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IntroductionCare of patients with suspected Idiopathic Intracranial Hypertension (IIH) involves neurolo- gists and ophthalmologists, however this can be difficult to co-ordinate. Consensus guidelines suggest all patients with suspected IIH should have weight, visual fields, neuroimaging and a CSF opening pressure. The aim of our study was to determine adherence to consensus guidelines.MethodsWe assessed medical notes of consecutive patients attending the new joint neuro-ophthalmol- ogy clinic in the Great Western Hospital, Swindon between 1st September–31st December 2020. Due to the Covid-19 pandemic a neurologist was not always present.ResultsOf 38 patients attending the clinic with suspected IIH, 35(92%) were female. 29(76%) had weight recorded; 14(37%) patients had BMI recorded, 12(32%) had BP recorded; 36(95%)had visual fields recorded, 12(32%) and 17(45%) respectively had whether neuroimaging or lumbar puncture were required. 23(61%) had weight management discussed, 22(58%) had a medication review discussed.ConclusionDocumentation of weight, BMI, BP, investigation results and management discussions could be improved in the joint neuro-ophthalmology clinic. We aim to address this by introducing an “IIH clinic checklist” for use by clinicians and patients to help improve adherence to consensus guidelines.kitt.dokal@kcl.ac.uk

Chronic traumatic encephalopathy (CTE) is a neurodegenerative tauopathy associated with repeated subconcussive and concussive head injury. Clinical features include cognitive, behavioral, mood, and motor impairments. Definitive diagnosis is only possible at postmortem. Here, the utility of neuroimaging in the diagnosis of CTE is evaluated by systematically reviewing recent evidence for changes in neuroimaging biomarkers in suspected cases of CTE compared with controls.Providing an update on a previous systematic review of articles published until December 2014, we searched for articles published between December 2014 and July 2016. We searched PubMed for studies assessing neuroimaging changes in symptomatic suspected cases of CTE with a history of repeated subconcussive or concussive head injury or participation in contact sports involving direct impact to the head. Exclusion criteria were case studies, review articles, and articles focusing on repetitive head trauma from military service, head banging, epilepsy, physical abuse, or animal models.Seven articles met the review criteria, almost all of which studied professional athletes. The range of modalities were categorized into structural magnetic resonance imaging (MRI), diffusion MRI, and radionuclide studies. Biomarkers which differed significantly between suspected CTE and controls were Evans index (P = 0.05), cavum septum pellucidum (CSP) rate (P0.0006), length (P0.03) and ratio of CSP length to septum length (P0.03), regional differences in axial diffusivity (P0.05) and free/intracellular water fractions (P0.005), single-photon emission computed tomography perfusion abnormalities (P0.01), positron emission tomography (PET) signals from tau-binding, glucose-binding, and GABA receptor-binding radionuclides (P0.0001, P0.005, and P0.005, respectively). Important limitations include low specificity in identification of suspected cases of CTE across studies, the need for postmortem validation, and a lack of generalizability to nonprofessional athletes.The most promising biomarker is tau-binding radionuclide PET signal because it is most specific to the underlying neuropathology and differentiated CTE from both controls and patients with Alzheimer disease (P0.0001). Multimodal imaging will improve specificity further. Future research should minimize variability in identification of suspected cases of CTE using published clinical criteria.

Background Migraine-tic syndrome was first reported in 2004 in a 44-year-old woman who had concomitant symptoms of both typical trigeminal neuralgia and migraine. We report here two further cases of migraine-tic syndrome and speculate on the relevance of this condition to the pathophysiology of headache. Case reports A 43-year-old woman presented with typical trigeminal neuralgia symptoms that preceded the onset of migraine headache; both headache types responded to treatment with sumatriptan. A 35-year-old woman presented with trigeminal neuralgia that consistently followed the onset of migraine headache. The former aspect responded to baclofen, but the migraine headache required treatment with amitriptyline. Discussion These two patients provide further support for the presence of an overlap syndrome of migraine-tic. We suggest that there is a common pathway for trigeminal neuralgia and migraine.

Injury to the spinal cord (myelopathy) can be due to many causes.

Adaptive behaviors require preparation and when necessary inhibition or alteration of actions. The right hemisphere has been posited to be dominant for preparatory motor activation. This experiment was designed to learn if there are hemispheric asymmetries in the control of altered plans of actions. Cues, both valid and invalid, which indicate the hand most likely to be called onto respond, as well as the imperative stimuli that indicate the actual response hand, were presented to either the right or left visual fields of 14 normal right handed participants. The delay after a miscue is dependent on the time taken to inhibit the premotor and motor systems of the incorrectly activated hemisphere, as well as to activate the motor systems of the opposite hemisphere, which might have been interhemispherically inhibited by this miscue. Analyses of reaction times revealed that miscues presented in left hemispace (right hemisphere) cost more time than those miscues presented in right hemispace (left hemisphere), suggesting that activation of the preparatory systems controlled by the right hemisphere may take longer to reverse than those controlled by the left hemisphere. This asymmetry may be related to asymmetries in the strength of hemispheric activation with contralateral inhibition.

20% of acute medical patients present with neurological symptoms, yet are often managed by non-specialist acute physicians. This district general hospital (DGH) introduced a direct access neurology clinic, to reduce hospital admissions and improve access to neurological expertise for vulnerable patients. Patients would otherwise have been admitted to await ward consultation. 20 ‘Hot’ clinic appointments each week were allocated by administration prior to discharge from the medical admissions unit. All appointments were within 48 hours. Common diagnoses were migraine, first seizure, and non-epileptic attack disorder and rarer presentations included 5 with transverse myelitis, 1 with cerebral vasculitis, and 1 with Hepatitis E related encephalomyelopathy.243 patients were seen by a Consultant Neurologist in 9 months in this hot clinic, thus saving at least 243 bed days and £73 000. Only 4 of these patients were readmitted. The hot clinic required 4PAs of consultant time split across weekdays, at an estimated cost of £30 000 per annum.This neurology acute clinic successfully provided front door neurological input, a vital service for GPs and patients, and made approximate annual saving of £70 000. Evidently, every DGH should consider implementing neurology ‘hot’ clinics.

Non-epileptic attack disorders (NEAD) and functional weakness present diagnostic and therapeutic challenges for both neurologists and psychiatrists. Compounded by limited hard evidence, pathways for the treatment of functional disorders are often poorly organised. This study was a historical review of 56 patient records. 45 patients had NEAD (2 with additional functional weakness) and 11 patients functional weakness only. 60.7% of patients were female, with a mean age of 44.2 years. Delay to diagnosis was 32.1 (±16.2) months. 81% of patients with functional weakness were referred from their GP, but only 51% for NEAD. No GP surgeries were identified for targeted intervention. Co-morbidities varied noticeably with diagnosis: history of epilepsy and anxiety prominent for NEAD versus other functional disorders and headache in functional weakness. Analysis of admissions data showed that for NEAD, diagnosis reduced admissions significantly, whereas this was not the case for functional weakness. This retrospective case review suggests a potential difference in co-morbidities and response to diagnosis between patients with NEAD and patients with functional weakness, and highlights the importance of early diagnosis in NEAD.