Seizure vs. Syncope

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In response to a request for an overview of differentiating seizure and syncope, I found the following nice review from Lancet Neurology, 5(2) 171-180.

Seizure versus Syncope

There are many articles available. One place to start a search is to enter (seizures[mesh] syncope[mesh] differential diagnosis[mesh]) into PubMed. You can broaden the search by removing the ddx portion.


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MedlinePlus is one of the best sources for consumer health information on the web.

Created by the National Library of Medicine, it provides short summaries on a wide range of conditions and then links out to high quality information created by non-profits, government groups, and other organizations. They also include links to information in other languages when possible. A Spanish version of the site is also available.

MedlinePlus also includes drug and supplement information, news alerts, and anatomy and surgery videos.


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PatientsLikeMe is a site that lets patients with a wide range of conditions record their symptoms, medications (and adverse effects), and disease progression and talk to other people with the same condition and share information. Membership is free and is also open to physicians, though you have to promise not to survey or recruit patients through the service.

I think this is a fascinating tool and, from the researcher standpoint, one that provides a novel way to gather information on disease progression, symptom prevalence, treatment effectiveness, and drug adverse effects. From a patient standpoint, I think it would be good to talk others, see what has worked for them and what hasn't, and develop a sense of community.

So here is the wrinkle. PatientsLikeMe is very open that they sell their data, it is how they get funded. So before using it or recommending it, I would make sure to read the privacy policy and understand what they do with the data.

Hashimoto Encephalopathy

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There was recently a patient on rounds with suspected Hashimotos encephalopathy, but the team had questions about diagnostic criteria. I pulled a few articles and wanted to share them:

Hashimoto's Encephalopathy 2008 - nice review article which focuses on diagnosis (and specifically relevant auto-antibodies)
Hashimoto's Encephalopathy: Systematic Review of the Literature and an Additional Case 2011 - case report and systematic review which includes summary of symptoms associated with HE
High prevalence of serum autoantibodies against the amino terminal of alpha-enolase in Hashimoto's encephalopathy 2007 - discusses the use alpha-enolase autoantibodies in diagnosing HE. While there there have not been many studies, they appear to have good sensitivity and specificity.

Neurological manifestations of Sjögren's

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There was a question this morning about what the various neurological manifestations of Sjögren's Syndrome are.

Here are a few overviews of neurologic symptoms:
Neurological manifestations of primary Sjogren's syndrome 2010
Involvement of nervous system pathways in primary Sjögren's syndrome 2008 (Dr. Walk is co-author)
Peripheral neuropathies in Sjogren syndrome: a new reappraisal 2011

If you want to search further, here are some searches to get you started:
High specificity search
Lower specificity search

Neurological Exam Videos

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Here are a few videos from AccessMedicine (primarily Harrison's) that cover neuro-ophthalmology and the neurological exam.

Let me know if there are any other sources for exam videos that you like.

Getting full text when browsing

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While the best way to get to full-text of articles is to use our special link to PubMed or find the journal in our ejournal list, it is often easier just to Google the journal. If you are on-campus (ie. PWB) a lot of journal websites will recognize that and automatically give you access to full-text. From off-campus, though, this does not work.

If you have browsed to a journal and want to get to the full-text, try using our proxy bookmarklet. It will not work for all journals (some we buy from non-publisher sources), but it should work for many.

Neurology iPad Apps

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For those of you with iPads, I wanted to point out that you can read both Neurology and Neurology Clinical Practice (new journal from AAN) on your iPad. Just download the following apps and enter in your AAN credentials to get full access.

Neurology Clinical Practice

You can download the full text of each journal (and can read it without an internet connection), easily access supplemental materials, post comments on articles, and even email, tweet, or post to Facebook about the articles.

They hope to add more videos and additional content in the future. All in all, it is pretty slick.

Stiff Person Syndrome

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Stiff person syndrome is a rare (estimated 1-2 cases per million) disorder, "characterized by progressive muscle stiffness, rigidity, and spasm involving the axial muscles, resulting in severely impaired ambulation." ("Stiff person syndrome," UpToDate)

60-80% of patients have autoantibodies against glutamic acid decarboxylase (GAD), though amphiphysin and gephyrin autoantibodies may also be present in the paraneoplastic variant.

A recent and concise review (with images, differential, and treatment) can be found at Stiff Person Syndrome.

Two additional case reports (with MRI and photographs respectively), can be found at:
Sudden spasms following gradual lordosis--the stiff-person syndrome
Stiff person syndrome presenting with sudden onset of shortness of breath and difficulty moving the right arm: a case report

SMART Syndrome

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There was a question last week about SMART Syndrome and potential therapies. While there have not been any experimentally tested treatments, in most of the case reports, patients are treated (if treatment is reported) with anti-epileptics. I have included a few of the more recent studies below, though there are also additional reports (cited in the below documents) from before the syndrome was proposed in 2003.

SMART syndrome: a late reversible complication after radiation therapy for brain tumours
SMART syndrome involves transient, reversible neurological dysfunction which may include migrainous headache, at times preceded by aura, prolonged hemispheric neurological impairment and sometimes seizure activity. Neuroimaging studies of patients with SMART syndrome typically show focal gyral thickening of the affected cortex and gyriform contrast enhancement.

Neurocognitive recovery in SMART syndrome: a case report

SMART: stroke-like migraine attacks after radiation therapy
Proposed diagnostic criteria:
SMART Criteria.jpg

Reversible, strokelike migraine attacks in patients with previous radiation therapy
Original article that first proposed the syndrome