What's new in neuromyelitis optica? A short review for the clinical neurologist.

The evolution of neuromyelitis optica spectrum disorder (NMOSD) from a rare, incurable and misunderstood disease with almost universally poor outcomes to its present state in just over a decade is unprecedented in neurology and possibly in medicine. Our knowledge of NMOSD biology has led to the recognition of wider phenotypes, new disease mechanisms, and thus clinical trials of new and effective treatments. This article aims to update readers on the recent developments in NMOSD with particular emphasis on clinical advances, the 2015 diagnostic criteria, biomarkers, imaging, and therapeutic interventions.

Migrating intrathecal high-velocity projectile.

Bullet injuries to the spine can cause significant damage to surrounding tissues and cause serious neurological sequelae. These cases are often associated with neurological deficits. We present a case of a gunshot injury to the spine with a migrating intrathecal bullet which subsequently developed neurological deficits.

Applications of the ultrasonic bone cutter in spinal surgery--our preliminary experience.

Objective: To present our experience with the Misonix Ultrasonic Bone scalpel in spinal surgery, highlighting its potential applications and advantages.

Methods: Between March and December 2011, a total of 937 spinal cases were performed at a single centre. The Misonix Bone Scalpel (MBS) was used in 62 of these cases.

Neurology and literature 2.

Introduction: Good literary fiction has the potential to move us, extend our sense of life, transform our prospective views and help us in the face of adversity. A neurological disorder is likely to be the most challenging experience a human being may have to confront in a lifetime. As such, literary recreations of illnesses have a doubly powerful effect.

Electromagnetic stereotactic ventriculoperitoneal csf shunting for idiopathic intracranial hypertension: a successful step forward?

Objective: The optimal management of medically refractory idiopathic intracranial hypertension (IIH) remains a point of debate. The senior author's practice evolved after a review of our units' practice in placing lumboperitoneal shunts revealed an unacceptably high rate of complication and revision. We now preferentially perform custom-designed electromagnetic (EM) image-guided ventriculoperitoneal shunt placement instead of lumboperitoneal shunting in treating medically refractory IIH and present our outcome data with this technique.

[Neurology and literature].

Introduction: Literature complements medical literature in the academic and clinical development of neurologists. The present article explores the contributions of writers of fiction on neurology.

Sources: Literary works of fiction with particular reference to neurology.

Effect of delayed lumbar punctures on the diagnosis of acute bacterial meningitis in adults.

Introduction: Bacterial meningitis is a medical emergency, the outcome of which is improved by prompt antibiotic treatment. For patients with suspected meningitis and no features of severe disease, the British Infection Society recommends immediate lumbar puncture (LP) before antibiotics, to maximise the chance of a positive cerebrospinal (CSF) culture. In such patients, CT scanning before LP is not needed.

The effectiveness of preconception counseling to reduce adverse pregnancy outcome in women with epilepsy: what's the evidence?

Objective: The purpose of this Cochrane review was to determine the effectiveness of delivering preconception counseling interventions to women with epilepsy (WWE) as a means of reducing adverse pregnancy outcomes, increasing knowledge, and increasing intentions to plan pregnancy.

Methods: Two hundred twenty-five citations were retrieved from a systematic search of the Cochrane Library and electronic databases: Medline (OVID), Scopus, CINAHL, PsychINFO, and ASSIA, and hand searches of relevant epilepsy and obstetric journals.

Results: The search strategy identified 11 studies for consideration for inclusion.

Recurrent myositis triggered by infections: a case report.

Introduction: Recurrent myositis triggered by infections is unusual, with only one other case reporting two attacks described in the literature.

Case Presentation: We report the case of a 24-year-old Caucasian woman with recurrent myositis triggered by sore throat, respiratory and urinary tract infections, over the past 18 years, up to four times a year. Myositis of this frequency and duration, apparently triggered by infections, has not been reported previously.

Clinical studies with targeted toxins in malignant glioma.

Targeted toxins represent a new class of agents with high specificity for tumor cells. Toxins in current clinical use for the treatment of brain tumors are mostly recombinant polypeptides consisting of a tumor-selective ligand coupled to a peptide toxin of bacterial origin. Targeted toxins are highly potent - one single molecule of toxin is enough to cause cell death.

Primary Nocardia farcinica brain abscess with secondary meningitis and ventriculitis in an immunocompetent patient, successfully treated with moxifloxacin.

We report a rare case of Nocardia farcinica occipital brain abscess in an immunocompetent patient with no underlying risk factors successfully treated with the antibiotic moxifloxacin. The patient underwent craniotomy and abscess drainage. Initial post-operative treatment with co-trimoxazole produced a limited response.

Nontraumatic spinal epidural hematoma associated with clopidogrel.

A 73-year-old female treated with clopidogrel for vascular disease presented with sudden onset of back pain, urinary retention and paraplegia. MRI scans demonstrated a thoracolumbar epidural hematoma and the patient underwent emergency laminectomy for evacuation of the hematoma. A possible causal link between clopidogrel and occurrence of the hemorrhage is discussed and the literature on spontaneous spinal hematomas is reviewed.

Expression of survivin, platelet-derived growth factor A (PDGF-A) and PDGF receptor alpha in primary central nervous system lymphoma.

Purpose: Primary central nervous system lymphomas (PCNSL) are rare tumours occurring in the brain. Their biology and the factors predicting survival are not well known. This study investigated expression of the antiapoptotic protein survivin and platelet-derived growth factor A (PDGF-A) and receptor (PDGFRalpha) in PCNSL.

Meningeal melanocytoma.

Background: Meningeal melanocytoma was first described over 30 years ago as a benign tumour derived from melanocytes. Since then, data suggest that its mode of presentation is variable without a clear predilection for any particular site in the neuroaxis. Although classified as a benign tumour, this tumour shows a marked tendency towards reduced survival following subtotal resection and transformation over time in a limited number to malignant melanoma.

Anatomical hemispherectomy for intractable seizures: excellent seizure control, low morbidity and no superficial cerebral haemosiderosis.

Objective: This current study was performed to evaluate whether superficial cerebral haemosiderosis (SCH) is still a complication of modern day anatomical hemispherectomy.

Methods: We report a 13-year institutional experience with anatomical hemispherectomy for intractable epilepsy. Seizure control at a mean follow-up interval of 7 years was 83%.

Technology evaluation: TransMID, KS Biomedix/Nycomed/Sosei/PharmaEngine.

KS Biomedix (formerly Avicenna Medica; now a subsidiary of the Xenova group) and Nycomed, together with Japanese licensee Sosei and Chinese licensee PharmaEngine, are developing TransMID, a transferrin-mediated diphtheria toxin delivery system for the potential treatment of adult, recurrent, inoperable, high-grade glioma (as TransMID-107R). It is also under investigation for other forms of brain cancer, including early brain cancer (as TransMID-107N), metastatic brain cancer (as TransMID-107M) and pediatric brain cancer (as TransMID-107P). TransMID is currently undergoing phase III clinical trials.

Self-inflicted penetrating head injury in a patient with manic-depressive disorder.

A 32-year-old Caucasian male with a history of repeated self-injury drilled a hole in his skull using a power tool and subsequently introduced intracerebrally a binding wire from a sketch pad. An emergency craniotomy was performed around the site of cranial injury, and the foreign body was carefully extracted. The wire was located partially in the subdural space and partially in the right hemisphere of the brain.

Technology evaluation: cintredekin besudotox, NeoPharm/Nippon.

NeoPharm Inc, under license from the National Institutes of Health and the FDA, and in collaboration with the Japanese licensee Nippon Kayaku Co Ltd, is developing cintredekin besudotox, a chimeric human IL-13 conjugated to a genetically engineered Pseudomonas exotoxin molecule, as a potential antitumor agent. This agent is currently undergoing phase III clinical trials.

Vanishing contrast enhancement in malignant glioma after corticosteroid treatment.

Malignant gliomas of the brain typically exhibit on CT or MRI a strong peripheral contrast enhancement area with a variable central zone of necrosis. These tumours are not known to change their radiological appearance and contrast enhancement pattern under systemic steroid treatment--a feature usually associated with primary CNS lymphoma. We report two cases of adult patients with glioblastoma multiforme and atypical hemispherical contrast enhancement initially demonstrated on MRI or CT, which disappeared after dexamethasone administration.

Patient-controlled Analgesia in Intrathecal Therapy for Chronic Pain: Safety and Effective Operation of the Model 8831 Personal Therapy Manager with a Pre-implanted SynchroMed Infusion System.

The Model 8831 Personal Therapy Manager (PTM) offers a patient-controlled analgesia (PCA) option for the SynchroMed Infusion System (Medtronic Inc., Minneapolis, MN). The safety and effective operation of the PTM activator was evaluated in 45 patients in five European centers receiving intrathecal drug infusion for the treatment of chronic pain via a SynchroMed pump.

Quality of life issues in motor neurone disease: the development and validation of a coping strategies questionnaire, the MND Coping Scale.

A person's ability to cope with having motor neurone disease may be an important factor in determining their quality of life. We have developed a scale to measure coping strategies in people with MND. A disease-specific and patient-focused approach was employed.

Problems with phenytoin administration in neurology/neurosurgery ITU patients receiving enteral feeding.

Our objective was to investigate the relationship between phenytoin bioavailability, enteral feeding and serum albumin levels in patients admitted to neurology/neurosurgery ITU, via case studies of three patients. The research was performed at the Walton centre for Neurology and Neurosurgery NHS Trust, Liverpool, England, and our subjects consisted of three cases admitted to ITU (1 status epilepticus, 1 post-trauma and 1 post-subarachnoid haemorrhage (SAH)). Phenytoin levels were assessed in relation to the type of feeding and serum albumin levels.

Mechanisms of central pain.

Central pain is common in patients with stroke, multiple sclerosis, syringomyelia, and spinal cord injury. It frequently develops after a delay of weeks or months, is associated with sensory change involving the spinothalamic pathways, and has a poor prognosis for spontaneous remission. Hypotheses to explain the varied clinical manifestations can be divided in two categories: those stressing aberrant neural activity in the deafferented circuits and those focusing on the postlesion imbalance between facilitatory and inhibitory neural pathways.

Pain in spasmodic torticollis.

Spasmodic torticollis (cervical dystonia) is frequently a painful condition but little is known of the characteristics of the pain. We assessed 39 patients with spasmodic torticollis for the presence or absence, location, and quality of pain, as well as its correlation to postural abnormality. Muscle tenderness was evaluated by manual palpation and pressure algometry.