Single-centre study surveying neurology trainees' and faculty's perceptions of the impact of the COVID-19 pandemic on residents' medical education.

OBJECTIVE: To assess perceptions of our neurology residents and faculty regarding training experience and medical education during the early COVID-19 pandemic. METHODS: We distributed two online, voluntary and anonymous surveys to trainees and teaching faculty of our Neurology Department at Henry Ford Hospital. Surveys inquired about trainees' stress, well-being, clinical experience and satisfaction with medical education and available support resources during the first wave of the COVID-19 pandemic in Michigan (mid-March to June 2020). RESULTS: A total of 17/31 trainees and 25/42 faculty responded to the surveys. Eight (47%) trainees reported high stress levels. Nine (57%) were redeployed to cover COVID-19 units. Compared with non-redeployed trainees, redeployed residents reported augmented medical knowledge (89% vs 38%, p=0.05). There was no difference in the two groups regarding overall satisfaction with residency experience, stress levels and didactics attendance. Twenty-one (84%) faculty felt that the redeployment interfered with trainees education but was appropriate, while 10 (59%) trainees described a positive experience overall. Both trainees and faculty believed the pandemic positively impacted trainees' experience by increasing maturity level, teamwork, empathy, and medical knowledge, while both agreed that increased stress and anxiety levels were negative outcomes of the pandemic. Twelve (70%) trainees and 13 (52%) faculty were interested in pursuing more virtual didactics in the future. CONCLUSION: Our findings provide an objective assessment of residents' experience during the COVID-19 pandemic and can guide teaching programmes in their medical education response in the face of future global crises.

Tales of a department: how the COVID-19 pandemic transformed Detroit's Henry Ford Hospital, Department of Neurology-part I: the surge.

The COVID-19 pandemic has reshaped the way healthcare systems operate around the world. The major hurdles faced have been availability of personal protective equipment, intensive care unit beds, ventilators, treatments and medical personnel. Detroit, Michigan has been an epidemic 'hotspot' in the USA with Wayne County among the hardest hit counties in the nation. The Department of Neurology at Henry Ford Hospital, in the heart of Detroit, has responded effectively to the pandemic by altering many aspects of its operations. The rapid engagement of the department and enhanced utilisation of teleneurology were two of the pivotal elements in the successful response to the pandemic. In this review, we describe the transformation our department has undergone, as it relates to its infrastructure redesigning, coverage restructuring, redeployment strategies, medical education adaptations and novel research initiatives.

Secondary Parkinsonism Due to a Large Anterior Cranial Fossa Meningioma.

Secondary Parkinson's disease or subacute Parkinson's may occur after stroke, drug overdose carbon monoxide or manganese toxicity, and rarely owing to a brain tumor. Loss of dopaminergic neurons in the substansia negra pars compacta (SNc), or presence of the proteinaceous inclusions called Lewy bodies are thought to be the cause of Parkinson's disease. Notwithstanding, in the past few decades, many case reports have been published describing Parkinson's symptoms following either stroke, ischemia, toxicity, brain haemorrhage or rarely neoplasm. LEARNING POINTS: Brain tumours can cause secondary parkinsonism.This type of secondary parkinsonism improves when the tumour is removed.

Education Research: Electronic patient portal enrollment and no-show rates within a neurology resident clinic.

OBJECTIVE: To identify factors that affect appointment adherence and investigate the association of electronic patient portal (ePP) enrollment and patient adherence rates to appointments in the Neurology Resident Clinic (NRC). METHODS: Patients scheduled for an appointment during the months of October 2015, February 2016, and June 2016 in the NRC were included. ePP enrollment, date of clinic appointment, method of referral to the clinic, and key demographic criteria were collected. χ2 tests were performed to assess the association of appointment status (i.e., no-show, showed, and canceled) with demographic, comorbidity, and visit information. RESULTS: Patients with ePP enrollment had significantly lower rates of no-show (19% vs 27%) and higher rates of showed (59% vs 48%) compared to patients without ePP enrollment. Younger patients (18-49) had the highest rates of no-show (28%), while older patients (65+) had the lowest rates of no-show (17%). Caucasian patients had significantly lower rates of no-show compared to non-Caucasian patients (14% vs 24%). Non-English-speaking patients had high rates of no-show (34%). Patients with a physician referral had significantly lower rates of no-show (20% vs 28%) and higher rates of showed (61% vs 44%) compared to patients with a self-referral. CONCLUSIONS: Our study indicates that ePP enrollment, age, race, and physician referral might be associated with reduced no-show rates in the NRC.

Atypical Presentation of Glioblastoma Multiforme.

BACKGROUND: Glioblastoma multiforme (GBM) is a highly malignant glial tumour classified by the World Health Organization (WHO) as a stage IV astrocytoma. It varies in shape and size and can be cystic, vascular and necrotic. It often appears as a ring-enhancing lesion on magnetic resonance imaging (MRI). The most common symptoms of GBM, such as headache, vomiting and seizures, are due to increased intracranial pressure. The objective of this case report is to describe an atypical presentation of GBM. CASE REPORT: A 53-year-old woman of Italian origin presented with a 2-week history of lack of coordination in her hands and some difficulty in speech. Electromyography for assessment of her arms and cranial bulbar function was normal. However, 2 days later, the patient presented to the emergency department with progressive weakness in her left arm and leg as well as difficulty in speech. Mild left facial asymmetry was noted. A brain MRI revealed a right frontal mass. Stereotactic surgical resection was performed 2 days later, and biopsy confirmed the diagnosis of GBM. Although headache and other features of raised intracranial pressure are the most common initial symptoms of GBM, any atypical neurological or psychiatric presentation in an adult patient should raise suspicion for this tumour. CONCLUSION: Careful analysis of an adult with atypical signs and symptoms along with thorough review of radiological tests will facilitate early diagnosis of dangerous tumours such as GBM. LEARNING POINT: An adult patient with symptoms that do not conform to a neurological condition should be investigated for a brain tumour.Careful history taking and examination are essential for reaching the correct diagnosis as soon as possible.Meticulous review of radiological images in order to detect subtle changes in brain anatomy is essential.

A significant temporal and quantitative relationship exists between high-density lipoprotein levels and acute ischemic stroke presentation.

BACKGROUND: Reduced serum high-density lipoprotein (HDL-C) is an independent risk factor for ischemic stroke in elderly men. The temporal and quantitative relationships between HDL-C and acute ischemic stroke have not been defined. METHODS: We identified patients with first ever acute ischemic stroke presenting to our hospital between 2003 and 2006. Patients with serum fasting lipid levels drawn within 24 h of admission and at least one follow-up visit with a neurologist in our hospital were included. Clinical and laboratory data before, immediately after, and several weeks after the index stroke were collected. RESULTS: 191 patients were included (47% women, mean age 62 years). The mean time interval between pre-stroke lipid data and index stroke was 5.2 months; 50% of these patients were taking a statin medication. The mean time interval between index stroke and follow-up lipid testing was 2.6 months. Immediately after the index stroke, HDL-C levels decreased by 18% (p<0.001) relative to pre-stroke levels. This phenomenon was independent of stroke severity, and was blunted among patients with a prior history of myocardial infarction (p<0.01). HDL-C levels increased to pre-stroke levels within 3 months post-stroke. CONCLUSIONS: HDL-C levels decrease significantly at the time of acute ischemic stroke. Prior history of myocardial infarction diminishes HDL-C depression at the time of stroke. HDL-C may be an acute phase reactant or nascent biomarker of acute stroke susceptibility. Further prospective studies are needed.