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Carphology by A Fo Ben

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Worldwide causes of mortality have changed between 1990 and 2013, but what has happened to the neurological causes of death? Cerebrovascular disease has risen (5th to 3rd) as has brain cancer (57th to 47th). Neurological infections have dropped: meningitis from 15th to 23rd and encephalitis from 49th to 59th; of note, measles plummeted from 12th to 43rd. Epilepsy, in contrast, is relatively unmoved (50th vs 52nd). Overall, however, neurological causes of death are marginally raised with one of the largest increases seen in Parkinson's disease (up by 28%).

Lancet 2014; S0140-6736(14)61682-2

Classic films of classic signs

Lecturers come and lecturers go, but some visual aids still speak to us as clearly as ever. In a recent volume of the New England Journal of Medicine, two early case study videos of patients with Duchenne's muscular dystrophy were published. These were first used by Arthur Van Gehuchten to illustrate a lecture in September 1910 and provide a graphic illustration of some of the classic signs of the condition. Apart from musing that in today's world, the patients in such videos would tend to wear rather more clothes, the films are still as clinically relevant as they were when first shown 100 years ago.

N Engl J Med 2014;371:e35

The shear stupidity of it all

The cast-iron fact that we only use 10% of our brains is the clear explanation as to how the bar patron from Chihuahua had the capacity to absorb a pair of scissors to the face (figure 1). We have all been there; one drink leads to another, which leads to hi-jinks, which leads to being impaled by a sharp implement in the face. Initially hospital staff, reportedly, diagnosed an elaborate hoax. The X-rays confirm a very genuine parietal lobe puncture.

Figure 1

Coronal and sagittal radiographs; a red arrow is not needed to identify the scissors. Credit: EuroPics.

When opinions become divided

A Fo Ben tries to avoid post-publication review, preferring in general to leave it to more august bodies. However, recent reports suggest that this may be a wise decision in more ways than one. Post-publication review, often anonymous and sometimes highly critical, has become increasingly popular over the past few years. However, there has begun to be a backlash against what can be perceived (by the targeted authors at least) as unchallenged, unsupported and damaging comments. Recently, a post-publication site in the USA has been subpoenaed by a scientist who believes that a lucrative job offer was withdrawn after critical comments about his recent work were posted on a post-review website. Of course, A Fo Ben would never condone hiding behind anonymity to comment on others’ work (ahem) but perhaps the line between free speech and liable may be thinner than it has previously appeared.

http://www.timeshighereducation.co.uk/news/can-post-publication-peer-review-endure/2016895.article

Adventures in Wonderland

If the day-to-day grind of clinic is getting to you, or the kids have started to wonder what it is you actually do all day, then this might be for you. Recently serialised on Radio 4, Reaching Down the Rabbit Hole is a new book from the Harvard Neurologist Allan Ropper. This series of case histories of his varied and fascinating patients is a (possibly timely) reminder as to how fascinating the brain still can be, and how little we still understand it.

http://www.bbc.co.uk/programmes/b04xn7cq

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  • Editors' commentary
    Phil Smith Geraint N Fuller