eLetters

121 e-Letters

  • 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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  • "thromboembolism until proved otherwise" should be the mantra
    oscar,m jolobe

    In the presence of risk factors for thromboembolism, a focal neurological episode which has a sudden onset should be assumed to be embolic until proved otherwise. Whether or not that episode is purely ischaemic, or whether or not it undergoes subsequent hamorrhagic transformation is a separate issue which should not detract from the urgency to identify the embolic source by means of echocardiography. That is why I am so...

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  • A plea to neurologists, especially privileged British neurologists.
    Gavin Giovannoni

    Sometimes it is necessary to make a point with overemphasis and we believe that was done in the letter by Chris Hawkes. We agree that it is essential to talk to a patient and to watch them and observe how they speak, what they are saying and what they are doing with their body as they walk in and out of a room. However, to exclude the examination is a form of conceit. The only reason that a very senior neurologist can o...

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  • Stop examining patients? Stop investigating them also.
    Richard G. Knight

    I am in general agreement with the notion expressed in Professor Hawkes' editorial that many patients in neurology outpatient clinics do not need examination. Certainly, the full neurological examination has a rather Zen-like quality: it takes a great deal of work to master it and then one finds one doesn't really need it. However, I would like to express a number of disagreements with some of what Professor Hawkes wr...

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  • The death of the neuro exam: not so soon please!
    Chloe E Hill

    Dear Editor,

    I read the title of Dr. Hawkes’ editorial three times before I was certain I had read it correctly1. As a fourth year medical student about to apply for a neurology residency, I was initially bewildered. When I read on though, I was impressed not only with his candidness, but also by the validity of what he was saying; although I am a newcomer, it does not take long to appreciate that imaging is cent...

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  • The death of clinical neurology: not so soon please!
    Nitin K Sethi

    Dear Editor,

    I read with interest the editorial by Dr. Hawkes titled “I have stopped examining patients!”1. The title appropriately has an exclamation mark at the end highlighting his shocking claim. I have to commend Dr. Hawkes for finally coming out and admitting boldly and maybe somewhat proudly what most neurologists already know but are afraid to accept.
    Bedside clinical neurology is a dyin...

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  • Careful Examination Irreplaceable
    Roger L. Albin

    Dear Editor,

    Perhaps because I don't have Dr. Hawkes' degree of experience (I have approximately 25 years of practice experience), I disagree very strongly with his conclusion. Careful examination remains the cornerstone of neurologic practice. I agree that a great deal of information is gleaned from informal examination - watching the patient walk into the exam room, etc. I agree as well that for paroxysmal d...

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  • Premature closure and other unintended consequences of omitting the clinical examination
    oscar,m jolobe

    Dear Editor,

    The admission that a neurologist has stopped examining patients(1) is a disturbing one, given the fact that "the practice of medicine is the art of drawing conclusions from incomplete evidence"(2), thanks to the fact that, as clinicians, "we work in a probabilisic enviroment in which the evidence we gather bears an imperfect relationship to its cause"(3).

    Accordingly, the evidence initial...

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  • Bipartisanship
    Roger L. Albin

    Dear Editor,

    It is not correct that the Democratic Party has historically been the major underwriter of biomedical research in the USA. American science, and biomedical science in particular, benefited historically from substantial bipartisan support. The major increase in NIH funding of the Clinton period owed at least as much to actions of moderate Republicans like Rep. John Porter (Republican of Illinois) an...

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