Preventing burnout increases the desirability of neurology as a career
Neurologic diseases comprise a major percentage of disease burden in the United States, and one that is predicted to increase as our population ages. The need for physicians with expertise in the recognition, diagnosis, and management of neurologic diseases also will increase. Over the next decade, the number of neurologists in the United States will grow from the current 16,000 to 18,000. However, even this number represents a predicted 20% shortfall in number of neurologists needed by 2025.1,2 Our neurology workforce therefore must increase to address this current and future need. (Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Khan, J., Bernat, J. L. Tags: EDITORIALS Source Type: research
Smoking cessation and secondary stroke prevention
The 7 million adult stroke survivors in the United States remain at high risk for a recurrent stroke. The increased morbidity and cost associated with recurrent stroke, in addition to the 5% to 20% yearly stroke recurrence, support the need for additional investigations into secondary stroke prevention.1,2 Stroke prevention guidelines, whether primary or secondary, focus on risk factor control of modifiable risk factors. The American Heart Association/American Stroke Association guidelines for secondary stroke prevention indicate evidence-based risk factor control, interventional approaches, and treatment options as approa...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Boehme, A. Tags: EDITORIALS Source Type: research
An improved way to predict neurologic recovery in acute spinal cord injury
In North America alone, spinal cord injury affects well over 1 million patients, with the average annual incidence expected to rise secondary to an increasing amount of falls in an aging population.1,2 Spinal cord injury (SCI) has detrimental health consequences that can frequently leave the injured patient with a lifetime of medical expenses exceeding $4 million.2 Although the current practice in treating SCI is to elevate a patient's mean arterial pressure (MAP) to 85–90 mm Hg for the first 7 days in an effort to maintain spinal cord perfusion, this treatment strategy has uncertain efficacy, as the actual spinal co...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Lyon, K. A., Huang, J. H. Tags: EDITORIALS Source Type: research
Spotlight on the October 17 issue
(Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Gross, R. A. Tags: IN FOCUS Source Type: research
Teaching Video NeuroImages: My weeping patient: Avoiding the pitfalls of a functional diagnosis
A 54-year-old man presented with symptoms of a posterior circulation stroke. A right facial palsy and horizontal right end gaze nystagmus was noted. On resolution, episodes of uncontrolled weeping without a provoking stimulus was observed (video at Neurology.org). These were initially unremitting, lasting minutes, with complete resolution after 1 month. An early consideration was of a functional neurologic disorder. Subsequent MRI brain demonstrated bilateral anterior pontine infarcts (figure). It has been hypothesized that pseudobulbar affect (PBA) results from the loss of frontal cortex input to the cerebellum during emo...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Peters, J., Vijiaratnam, N., Wijeratne, T. Tags: All Cerebrovascular disease/Stroke, All Education RESIDENT AND FELLOW SECTION Source Type: research
Teaching NeuroImages: MR neurography for the diagnosis of hypertrophic neuropathies
A 25-year-old woman presented with a 10-year history of frequent falls and deafness. Her mother had a similar neurologic picture. Examination showed peroneal amyotrophy, pes cavus, and hearing loss. Magnetic resonance (MR) neurography showed diffuse nerve enlargement in the lower limbs (figure). Genetic analysis revealed heterozygous mutation c.82T>C (p.Trp28Arg) in the PMP22 gene, defining diagnosis of Charcot-Marie-Tooth disease (CMT) type 1A. (Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Souza, P. V. S. d., Bortholin, T., Naylor, F. G. M., Pinto, W. B. V. d. R., Oliveira, A. S. B. Tags: MRI, Peripheral neuropathy RESIDENT AND FELLOW SECTION Source Type: research
Teaching NeuroImages: Spontaneous involution of symptomatic delayed tumefactive cyst following radiosurgery for AVM
A 65-year-old woman underwent radiosurgery for a left temporal arteriovenous malformation (AVM) (figure 1A). Follow-up MRI/magnetic resonance angiography 3 years later demonstrated postradiation changes (figure 1B) and AVM resolution (figure 2). Six years posttreatment, she had progressive headaches and aphasia and a large cyst (figure 1C). Her symptoms resolved acutely without treatment. MRI 3 months later showed reduction of the cyst with mass effect resolution related to spontaneous fenestration in the ventricle (figure 1D). (Source: Neurology)
Source: Neurology - October 16, 2017 Category: Neurology Authors: Aiello, G., Snyder, K., Brinjikji, W., Lanzino, G. Tags: MRI, Arteriovenous malformation RESIDENT AND FELLOW SECTION Source Type: research
Teaching NeuroImages: Artery of Percheron thrombosis causing selective downgaze palsy
A 47-year-old man with migraines presented with sudden onset of vertical diplopia, dysarthria, right facial weakness, and downgaze palsy (figure 1). Brain MRI revealed ischemic strokes in the midbrain periaqueductal gray, bilateral thalamic–midbrain junction, and thalamus (figure 2, A–C). Gradient echo and T1 MRI showed hypointensity in the interpeduncular fossa (figure 2, D and E). No flow could be visualized in this structure on CT angiogram or catheter angiogram, demonstrating a thrombosed artery of Percheron (figure 2, F–H). Downgaze palsy, which improved 18 months later, may result from bilateral les...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Sechler, M., Singh, J., El Husseini, N. Tags: MRI, DWI, All Cerebrovascular disease/Stroke, Infarction RESIDENT AND FELLOW SECTION Source Type: research
Clinical Reasoning: A 46-year-old man with persistent hiccups, cognitive dysfunction, and imbalance
A 46-year-old, right-handed, African American man presented to the emergency department after 1 week of persistent hiccups and 3 days of nausea and vomiting. His family member also noted that he had been experiencing right-hand tremor and gait imbalance for the last 3 months. Over the 6 months prior to presentation, the patient's coworkers had noticed that he was completing his work more slowly, that he was forgetting how to perform simple tasks, and that several times he had come to work at the wrong hours. The patient had a history of HIV diagnosed 10 years earlier and reported good adherence to an antiretroviral regimen...
Source: Neurology - October 16, 2017 Category: Neurology Authors: Lamb, C. J., Lopez Chiriboga, A. S., Sotello Aviles, D. A., Mendez, J. C., Robinson, M. T. Tags: All Infections, Encephalitis, HIV, Executive function, Assessment of cognitive disorders/dementia RESIDENT AND FELLOW SECTION Source Type: research
Increased brain-predicted aging in treated HIV disease
(Source: Neurology)
Source: Neurology - October 9, 2017 Category: Neurology Tags: CORRECTIONS Source Type: research
Author response: Burnout, career satisfaction, and well-being among US neurologists in 2016
We thank Bagot et al. for their comments. Burnout, career satisfaction, and well-being in neurologists who practice telemedicine is important to study as this practice model becomes more common. (Source: Neurology)
Source: Neurology - October 9, 2017 Category: Neurology Authors: Busis, N. A., Shanafelt, T. D., Keran, C. M., Levin, K. H., Schwarz, H. B., Molano, J. R., Vidic, T. R., Kass, J. S., Miyasaki, J. M., Sloan, J. A., Cascino, T. L. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Letter re: Burnout, career satisfaction, and well-being among US neurologists in 2016
I read with interest the article on burnout among US neurologists.1 There are 2 additional factors contributing to burnout that the authors fail to address. One is the electronization of medicine. Electronization is a term used to describe the process of taking an item or process from paper-based form and electronically producing it, mainly to increase profitability and efficiency. We now have electronic health records (EHR) available on laptop, iPad, and cell phone. Patients can email physicians through the myconnect portal on the EHR, contact physicians through work email, or, in some instances, text physicians on cell p...
Source: Neurology - October 9, 2017 Category: Neurology Authors: Sethi, N. K. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Letter re: Burnout, career satisfaction, and well-being among US neurologists in 2016
The study by Busis et al.1 of 1,671 US neurologist survey respondents revealed that burnout was common among all neurology practice settings and subspecialties. During Dr. Cascino's 2017 Presidential Plenary Address, he presented a figure from a larger survey of US physicians in general that correlated the percentage of physicians with burnout identified by specialty with the percentage satisfied with their work–life balance.2 This graph seemed to indicate that neurology was among the specialties with the greatest degree of burnout and the least satisfaction with work–life balance.2 (Source: Neurology)
Source: Neurology - October 9, 2017 Category: Neurology Authors: Berger, J. R. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Letter re: Burnout, career satisfaction, and well-being among US neurologists in 2016
I heard the excellent Presidential Plenary Address by Dr. Terrence Cascino at the 2017 American Academy of Neurology (AAN) meeting. The focus of the AAN on this issue, especially early retirement, is to be applauded, but the emphasis on work–life balance and yoga is misplaced. The term burnout is demeaning to our colleagues. (Source: Neurology)
Source: Neurology - October 9, 2017 Category: Neurology Authors: Yanofsky, C. S. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
Letter re: Burnout, career satisfaction, and well-being among US neurologists in 2016
Busis et al.1 investigated the prevalence and factors that contribute to burnout, career satisfaction, and well-being in US neurologists. Within the last decade, there has been growing interest in considering factors defined at multiple levels in psychological and health research; multilevel analysis emerged as a way to partly address this need by allowing simultaneous examination of group-level and individual-level factors.2 Given that doctors do not live in a social vacuum, without emotional, cognitive, and behavioral influences, but are active members of working groups with lead roles in health care organizations, a shi...
Source: Neurology - October 9, 2017 Category: Neurology Authors: Giannouli, V. Tags: WRITECLICK & amp;reg; EDITOR ' S CHOICE Source Type: research
