Background: In an effort to better understand why cognitively normal patients are referred to a memory clinic, we sought to identify features of “worried well” patients to better identify those more likely to be cognitively normal. Methods: Three hundred and seventy-five consecutive patients referred by primary care practitioners to a Rural and Remote Memory Clinic, were categorized into two groups based on their neurologic diagnosis, “worried well” (cognitively normal, N=81) or “other” (patients with any neurologic diagnosis, N=294). The two groups were compared using a t-test and a Chi-squared test. The same comparison was done between the same set of “worried well” patients (N=81) and the subgroup of patients with a diagnosis of Alzheimer’s disease (N=146) from the “other” group. Ethics approval was obtained from the University of Saskatchewan Biomedical Research Ethics Board. Results: Significant differences included younger age, more formal education, more frequent previous psychiatric diagnosis and more self-reported alcohol consumption in the “worried well” group. The “worried well” and “Alzheimer’s Disease” comparison had the same significant differences as the “worried well” and “other” comparison. Conclusions: We observed a pattern of differences between the “worried well” patients and those with cognitive disease. Taking multiple factors into account when evaluating a patient may help with clinical decision making.

Trigeminal neuralgia (TN) associated with multiple sclerosis (MS) was first described in Lehrbuch der Nervenkrankheiten für Ärzte und Studirende in 1894 by Hermann Oppenheim, including a pathologic description of trigeminal root entry zone demyelination. Early English-language translations in 1900 and 1904 did not so explicitly state this association compared with the German editions. The 1911 English-language translation described a more direct association. Other later descriptions were clinical with few pathologic reports, often referencing Oppenheim but citing the 1905 German or 1911 English editions of Lehrbuch. This discrepancy in part may be due to the translation differences of the original text.

Background: Jacklin et al. (2013) described a rising incidence and a younger onset of dementia in Albertan First Nations compared to non-First Nations patients. Canadian research is limited in Indigenous patients with dementia, leaving it difficult to understand factors contributing to the differences in incidence and prevalence. Methods: 375 patients (41 Indigenous) was seen at the clinic. The questionnaire given during initial assessments were reviewed and differences between groups (non-Indigenous patients versus Indigenous) were assessed. Results: Compared to the non-Indigenous patient, Indigenous patients were younger (p=0.007), were more likely to be female (p=0.033) and had less education (p=0.055). They were less likely to live solely with a partner (p<0.001) and more likely to have a daughter as caregiver (p=0.004). The Indigenous patients were more likely to smoke (p<0.001). Although no differences in diagnosis of mental health disorders were seen (p=0.735), the Indigenous patients scored significantly higher on the CES-D (p<0.0001). Conclusions: This comparison highlights differences potentially affecting the health of Indigenous patients. Acknowledging these differences is critical to individualized patient care. Further research is required to explore how these factors affect dementia disease course and treatment, and how these factors play a role in the differences in incidence and prevalence demonstrated in previous studies.

Severe longitudinally extensive transverse myelitis (LETM) can cause quadriplegia, marked sensory dysfunction, and respiratory failure. Some patients are unresponsive to conventional immune therapy. We report two cases of severe immune-mediated LETM requiring intensive care admission that failed to respond to high-dose corticosteroids, plasma exchange, intravenous immunoglobulin, and rituximab. Disease cessation and significant recovery was achieved after cyclophosphamide induction. In patients with severe acute immune-mediated LETM who fail to respond to corticosteroids and plasma exchange, cyclophosphamide induction should be considered. This agent and regimen provides a robust immunosuppressive response and can be induced rapidly. Cyclophosphamide effects and supportive evidence are discussed.

Patterns of practice for management of cerebral venous thrombosis in Canada are unknown. We surveyed Canadian neurologists and hematologists regarding anticoagulation in cerebral venous thrombosis. The response rate was 28%, with 27 neurologists and 20 hematologists responding. We found that choice of first-line initial anticoagulation differed significantly between neurologists and hematologists, with 89% of neurologists favouring unfractionated heparin and hematologists’ preference split between unfractionated heparin (50%) and low-molecular-weight heparin (50%). Differences in patterns of practice likely reflect clinical equipoise.

Although the common carotid artery is the second most common site for extracranial carotid artery stenosis, complete symptomatic occlusion in the absence of devastating stroke is rare. We present a case of complete common carotid artery occlusion failing medical management and requiring endovascular intervention. The clinical presentation, diagnostic investigations, and management of complete carotid artery occlusions are discussed.

Cet article présente le processus de traduction en français du Charcot-Marie-Tooth Disease Pediatric Scale (CMTPedS), le seul outil de mesure validé évaluant la sévérité de la maladie chez les enfants atteints de CMT. Le processus de traduction utilisé s’inspire des lignes directrices de la Food and Drug Administration (FDA). La version préliminaire francophone du CMTPedS a été testée auprès de 14 enfants atteints. Les résultats de l’application démontrent que la passation a été bien tolérée par les enfants et s’est avérée conviviale pour les cliniciens. La disponibilité de cet outil en français semble prometteuse pour le suivi des enfants atteints et la réalisation d’essais clinique.

Background: Vestibular Schwannomas (VS) have a well- documented response to Gamma Knife® Stereotactic radiosurgery (SRS). However, there is limited data available regarding the volumetric response of cystic tumors. This report correlates the radiographic appearance of VS before radiosurgery with the delayed volumetric response. Methods: This study reviewed 219 VS patients between 2003 and 2013. Patients were treatment naïve and had a significant extracanalicular tumor volume. MRI at SRS identified; 42 contrast enhancing macrocystic tumors, 45 contrast enhancing microcystic tumors, and 132 homogeneously enhancing tumors with no intra-tumoral cyst formation. The median follow-up was 49.1 months. The median tumor volume was 2.6cm3 (0.70-16.1cm3) and the median dose was 12.5Gy (11-13Gy). Results: The actuarial tumor control rate was 99.4% at 2-years and 96.4% at 5-years. A volumetric reduction of >20% occurred in 85.4% of macrocystic tumors, 76.1% of microcystic tumors and 62.8% of homogeneously enhancing VS. The median volume decrease per year for macrocystic, microcystic and homogenous tumors was 17.2%, 7.5% and 7.9% per year respectively (p<0.001). Serviceable hearing was maintained in 61.5% of patients that had Gardner-Robertson grade I-II hearing. Conclusions: SRS provided VS tumor control in >95% of patients, regardless of radiographic characteristics. Tumor volume regression was most evident in patients with cystic tumors.