A summary of recently published articles in the Neurology® Resident & Fellow Section
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April 6, 2021, Issue
This issue covers a range of topics in child neurology. The Child Neurology article reminds us that late reactivation of herpes simplex virus (HSV) encephalitis can occur. The Pearls & Oy-sters stresses the value of early recognition of medial medullary syndrome aided by nystagmus evaluation to expedite thrombolytic therapy. This and the Video Teaching NeuroImage demonstrate important tips in eye movement evaluation in children. The Teaching NeuroImage teaches the value of brain imaging in cases of congenital muscular dystrophy.
Child Neurology: Intractable Epilepsy and Transient Deficits in a Patient With a History of Herpes Simplex Virus Encephalitis
Reactivation of HSV encephalitis may occur years after initial illness. Neurologists should be aware that although most cases of HSV reactivation occur within the first year of initial infection, late reactivation in the setting of physiologic stress may occur.
Page 679
Pearls & Oy-sters: Upbeat Nystagmus and Quadriplegia in a Young Girl With Bilateral Medial Medullary Syndrome
Upbeat nystagmus differentiates a high cervical cord from a brainstem lesion in an acutely quadriplegic patient. An excellent clinical video illustrates the characteristics and topography of vertical nystagmus.
Page e1921
Teaching NeuroImages: An Imaging Clue in a Boy With Developmental Delay
Characteristic neuroimaging findings in the brain are seen in patients with α-dystroglycanopathy variant of congenital muscular dystrophy. This case reinforces the relevance of CNS imaging in patients with muscular dystrophy and developmental delay.
Page e1925
Teaching Video NeuroImages: Atypical Abnormal Eye Movements in PNPO-Related Epilepsy
Neurologists should be aware of the newly described symptomatology of PNPO-related epilepsy, which presented in an infant with nonepileptic, paroxysmal abnormal eye–head movements.
Page e1927
April 13, 2021, Issue
This issue covers a range of topics from bread and butter neurology to rare conditions and training pathways. The Education Research article provides national needs assessment data on the barriers to pursuing neurointerventional training for neurology residents. The Pearls & Oy-sters article is an excellent and concise review of the differential diagnosis of pupillary anisocoria. The 2 Teaching NeuroImage cases illustrate how to approach the ocular examination in patients with suspected neuroinfectious diseases.
Education Research: Challenges Faced by Neurology Trainees in a Neuro-Intervention Career Track
Neurology graduates face challenges in carving a niche in the field of endovascular neurology. These authors report that lack of early exposure and a clear training pathway are barriers to entry for trainees interested in neurointervention.
Page e2028
Pearls & Oy-sters: Anisocoria Greater in the Dark: It's Not Just All About Horner Pupil
A careful pupillary examination including pharmacologic testing is critical in evaluating patients with pupil asymmetry and may help to avoid unnecessary imaging work p in patients with Adie tonic pupil.
Page 719
Teaching NeuroImages: Hutchinson Sign in Herpes Zoster Ophthalmicus
The presence of herpetic skin lesions along the nasociliary nerves of the nose is a predictor of ocular complications of herpes zoster ophthalmicus.
Page e2033
Teaching NeuroImages: Neurocysticercosis With Unilateral Vision Loss
Subretinal cysticercosis is a rare ocular manifestation of neurocysticercosis and may present with unilateral vision loss. This case illustrates the fundus findings, ocular ultrasound, and brain imaging features in this case.
Page e2035
April 20, 2021, Issue
In this issue, the Journal Club article critiques the limitations of retrospective clinico-radiographic correlation studies including selection of optimal controls. The Pearls & Oy-sters article presents a unique case of CNS lymphoma in pregnancy and discusses important aspects of neurologic care in the pregnant patient. The Teaching NeuroImages demonstrate the mechanisms of mechanical factors in the pathophysiology of glossopharyngeal neuralgia and nystagmus in patients with Ménière disease.
Journal Club: Diffusion-Weighted MRI in Transient Global Amnesia and Its Diagnostic Implications
A recent article published in Neurology proposes the addition of MRI-based diagnostic criteria to existing clinical criteria for diagnosis of transient global amnesia. This journal club reminds us of the importance of interpreting these data in the context of limitations in optimal controls for this retrospective study.
Page e2138
Pearls & Oy-sters: Primary CNS Burkitt Lymphoma in Pregnancy: Management Challenges of a Rare Entity
Primary CNS Burkitt lymphoma may rarely occur during pregnancy and can be difficult to treat. The authors discuss the diagnostic workup, treatment challenges, and why this may occur during pregnancy.
Page e2141
Teaching NeuroImages: Glossopharyngeal Nerve Focal Pressure Atrophy in Glossopharyngeal Neuralgia
In patients with glossopharyngeal neuralgia, objective evidence of vascular compression is rare, but in this case was associated with resolution of symptoms after decompression. Striking intraoperative imaging illustrates focal pressure atrophy of the nerve.
Page 769
Teaching Video NeuroImages: Spontaneous Nystagmus Reversal in Acute Attack of Ménière Disease
Neurologists and trainees should be aware of videonystagmography. In this case, the authors recorded 2 phases of nystagmus in Ménière disease—irritative (ipsilateral) and paralytic (contralateral)—allowing the observer to see unique aspects of this patient's nystagmus and learn how to define and correlate the phases.
Page e2145
April 27, 2021, Issue
This issue covers several topics important for trainees and neurologists. The Education Research article presents data from a national survey on the status of EEG training in US neurology residency programs. Rare CNS involvement in Hodgkin lymphoma is presented in the Pearls & Oy-sters highlighting how to approach CNS imaging in patients with history of cancer. The Teaching Video NeuroImages demonstrate characteristic breathing and speech findings in patients with brainstem syndromes.
Education Research: Neurology Resident EEG Education: A Survey of US Neurology Residency Program Directors
This survey study of approximately 30% of American adult neurology programs reports a lack of consistency in teaching and evaluating EEG training during residency and identifies education barriers along with possible solutions.
Page 821
Pearls & Oy-sters: Nonmotor Seizures as Presenting Feature of Hodgkin Lymphoma CNS Involvement
CNS involvement is rare in patients with Hodgkin lymphoma. This case reminds us that new neurologic symptoms in patients with a known history of Hodgkin lymphoma should be thoroughly investigated to rule out secondary causes.
Page e2239
Teaching Video NeuroImages: Cluster Breathing in Brainstem-Sparing Bihemispheric Cerebral and Cerebellar Lesions
Cheyne-Stokes and cluster breathing localize to different regions of the brainstem and posterior fossa. Combined cerebellar and cerebral lesions may affect brainstem-mediated respiratory control differently.
Page e2243
Teaching Video NeuroImages: Paroxysmal Dysarthria-Ataxia in Multiple Sclerosis
This case provides a highly illustrative example of paroxysmal dysarthria-ataxia as the presenting manifestation of multiple sclerosis and summarizes the differential diagnosis.
Page e2245
Footnotes
Editor's Blog NPub.org/rfblog
Resident & Fellow Child Neurology BookNPub.org/cn_about
Latest Resident & Fellow Section e-PearlsNpub.org/epearls
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