlights these and their neurological presentations to raise awareness for neurologists who may encounter those affected by them.

A 76-year-old man developed progressive motor weakness, bulbar symptoms and hand muscle atrophy, initially suspected to be due to motor neurone disease. Unexpected findings on cardiological evaluation identified amyloidosis, and genetic testing confirmed the TTR p.Val50Met mutation, indicating late-onset hereditary transthyretin amyloidosis with a mixed neuropathic and cardiac phenotype. The diagnosis was delayed and complicated by minimal sensory symptoms and the atypical presentation.

Pulsatile tinnitus refers to the perception of intermittent, often rhythmical sounds, which are typically throbbing, beating or whooshing in nature, and may or may not be synchronised to the patient's pulse. It may also be classified as either objective, where the clinician can also hear the sound on auscultation, or subjective, where only the patient hears it, often due to heightened awareness of blood flow in the ear. It is important for neurologists to have an understanding of pulsatile tinnitus as, especially when combined with other symptoms and signs, it may suggest a specific neurological or neurovascular diagnosis.

Attacks of bilateral simultaneous acute angle closure glaucoma are rare. A 59-year-old man developed vertigo and vomiting, with nystagmus in primary gaze, left-beating nystagmus in left gaze and a positive head impulse test. He was diagnosed with acute vestibular neuritis and received standard therapy, using four drugs that have anticholinergic effects. He subsequently developed bilaterally red eyes, initially diagnosed as bacterial conjunctivitis, and then blurred vision with ocular pain. An ophthalmological assessment identified mid-dilated, non-reactive pupils with corneal oedema and markedly elevated intraocular pressures, consistent with bilateral acute angle closure glaucoma. This was treated with topical and oral ocular hypotensive therapy, pupillary constriction and corneal indentation. Following peripheral iridotomies with the Yttrium Aluminum Garnet laser, his acute angle closure glaucoma rapidly and totally resolved. The use of multiple medications with anticholinergic effects in people with acute vestibular neuritis, and especially in those with a shallow anterior chamber, may cause acute angle closure glaucoma, requiring urgent ophthalmological assessment.

Subhairline electroencephalography (EEG) is a limited-montage EEG with applications in epilepsy and neurocritical care. It has potential advantages in resource-limited settings and may help in the early diagnosis and management of seizures and status epilepticus while providing real-time electrophysiological monitoring. It has several important technical limitations such as reduced spatial coverage, low sampling rate, inadequate bit depth and review software with limited features. Clinicians must carefully consider these limitations for proper interpretation and so avoid diagnoses based on false positives or false negatives. We present six cases using subhairline EEG and their corresponding 10-20 EEG recordings to help in pattern recognition and to highlight the usefulness and limitations of this technique.

Syphilis is a multisystem infectious disorder with a myriad of neurological complications, although myelitis is rare. A 29-year-old man presented with sudden onset bilateral leg weakness, back pain and urinary retention. He had a flaccid, areflexic paraplegia with a T10 sensory level but preserved joint position and vibration sense. MR scan of the spine showed a longitudinally extensive myelitis with characteristic 'candle guttering' appearance and 'flip-flop' sign. Syphilis serology was positive in the serum and cerebrospinal fluid. There was a dramatic response to corticosteroids and antimicrobial treatment, which was sustained at follow-up. We encourage the consideration of neurosyphilis in the setting of hyperacute cord syndromes.