Practical neurology
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Acute neurology is the neurological care that a patient receives in an emergency or urgent care situation. This can be adapted successfully to training in a simulation where learners are immersed in realistic scenarios in a safe, controlled and reproducible environment. ⋯ These training sessions require clear learning objectives, and involve designing the scenarios, running the session and ending with a structured debriefing to consolidate learning. The ultimate aim is to improve the team's effectiveness to deliver safe acute neurological care in the emergency department and on the wards.
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Practical neurology · Aug 2018
ReviewZika virus infection in the returning traveller: what every neurologist should know.
Zika virus has been associated with a wide range of neurological complications. Neurologists in areas without current active transmission of the virus may be confronted with Zika-associated neurological disease, as a large number of returning travellers with Zika virus infection have been reported and the virus continues to spread to previously unaffected regions. This review provides an overview of Zika virus-associated neurological disease and aims to support neurologists who may encounter patients returning from endemic areas.
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Practical neurology · Jun 2018
Case ReportsNeurosarcoidosis associated with intracerebral haemorrhage: a challenge in diagnosis and management.
Sarcoidosis is an idiopathic multisystem granulomatous disorder of unknown cause. Nervous system involvement (central and/or peripheral) is uncommon, developing in 5%-10%. The presenting symptoms are variable, reflecting the level of involvement, and frequently fluctuate and progress. ⋯ Serial imaging, cerebrospinal fluid sampling and tissue biopsy gave a diagnosis of probable neurosarcoidosis. Her clinical course was complicated by intracerebral haemorrhage following intravenous corticosteroids for neurological relapse. This is a very rare complication of neurosarcoidosis; we discuss its possible causes and suggest ways to reduce its risk.
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Practical neurology · Feb 2018
ReviewPersistent postural-perceptual dizziness (PPPD): a common, characteristic and treatable cause of chronic dizziness.
Persistent postural-perceptual dizziness (PPPD) is a newly defined diagnostic syndrome that unifies key features of chronic subjective dizziness, phobic postural vertigo and related disorders. It describes a common chronic dysfunction of the vestibular system and brain that produces persistent dizziness, non-spinning vertigo and/or unsteadiness. ⋯ Patients often develop secondary functional gait disorder, anxiety, avoidance behaviour and severe disability. Once recognised, PPPD can be managed with effective communication and tailored treatment strategies, including specialised physical therapy (vestibular rehabilitation), serotonergic medications and cognitive-behavioural therapy.
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Headaches are a common neurological complaint during pregnancy and the postpartum period. Most are primary and benign, but there are also several secondary headaches. This review uses a practical case-based approach to the evaluation and management of the most common headaches referred for neurological consultation: primary headaches such as migraine as well as the presentation and management of some of the secondary headaches complicating pregnancy and the puerperium. These include: idiopathic intracranial hypertension, eclampsia, reversible cerebral vasoconstriction syndrome, cerebral venous thrombosis, pituitary apoplexy and postdural puncture headache.