bluuebunny/crossref_metadata_2025_split huggingface dataset:
040  Service evaluation of acute neurology referrals in the regional neuroscience centre
Authors: Grundmann Alexander , Duddy Martin , Anderson Kirstie , Ng Yi Shiau 
Published: May 2022

BackgroundNeurological disorders account for 20% of acute medical admissions and 7% of GP consulta- tions. We evaluated our acute neurology service with the catchment area of 3 million people. Moreover, we investigated the impact on the service during the COVID19 pandemic.MethodsWe identified 6618 urgent phone calls logged between March 2017 and June 2020. We performed a detailed analysis of 800 referrals: 400 in 10 weeks before and 400 in 11 weeks during the first national lockdown.ResultsReferrals were made by teaching hospitals (43%), district general hospitals (35%) and GPs (22%). The reasons for referrals were similar between hospitals and GPs: epilepsy (33% vs 30%), headache (15% vs 20%), sensory symptoms (10% vs 7%) and weakness (10% vs 8%). The outcomes of these referrals were telephone advice only (64%), neurology ward admission (9%), rapid assessment and other outpatient clinics (8% and 25% respectively). There was a threefold decrease in the number of phone calls during the initial four weeks of national lockdown. However, the patient demographics and the range of diagnoses remained overall unchanged.ConclusionsThis provides important descriptive data on demographics and outcomes for acute neurology referrals, which can be used to guide service provision and training.alexandergrundmann@nhs.net45
042  Opportunities and challenges of remote neurological outpatient consultations
Authors: Hogan Joseph , MacDonald Bridget , Mastrolilli Francesca , Nitkunan Arani 
Published: May 2022

Croydon University HospitalRemote consultations were rapidly introduced in the spring of 2020 in the neurology outpatient setting across the UK and worldwide due to the Covid-19 pandemic. Consulting remotely provides new chal- lenges to previously familiar practices. Here we present four different but commonly seen cases in a south London outpatient neurology service. With each case we address a key domain: history taking, examina- tion, the digital divide and changing the consulting environment. History taking is largely unchanged and indeed may improve the patient experience when performed in a familiar environment. The examina- tion is different and a greater understanding of which aspects of the neurological exam are and are not possible remotely continues to be discussed. The adoption of remote consultations requires patients to have a confident ability to activate and interact with technologies. The future development of technolo- gies and guidelines should proactively engage with patients of all ages and abilities to avoid biases in their development. Remote consultations are likely to continue to play a part in the future of outpatient neurology; understanding their most effective allocation and proactively developing technologies with patients will be essential for their success.josephhogan1@nhs.net|ABN Bursary46
044  Analysis of urgent acute medicine and ward referrals to neurology at the district hospital
Authors: Melikyan Elina , Nandoskar Ashwini 
Published: May 2022

PurposeThe aim of the study was to analyse the referrals for patients presenting with neurological emergency to the district hospital, as this aspect of the neurologist’s workload is often under-recognised, in comparison to attention dedicated to out-patient clinics.MethodsWe retrospectively reviewed acute medicine and ward referrals to Neurology service at the Hillingdon Hospital (July 2019-June 2020).ResultsTotal 1480 referrals were identified, with 50% of them from the Acute Medicine, 42% from the General Medicine, 8% from the other units. A 73.2% of referrals constitute delirium, falls, and other multi- factorial syndromes, presented as ill-defined and clinically challenging cases, 14.5% - acute headaches and neuroinflammatory disorders, 12.3% seizures/fits/syncopes. Regarding ward referrals, there was an average 5.4 days’ time lag between time of admission and neurological input, at the average 11.8 days of hospitalization. An early neurological consultation was likely to lead to more tailored diagnostic workup, improving outcome for the patient.ConclusionThe amount of referrals reaffirms the importance of the neurologist’s role in the Emergency Care and the unmet need for acute neurology service, which is likely to increase with pressure on the district general hospitals to manage complex neurological cases locally given that the pandemic affects the safe transfer of patients to tertiary neurosciences centre for onward management.ehmelikyan@yandex.ru47
045  Post discharge telephone calls from neurology specialist nurses can reduce re-admission rates: a re-audit
Authors: Ravindran Pahalavi , Shanmuganathan Sarah , Boodhoo Ajay , Schon Fred , Nitkunan Arani 
Published: May 2022

We carried out audits of all in-patients referred for consultant neurology opinions in a single district general hospital over 2-month periods in 2018 and after relevant adjustments in 2020.In 2018, of 235 patients seen, the overall 30-day re-admission rate was 18.7% (44 patients). Of the 235 patients, the consultant requested post discharge follow-up on 76 (32.3%) but only 42 were contacted (55%) of which 24 (57%) were phoned within 30 days. The re-admission rate was reduced by only 0.5% in those successfully contacted.In 2020, of 252 patients seen, the 30-day re-admission rate was 18.7% (47 patients). Follow up was requested for 52.8% (133 patients). We improved our successful telephone rate to 77% of which 49 (47.6%) were contacted in under 30 days. Re-admission rate for those contacted was reduced to 16.5% compared to 21% amongst those not contacted. The majority of re-admissions (55%) were for non-neurological diagnoses. Patients with multiple co-morbidities were 46% more likely to be re-admitted.NICE guidelines recommend a post discharge telephone follow-up. Our results suggest trying to achieve maximum early contact is likely to reduce re-admission rates.pahalavi@hotmail.co.uk
046  Preparing new registrars for practice in the age of Zoom
Authors: Rees Richard , Russell Amy Ross , Patel Faheemah , Lawrence Joanne , Jones Matthew , Warner Tom 
Published: May 2022

IntroductionIn 2019 the ABN delivered the first Acute Neurology Boot Camp. This addressed an unmet need in post-graduate training. We designed a one-day series of seminars covering common or critical presentations for neurology registrars on-call.In 2020, face-to-face events weren’t feasible, and while having to adapt to a new model of working including tele-neurology, virtual radiology meetings, we adapted the boot camp to this model.MethodsWe designed an online version of the boot camp over two weeks. Videos were recorded for repeat viewing. All delegates were encouraged to complete surveys on confidence levels, before and after each session, and with reference to the course as a whole.Results77 participants provided feedback. 289 logged-in live and YYY have viewed the videos on-demand. This compares to XYZ in the 2019 iteration. 30% of respondents were confident or very confident at being the neurology registrar on-call prior to the course, compared to 88% at the end of the course (p< 0.00001).Participants were very happy with the delivery, content and format of the talks, with “very good” ratings for 60%, 56% and 57% respectively.ConclusionThe Covid-19 pandemic brought tumultuous shifts in practice that were uncharted waters for the entire neurological community. As we all tried to stay afloat, we also provided a necessary life-raft to trainees who were negotiating the challenge of the transition to being a neurology registrar.rnrees@gmail.com|ABN Bursary48
047  The cord, the COVID and the cancer
Authors: Torabi Parisa , Corkill Robin , Johnston Ann 
Published: May 2022

IntroductionThroughout the COVID-19 pandemic, our understanding of the relationship between COVID-19 infection and acute neurological disorders has been evolving. We present two cases of trans- verse myelitis, both with positive COVID-19 PCRs.Case 1: A 62-year old man presented with an ascending paraparesis 3 weeks after COVID-19 infection. Initial neuroimaging showed cord compression with signal change at C5/6. Repeat imaging 7 days later showed a longitudinal myelitis. CSF examination was unremarkable. He was treated with intravenous steroids and an oral taper. No other cause was identified.Case 2: A 55-year old woman presented with sub-acute back pain and worsening leg weakness over 2 weeks. She had a positive COVID-19 test on admission but was asymptomatic. Neuroimaging showed a longitudinal myelitis, but also noted a multicystic lesion within the pelvis. A CSF examination was unremark- able with negative cytology. A raised CA-125 coupled with an adnexal mass on CT-TAP was felt in keeping with ovarian malignancy which we hypothesise caused the myelitis through an immune phenomena, rather than by a para-infectious route or by COVID-19 itself.ConclusionsThese cases highlight the broad aetiology of transverse myelitis and illustrate the need for a careful search for underlying causes, which may include post-COVID syndromes.parisa.torabi@wales.nhs.uk
049  Is the out of hours acute neurology service provision in South West London equitable?
Authors: Yiu Daniel , Harral Josie , Fisk Monica , Nitkunan Arani 
Published: May 2022

Providing equitable access to neurologists out of hours regardless of whether a hospital is a neurosciences centre or a district general hospital (DGH) is key to ensuring excellent patient care for all. The aim of this audit was to determine whether there was variability in the out of hours referrals across South West London (SWL). Data were collected from June to August 2020. We found a large disparity - 78% of referrals were from the hospital aligned with the neurosciences centre although it accounted for 31% of the SWL population and 46% of acute admissions. 46% of the calls received by trainees at the neurosciences centre were discussed with the consultant, with 5% of cases requiring transfer. 84% of referrals from DGHs were advised to contact local teams for continued input. Conditions with established pathways such as seizures (23% of referrals) and headaches (11%) were less likely to require escalation to the consultant on-call. The awareness of a regional out of hours service is being addressed at the DGHs. Increasing trainee time at DGHs with the Shape of Training changes will hopefully increase trainees’ awareness of DGH neurology teams. We aim to repeat this analysis next year.Acknowledgements – SWL consultants, trainees in SWL daniel.yiu93@gmail.com
057  Para-herpetic SUNCT syndrome
Authors: Sim Nicholas Keyi ,   Goh, Ying Li , Mowafi Walied 
Published: May 2022

Pre and post-herpetic SUNCT syndrome is a rare but previously reported complication of herpes zoster reactivation. We report a case of a zoster associated SUNCT syndrome developing at the same time as reactivation.A 79-year-old gentleman was referred to Neurology for refractory right sided facial pain. 7 months prior to presentation he had developed shingles in the right upper face around his forehead area, which was managed by his GP. At the same time, he developed daily attacks of sharp stabbing pain behind his eye, up to 5 a day, lasting up to 5 minutes each. This was associated with injection and lacrimation of the affected eye. The attacks can be triggered by touch, such as a shower. Neurological examination was unremarkable except for allodynia in the right V1 distribution. Plain MRI scan showed cortical atrophy only.He had a good response to lamotrigine. nchlasim@doctors.org.uk
A wolf in sheep’s clothing
Authors: Gibbons Emily , Whittam Daniel , Karthikeayan Venkatraman , Campagna Giovanna , Wong Sui , Yu-Wai-Man Patrick , Huda Saif , Jacob Anu 
Published: May 2022

A 28 year-old Caucasian woman was found to have reduced visual acuity during routine optician checks and was referred to ophthalmology and then neurology. Examination revealed acuities of 6/12 in both eyes, pale optic discs and reduced colour perception. MRI brain did not show any lesions. Routine bloods were normal as were serum ACE, B1, B12, folate, HIV, syphilis, Lyme serology, AQP4-IgG and MOG-IgG. Leber’s and AD optic atrophy screens were negative. CSF protein was 0.41, WBC 7 (100% lymphocytes), elevated IgG Index 1.4 (normal<0.8),OCBs in serum and CSF with a single additional band raising the possibility of inflammatory optic neuritis. There was apparent stabilisation on empiric steroids which was then converted to steroid sparing immunosuppressants. However, as vision declined, whole mitochondrial genome sequencing and the clinical Exome Optic Atrophy Panel revealed compound heterozygous WFS1 mutations (c.605A>G p. (Glu2020Gly); c.874C>T p.(Pro292Ser) leading to diagnosis of‘Wolfram’Syndrome or DIDMOAD (diabetes insipidus, diabetes mellitus, optic atrophy, deafness) with an isolated optic atrophy phenotype. This case is unusual given the late age of presentation, lack of classical associ- ated features, suggestion of CSF inflammation and apparent steroid responsiveness. It also highlights the importance of expanded genetic testing in atypical optic atrophy cases.emily.gibbons@doctors.org.uk
068  The effective management of idiopathic intracranial hypertension delivered by in-person and virtual group consultations
Authors: Wong Sui , Barrow Natasha , Hall Kimberley , Gandesha Prianka , Manson Alison 
Published: May 2022

BackgroundIn response to the rising incidence of IIH and service pressures, we set out to develop a group consultation(GC) service for IIH.MethodIterative, co-designing(with patients) a bespoke GC, i.e. clinical reviews in a group setting. Outcomes measured: patient satisfaction, self-perceived health literacy, successful implementation of GC.ResultsEight in-person GCs delivered: once-monthly(Oct-Dec 2019), then twice-monthly(Jan-Feb 2020). Feedback from 49/53: 100% felt more satisfied and heard; 100% felt more involved in decision making; 98% had a better understanding of their condition; 96% felt more able to cope with their condition and keep themselves healthy; 94% rated this as a positive experience; 90% reported improved access and more time with their clinician compared to existing 1:1 appointments.Since Sept 2020 (in response to COVID-19 pandemic) we have delivered once-weekly virtual GC (18 to date). Feedback median scores: patient satisfaction 9.5/10; being listened to by clinician 10/10; involved by clinician in treatment decisions 10/10; clinician explanation of treatment 10/10; opportunity to discuss condition or treatment 10/10).ConclusionsGC is safe and effective for IIH and preferred in our cohort. This allowed ongoing high-quality, person-centred care despite the COVID19 pandemic. We will also share the potential for GC for other neurological conditions.drsuiwong@gmail.com59
069  Post COVID neuropathic pain: a case report
Authors: Campos Hernandez Ana Karen , Win Myat , McWilliam Matthew , Ismail Shoaib , Fox Robin , Alkufri Fadi 
Published: May 2022

COVID-19 has been reported to be associated with various neurological manifestations involving both the central and peripheral nervous system. Somatic and visceral pain, as well as headache, are all widely recognised in association with COVID-19, however, there is a comparative paucity of reports of neuropathic pain.We present a case of COVID-19 associated neuropathic pain in a 61-year-old male. He developed acute severe burning pain affecting all four limbs distally, one week following confirmed COVID-19 infection. There was no ataxia or autonomic failure. Neurological examination was unremarkable. Electrophysiologi- cal tests revealed delayed SSEP in the lower limbs, however, skin biopsy and MRI of the neuroaxis was unremarkable. His pain was inadequately controlled with gabapentin but improved significantly after a short course of steroids. This case adds to the various neurological manifestations of COVID-19 infection, highlighting the possible variability of symptoms in patients with nervous system involvement of SARS-CoV-2 infection. This report provides additional evidence that COVID-19 disease can trigger autoimmunity which is consistent with previous reports of several autoimmune neurological diseases.a.camposhernandez@nhs.net
071  Motor network remodelling in ALS and PLS
Authors: Edmond Evan , Proudfoot Malcolm , Menke Ricarda , Thompson Alexander , Talbot Kevin , Stagg Charlotte , Turner Martin 
Published: May 2022

BackgroundPrimary motor cortex hyperexcitability demonstrated in amyotrophic lateral sclerosis (ALS) is associated with wider network dysfunction. The precise topology and nature of these functional altera- tions remains unclear, including the extent of overlap between ALS and the pure upper-motor-neurone phenotype - primary lateral sclerosis (PLS).MethodsStudy participants comprised 41 ALS, 7 PLS, and 18 age matched healthy individuals. Partici- pantsunderwent motor task functional MRI (fMRI) of the brain at 3T (Siemens Magnetom). The task involved unilateral finger response (Go) to a directional visual cue with intermittent response inhibition (NoGo). Image preprocessing, voxelwise statistics with general linear modelling, and exploratory network analysis were performed using FSL (FMRIB software library).ResultsA bilateral pattern of activation was observed with finger movement in the ALS group, compared to the more restricted contralateral hemispheric activity in healthy controls (n.s. after stringent voxelwise multiple-comparison correction). Significantly increased activation was noted in the posterior insula in PLS patients during successful response inhibition compared to both ALS patients and healthy control. Network analysis demonstrated a significant positive association of increasing disability with pre-motor and supplementary motor nodes.DiscussionRegional brain motor network remodelling in ALS may signify degeneration of inhibitory local circuit functional partitioning, or reflect adaptation and mobilisation of reserves to support motor execution. Replication and validation through standardised imaging protocols and task design offers the potential to refine targets for therapeutic neuromodulation.eedmond@gmail.com|NIHR Bursary
073  Magnetic resonance spectroscopy to detect markers of brain injury in tuberculous meningitis (TBM)
Authors: Davis Angharad , Robertson Frances , Maxebengula Mpumi , Meintjes Ernesta , Wilkinson Robert 
Published: May 2022

Centre for Infectious Diseases Research in Africa;4UCT Medical Imaging Research Unit, Division of Bio- medical Engineering, UCT, RSA;5Cape Universities Body Imaging Centre, UCT and Neuroscience Institute, University of Cape Town, RSA;6Department of Medicine, Imperial College London1H-Magnetic Resonance Spectroscopy (MRS) allows non-invasive quantification of the biochemical com- position of imaged tissue in a single voxel within the brain; including concentrations of the neuroinhibitory and neuroexcitatory metabolites, GABA and glutamate. Excessive glutamate and neuro-excitotoxicity contribute to pathogenesis in tuberculous meningitis (TBM)[1], and like in other neurological conditions[2] may lead to cell death and brain injury. We hypothesised that glutamate would be raised and GABA decreased, in TBM vs healthy controls (HC). 11 patients with TBM, and 8 HC underwent 3-T MRI imaging at the University of Cape Town, South Africa, at two timepoints (baseline, day-56). We used MEGA-PRESS spectroscopy and GANNET software[3] to estimate metabolite concentrations in a voxel placed within the ‘tubercular zone’. Glutamate at baseline was significantly higher in TBM vs HC (15.9 vs 12.2 IU, p=0.042). This decreased by day-56, although did not return to levels seen in HC, suggesting ongoing neuro-excitation in the post-acute phase. By contrast, at baseline GABA was non-significantly decreased in TBM vs HC (3.79 vs4.02 IU, p=0.5). These findings provide further rationale for the investigation of glutamate/GABA as brain injury pathways and potential drug targets in TBM.1. Rohlwink, U.K., et al., Nat Commun, 2019. 10(1): p. 3767 2. Meldrum, B.S., J Nutr, 2000. 130(4S Suppl): p. 1007S-15S. 3. Edden, R.A., et al., J Magn Reson Imaging, 2014. 40(6): p. 1445–52.angharadgracedavis@gmail.com
Effects of immunotherapies and clinical outcomes in neurosarcoidosis : a retro- spective cohort study
Authors: Arun Tarunya , Freeman Sarah , Mistry Kieran 
Published: May 2022

IntroductionNeurosarcoidosis is associated with a high degree of morbidity and mortality and its treat- ments are varied and complex. There is a paucity of information in current literature on patterns of treatment and long term outcomes. This study aimed to evaluate the clinical outcomes and responses to immunosuppressive therapy in a large cohort of biopsy proven neurosarcoidosis patients.MethodsWe enrolled 85 patients with a diagnosis of neurosarcoidosis. Prescription patterns and clinical outcomes before and after treatment and differences between the treatment groups were compared using Kruskal Wallis and Mann-Witney U tests.ResultsPatients with cranial mononeuropathy were more likely to be treated with steroids alone than patients with brain parenchymal involvement, hydrocephalus and spinal cord presentations who were likely to require second and third line treatments. Commonly used immunosuppressive agents were azathioprine (26%), methotrexate (17.5%) and corticosteroids alone (11%). Just over 85% of patients on corticosteroids went onto second or third line treatments. Patients on steroid monotherapy had the worst outcomes and those on a combination of corticosteroids, azathioprine and infliximab showed superior clinical improvements (p=0.008).ConclusionsOur results provides evidence that early immunosuppressive treatments, with azathioprine, methotrexate and infliximab could effectively improve clinical outcomes in neurosarcoidosis.tarunya1@gmail.com
077  ‘NeuroPodcases: a clinical neuroscience podcast’ – a remote learning resource
Authors: Bharambe Viraj , Healy Sarah , Mayer Josie , Williamson John 
Published: May 2022

BackgroundRemote learning resources, such as podcasts, have grown in popularity and are of increas- ing importance during the 2020 pandemic. Podcast benefits include; convenience, accessibility to global expertise; and can be a useful adjunct to in-person teaching or a ‘flipped classroom’ approach.MethodsWe developed a case-based podcast covering topics across clinical neuroscience for medical students and doctors. ‘NeuroPodcases’ are freely available via a dedicated website (neuropodcases. co.uk), Spotify, Apple Podcasts and Soundcloud. To maintain quality, all podcasts are created with a Neurology trainee and Consultant.ResultsOver 35 neuroscience podcasts have been recorded for undergraduates (Essentials) and graduates (Advanced). Many are enhanced with additional illustrations and videos. There have been over 2,700 plays across 36 countries, from all habitable continents.Feedback from local undergraduates suggests the podcasts are a useful adjunct at a time of limited bedside teaching. During a 4 week placement, the majority of students listened to >5 podcasts with 100% of respondents saying it increased their confidence in neurology.ConclusionsPodcasts offer a global learning resource which is freely available and can support clinical learning outside traditional clinical education environments. NeuroPodcases is an example of their utility for clinical neuroscience education.virajbh@hotmail.com