Neurological Differential Diagnosis Research Articles

Myositis -specific and -associated antibodies in neurological disorders - A retrospective study of 727 patients

ObjectiveMyositis-specific antibodies (MSAs) and myositis-associated antibodies (MAAs) are assessed in clinical neurology, serving as a non-invasive tool for the differential diagnosis of autoimmune myopathies. However, the presence of MSAs and MAAs in neurological disorders remains uncertain. MethodsRetrospective analysis was conducted on 878 serum samples from the neurological laboratory of the University Hospital Tübingen, Germany. The EUROLINE Myositis Profil 3 (IgG) Line Blot was used for antibody evaluation (anti-Mi2, -Ku, -PM-Scl100, -PM-Scl75, -Jo1, -SRP, -PL7, -PL12, -EJ, -OJ, and -Ro52). Samples were categorized into 19 disease groups, with consideration for myositis-linked and non-myositis-linked diseases. Then, the distribution of positive findings and the concurrent presence of more than one MAA/MSA were analyzed. ResultsAmong 727 included line blots, 84 could be assigned to myositis-linked diseases (thereof 44 positive for MAA/MSA). MAA and MSA taken together were more frequently positive for the main group of myositis-linked disease (52.4 %) compared to the non-myositis-linked group (14.6 %, overall specificity 85.4 %). However, individual antibodies were specific, ranging above 97.5 %. False positive antibody results can also occur in neurological differential diagnoses such as muscle dystrophy or cramp fasciculation syndrome. Furthermore, the concurrent presence of more than one MAA/MSA does not show a significant association with the presence of a myositis-linked disease for antibody-positive samples (p = 0.136). DiscussionTesting MSA and MAA simultaneously may not be suitable as a primary screening method for myositis-linked diseases in clinical neurological groups. However, MSAs and MAAs may offer valuable diagnostic support, particularly in cases where myositis is strongly considered.

Retropharyngeal calcific tendinitis-An underestimated cause of acute neck pain

Retropharyngeal calcific tendinitis is an aseptic inflammation of the longus cervicis muscle. This rare acute pain disorder of the neck region is aprognostically benign condition compared to neurological or otorhinolaryngological differential diagnoses. To capture the clinical appearance, diagnostics, treatment and course of this rare disease. In this retrospective monocentric observational study, demographic, clinical, paraclinical as well as treatment and follow-up data of all inpatients with adiagnosis of retropharyngeal calcific tendinitis admitted to the Diako Hospital Mannheim in the years 2018 to 2021 were analyzed. This study included four female and one male patient with an age between 36 years and 77years. Severe neck pain with restriction of cervical spine rotation was the leading clinical appearance, in four out of five patients there was apainful swallowing disorder. Inflammatory markers were elevated in four patients. Characteristic MRI or CT imaging alterations of the cervical spine confirmed the diagnosis. The symptoms resolved within 4-14days after treatment with nonsteroidal anti-inflammatory drugs (NSAID) and four patients additionally received glucocorticoids. No recurrences were observed during the follow-up period of 5-30months. The good prognosis of this rare disease is reflected by the rapid remission of symptoms under NSAIDs and glucocorticoids and by the absence of recurrences during follow-up. CT or MRI imaging is required to rule out differential diagnoses, and to confirm the characteristic imaging alterations of retropharyngeal calcific tendinitis. Additionally, cerebrospinal fluid puncture and otorhinolaryngological assessment may be necessary in some cases.

The Neurology Rotation: Evaluation of the Medical Student Experience (P3-2.003)

<h3>Objective:</h3> To identify areas of perceived weakness by medical students during their Neurology rotation. <h3>Background:</h3> Neurology rotations can range between 2–4 weeks at academic institutions, leading educators to cover a large swath of content over a relatively short amount of time. Efficient education optimizes the time spent with each learner. To better facilitate the educational needs of students at our institution, we sought to identify areas that could be strengthened. <h3>Design/Methods:</h3> An anonymous survey was completed by students after the completion of their Neurology rotation. In the survey a Likert scale was used to assess their knowledge base at the end of the rotation. Areas rated included the following: understanding basic neuroanatomy, performing a focused and reliable neurological exam, generating a neurological differential diagnosis, recognizing neurological emergencies, localizing lesions along the neuroaxis, interpreting neuroimaging, managing and treating common neurological conditions, understanding common neuropharmacology, recognizing and managing acute stroke syndromes, identifying appropriate indications for neurological consultation, and knowledge of landmark medical literature. <h3>Results:</h3> A total of 23 participants completed the survey. Of the 23, 19 were MS3 and 4 were MS4 (sub-I) students. When looking at combined “good” and “excellent” Likert scale ratings, students are most prepared with performing a neurological exam (23/23), recognizing and managing acute stroke syndromes (21/23), and recognizing neurological emergencies (19/23). Areas with the most combined “fair” and “poor” ratings included knowledge of landmark medical literature (13/23) and interpreting neuroimaging (12/23). <h3>Conclusions:</h3> With the above data, our institution will be able to place more attention on neuroimaging and landmark study review during future Neurology rotations. As a QI project, Neurology residents are creating a student handbook that will address the above-mentioned subject areas. This pre-intervention survey data will help us better appreciate the educational value this handbook will provide for trainees. <b>Disclosure:</b> Dr. Moceri has nothing to disclose. Dr. Shaji has nothing to disclose. Dr. Mendez has nothing to disclose. Dr. Mufti has nothing to disclose. Dr. Craven has nothing to disclose. Ms. Mayeda has nothing to disclose. Dr. Hanrahan has received personal compensation for serving as an employee of Nowyouknow Neuro.

K-21 Neurological Differential Diagnosis in sheep: The relevance of the neurological examination

K-21 Neurological Differential Diagnosis in sheep: The relevance of the neurological examination

Neurological manifestations of Kawasaki disease and multisystem inflammatory syndrome in children associated with COVID-19: A comparison of two different clinical entities.

Kawasaki disease (KD) is one of the most frequent idiopathic vasculitis in children, affecting medium- and small-sized vessels. Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 has recently emerged as a new systemic hyperinflammatory condition affecting children some weeks after an acute COVID-19 infection. KD and MIS-C share different aspects and differ in many others: patients affected by MIS-C are usually older, with prominent gastrointestinal manifestations, diffuse adenopathy, extensive conjunctivitis, myocardial damage, leukopenia, and thrombocytopenia at the laboratory exams. Both conditions can present neurological complications. The aim of this manuscript is to provide a narrative review of neurological involvement in KD and MIS-C. A comprehensive review literature has been performed, and the main clinical features have been analyzed, contributing to neurological differential diagnosis.

Neurology in the psychiatric patient: how to think about differentials in altered mental status and diagnoses not to miss

SUMMARYA wide variety of neurological conditions may present first to a psychiatrist and it is important to be aware of these in differential diagnosis. A careful history, examination and a broad differential diagnosis can help set up an appropriate management plan – with room to change if things change in unexpected ways. In this article we explore common ground shared by psychiatry and neurology and show how incorporation of neurological knowledge can improve the practice of psychiatry. Using four fictional case vignettes of altered mental status we explore important neurological differential diagnoses which could present to the Psychiatrist.

Integrating Advanced Practice Providers in an Academic Department of Neurology.

Integrating advanced practice providers (APPs) into neurologic practice can improve access, promote patient education, and reduce health care costs. APPs receive limited formal education in neurology, so on-the-job training is essential. We set out to identify common challenges and best practices for onboarding, training, and integrating APPs into neurologic practice. We conducted a survey and focus group with 8 APPs currently practicing within an academic neurology department as part of a clinical quality improvement initiative. We explored their roles in multidisciplinary teams, challenges faced during onboarding and training, and strategies for success. Qualitative thematic analysis was performed. Neurology APPs serve diverse roles including caring for hospitalized and ambulatory patients, performing procedures, assisting trainees, and performing research. Participants reported limited formal neurologic education before their job and a need for educational sessions and resources tailored to APPs. Neuroanatomy, neuroimaging, and generating a neurologic differential diagnosis were key knowledge gaps identified. We identified 7 informal strategies for on-the-job training, 7 challenges to on-the-job training, and factors promoting or threatening job satisfaction. Graded responsibility and clinical mentorship were essential for successful onboarding. APPs desired peer-to-peer mentorship and structured educational opportunities. Common challenges and success strategies identified can inform the design of a formal curriculum for onboarding neurology APPs. Our findings suggest that an optimal APP training process involves graded responsibility and support for self-directed learning, employs peer mentors, and targets education of the multidisciplinary team including physicians and patients. Our results may inform other institutions recruiting, hiring, and training APPs.

Importance of Selected Acute Flaccid Paralysis Diagnoses in an Emergency Department Setting for the Pediatric Population

A review for the bedside practitioner of practical clinical exam, subtle differences, and diagnostic criteria for some of the difficult to distinguish acute flaccid paralysis diagnoses in the pediatric patient and to summarize the current findings of the evolving and elusive diagnosis termed acute flaccid myelitis. Since the first public epidemiological reports in 2014 using the newly coined diagnosis of acute flaccid myelitis (AFM), emergency department clinicians and other frontline medical professionals have become primarily responsible for identifying patients who may become subsequently critically ill. New research has identified a causal relationship between a specific enterovirus strain and AFM subsequently adding to the required neurologic differential diagnosis for the bedside clinician. Despite the seemingly intimidating diagnostic challenges of distinguishing various ailments under the umbrella of acute flaccid paralysis, the more potentially devastating but not as obvious diagnoses of Guillain-Barre syndrome and acute transverse myelitis should be considered with any reports in the pediatric patient of limb or sensory disorder, especially in the absence of other systemic or traumatic explanations. Likewise, acute flaccid myelitis is a diagnosis that the bedside emergency department clinician should be both aware of and pursue along with other entities in the differential diagnosis.

38.1 Identification of Various Abnormal Movements by Proper Neurological Examination and Differential Diagnosis

38.1 Identification of Various Abnormal Movements by Proper Neurological Examination and Differential Diagnosis

Painless motor radiculopathy of the cervical spine: clinical and radiological characteristics and long-term outcomes after operative decompression.

OBJECTIVE Various neurological diseases are known to cause progressive painless paresis of the upper limbs. In this study the authors describe the previously unspecified syndrome of compression-induced painless cervical radiculopathy with predominant motor deficit and muscular atrophy, and highlight the clinical and radiological characteristics and outcomes after surgery for this rare syndrome, along with its neurological differential diagnoses. METHODS Medical records of 788 patients undergoing surgical decompression due to degenerative cervical spine diseases between 2005 and 2014 were assessed. Among those patients, 31 (3.9%, male to female ratio 4.8 to 1, mean age 60 years) presented with painless compressive cervical motor radiculopathy due to neuroforaminal stenosis without signs of myelopathy; long-term evaluation was available in 23 patients with 49 symptomatic foraminal stenoses. Clinical, imaging, and operative findings as well as the long-term course of paresis and quality of life were analyzed. RESULTS Presenting symptoms (mean duration 13.3 months) included a defining progressive flaccid radicular paresis (median grade 3/5) without any history of radiating pain (100%) and a concomitant muscular atrophy (78%); 83% of the patients were smokers and 17% patients had diabetes. Imaging revealed a predominantly anterior nerve root compression at the neuroforaminal entrance in 98% of stenoses. Thirty stenoses (11 patients) were initially decompressed via an anterior surgical approach and 19 stenoses (12 patients) via a posterior surgical approach. Overall reoperation rate due to new or recurrent stenoses was 22%, with time to reoperation shorter in smokers (p = 0.033). Independently of the surgical procedure chosen, long-term follow-up (mean 3.9 years) revealed a stable or improved paresis in 87% of the patients (median grade 4/5) and an excellent general performance and quality of life. CONCLUSIONS Painless cervical motor radiculopathy predominantly occurs due to focal compression of the anterior nerve root at the neuroforaminal entrance. Surgical decompression is effective in stabilizing or improving motor function with a resulting favorable long-term outcome.

P273 Contribution to neurology from military medical service during the Russo-Turkish war (1877–1878) and Russo-Japanese war (1904–1905) by V.M. Bekhterev, his colleagues, and students

V.M. Bekhterev (1857–1927) developed research in anatomy and physiology of the nervous system, improved methodology on neurological examination and differential diagnosis in clinical psychiatry, elaborated techniques of neurological rehabilitation and is acknowledged as one of the founders of the system of military psychiatry. The neurological and psychiatrical observations were first conducted during the Russo-Turkish war in 1877–1878. As a student of the Saint-Petersburg Medical Military Academy, V.M. Bekhterev joined a voluntary medical group, which localized in different battle places in Bulgaria, including Zimnica, Tyrnow and Plevna. During spring and summer of 1877 V.M.Bekhterev corresponded his observations to the “Northern Bulletin”, a literature, scientific and political progressive journal. During Russo-Japanese war (1904–1905), one of Bekhterev‘s students S.D. Vladychko headed the psychiatry department in Port-Artur, which later was evacuated by sea to Odessa. On the ground of this experience S.D. Vladychko defended one of the first dissertations in the field of military psychiatry under supervision by V.M. Bekhterev. The difficulties in detachment of psychiatrical and neurological diagnoses, the organizational problems and the rehabilitation were a field of research of the students of V.M. Bekhterev during the I World War, mentioning V.P. Osipov, S.A. Preobrazshensky, N.M. Dobrotvorsky. These achievements were acknowledged and applied by the USA in the II World War, in Korea and Vietnam, and by Israel in Middle East conflict. The report is elaborated with help of the Archives of the Saint-Petersburg Psychoneurological scientific and research institution by the name of V.M. Bekhterev and the State Archive of Saint-Petersburg.

Clinical Features and Management of Some Muscular Disorders in Children - A Brief Review

Study has proven that electrical activity of resting and contracting skeletal muscles and conduction of the nerve impulse have become one of the most useful diagnostic tools in neurology. EMG and nerve conduction studies have become indispensable in the diagnosis and management of peripheral nerve and muscle disease (neurological differential diagnosis).

Acute Polyneuropathy in Children with Acute Lymphocytic Leukemia: Case Report and Systemic Review of the Literature

Acute polyneuropathy in children with acute lymphoblastic leukemia is extremely rare, but its onset and association with Guillain-Barre syndrome presents a diagnostic challenge. We report a 5-year-old boy who presented with inability to walk during induction chemotherapy for acute lymphoblastic leukemia. Subsequently he developed painful penile erections, difficulty urinating and swallowing. Besides adding a rare case to the literature and based on a systemic review of the literature, we provide and discuss the neurologic profile and differential diagnosis of the acute polyneuropathy in childhood leukemia. Early recognition of acute polyneuropathy in children with acute lymphocytic leukemia will facilitate a judicious use of immunotherapy for Guillain-Barre syndrome and prevent a high morbidly and mortality. KEyWoRDS: Acute lymphoblastic leukemia; Acute polyneuropathy; Vincristine neurotoxicity; Guillain-Barre syndrome; Magnetic Resonance Image.

National survey of UK medical students on the perception of neurology.

BackgroundMedical students perceive neurology to be a difficult subject, a phenomenon described as “neurophobia”. Studies investigating student attitudes towards neurology have so far been limited by small sample sizes as a consequence of being conducted within a single medical school or region. We aimed to conduct the first national survey of the perception of neurology among UK medical students.MethodsA 24 question online survey was designed and distributed in the form of a web-link to all UK medical schools. Responses were collected for 10 weeks with reminders sent at 3 and 6 weeks. A prize-draw of £300 was offered upon completion of the survey.Results2877 medical students from 25 of 31 medical schools responded. Students found neurology to be significantly more difficult than other specialties and were least comfortable drawing up a neurological differential diagnosis compared to other specialties (p < 0.0001 for neurology vs. each of the other specialties). Neuroanatomy was regarded as the most important factor contributing to neurology being perceived as difficult.ConclusionsThe findings of the first national survey addressing this issue are consistent with previous research. The perception of neurology remains unchanged, in contrast to the rapidly changing demands of neurological care in an ageing population. Neurological examination and formulating a differential diagnosis are important skills in any medical specialty, and combatting “neurophobia” in medical students is therefore essential.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6920-14-225) contains supplementary material, which is available to authorized users.

SURVEY OF UK MEDICAL STUDENTS ON THE PERCEPTION OF NEUROLOGY

Objective Medical students perceive neurology as a difficult subject, a phenomenon described as “neurophobia”. Studies investigating student attitudes towards neurology have been limited by small sample sizes within individual medical schools. We aimed to conduct the first national survey of the perception of neurology among medical students. Methods A 24 question online survey was designed and distributed in the form of a web-link to all UK medical schools. Responses were collected for 10 weeks with reminders sent at 3 and 6 weeks. A £300 prize-draw was offered upon completion of the survey. Results 2877 medical students from 25/31 medical schools responded. Students found neurology to be significantly more difficult than other specialties (both before and after a clinical neurology placement) and were least comfortable drawing up a neurological differential diagnosis compared to other specialties (p Conclusions The perception of neurology remains unchanged, in contrast to the rapidly changing demands of neurological care in an ageing population. Neurological skills are necessary in any medical specialty, thus combatting “neurophobia” in medical students is essential.

Review of Brain On Fire: My Month of Madness by Susannah Cahalan

[Author Affiliation]Deborah M. Weisbrot. 1 Child & Adolescent Psychiatry Outpatient Clinic, Stony Brook University Medical Center, Stony Brook, New York.Alan B. Ettinger. 2 Albert Einstein College of Medicine, Bronx, New York, and Epilepsy Center, Neurological Surgery P. C. , Lake Success, New York.IBSN: 987-1-4516-2137-2. 2012. New York: Simon and Schuster. 263 pagesAddress correspondence to: Deborah M. Weisbrot, MD, Associate Professor of Psychiatry, Director, Child & Adolescent Psychiatry Outpatient Clinic, Stony Brook University Medical Center, Stony Brook, New York 11894-8790, E-mail: deborah.weisbrot@stonybrook.eduWhat is the value for doctors to read about the experience of illness? Certainly there is an abundance of books written by individuals who have suffered from assorted medical problems. If physicians conclude that the value is simply to remind them to be more sensitive or compassionate, they will miss the point of the extraordinary learning opportunities afforded by reading Brain on Fire.Brain on Fire will undoubtedly create healthy anxiety in medical readers who will have to ask themselves the crucial question, What would I have done if I had been in charge of this case? Brain on Fire will be both humbling and frightening for the neurologist or psychiatrist reader. Clinicians will ask themselves how many of their own patients could have had an unrecognized neurological syndrome of the type incurred by Cahalan. Even we, the authors of a soon-to-be-released text on neurologic differential diagnosis, scrambled to ensure that this particular diagnosis was adequately represented. Yet, hoping to figure out the enigmatic diagnosis misses the more important lesson. We would argue that the best physicians are not necessarily the most savvy or knowledgeable; rather, they are the ones with humility who asks themselves the vital questions, What else could this be? and, Should I get help?The initial symptoms experienced by author, Susannah Cahalan, were both neurological and Cahalan's experience early on with a psychiatrist who did not apparently inquire further about neurological symptoms might lead neurologists to feel justified in failing to bring in psychiatrists early in the evaluation of patients with altered mental status, out of concern that symptoms would be dismissed as merely psychiatric. This conclusion would be unfortunate since the broader concern is the frequent failure of neurologists and psychiatrists to communicate with each other. A better model of collaboration is demonstrated subsequently when the new psychiatrist appropriately states that bipolar disorder was a possibility, but only after neurological causes are excluded.It was disturbing to read the description of the original outpatient neurologist who dismissed Cahalan's symptoms as a result of drinking and partying. While this attribution was particularly egregious because it was completely unfounded, the reader's demonizing of the neurologist will also block consideration of a broader issue that affects all of us. How often do clinicians latch on to diagnoses that seem easy to package and most probable, rather than taking each and every case and wonder, What else could it be? How often do we discipline ourselves to ask Have we reasonably excluded other possibilities? How many of us take the time to examine the broad differential diagnosis for each case we encounter before moving on to the next patient in a busy work day?Furthermore, Brain on Fire poses a dilemma for all physicians who want to do well for their patients but find themselves practicing in a health care system that limits the amount of time which can be reasonably spent with each patient. Indeed, the emergency room physician evaluating Cahalan for a new-onset seizure followed typical clinical practice in discharging Cahalan after performing routine testing. Yet, taking more time to elicit a detailed history would have revealed her extraordinary change in mental status and that would likely have led to her admission and further investigations. …

Syncope from the viewpoint of a neurologist

Syncope is a pathogenetically diverse syndrome that often requires an interdisciplinary investigation. In addition to cardiovascular reasons of syncope neurological diseases and differential diagnoses have to be considered. In particular, neurodegenerative disorders, such as Parkinson's disease or polyneuropathy may cause orthostatic intolerance and syncope due to a malfunction of autonomic reflexes. Furthermore, important differential diagnoses of syncope, such as epilepsy, drop attacks or circulatory disorders in the territory of the basilar artery are attributed to the neurological field.

VLADIMIR MIKHAILOVITCH BEKHTEREV — THE FOUNDER OF THE CLINICAL NEUROPSYCHIATRY

The article presents main milestones in the career of Vladimir Mikhailovitch Bekhterev. The research in anatomy and physiology of the brain performed by V.M. Bekhterev gave original data of worldwide priority. V.M. Bekhterev significantly improved methodology of neurological examination and differential diagnosis in clinical neuropsychiatry. The scientific heritage of V.M. Bekhterev proves his outstanding role in establishment and development of the neuropsychiatry.

Neurological manifestations of chronic graft-versus-host disease after allogeneic haematopoietic stem cell transplantation: report from the Consensus Conference on Clinical Practice in chronic graft-versus-host disease

A major obstacle of allogeneic haematopoietic stem cell transplantation is graft-versus-host disease, an immune-mediated disorder that affects multiple tissues and organs with varying severity. Neurological complications of acute and chronic graft-versus-host disease are rare but can produce severe clinical problems with significant morbidity and mortality. In this article, we review neurological manifestations of chronic graft-versus-host disease that comprise immune-mediated neuropathies, myasthenia gravis and myositis in the peripheral nervous system and various cerebrovascular complications, demyelination and immune-mediated encephalitis in the central nervous system. The National Institutes of Health consensus on criteria for clinical trials in chronic graft-versus-host disease recommended that the diagnosis of chronic graft-versus-host disease of the nervous system can be made only when other organs are affected by graft-versus-host disease and frequent neurological differential diagnoses such as drug-induced toxicities or opportunistic infections are excluded. The Consensus Conference on Clinical Practice in chronic graft-versus-host disease, held in autumn 2009 in Regensburg, aimed to summarize the literature and to provide guidelines for the diagnostic approach in children and adults with neurological manifestations of chronic graft-versus-host disease. Moreover, we present therapeutic recommendations and their level of evidence for the management of these complications. Overlapping symptoms and comorbidities after allogeneic haematopoietic stem cell transplantation and the limited knowledge about the underlying biological mechanisms of chronic graft-versus-host disease affecting the nervous system emphasize the need for further experimental and clinical investigations.

Lipidspeichermyopathien

Lipid storage myopathies are a clinically and genetically heterogeneous group of muscle diseases characterized by an accumulation of lipid in skeletal muscle. Currently four different groups of lipid storage myopathies are described: primary carnitine deficiency (PCD), multiple acyl-CoA dehydrogenase deficiency, primary and secondary coenzyme Q10 deficiency and neutral lipid storage diseases. It might be due to their rareness and considerable clinical variability that these disorders are frequently disregarded in neurological differential diagnosis. This article provides a synopsis of several new aspects of pathophysiology, symptoms, diagnostic tools and current therapeutic approaches of lipid storage myopathies.