27 e-Letters

published between 2015 and 2018

  • Correspondence and referee’s reports on Carr AS, et al. Wisdom tooth extraction causing lingual nerve and styloglossus muscle damage. Pract Neurol 2017;17:218–221.

    Dear Editors,
    Carr AS, et al. Pract Neurol 2017;17:218–221. doi:10.1136/practneurol-2016-001491
    In the interests of enhancing our understanding of bulbar function from the perspective of the jobbing clinical neurologist, I am writing to you regarding a publication in this month’s edition of Practical Neurology (Carling et al.). As it stands I do not think the case report does justice to the scholarship of the seven authors.
    I enjoyed formally refereeing the paper on two separate occasions (enclosed), and offered a third comment (“I think the patient has a lingual nerve palsy and a tethered tongue on the left, both occurring as a complication of surgery”) by email, in the hope that it could appear in a little box as “reviewer’s comments”. I now think that I would have provided a better service to PN if I had sent this single sentence to you instead of the first review.
    In the report, the authors champion the careful approach required in patients with very focal abnormalities involving the lower cranial nerves and the muscles they innervate. They describe in pictures and very useful tables—copies of which are already on my office wall—the detailed knowledge that is required to avoid misattribution in the crowded and inaccessible house of the structures involved in bulbar function.
    The patient concerned had a third molar removed and postoperatively had a lingual nerve palsy. This complication is anticipated, and is included in the consent pro...

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  • Re:Psychogenic non-epileptic seizures in early Huntington's disease - a different experience
    Filipe B Rodrigues

    Dear Editor,

    We thank Prof Barker for sharing his thoughts and experience[1] on our report of psychogenic non-epileptic seizures in Huntington's disease[2]. We agree that neuropsychiatric manifestations are extremely common in HD and most cases of unusual behaviours or movements would not fall into the category of functional disorders. Moreover we certainly do not wish to give the impression that non- epileptic...

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  • The palmomental reflex: Reply to Schott and Rossor
    Andrew J Lees

    Dear Editor,

    The only thing that I can disagree with in Jonathan Schott and Martin Rossor's article on the palmomental reflex in the December issue of Practical Neurology is their plea that I should stop scraping. I have found that the palmomental reflex can be made more specific for detecting brain damage by applying the orange stick or car key to the hypothenar rather than the thenar eminence. A positive palmomen...

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  • Psychogenic non-epileptic seizures in early Huntington's disease - a different experience
    Roger A Barker

    Dear Editor,

    We were interested to read the recent case study presented by Rodrigues and Wild in the current edition of Practical Neurology where they discussed "Psychogenic non-epileptic seizures in early Huntington's disease"[1]. The authors gave an in-depth account of the clinical profile of a 51-year-old male with early Huntington's disease (HD) who presented with repeated episodes of repetitive, purposeless, c...

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  • The Babinski sign: Key Facts
    Mark Baker

    Dear Editor,

    In his recent Neuromythology article1 on the Babinski sign, Professor Kiernan repeats the oft quoted recommendation regarding the best method for testing the plantar response, which is to:

    'Run a car key (figure 1; or as some have suggested, a most expensive motor car key...) along the lateral border of the sole.'

    It will not surprise many readers of Practical Neurology to learn th...

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  • The biography of functional disorders
    Jonathon P Tomlinson

    This sensitive review is very welcome, as in our experience, most patients with functional disorders are told by specialists what they do not have. I would be much more inclined to refer patients if this kind of approach was more common. It is one reason why relatively few of the patients we see in primary care are referred for specialist attention. Specialists are seeing only the tip of the primary care functional iceb...

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  • Romberg's test has stood up to the test of time and should remain standing
    Angus Nisbet

    Title: Romberg's test has stood up to the test of time and should remain standing (Neuromythology: Letter to the Editor)

    I was Interested to read Professor Martin Turner's article entitled Romberg's test no longer stands up. In the article Professor Turner describes the test as "the process of standing unsupported with the eyes closed and feet together for 30 s" and asserts that "the positive result is the p...

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    Fabio Bandini

    Sir, I read with much interest the review by Weerasinghe and Lueck on the diagnosis of optic neuritis. The authors provide an extensive and detailed analysis on the differential diagnoses and the management of the disease. The importance of retinal electrophysiology is also acknowledged when differentiating retinal disorders that can mimic optic neuritis. Surprisingly, however, the diagnostic role of pattern-reversal Visua...

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  • Reply from Pennington et al.
    C Pennington

    We welcome debate around this emerging condition. We all recognise a situation when as clinicians we have had a strong feeling that a patient has a functional complaint from early on in the consultation. However, the differential diagnosis for Functional Cognitive Disorder is neurodegenerative dementia which itself affects behaviour and personality and could, therefore, influence many of the cues clinicians pick up on wh...

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  • Re: Pennington et al. Functional cognitive disorder: what is it and what to do about it?
    Jan A Coebergh

    Pennington and colleagues review of Functional Cognitive Disorder (FCD) [1] is very welcome to guide practice in a complex condition that is presenting increasingly to general and cognitive neurology clinics. However, in our view Pennington's presumption towards specialist assessment, investigation and surveillance is unnecessary and misses an opportunity to provide patients with a prompt diagnosis, explanation and reas...

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