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Coveney S, Murphy S, Belton O, Cassidy T, Crowe M, Dolan E, de Gaetano M, Harbison J, Horgan G, Marnane M, McCabe JJ, Merwick A, Noone I, Williams D, Kelly PJ. Inflammatory cytokines, high-sensitivity C-reactive protein, and risk of one-year vascular events, death, and poor functional outcome after stroke and transient ischemic attack. Int J Stroke 2021; 17:163-171. [DOI: 10.1177/1747493021995595] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Inflammation driven by pro-inflammatory cytokines is a new therapeutic target in coronary disease. Few data exist on the association of key upstream cytokines and post-stroke recurrence. In a prospective cohort study, we investigated the association between pivotal cytokines, high-sensitivity C-reactive protein (hsCRP) and one-year outcomes. Methods BIO-STROKETIA is a multi-center prospective cohort study of non-severe ischemic stroke (modified Rankin score ≤ 3) and transient ischemic attack. Controls were patients with transient symptoms attending transient ischemic attack clinics with non-ischemic final diagnosis. Exclusion criteria were severe stroke, infection, and other pro-inflammatory disease; hsCRP and cytokines (interleukin (IL) 6, IL-1β, IL-8, IL-10, IL-12, interferon-γ (IFN-γ), tumor-necrosis factor-α (TNF-α)) were measured. The primary outcome was one-year recurrent stroke/coronary events (fatal and non-fatal). Results In this study, 680 patients (439 stroke, 241 transient ischemic attack) and 68 controls were included. IL-6, IL-1β, IL-8, IFN-γ, TNF-α, and hsCRP were higher in stroke/transient ischemic attack cases (p ≤ 0.01 for all). On multivariable Cox regression, IL-6, IL-8, and hsCRP independently predicted one-year recurrent vascular events (adjusted hazard ratios (aHR) per-quartile increase IL-6 1.31, confidence interval (CI) 1.02–1.68, p = 0.03; IL-8 1.47, CI 1.15–1.89, p = 0.002; hsCRP 1.28, CI 1.01–1.62, p = 0.04). IL-6 (aHR 1.98, CI 1.26–3.14, p = 0.003) and hsCRP (aHR 1.81, CI 1.20–2.74, p = 0.005) independently predicted one-year fatality. IL-6 and hsCRP (adjusted odds ratio per-unit increase 1.02, CI 1.01–1.04) predicted poor functional outcome, with a trend for IL-1β (p = 0.054). Conclusion Baseline inflammatory cytokines independently predicted late recurrence, supporting a rationale for randomized trials of anti-inflammatory agents for prevention after stroke and suggesting that targeted therapy to high-risk patients with high baseline inflammation may be beneficial.
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Affiliation(s)
- S Coveney
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland
- Health Research Board Stroke Clinical Trials Network, Ireland
| | - S Murphy
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland
- Health Research Board Stroke Clinical Trials Network, Ireland
| | - O Belton
- University College Dublin, Conway Institute, Dublin, Ireland
| | - T Cassidy
- Health Research Board Stroke Clinical Trials Network, Ireland
- Medicine for the Older Person, St Vincent's University Hospital, Dublin, Ireland
| | - M Crowe
- Health Research Board Stroke Clinical Trials Network, Ireland
- Medicine for the Older Person, St Vincent's University Hospital, Dublin, Ireland
| | - E Dolan
- Health Research Board Stroke Clinical Trials Network, Ireland
- Medicine for the Older Person, Connolly Hospital Blanchardstown, Dublin, Ireland
| | - M de Gaetano
- University College Dublin, Conway Institute, Dublin, Ireland
| | - J Harbison
- Health Research Board Stroke Clinical Trials Network, Ireland
- Stroke Service, St James’ Hospital and Trinity College Dublin, Ireland
| | - G Horgan
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland
- Health Research Board Stroke Clinical Trials Network, Ireland
| | - M Marnane
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland
- Health Research Board Stroke Clinical Trials Network, Ireland
| | - JJ McCabe
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland
- Health Research Board Stroke Clinical Trials Network, Ireland
| | - A Merwick
- Health Research Board Stroke Clinical Trials Network, Ireland
- Stroke Department, Cork University Hospital, Cork, Ireland
| | - I Noone
- Health Research Board Stroke Clinical Trials Network, Ireland
- Medicine for the Older Person, St Vincent's University Hospital, Dublin, Ireland
| | - D Williams
- Health Research Board Stroke Clinical Trials Network, Ireland
- Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland
| | - PJ Kelly
- Stroke Service, Mater University Hospital and University College Dublin, Dublin, Ireland
- Health Research Board Stroke Clinical Trials Network, Ireland
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Lyndon D, Davagnanam I, Wilson D, Jichi F, Merwick A, Bolsover F, Jager HR, Cipolotti L, Wheeler-Kingshott C, Hughes D, Murphy E, Lachmann R, Werring DJ. MRI-visible perivascular spaces as an imaging biomarker in Fabry disease. J Neurol 2020; 268:872-878. [PMID: 33078310 PMCID: PMC7914182 DOI: 10.1007/s00415-020-10209-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/30/2020] [Accepted: 09/02/2020] [Indexed: 12/02/2022]
Abstract
Introduction Fabry disease (FD) is an X-linked lysosomal storage disorder resulting in vascular glycosphingolipid accumulation and increased stroke risk. MRI findings associated with FD include white matter hyperintensities (WMH) and cerebral microbleeds (CMBs), suggesting the presence of cerebral small vessel disease. MRI-visible perivascular spaces (PVS) are another promising marker of small vessel disease associated with impaired interstitial fluid drainage. We investigated the association of PVS severity and anatomical distribution with FD.
Patients and methods We compared patients with genetically proven FD to healthy controls. PVS, WMH, lacunes and CMBs were rated on standardised sequences using validated criteria and scales, blinded to diagnosis. A trained observer (using a validated rating scale), quantified the total severity of PVS. We used logistic regression to investigate the association of severe PVS with FD. Results We included 33 FD patients (median age 44, 44.1% male) and 20 healthy controls (median age 33.5, 50% male). Adjusting for age and sex, FD was associated with more severe basal ganglia PVS (odds ratio (OR) 5.80, 95% CI 1.03–32.7) and higher total PVS score (OR 4.03, 95% CI 1.36–11.89). Compared with controls, participants with FD had: higher WMH volume (median 495.03 mm3 vs 0, p = 0.0008), more CMBs (21.21% vs none, p = 0.04), and a higher prevalence of lacunes (21.21% vs. 5%, p = 0.23). Conclusions PVS scores are more severe in FD than control subjects. Our findings have potential relevance for FD diagnosis and suggest that impaired interstitial fluid drainage might be a mechanism of white matter injury in FD.
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Affiliation(s)
- D Lyndon
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, Institute of Neurology, Russell Square House, London, UK
| | - I Davagnanam
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK.
| | - D Wilson
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, Institute of Neurology, Russell Square House, London, UK.,New Zealand Brain Research Institute, Christchurch, New Zealand
| | - F Jichi
- Department of Biostatistics, University College of London, London, UK
| | - A Merwick
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, Institute of Neurology, Russell Square House, London, UK
| | - F Bolsover
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - H R Jager
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK
| | - L Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - C Wheeler-Kingshott
- Department of Neuroinflammation Queen Square MS Centre, UCL Institute of Neurology, London, UK
| | - D Hughes
- Lysosomal Storage Disorders Unit, Royal Free Hospital, Rowland Hill Street, London, UK
| | - E Murphy
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - R Lachmann
- Charles Dent Metabolic Unit, National Hospital for Neurology and Neurosurgery, London, UK
| | - D J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, Institute of Neurology, Russell Square House, London, UK
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Callaly EL, Ni Chroinin D, Hannon N, Sheehan O, Marnane M, Merwick A, Kelly LA, Horgan G, Williams E, Harris D, Williams D, Moore A, Dolan E, Murphy S, Kelly PJ, Duggan J, Kyne L. Falls and fractures 2 years after acute stroke: the North Dublin Population Stroke Study. Age Ageing 2015; 44:882-6. [PMID: 26271048 DOI: 10.1093/ageing/afv093] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/15/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stroke patients are at increased risk of falls and fractures. The aim of this study was to determine the rate, predictors and consequences of falls within 2 years after stroke in a prospective population-based study in North Dublin, Ireland. DESIGN Prospective population-based cohort study. SUBJECTS 567 adults aged >18 years from the North Dublin Population Stroke Study. METHODS Participants were enrolled from an Irish urban population of 294,592 individuals, according to recommended criteria. Patients were followed for 2 years. Outcome measures included death, modified Rankin Scale (mRS), fall and fracture rate. RESULTS At 2 years, 23.5% (124/522) had fallen at least once since their stroke, 14.2% (74/522) had 2 or more falls and 5.4% (28/522) had a fracture. Of 332 survivors at 2 years, 107 (32.2%) had fallen, of whom 60.7% (65/107) had 2 or more falls and 23.4% (25/107) had fractured. In a multivariable model controlling for age and gender, independent risk factors for falling within the first 2 years of stroke included use of alpha-blocker medications for treatment of hypertension (P = 0.02). When mobility measured at Day 90 was included in the model, patients who were mobility impaired (mRS 2-3) were at the highest risk of falling within 2 years of stroke [odds ratio (OR) 2.30, P = 0.003] and those functionally dependent (mRS 4-5) displayed intermediate risk (OR 2.02, P = 0.03) when compared with independently mobile patients. CONCLUSION Greater attention to falls risk, fall prevention strategies and bone health in the stroke population are required.
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Affiliation(s)
- E L Callaly
- Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland
| | - D Ni Chroinin
- Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland
| | - N Hannon
- Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland
| | - O Sheehan
- Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland
| | - M Marnane
- Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland
| | - A Merwick
- Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland
| | - L A Kelly
- Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland
| | - G Horgan
- Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland
| | - E Williams
- Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland
| | - D Harris
- Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland
| | - D Williams
- Beaumont Hospital, Dublin, Ireland Royal College of Surgeons, Dublin, Ireland
| | - A Moore
- Beaumont Hospital, Dublin, Ireland
| | - E Dolan
- Connolly Hospital, Dublin, Ireland
| | - S Murphy
- Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland Royal College of Surgeons, Dublin, Ireland
| | - P J Kelly
- Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland
| | - J Duggan
- Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland
| | - L Kyne
- Neurovascular Clinical Science Unit, Catherine McAuley Research Centre, Mater Misericordiae University Hospital, University College Dublin at Dublin Academic Medical Centre, Dublin 7, Ireland
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Merwick A, Dalmau J, Delanty N. Bickerstaff encephalitis and atypical features — Bickerstaff's papers revisited. J Neurol Sci 2014; 341:173. [DOI: 10.1016/j.jns.2014.03.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
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Adler H, Mat A, Merwick A, Chadwick G, Gullo G, Dalmau J, Tubridy N. O! WHAT A NOBLE MIND IS HERE O'ERTHROWN! J Neurol Neurosurg Psychiatry 2012. [DOI: 10.1136/jnnp-2012-304200a.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mullane D, Williams L, Merwick A, Tobin WO, McGuigan C. Drug induced aseptic meningitis caused by intravenous immunoglobulin therapy. Ir Med J 2012; 105:182-183. [PMID: 22973657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Drug induced aseptic meningitis (DIAM) is an uncommon condition that can mimic infective conditions. DIAM has been recognized with various treatments including non-steroidal anti-inflammatory drugs, monoclonal antibodies and some antibiotics. We report a patient presenting with aseptic meningitis forty-eight hours after commencing a course of intravenous immunoglobulin (IVIG) treatment. It is important that physicians prescribing this medication are aware of this rare complication so the diagnosis can be made quickly and the patient is not exposed to unnecessary treatments.
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Affiliation(s)
- D Mullane
- Department of Neurology, St Vincent's University Hospital, Elm Park, Dublin 4
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Giles MF, Albers GW, Amarenco P, Arsava EM, Asimos AW, Ay H, Calvet D, Coutts SB, Cucchiara BL, Demchuk AM, Johnston SC, Kelly PJ, Kim AS, Labreuche J, Lavallee PC, Mas JL, Merwick A, Olivot JM, Purroy F, Rosamond WD, Sciolla R, Rothwell PM. Early stroke risk and ABCD2 score performance in tissue- vs time-defined TIA: a multicenter study. Neurology 2011; 77:1222-8. [PMID: 21865578 DOI: 10.1212/wnl.0b013e3182309f91] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Stroke risk immediately after TIA defined by time-based criteria is high, and prognostic scores (ABCD2 and ABCD3-I) have been developed to assist management. The American Stroke Association has proposed changing the criteria for the distinction between TIA and stroke from time-based to tissue-based. Research using these definitions is lacking. In a multicenter observational cohort study, we have investigated prognosis and performance of the ABCD2 score in TIA, subcategorized as tissue-positive or tissue-negative on diffusion-weighted imaging (DWI) or CT imaging according to the newly proposed criteria. METHODS Twelve centers provided data on ABCD2 scores, DWI or CT brain imaging, and follow-up in cohorts of patients with TIA diagnosed by time-based criteria. Stroke rates at 7 and 90 days were studied in relation to tissue-positive or tissue-negative subcategorization, according to the presence or absence of brain infarction. The predictive power of the ABCD2 score was determined using area under receiver operator characteristic curve (AUC) analyses. RESULTS A total of 4,574 patients were included. Among DWI patients (n = 3,206), recurrent stroke rates at 7 days were 7.1%(95% confidence interval 5.5-9.1) after tissue-positive and 0.4% (0.2-0.7) after tissue-negative events (p diff < 0.0001). Corresponding rates in CT-imaged patients were 12.8% (9.3-17.4) and 3.0% (2.0-4.2), respectively (p diff < 0.0001). The ABCD2 score had predictive value in tissue-positive and tissue-negative events (AUC = 0.68 [95% confidence interval 0.63-0.73] and 0.73 [0.67-0.80], respectively; p sig < 0.0001 for both results, p diff = 0.17). Tissue-positive events with low ABCD2 scores and tissue-negative events with high ABCD2 scores had similar stroke risks, especially after a 90-day follow-up. CONCLUSIONS Our findings support the concept of a tissue-based definition of TIA and stroke, at least on prognostic grounds.
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Affiliation(s)
- M F Giles
- Stroke Prevention Research Unit, NIHR Biomedical Research Centre, Oxford University Department of Clinical Neurology, Level 6, West Wing, John Radcliffe Hospital, Oxford OX3 9DU, UK.
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Marnane M, Ni Chroinin D, Callaly E, Sheehan OC, Merwick A, Hannon N, Horgan G, Kyne L, Moroney J, McCormack PME, Dolan E, Duggan J, Williams D, Crispino-O'Connell G, Kelly PJ. Stroke recurrence within the time window recommended for carotid endarterectomy. Neurology 2011; 77:738-43. [PMID: 21849640 DOI: 10.1212/wnl.0b013e31822b00cf] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In the North Dublin Population Stroke Study, we investigated the risk of recurrent stroke within the 14-day time window recommended for endarterectomy. METHODS In a population-based prospective cohort study, all ischemic stroke patients were identified over 1 year and categorized into those with (CS-positive) and without (CS-negative) ipsilateral carotid stenosis (CS) (≥50% lumen narrowing). Nonprocedural stroke recurrence was determined at 72 hours and 7 and 14 days. RESULTS Of 365 ischemic stroke patients with carotid imaging, 51 were excluded due to posterior circulation or nonlateralizing stroke, ipsilateral carotid occlusion, or intracranial stenosis, leaving 314 included for analysis (36 CS-positive and 278 CS-negative). Recurrent stroke occurred in 5.6% (2/36) CS-positive and 0.4% (1/278) CS-negative patients by 72 hours of symptom onset (p =0.003), 5.6% (2/36) CS-positive and 0.7% (2/278) CS-negative patients (p =0.01) by 7 days, and in 8.3% (3/36) CS-positive and 1.8% (5/278) CS-negative patients by 14 days (p =0.02). On multivariable Cox regression analysis, CS was the only independent predictor of recurrence at 72 hours (adjusted hazard ratio [HR] 36.1, 95% confidence interval [CI] 1.6-837.5, p =0.03), and 7 days (HR 9.1, 1.1-79.2, p =0.05), with a trend at 14 days (HR 4.6, 0.9-22.8, p =0.06). CONCLUSIONS Although only a minority of patients with symptomatic CS had a recurrent stroke within 14 days, early recurrent stroke risk was high, particularly within the first 72 hours. Earlier carotid revascularization or improved acute medical treatment may reduce recurrence in this high-risk group.
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Affiliation(s)
- M Marnane
- Neurovascular Clinical Science Unit, Mater University Hospital/University College Dublin at Dublin Academic Medical Centre, Dublin, Ireland.
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Merwick A, Sweeney BJ. Functional symptoms in clinically definite MS--pseudo-relapse syndrome. Int MS J 2008; 15:47-51. [PMID: 18782499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/02/2007] [Accepted: 11/20/2007] [Indexed: 05/26/2023]
Abstract
Although the diagnostic criteria for multiple sclerosis (MS) have become more formalized and sensitive in the era of magnetic resonance imaging (MRI) scanning, the assessment of individual relapses may not always be straightforward or easily linked to a particular lesion seen on imaging. In addition, acute episodes often have to be assessed outside of normal working hours or when the individual patients usual medical team is not available. Often the emergency department physicians have little formal neurological training and are under time pressure to get patients through the system as quickly as possible. It is therefore possible to mislabel functional symptoms as being true relapses. To illustrate scenarios of possible pseudo-relapse, three clinical vignettes are described. Misclassification of functional symptoms as relapse carries a number of inherent risks. Functional symptoms can be multifactorial and may cause a burden of disease. A multidisciplinary approach may be useful in minimizing unnecessary harm and identify if there is more than meets the eye to an episode of clinical deterioration.
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Affiliation(s)
- A Merwick
- Department of Clinical Neurology, Cork University Hospital, Wilton, Cork, Ireland.
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Merwick A, Kelly S, Galvin R. Meningitis due to leptospiria hardjo--identifying a treatable cause of aseptic lymphocytic meningitis. Ir Med J 2008; 101:91. [PMID: 18540550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Merwick A, O'Sullivan SS, O'Regan KN, Marks CJ, Ryders DQ, Sweeney BJ. A role for myelography in assessing paraparesis. Ir Med J 2008; 101:21-22. [PMID: 18369020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Imaging of the spine is a fundamental part of assessment of paraparesis. Since the advent of MRI the indications for myelograms have diminished. However, a myelogram, although an invasive test, should still be considered a useful investigation for localising lesions in the spinal cord and for identifying rare causes of myelopathy. This case illustrates how a CT myelogram identified an arachnoid cyst, which is a potentially treatable cause of paraparesis.
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Affiliation(s)
- A Merwick
- Department of Clinical Neurology, Cork University Hospital, Wilton, Cork.
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