‘We are called to be architects of the future, not its victims’—Buckminster Fuller
People with chronic neurological conditions may be vulnerable to change and less able to manage its demands: neurological diseases are among the most burdensome. Whether climate change has particular effects on specific neurological diseases or not, the known impaired resilience to change affecting people with neurological diseases requires neurologists to have awareness of potential climate impacts and their management. Preparedness should include understanding of general national and local alerts and action systems, and the ability to advise patients about managing extreme weather events, particularly heatwaves, but also floods and cold snaps. At the same time, we need more research into the particular consequences of climate change on specific neurological diseases. Climate change is a serious healthcare issue, requiring the neurological community to respond as it would, or did, to other serious challenges, such as COVID-19. As disease experts, we all have a role to play.
]]>A 60-year-old man had a 2-week history of daily recurrent episodes of transient, painless vision loss, each lasting 3–5 s. He had attended ophthalmology for years because of intermittent diplopia, and a history of type 1 diabetes mellitus, primary open angle glaucoma, bilateral cataract surgery and Graves’ disease with subsequent hypothyroidism. In April 2021, he developed vision loss described as complete bilateral, non-simultaneous visual blackout prompted by left/right gaze. His vision returned to baseline on return to centre gaze. There was also a more persistent left visual field defect. Funduscopy identified asymmetric optic disc oedema. The right optic disc showed mild margin blurring with congestion, but with distinct optic disc vessels (Frisén grade 2). The left optic disc had more pronounced optic nerve swelling, indistinct peripapillary arterioles and microhaemorrhages (Frisén grade 3) (
On examination, he had waxy, non-pitting oedema particularly of the lower limbs (
Investigations included a markedly raised serum creatine kinase (prompting neurology referral), a significant pancytopenia with macrocytosis and elevated thyroid-stimulating hormone (TSH) with low thyroxine (T4) (
An adult man with well-controlled HIV (taking emtricitabine/tenofovir disoproxil fumarate and raltegravir) presented with 1–2 months of gradual-onset generalised headache, preceded by a diffuse symmetrical rash. He was afebrile and there were no abnormal neurological examination findings.
A CT scan of the head showed multiple lytic calvarial lesions, with destruction of the inner and outer tables and diploic space (
His HIV viral load was undetectable and his CD4 count was 552 cells/µL (29.8%). He had a reactive serum rapid plasma reagin (RPR) test (1:256) and a positive Treponema pallidum particle agglutination (TPPA) assay, confirming a diagnosis of syphilis....]]>
A 68-year-old woman presented with 3 weeks of progressive left-sided weakness. She had a history of Sjögren’s syndrome, complicated by mononeuritis multiplex and arteritic anterior ischaemic optic neuropathy, and had taken azathioprine for 14 months. On examination, she was disorientated, inattentive, with a left hemiparesis and extensor left plantar response. MR scan of brain showed asymmetrical bilateral frontoparietal leukoencephalopathy, involving U-shaped fibres and deep white matter, with foci of diffusion restriction in the right frontoparietal and left parietal lobes, and a thin, linear, gyriform susceptibility weighted imaging (SWI)-hypointense rim in the periphery of the lesion (
A 44-year-old man presented with a 1-year history of progressively poor balance and recurrent falls. On examination, he had a cerebellar syndrome with nystagmus, dysarthria, truncal and limb ataxia, dysmetria, and bilateral intention tremor. Limb strength and sensory examination were normal, with no pyramidal or extrapyramidal signs. His cognitive functions were normal (Montreal Cognitive Assessment score was 30). He had no psychiatric features such as stereotypy or punding, and no choreoathetosis or involuntary movements.
MR scan of the brain showed multiple diffuse and scattered T2/fluid-attentuated inversion recovery (FLAIR) hyperintense lesions involving the periventricular, subcortical and deep white matter bilaterally along the frontal, parietal, temporal, occipital lobes, brainstem as well as both cerebellar hemispheres (
The focus of the book is OxyContin, a drug which some believe is responsible for two hundred thousand deaths. One colleague pointed out that their original goal was to develop OxyContin as a pain killer for patients with intractable cancer-related pain at a time when palliative care services were not well developed; they found it hard to believe that...]]>
Three cheers for neuroscience, as other ‘non brain’ disorders need to rely upon our boffins to address their major unmet needs. Step forward fezolinetant, described breathlessly as ‘game-changing’ ‘transformative’ and as a ‘completely blockbuster drug’ in the press - not by the journalists, but by quoted experts. For a mere £5160 per annum, the CNS active drug blocks a protein called neurokinin-3 that plays a unique role in regulating body temperature in menopausal women. The drug appears remarkably well tolerated, and reduced hot flushes by 60% (compared with 45% with placebo).
BMJ 2023;383:p2969
Tony Pulis, the former Stoke football manger is said to have coined the phrase, ‘but can they do it on a wet Wednesday night in Stoke?’ This is a dour dismissing of seemingly ‘luxury players’ (read talented, but can they roll their sleeves up and compete when the...]]>
In the middle of January, we welcomed our new executive director, Emily Linnemann, to lead the ABN office team. She will be ably guided in getting to know the organisation by the hugely competent staff team who have been holding the fort for many months now.
She is looking forward to meeting lots of the members at the annual meeting 21st– 23rd May, with the trainee day on Monday 20th May. This year it is being held in the beautiful city of Edinburgh.
Early bird registration for the meeting ends on March 11th so make sure you book your place early https://abnconference.co.uk/
The first 2 days will be packed full of talks on...]]>