{"title":"Tuberculous optochiasmatic arachnoiditis.","authors":"Paba Atapattu, Thashi Chang","doi":"10.1136/pn-2024-004452","DOIUrl":"10.1136/pn-2024-004452","url":null,"abstract":"<p><p>A 24-year-old woman developed multiple cerebral tuberculomas during treatment for central nervous system tuberculosis, requiring a protracted course of antituberculous therapy. Four years later, while on a second course of antituberculous therapy for relapsed disease, she developed deteriorating vision and further cerebral tuberculomas with inflammation; this was attributed to optochiasmatic arachnoiditis. She was treated at different stage with intravenous corticosteroids, second-line antituberculous therapy, infliximab and thalidomide. Her visual deficits initially improved but subsequently deteriorated despite escalating the anti-inflammatory medication. She died following severe sepsis. Optochiasmatic arachnoiditis threatens to cause irreversible complete blindness, but its best treatment is uncertain with no controlled trial data. We discuss the challenges of treating paradoxical reactions to antituberculous therapy and of treating optochiasmatic arachnoiditis.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":"462-465"},"PeriodicalIF":2.3,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732357","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}
Jochum J van 't Hooft, Jessica Jiang, Lucy B Core, Yolande A L Pijnenburg, Ross W Paterson, Jason D Warren
{"title":"Pathological fondness for noises with right temporal lobe atrophy.","authors":"Jochum J van 't Hooft, Jessica Jiang, Lucy B Core, Yolande A L Pijnenburg, Ross W Paterson, Jason D Warren","doi":"10.1136/pn-2025-004714","DOIUrl":"https://doi.org/10.1136/pn-2025-004714","url":null,"abstract":"","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145024332","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}
Sylvain Lescuyer, Sarah Garvin, Olivier Hinschberger, François Sellal
{"title":"A man with weakness and hearing loss.","authors":"Sylvain Lescuyer, Sarah Garvin, Olivier Hinschberger, François Sellal","doi":"10.1136/pn-2025-004809","DOIUrl":"10.1136/pn-2025-004809","url":null,"abstract":"","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972861","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}
David Rowland, Dwij Mehta, Ayman Qureshi, Indran Davagnanam, Ahmed K Toma, Parag Sayal, Manjit Matharu
{"title":"Syrinx in spontaneous intracranial hypotension treated by surgical disconnection of CSF venous fistula.","authors":"David Rowland, Dwij Mehta, Ayman Qureshi, Indran Davagnanam, Ahmed K Toma, Parag Sayal, Manjit Matharu","doi":"10.1136/pn-2025-004683","DOIUrl":"10.1136/pn-2025-004683","url":null,"abstract":"<p><p>A 49-year-old woman developed symptoms of syringomyelia 3 years after having presented with spontaneous intracranial hypotension (SIH). She had previously undergone two unsuccessful non-targeted epidural blood patches. The MR scan showed features of cervicothoracic syringomyelia and ongoing intracranial features of SIH. Following two further ineffective non-targeted epidural blood patches, a cerebrospinal fluid venous fistula was identified on myelography, which was surgically disconnected. At subsequent follow-up, she showed marked and progressive clinical and radiological improvement. This case shows that offering curative treatment for the underlying cause of SIH is an effective-and the preferred-way of managing SIH-associated syrinx.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972964","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}
Gabriel García-Alcántara, Esther Barbero, Ignacio Ruz-Caracuel, Carmen Rodríguez, Cristina Moreno-López, Rodrigo López-Rebolledo, Erik S Stiauren, Rodrigo Álvarez-Velasco
{"title":"Hereditary myopathy with early respiratory failure.","authors":"Gabriel García-Alcántara, Esther Barbero, Ignacio Ruz-Caracuel, Carmen Rodríguez, Cristina Moreno-López, Rodrigo López-Rebolledo, Erik S Stiauren, Rodrigo Álvarez-Velasco","doi":"10.1136/pn-2025-004692","DOIUrl":"https://doi.org/10.1136/pn-2025-004692","url":null,"abstract":"<p><p>Neuromuscular diseases can present with acute respiratory failure with no other symptoms. A 30-year-old woman presented with progressive dyspnoea, culminating in respiratory failure requiring critical care admission for non-invasive ventilation. On examination, she had proximal and distal muscle weakness with bilateral scapular winging. An MR scan of the muscle showed selective fatty replacement in the semitendinosus, tibialis anterior and peroneus longus muscles. Muscle biopsy identified rimmed vacuoles, core-like structures and desmin-positive aggregates. Genetic testing identified a novel heterozygous missense mutation (c.95350G>A, p.Ala31784Thr) in the fibronectin type-III 119 domain of the <i>TTN</i> gene, leading to the diagnosis of hereditary myopathy with early respiratory failure (HMERF). Her muscle weakness has since progressed over 3 years, and she still depends on non-invasive ventilation. Clinicians should consider HMERF in adults presenting with unexplained respiratory failure.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972928","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}
Fernanda Lustosa Cabral Gomez, Paulo Henrique Ferreira Bertolucci
{"title":"Clock drawing test.","authors":"Fernanda Lustosa Cabral Gomez, Paulo Henrique Ferreira Bertolucci","doi":"10.1136/pn-2025-004676","DOIUrl":"https://doi.org/10.1136/pn-2025-004676","url":null,"abstract":"<p><p>The clock drawing test is one of the most common screening instruments for dementia. It is easy and fast to administer and provides a straightforward way to assess a range of cognitive domains. In this article, we divide its interpretation into three main errors, allowing readers to become familiar with its key findings and their meanings.</p>","PeriodicalId":39343,"journal":{"name":"PRACTICAL NEUROLOGY","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875715","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}