{"title":"How many cranial CT scans does a man need?","authors":"Josef G Heckmann, Martin Breckner, Michael Reng","doi":"10.1136/pn-2024-004447","DOIUrl":"10.1136/pn-2024-004447","url":null,"abstract":"<p><p>A 61-year-old man had epilepsy related to chronic alcoholism and occipito-temporal porencephaly. Over a span of 19 years, he had been admitted to our institution 227 times, undergoing 55 CT scans of the head and 11 CT scans of the cervical spine. His blood alcohol concentrations varied between 1.9 g/L and 5.1 g/L. We discuss the challenges of emergency management of patients with alcoholism and seizures and the overuse of radiological examinations.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144334091","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}
Valeria Ariza Hutchinson, Aivi T Nguyen, Eelco F M Wijdicks
{"title":"Unexpectedly abnormal MR brain scan in liver disease.","authors":"Valeria Ariza Hutchinson, Aivi T Nguyen, Eelco F M Wijdicks","doi":"10.1136/pn-2025-004666","DOIUrl":"https://doi.org/10.1136/pn-2025-004666","url":null,"abstract":"<p><p>An elderly woman presented with coma secondary to acute-on-chronic liver failure and was found to have severe hyperammonaemia. MR scan of brain showed extensive bilateral and symmetric cortical and thalamic fluid-attenuated inversion recovery hyperintense signals and diffusion restriction. How should clinicians address the prognosis of such cases? Postmortem findings from this case provide new insights in pathophysiology.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327112","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}
Rodrigo Alencar E Silva, Pedro Fraiman, Clécio de Oliveira Godeiro Junior
{"title":"Visual cueing for freezing of gait in Wilson's disease.","authors":"Rodrigo Alencar E Silva, Pedro Fraiman, Clécio de Oliveira Godeiro Junior","doi":"10.1136/pn-2025-004564","DOIUrl":"https://doi.org/10.1136/pn-2025-004564","url":null,"abstract":"","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303144","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}
Robin S Howard, Aravindhan Baheerathan, Rachel Brown, Jennifer Spillane, Manprit Waraich
{"title":"Neurological aspects of electrolyte disorders.","authors":"Robin S Howard, Aravindhan Baheerathan, Rachel Brown, Jennifer Spillane, Manprit Waraich","doi":"10.1136/pn-2023-003801","DOIUrl":"https://doi.org/10.1136/pn-2023-003801","url":null,"abstract":"<p><p>Electrolyte disorders are common in clinical practice and can occur as a consequence of primary neurological disease or as a complication of general medical disorders or critical illness. They may affect fluid shifts, cause disordered transmembrane potential or disrupt neurotransmission. Disorders of sodium, potassium, calcium, phosphate and magnesium metabolism are associated with a range of neurological complications that cause neuromuscular and central neurological disturbance. It is important to distinguish between acute and chronic hyponatraemia because prevention of long-term complications depends on appropriate management. Acute hyponatraemia can rarely cause cerebral oedema, seizures or encephalopathy. Potassium metabolism disorders are associated with cardiac and neuromuscular abnormalities. Calcium derangement can give neurological manifestations that range from mild and non-specific symptoms to encephalopathy. Phosphate and magnesium disturbances are particularly associated with neuromuscular weakness and are important causes of respiratory impairment and failure to wean from ventilatory support in critically ill patients.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303143","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":"When the conductor is right on cue….","authors":"Eileen Gülke, Simon Lewis","doi":"10.1136/pn-2025-004614","DOIUrl":"https://doi.org/10.1136/pn-2025-004614","url":null,"abstract":"","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303145","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":"Hypertrophic olivary degeneration in a patient with lung cancer.","authors":"Kota Igari, Motoki Fujimaki, Shinji Saiki","doi":"10.1136/pn-2025-004636","DOIUrl":"https://doi.org/10.1136/pn-2025-004636","url":null,"abstract":"<p><p>A 78-year-old woman developed a coarse tremor in her left hand that had persisted for 2 months. 3 years before, she had undergone surgery for lung adenocarcinoma, followed by chemotherapy. On examination, there was a postural and action tremor (3-4 Hz) in the left upper limb, identified as a Holmes tremor, with oculopalatal myoclonus. MR scan of the brain showed bilateral hypertrophic olivary degeneration with hyperintensity of the middle cerebellar peduncles. CT scan of the head showed a calcified lesion in the pontine tegmentum, suggesting disruption of the Guillain-Mollaret triangle, which comprises the dentatorubral, rubro-olivary and olivocerebellar pathways. The underlying cause was a pontine metastasis, evidenced by calcification on CT brain scan. This case highlights the importance of considering underlying malignancy in people with hypertrophic olivary degeneration or related symptoms and emphasises the role of CT brain scanning in identifying metastatic calcification when MR scan findings are inconclusive.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286714","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":"Double lumens and flaps (and their mimics) on CT and MR angiography.","authors":"Dimitri Renard","doi":"10.1136/pn-2025-004576","DOIUrl":"https://doi.org/10.1136/pn-2025-004576","url":null,"abstract":"<p><p>CT and MR angiograms (CTA and MRA) often show a double lumen (circulating or non-circulating), double lumen mimics, flaps and flap-like lesions. Interpreting these radiological abnormalities is important since their causes range from benign variants to high-risk disorders. This review illustrates the radiological characteristics of a double lumen or a flap on standard CTA and MRA/MRI and discusses their causes.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286713","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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