MaryAnn Mays

Acute Treatment of Basilar-Type Migraine With Greater Occipital Nerve Blockade

(Headache 2010;50:1057‐1069)

Pitfalls in the electrodiagnostic studies of sacral plexopathies.

This retrospective review characterizes the electrodiagnostic (EDX) features and etiologies of sacral plexopathies (SPs) and discusses difficulties in their identification. The EDX findings of 171 clinically suspected SPs were reviewed using the following criteria: reduced/absent sensory nerve action potentials (SNAPs) of the sural or superficial peroneal nerve, denervation of plexus‐innervated muscles, and the absence of paraspinal denervation. Sixty cases localized unequivocally to the sacral plexus. The majority were cancer‐related, followed by traumatic, idiopathic, and iatrogenic causes. Final diagnoses in the remaining 111 cases were indeterminate. Lesions localized to either the plexus or L4–5, S1 roots in 52 cases, the plexus or sciatic nerve in 32 cases, and were equally compatible with an SP, sciatic neuropathy, or radiculopathy in 27 cases. Findings in the EDX evaluation of SPs are often complex and difficult to localize to a specific site due to multiple complicating factors. Frequently, SPs cannot be diagnosed definitively by EDX assessment alone. Muscle Nerve, 2007

Unusual headaches in the elderly.

Prevalence of headache lowers with age, and headaches of elderly adults tend to be different than those of the younger population. Secondary headaches, such as headaches associated with vascular disease, head trauma, and neoplasm, are more common. Also, certain headache types tend to be geriatric disorders, such as primary cough headache, hypnic headache, typical aura without headache, exploding head syndrome, and giant cell arteritis. This review provides an overview of some of the major and unusual geriatric headaches, both primary and secondary.

Opinion and Special Articles: Electronic media in neurology education Progress, promise, and pitfalls

Todays neurology learners have more information to assimilate than ever before,1 requiring them to learn as quickly and efficiently as possible, while also becoming lifelong learners. To facilitate more effective and expedient learning, neurology educators have begun using computer-assisted learning technologies in education and residency. Electronic media have been found to be effective additions to education due to their flexibility, scalability, timeliness, and adaptability.2 Computer-based learning is increasingly employed by medical students, neurology trainees, and practicing neurologists, making it necessary to acclimate students and trainees to such technology before they enter professional practice.

Mentored peer review of standardized manuscripts as a teaching tool for residents: a pilot randomized controlled multi-center study

BackgroundThere is increasing need for peer reviewers as the scientific literature grows. Formal education in biostatistics and research methodology during residency training is lacking. In this pilot study, we addressed these issues by evaluating a novel method of teaching residents about biostatistics and research methodology using peer review of standardized manuscripts. We hypothesized that mentored peer review would improve resident knowledge and perception of these concepts more than non-mentored peer review, while improving review quality.MethodsA partially blinded, randomized, controlled multi-center study was performed. Seventy-eight neurology residents from nine US neurology programs were randomized to receive mentoring from a local faculty member or not. Within a year, residents reviewed a baseline manuscript and four subsequent manuscripts, all with introduced errors designed to teach fundamental review concepts. In the mentored group, mentors discussed completed reviews with residents. Primary outcome measure was change in knowledge score between pre- and post-tests, measuring epidemiology and biostatistics knowledge. Secondary outcome measures included level of confidence in the use and interpretation of statistical concepts before and after intervention, and RQI score for baseline and final manuscripts.ResultsSixty-four residents (82%) completed initial review with gradual decline in completion on subsequent reviews. Change in primary outcome, the difference between pre- and post-test knowledge scores, did not differ between mentored (−8.5%) and non-mentored (−13.9%) residents (p = 0.48). Significant differences in secondary outcomes (using 5-point Likert scale, 5 = strongly agree) included mentored residents reporting enhanced understanding of research methodology (3.69 vs 2.61; p = 0.001), understanding of manuscripts (3.73 vs 2.87; p = 0.006), and application of study results to clinical practice (3.65 vs 2.78; p = 0.005) compared to non-mentored residents. There was no difference between groups in level of interest in peer review (3.00 vs 3.09; p = 0.72) or the quality of manuscript review assessed by the Review Quality Instrument (RQI) (3.25 vs 3.06; p = 0.50).ConclusionsWe used mentored peer review of standardized manuscripts to teach biostatistics and research methodology and introduce the peer review process to residents. Though knowledge level did not change, mentored residents had enhanced perception in their abilities to understand research methodology and manuscripts and apply study results to clinical practice.

Differential Diagnosis and Workup of the Headache Patient: Should I Order a Scan?

The complaint of headache may be associated with a number of medical disorders but is most often a symptom of a primary headache disorder. An astute clinician must recognize red flags in the medical history and examination that will point to a more ominous and potential life-threatening secondary headache. Although most patients can be accurately diagnosed by history and physical alone, additional neuroimaging and laboratory testing may be appropriate in select patients. Once secondary headaches have been excluded, determining which primary headache to classify the patient will assist in choosing the appropriate therapy. The most common primary headache disorders seen in clinical practice include migraine, tension-type headache, and cluster headache.

Diagnosis of Major Secondary Headaches, Nonvascular Disorders

This chapter is a guide to the diagnosis of secondary headaches that are nonvascular. By necessity, the sections are disparate, but important for diagnostic purposes.

Diagnosis of Major Secondary Headaches 2, Non-traumatic and Non-vascular Disorders

This chapter on secondary headaches focuses exclusively on headaches which are due to non-vascular causes. The chapter begins with considerations on diagnosis of idiopathic intracranial hypertension (IIH, pseudotumor cerebri) and headaches of low CSF pressure or intracranial hypotension. Next, the author provides a discussion on headaches associated with intracranial neoplasm, disorders of infectious disease, disorders of homeostasis, and toxic headaches, along with clinical pearls for diagnosing these myriad secondary headaches. Tips on diagnosing cervicogenic headache and temporomandibular disorder are provided. Finally, the author summarizes clinical pearls on diagnosis of classic and secondary trigeminal neuralgia, along with clinical features of other, more rare facial neuralgias and persistent idiopathic facial pain.

Diagnosis of Major Secondary Headaches 1, the Basics, Head and Neck Trauma, and Vascular Disorders

The recognition of secondary etiologies is critically important to all those treating patients with headaches. Secondary headaches occur in close temporal relation to another disorder, or there is evidence of a causal relationship. Secondary headache, by definition, should improve or go away within 3 months spontaneously or after successful treatment of the cause. While the ICHD-2 lists eight different classifications of secondary headaches, this clinically focused chapter delves into recognizing red flags, when to order neuroimaging and appropriate laboratory testing, as well as other workup. Posttraumatic headaches must start within 7 days of precipitating trauma and are most often associated with milder headache and neck trauma. They can bring about a syndrome of symptoms frequently best treated with a multidisciplinary plan. Vascular headaches are those associated with ischemia, vasculitis, hemorrhage, or alteration in brain circulation. While stroke, aneurysm, and TIA are considered first, other genetic and mitochondrial abnormalities can result in serious and progressive secondary headache disorders.