WESAN 2017: The Full Brochure, The Final Countdown

Here it is-the full WESAN 2017 brochure

 

Check out the full bios of all 13 speakers and topics

 

WESAN 2017 Brochure

 

Be patient as it downloads-it is loaded!

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And return to view our previous WESAN-related blog posts:

What has the Exeter neurology course accomplished in the last decade?

 

A short history of WESAN

 

Who are on the line-up of the WESAN Exeter Neurology course in 2017?

 

The 7 most ruthless bacterial infections of the nervous system

This is a follow up to our previous post, the 7 most devastating viral neurological infections. The list of bacteria that invade the nervous system is endless, but some stand out because of the fear they evoke, and the peril they pose. Here then are the 7 most horrifying bacterial infections that threaten the nervous […]

via The 7 most ruthless bacterial infections of the nervous system — Neurochecklists Updates

Does thrombolysis add any value to mechanical thrombectomy after stroke?

Mechanical thrombectomy outcomes with and without intravenous thrombolysis in stroke patients: a meta-analysis. Mistry EA, Mistry AM, Nakawah MO, et al. Stroke 2017; 48:2450-2456. Abstract Background: Whether prior intravenous thrombolysis provides any additional benefits to the patients undergoing mechanical thrombectomy for large vessel, acute ischemic stroke remains unclear. Methods: We conducted a meta-analysis of 13 studies obtained through PubMed and EMBASE database searches to determine whether functional […]

via Does thrombolysis add any value to mechanical thrombectomy after stroke? — Neurochecklists Updates

Is head injury a risk factor for multiple sclerosis?

Concussion in adolescence and risk of multiple sclerosis Montgomery S, Hiyoshi A, Burkill S, Alfredsson L, Bahmanyar S, Olsson T. Ann Neurol 2017; 82:554-561 Abstract Objective: To assess whether concussion in childhood or adolescence is associated with subsequent multiple sclerosis (MS) risk. Previous research suggests an association, but methodological limitations included retrospective data collection and […]

via Is head injury a risk factor for multiple sclerosis? — Neurochecklists Updates

What is the value of temporal artery biopsy in the diagnosis of GCA?

Giant cell arteritis (GCA) is a nasty inflammatory disorder that affects the large arteries. Because it characteristically involves the temporal artery, this form of vasculitis is also referred to as temporal arteritis. It usually affects people over the age of 50 years and manifests with sudden onset headache, scalp pain, and a thick, tender temporal artery. GCA is often accompanied by polymyalgia rheumatica (PMR) , a painful condition of the joints and muscles. The active systemic inflammation in GCA is often detected by the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) tests. These distinguishing features constitute most of the diagnostic criteria for GCA.

By National Institute of Standards and Technology – https://www.flickr.com/photos/usnistgov/5828207621/, Public Domain, Link

Most people with GCA however do not have all the ‘classical’ features of the disease. A high index of suspicion is therefore required to sniff out the duplicitous miscreant. It is particularly imperative to make the diagnosis as early as possible to prevent the dreaded complications of GCA, sudden blindness and stroke. The treatment of GCA, implemented according to established treatment guidelines, involves several months of oral steroids, drugs which cause immune suppression and a host of other side effects. It is therefore essential that the diagnosis of GCA is made correctly to avoid putting the patient on a long, risky, and unnecessary treatment.

By Henry Vandyke CarterHenry Gray (1918) Anatomy of the Human Body (See “Book” section below)Bartleby.com: Gray’s Anatomy, Plate 508, Public Domain, Link

The conventional method of establishing the definitive diagnosis of GCA is by performing a temporal artery biopsy. This involves taking a short segment of the temporal artery as it traverses the temple. This procedure however only confirms the diagnosis of GCA in 1335% of people with the condition. One reason the biopsy has such a poor sensitivity is that it is often performed after treatment has already commenced. Another reason the biopsy is often normal is that the inflammation in GCA occurs in patches, sparing large segments of the artery. Don’t even think about it-taking a longer biopsy segment does not increase the yield of temporal artery biopsy. Put another way, “specimen length is not associated with diagnostic yield of temporal artery biopsy.

By NephronOwn work, CC BY-SA 3.0, Link
What then is the value of the temporal artery biopsy in the diagnosis of GCA? This is the question posed by Bowling et al in their incisive paper titled Temporal artery biopsy in the diagnosis of giant cell arteritis: does the end justify the means? They reviewed 129 temporal artery biopsies and found that the clinical diagnosis of GCA was confirmed in only 13% of cases. Furthermore, the outcome of the biopsy rarely ever influenced the treatment; 87% of those with a normal biopsy result still continued their treatment. The miffed authors therefore rhetorically, and indignantly, asked: “can we justify invasive surgery to all patients on histological grounds when the results may not alter management?” 
Ipswich, Waterfront, Ipswich Campus, The Big Question Mark Sculpture. Martin Pettitt on Flikr. https://www.flickr.com/photos/mdpettitt/8671901426

This is an entirely reasonable question especially because there are other more accurate and less invasive ways of establishing the diagnosis of GCA. These include:

But the answer to the authors’ rhetorical question is anyones guess. It is a sad tradition of medicine that studies such as these take ages to change practice. Indeed I predict the the temporal artery biopsy will sidestep this minor hurdle and simply continue its long and agonising reign. Despair!
By No machine-readable author provided. Spekta assumed (based on copyright claims). – No machine-readable source provided. Own work assumed (based on copyright claims)., Public Domain, Link
You can at least read more on GCA in my previous blog post titled Advances in the management of giant cell arteritis. You may also explore these comprehensive neurochecklistsGiant cell arteritis (GCA): clinical featuresand Giant cell arteritis (GCA): diagnosis and management.

 

FDG. TRIUMF Lab on Flikr. https://www.flickr.com/photos/triumflab/8232448893

 

The most unusual headache syndromes in neurology

Headaches constitute the bulk of what neurologists see in their general clinics. Most people with headaches fall neatly into one of two categories, migraine or tension type headache (TTH). The neurology clinic may have a sprinkling of people with cluster headache or paroxysmal hemicrania, two of the more common trigeminal autonomic cephalalgias (TACs). All these headaches are easy to recognise […]

via The most unusual headache syndromes in neurology — Neurochecklists Updates

The 50 faces of multiple sclerosis: the diverse presentations of a common disease

Multiple sclerosis (MS) dominates neurological practice in many parts of the world. This is no doubt because it is a common disorder which favours the young.The typical form, relapsing remitting MS (RRMS), is often easy to recognise and diagnose. The are however other types and variants such as primary progressive MS (PPMS), that often pose a […]

via The 50 faces of multiple sclerosis: the diverse presentations of a common disease — Neurochecklists Updates