NEURO

In-person resident didactics are traditionally limited to the faculty within a single institution. Tele-education efforts have been implemented in neurology to various degrees historically, but the coronavirus disease 2019 (COVID-19) pandemic has necessitated a broad and immediate overhaul in neurology didactic training. To respond to the immediate need for resident didactics, we created a rapid onset, volunteer tele-education didactic series publicized on online forums to the American Academy of Neurology A.B. Baker Section via Synapse and the Women Neurologists Group via Facebook. We describe how, with just 1 week of lead time, we created an ongoing neurology lecture series featuring faculty from across the country lecturing on a diverse range of neurology topics. The series is ongoing and draws upwards of 120 residents per lecture. Tele-education offers unique benefits to enhance the education of all neurology trainees everywhere. from Neurology recent issues https://ift.tt/3eFjB...

In the article, "Questionnaire-based diagnosis of benign paroxysmal positional vertigo (BPPV)," Kim et al. presented a study of a 6-item questionnaire developed for the diagnosis of BPPV, with the first 3 questions intended to identify BPPV and the next 3 intended to determine the involved canal and type of BPPV. Among 578 patients who completed the questionnaire before positional tests at a dizziness clinic, the questionnaire could diagnose BPPV with a sensitivity of 87.0% and specificity of 89.8%. The questionnaire and positional tests showed similar results in identifying the BPPV subtype and the affected side. In response, Drs. Gold and Newman-Toker noted that although BPPV itself can often be diagnosed by history, the physical examination is traditionally key to identify the site of the culprit otoliths. Although hailing the questionnaire-based method as an important step forward, they raise questions about its reproducibility—particularly in other care settings—and abou...

Clinicians who frequently evaluate dizzy patients know that benign paroxysmal positional vertigo (BPPV) can usually be diagnosed by telephone and treated by video chat. The history is often clear, so the main questions is, "Where are the ‘rocks’?" The answer is traditionally gleaned from the physical examination. The vector/direction of provoked nystagmus identifies the location of offending otolithic debris, which defines the correct repositioning maneuver. from Neurology recent issues https://ift.tt/38rL5cX

We thank Drs. Gold and Newman-Toker for their interest in our article 1 on self-diagnosis of benign paroxysmal positional vertigo (BPPV) using a questionnaire. As they indicated, questionnaire-based diagnosis of BPPV seems feasible with acceptable accuracy, although generalizability of the results should further be determined in other clinical settings. The ultimate goal of the study was self-application of canalith repositioning maneuvers by the patients themselves based on the results of the questionnaire. We are now conducting a clinical trial for this purpose (CRIS registry no. KCT00002364) and look forward to reporting the results soon. from Neurology recent issues https://ift.tt/3eTTqY9

Kim et al.'s 1 6-question strategy to diagnose benign paroxysmal positioning vertigo (BPPV) provides "acceptable" accuracy for BPPV diagnosis but less utility for type of BPPV. Reported accuracy of question 4—"to distinguish horizontal canal (HC) from posterior canal (PC) BPPV"—is largely due to vastly different frequencies of BPPV types. from Neurology recent issues https://ift.tt/3eIRZvj

We thank Dr. Lanska for the interest in our article 1 that introduced a questionnaire comprising 6 questions to diagnose benign paroxysmal positional vertigo (BPPV) and its subtypes. Dr. Lanska instead proposed a rather simple 4-question approach. This proposition is based on the assumption that BPPV preferentially involves the posterior semicircular canal (PC-BPPV). Indeed, the posterior semicircular canal is more commonly involved (60%–90%) than other canals in BPPV. 2 The proportion of BPPV involving the horizontal canal (HC-BPPV), however, should not be underestimated. According to the prior studies, HC-BPPV comprises 20%–35% of idiopathic BPPV. 3,4 Given the similar proportion of HC-BPPV among the centers in South Korea 3 and a lower incidence of HC-BPPV in patients with a lesser interval from symptom onset to diagnosis, 5 this seemingly higher proportion of HC-BPPV in our studies may not be ascribed to a referral-bias, and the proportion of HC-BPPV seems higher than is belie...

In the article "Aerobic exercise improves cognition and cerebrovascular regulation in older adults" by Guadagni et al., 1 the tests mentioned should read "Card Sorting Test" and "Color-Word Interference Test." The authors regret the errors. from Neurology recent issues https://ift.tt/38qQcKh

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A 72-year-old right-handed man was referred to the cognitive neurology clinic after being involuntarily committed to an inpatient psychiatry unit for 2 years. He was unable to give a coherent history, which was obtained from his wife. His birth and early development were unremarkable. He had previously held a number of jobs including working in the merchant navy for 2 years. He was unemployed before admission. He did not drink alcohol excessively and was a heavy smoker. He was fit and medically well until 5 years before the assessment, when he developed progressive balance and behavioral problems. This included an ataxic gait requiring intermittent wheelchair use, slurred speech, and poor memory. He had become increasingly irritable and aggressive with paranoid ideas of spousal infidelity. from Neurology recent issues https://ift.tt/36lGNBa