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Tetrodotoxin toxicity: an increasing threat. 河豚毒素中毒：威胁与日俱增。
IF 2.4
PRACTICAL NEUROLOGY Pub Date : 2024-12-14 DOI: 10.1136/pn-2024-004368
Emily Burton, Alastair Ward, Lachlan Tamlin, Shaddy El-Masri, Rudy Goh, Roula Ghaoui, Stephen Bacchi
{"title":"Tetrodotoxin toxicity: an increasing threat.","authors":"Emily Burton, Alastair Ward, Lachlan Tamlin, Shaddy El-Masri, Rudy Goh, Roula Ghaoui, Stephen Bacchi","doi":"10.1136/pn-2024-004368","DOIUrl":"10.1136/pn-2024-004368","url":null,"abstract":"<p><p>A man aged in his sixties presented to the emergency department with vomiting, dizziness and generalised weakness preceded by perioral and peripheral paraesthesias for several hours. He did not speak English and was visiting from overseas. Examination revealed multidirectional nystagmus, subtle bilateral ptosis, marked bilateral upper limb dysmetria and heel-shin ataxia, with mild proximal limb weakness. Brain imaging was unremarkable. Further history revealed the man had gone fishing and eaten a fish he had caught earlier that day. He was subsequently diagnosed with tetrodotoxin toxicity from pufferfish ingestion. He was managed supportively and made a complete recovery. Tetrodotoxicity has been hitherto considered rare outside of Southeast Asia, but rising water temperatures and human interventions have facilitated the migration of marine species containing tetrodotoxin to a wider geographical range.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824660","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}
引用次数: 0
Neurogenic disease with high CK: think muscle. 神经源性疾病与高CK：认为肌肉。
IF 2.4
PRACTICAL NEUROLOGY Pub Date : 2024-12-05 DOI: 10.1136/pn-2024-004401
Andrea Barp, Paola Tonin, Salvatore Stano, Gaetano Nicola Vattemi, Marta Cheli, Giulia Marchetto, Matteo De Iorio, Riccardo Zuccarino
{"title":"Neurogenic disease with high CK: think muscle.","authors":"Andrea Barp, Paola Tonin, Salvatore Stano, Gaetano Nicola Vattemi, Marta Cheli, Giulia Marchetto, Matteo De Iorio, Riccardo Zuccarino","doi":"10.1136/pn-2024-004401","DOIUrl":"10.1136/pn-2024-004401","url":null,"abstract":"<p><p>HyperCKaemia is common in several myopathies but can accompany other disorders, including neuropathies. However, distinguishing neurogenic from myopathic hyperCKaemia is not always straightforward. A 58-year-old man had experienced muscle cramps and fatiguability since aged 3 years, with persistently high serum creatine kinase (CK). A positive family history prompted genetic testing for Charcot-Marie-Tooth disease type 1A, which was positive. However, his serum CK remained persistently high and neurological examination 17 years later identified diffuse muscle atrophy and weakness. Genetic testing for dystrophinopathy identified a novel missense variant on the <i>DMD</i> gene. Patients whose serum CK is in 'myopathic range', even those with definite neurogenic disease, should be investigated for additional myopathy, since this may require additional monitoring for pulmonary and cardiac complications.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787371","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}
引用次数: 0
Sniffed levamisole-adulterated cocaine mimicking acute demyelinating encephalomyelitis. 嗅吸左旋咪唑掺假可卡因模拟急性脱髓鞘性脑脊髓炎。
IF 2.4
PRACTICAL NEUROLOGY Pub Date : 2024-12-04 DOI: 10.1136/pn-2024-004343
Joshua Yap, Kayla Ward, Simon Broadley
{"title":"Sniffed levamisole-adulterated cocaine mimicking acute demyelinating encephalomyelitis.","authors":"Joshua Yap, Kayla Ward, Simon Broadley","doi":"10.1136/pn-2024-004343","DOIUrl":"10.1136/pn-2024-004343","url":null,"abstract":"<p><p>A 38-year-old man developed headache, dysarthria and dysphasia after insufflation of cocaine. Brain imaging showed multiple white matter lesions, suggesting acute disseminated encephalomyelitis (ADEM), but the clinical features were atypical for demyelination. These lesions may represent a levamisole-associated vascular endotheliopathy, with a mechanism similar to posterior reversible encephalopathy syndrome. Levamisole is a no longer used chemotherapeutic agent but is a legally acquirable veterinary antihelminthic and is often used to adulterate cocaine. Given the rise in cocaine-related hospitalisations, this case raises awareness of an important ADEM mimic.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781597","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}
引用次数: 0
Progressive tetraparesis and bulbar symptoms. 进行性四肢麻痹和球症状。
IF 2.4
PRACTICAL NEUROLOGY Pub Date : 2024-12-04 DOI: 10.1136/pn-2024-004394
Carolina Cunha, Henrique Coimbra de Lemos Queirós, Marco Almeida, Daniela Pereira, João Parente Freixo, Patrícia Marques, Fernando Matias, João Durães
{"title":"Progressive tetraparesis and bulbar symptoms.","authors":"Carolina Cunha, Henrique Coimbra de Lemos Queirós, Marco Almeida, Daniela Pereira, João Parente Freixo, Patrícia Marques, Fernando Matias, João Durães","doi":"10.1136/pn-2024-004394","DOIUrl":"10.1136/pn-2024-004394","url":null,"abstract":"","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142781596","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}
引用次数: 0
Neurological Sweet's syndrome: a rare but treatable manifestation of an autoinflammatory disease. 神经系统斯威特综合征：一种罕见但可治疗的自体炎症性疾病。
IF 2.4
PRACTICAL NEUROLOGY Pub Date : 2024-12-03 DOI: 10.1136/pn-2024-004379
Gareth Zigui Lim, Jiekai Tan, Joyce Siong-See Lee, Xin Rong Lim, Tianrong Yeo
{"title":"Neurological Sweet's syndrome: a rare but treatable manifestation of an autoinflammatory disease.","authors":"Gareth Zigui Lim, Jiekai Tan, Joyce Siong-See Lee, Xin Rong Lim, Tianrong Yeo","doi":"10.1136/pn-2024-004379","DOIUrl":"10.1136/pn-2024-004379","url":null,"abstract":"<p><p>Sweet's syndrome is an autoinflammatory disease characterised by systemic symptoms and a cutaneous neutrophilic dermatosis. Neurological involvement is rare but important to recognise. Patients may have headache, confusion, seizures, and focal neurological deficits; MR brain scanning may show widespread T2-hyperintense lesions, with a CSF pleocytosis. Clinicians should suspect neurological Sweet's syndrome in patients with central nervous system dysfunction, who have unexplained fever or systemic inflammation, and a pustular neutrophilic dermatosis. The condition responds well to corticosteroids, which can prevent long-term neurological sequalae.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773227","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}
引用次数: 0
Somatosensory evoked potentials: technique, interpretation and clinical applications. 体感诱发电位：技术、解释及临床应用。
IF 2.4
PRACTICAL NEUROLOGY Pub Date : 2024-12-03 DOI: 10.1136/pn-2024-004179
Aicee Dawn Calma, James Triplett, Steve Vucic, Con Yiannikas
{"title":"Somatosensory evoked potentials: technique, interpretation and clinical applications.","authors":"Aicee Dawn Calma, James Triplett, Steve Vucic, Con Yiannikas","doi":"10.1136/pn-2024-004179","DOIUrl":"10.1136/pn-2024-004179","url":null,"abstract":"<p><p>Somatosensory evoked potentials (SSEPs) are electrical potentials that measure various parts of the ascending somatosensory pathways. They are elicited through stimulating mixed nerves, with subsequent orthodromic stimulation of sensory nerves. Despite advances in imaging, SSEPs complement both the clinical examination and peripheral neurophysiological studies when assessing the functional integrity of the sensory pathways, being especially helpful when imaging is inconclusive. We describe the technique of performing SSEPs and the anatomical substrates of their waveforms, and we highlight important clinical applications both in central and peripheral nervous system disorders.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773229","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}
引用次数: 0
Editors' commentary. 编辑评论。
IF 2.4
PRACTICAL NEUROLOGY Pub Date : 2024-11-17 DOI: 10.1136/pn-2024-004387
Philip Smith, Geraint N Fuller
{"title":"Editors' commentary.","authors":"Philip Smith, Geraint N Fuller","doi":"10.1136/pn-2024-004387","DOIUrl":"10.1136/pn-2024-004387","url":null,"abstract":"","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":"24 6","pages":"445"},"PeriodicalIF":2.4,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669556","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}
引用次数: 0
Islands and bridges in healthcare: the importance of general neurology. 医疗保健中的岛屿和桥梁：普通神经病学的重要性。
IF 2.4
PRACTICAL NEUROLOGY Pub Date : 2024-11-17 DOI: 10.1136/pn-2023-004080
Rui Araújo, Nens van Alfen, Saskia Middeldorp, Bastiaan R Bloem
{"title":"Islands and bridges in healthcare: the importance of general neurology.","authors":"Rui Araújo, Nens van Alfen, Saskia Middeldorp, Bastiaan R Bloem","doi":"10.1136/pn-2023-004080","DOIUrl":"10.1136/pn-2023-004080","url":null,"abstract":"","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"532-534"},"PeriodicalIF":2.4,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094551","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}
引用次数: 0
Neuromuscular junction disorders: mimics and chameleons. 神经肌肉接头疾病：模仿者和变色龙。
IF 2.4
PRACTICAL NEUROLOGY Pub Date : 2024-11-17 DOI: 10.1136/pn-2024-004148
Shadi El-Wahsh, Clare Fraser, Steve Vucic, Stephen Reddel
{"title":"Neuromuscular junction disorders: mimics and chameleons.","authors":"Shadi El-Wahsh, Clare Fraser, Steve Vucic, Stephen Reddel","doi":"10.1136/pn-2024-004148","DOIUrl":"10.1136/pn-2024-004148","url":null,"abstract":"<p><p>Neuromuscular junction (NMJ) disorders represent a heterogenous group of acquired and congenital disorders that present in variable and distinctive ways. The diagnosis is typically reached through a combination of clinical, serological, pharmacological and electrophysiological evaluation. While the diagnosis can be fairly straightforward in some cases, the overlap with other neurological disorders can make diagnosis challenging, particularly in pure ocular presentations and in seronegative patients. The over-reliance on serological tests and electrophysiological evaluation in isolation can lead to misdiagnosis. In this article, we provide an overview of the NMJ disorders, discuss red flags for the key differential diagnoses (mimics) and report the atypical ways in which NMJ disorders may present (chameleons).</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"467-477"},"PeriodicalIF":2.4,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037256","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}
引用次数: 0
ABN news. ABN 新闻。
IF 2.4
PRACTICAL NEUROLOGY Pub Date : 2024-11-17 DOI: 10.1136/pn-2024-004421
Biba Stanton, Maya McCourt
{"title":"ABN news.","authors":"Biba Stanton, Maya McCourt","doi":"10.1136/pn-2024-004421","DOIUrl":"10.1136/pn-2024-004421","url":null,"abstract":"","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":"24 6","pages":"550"},"PeriodicalIF":2.4,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669519","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}
引用次数: 0
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