bluuebunny/crossref_metadata_2025_split huggingface dataset:
022 Bilateral tapia’s syndrome following complication from coronary angiography – a case report
Authors: Shi Jiaqi , Cahill Varduhi , Jacob Saiju 
Published: March 2023

BackgroundTapia’s syndrome is very rare and manifests from concurrent recurrent laryngeal nerve and hypoglossal nerve palsies, often following general anaesthesia. It is commonly characterised as dysphonia, tongue dysmotility with dysarthria and dysphagia. This usually presents after orotracheal intubation and the mechanism of injury is thought to occur from over stretching of both the vagal and hypoglossal nerves at either the transverse process of the first cervical vertebra, or over the wall of the pharynx. Typically the deficit is temporary with anticipated full recovery. Diagnosis is clinical and requires exclusion of central causes with imaging, which includes contrast CT and MRI. A multidisciplinary approach is essential and treatment is supportive. Around one-third of the patients will achieve full resolution.Case reportA case of a 60 year old man is described, who suffered intraoperative complication and required emergency coronary artery bypass graft surgery after an elective angiogram. He was diagnosed with Tapia’s syndrome 3 weeks post-operatively, when he was found to have left sided tongue atrophy, and bilateral vocal cord palsy after extubation. No other neurological features were noted and further imaging did not reveal any central causes for vocal cord palsy. He was discharged home after a gradual improvement with supportive therapy that included a tracheostomy insertion.
029 Importance of face-to-face consultation in complex decision-making
Authors: Nicholas Richard , Solari Alessandra , Wilkie David 
Published: March 2023

Recent focus on self-care and telemedicine have challenged the role of face-to-face consultations in medicine. Disease activity, national guidelines, life goals e.g. pregnancy, multiple therapies and varying side effects need to be considered on starting disease modifying treatments in multiple sclerosis (MS). We studied the factors driving decisional conflict (DC), a measure of a decision satisfaction in people with (pw)MS making this decision.MethodsAntecedents, features and outcomes of the consultation were measured in pwMS attending clinics who were making decisions about treatment. The SURE scale for DC was the primary outcome.ResultsThe patient activation measure (PAM) was the only antecedent prior to the consultation associated with DC (n=72, Adjusted R2 0.062, p=0.020). In the consultation shared decision making (SDM) (p=0.000) and PAM (0.043) were both drivers of DC (n=67, Adjusted R2 0.383, p=0.000). In turn the significant factor associated with the SDM score from within the consultation was satisfaction with the health care professional (HCP) (n=68, Adjusted R2 0.220, p=0.000).ConclusionsPatient engagement impacts DC but the HCP delivering the optimal shared decision-making approach is also significant in reducing DC. In complex decisions there is a clear role for the face-to-face consultation in current practice.
030 Automating clinical audit in neurology
Authors: Middleton R , Lacey A , Pickrell WO , Fonferfko-Shadrach B , Pearson O , Marta M , McDonnell G , Thompson SE , Ford DV , Nicholas R 
Published: March 2023

BackgroundExtracting data from healthcare records is essential for clinical and research purposes but can be labour and time intensive. We developed a natural language processing (NLP) application to automatically extract meaningful data from routinely-generated multiple sclerosis (MS) clinic letters.MethodWe developed the system using the open source platform GATE (General Architecture for Text Engineering) and a training set of 100 manually annotated MS clinic letters. The system extracts information from each clinic letter including: MS diagnosis and type, Extended Disability Status Scale (EDSS) score, current and previous Disease Modifying Therapies (DMT), walking distance, and MRI information.For initial validation, we used 250 MS clinic letters. We compared the systems performance in extracting MS diagnosis, EDSS score and current and previous DMTs with human annotation. We recorded precision (proportion of extracted items that are accurate), recall (proportion of items that are extracted) and F1-score (harmonic mean of precision and recall).Results(see poster)ConclusionNLP can be used to automatically extract specific information from MS clinic letters and has the potential to transform clinical practice and research at a large scale.
11.27 Understanding variability in UK acute neurology services: what works, and what doesn’t?
Authors: Best Jonathan , Kamourieh Salwa , Mummery Cath 
Published: March 2023

BackgroundThe 2017 ABN Acute Neurology Survey showed acute neurological services in the United Kingdom to vary widely, even between otherwise-similar departments. Focussing on positive outliers, we conducted qualitative research to understand this.MethodsThrough the 2017 survey, we identified DGHs and neurology/neuroscience centres which indicated high overall acute neurology service provision or outstanding performance in a particular area. From 39 hospitals meeting our criteria, we asked 15 clinical leads from throughout the UK to complete a questionnaire on their service model and development. We also analysed free text comments from the 2017 survey.ResultsWe received 9 responses, 6 from DGHs. Successful innovations included a neurology take, seven-day consultant-delivered reviews, and an ‘acute neurologist of the week’. Respondents viewed a well-functioning acute clinic as important, and we profiled how this was achieved. In DGHs, acute care was mainly delivered by consultants, who described heavy workloads.Of 120 comments from the 2017 survey, 37.5% described acute clinic arrangements. Overbooking of urgent patients into routine clinics was common. After this, the most frequent themes were understaffing (13.3%) and excessive workload (10%).DiscussionOur qualitative data identifies difficulties facing UK acute neurologists, and highlights successful approaches which may inform future service development.
036 mHealth in traumatic brain injury: a systematic review of the app markets and the literature
Authors: Christopher Edward , Alsaffarini Kareem , Jamjoom Aimun 
Published: March 2023

BackgroundTraumatic brain injury (TBI) carries a high morbidity and mortality. It has been suggested that the practice of providing healthcare support via mobile technologies i.e. mobile health (mHealth) can considerably alleviate the global burden of TBI. However, the current landscape of mHealth and the evidence surrounding their use in TBI has not been defined and critically appraised.MethodsWe systematically reviewed the mobile app markets (iOS and Android) and the literature for TBI-focused apps and studies investigating the use of mHealth in TBI. We extracted and analysed data from the apps and studies that met our inclusion criteria. Results are reported as median (interquartile range). Full study methodology is available from PROSPERO (CRD42018107386).Results53 apps met our inclusion criteria. The top three functions were TBI screening (34.0%), education (28.3%) and biomechanics monitoring (20.8%). Median number of downloads was 300(75–3000). 8 studies met our inclusion criteria. Most (62.5%) were either case series or case report with only one (12.5%) randomised controlled trial. Median number of TBI patients involved in the study was 7(1–43).ConclusionThere is a disproportionately small number of TBI-focused apps. Their uptake is limited and the evidence surrounding the use of mHealth in TBI particularly remains low at present.
039 Functional cognitive disorders: prognosis
Authors: Elhadd Kariem , Bharambe Viraj , Larner AJ 
Published: March 2023

ObjectiveTo assess 6-month outcomes of patients diagnosed with functional cognitive disorders (FCD) in a dedicated cognitive disorders clinic based in secondary care. A cohort of patients diagnosed with FCD (Neurodegener Dis Manag 2018;8:377–83) were contacted by telephone (maximum three attempts) 6 months after diagnosis, and administered the same subjective memory complaints (SMC) Likert scale assessing metamemory as administered at the initial clinic visit.ResultsOf 51 FCD patients, 44 had baseline SMC Likert and 29 provided follow-up data (57% of whole cohort, 66% of those with baseline data). Of these 29, 16 (55%) gave the same self-rating on SMC Likert, 11 (38%) higher, and 2 (7%) lower than at baseline. Only 5 patients changed category, all from SMC+ (self-rating memory poor or fair) to SMC- (self-rating memory good, very good or excellent). The null hypothesis that the proportion of SMC+ patients did not differ significantly between baseline (27/29=93%) and follow-up (22/29=76%) was not rejected (Z=1.81, 0.1 > p>0.05).ConclusionsWhilst some patients with FCD may improve spontaneously over six months, perhaps reassured by the finding of no neurodegenerative disorder, the majority remain unchanged as judged by a brief measure of metamemory.
047 An unusual cause of psychosis
Authors: Mohamed Ahmed Mubarak , Blackburn Daniel , Iqbal Ahmed , Prasad Suveera 
Published: March 2023

A 24 year old woman was referred with a 3/52 history of headaches, memory problems, paranoia and confabulation.Examination was normal. AMT was 8/10. CT head and CSF were unremarkable. She self-discharged before an MRI. She was felt to have capacity.Four weeks later the psychiatry team sought advice reporting worsening symptoms. This patient was held under section. She reported significant headache, an unusual feature of a primary mental health problem.Anti NMDA of the serum and CSF were arranged (negative) an EEG did not show any concerning findings.During the hospital stay she managed to sneak off twice and was bought back by the police as it was felt that she lacked capacity.MRI revealed a pituitary microadenoma. She was assessed by Endocrinology. Extensive investigations concluded a diagnosis of ‘Cushing disease’. Metyrpaone was administered for Cortisol suppression. Tansphenoidal surgery took place after.On subsequent clinic visits, gradual improvement in the symptoms was reported until ultimately she was completely back to her normal self (around 2/12 post-surgery).DiscussionPsychosis is a rare feature of Cushing disease.1This case demonstrates the diagnostic difficulties in these cases and the need of involvement and collaboration of different specialties for diagnosis and management.ReferencesMcCallum RW, Parameswaran V, Duffield A, Hoffman L, Burgess JR, Greenaway T. Cushing’s disease presenting as a Schizophreniform psychosis.Endocrine Abstracts(2006):11;P117.
049 Characterising behaviour in behavioural variant frontotemporal dementia and semantic dementia
Authors: Heartshorne Rosie , Jones Matthew , Kobylecki Christopher , Snowden Julie S , Thompson Jennifer C 
Published: March 2023

Frontotemporal dementia (bvFTD) and semantic dementia (SD) are canonical syndromes associated with frontotemporal lobar degeneration. Change in behaviour is the cardinal symptom in bvFTD but is also observed in SD. We aimed to identify behaviours specific to each of these conditions and explore correlations between behaviours and regional atrophy.We performed retrospective analysis of clinical data in 84 patients with bvFTD and SD presenting to a tertiary cognitive neurology clinic. Behaviours were rated on an internally developed proforma, and a visual rating scale was used to grade atrophy on MR scan. A chi-squared test was used for comparative analysis of behaviours and Spearman’s Rank Correlation Coefficient for imaging and behaviour.Blunted affect, poor self-care, and loss-of-empathy were highly specific to bvFTD (P<0.001). Loss-of-empathy correlated with orbitofrontal and dorsolateral frontal cortical atrophy (<0.05). Food fads (P=0.003) and number games (P=0.001) were highly specific for SD. Food fads were associated with left anterior fusiform atrophy (P=0.004), and number games with posterior temporal atrophy (P<0.05).This study identified certain behavioural features specific for each syndrome, which has implications for accurate diagnosis. Behaviours specific to bvFTD were associated with regional frontal atrophy, whereas those seen in SD correlated more strongly with temporal atrophy.
050 Western blot analysis of KPNA4 and its relevance to nucleocytoplasmic transport dysfunction in ALS/FTD
Authors: Zatorska Anna , Solomon Daniel , Hortobagyi Tibor , Hirth Frank 
Published: March 2023

ALS and FTD are progressive neurodegenerative diseases, often characterised by cytoplasmic aggregation of TDP-43. Nuclear import of TDP-43 occurs via the classical pathway in which karyopherin alphas (KPNAs) act as adaptor proteins. KPNA4 has been identified as the strongest interactor of TDP-43, and karyopherins co-localise with the aberrant cytoplasmic aggregates in ALS/FTD.This study explored how KPNA4 is affected in the spinal cord of sporadic-ALS (n=8), C9ORF72-ALS cases (n=7) as compared to control (n=6) and in the frontal cortex of sporadic-FTD (n=8), C9ORF72-FTD (n=8), and Tau-FTD (n=8) as compared to control (n=8). Quantitative western blotting was used to analyse whether KPNA4 differed between the protein samples from post-mortem tissue.Soluble levels of KPNA4 were significantly lower in the spinal cord of sporadic-ALS patients compared to control (D=0.4321, CI= 0.124–0.7401, p=0.0086), in the frontal cortex of sporadic-FTD patients compared to control (D=0.258, 95% CI=0.065–0452, p= 0.01) and in the frontal cortex of Tau-FTD patients compared to control (D= 0.22, CI= 0.03–0.42, p= 0.022) but not in C9ORF72 ALS/FTD.The results show a statistically significant downregulation of KPNA4 in sporadic ALS/FTD and Tau-FTD, suggesting KPNA4 could be forming insoluble aggregates or that the translation of KPNA4 mRNA may be reduced.
054 Dementia mortality in wales: a population-based e-cohort
Authors: Wilkinson Tim , Schnier Christian , Akbari Ashley , Orton Chris , Lyons Ronan , Sudlow Cathie 
Published: March 2023

BackgroundThe Secure Anonymised Information Linkage Dementia e-Cohort (SAIL-DeC) is composed of anonymised, linked, routinely-collected healthcare datasets for the population of Wales. We used this population-based e-cohort to investigate dementia mortality.MethodsSAIL-DeC uses a validated algorithm to identify all-cause dementia cases from coded primary care, hospital admissions and mortality datasets. We ascertained death dates and causes from mortality data. For dementia cases, we calculated median survival (stratified by 10-year age categories), identified the underlying causes of death and compared 10-year survival rates to people without dementia.ResultsFrom 1.2 million participants, 129,650 developed dementia. Of these, 102,388 died during follow-up. Median age at dementia diagnosis was 82 years. Median survival after diagnosis was 12.3 years for ages 50–60, 6.8 years for ages 60–70, 4.2 years for ages 70–80 and 2.4 years for ages 80–90. Ten-year survival rates for dementia cases were lower than those without dementia. The most common recorded underlying causes of death were Dementia/Alzheimer’s disease (34%), stroke (13%), ischaemic heart disease (IHD) (9%), influenza/pneumonia (6%) and chronic respiratory diseases (3%).ConclusionMortality in dementia cases is higher than non-cases across all ages. The leading causes of death amongst people with dementia are stroke, IHD and respiratory diseases.
055 The digital doctor: a fully automated stratification and monitoring system for patients with memory complaints
Authors: O’Malley Ronan , Mirhedari Bahman , Harkness Kirsty , Reuber Markus , Venneri Annalena , Christensen Heidi , Blackburn Daniel 
Published: March 2023

IntroductionReferrals to specialist memory clinics have increased out of proportion to the incidence of dementia. Time and financial pressures are consequently exerted on a service striving to deliver high quality care. We have developed a fully automated ‘Digital Doctor’ with the aim of providing pre-clinic risk stratification and ongoing monitoring for patients with memory concerns.MethodsWe recruited 15 participants with Functional Memory Disorder (FMD), Mild Cognitive Impairment (MCI) and Alzheimer’s disease each as well as 15 healthy controls. Participants answered 12 questions posed by the ‘Digital Doctor’. Audio and visual data is analysed using diarization and automatic speech recognition tools and machine learning classifiers.ResultsThe ‘Digital Doctor’ can distinguish between neuro-degenerative dementia and FMD with an accuracy of 95%. We will have results of a 4-way classification accuracy (HC, FMD, MCI & AD) at time of conference.DiscussionWe demonstrate the potential value of the ‘Digital Doctor’ as a stratification and triage tool. Accuracy will be improved with greater number of users and inclusion of fluency and picture description data. Patients at low risk could avoid the burden of a clinic appointment, whilst patients with higher risk could benefit from a more streamlined service.
060 Fulminant meningitis as a presenting feature of anti-NMDA receptor encephalitis
Authors: Stavrou Maria , Yeo Jing Ming , Slater Alexander David , Irani Sarosh , Foley Peter 
Published: March 2023

Anti-NMDA receptor encephalitis is a well-recognised immunotherapy-responsive condition which often occurs as a paraneoplastic phenomenon. A typical presentation is in a young individual with a viral-like prodrome followed by the development of severe psychiatric symptoms, memory loss, seizures, reduced consciousness and sometimes orofacial dyskinesias, and progression to autonomic and respiratory instability. Fulminant meningitis is a very rare presenting feature of anti-NMDA receptor encephalitis with our literature search only revealing one other reported case.We present a case of a 33-year old Caucasian woman who initially presented with lymphocytic meningitis but subsequently developed clinical and investigative features consistent with anti-NMDA receptor encephalitis. Through this case, we aim to present and discuss possible mechanisms1–3underlying this atypical presentation and to highlight frank meningitis as an atypical presenting feature of anti-NMDA-receptor encephalitis. Clinicians should consider autoimmune encephalitides in individuals with meningitis, particularly where extensive investigations fail to identify a causative micro-organism and there is rapid development of an encephalitic phenotype. A multidisciplinary approach is required to address the neurological, gynaecological, oncological, and neuropsychiatric aspects of this challenging and incompletely understood disorder.ReferencesBektaş Ö, et al.Neuropediatrics2014;45(6):396–401Irani SR, et al.Brain2010;133(Pt 6):1655–67Dalmau J, et al.Lancet Neurol2008;7(12):1091–8
065 CXCL13 levels and autoantibody epitope specificities in LGI1-autoantibody syndromes
Authors: Michael Sophia , Ramberger Melanie , Leite Isabel Maria , Sen Arjune , Waters Patrick , Irani Sarosh 
Published: March 2023

CXCL13 triggers B-cell homing to germinal-centres (GCs). Plasma CXCL13 levels are a marker of GC activity, and CSF CXCL13 levels are elevated in MS, NMDA-R-antibody encephalitis, and NMO. Our objectives were to examine CXCL13 concentrations in LGI1-antibody patients, and the concept of GC-reactions in these patients. Additionally, we explored patient serum binding patterns to two LGI1 domains: LRR and EPTP.End-titrations against full-length LGI1, LRR and EPTP were quantified by live-CBA for 100 sera from 38 LGI1-antibody patients. Serum CXCL13 levels were determined by ELISA in 86 samples from 19 LGI1-antibody patients and HCs (n=20), and evaluated with Mann-Whitney and Spearman’s correlation.98% sera bound both EPTP and LRR, with tight correlation in end-titres (r 0.9257;p<0.0001****) which did not change over disease course. LGI1- antibody patients showed higher serum levels of CXCL13 compared to HCs (p<0.0001). CXCL13 trends over time showed markedly high levels at onset and sharp rises during relapses.LGI1-antibody patients showed high CXCL13 levels with dynamic longitudinal fluctuations. Autoantibodies with reactivity to both EPTP- and LRR-LGI1 domains were detected in equal proportions throughout disease, indicating their ongoing production. Overall, these findings suggest that sustained, ongoing GC-reactions may act as a dominant mechanism of autoantibody production in LGI1-antibody syndromes.
067 Bannwarth syndrome presentation of neuroborreliosis, with radiological evidence of CNS demyelination
Authors: Soane Tim , Shaikh Fahad , Mair Grant , Baggott Amy , Pal Suvankar 
Published: March 2023

A 59 year old right handed IT professional presented with left shoulder pain, which evolved to whole arm weakness, numbness and pain, before affecting his right arm and then legs to a lesser degree. Over subsequent weeks he developed right facial weakness and circumferential numbness around his torso. Examination revealed a mixed picture of lower motor neurone signs and long tract signs. CSF analysis showed a pleocytosis of 415 white cells, predominantly lymphocytes and elevated protein at 3.49 g/dL. MRI head showed a number of periventricular and brainstem lesions with appearances and locations typical for demyelination. Nerve conduction studies were compatible with a demyelinating polyradiculoneuropathy.Lyme serology showed elevated IgG positive and borderline elevated IgM. His CSF antibody levels were compatible with neuroborreliosis. He was treated with ceftriaxone 4 g daily for 21 days.The Bannwarth syndrome is a triad of painful polyradiculopathy and facial nerve palsy and lymphocytic pleocytosis, and is a presentation of neuroborreliosis typically associated with European neuroborreliosis caused by infection with Borrelia afzelii and garinii genospecies.
082 Safety of ondansetron in a case series of patients with a predisposition to seizures
Authors: White Laura , Pipe Michelle , Hayton Tom , Barnes Nicholas 
Published: March 2023

BackgroundPatients with temporal lobe epilepsy and hippocampal sclerosis (TLE-HS) have increased hippocampal 5-hydroxytryptamine (5HT)-3 receptors versus controls. 5HT-3 antagonists may therefore be efficacious in TLE-HS. However, rare case reports have described seizures in patients treated with 5HT-3 antagonists. We retrospectively investigated seizure episodes in patients with a seizure predisposition treated with ondansetron.MethodsInpatients admitted to the West Midlands regional neurosciences centre from 08/09/2015–31/01/2017 with an epilepsy diagnosis or prescribed ≥1 antiepileptic drug and treated with ondansetron for ≥4 days were included. Patient notes were reviewed to identify seizure episodes during ondansetron treatment.Results50 patients were identified; 14 had epilepsy, 36 had other diagnoses predisposing to seizures. During ondansetron treatment, 21.4% epilepsy patients and 11.1% with other diagnoses experienced ≥1 seizure; all seizures were deemed unlikely to be ondansetron related. Patients with seizures had similar treatment duration versus patients without (median 8 vs 6 days) and a lower cumulative dose (median 56 vs 72 mg).ConclusionThree patients with epilepsy and four with other diagnoses experienced seizures during ondansetron treatment; none of the seizures were thought to be ondansetron related. A randomised controlled study is needed to assess the efficacy and safety of ondansetron in patients with epilepsy.