29 e-Letters

published between 2011 and 2014

  • Undiagnosing neurological disease
    Nitin K. Sethi

    With great interest I read Coebergh et al. piece on how to undiagnose neurological disease. 1 My experience as a neurologist with subspecialty training in epilepsy has taught me that diagnostic labels such as seizure disorder or epilepsy once attached are very hard to purge either from the patient's medical records or his memory. I frequently encounter patients carrying a diagnostic label of epilepsy in whom continuous vi...

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  • Re:The article by Zanette et al (2014;14:351-353). T
    Stefano Tamburin MD

    We thank Dr. Davenport for his interest in our case report [1] and the opportunity to better explain our clinical reasoning. In his e-letter Dr. Davenport argues that there is a discrepancy between the distribution of the pain, which appeared more suggestive of L2 and perhaps a contribution of L1 and L3, and the involvement of L4 root as documented by clinical neurophysiology and neuroimaging. The patient was asked to d...

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  • The article by Zanette et al (2014;14:351-353). T
    Richard J Davenport DM FRCP Edin

    I thoroughly enjoyed the article by Zanette et al (2014;14:351-353). The authors are to be congratulated for their skilful history taking skills, specifically the key observation that the pain coincided with menses, suggesting the diagnosis, and thus confirming that a neurology opinion, far from being "the last resort", should have been the "first resort". I am troubled by the distribution of the pain however; the autho...

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  • CSF Evaluation
    Barbara A. Busall

    Is there any reason you can think of when the CSF protein and the CSF glucose should be evaluated from different tubes of CSF and not the same tube?

    Conflict of Interest:

    None declared

  • How I start a new patient consultation-view from across the pond
    Nitin K. Sethi

    I read with interest Allen et al. approach to starting a new patient consultation1. Apart from a few minor differences the basic methodology employed by all four physicians is essentially the same. Across the pond, I start a new patient consultation in much the same way. I walk into the reception area, call out the patient's name and upon acknowledgement ("right here" or "yes" is the usual response, rarely "yo" and I hav...

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  • HIV testing in a patient presenting with cognitive impairment-to test or not to test
    Nitin K. Sethi

    I read with interest the debate between Nightingale el al. and Schott about whether we should routinely test for HIV in patients presenting with cognitive impairment 1,2 . I assume that while the authors have taken rather polarized views to state their point, the correct answer lies somewhere in between. Testing for HIV shall not be the foremost in my mind in a 75-year-old male presenting with slowly progressive cognitive...

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  • aetiology of myoclonus
    Dr Ramesh Kumarans


    Can myoclonus involve large muscles like the trunk muscles giving out just one jerk with a duration of a fraction of a second?Would it be justified to term this phenomena as a myoclonic seizure or a complex myoclonus when there is LOC for that fraction of a second;happening while falling asleep only.Or can it be a sleep disorder,a hypnic jerk?

    Conflict of Interest:

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  • Pre-protocol experience from Belfast.
    Michael O. Kinney

    We welcome the article by Jones et al, and in particular the chance to compare the protocol used in their institution with the one we hope to implement (1).

    In Northern Ireland, we are in the process of drawing up a regional protocol for the management of status epilepticus, due to wide variation in current practice. We carried out preliminary work to see where the gaps in knowledge are, so that we can create a...

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  • Re:What is the risk of PCP in patients with neurological disease?
    Simon Cronin

    We thank Dr Lilleker for his comments. We agree that use of PCP prophylaxis must provide benefit that would outweigh any attendant risk. As suggested in our article, this risk is likely to vary depending on the dose and duration of steroid therapy, the co-administration of other biologicals and the systemic health of the patient. A patient with e.g., systemic vasculitis-associated mononeuritis multiplex who has also b...

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  • What is the risk of PCP in patients with neurological disease?
    James B Lilleker

    I thank the authors for highlighting this difficult topic with a very thought provoking article.

    In immunosuppressing a patient with neurological disease, as with anything a physician does to a patient, there are potential risks to take into account and to be weighed up against the proposed benefits. Indeed, this sort of "cost-benefit" analysis is a central tenant of decision making in much of life outside of me...

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