Reaching Down the Rabbit Hole 

Reaching Down the Rabbit Hole Authors: Allan H. Ropper and Brian David Burrell Synopsis This book is about the day-to-day practice of one of the leading neurologists in the world. It explores his challenging work in one of the most prestigious of hospitals, the Brigham and Women’s Hospital– ‘a place where the strangest and challenging […]

via Reaching Down the Rabbit Hole  — The Doctors Bookshelf

The Man Who Mistook His Wife for a Hat

The Man Who Mistook His Wife for a Hat Author: Oliver Sacks Synopsis This book is an exhilarating excursion into the world of some the most intriguing neurological disorders. The main theme linking the stories is the detailed narrative of each case study. The author’s trademark is his ingenious capacity for probing beneath the […]

via The Man Who Mistook His Wife for a Hat — The Doctors Bookshelf

10 fascinating books about the brain…written by those who know it best

Today is World Brain Day! And we are celebrating with an appropriate series of book reviews. We will be exploring 10 excellent books about the brain. But these are not just any set of brain books. These are books written by those who know it best. As neurologists, neuroscientists, and psychologists, the authors spend, or […]

via 10 fascinating books about the brain…written by those who know it best — The Doctors Bookshelf

What should we really know about cerebral aneurysms?

Cerebral aneurysms are scary things. It is alarming enough that they exist, but it is more spine-chilling that they enlarge with time. The most infamous aneurysm arises from the posterior communicating artery, the so-called PCOM aneurysm. And it signifies its sinister intent when it gradually enlarges and compresses its vascular neighbour, the third cranial nerve, otherwise known as the oculomotor nerve. A dysfunctional third nerve manifests with a droopy eyelid (ptosis) and double vision (diplopia). The reason for the double vision becomes obvious when the neurologist examines the eyes; one eyeball is out of kilter and is deviated downwards and outwards; it is indeed down and out! The pupil is also very widely dilated (mydriasis). These are among the most worrying red flags in medicine, and a very loud call to arms. Cerebral aneurysms however often wave no flags, red or otherwise. Indeed the most malevolent of them will expand quietly until they reach horrendous proportions, and then, without much ado, just rupture. They are therefore veritable time bombs…just waiting to go off.

By Tiago Etiene Queiroz – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=24418848

Cerebral aneurysm however do not need to reach large proportions to rupture; some just rupture when they feel like. Aneurysms under 7mm in diameter however are less prone to rupture. A rupturing aneurysm presents with very startling symptoms. The most ominous is a sudden onset thunderclap headache (TCH), subjects reporting feeling as if they have been hit on the back of the head with a baseball or cricket bat. It is not quite known what non-sporting patients experience-for some reason they never get aneurysms in neurology textbooks! More universally appropriate, a ruptured aneurysm may manifest as sudden loss of consciousness. Both symptoms result from leakage of blood into the cerebrospinal fluid (CSF) space, a condition known as a subarachnoid haemorrhage (SAH).

By Lipothymia – Anonymised CT scan from my own practice, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=787177

You may breath a small sigh of relief here because the vast majority of people with thunderclap headaches do not have subarachnoid haemorrhage. Unfortunately, every person who presents with a thunderclap headache must be investigated- to exclude (hopefully), or confirm (ruefully), this catastrophic emergency. The first test is a CT head scan which identifies most head bleeds. The relief of a normal scan is however short-lived because some bleeds do not show on the CT. The definitive test to prove the presence or absence of a bleed is less high tech, but more invasive: the humble spinal tap or lumbar puncture (LP). This must however wait for least 12 hours after the onset of headache or blackout. This is the time it takes for the haemoglobin released by the red blood cells to be broken down into bilirubin and oxyhaemoglobin. These breakdown products are readily identified in the biochemistry lab, and they also impart on the spinal fluid a yellow tinge called xanthochromia. The test may be positive up to 2 weeks after the bleed, but the sensitivity declines after this time. A positive xanthochromia test is startling and sets off an aggressive manhunt for an aneurysm-the culprit in most cases. 

By Ben Mills – Own work, Public Domain, https://commons.wikimedia.org/w/index.php?curid=13051957

Many people with cerebral aneurysms have a family history of these, or of subarachnoid haemorrhage. Some others may have connective tissue diseases such as Ehler’s Danlos syndrome (EDS), adult polycystic kidney disease (APCKD), or the rare Loeys-Dietz syndrome. This family history is a window of opportunity to screen family members for aneurysms. The screening is usually carried out with a CT angiogram (CTA) or MR angiogram (MRA). People are often not born with aneurysms, but tend to develop them after the age of 20 years. Aneurysm surveillance therefore starts shortly after this age, and many experts advocate repeating the screening test every 5-7 years until the age of 70-80 years.

By Nicholas Zaorsky, M.D. – Nicholas Zaorsky, M.D., CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=15533196

How are aneurysms treated? This will be the subject of a future blog post so watch this space!

 

Is hypertonic saline better than mannitol for traumatic brain injury?

Hypertonic saline is superior to mannitol for the combined effect on intracranial pressure and cerebral perfusion pressure burdens in patients with severe traumatic brain injury. Mangat HS, Wu X, Gerber LM, et al. Neurosurgery 2019 (Epub ahead of print). Abstract BACKGROUND: Hypertonic saline (HTS) and mannitol are effective in reducing intracranial pressure (ICP) after severe […]

via Is hypertonic saline better than mannitol for traumatic brain injury? — Neurochecklists Blog

Does helicobacter pylori predispose to Parkinson’s disease?

H. pylori and Parkinson’s disease: meta-analyses including clinical severity. Dardiotis E, Tsouris Z, Mentis AA, et al. Clin Neurol Neurosurg 2018; 175:16-24. Abstract Background: The exact etiology of Parkinson’s disease (PD) remains unclear. Some evidence supports Helicobacter pylori infection as a trigger or driving event, but detection and eradication of H. pylori are not part […]

via Does helicobacter pylori predispose to Parkinson’s disease? — Neurochecklists Blog

Does helicobacter pylori predispose to Parkinson’s disease?

H. pylori and Parkinson’s disease: meta-analyses including clinical severity. Dardiotis E, Tsouris Z, Mentis AA, et al. Clin Neurol Neurosurg 2018; 175:16-24. Abstract Background: The exact etiology of Parkinson’s disease (PD) remains unclear. Some evidence supports Helicobacter pylori infection as a trigger or driving event, but detection and eradication of H. pylori are not part […]

via Does helicobacter pylori predispose to Parkinson’s disease? — Neurochecklists Blog