125 e-Letters

  • Ambiguity in EEG lies in the eyes of the beholder
    Nitin K. Sethi

    The term generalized in EEG is certainly ambiguous and can be a cause of confusion, especially to a reader who is not formally trained in neurophysiology. As a neurology resident in training, the importance of personally reviewing the patient's CT or MRI scan was impressed upon me time and time again. Do not just take the radiologist's report at face value, look at the pictures yourself since you after seeing the patient...

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  • We all need someone to lean on
    Nitin K. Sethi

    Dear Editor,

    Dr. Fuller makes a strong case for coaching in neurology(1). Formal coaching in neurology usually occurs during residency and fellowship training. In the United States we have the 360 degree evaluation. The resident physician in training is evaluated and coached by everyone he comes in contact with namely the staff attending, nursing staff, other residents, patient and even the medical student. There...

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  • Amantadine for Tardive dyskinesia: active in patients with overactive NMDA receptors
    Salvador Vale

    In the Saifee TA et al article (1) regarding the treatment of "Tardive movment disorders" (TD), the authors recommend the use of amantadine as second or third line among other possible drugs ("each with fairly limited evidence for effectiveness" in author?s words).

    In 1971, the late Dr. Espejel and I informed for the first time the benefits of amantadine in drug-induced dyskinesias (2); consequently, I have f...

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  • The Dunning Kruger effect
    Ibrahim Imam

    Geraint Fuller's neurological reflections describe the Dunning Kruger effect (1). This is one expression of illusory superiority, the cognitive bias that makes us over-rate our attributes (2). Apart from Shakespeare, whom the author quoted, other eminent people have noted that the less skilled and less educated are usually unaware of their inadequacy. Charles Darwin for example says: 'ignorance more frequently begets confi...

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  • Should neurologists throw away their stethoscopes?
    John W Norris

    As a long term and avid reader of Practical Neurology I was somewhat surprised by the article and correspondence suggesting that the stethoscope is now an irrelevancy to clinical neurologists (Practical Neurology 2010;10:344) On the contrary, I believe neurologists should still use their stethoscopes. Heres why.

    Most neck bruits indicate underlying arterial disease. For instance, in a study comparing the 'blind...

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  • CSF:plasma glucose
    oscar,m jolobe

    Although it is true that, in patients with suspected meningitis, a CSF:plasma glucose of >0.5 suggests a viral aetiology(1), underrecognition of the fact that the ratio may sometimes fall below 0.5 has led to inclusion of a CSF:plasma ratio > 0.5 among the "clinical case definitions" of aseptic meningitis(2), notwithstanding the fact that CSF:plasma glucose ratios below 0.5(and even as low as 0.26) may be encounte...

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  • Warum in die Ferne schweifen, wenn das Gute liegt so nah? - Goethe. (Why search far afield when the good is so nearby?)
    Annett Blochberger

    Dear Editor

    Imagine my surprise on reading your recent editorial regarding head injury. Perhaps the editor could have looked a little closer to home before concluding that neurologists in the UK are not involved in the management of patients with head injuries per se.

    I am a neurosciences pharmacist who is working very closely with a consultant neurologist who has recently developed a fully comprehens...

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  • Formula given in this paper cannot be used to calculate the QTc
    Tony Lopez

    The formula given in this paper can only be used to calculate a QTc if the variables QT and RR are entered as time measured in seconds.

    The RR is not the "heart beat in beats per min". It is the time elapsing between R wave peaks eg ten small squares which equals 0.4 seconds.

    Sadly, despite the obvious good intentions of this paper, any neurologist who follows the instructions to calculate the QTc wil...

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  • sometimes a stethoscope may be more of a hinderance than a help
    oscar,m jolobe

    The irony of the provocative invocation "Get rid of your stethoscope"(1) is that, for evaluation of systolic blood pressure(SBP) in the context of hypertension-related neurological disorders such as stroke(hypertension being the underlying cause of 54% of strokes worldwide)(2), and reversible cerebral vasoconstrictor syndrome(3), palpatory measurement of sytolic blood pressure may be a good substitute for auscultation, a...

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  • I like my stethoscope!
    Nitin K. Sethi

    We read with interest Dr. Hawkes point of view titled "get rid of your stethoscope"1. In his indomitable style of writing (which we have grown to appreciate!) he makes a rather outlandish plea to neurologists around the world to sell their stethoscopes and move on to new more fancy gizmos. I trust Dr. Hawkes takes this polarized viewpoint with the intention to spur debate among the readers. Old technology is not synonymous...

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