Neurologist
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Neuromuscular junction disorders are usually categorized as either presynaptic or postsynaptic. The most frequently encountered disorder of the postsynaptic neuromuscular junction is acquired myasthenia gravis. Lambert-Eaton myasthenic syndrome is a well-known prototype of the presynaptic autoimmune disorders of neuromuscular transmission. These major disorders of neuromuscular transmission are relatively common and distinctly recognized, but co-occurrence of these disorders (overlap myasthenic syndrome) is rare and has so far attracted little attention. ⋯ To our knowledge, this is the first report of overlap myasthenic syndrome in conjunction with abdominal leiomyosarcoma. The immunologic coexistence of acquired myasthenia gravis and Lambert-Eaton myasthenic syndrome in a patient with a malignant smooth-muscle tumor is intriguing and suggests that a common paraneoplastic process targeting 2 different onconeural antigens was the underlying pathogenic mechanism in this patient.
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Incidence, prevalence, and clinical impact of blunt cerebrovascular injury (BCVI) are unknown. There are no standardized recommendations for screening. ⋯ BCVI and BCVI-related strokes are not rare. The time window for the development of ischemic complications is highly variable and may be longer than is currently assumed. Even if clinically silent, a diagnosis of BCVI has medicolegal implications and may influence therapy and prognosis in later life. Because of the association of BCVI and motor vehicle accidents, screening is suggested in these patients, and ultrasound could be a practical tool. Although there is substantial suspicion for BCVI in individual trauma patients suffering from stroke, the diagnosis cannot always been proven.
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To improve our ability to teach psychiatry residents during their required 2 months on neurology rotations, we investigated the perceived needs of psychiatry program training directors. ⋯ In an era of deliberation about neurobehavioral integration and cross-training of neurologists and psychiatrists, neurologists should strive to provide the best possible multidisciplinary education to psychiatry trainees.
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The effect of lumbar puncture needle bevel direction on the incidence of postdural puncture headache (PDPH) is somewhat controversial. We performed a meta-analysis of available trials to determine if bevel direction during lumbar puncture would influence the incidence of PDPH. ⋯ Our meta-analysis indicates that with use of a cutting needle, insertion in a parallel/longitudinal fashion may significantly reduce the incidence of PDPH, although the reasons for this decrease are unclear.
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Cerebral edema is a potentially devastating complication of various acute neurologic disorders. Its successful treatment may save lives and preserve neurologic function. ⋯ The therapy for brain edema remains largely empirical. More research aimed at enhancing our understanding of the pathophysiology of cerebral edema is needed to identify new and more effective forms of treatment.