Related Articles

“Can I drive, doctor?” LEAN thinking may help us answer the question.

Pract Neurol. 2009 Apr;9(2):71-8; discussion 78-9

Authors: Thomas RH, Hughes TA

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.

PMID: 19289556 [PubMed - indexed for MEDLINE]

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Lacunar infarcts: no black holes in the brain are benign.

Pract Neurol. 2008 Aug;8(4):222-8

Authors: Norrving B

Lacunar infarcts–small subcortical infarcts that result from occlusion of a single penetrating artery–account for about one quarter of all ischaemic strokes. However, there are many diagnostic pitfalls, and causes other than penetrating small vessel disease in up to one third of cases. Recent studies have shown that the prognosis after lacunar infarcts is not benign; the risk of recurrent stroke is no lower than for other ischaemic stroke subtypes, and there is an increased risk for cognitive decline, dementia and death in the long term. Furthermore, silent small vessel disease in the brain at the time of an index stroke has significant prognostic implications. In the acute phase, response to intravenous thrombolysis appears to be similar to other subtypes of ischaemic strokes. Antiplatelet drugs, careful blood pressure control, statins and modification of lifestyle risk factors are key elements in secondary prevention after lacunar infarcts.

PMID: 18644908 [PubMed - indexed for MEDLINE]

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A practical approach to acute vertigo.

Pract Neurol. 2008 Aug;8(4):211-21

Authors: Seemungal BM, Bronstein AM

Patients complaining of symptoms of acute vertigo present a diagnostic challenge for the clinician; the main differential diagnoses are acute unilateral peripheral vestibulopathy ("vestibular neuritis"), cerebellar stroke or migraine. The head impulse test is useful in the acute situation because, of these three diagnostic alternatives, it will only be positive in patients with vestibular neuritis. A history of acute vertigo and hearing loss suggests Ménière's disease but the clinician must be wary of anterior inferior cerebellar artery strokes which may cause audiovestibular loss due to peripheral vestibulocochleal ischaemia, although the accompanying brainstem signs should remove diagnostic ambiguity. We also discuss other less common vertigo diagnoses that may be referred to the neurologist from the acute general hospital take. As ever in neurology, a careful history and focussed examination is necessary in the evaluation and management of acute vertigo.

PMID: 18644907 [PubMed - indexed for MEDLINE]

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Related Articles

Community-acquired bacterial meningitis in adults.

Pract Neurol. 2008 Feb;8(1):8-23

Authors: Schut ES, de Gans J, van de Beek D

Despite the availability of effective antibiotics, vaccination programmes and skilled acute-care facilities, there is still a significant mortality and morbidity from bacterial meningitis. Neurologists are often called on to “rule out bacterial meningitis”, which can be difficult with the history and physical examination alone. In this review the authors will discuss the epidemiology, diagnosis and treatment of acute community-acquired bacterial meningitis in adults, focussing particularly on the management of patients with neurological complications, and stressing the importance of adjunctive dexamethasone.

PMID: 18230706 [PubMed - indexed for MEDLINE]

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