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Volume 5, No 1 - Winter 2008

Volume 5, No 1 - Winter 2008

Table of Contents

The Interactions Between Sleep and Epilepsy Diagnosis and Management Update
The interactions between sleep and epilepsy have been recognized for centuries. The electroencephalogram and more recently the polysomnogram have helped us understand these interactions. Certain epilepsy syndromes are more common during sleep, and frequently a sleep disorder is misdiagnosed as epilepsy. Management of epilepsy includes improvements in sleep quality and quantity, and aggressive treatment of epilepsy has a positive impact on sleep disorders. [Rev Neurol Dis. 2008;5(1):1-7]
Acute Pyogenic Diskitis (Spondylodiskitis) in Adults Diagnosis and Management Update
Most cases of back pain are the result of degenerative changes in the spine or are related to musculoskeletal elements. Pyogenic infections of the back can be subcategorized into cases involving the paraspinal epidural space, vertebral bodies, or the intervertebral disk spaces. Any region of the spine may be the site of diskitis, although the process most commonly involves the lumbar spine. Most cases of diskitis are managed with conservative therapy, including antibiotics and spinal immobilization using braces or corsets. Surgical therapy is generally reserved for patients with neurological complications, spinal instability, or progressive spinal deformity or those who fail to respond clinically to antibiotic therapy alone. [Rev Neurol Dis. 2008;5(1):8-13]
Peripheral Neuropathies Associated With Monoclonal Gammopathies of Undetermined Significance Diagnosis Update
Monoclonal gammopathies (MGs) or plasma cell dyscrasias (PCDs) are hematologic disorders that may affect peripheral nerves. An MG is a proliferation of a single clone of neoplastic or nonneoplastic plasma that usually secretes a monoclonal protein (M-protein) serum or urine. If a diagnosis of monoclonal gammopathy of undetermined significance (MGUS) is established, a sudden increase in M-protein levels can indicate malignant transformation of a benign PCD. Roughly 50% of MGUS neuropathies are associated with an IgM gammopathy and the remaining 50% with IgG- and IgAMGUS– associated neuropathies. MGUS is the most common of the PCDs associated with neurologic disorders, which are easily approached clinically by classifying them as IgM or non-IgM types. [Rev Neurol Dis. 2008;5(1):14-22]
Neuromuscular Diseases Meeting Review
Highlights of the 59th Annual Meeting of the American Academy of Neurology, April 28-May 5, 2007, Boston, MA [Rev Neurol Dis. 2008;5(1):23-26]
An Unusual Case of Multiple Discrete Brain Lesions Case Review: Presentation
The case of a patient with multiple enhancing lesions in the brain is presented, along with discussion of the differential diagnosis of granulomatous lesions of the brain, and a brief review of the essential features and neurological complications of the eventual diagnosis. Aspects of the disease of interest to neurologists are emphasized. [Rev Neurol Dis. 2008;5(1):27-28]
Language Impairment: Stepwise or Slowly Progressive? Case Review: Presentation
MRI showed ischemic lesions of the left hemisphere in a patient with a worsening language disturbance that by history could be caused either by ischemia or by a focal degenerative brain disorder. A positron emission tomography study indicated the presence of a degenerative disorder, the most common cause of which is tau-positive pathology. [Rev Neurol Dis. 2008;5(1):29-31]
An Unusual Case of Multiple Discrete Brain Lesions Case Review: Discussion
A differential diagnosis is offered for the case presented on pages 27-28. Additional laboratory test results are presented, the final diagnosis is revealed, and management options are discussed. Aspects of the disease of interest to neurologists are emphasized. [Rev Neurol Dis. 2008;5(1):38-41]
Language Impairment: Stepwise or Slowly Progressive? Case Review: Discussion
Diagnosis and treatment of the case presented on pages 29-31. The role of neuroimaging is emphasized. [Rev Neurol Dis. 2008;5(1):42-44]