eLetters

620 e-Letters

  • MIBG in clinical routine
    Stefan Braune

    Dear Editor,

    Nagayama and colleagues report on the greatest number of patients with Parkinsonian syndromes undergoing MIBG scintigraphy sofar. They calculated a sensitivity of 87.7% and a specificity of 37.4% to correctly detect 122 patients with idiopathic Parkinson´s disease (PD) in relation to patients with MSA (n=14), dementia of Lewy body type (DLB) (5), PSP (7), senile dementia of Alzheimer type (SDAT) (...

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  • Trigeminal autonomic cephalalgias: ‘noso-physiology’ or pathophysiology?
    Vinod K Gupta

    Dear Editor,

    The ultimate aims and objectives of the neurologist immersed in clinical work are no different from those of the academic: put simply, we all like to understand why we make certain management decisions, investigative or therapeutic, and yearn for scientific validity and logical defensibility of our medical or surgical practices and procedures. By placing great emphasis on nosologic sophistication in...

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  • Thrombophilia screen should not be routinely performed
    Joseph Kwan

    Dear Editor,

    I read with interest the article by Nedeltchev et al. [1]. Using their standard protocol, thrombophilia screen only managed to identify 2 patients with Factor V Leiden deficiency and 1 patient with Protein C deficiency. Thrombophilia is well known to cause venous thrombosis but only very rarely associated with arterial occlusive disease in adulthood. In contrast, thrombophilia is significant...

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  • Surgery for cluster headache: desperate measures for a desperate syndrome?
    Vinod K Gupta

    Dear Editor,

    Donnet, Valade and Régis did not find gamma knife radiosurgery clinically useful in the intermediate or long-term management of patients with severe cluster headache (CH) refractory to other therapies; intriguingly, immediate / short-term results are dramatic and definitely encouraging but rather unpredictable. [1] The disconnect between these two set of results remains unexplained but may hold the vi...

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  • “Wilson’s disease: diagnostic errors and clinical implications”
    Kalyan B Bhattacharyya

    Dear Editor,

    We read with interest the article “Wilson’s disease: diagnostic errors and clinical implications”, written by Prasanth et al, in your journal, 2004;75:907-909. [1]

    We would like to thank the authors for bringing to light the difficulties in diagnosing Wilson’s disease (WD) and the protean manifestations that often masquerade as other diseases in India. We would like to share our expe...

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  • Hidden costs of increasing nosologic sophistication
    Vinod K Gupta

    Dear Editor,

    Eriksen, Thomsen and Olesen present data underpinning the new criteria for migraine with aura (MA) in the International Headache Society -2 Classification. The research as well as clinical utility of being able to delineate a more homogeneous sample of MA patients or the evolution of a system that can be used at different levels of specialisation is debatable. At the research level, increasing nosolog...

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  • White matter lesions in MRI: searching a concept for a finding
    Vinod K Gupta

    Dear Editor,

    Artero and colleagues detected a patterned non-random distribution of white matter lesions (WML) in the aging brain associated with symptoms and suggest progression of lesions from frontal through parietal to temporal and occipital regions.

    Since blood pressure is an established risk factor for the presence and severity of WML, the rheological state of the brain circulation appears to be the...

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  • Migraine: searching for pathophysiology in semantics and nosology
    Vinod K Gupta

    Dear Editor,

    While Pearce analyses the paper of Furman, Balaban, Jacob, and Marcus [1] with precision [2] insofar as migraine is concerned no suffix carries any pathophysiological import or diminishes the mystery of migraine. With both migraine [3] and dizziness having been around since antiquity, restraint is the key watchword that determines - or should determine - use of the term ‘new’ in describing any migraine...

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  • Alzheimer's results from low DHEA
    James M Howard

    Dear Editor,

    It is my hypothesis (1985) that Alzheimer's disease results from low DHEA. This has since been supported. HRT reduces DHEA production (Metabolism. 2001 Apr;50(4):488-93). This may be why HRT has recently been found to increase the onset of Alzheimer's disease. I suggest the past support of positive effects of HRT are due to a stimulus of DHEA production followed by loss of DHEA production with...

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  • Long duration asymmetrical postural tremor is likely to predict development of Parkinson’s disease a
    Elan D. Louis

    Dear Editor,

    We read with interest the paper of Chaudhuri et al. [1] on long duration asymmetrical postural tremor. Like all thought-provoking research, the paper raises many questions that lend themselves to further research and thought.

    The issue of the relationship between ET and parkinsonism is complicated and this study underscores the need for further longitudinal research to clarify dise...

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