A diagnostic sign in migraine?

At the bedside it was noted that, after ocular fundoscopy, patients with migraine complained more often of an after-image than did non-migraineurs. This phenomenon was then investigated in consecutive patients attending a general neurology outpatient clinic. The relative risk for the diagnosis of migraine in patients reporting an after-image was 2.91 (95% confidence interval 1.96 to 4.34), and the sensitivity, specificity and positive predictive value of this observation for the diagnosis of migraine were 0.63, 0.75 and 0.55 respectively. After-images were equally likely to be reported by migraineurs with and without aura, and by patients with migraine equivalents. The after-image phenomenon probably reflects the heightened sensitivity to visual stimuli of patients with migraine. Although a diagnosis of migraine is primarily established by the patient's history, the presence of an after-image following ocular fundoscopy may support this diagnosis.

Variant Creutzfeldt-Jakob disease: an update

There cannot have been many medical publications this decade that have had an impact to equal that of the paper by Robert Will and colleagues on a ‘new variant’ of Creutzfeldt–Jakob disease (CJD), published in the Lancet in April 1996 (Will et al, 1996). This did not simply affect the scientific community, but also farming, economics, politics and diplomacy.

Pure alexia without agraphia: a classical cortical syndrome revisited

A patient who developed pure alexia without agraphia following a stroke is described. An infarction of the left occipital pole was demonstrated by Magnetic Resonance Imaging (MRI). The literature on this rare syndrome is reviewed, and the localisation of damage in relation to the clinical findings discussed.