PRACTICAL NEUROLOGY最新文献

Non-motor symptoms of Parkinson's disease (PD) drive disability, reduce quality of life and increase healthcare resource use. Yet, they are often under-recognised in time-limited clinics. We outline an evidence-informed approach for everyday neurology. We propose brief previsit process followed by in-visit prioritisation of one or two high-impact symptoms and simple education/resources for the rest. Psychosis requires clinicians to address triggers, simplify dopaminergic therapy and use PD-safe antipsychotics when required. Mood and anxiety benefit from optimised dopaminergic regimens, selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors, counselling, exercise and online cognitive-behavioural programmes. Cognitive impairment warrants regular screening and medication review; cholinesterase inhibitors are indicated for dementia. Sleep management includes treating contributing factors, hygiene measures and cautious hypnotic use. Pain and autonomic dysfunction require pragmatic, stepwise strategies tailored to real-world practice. We include special considerations for atypical Parkinsonism and caregiver needs. Integrating these steps into routine visits improves safety, function and patient-carer well-being.

A 20-year-old woman with fulminant idiopathic intracranial hypertension (severe visual loss within 4 weeks of initial symptoms) was successfully managed with cerebral venous sinus stenting. She had presented with severe headache, vomiting and blurring of vision for 2 weeks. On examination, she had severe papilloedema with bilaterally constricted visual fields on perimetry. Because of persistent symptoms despite medical management, she underwent transcutaneous cerebral venous sinus stenting on day 7, with symptom relief 3 days later. On review at 7 months, she had complete resolution of papilloedema and restoration of normal visual fields. Cerebral venous sinus stenting performed early in fulminant idiopathic intracranial hypertension can give complete resolution of visual loss, with a good safety profile.

Aphasic status epilepticus is a rare neurological complication of the hyperosmolar hyperglycaemic state, a severe metabolic emergency in diabetes mellitus. Symptoms include language disturbance without significantly impaired consciousness. The diagnosis is complex, and management of the aphasic status epilepticus involves metabolic correction and antiseizure medications. We describe a 66-year-old man with type 2 diabetes who presented with progressive speech decline and impaired coordination following a fall. EEG confirmed non-convulsive status epilepticus, and MR brain scan showed transient left temporal changes with later hippocampal atrophy. Initial treatment with insulin and levetiracetam led to significant recovery. This case underscores hyperosmolar hyperglycaemic states as a reversible cause of aphasic status epilepticus and highlights the varied neurological presentations of uncontrolled diabetes. We include a review of the literature to contextualise this under-recognised clinical entity.

The interplay between skin and neurological disorders is well recognised, given the shared embryological origin of both skin and nervous system cells from the ectoderm. Certain cutaneous manifestations may guide the neurological workup and contribute to a more accurate diagnosis. We report a 20-year-old man with drug-resistant epilepsy and developmental regression since childhood, who had characteristic skin findings compatible with ichthyosis. Despite the broad differential diagnosis for these neurological manifestations, recognising the skin involvement was important in guiding the genetic investigation, ultimately narrowing the diagnosis to the group of neuro-ichthyotic syndromes.

Symptoms related to bladder, bowel and sexual dysfunction are common in patients with neurological diseases and are associated with significant morbidity and impacts on quality of life. However, compared with other neurological problems, they are often less visible, under-ascertained and under-treated. This review aims to provide neurologists with an evidence-based, structured approach to evaluating bladder, bowel and sexual dysfunction in patients with neurological disorders. As with any other presenting concern, this requires a structured approach to history, examination and the judicious use of investigations.

According to the Global Burden of Disease Project (2021), back pain affects over half a billion people worldwide and is responsible for the most years lived with disability of any condition. Only a small fraction of these will ever see a neurologist, but those that do pose a range of difficulties, from attempting an accurate diagnosis to estimating prognosis and providing advice as to whether any interventions, particularly surgery, are likely to be better than the effect of time alone. There are many guidelines, mainly aimed at primary care practitioners. This article tries to provide succinct evidence-based messages for neurologists (and others in secondary care) to use with patients at different stages of back pain duration-from acute to chronic-to help in navigating some of these difficulties.

A 29-year-old woman developed bilateral facial nerve palsy for which no cause could be identified despite neuroimaging, lumbar puncture, viral serology and blood testing. Neuroinflammatory and dermatology input was sought. The patient later presented with a new manifestation of upper lip swelling, leading to a clinical diagnosis of Melkersson-Rosenthal syndrome. The diagnosis of this neuromucocutaneous disorder is challenging, with the classical triad of signs-facial nerve palsy, orofacial oedema, lingua plicata-often not presenting together. Suspecting the condition in oligosymptomatic presentations could reduce the delay in diagnosis, thereby facilitating earlier consideration for corticosteroid or immunosuppressive treatment and involvement of dermatology as appropriate.