Topics
Neurology
Motor neurone disease: progress and challenges
Recent evolution in the clinical, pathological and genetic understanding of MND is progressively unmasking the multifactorial nature of this complex condition
Thanuja Dharmadasa · Robert D Henderson · Paul S Talman · Richard AL Macdonell · Susan Mathers · David W Schultz · Merrillee Needham · Margaret Zoing · Steve Vucic · Matthew C Kiernan
Neurobionics and the brain–computer interface: current applications and future horizons
The brain–computer interface is an exciting advance in neuroscience and engineering
Jeffrey V Rosenfeld · Yan Tat Wong
The stroke gap
To the Editor:Acute stroke management has undergone major transformations with the advent of endovascular thrombectomy, but there remains a large gap in care between metropolitan and rural Australia. While metropolitan stroke centres are currently redesigning their services to expedite intervention for patients eligible for endovascular thrombectomy, rural and remote areas are still lagging behind with basic stroke therapies. Alteplase therapy for acute stroke within 4.5 hours remains the bedrock of treatment. Nevertheless, presenting to a hospital that has the capability to facilitate this treatment is not as simple for a rural patient as for a metropolitan patient. Distance and isolation are major factors in preventing access to treatment, as is lack of local expertise. In addition, there is a paucity of neurologists working in rural Australia. Where Melbourne and Sydney boast one neurologist for every 25 000 persons, rural Australia ranges from one in 100 000–200 000 people (Costello, C. Australian and New Zealand Association of Neurologists Workforce Survey. Sydney: ANZAN; 2016 [unpublished internal report]). There are rural physicians who are skilled in the management of acute stroke, but there remain barriers and reluctance to use thrombolysis within this group.1 The impact of stroke also significantly burdens the rural Indigenous community. In the Northern Territory, the Indigenous population have a three times higher incidence (307 per 100 000 people) of stroke, a younger age of onset (10 years earlier), higher case fatality, higher stroke recurrence and higher cost of lifetime stroke compared with non-Indigenous and metropolitan patients.2,3 Due to remoteness and delays in transfer, Indigenous people often miss the opportunity for acute therapy. Telestroke services are currently being used in certain parts of regional Australia; they are an effective, safe and efficient method of bringing the metropolitan neurologist to the rural patient’s bedside.4 However, more resources must be invested to make this a service that covers all corners of the country. In addition, it is necessary to implement better recruitment strategies for neurologists to rural centres and stroke-specific public health campaigns that are culturally appropriate, and to increase funding for research to design innovative and creative ways to provide comprehensive care to remote patients. Urgent action is required now; otherwise, an isolated part of our country and community will only face greater challenges over time.
Prashanth Ramachandran · James Burrow
Australian Institute of Sport and Australian Medical Association position statement on concussion in sport
n/a
Lisa J Elkington · David C Hughes
Appropriate care for older people with cognitive impairment in hospital
More than half of the patients in adult hospitals are over 65 years of age
Gideon A Caplan · Susan E Kurrle · Anne Cumming
Central retinal venous pulsations
Diagnosing raised intracranial pressure through ophthalmoscopic examination
Balakrishnan (Kichu) R Nair · Christine Y Chen · William Browne · Daniel McKay
Primary amoebic meningoencephalitis in North Queensland: the paediatric experience
A potentially fatal disease associated with warm, non-chlorinated water in rural areas
Claire L Nicholls · Fiona Parsonson · Lawrence EK Gray · Adele Heyer · Steven Donohue · Greg Wiseman · Robert Norton
Medication overuse headache in Australia: a call for multidisciplinary efforts at prevention and treatment
n/a
Richard J Stark · Treasure McGuire · Mieke L van Driel
Stroke in a young man with untreated HIV infection and neurosyphilis
HIV infection is an important risk factor for stroke and testing should be performed in all young stroke patients
Abhay R Venkat · Jason Wenderoth · Louise Evans · Cecilia Cappelen-Smith
Ankles jerk — yes, but how?
Eliciting an ankle jerk requires the skills of an experienced bell-ringer, an expert golfer and a mechanical engineer
David B Williams
Medicines and dementia consumer campaign
Helping people living with a diagnosis of dementia to navigate their medicine and non-medicine choices
Lynn M Weekes
A patient with sarcoidosis and a cryptococcal infection of the skull
n/a
Paul A Rootjes MD · Wouter Rozemeijer MD · Jacob C Dutilh MD
The role of neurosurgery in the treatment of chronic pain
Neurosurgical training should formally incorporate chronic pain management
Peter J Teddy DPhil, FRACS, FFPMANZCA
Surgical management of low back pain
Spinal surgery for chronic low back pain is controversial, and the disproportionate number of fusions in private hospitals is unexplained
Leigh Atkinson FACS, FRCS, FAFRM · Andrew Zacest MB BS, FRACS, FFPMANZCA
A case of subacute sclerosing panencephalitis in a 23-year-old recent immigrant to Australia
Measles vaccination rates in Australia need to be higher
Eloise Williams MB BS, BMedSci, MPHTM · Iain J Abbott MB BS, FRCPA, FRACP · Lai Yin Law MB BS · Stephen David Guy MB BS(Hons), FRACP
A moving account of resilience and love
Bleed: surviving cerebral catastrophe: a tale of the mind, love and modern medicine
Marion G Carey MB BS(Hons), MPH, FAFPHM
Clinical practice guidelines for dementia in Australia
New guidelines emphasise timely diagnosis and optimal management
Kate Laver PhD, MClinRehab, BAppSc(OT) · Robert G Cumming MB BS, MPH, PhD · Suzanne M Dyer PhD, GradCertPH · Meera R Agar FRACP, FAChPM, PhD · Kaarin J Anstey BA(Hons), PhD · Elizabeth Beattie PhD, MA, BA · Henry Brodaty MD, DSc, FRANZCP · Tony Broe MRACP, MB BS, BA · Lindy Clemson PhD, MAppSc, BAppSc(OT) · Maria Crotty MPH, PhD, FAFRM · Margaret Dietz BA, BSW, GradCertFamilyTherapy · Brian M Draper MB BS, MD, FRANZCP · Leon Flicker FRACP, GradDipEpid, PhD · Margeret Friel MEd, BJuris · Louise Mary Heuzenroeder BN, MBA, MPH · Susan Koch PhD, RN, MN · Susan Kurrle MB BS, PhD, DGM · Rhonda Nay PhD · C Dimity Pond MB BS, FRACGP, PhD · Jane Thompson BSc(Hons), MSc, PhD · Yvonne Santalucia BEd · Craig Whitehead FAFRM, FRACP · Mark W Yates MB BS, FRACP
Lessons from Oliver Sacks
The art of appreciating each patient’s uniqueness
Daniel R Schweitzer MB BS, FRACP, PhD
Rethinking autism
Neurotribes: the legacy of autism and how to think smarter about people who think differently
Louise K Newman BA(Hons), MB BS(Hons), FRANZCP
Therapeutic advances and risk factor management: our best chance to tackle dementia?
An update on research advances in this field that may help tackle this growing challenge more effectively
Terence WH Chong MB BS, MP, FRANZCP · Samantha M Loi MB BS, FRANZCP, GradCertPOA · Nicola T Lautenschlager MD, FRANZCP · David Ames BA, MD, FRCPsych
Pitfalls in photographing radiological images from computer screens
Caution is required in using mobile phone images in clinical practice
Jarrel Seah · Andrew D Nichols MB BS · Philip M Lewis PhD, BAppSc · Jeffrey V Rosenfeld MD, FRACS, FAHMS
Massive subdural haematoma and dementia: a “yin and yang” paradigm
Two interdependent entities giving rise to each other
Pietro Maggi MD, PhD · Jean Christophe Bier MD · Sandra De Breucker MD
Initial presentation of a urea cycle disorder in adulthood: an under-recognised cause of severe neurological dysfunction
Emergency treatment of hyperammonaemia should be undertaken early to prevent devastating neurological injury
James R Anstey MB BS, FRACP, FCICM · Timothy P Haydon FRACP, FCICM, FANZCA · Rashmi B Ghanpur MB BS · Gerard de Jong MD, PhD, FRACP
’Twas the night before Grand Round …
’Twas the night before Grand Round, when all through the Walton
Richard J B Ellis MBChB(Hons), MPhil, MRCP · Barnaby N Hirons MBChB, MSc, MRCP · Alexandra E May MBChB(Hons), MRCGP · David J McCreary MBChB, MRCEM · Nicholas D Peterson MBChB(Hons), MRCS · Leonard M Quinn MBChB(Hons), MRCS · Besa Ziso MBChB, MRCP · Michael Bonello MD, MRCP · Brython Hywel MBBCh(Hons), MRCP · Benedict D Michael MBChB(Hons), MRCP, PhD · Sean D Brown BSc(Hons), MBChB, MRCP · Benjamin D Murray BSc(Hons), MBChB(Hons), FRCA · Duncan M Rogers MBChB, MRCGP · Matt Barrett BSc · Mark Doran MD, PhD, FRCP
