Neurology is an extraordinary specialty. This is because it deals with the most complex organ, the brain. Neurologists therefore come up against very odd symptoms, and diagnose the most unusual syndromes. Below are 20 curious neurochecklists which reflect this peculiar feature of neurology. AEROPLANE HEADACHE BATHING HEADACHE BURNING MOUTH SYNDROME CRYING EPILEPSY EXPLODING HEAD SYNDROME FUGUE IMPAIRED FACIAL RECOGNITION OF EMOTIONS MIRROR […]
Neurologists often refer their patients with headache for a brain MRI scan. Quite often the reason for this is to reassure their patients who are worried about a sinister cause for their headache…and the anxiety provoking culprit is usually a brain tumour. The headache is often a migraine which has recently changed in character, or which is defying conventional treatment.
The neurologist is often ambivalent when requesting such scans. On the one hand, she expects the scan to be normal. On the other hand, she can not be certain there is indeed no sinister cause for the headaches. Another thing also bothers the neurologist, beyond the chance of detecting a brain tumour. And this is the ‘risk’ that the brain scan detects ‘incidental’ findings called white matter lesions (WML). Alas, these reassurograms frequently pick up these less sinister, but nevertheless unexplained, findings.
By Xavier Gigandet et. al. – Gigandet X, Hagmann P, Kurant M, Cammoun L, Meuli R, et al. (2008) Estimating the Confidence Level of White Matter Connections Obtained with MRI Tractography. PLoS ONE 3(12): e4006. doi:10.1371/journal.pone.0004006, CC BY 2.5, Link
White matter lesions are often just age-related, ‘wear and tear’ changes, and they are more common in people with vascular risk factors such as hypertension, smoking and raised cholesterol levels. Neurologists generally believe migraine is also a risk factor for white matter lesions. And there are several studies to support this belief.
With this strong evidence, neurologists are able to convince themselves there is nothing to these MRI high signal changes in their patients with migraine. No ‘chicken and egg’ philosophical equivocation is entertained. The scans are sometimes discussed at neuroradiology meetings where everybody murmurs ‘migraine white matter lesions’. All doubt dispelled, the neurologist reassures the patient, and hurriedly closes the chapter.
It is therefore with a strong jolt that neurologists read a recent article in the prestigious journal, Brain, greatly upsetting this cosy neurological consensus. In the paper titled migraine with aura and risk of silent brain infarcts and white matter hyperintensities, the authors found no association between migraine and brain white matter lesions. Shocking!
The authors studied female twin pairs aged between 30–60 years. The twins were identified through the population-based Danish Twin Registry. The authors compared the MRI scans of the subjects with and without migraine, and found no difference in the frequency of white matter changes between the two groups. They proudly, and disconcertingly, declare that ‘we found no evidence of an association between silent brain infarcts, white matter hyperintensities, and migraine with aura‘.
Nothing depicts the strange mix of beauty and complexity of the brain as the 12 pairs of cranial nerves. These nerves take off from the three sections of the brainstem and have intriguing names such as the olfactory, the trigeminal, the vestibulochochlear, and the hypoglossal. These magnificent twelve turn and twist, loop and meander, as they find their way to their varied […]
Progress report on new antiepileptic drugs: a summary of the Thirteenth Eilat Conference on New Antiepileptic Drugs and Devices (EILAT XIII) Bialer M, Johannessen SI, Levy RH, Perucca E, Tomson T, White HS Epilepsia 2017; doi: 10.1111/epi.13634 (Epub ahead of print) Abstract The Thirteenth Eilat Conference on New Antiepileptic Drugs and Devices (EILAT XIII) took […]
CLIPPERS is unusual enough you would think. Nothing to do with barbing and shearing I assure you. CLIPPERS stands for Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. The striking feature of CLIPPERS is inflammation in the pons, the chunky middle part of the brainstem. This distinguishes it from other neurological inflammatory disorders such as multiple sclerosis (MS) and neuromyelitis optica (NMO).
By Images are generated by Life Science Databases(LSDB). – from Anatomography[1] website maintained by Life Science Databases(LSDB).You can get this image through URL below. 次のアドレスからこのファイルで使用している画像を取得できますURL., CC BY-SA 2.1 jp, Link
CLIPPERS has however now broken loose from its shackles to the pons, and is spreading down into the spinal cord. Sacrilege you might say.
What is it about neurological inflammatory disorders that makes them so rebellious? Why do they defy convention and disregard their defining features. I discussed a similar phenomenon in my previous blog post titled Why is neuromyelitis optica (NMO) endlessly surprising neurology? NMO refused to play by the rules and was punished by having it’s named changed to NMOSD. Perhaps it’s time for CLIPPERS to suffer the same fate….starting with a shorter acronym perhaps?