eLetters

26 e-Letters

published between 2006 and 2009

  • The death of the neuro exam: not so soon please!
    Chloe E Hill

    Dear Editor,

    I read the title of Dr. Hawkes’ editorial three times before I was certain I had read it correctly1. As a fourth year medical student about to apply for a neurology residency, I was initially bewildered. When I read on though, I was impressed not only with his candidness, but also by the validity of what he was saying; although I am a newcomer, it does not take long to appreciate that imaging is cent...

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  • The death of clinical neurology: not so soon please!
    Nitin K Sethi

    Dear Editor,

    I read with interest the editorial by Dr. Hawkes titled “I have stopped examining patients!”1. The title appropriately has an exclamation mark at the end highlighting his shocking claim. I have to commend Dr. Hawkes for finally coming out and admitting boldly and maybe somewhat proudly what most neurologists already know but are afraid to accept.
    Bedside clinical neurology is a dyin...

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  • Careful Examination Irreplaceable
    Roger L. Albin

    Dear Editor,

    Perhaps because I don't have Dr. Hawkes' degree of experience (I have approximately 25 years of practice experience), I disagree very strongly with his conclusion. Careful examination remains the cornerstone of neurologic practice. I agree that a great deal of information is gleaned from informal examination - watching the patient walk into the exam room, etc. I agree as well that for paroxysmal d...

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  • Premature closure and other unintended consequences of omitting the clinical examination
    oscar,m jolobe

    Dear Editor,

    The admission that a neurologist has stopped examining patients(1) is a disturbing one, given the fact that "the practice of medicine is the art of drawing conclusions from incomplete evidence"(2), thanks to the fact that, as clinicians, "we work in a probabilisic enviroment in which the evidence we gather bears an imperfect relationship to its cause"(3).

    Accordingly, the evidence initial...

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  • Bipartisanship
    Roger L. Albin

    Dear Editor,

    It is not correct that the Democratic Party has historically been the major underwriter of biomedical research in the USA. American science, and biomedical science in particular, benefited historically from substantial bipartisan support. The major increase in NIH funding of the Clinton period owed at least as much to actions of moderate Republicans like Rep. John Porter (Republican of Illinois) an...

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  • Leprosy
    Colin L. Crawford

    Dear Editor,

    Richard Hughes does not include leprosy in his list of peripheral nerve disorders.(1) While it is true that new cases of leprosy are declining rapidly , as a result of effective anti-bacterial therapy, there are still frequent numbers with residual disabilities in endemic countries.

    In neurological text books, a mononeuropathy or multiple mononeuropathy is regarded as the sole neurolog...

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  • Clinical signs and symptoms emphasized.
    Ivy A.E. Ekem

    Dear Editor,

    I wish to commend the authors for their paper on functional vitamin B12 deficiency.

    It is important that despite the array of investigative tools that may be available at the disposal of clinicians, clinical signs and symptoms are given their due emphasis particularly in Vitamin B12 deficiency. The authors report a case where the serum cobalamin was normal in the face of anaemia and neurol...

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  • Neurologic complications of celiac disease
    Chiara Briani

    Dear Editor,

    We read with great interest the review by Grossman on neurologic complications of celiac disease in a recent issue of Pract Neurol.(1)

    Using an evidence-based approach, the author has carefully and critically analyzed articles published in the last decade on the most common neurologic manifestations associated with celiac disease, namely ataxia, epilepsy, and peripheral neur...

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  • "Functional" Vitamin B12 Deficiency
    Lawrence R. Solomon

    Dear Editor,

    I read with interest the important case report of Turner and Talbot describing clinical subacute combined degeneration in a patient with “functional” vitamin B12 deficiency (defined by elevated levels of the B12 -dependent metabolites, methylmalonic acid and homocysteine, despite normal serum B12 values).1 It is important to note that although their patient did not improve with hydroxycobalamin the...

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  • "Ice-on-eyes" test
    Andrew J Larner

    Dear Editor

    Further to previous articles on the "ice-on-eyes" test or ice-pack test in myasthenia gravis,1,2 a prior report pooling six studies adjudged to have sufficient clinical and experimental detail (n = 76 patients with myasthenia gravis, n = 77 non-myasthenic patients with ptosis), rather than just the two studies alluded to by Reddy & Backhouse,1 gave a test sensitivity of 89% and specificity of 100%....

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