Maria Francisca Rocha, Hamish D C Bain, Neil Stone, David Meya, Lucia Darie, Ahmed K Toma, Michael P T Lunn, Arpan R Mehta, Charles Coughlan
Cryptococcal meningitis is an important global health problem, resulting from infection with the yeast Cryptococcus, especially Cryptococcus neoformans and Cryptococcus gattii, which cause a spectrum of disease ranging from pulmonary and skin lesions to life-threatening central nervous system involvement. The diagnosis and management of cryptococcal meningitis have substantially changed in recent years. Cryptococcal meningitis often occurs in people living with advanced HIV infection, though in high-income countries with robust HIV detection and treatment programmes, it increasingly occurs in other groups, notably solid-organ transplant recipients, other immunosuppressed patients and even immunocompetent hosts. This review outlines the clinical presentation, management and prognosis of cryptococcal meningitis, including its salient differences in people living with HIV compared with HIV-negative patients. We discuss the importance of managing raised intracranial pressure and highlight the advantages of improved multidisciplinary team working involving neurologists, infectious disease specialists and neurosurgeons.
{"title":"Reframing the clinical phenotype and management of cryptococcal meningitis.","authors":"Maria Francisca Rocha, Hamish D C Bain, Neil Stone, David Meya, Lucia Darie, Ahmed K Toma, Michael P T Lunn, Arpan R Mehta, Charles Coughlan","doi":"10.1136/pn-2024-004133","DOIUrl":"10.1136/pn-2024-004133","url":null,"abstract":"<p><p>Cryptococcal meningitis is an important global health problem, resulting from infection with the yeast <i>Cryptococcus</i>, especially <i>Cryptococcus neoformans</i> and <i>Cryptococcus gattii</i>, which cause a spectrum of disease ranging from pulmonary and skin lesions to life-threatening central nervous system involvement. The diagnosis and management of cryptococcal meningitis have substantially changed in recent years. Cryptococcal meningitis often occurs in people living with advanced HIV infection, though in high-income countries with robust HIV detection and treatment programmes, it increasingly occurs in other groups, notably solid-organ transplant recipients, other immunosuppressed patients and even immunocompetent hosts. This review outlines the clinical presentation, management and prognosis of cryptococcal meningitis, including its salient differences in people living with HIV compared with HIV-negative patients. We discuss the importance of managing raised intracranial pressure and highlight the advantages of improved multidisciplinary team working involving neurologists, infectious disease specialists and neurosurgeons.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"25-39"},"PeriodicalIF":2.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141601951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christopher Hutchcroft, Daniel Whittam, Stephanie Azzopardi, Rachel Todd, Keira Markey, Katy Dodd, Matthew Jones, Anna Richardson, James Lilleker, Fernando Garcia Del Carrizo, Rajiv Mohanraj
{"title":"Time Shelter by <i>Georgi Gospodinov</i>.","authors":"Christopher Hutchcroft, Daniel Whittam, Stephanie Azzopardi, Rachel Todd, Keira Markey, Katy Dodd, Matthew Jones, Anna Richardson, James Lilleker, Fernando Garcia Del Carrizo, Rajiv Mohanraj","doi":"10.1136/pn-2024-004236","DOIUrl":"10.1136/pn-2024-004236","url":null,"abstract":"","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"97"},"PeriodicalIF":2.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Weverton Carlos Da Silva Teixeira, José Pedro Soares Baima, Angelina Maria Martins Lino
While acute and monophasic diabetic neuropathy variants are considered relatively uncommon, diabetes mellitus affects over 6% of the global population, with more than 50% experiencing some form of diabetic neuropathy. Treatment-induced neuropathy of diabetes is an iatrogenic, transient neuropathy characterised by small fibre involvement precipitated by rapid glycaemic control. Diabetic lumbosacral radiculoplexus neuropathy is an asymmetric, predominantly motor neuropathy of the lower limbs, typically starting with localised leg pain. We present a 59-year-old man manifesting features of both conditions following a 12.5% decrease in glycated haemoglobin over 3 months.
{"title":"Combination of acute diabetic neuropathies following intensive glycaemic management.","authors":"Weverton Carlos Da Silva Teixeira, José Pedro Soares Baima, Angelina Maria Martins Lino","doi":"10.1136/pn-2024-004262","DOIUrl":"10.1136/pn-2024-004262","url":null,"abstract":"<p><p>While acute and monophasic diabetic neuropathy variants are considered relatively uncommon, diabetes mellitus affects over 6% of the global population, with more than 50% experiencing some form of diabetic neuropathy. Treatment-induced neuropathy of diabetes is an iatrogenic, transient neuropathy characterised by small fibre involvement precipitated by rapid glycaemic control. Diabetic lumbosacral radiculoplexus neuropathy is an asymmetric, predominantly motor neuropathy of the lower limbs, typically starting with localised leg pain. We present a 59-year-old man manifesting features of both conditions following a 12.5% decrease in glycated haemoglobin over 3 months.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"51-55"},"PeriodicalIF":2.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aida Suárez-González, Nathalie Bier, Hélène Sauvageau, Victoria S Pelak, Samrah Ahmed
Posterior cortical atrophy is an uncommon type of dementia often caused by Alzheimer's disease and characterised by progressive loss of visuospatial and perceptual abilities. Although there is no curative treatment, patients may benefit from a range of symptom-based techniques and strategies to address visuospatial deficits and apraxia, and to reduce disability. Specific techniques based on visual and tactile cues, adapted and assistive equipment, environmental modifications and skill training may help people with posterior cortical atrophy continue to carry on activities that are important to them. We share vignettes from patients treated in our clinics to illustrate the practical delivery and potential impact of these therapies.
{"title":"Cognitive rehabilitation in posterior cortical atrophy.","authors":"Aida Suárez-González, Nathalie Bier, Hélène Sauvageau, Victoria S Pelak, Samrah Ahmed","doi":"10.1136/pn-2024-004259","DOIUrl":"10.1136/pn-2024-004259","url":null,"abstract":"<p><p>Posterior cortical atrophy is an uncommon type of dementia often caused by Alzheimer's disease and characterised by progressive loss of visuospatial and perceptual abilities. Although there is no curative treatment, patients may benefit from a range of symptom-based techniques and strategies to address visuospatial deficits and apraxia, and to reduce disability. Specific techniques based on visual and tactile cues, adapted and assistive equipment, environmental modifications and skill training may help people with posterior cortical atrophy continue to carry on activities that are important to them. We share vignettes from patients treated in our clinics to illustrate the practical delivery and potential impact of these therapies.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"40-44"},"PeriodicalIF":2.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alvaro Urbaneja, David Gimeno, Carlos Velasquez, Ruben Martin, Patricia Lopez Gomez
{"title":"Bulbar oedema complicating surgery for Chiari malformation.","authors":"Alvaro Urbaneja, David Gimeno, Carlos Velasquez, Ruben Martin, Patricia Lopez Gomez","doi":"10.1136/pn-2024-004245","DOIUrl":"10.1136/pn-2024-004245","url":null,"abstract":"","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"78-79"},"PeriodicalIF":2.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gabriela Petersen, Mónica Edith Salmerón-Mercado, Karla Madrigal-Rentería, Alexandra Díaz-Alba, Víctor García-Navarro
A middle-aged man had classical clinical and radiographical features of spontaneous intracranial hypotension, refractory to conservative management. His medical history included antiphospholipid syndrome, autoimmune thrombocytopenia and recurrent thrombotic events. To reduce his risk from epidural blood patching, we stopped his anticoagulation, but he developed thrombosis. Despite therapeutic challenges, we performed a fluoroscopically guided epidural blood patch successfully at multiple levels, with significant symptom and radiological improvement maintained at 9 months. We review the place of epidural blood patching in people with spontaneous intracranial hypotension who either take anticoagulants or have coexisting blood disorders.
{"title":"Epidural blood patching in an anticoagulated patient with intracranial hypotension.","authors":"Gabriela Petersen, Mónica Edith Salmerón-Mercado, Karla Madrigal-Rentería, Alexandra Díaz-Alba, Víctor García-Navarro","doi":"10.1136/pn-2024-004218","DOIUrl":"10.1136/pn-2024-004218","url":null,"abstract":"<p><p>A middle-aged man had classical clinical and radiographical features of spontaneous intracranial hypotension, refractory to conservative management. His medical history included antiphospholipid syndrome, autoimmune thrombocytopenia and recurrent thrombotic events. To reduce his risk from epidural blood patching, we stopped his anticoagulation, but he developed thrombosis. Despite therapeutic challenges, we performed a fluoroscopically guided epidural blood patch successfully at multiple levels, with significant symptom and radiological improvement maintained at 9 months. We review the place of epidural blood patching in people with spontaneous intracranial hypotension who either take anticoagulants or have coexisting blood disorders.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"60-62"},"PeriodicalIF":2.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142141325","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Eduarda Slhsessarenko Fraife Barreto, João Victor Cabral Correia, Marianna P M de Moraes, Nathália Lopes da Silva, José Luiz Pedroso, Orlando G P Barsottini
{"title":"Acute spinal cord compression due to extramedullary haematopoiesis.","authors":"Maria Eduarda Slhsessarenko Fraife Barreto, João Victor Cabral Correia, Marianna P M de Moraes, Nathália Lopes da Silva, José Luiz Pedroso, Orlando G P Barsottini","doi":"10.1136/pn-2024-004270","DOIUrl":"10.1136/pn-2024-004270","url":null,"abstract":"","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"82-83"},"PeriodicalIF":2.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Stroke is not optional for neurologists.","authors":"Matthew C Kiernan, Stephen M Davis","doi":"10.1136/pn-2024-004230","DOIUrl":"10.1136/pn-2024-004230","url":null,"abstract":"","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"2-3"},"PeriodicalIF":2.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141440945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"What is rehabilitation?","authors":"Siobhan M Leary, Valerie L Stevenson","doi":"10.1136/pn-2024-004384","DOIUrl":"10.1136/pn-2024-004384","url":null,"abstract":"","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"4-5"},"PeriodicalIF":2.4,"publicationDate":"2025-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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