bluuebunny/crossref_metadata_2025_split huggingface dataset:
1 Asymptomatic meningiomas: not so indolent after all?
Authors: Christopher Edward 
Published: March 2023

The incidental discovery of asymptomatic meningiomas and their conservative management are becoming more common with the growth in accessibility and use of neuroimaging. These asymptomatic meningiomas may predispose patients to certain risks, some of which can potentially be fatal.This case describes a 75-year-old woman with known asymptomatic meningiomas and recent history of urosepsis who initially developed recurrent focal motor seizures before rapidly decompensating into super-refractory status epilepticus (SRSE) requiring general anaesthesia. MRI demonstrated the formation of abscess secondary to an infected meningioma (meningioma abscess). She underwent abscess resection and was managed with antibiotics and maintenance antiepileptic drugs post-operatively. The meningioma abscess culture grew the same organism as the urine culture from the preceding urosepsis, suggestive of haematological seeding. She was neurologically and clinically stable and remained seizure-free at three months follow up.Only ten cases of meningioma abscesses have been reported to date. Risk factors or recent history for infection can be found in all cases. The three joint most common symptoms are fever, headache, and seizures. Our case illustrates the most potentially fatal sequela of meningioma abscess reported to date.Meningioma abscess is an important differential/complication to recognise in patients with known meningioma in the context of systemic infection. This is becoming increasingly important as the incidental discovery of asymptomatic meningiomas and the proportion of elderly patients with comorbidities and immunosuppression continue to increase. Early suspicion and setting low thresholds for imaging can lead to timely management, improve prognosis, and avoid potentially fatal complications such as SRSE.
2 Meningitis management audit at a single centre: further support for culture-independent techniques in diagnosing meningitis
Authors: Williams Simon , Hassan-Smith Ghaniah 
Published: March 2023

ObjectiveRapid identification of meningitis and initiation of rational treatment is critically important. We reviewed whether our management was consistent with recent recommendations, for patients treated August 2015-July 2018.MethodsPatients aged ≥16 coded as having meningitis/meningoencephalitis/specific meningitides (total codes=27) at QEHB over this period (n=497) were identified by informatics and data analysed using electronic records. Specific patient groups were analysed including post-neurosurgical and community-acquired meningitis.Results183 patients met the inclusion criteria, for community-acquired meningitis (n=118) or post-neurosurgery (n=65). Within the A&E subgroup (n=92), 80% received neuroimaging pre-LP despite 78% not having contraindication to LP. Median time to LP was 19hours (IQR:11.0–31.0); none performed within 1hour. Antibiotics were administered prior to LP in 72% cases. No neurosurgical patients had meningococcal/pneumococcal serum or CSF PCR sent. Serum PCR was sent in 11% of community-acquired meningitis patients - 23% were positive. CSF PCR was sent in 28% - 22% were positive. None of these cases had positive CSF culture.ConclusionsDespite BIA recommendations, time-to-LP was delayed and culture-independent techniques such as serum/CSF PCR for bacterial pathogens were under-utilised, despite out-performing CSF culture. The emergence of novel culture-independent methods, including targeted point-of-care and unbiased-metagenomic sequencing, are likely to become increasingly relevant.
09.48 Acute psychosis in a young woman
Authors: Gorgoraptis Nikos , Kolanko Magda , Petridou Christina , Patel Sachin , Singh-Curry Victoria , Davies Nicholas , Irani Sarosh , Carswell Christopher 
Published: March 2023

NMDA receptor (NMDA-R) encephalitis may occur as a post-infectious syndrome following HSV encephalitis. Borrelia burgdorferi is not a well-established infective trigger of NMDA-R antibody encephalitis. There is one previous report of NMDA-R antibodies in association with Lyme disease.We report the case of a 27-year-old woman who presented with acute psychosis. She had a history of tick bite in Slovenia two months previously, followed by headache, flu-like symptoms and diplopia two weeks later. She then developed behavioural disturbance, with disinhibition, disordered thought and paranoia, resistant to antipsychotic medication. MRI brain revealed multiple white matter lesions and diffuse cranial nerve enhancement. CSF was active. Lyme serology (Borrelia IgG and IgM immunoblot) was positive. NMDA-R antibodies were positive (serum and CSF; fixed- and live-cell assays). Infective, autoimmune and neoplastic workup was otherwise unremarkable. She received antimicrobial treatment for neuroborreliosis as well as a course of intravenous immunoglobulin, with gradual resolution of the neuropsychiatric disturbance, normalisation of her neuropsychological assessment and improvement of the MRI appearances. Repeat NMDA-R antibody testing upon convalescence was negative in the serum and CSF (live-cell assay).This is the second reported case of NMDA-R antibody positivity with clinical features of NMDA-R antibody-associated encephalitis in serologically confirmed Lyme disease.
11.42 The scottish epilepsy deaths study (SEDS): identifying avoidable epilepsy-related deaths
Authors: Mbizvo Gashirai K , Schnier Christian , Simpson Colin R , Chin Richard FM , Duncan Susan E 
Published: March 2023

PurposeQuantify avoidable epilepsy-related mortality in adults (aged ≥ 16 years).MethodWe identified adult epilepsy-related deaths occurring between 01/01/2009–2016 in Scotland by linking death certificates to administrative primary and secondary care datasets. International Classification of Disease (ICD-10) codes (G40–41, R56.8), Read Codes (F25..), and antiepileptic drugs (AED) were examined in the linked dataset to identify potential epilepsy patients, using clinical data from medical records as a diagnostic reference to calculate positive predictive values (PPV). EPRDs were determined from death certificates (including post-mortem indicators) and medical records, estimating their standardised mortality ratio (SMR) and mortality rate (MR). The Office for National Statistics’ Revised Definition of Avoidable Mortality Causes 2016 was used to identify potentially avoidable EPRDs.ResultsCombining AED prescription with death certificate epilepsy codes G40–41 had the highest PPV (99%) for epilepsy diagnosis. There were 2,149 EPRDs. Age-standardised MR per 100,000 ranged between 6.8 (95%CI 6.0–7.6) in 2009 and 9.1 (95%CI 8.2–9.9) in 2015. SMR was higher in young adults (≤55 years), peaking at 6 (95%CI 2.3–9.7) in the 16–24-year-old group. There were 579 EPRDs in those aged ≤55 years. 31% were SUDEP, 26% respiratory causes (mainly aspiration pneumonias), and 15% mental disorders (mostly alcohol-related). 79% of all EPRDs were potentially avoidable. Commonest modifiable factors were absent epilepsy specialist input, poor patient education, and drug errors.ConclusionThe burden of avoidable epilepsy-related mortality remains high, particularly in young adults.
12.30 Do anticholinergic drugs increase alzheimer’s pathology in parkinson’s patients? A retrospective post-mortem investigation
Authors: Liu Alan King Lun , Lim Yau Mun , Pearce Ronald KB , Gentleman Steve M 
Published: March 2023

IntroductionRecent studies have highlighted the accumulated use of anticholinergic drugs is associated with an increased risk of dementia, and many of those are used for symptomatic management in Parkinson’s disease (PD). Unfortunately, the only available post-mortem study investigating the effect of anticholinergic agents on Alzheimer’s pathology burden suffers from several methodological limitations. Therefore, we aimed to validate if cumulative use of anticholinergic medication will increase Alzheimer’s pathologies in the post-mortem PD brains.Material and methodsRetrospective case note analysis was carried out on 54 selected PD cases from the Parkinson’s UK Brain Bank and cases were stratified into no, low and high anticholinergic burden using literature-based anticholinergic scores. Association of anticholinergic burden and Alzheimer’s pathology in post-mortem tissues was analysed with logistic regression modelling.ResultsA higher anticholinergic burden is associated with a greater tau burden in entorhinal cortex in PD cases (OR=2.21). Interestingly, a high anticholinergic burden decreases the odds of amyloid-beta presence in the anterior hippocampus (OR=0.127), entorhinal cortex (OR=0.124) and frontal cortex (OR=0.113) of PD cases.ConclusionWe have demonstrated that anticholinergic drugs have varying effect on Alzheimer’s pathology in post-mortem PD brain tissues. Complex mechanism is probably involved and require further studies.
11.54 Current challenges in the assessment and diagnosis of optic disc swelling and idiopathic intracranial hypertension
Authors: Ransley George , Vijay Vivek , Grant Laura , Bahra Anish 
Published: March 2023

Optic disc swelling is a challenging presentation with a wide differential including potentially life-threatening diagnoses alongside benign causes. In this retrospective review, we assess over 33,000 referrals to an Eye Treatment Centre between 2014 and 2018. We identify 167 referrals for ‘optic disc swelling’ or similar terms. The overall rate of referrals to the ETC remained stable throughout this period, however the rate of referrals for optic disc swelling increased almost threefold from 2016 onwards. This was primarily due to a large increase in the number of referrals from Opticians, which correlates chronologically with the case of missed papilloedema resulting in a criminal conviction of the optometrist in question, Honey Rose.77 patients were confirmed to have papilloedema, and in this group the most common final diagnosis was Idiopathic Intracranial Hypertension (IIH). 74 patients were diagnosed with pseudopapilloedema, the most common cause of which was drusen. Of note, over one-fifth were found to have normal optic discs on examination.Pathways for the workup of patients with suspected IIH were examined. A large proportion of patients experienced delays of up to 31 months awaiting essential imaging or lumbar puncture. Importantly, 37% never had venography.
12.06 Gait symptoms correlate with cognitive problems in parkinson’s
Authors: Tilley BS , Romozzi M , Hession CM , Shiwani T , Goldfinger MH , Gentleman SM , Nicholas R 
Published: March 2023

The akinetic-rigid (AR) subtype of Parkinson’s disease (PD), characterised by rigidity, akinesia and gait impairment, is associated with cognitive impairment unlike the tremor dominant (TD) subtype. It is unknown which symptoms in AR-PD drive this relationship, and whether individual symptoms are better predictors of cognitive impairment than motor subtype.MethodsUsing a 100 item questionnaire, self-rated symptom severity data on PD-related symptoms sampled when the person signed up to the Parkinson’s UK Tissue Bank. Multivariate regression analysis was used to assess individual symptom scores as predictors of cognitive impairment severity, measured using composite scores of the cognitive symptom questionnaire items.ResultsGait disturbance was the only motor symptom predicting increasing cognitive impairment score (β=0.4025; p=0.0003). Additional significant predictors included: neuropsychiatric symptom score (β=0.2952; p=0.001), anosmia score (β=0.627; p=0.0004) and hallucination score (β=0.7586; p<0.0001).DiscussionGait disturbance, hallucinations, neuropsychiatric symptoms and anosmia are associated with cognitive impairment in PD. Gait disturbance is unique among PD motor symptoms, in its relationship to cognitive impairment. Individual motor symptoms are of greater prognostic value than motor subtypes.
017 When the (genetics) penny drops…
Authors: Sutton Fiona , Mattoscio Miriam , Rosser Elisabeth , Silva Rajith de 
Published: March 2023

BackgroundDrop attacks are commonly referred to Neurologists and their differential diagnosis is wide. The family history and clinical examination proved critical in establishing the (very rare) cause here.Clinical caseA 21-year-old man was seen with drop attacks provoked by auditory stimuli. He had global developmental delay, and dysmorphic features- traits shared by his mother, sister and brother (none of whom had neurological complaints or severe learning disability [LD]). Examination revealed hypertelorism, low slanting palpebral fissures, ‘fleshy’ hands & tapering fingers and kyphoscoliosis. His mother and sister had similar hands.An archived genetic test confirmed the presence of a mutation in RPS6KA3, supporting the diagnosis of Coffin-Lowry syndrome (CLS). CLS is rare (1:50,000) and X-linked dominant. In addition to LD and dysmorphic features (as here), stimulus-induced drop attacks (responsive to Clonazepam, usually) are common.CLS affects women less severely, due to the ameliorating effect of the non-mutated allele in females. The mildly affected brother of the proband has Klinefelter’s syndrome.Our patient’s attacks were completely abolished with Clonazepam.Key pointsThe differential diagnosis of drop attacks is wide.Don’t forget the family!Genetic testing, as well as elucidating diagnoses, can point to effective therapies.
018 Lost in translation: documentation of on call neurology advice and the clinical impact of discrepancies
Authors: Mahmood Ammad , Davidson Amy , Dani Krishna 
Published: March 2023

BackgroundOn-call neurology advice in the West of Scotland is centralised to one site handling 128±19 calls during working hours weekly. Telephone advice is documented at the regional centre by the neurologist and in patients’ notes by the referrer. Errors in transcription can result in patient harm.MethodsNeurologists’ documentation was compared retrospectively to patients’ notes to identify discrepancies which were classified as major or minor based on potential for harm. Analysis was undertaken for one week in November 2016. A change in practice was implemented with all neurologists’ documentation uploaded electronically to the patients’ case record. The analysis was repeated in November 2018.Results53 cases were analysed before intervention and 63 afterwards. Post intervention the following improvements were seen: proportion of unsatisfactorily documented cases reduced from 21%→13% (undocumented cases increased 8%→13%, incomplete/inaccurate cases reduced 13%→0%); number of major and minor cases reduced (3→1 and 6→1 respectively); proportion of patients not receiving recommended treatment reduced from 20%→0%. The proportion of patients not undergoing recommended investigations increased from 10%→14%.ConclusionIn a regional service, neurologists documenting on-call advice in a manner accessible to all care providers led to reduced potential for patient harm, particularly in patients receiving recommended treatment.
019 A rare cause of oculomotor nerve palsy
Authors: Jones Andrew , Williams Toby , Herwadkar Amit , McKee David , Kobylecki Chris 
Published: March 2023

IntroductionBehçet’s disease is a multisystem inflammatory disease of unknown aetiology characterised by oral and genital ulceration, vascular lesions, and ocular, cutaneous and neurological manifestations. Many disease features are due to vasculitis and it is particular for its involvement of all sizes of blood vessels on both sides of the circulation.Case reportWe present a report of a 43-year-old female with a background of severe neurological complications of Behçet’s disease (previous rhombencephalitis) presenting with left-sided headache, neck pain, photophobia, diplopia, nausea and vomiting. Complete left third nerve palsy developed during admission. MR brain imaging excluded acute parenchymal disease but was suggestive of a left posterior communicating artery aneurysm, confirmed on CT angiogram. Urgent catheter angiography demonstrated a 5×3 mm left anterior choroidal artery aneurysm, which was occluded by coiling. Two months later, left oculomotor nerve palsy had resolved and follow-up imaging at six months showed stable appearances.DiscussionIntracranial aneurysms are a rare but potentially life-threatening complication of Behçet’s disease. Intracranial aneurysms are potentially treatable and should be considered in Behçet’s patients presenting with intracranial pathology.
11.15 ABN survey 2016: geographic variations in service provision
Authors: Fernandes Peter , Mummery Cath 
Published: March 2023

IntroductionThe 2016 ABN Acute Neurology survey provides a wealth of data on geographic variations in the provision of neurological services. In this abstract we discuss differences in access to neurological care and services with respect to the 19 ABN regions.Methods2016 ABN survey data were analysed by region with bed data obtained from ONS records. Missing data were checked where possible but otherwise assumed to be negative responses.ResultsAcross the UK there are 263 beds/FTE consultant, ranging from 455 (Wales) to 154 (SW Thames). Neurology inpatients as a proportion of total patients differ 16-fold between South West (0.016) and Wales (0.001). There are wide variations in acute neurological services (ward consultants, acute clinics, MAU ward-rounds). Only East Anglia and Northern Ireland regions have on-site stroke thrombolysis in all hospitals. Involvement in acute stroke thrombolysis ranges from 2.5 neurology consultants/hospital (Wessex) to 0 (NW Thames and Mersey). Access to investigations differs widely for 24/7 MRI (35% all hospitals, regional ranges 0% to 83%); EEG (61% [38%-85%]); NCS/EMG (57% [20%-85%]); and on-site neuro-radiology (38% [17%-71%]).ConclusionThese data show considerable differences in a variety of metrics between ABN regions, with implications for equitability of care.
032 Clinical audit research and evaluation for motor neurone disease (CARE-MND): alignment with clinical care standards
Authors: Beswick Emily , Newton Judith , Pal Suvankar , Colville Shuna , Davenport Richard , Morrison Ian , Swingler Robert , Gorrie George , Bateman Antony , Chandran Siddharthan 
Published: March 2023

AimsTo establish 14 Key Performance Indicators (KPIs) of clinical care to provide a prospective audit framework to review routinely collected data fields on the Care Audit Research Evaluation (CARE-MND). Based upon Scottish and UK motor neuron disease (MND) standards of clinical care outlined in HIS/QIS Neurological Standards (2009) and NICE MND Guidelines (2016).Methods14 KPI categories of clinical care were reviewed. The completion percentage of 53 fields from CARE-MND were analysed for deceased people with MND (pwMND) diagnosed between 01/01/2015 and 31/12/2018.ResultsThere was a 73% average completion in data capture for deceased patients diagnosed in the specified range for the 14 KPI areas of clinical care.ConclusionsThe introduction of CARE-MND as a research register and tool to support clinical care has resulted in more complete routine data capture of information which can be used to audit and improve delivery of care. The KPI audit framework will be repeated in the future to assess variation in data capture.
033 Audit on the diagnostic pathway of patients with glioma mimics
Authors: Joe Dorothy , Lavrador Jose , Vergani Francesco , Gullan Richard , Bhangoo Ranjeev , Ashkan Keyoumars , Finnerty Gerald 
Published: March 2023

BackgroundConditions such as primary CNS lymphoma (PCNSL) or demyelinating/inflammatory diseases may present with similar clinical and neuroradiological features to gliomas. These ‘glioma mimics’ are commonly diagnosed with brain biopsy, but this is not always possible. We aim to optimize the contribution of less invasive investigations to the diagnostic pathway.MethodRetrospective review of the diagnostic process of glioma mimics between September to November 2018 in a tertiary Neuro–oncology unit.ResultsThe Neuro-oncology MDT gave 558 opinions excluding post –operative reviews. Twelve cases were identified as glioma mimics. 6/12 were new cases. Further investigations in five new cases took 2.5 – 11 weeks to complete. Two patients deteriorated during diagnostic workup and had expedited brain biopsies which confirmed PCNSL. One proceeded with chemotherapy and one was referred to palliative care.ConclusionDiagnostic tests prior to brain biopsy were not performed in all glioma mimic cases. This was because test results excluding brain biopsy were not available to start treatment before the patient deteriorated clinically. We anticipate that the frequency of glioma mimics will increase due to the greater use of immunomodulatory therapies. A dedicated protocol to achieve rapid diagnosis of glioma mimics is imperative to facilitate early, appropriate treatment.
035 RAID referral patterns in neurology in-patients
Authors: See Stephanie Mei Ling , Cahill Varduhi , Khan Geoffrey , Jacob Saiju 
Published: March 2023

BackgroundStudies have shown that the psychiatric burden of progressive and debilitating spectrum of neurological diseases increases the general prevalence of psychiatric illnesses in neurology wards to up to 64%.AimThis service evaluation is to analyse the interface and referral patterns to liaison psychiatry (RAID) in neurology inpatients compared to general medicine inpatients.MethodsOur retrospective data collection and analysis studied 100 neurology inpatients and 100 general medicine inpatients randomly selected within 1 year.ResultsThe RAID referral rate from neurology inpatients was three-fold to that of general medicine inpatients. In this group, the neurological inpatients had twice the length of hospital stay, higher re-referral rates and required highly specialised psychiatry input.Clinical ImplicationsThis highlights the growing overlap between psychiatry and neurology as well as its vulnerable sustainability as separate entities. We discuss the possibility of altering the formal training curriculum to accommodate the cross-overs between specialties and introduce better screening processes for psychiatric illnesses within neurology wards, hence providing a more cost-effective and holistic service.
038 MACE: optimal cut-offs for dementia and MCI
Authors: Larner AJ 
Published: March 2023

ObjectiveTo determine optimal test cut-offs for diagnosis of dementia and MCI using the mini-Addenbrooke’s Cognitive Examination (MACE) and compare these with index study cut-offs (Dement Geriatr Cogn Disord 2015;39:1–11), and to calculate MACE predictive values across a range of disease prevalences.ResultsOf 755 patients (F:M = 352:403, 47% female; median age 60 years), 114 received criterion diagnosis of dementia and 222 MCI. For diagnosis of dementia, optimal MACE cut-off determined by maximal Youden index was ≤20/30 (sensitivity 0.91, specificity 0.71) and by maximal correct classification accuracy was ≤14/30 (sensitivity 0.59, specificity 0.92). For MCI diagnosis, optimal MACE cut-off determined by maximal Youden index was ≤24/30 (sensitivity 0.90, specificity 0.57) and ≤19/30 (sensitivity 0.47, specificity 0.88) by maximal correct classification accuracy. These MACE cut-offs differed from the index study (≤25/30 high sensitivity, ≤21/30 high specificity). NPV was high (≥0.9) at all prevalences of dementia and MCI examined (range 0.05–0.4) suggesting normal MACE score effectively rules out dementia and MCI.ConclusionsIn this large dataset, optimal MACE cut-offs for dementia and MCI differed from the index study reflecting the different casemix of the studies. Revision of MACE cut-offs in may be required in clinical practice to maximise test discriminative utility.