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PubMed1989

Focal neurological signs in cerebral malaria accounted for by preceding neurological damage.

In 1987 at Port Moresby General Hospital, Papua New Guinea, two out of 103 adults with a final diagnosis of cerebral malaria had focal neurological signs noted on admission. In both cases the focal signs could be explained by documented prior neurological disease with residual focal damage. Focal neurological signs in patients presenting with malaria should prompt careful investigation to exclude other active neurological disease. Where no additional diagnosis is evident a history of past neurological damage may become apparent to explain the focal nature of the malaria presentation.

Adult↗
PubMed1994

Bedside diagnosis for neurological residents in neurological emergencies: a retrospective analysis.

BACKGROUND: Critical assessment of diagnostic accuracy is indispensable to resident training and medical education, especially in regard to our situation of the extremely low rate of autopsy. Recent setup of advanced technology for neurological diagnosis has resulted in a tendency to overuse these tools at the expense of using classic bedside diagnostic approach. Disclosing the common errors of daily practices among neurological residents necessitates implementing this pioneer study. METHODS: The tentative diagnosis of each patient, as performed by neurological residents after finishing bedside diagnostic processes, was assessed by final diagnosis concluded from clinical syndrome and/or the results of laboratory studies. The overall rate of diagnostic error and the frequency of diagnostic inaccuracy in various disease entities were evaluated. The reason for the diagnostic error was determined by reviewing the records regarding the entire diagnostic process. RESULTS: 1336 consecutive patients from January 1990 to December 1990 were recruited for this study. The initial bedside diagnosis was correct in 901 (67%) patients. No definite final diagnosis could be obtained in 169 (13%) patients. The diagnoses were incorrect in 266 (20%) patients. The highest rate of inaccuracy was found in the diagnosis of subdural hematoma (56%). The other common diseases of high rate of diagnostic inaccuracy were myasthenia gravis (50%), subarachnoid hemorrhage (42%), Guillain-Barré syndrome (40%), traumatic disorders (39%), herniation of intervertebral disc (33%), metabolic encephalopathy (30%), infection of central nervous system (30%), intracranial neoplasm (24%), drug overdose or intoxication (22%), and mixed neurological and metabolic encephalopathy (21%). The explored reasons for diagnostic inaccuracy were errors of reasoning (38%), inadequate data base (35%), and inadequate fund of knowledge (27%). CONCLUSIONS: This study confirmed that the basic methods of bedside diagnosis with a standardized sequence of history taking, physical examination and diagnostic reasoning are currently still the most fundamental process of achieving an accurate diagnosis in neurological emergencies. No shortcut or mechanical substitute is available for clinical diagnosis.

Diagnostic Errors↗
PubMed1977

Neurological and motor functioning of 10--12-year-old children who showed mild transient neurological symptoms in the first five days of life.

This study concerns itself with the neurological functioning of 11-year-old children who neonatally presented a variety of shortlived or transient symptoms. These symptoms, while shortlived, are similar in nature to symptoms which other authors have shown to be correlated with later increased rate of neurological deviance. By using the data from a birth cohort of 9,006 consecutive deliveries, we attempted to discover whether such symptoms, when only transiently present in the newborn, are correlated with later neurological functioning. Results indicate that the subjects with transient neonatal symptoms presented more neurological deviance at age 10--12 than did matched controls.

Cerebral Cortex↗
PubMed2004

Prevalence and predictors of unexplained neurological symptoms in an academic neurology outpatient clinic--an observational study.

OBJECTIVES: (a) To determine the prevalence of unexplained symptoms among newly referred patients in a Dutch academic outpatient clinic for general neurology; (b) To identify factors that can serve as characteristics and possibly as screening instruments for unexplained symptoms in this population. METHODS: Observational study, consisting of self-assessment questionnaires. Patients and resident neurologists completed self-designed questionnaires, which included questions about possible features of unexplained symptoms. Patients also completed the Hospital Anxiety and Depression Scale (HADS), evaluating the existence of anxiety and depressive symptoms. Diagnosis of unexplained symptoms was based on the final classification of the patient's symptoms as non-organic, after assessment by a senior neurologist. In the analysis, separate predicting factors and groups of factors were adjusted for age, sex and HADS-score, and analysed as possible characteristics of unexplained symptoms. RESULTS: 35% of the patients (208 total, 174 completed questionnaires) were considered to suffer from unexplained symptoms. Young age (p < 0.001) and female sex (p = 0.007) were significantly associated with unexplained symptoms, high HADS-scores were not (p = 0.10). Characteristics associated with unexplained symptoms were the resident's preliminary impression of symptoms being non-organic, after reading of the referral letter [OR 96.8, 95% confidence interval (95 %-CI) 29.7-315, PPV 82%, NPV 96%] and after the first encounter (OR 305, 95 %-CI 37.3-2494.6, PPV 83%, NPV 98%), but before the actual history taking and neurological examination. The only other non-demographic characteristic of unexplained symptoms was a visit in order to obtain a second opinion (OR 2.43, 95 %-CI 1.15-5.10). Clustering of these factors, however, did not have sufficient predictive power to result in an accurate screening instrument. CONCLUSIONS: Unexplained symptoms are common in the neurology outpatient clinic and are to some extent predicted by the physician's preliminary judgement of symptoms. However, history taking and neurological examination remain indispensable for the detection of less obvious organic disorders.

Adolescent↗
PubMed1995

The Cambridge Neurological Inventory: a clinical instrument for assessment of soft neurological signs in psychiatric patients.

A schedule (the Cambridge Neurological Inventory) has been constructed for standardized neurological assessment of psychiatric patients. Normative data and data resulting from its application to a group of patients with schizophrenia are reported. The instrument is comprehensive, reliable, and easy to administer. In conjunction with other forms of clinical assessment, it may be useful for identifying soft neurological signs and other patterns of neurological impairment relevant to neurobiological localization and prognosis in schizophrenia and other psychiatric disorders.

Adolescent↗
PubMed1995

Neurological examination of the preterm and full-term infant at risk for developmental disabilities using the Dubowitz Neurological Assessment.

The Dubowitz Neurological Assessment of the Preterm and Full-term Infant was used to evaluate infants at risk for developmental disabilities. Criteria for categorising the results of the Dubowitz Neurological Assessment were developed by documenting the findings on a group of relatively low risk infants managed in a NICU. The criteria, expressed as a number of deviant responses on items in the assessment, were used to test the concurrent and predictive validity. The Dubowitz Neurological Assessment was found to correlate with a perinatal risk rating and the findings on brain ultrasonography, indicating concurrent validity. Predictive validity was demonstrated by correlation with neurodevelopmental outcome and neurological status at 1 year corrected age. The sensitivity and specificity of the assessment were also used to develop a management protocol for graduates of the NICU.

Apgar Score↗
PubMed2002

Open Facilities for Training in European Neurology (OFTEN): a European Board of Neurology initiative.

The European Board of Neurology has established Open Facilities for Training in European Neurology (OFTEN) by creating a databank of excellent or good neurological departments from 14 European countries willing to receive trainees from abroad (http://www.uems.be/neuro.htm). Further expansion of this databank with an increased number of participating departments and countries is planned. The databank should make it easier both to find a relevant department for training abroad and to obtain funding from various sources. No financial support is available in the program itself. The ultimate aim of this cross-European training is to improve neurological skill, knowledge and attitude. It will also promote European co-operation and harmonization in quality of care.

Databases, Factual↗
PubMed1985

Construction of an Infant Neurological International Battery (Infanib) for the assessment of neurological integrity in infancy.

In this article, we describe the construction of an instrument for the assessment of the neurological integrity of infants. In a follow-up program for infants from the neonatal intensive care unit, 365 evaluations of 308 infants were made by using a 32-item battery with items from four methods. Factor analyses were used for data analyses, which yielded a 20-item instrument with five factors. We named the instrument the Infant Neurological International Battery (Infanib). The Infanib has sufficient reliability for clinical and research purposes. We have formed scoring sheets, which permit clinical use of the instrument. Cut points are recommended for the separation of infants with normal, transiently abnormal, and abnormal neurologic development. The quantified scoring system enables comparison of infants on item scores, subscores (factor scores), and total scores. It also permits entry of these scores in the computer so that more complex descriptions are possible of the relationship of the neurological assessment of infants both to earlier (eg, birth) and later variables (eg, cerebral palsy, cognitive function, and school performance).

Child Development↗
PubMed2004

Vascular neurology: a new neurologic subspecialty.

This article presents information about the American Board of Psychiatry and Neurology's new subspecialty certificate in vascular neurology, including the requirements for board certification. Practicing neurologists and child neurologists who have a major focus in vascular neurology can apply for the new certificate. In addition, the Accreditation Council for Graduate Medical Education has approved fellowship training in the subspecialty, and it is likely that residents who wish to pursue a career in vascular neurology will select this training option.

Adult↗
PubMed1985

The birth of American neurology and highlights from the first 100 years of the Philadelphia Neurological Society, 1884-1984.

The Philadelphia Neurological Society was founded 100 years ago by Charles K. Mills, together with Wharton Sinkler, J.T. Eskridge, and Francis X. Dercum. S. Weir Mitchell was the first president and served for 5 additional years. American neurology was born in Philadelphia at the Orthopedic Hospital and the Infirmary for Nervous Diseases. The growth in neurology in this country is reflected in the activities of the Philadelphia Neurological Society.

History, 19th Century↗
PubMed1996

Report of the AAN Task Force on access to health care: the effect of no personal health insurance on health care for people with neurologic disorders. Task Force on Access to Health Care of the American Academy of Neurology.

Access to medical care is limited for people with no health insurance. In the United States, an estimated 31 to 41 million people under age 65 have no health insurance. Among the uninsured, an estimated 340,000 new cases of neurologic disorders occur annually. The Task Force on Access to Health Care of the Academy analyzed data from four nationwide health surveys to describe the national population of people with neurologic disorders (PWND) by insurance status and to examine access to care, utilization of services, and expenses for health care of PWND. Health insurance status significantly affected access to and utilization of health care services. Compared with insured PWND, the uninsured less often had a usual source of medical care, saw a particular doctor, or visited a neurologist. The uninsured had fewer doctor's office visits and fewer hospital admissions than privately insured PWND. In the doctor's office they got fewer tests, fewer referrals for therapies, but more medications. In the hospital they received more diagnostic and therapeutic procedures overall, but those with cerebrovascular disease received fewer angiograms and endarterectomies. National health care reform may improve access to care for PWND if they are equitably included in the new systems. However, neurologists should assertively advocate for the needs of PWND to have adequate insurance and appropriate access to neurologic consultations, neurologic tests, and treatments.

Adult↗
PubMed1992

Neurologic evaluation and its relation to acupuncture. Acupuncture for neurologic disorders.

Acupuncture provides companion animal veterinarians a valid therapeutic alternative to medicine and surgery in a variety of neurologic disorders. The veterinarian must arrive at a lesion localization in the nervous system and determine a presumptive diagnosis before instituting acutherapy. Signalment, type of neurologic disorder, efficacy of conventional treatments versus acupuncture, financial constraints, and ethical issues are useful patient selection criteria. In general, animals experiencing pain respond faster and more completely to acupuncture than those demonstrating neurologic deficits consistent with loss of function. Acupuncture offers clients a noninvasive alternative when medications are contraindicated or surgery is not an option. This chapter serves as an introduction to acupuncture for neurologic disorders in pets. It is hoped that the information here will inspire clinical investigations to evaluate more completely patient selection, patient response, and long-term outcome.

Acupuncture Therapy↗
PubMed1991

The construction of a scored neonatal neurological examination for assessment of neurological integrity in full-term neonates.

We describe the construction of a scored form for the neurological examination of the full-term neonate. Extensive data analyses were obtained from a large sample of neonatal neurological examinations performed by one examiner (MSP). Examinations were used from neonates with ages less than or equal to 48 hours (n = 727) and 72 hours to 1 week (n = 510) with gestational ages greater than or equal to 37 weeks. Forty-four items from several neonatal assessments were used in these neurological examinations. Further subdivision yielded a total of 65 items. Correlations were obtained for the 65 items. We factored the matrix of these correlations, using several solutions of factor analysis. Thirty-two items were thus grouped and pruned into seven dimensions (factors) to provide a scorable neonatal neurological examination (Neoneuro) with an internal consistency or reliability of 0.80. From the total scores, cut points are recommended for categories of normality/abnormality: normal, mildly abnormal, moderately abnormal, and severely abnormal. This scoring system is well-based both theoretically and psychometrically. The quantified computer-compatible scoring system permits evaluation of individual neonates, as well as comparison of samples of neonates on item scores, subscores (factor scores), and total scores. Such quantification will permit documentation of the natural history of specific abnormalities and the evaluation of various therapies.

Brain Damage, Chronic↗
PubMed1987

Neurologic symptoms and hysterectomy: a retrospective survey of the prevalence of hysterectomy in neurologic patients.

Eleven percent of the 272 women aged 25-45 years admitted consecutively to a neurologic department in 1980-1984 had undergone hysterectomy. The population was divided into two groups according to the discharge diagnoses. Among women with discharge diagnoses usually associated with no objective neurologic findings, the frequency of hysterectomy was 14%, compared with 5.4% in women discharged with diagnoses indicating organic neurologic disease. Gynecologic and psychiatric admissions were more frequent in the former than in the latter group. Of the 30 hysterectomized women, only six had had malignant or premalignant changes in the uterus, whereas in 22 cases the removed organs had been normal. These results suggest that a somatization disorder might have been the underlying cause for the hysterectomy as well as for the symptoms and complaints leading to referral to the neurologic service. Awareness of this problem is important in order to avoid unjustified surgery.

Adult↗
PubMed1983

[Electronic data processing-compatible documentation in neurology--developmental stage of neurologic findings for a specialty-specific scientific evaluation system and print-out of a computer assisted epicrisis].

A computer compatible neurological examination record has been drawn up for a neurological documentation called "ADOK Neurologie" as part of a scheme for the basic registration of patient-related information from all patients receiving ward treatment at the Medical Academy Dresden and the County Neurological and Psychiatric Hospital Arnsdorf. The examination questionnaire consists of dichotomous questions and permits up to 1,525 separate items of neurological information per patient to be stored and processed. The information permits purposeful scientific analysis and computer print-out of the epicrisis. The article reports on the structure of the questionnaire, the prospects and limits of the method and experience gained during many years of practical use.

Computers↗
PubMed2006

Paraneoplastic neurological syndromes and breast cancer. Regression of paraneoplastic neurological sensorimotor neuropathy in a patient with metastatic breast cancer treated with capecitabine: a case study and mini-review of the literature.

Paraneoplastic neurological syndromes are a rare complication of breast cancer. Nevertheless, they may be clinically relevant leading to neurological impairment. Clinicians should be aware that these neurological disorders could even precede the diagnosis of breast cancer. Here we present the case of a female patient with advanced breast cancer who developed paraneoplastic sensorimotor neuropathy. Treatment with capecitabine lead to clinical amelioration. A review of the literature on the paraneoplastic neurological syndromes in breast cancer is also included.

Adenocarcinoma↗
PubMed1982

Mutations of glucocerebrosidase: discrimination of neurologic and non-neurologic phenotypes of Gaucher disease.

Multiple molecular forms of beta-glucocerebrosidase that permit discrimination between neurologic and non-neurologic phenotypes of Gaucher disease have been identified radioimmunologically in fibroblasts and human brain tissue. In normal human fibroblasts these forms have been shown by NaDodSO4/polyacrylamide gel electrophoresis to have apparent Mr of 63,000 (form A1), 61,000 (form A2), and 56,000 (form B). The Mr 63,000 form may be a precursor of the Mr 56,000 form. Non-neurologic Gaucher disease (type 1) fibroblasts and normal brain tissue are characteristic in that they contain only one major immunoreactive protein, the Mr 56,000 form. In contrast, fibroblast extracts and brain tissue from neurologic Gaucher disease phenotypes contain only the higher molecular weight forms A1 and A2. These data and the low residual activity of the enzyme in all the variants of Gaucher disease suggest that the mutations of beta-glucocerebrosidase are allelic and involve the active site.

Brain↗
PubMed2003

[Analysis of the neurologic demand of immigrant population in a outpatient neurological consultation].

INTRODUCTION: We analyse the demand for neurologic care reasons for consultation and diagnoses of the immigrant population in two extrahospitalary neurological outpatient clinics. PATIENTS AND METHODS: A prospective one-year study of first visits of adult immigrant patients sent to the neurological outpatient clinic. RESULTS: A total of 342 patients were included in the study. They represented 9.4% of total patients in one clinic and 4.1% in another. The average age was 32.9 years old. There was a predominance of women (62.2%). The average stay in our country was two years. Latin America (especially from Ecuador and Colombia), Morocco and East Europe were mainly the origin of the patients. The cause of consultation was headache in a half of the cases and neuromuscular pathology, epilepsy and psychiatric disorders were the next most frequent diagnoses in descending order. The most frequent diagnoses was tension-type headache, and in descending order of frequency: migraine and transformed migraine, epilepsy, carpal tunnel syndrome, idiopathic facial palsy, low back pain and sciatica and syncope. Tension-type headache and transformed migraine were in relation to their situation of immigrants (family, working, adaptive problems). CONCLUSIONS: The neurologic care demands in immigrant population is the same as in spanish one. These are a young people that fundamentally consults by headache (in relation to adaptive problems), neuromuscular disorders, epilepsy and psychiatric disorders. The public health service have to take into account this population to health resources planning.

Adult↗