eLetters

42 e-Letters

published between 2009 and 2012

  • a restatement of core values
    oscar,m jolobe

    Professor Warlow is to be congratulated on his masterly restatement of the core values of clinical medicine, in general, and neurology, in particular(1). As a corollary to his observation regarding "whether what you find on imaging is relevant to the problem or is merely incidental"(1), recognition should be made that the scan, itself, may generate images which are either falsely normal(2), or too nonspecifically abnormal...

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  • Why I shall never stop examining patients
    Nitin K. Sethi

    Dear Editor,

    I read with interest the editorial by Dr. Warlow (1). It follows the earlier editorial by Dr. Hawkes titled "I have stopped examining patients" (2). That editorial evoked a fury of concerned responses from both neurologists and neurologists to be. The editorial by Dr.Warlow will be far less controversial and I feel aptly balances the debate between examining and not examining neurologists. Dr....

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  • neurogenic bladder dysfunction and chronic subdural haematoma
    oscar,m jolobe

    Although no mention of subdural haematoma was made by the authors(1), the occurence of reversible urinary retention, even in a patient who is awake and ambulatory, can be a feature of bilateral chronic subdural haematoma, as was the case in an 87 year old woman reported by Lang et al(2). On the basis of the fact that she regained full bladder control after evacuation of the haematoma, the authors proposed that there might be...

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  • another moral from the cautionary tale
    oscar,m jolobe

    The cautionary tale of miscalculation of the corrected QT interval(1) highlights the extent to which clinicians and their patients can become hostages to fortune when they base important clinical decisions on "numbers" churned out by electronic gadgets whose validity has not been "cross checked" manually. The sometimes indiscriminate use of oscillometric devices for blood pressure measurement is another case in point. My anx...

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  • diagnostic accuracy is required also for the short QT syndrome
    oscar,m jolobe

    Accurate measurement of the QT interval is relevant, not only for the diagnosis of long QT interval syndromes(1), but also for the recognition of short QT syndromes which are familial disorders now recognised to be characterised by complications such as a trial fibrillation, syncope, and sudden death, in the absence of structural heart disease(2)(3). The typical electocardiographic "signature" is a short QT interval associate...

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  • The wider issue of non-Wilsonian movement disorders associated with subnormal or borderline caerulop
    oscar,m jolobe

    When dealing with movement disorders which are associated with subnormal caeruloplasmin levels, account should be taken, not only of Wilson's disease(as was the case in a recent review)(1) where neurological features are attributable to copper deposition in the basal ganglia(2), but also of acaeruloplasminaemia, where neurological features are attributable to iron deposition in the basal ganglia, thalamus, dentate nucleus, an...

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  • Neurology in Iraq
    H Ramadan

    I am very grateful to Dr Amin's interest in this short letter and his useful comments. The aim of this letter was to inform PN readers about difficulties of Iraqi doctors especially neuroscience clinicians been through in light of successive damaging wars inflicted in to this country.

    Dr Amin himself, names he mentioned and others (locally and overseas trained) are among distinguished hardworking neurologists in...

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  • Neurology in Iraq; the past and the future, who is the winner?
    Osama SM Amin MRCPI, FCCP, FACP

    Many thanks to Ramadan and his colleagues for this article about neurology in the land of Mesopotamia. I have few notes:

    1. The author has not mentioned other neurologists who participated substantially in the creation of the subject "neurology in Iraq," and these are Muhammed Tawfiq, Fadhil Al-Hadithy, and Adnan Al-Araji; Ajeeb Ali practiced neurology in a city in the north of Iraq and was away from the teachi...

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  • Onset of subarachnoid haemorrhage during sleep
    Jeannette Hofmeijer (MD, PhD)

    Larner wrote an interesting article on morning headaches.1 We would like to react to the statement 'Onset of subarachnoid haemorrhage during sleep is extremely rare, if it occurs at all.' In October 2008 a 62 year old woman was seen on the emergency department. She reported moderately severe headache on awakening with chills and a slight dizziness. There was a history of ulcerative colitis and she smoked 5 cigarettes a da...

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  • sometimes, there is a reversal of roles
    oscar,m jolobe

    In the referring doctor vs consultant neurosurgeon interaction(1), there is, sometimes, a reversal of roles with the result that it is the patient(often elderly) who is confronted with the reality that he or she is not suitable candidate for acceptance by the neurosurgeon. For a succesful referral to take place the referring doctor(often a harassed trainee) has to make the patient marketable(2) to tertiary care, using...

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