Robert M. Pascuzzi

Familial autoimmune myasthenia gravis and thymoma: Occurrence in two brothers

At ages 31 and 42 years, two brothers presented with clinical, pharmacologic, electrophysiologic, and immunologic characteristics of autoimmune myasthenia gravis. At thymectomy, both had histologic findings of epithelial thymoma. HLA analysis revealed A2, A3, B7, and B39 antigens in one patient and A3, A24, B7, and B40 antigens in the other. Familial myasthenia gravis with thymoma has not been described previously. Familial thymoma has been rarely reported, but never with myasthenia gravis.

Primary intravascular lymphomatosis associated with Mycobacterium marinum.

Intravascular lymphomatosis (IVL) is a rare condition in which neoplastic cells preferentially infiltrate blood vessels of the central nervous system. Nonspecific symptoms associated with IVL include dementia, seizures, and multifocal cerebrovascular events. IVL was discovered at autopsy of a patient whose neurological deficits were predated by a particularly aggressive form of Mycobacterium marinum soft–tissue infection. It is speculated that IVL may have had an occult effect on the patients cellmediated immunity that predisposed him to this normally innocuous mycobacteria.

A dinosaur roars Assessing clinical skills in residency

In this issue of Neurology ®, Schuh et al.1 report on internal bias and interrater reliability of the residency-based neurology clinical skills evaluation (NEX).nnI began training in the pre-MRI era and that qualifies me as a dinosaur. Forces combine to erode the quality of bedside clinical skills that serve as the backbone of our profession and define us as neurologists. Residents are consumed by duty hours restrictions, patient handoffs, electronic medical records, diagnostic antibody panels, high-tech imaging, and systems-based practice, and their faculty members are strapped for time as never before. Bedside clinical skills may become extinct.nnFor many years, the American Board of Psychiatry and Neurology (ABPN) and others have recognized the problems associated with testing fundamental clinical skills 1-2 years following completion of training and view the residency as the most logical and appropriate time for evaluating such skills. It seems most fair to the trainee and their patients to have deficiencies recognized in a timeframe that allows for improvement and remediation. The Accreditation Council for Graduate Medical Education (ACGME) requires our training programs to evaluate clinical skills during residency and the program director (PD) signs a letter upon completion of residency testifying that the graduate is competent …

Opinion/Education: The ABPN is the neurology resident’s best friend

The American Board of Psychiatry and Neurology (ABPN) is in the midst of major changes in the way in which candidates are credentialed and evaluated for board certification. These changes will have a major impact on current residents-in-training. Such changes are largely driven by the desire of the ABPN to provide a certification process that is framed in fairness, validity, and reliability, and at the same time respects the problems inherent in psychologically and financially stressful oral examinations. It is essential that communication and dialogue among the ABPN, the program directors, and the residents remain a priority. The following discussion summarizes ongoing changes with regard to ABPN certification and attempts to articulate why these changes are good for the field and may be viewed with particular enthusiasm by residents-in-training.nnDr. Larry Faulkner has assumed the role of Executive Vice-President of the ABPN. The ABPN is comprised of eight psychiatrists (the Psychiatry Council) and eight neurologists (the Neurology Council). Dr. Faulkner served for 8 years as a Director in Psychiatry for the ABPN, and during that time he developed close ties with the Neurology Counsel. Prior to assuming the leadership position with the ABPN, he was Dean of the University of South Carolina School of Medicine, and he is familiar with most aspects of academic medicine, including those related to residency training. Dr. Faulkner brings to the APBN energy, insight, and an understanding of a great deal of practical organization. Dr. Michael Johnston is the 2007 Chair of the Neurology Council of the ABPN. He is in the final year of an 8-year term serving as a Neurology Director of the ABPN. Filling out the ranks of neurologists in order of seniority as Directors on the Board are Patricia Coyle (who becomes Chair in 2008), Bob Pascuzzi, Steven DeKosky, Michael Aminoff, …

Lawful physician-hastened death: AAN position statement

In 1998, the American Academy of Neurology published its prior position on physician-hastened death, titled “Assisted suicide, euthanasia, and the neurologist.” In that statement, the American Academy of Neurology (AAN) expressed its vigorous opposition to its members participation in either physician-assisted suicide (PAS) (prescription without clinician administration) or euthanasia (prescription with clinician administration).1 At that time, physician participation in either of these hastened-death practices was illegal in all US jurisdictions except Oregon.