Speaker: Date: Topic
Penny Greenstein, MD
Mar. 6, 2013
Neurology Cases the Primary Care Physician Should Not Miss
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Take-Away Points of the Lecture
Herpes Simplex Encephalitis (HSE):
1. If untreated, HSV encephalitis (HSE) has > 70% mortality rate and only about 11% of survivors return to normal function.
2. With acyclovir, 6 month mortality is about 6-19% and 18 month mortality is about 28%.
3. If onset of therapy is within 4 days or less, the 18 month mortality decreases to about 8%.
4. Strongly consider empiric therapy in anyone presenting with fever and encephalopathy, especially if the MRI shows
focal temporal lobe lesions, or CSF or EEG are abnormal.
Pancoast Tumor Syndrome:
1. Symptoms are shoulder pain (“arthritis”), root pain in ulnar nerve distribution, classical symptoms of lung malignancy
(cough, hemoptysis, anorexia, weight loss may/may not be present).
1. Lhermitte’s Sign is a sudden electric-like sensation with flexion of the neck. It usually implies pathology of the posterior
columns and is seen with demyelinating disease, vacuolar myelopathy (AIDS), or B12 deficiency.
2. All that tingles is not HIV or MS.
Delayed Subdural Hemorrhage:
1. Subdural hemorrhages are venous and can present months to years later as the bridging veins in the subdural space are torn.
2. Large subdurals can often have very few clinical signs.
1. Do not forget the importance of the family history and genetics in primary care. We cannot escape our genes and who we are.
1. Always check an SPEP when doing a hyper coagulable workup.
Links to Articles Cited in the Presentation
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