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CASEBOOK

Ramsay Hunt syndrome presenting in primary care

22 Mar 2010Registered users

Ramsay Hunt syndrome is a lower motor neurone weakness of the seventh (facial)cranial nerve caused by reactivation of the herpes zoster virus. It was first described by James Ramsay Hunt (1874 - 1937), an American neurologist. The virus infects the geniculate ganglion of the nerve causing facial weakness. The onset of a motor neuropathy thereby makes it inherently different from the more typical presentation of shingles, which predominantly causes a sensory neuropathy. A vesicular erythematous rash on, or around, the pinna (zoster oticus) may be present.

 

Lithium toxicity presenting as delirium in an older patient

21 May 2009Registered users

Around 1 in 400 adults suffer from bipolar disorder at some point during their lives although it is unusual for the condition to develop after the age of 40. The prevalence of bipolar disorder in the elderly is reported to be 1%.Medical management with lithium, valproate or olanzapine is recommended as first-line therapy by NICE. Careful monitoring of lithium levels is essential, in particular to prevent toxicity as lithium has a low therapeutic index. Older patients are especially vulnerable, with one study reporting that over a period of 9 years 4% of elderly patients on lithium were hospitalised because of lithium toxicity.

 

Early identification key in autism spectrum disorders

01 Aug 2007Paid-up subscribers

Autism spectrum disorders (ASD) is the current term used to describe a group of complex neurodevelopmental disorders that includes autism, atypical autism and Asperger syndrome. Recent studies have reported increased rates of ASD, which are now thought to result from improved recognition and diagnosis rather than environmental factors.1 While autism is traditionally considered to be associated with learning disabilities, it is now recognised that around 50% of children and young people with ASD have normal intellectual functioning.2
 

April 2007: Accurate history the key to diagnosis of macrocytic anaemias

01 Apr 2007Paid-up subscribers

What are the causes of macrocytic anaemias? Which patients are at risk? How should macrocytic anaemias be investigated?
 

March 2007: Achieving optimum pain control in terminally ill patients at home

01 Mar 2007Paid-up subscribers

How is breakthrough pain best managed? When should you use a syringe driver? How do you calculate doses when switching opioids?