Neurology

Patients with multiple sclerosis are more than twice as likely to report migraines as controls, according to a recent meta-analysis.

Population-based studies have firmly established that relatives of patients with MS are at increased risk for the disease.

A recent meta-analysis of all published studies showed that women with MS who decide to breast feed are almost half as likely to experience a postpartum relapse compared with women who do not.

Although genetics risk explains the familial clustering of MS, it cannot fully explain the geographic distribution of MS and the changes in risk that occur with migration. Infections have been suggested as a possible explanation. The most convincing candidate for involvement in MS is the Epstein-Barr virus.

Here: evidence that disease-modifying therapies can positively affect the long-term evolution of multiple sclerosis.

Even at disease onset, patients with MS have significantly lower bone mineral density than healthy controls. Close attention needs to be paid to the bone health of these patients.

Evidence for a treatment effect of vitamin D in modifying the course of MS is less compelling than evidence of a preventive effect.

Physical therapy can specifically address mobility deficits associated with multiple sclerosis-if the patient is referred early on in the disease’s course.

How to assess the degree of cognitive impairment in your MS patient if you work outside of a major medical center and have little access to experts trained to administer cognitive tests? BICAMS can help. Details from an expert here.

Lhermitte-Duclos disease is a rare, slow-growing, benign lesion of the cerebellum and is considered a hamartomatous tumor of the cerebellar cortex.

Common MS exacerbation triggers: infection, vaccination, stress, smoking, vitamin deficiency, or environmental changes.

Vertebral artery dissection may be misdiagnosed as post-concussive syndrome, stroke, or TIA, based on neurologic symptoms. Always consider after neck trauma.

Use of aspirin in primary prevention of cardiovascular disease must be based on individual risk-benefit analysis and is not appropriate for patients at low risk.

Medication overuse headache can result from overuse of any drug to abort acute headache. Discontinuation is the only effective treatment and is difficult.

The European Society of Cardiology just weighed in on the 3 new alternatives to warfarin for oral anticoagulation. The response is tempered enthusiasm.

Phrenic nerve paralysis can present with chest wall pain, cough, and exertional dyspnea mimicking cardiac dyspnea. Fluoroscopy is the most reliable way to document diaphragmatic paralysis, and the sniff test confirms that abnormal hemidiaphragm excursion is due to paralysis rather than unilateral weakness.

A 58-year-old man with a past medical history of chronic sinus disease and hypothyroidism presented with left periorbital pain and erythema that worsened despite outpatient treatment with topical antibiotics. An outpatient CT scan showed pansinusitis and orbital stranding. The diagnosis was orbital cellulitis and sinusitis.

A 4-year history of headache and severe neck pain led to a diagnosis of Chiari I malformation in this patient. Here: symptoms, diagnostic tests, and treatment approaches.

Here: 10 tips that can help you provide optimal care of your patients with MS.

In many patients, episodic migraines increase in frequency and transform into a refractory pattern.

What are the factors that underlie the transformation of episodic migraine to refractory migraine? Dr Susan Hutchinson explains.

A bad ("sick" or killer) headache is usually a migraine if underlying organic causes of pain are ruled out.

When counting sheep fails as first line therapy, what measures can you recommend to help your patient get some sleep?

In Part 2 of this podcast series, Dr Smith continues his discussion of the practice of nonsuicidal self-injury in adolescents.

Early differentiation of epileptic from nonepileptic seizures is important. Clues that suggest epilepsy are a history of febrile seizures (particularly if prolonged), past brain injury from trauma or infection, and epilepsy in first-degree relatives.

In this podcast, Dr Smith discusses the practice of nonsuicidal self-injury in adolescents-cutting, burning, self-hitting or banging, scratching, interfering with wound healing-may be increasing.

A 59-year-old woman had aphasia and right-sided weakness after a routine total knee replacement. CT and MRI scans revealed a large left middle cerebral artery infarct. A CT angiogram showed no significant disease of the cerebrovascular arteries. Test results for the lupus anticoagulant were positive. A venous study of the legs showed no deep venous thrombosis. She was treated with warfarin and aspirin and discharged. After speech and physical therapy, she had mild residual aphasia.

Psychiatrist Sidney Zisook, MD-a guest speaker at the recent American College of Physicians meeting in San Diego