On February 24, 2022, Russia launched a full-scale invasion of Ukraine that dominated headlines around the world. Millions of Ukrainians would flee the country, and a third of the population would be ...displaced. In the days following the invasion, Swedish migration expert Gregg Bucken-Knapp sent text messages to his Ukrainian colleagues, offering support and assistance. These were their responses. In a series of graphic vignettes, Messages from Ukraine takes the words of Ukrainian migration professionals and transforms them into snapshots of how war affects the lives of everyday people: those who are forced to flee home and seek safety elsewhere, those who choose to stay and volunteer or fight, those who witness events unfolding from afar, and those who find themselves trapped in cities under siege. Messages from Ukraine captures a moment in time to tell a timeless story about war, displacement, determination, and resilience. Proceeds from the sale of Messages from Ukraine will go to the Canada-Ukraine Foundation, a national charitable foundation that provides humanitarian aid to the people of Ukraine.
5 years ago we embarked on a series of novel developments to improve our DGH neurology services. The key was ever closer integrated working between consultant neurologists and specialist nurses with ...support from our Trust and commissioners.We highlight 6 very diverse ongoing projects:1. Acute neurology ward referrals have increased by 49% between 2016-2021 with nurses triaging referrals prior to consultant review.2. Post discharge nurse telephone review for selected patients since 2020 to try and reduce readmission rates.3. Consultant delivered helpline for all local GPs Monday to Friday since 2020 to discuss urgent cases of concern.4. Nurse delivered lumbar puncture service, since 2019 138 procedures carried out.5. Diagnostic coding for all neurology outpatients started in 2021. Within 8 months all 5 consultants were coding over 70% of attendances.6. Patient initiated follow up (PIFU) – 2020 NHS England initiative. Specialist nurse Helpline for patients with epilepsy, multiple sclerosis and Parkinson’s running successfully since 2018.Service improvements need not be expensive or onerous but require imagination and team cohesion. We strongly recommend others to try what seems most appropriate to their service.
BackgroundDepression may be a potentially modifiable risk factor for dementia, but it is not clear whether this is due to a causal effect, or whether depressive symptoms are an early prodromal ...feature of Alzheimer’s disease.ObjectivesTo investigate whether depressive symptoms are associated with an increased risk of dementia. To establish associations between depressive symptoms and structural neuroanatomy.MethodsA total of 491,603 adults from the UK Biobank study were included. Depression and dementia diagnoses were determined using linked medical records and self-report; depression symptomatology was based on questionnaire data. Brain MRI image-derived phenotypes in 42,471 participants were used to measure regional brain volumes.ResultsThe risk for incident all-cause dementia was increased in participants with depressive symptoms or a recorded depression diagnosis (all OR>2, p<0.01). After excluding those with incident dementia, depressive symptoms were associated with volume reduction in a fronto-insular-cerebellar network.ConclusionDepression is associated with an increased risk of incident dementia. The neuroanatomical correlates of depressive symptoms do not relate to the default mode network degeneration found in prodromal Alzheimer’s disease, suggesting that increased dementia risk in depression may be due to poor brain health and diminished neural reserve more broadly.
078 Bruns syndrome – broadening the phenotype Seddigh, Arshia; Mollan, Susan; Samarasekera, Shanika ...
Journal of neurology, neurosurgery and psychiatry,
09/2022, Volume:
93, Issue:
9
Journal Article
Peer reviewed
We present a 50-year-old lady with 6-months’ history of episodes of feeling weak with legs giving way triggered by sudden change of position or head-turning and no loss of consciousness. She had left ...tinnitus for years and one year worsening migraines with fortification spectra, visual blurring, and vertigo. ENT made a diagnosis of vestibular migraines.Her neurological examination was normal and attempted provocation of attacks with sudden changes in position and Dix-Hallpike was unsuccessful. Brain MRI revealed a large lesion obstructing foramina of Luschka-Magendie giving rise to obstructive hydrocephalus.Neuro-ophthalmology review showed bilateral papilledema and no evidence of Parinaud’s syndrome (no convergence retraction nystagmus or tectal pupils). Tumour biomarkers (bHCG-AFP-AlkPh-LDH) and body CT scan were normal. She underwent urgent CSF diversion. MDTs confirmed radiological diagnosis of epidermoid cyst awaiting debulking.Episodic headaches/vertigo with head-turning are described in Bruns syndrome manifesting as abrupt headaches, vertigo, vomiting provoked by changes in head position due to intermittent obstructive hydrocephalous (mass lesion and ball-valve mechanism). We propose patient’s acute episodes of lower limb weakness were similar phenomenon highlighting importance of imaging in stereotypical attacks after triggers.
IntroductionThe Neurological Alliance Patient Experience Survey 2019/2020 has highlighted the delay to access of neurological care, infrequent monitoring by specialists and a wide regional variation ...in referral to support services for chronic disease management in patients with neurological diagnosis.AimTo design a patient-held wellbeing app to support longitudinal symptom monitoring and provide signposting of support services for patients.MethodsThe project is led by the South London Neurosciences network, co-designed with its patient advisory group, King’s Health Partners and a medical technology firm (BMI Inc). Together, we identified key attributes which were beneficial to symptom monitoring. The app went through four cycles of devel- opment, and has been launched for public use.ResultsThe NeuroHealth app consists of 4 key sections: mood, sleep, diet and exercise, identified by the patient group as beneficial for daily symptom monitoring. Each section uses illustrations and can be customised to individual needs. Such longitudinal recordings can be shared with health professionals and may help improve joint decision-making.SummaryNeuroHealth app is a co-designed and freely available digital resource which can benefit chronic condition monitoring and self-management.
BackgroundClinical trial populations do not fully reflect routine practice. The power of routinely collected data is increasingly recognised.MethodsThe OPTIMISE:MS pharmacovigilance study is a ...prospective, pragmatic observational study, conducted across 13 UK MS centres. Data were collected at the time of routine clinical visits. The first participant was recruited on 24th May 2019; data were extracted on 11th November 2021.Results2112 participants were included (median age 44.0 years; 1570 (72%) female; 1981 (94%) relapsing- remitting MS). 639 (30%) were untreated at study entry, 205 (10%) taking interferon beta/copaxone, 1004 (47%) were taking second/third generation DMT first line (including dimethyl fumarate, oral cladribine, natalizumab, ocrelizumab), and 264 (13%) had escalated from either interferon beta or copaxone. 342 clinical events were reported, of which 108 were infections. There was an increased risk of adverse events in people taking second/third generation DMT (RR 3.45, 95%CI 1.57-7.60, p<0.01 vs no DMT). Unadjusted Poisson regression demonstrated increased incident adverse events in people taking natalizumab (IRR 5.28, 95%CI 1.41-19.74, p<0.05), ocrelizumab (IRR 3.24, 95%CI 1.22-8.62, p<0.05), and GA biosimilar (Brabio) (IRR 4.89, 95%CI 1.31-18.21, p<0.05) vs no DMT.ConclusionsRoutinely collected healthcare data can be used to evaluate DMT safety in people with MS. These data highlight the potential of pragmatic studies to guide understanding of risks and benefits associated with DMT.
Trigeminal neuralgia is a common cause of facial pain, typically producing paroxysmal bursts of shooting pain in one or more divisions of the trigeminal nerve. Whilst it usually occurs as a primary ...phenomenon due to neurovascular conflict, secondary causes account for around 15% of cases, most commonly cerebellopontine angle tumours. Multiple sclerosis is another common secondary cause of presumed inflammatory aetiology.We report a case of trigeminal neuralgia in association with diffuse scleroderma. A 43 year old carpenter presented with typical symptoms of unilateral facial pain around a year after receiving a diagnosis of systemic sclerosis with seropositivity to Scl-70 and centromere antibodies. MR imaging at the time revealed enhancement of the left trigeminal nerve, which resolved on subsequent imaging six months later.The association of trigeminal neuralgia and diffuse scleroderma has previously been reported, with a recent case-control study providing novel evidence of a direct association between the two conditions. Nevertheless it represents a very rare cause in patients presenting to the neurology clinic. In this presen- tation we explore the subject of secondary trigeminal neuralgia and provide a précis of the up-to-date management for this painful condition.
IntroductionHNPP is an autosomal dominant disorder with estimated prevalence between 0.84- 16/100,000, commonly presenting as mononeuropathies involving pressure-prone areas. Presentation as both a ...brachial plexopathy and spinal accessory neuropathy is rare, and previously unreported.Case ReportA 30-year old female with no known medical co-morbidities presented with a 3-month history of right shoulder pain and weakness, and intermittent numbness of the elbow and hand. Examina- tion showed wasting of right trapezius and spinati muscles, shoulder droop, and weakness involving the right sternocleidomastoid, shoulder, and median and ulnar-supplied hand muscles. Nerve conduction studies and electromyography revealed axonal-loss pattern neuropathy of right suprascapular and spinal accessory nerves. Focal demyelination was seen in bilateral median and ulnar nerves across the wrists and elbows. Needle EMG showed denervation changes in right infraspinatus and trapezius muscles. Sub- sequent genetic testing of patient and her mother revealed deletion of chromosome 17p11.2 including PMP22. She improved clinically following a period of intensive physiotherapy.ConclusionHNPP typically affects pressure-prone sites such as the median, ulnar or peroneal nerves. Brachial plexopathy is uncommon, and involvement of spinal accessory nerve is very rare. Recognition of symptoms, with appropriate targeted electrodiagnostic and genetic investigations is important in achieving an accurate diagnosis and management.
BackgroundVaccination is a recognised trigger of ADEM and approximately 50% paediatric cases have antibodies to MOG. The SARS-CoV-2 mass vaccination programme could therefore trigger cases of MOGAD. ...Neuromyelitis optica (NMO) is an autoimmune inflammatory condition of the CNS associ- ated with antibodies to AQP4.MethodTen patients (ages 22 – 65 years) with antibodies to MOG or AQP4 were referred to the NHS England NMO service having developed acute onset CNS inflammation within 8 weeks of vaccination.ResultsEight patients had MOGAD, seven of whom received the AstraZeneca vaccine (AZV) and one the Pfizer vaccine (PV). Only the post-PV MOGAD patient presented with typical adult-onset phenotype of isolated ON. All post-AZV MOGAD patients presented atypically; 85.7% had LETM and 71.4% had intrac- erebral lesions, resembling ADEM more commonly seen in paediatric MOGAD. The atypical presentation supports a causative role of AZV, but the role of PV is less convincing.Two patients had AQP4-NMOSD with typical demographic features. Both received AZV. Less typically, one young adult presented with LETM rather than characteristic young adult ON, the other had a silent short segment myelitis, which is rarely seen in AQP4-NMOSD. Both patients achieved good outcomes.ConclusionWe discuss the potential causation and pathophysiological mechanisms.
Anti-viral vaccination has rarely been associated with Guillain-Barré syndrome(GBS). We performed a population-based study of NHS England data and a UK multicentre surveillance study to investigate ...the relationship between COVID-19 vaccination and GBS.We linked GBS cases from England’s National Immunoglobulin Database(NID) with COVID-19 vaccina- tion data from December 2020–July 2021. GBS temporally associated within a 6-week risk window of any COVID-19 vaccine was identified.We prospectively collected incident UK GBS cases January–November 2021 regardless of vaccine exposure.The NID recorded 996 English GBS cases January–October 2021. A spike of cases above the 2016-2020 average occurred March–April 2021. 198 cases occurred within 6 weeks of first-dose COVID-19 vaccina- tion (0.618cases/100,000vaccinations: 176 ChAdOx1 nCoV-19, 21 tozinameran, 1 mRNA-1273). First-dose ChAdOx1 nCoV-19 accounted for the excess of 98-140 GBS cases with a peak 24 days post-vaccination. First-dose tozinameran and second-dose any vaccination showed no excess GBS risk. The UK multicen- tre surveillance dataset (121 patients) identified no phenotypic or demographic differences between vaccine-linked and unlinked cases.First-dose ChAdOx1 nCoV-19 vaccination is associated with excess GBS risk 0.576 (95%CI 0.481-0.691) cases/100,000 doses. No specific features are associated with vaccination-related GBS cases. The mechanism of immunogenicity of ChAdOx1 nCoV-19- warrants further study.
