presentation suggested a bilateral C-5 radiculopathy. EMG studies revealed that this clinical picture was, in fact, produced by injury at the level of the brachial plexus, with a C-5, C-6, and C-7 denervation, and the authors proposed an ischemic mechanism that could involve the subclavian and axillary arteries.Typical pathologic findings of GCA occur in these vessel^.^ In our patient, however, only C-5 abnormalities were present in electrodiagnostic studies.Even if the ischemic mechanism remains unclear, the ipsilat-era1 vertebral artery was grossly abnormal in this patient, and the clinical response to corticosteroid therapy with concomitant improvement of the lumen of the vertebral artery on MRI angiography supports a local vascular mechanism caused by GCA.In conclusion, C-5 radiculopathy is a rare manifestation of GCA. After exclusion of radicular compression, the presence of other typical manifestations of GCA and, probably, angiographic abnormalities of the ipsilateral vertebral artery would be necessary for the diagnosis. The prognosis appears excellent with corticosteroid therapy.
Objective:Use a modified Delphi approach to develop competencies for neurologists completing>1 year of advanced global neurology training.Methods:An expert panel of 19 US-based neurologists involved in global health was recruited from the American Academy of Neurology Global Health Section and the American Neurological Association International Outreach Committee. An extensive list of global health competencies was generated from review of global health curricula and adapted for global neurology training. Using a modified Delphi method, US-based neurologists participated in three rounds of voting on a survey with potential competencies rated on a 4-point Likert scale. A final group discussion was held to reach consensus. Proposed competencies were then subjected to a formal review from a group of seven neurologists from low- and middle-income countries (LMICs) with experience working with neurology trainees from high-income countries (HICs) who commented on potential gaps, feasibility, and local implementation challenges of the proposed competencies. This feedback was used to modify and finalize competencies.Results:Three rounds of surveys, a conference call with US-based experts, and a semi-structured questionnaire and focus group discussion with LMIC experts were utilized to discuss and reach consensus on the final competencies. This resulted in a competency framework consisting of 47 competencies across eight domains: (1) Cultural Context, Social Determinants of Health and Access to Care; (2) Clinical and Teaching Skills and Neurological Medical Knowledge; (3) Team-Based Practice; (4) Developing Global Neurology Partnerships; (5) Ethics; (6) Approach to Clinical Care; (7) Community Neurological Health; (8) Health Care Systems and Multinational Health Care Organizations.Conclusions:These proposed competencies can serve as a foundation on which future global neurology training programs can be built and trainees evaluated. It may also serve as a model for global health training programs in other medical specialties as well as a framework to expand the number of neurologists from HICs trained in global neurology.
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