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The article Intracerebral haemorrhage on the acute stroke unit.
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The loss of a driving licence can have a devastating effect on an individual's domestic life and work. Driving is a complex composite function comprising a number of other complex composite functions, and it is difficult to predict driving ability just from the traditional neurological examination. We propose the acronym LEAN as an aide-memoire to help structure a suggested driving section in the routine neurological clerking, and to help unpack the concept of "fitness" to drive: Licence status, Eligibility (to drive), Ability (to drive) and Notification requirements (to the licensing authorities), now and in the future; cover most of the important issues and may help ensure that people get the best advice. If there are concerns about someone's driving ability, with or without vehicle adaptations, an assessment in a Disabled Drivers Assessment Unit is recommended.
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Condução de Veículo , Doenças do Sistema Nervoso/complicações , Papel do Médico , Idoso , Condução de Veículo/legislação & jurisprudência , Feminino , Humanos , Responsabilidade Legal , Licenciamento/legislação & jurisprudência , Masculino , Notificação de Abuso , Pessoa de Meia-IdadeRESUMO
Three to 12 evaluations of clinical performance using the mini-clinical evaluation exercise (Mini-CEX) (n = 124) or direct observation of procedural skills (DOPS) (n = 21) were performed on 27 trainees working in an NHS neurology department. The communications/ counselling skills subdomain was scored in 64 evaluations. For Mini-CEX the focus was on gathering data (22%), diagnosis (31%), management (34%) and counselling (7%) (focus not recorded in 6%). For DOPS, lumbar puncture was the most common evaluated procedure (57%). Mini-CEX evaluations lasted 23.8 minutes (10.6) (mean, sd) and DOPS 25.9 minutes (12.6). Mini-CEX scores for overall competence and communication skills were mean 5.99 (sd 0.95, range 4-8) and 5.98 (sd 1.21, range 3-9) and for DOPS 5.71 (sd 0.90, range 4-8) both on scales of 1 to 9. Overall trainee competence and communication scores increased with year of training (p < 0.001, p < 0.004 univariate analysis). Assessors undertook up to three or four assessments in a session. Assessors and trainees considered that the observation and feedback had been 'very' or 'quite' useful in providing a relevant element of assessment. These assessments were feasible and useful in a neurology department and provided some evidence for increasing performance with trainee seniority. More assessor time (approximately one hour) than trainee time (24-26 min) was needed for each assessment undertaken.
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Competência Clínica/normas , Avaliação de Desempenho Profissional/métodos , Neurologia , Humanos , Medicina Estatal , Reino UnidoAssuntos
Fibrilação Atrial , Acidente Vascular Cerebral , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Humanos , Hemorragias Intracranianas/complicações , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/tratamento farmacológicoAssuntos
Encéfalo/patologia , Encefalomielite Aguda Disseminada/diagnóstico , Hemianopsia/etiologia , Esclerose Múltipla/diagnóstico , Transtornos da Percepção/etiologia , Adulto , Ataxia/etiologia , Encéfalo/fisiopatologia , Córtex Cerebral/patologia , Córtex Cerebral/fisiopatologia , Corpo Caloso/patologia , Corpo Caloso/fisiopatologia , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Esclerose Múltipla/fisiopatologia , Exame Neurológico , Testes Neuropsicológicos , Paresia/etiologia , Tálamo/patologia , Tálamo/fisiopatologia , Viroses/complicaçõesAssuntos
Carcinoma de Células Renais/complicações , Neoplasias Renais/complicações , Doenças do Sistema Nervoso/etiologia , Adulto , Encéfalo/patologia , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/terapia , Eletrocardiografia/métodos , Eletroencefalografia/métodos , Humanos , Neoplasias Renais/patologia , Neoplasias Renais/terapia , Imageamento por Ressonância Magnética/métodos , Masculino , Miocárdio/patologia , Doenças do Sistema Nervoso/patologia , Doenças do Sistema Nervoso/terapia , Tomografia Computadorizada por Raios XRESUMO
A 54 year old man presented with numerous cutaneous schwannomas, cranial nerve lesions, and spinal cord lesions, but no evidence of vestibular nerve involvement. There was no family history of neurocutaneous lesions. To help discriminate between the various possible diagnoses in this patient, molecular analysis of two cutaneous schwannomas was undertaken. An identical point mutation in the NF2 gene in the two anatomically distinct tumours was found, confirming this as a case of NF2 mosaicism.