Acute bilateral sensorineural hearing loss as presentation of leptomeningeal metastases.

We describe a rare occurrence of bilateral acute severe sensorineural hearing loss in a middle-aged man that heralded the diagnosis of metastatic gastric cancer.

Beware! We are Skating on a Thin Ice: Air Pollution is a Killer.

Air pollution has rapidly emerged as a major environmental hazard in recent times, with potentially catastrophic ramifications for human health.1,2 It has the ability to severely and adversely impact multiple body systems, including the central nervous system (CNS), cardiovascular, dermatological, respiratory, ophthalmologic, and gastrointestinal health. It is a global public health hazard, being responsible for an estimated 6.7 million deaths worldwide in 2016. The World Health Organization (WHO) estimates that between 3.2 to 4.8 million persons succumb yearly because of outdoor and indoor air pollution, respectively. Nearly 90% of people worldwide live in regions where mean air pollution levels exceed acceptable ranges established by WHO.3 Air pollution is caused by several components in the air, which include particulate matter (PM), organic compounds such as polycyclic aromatic hydrocarbons (PAH), inorganic compounds, gases such as nitrogen oxides (NOx), and sulfur dioxide (SO2). PM, in turn, is further classified based on the aerodynamic diameter of the particles: coarse particles are defined as those with a diameter between 2.5 and 10 µm (PM10), fine particles are those with a diameter <2.5 µm but above 100 nm (PM2.5) and ultrafine particles are those with diameter below 100 nm (ultrafine PM). Larger particles (PM10) are more common in industrial emissions, and smaller particles in automobile emissions. Data continues to accumulate on the adverse consequences of air pollution on brain health, with pathogenetic contributions  to the development of dementia, headache, stroke, demyelinating conditions, and psychiatric disorders.

The Enemy within-Multifocal Tuberculous Abscesses Complicating Dermatomyositis.

Tuberculosis can present with diverse manifestations, particularly in immunocompromised hosts. Although cold abscesses can complicate spinal tuberculosis, subcutaneous abscesses due to tuberculosis are considerably uncommon and, unlike cold abscesses, necessitate surgical drainage.1 We present an extremely rare case of disseminated tuberculosis in a patient with subcutaneous involvement mimicking cellulitis.

Brain imaging inspired by outer space.

Medicine has many vividly named signs. We have compiled a list of radiological cerebral signs inspired by phenomena in outer space. These range from the well-known 'starry sky' appearance of neurocysticercosis or tuberculomas, to various lesser known signs including the 'starfield' pattern of fat embolism; 'sunburst' sign of meningiomas; 'eclipse' sign of neurosarcoidosis; 'comet tail' sign of cerebral metastases; 'Milky Way' sign of progressive multifocal leukoencephalopathy; 'satellite' and 'black hole' sign of intracranial haemorrhage; 'crescent' sign of arterial dissection and 'crescent moon' sign of Hirayama disease.

Classification and comparative analysis of psychogenic nonepileptic seizures (PNES) semiology based on video-electroencephalography (VEEG).

BACKGROUND: Multiple classification systems for psychogenic nonepileptic seizures (PNES) based on semiological features have been described. We sought to compare the efficiency of four PNES classification systems. METHODS: We retrospectively analyzed medical and video-electroencephalography (VEEG) records of patients with PNES with at least one typical event recorded on VEEG. Semiology of PNES events was stringently classified using Hubsch, Dhiman, Wadwekar, and Asadi-Pooya's classification systems. RESULTS: We studied 248 patients with PNES (78% females, mean age 23.1 ±â€¯10.3 years) and reviewed 498 PNES events. Using Hubsch's scheme, we classified events into: dystonic attacks with primitive gestural activity (5.2%), paucikinetic attacks with preserved responsiveness (9.7%), pseudosyncope (59.8%), hyperkinetic prolonged attacks (16.2%) and axial dystonic prolonged attacks (1.6%), and unclassified (7.5%). Using Dhiman's classification, events were: abnormal motor (hypermotor [10.4%]/ partial motor [12.7%]), dialeptic type (58.6%), mixed patterns (17.3%), and unclassified (1%). Using Wadwekar's classification: dystonic attacks with primitive gestural activity (5.2%), paucikinetic attacks with preserved responsiveness (9.6%), pseudosyncope with/without hyperventilation (65.1%), hyperkinetic prolonged attacks involving limbs ±â€¯trunk (18.5%), and axial dystonic prolonged attacks (1.6%). Using Asadi-Pooya's classification, events were: hypermotor (30.1%), non-motor (62.9%), and mixed (7.0%). All events could be classified via Wadwekar and Asadi-Pooya systems. CONCLUSION: In our study, pseudosyncope/dialeptic/non-motor semiology emerged as most frequent. Most of our patients with PNES had stereotyped semiology. All events could be classified using the schemes by Asadi-Pooya and Wadweker et al. Dhiman et al. scheme could classify 99% and 7.5% remained unclassified using Hubsch et al. scheme.

Use of Twitter in Neurology: Boon or Bane?

Twitter is a free, open access social media platform that is widely used in medicine by physicians, scientists, and patients. It provides an opportunity for advocacy, education, and collaboration. However, it is likely not utilized to its full advantage by many disciplines in medicine, and pitfalls exist in its use. In particular, there has not been a review of Twitter use and its applications in the field of neurology. This review seeks to provide an understanding of the current use of Twitter in the field of neurology to assist neurologists in engaging with this potentially powerful application to support their work.

Beyond Fever, Cough and Dyspnea: The Neurology of COVID-19.

The pandemic due to Severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) has rapidly engulfed the entire world, and continues to evolve at an aggressive pace. Although the characteristic concern in patients with COVID-19 is acute respiratory distress, there is meteoric accrual of data on neurological involvement. Neurological manifestations in COVID-19 have staggering diversity, ranging from mild olfactory and gustatory perception abnormalities to necrotising encephalopathy and stroke. Understanding of pathophysiological mechanisms underlying neurological invasion and disease is still nascent, and dictated largely by evidence from previous coronavirus infections which are known to have neuroinvasive potential. It has also been postulated that SARS CoV2 may affect the medullary respiratory centres in the brain stem thereby playing a possible role in causing neurogenic acute respiratory failure. Preliminary data suggest a role of immune hyperinflammation and hyperthrombosis mediating neurological features. Apart from acute neurological manifestations, immune dysregulation may contribute to para and post-infectious complications and potentially, neurodegenerative conditions. These concepts are paramount in developing therapeutic paradigms to mitigate the impact of the pandemic. In this review, we summarise putative pathophysiological underpinnings of neurological manifestations of COVID-19 and guidance for their management.

Langerhans cell histiocytosis presenting as a rapidly evolving frontotemporal syndrome.

Langerhans cell histiocytosis (LCH) is a rare disorder in adults which usually manifests with involvement of multiple organ systems, including the central nervous system. We describe an unusual case of biopsy-proven LCH presenting with frontotemporal-dominant cognitive impairment with hypothalamic involvement, along with multisystem disease. We propose that the dementia was probably an immune-mediated process triggered by LCH which responded dramatically to high-dose steroids.

Neuroleptic malignant syndrome as a presenting feature of subacute sclerosing panencephalitis.

Subacute sclerosing panencephalitis (SSPE) is a slowly progressive degenerative disorder caused by measles virus. It is characterised by typical clinical and electrophysiological features in the form of slow myoclonic jerks, with progressive cognitive impairment, visual symptoms, and periodic complexes on EEG, with raised titres of anti-measles antibodies in CSF and serum. Atypical presentations of SSPE have been reported including brainstem involvement, ADEM-like presentation, acute encephalitis, and cerebellar ataxia. Presentation with predominant extrapyramidal features is uncommon. We describe a case of SSPE presenting with extensive rigidity with highly elevated CPK values, mimicking neuroleptic malignant syndrome (NMS) which was most probably due to central dopaminergic blockade induced by the disease process. To our knowledge, this is the first case of SSPE presenting with a NMS-like syndrome.