Multifocal necrotising leucoencephalopathy is a rare disorder affecting the central nervous system. It is characterised pathologically by microscopic areas of necrosis with pontine predilection but also involvement of extrapontine regions, including the cerebellum, medulla and cerebral hemispheres. It usually occurs on the background of immunosuppression. Here we describe an immunocompetent patient with a recent history of Salmonella infection who presented with subacute neurological deterioration. At postmortem, she had evidence of multifocal necrotising leucoencephalopathy.
IntroductionDimethyl fumarate is used to treat relapsing-remitting multiple sclerosis. We audited it’s use at the Royal Devon and Exeter Hospital against the manufacturers recommendations for monitoring bloods and reviewed it’s tolerability and effectiveness.MethodsPatients were identified who started dimethyl fumarate between December 2014 and July 2016 from a database kept by the multiple sclerosis specialist nurse. The dates the drug was taken, side effects, outcomes of MRI scans and blood test results were recorded and analysed to assess compliance with the manufacturers recommendations.Results98 patients were started on dimethyl fumarate. 68.4% remained on the drug. 82.8% of those that stopped the drug did so because of side effects. The commonest side effects of the drug recorded were flushing, gastrointestinal disturbance and dermatological. 27.6% of patients had an MRI scan just prior to treatment or within 2 months of starting. 2 of 22 scans performed over 2 months after starting the drug showed enhancement. 61.0% of patients had the desired blood monitoring.ConclusionsDimethyl fumarate was effective in our cohort, but side effects were frequent. Many patients didn’t get the desired monitoring with MRI or bloods and ideally systems will be instituted so this happens in the future.
IntroductionSuccessful Trainee Clinical Research Networks have been established since 2007. Our network in the peninsula, the SOuthwest Neurology Audit and Research Group (SONAR) is the first such Neurology trainee network in the UK. To enable development of cohesive collaborative working of the network we designed an audit which would be deliverable across three neurology centres within the peninsula.MethodWe audited management of suspected acute meningitis and meningococcal sepsis against national guidelines within a 4 week period in December. A standardised anonymsed data collation tool was used across the three centres and results were analysed at one centre.ResultsAll 9 registrars on the rotation contributed to audit methodology design and data analysis; seven contributed cases (from all three centres). Ten cases were included in the audit, 6 (Exeter), 3 (Plymouth), and 1 (Truro). Our audit highlighted deficiencies in timely senior review, delivery of antibiotics and steroids, inappropriate administration of acyclovir and delay in lumbar puncture.ConclusionThis was SONAR’s first collaborative project and demonstrated that as a group of trainees we can successfully conduct a project across multiple hospital sites. We plan to extend the scope and ambition of our future undertakings.
IntroductionSuccessful Trainee Clinical Research Networks have been established since 2007 and are primarily run by Surgical and Anaesthetic Trainees. In the southwest peninsula we have set up the first UK Neurology Trainee Audit and Research Collaborative to deliver clinical studies. Ensuring all trainees have appropriate training is a key requirement; we aimed to ascertain the training needs of our network members.MethodA survey was sent to all 9 neurology trainees in the Peninsula Deanery. It comprised 5 questions to establish trainee clinical research training and experience.ResultsResponse rate was 100%. Training level varied from ST3–5; 22% had previously completed higher degrees. 40% of trainees had not been involved in clinical research. One trainee had not had formal good clinical practice (GCP) training and none had formal Informed Consent training. Of those who had been involved in research, there had been limited involvement in project design, ethics approval processes, data analysis, manuscript preparation or findings presentation.ConclusionWe identified a training need in our Trainee Audit and Research Network. In order to address this, we have organised formal GCP and Informed Consent training; to broaden the research experience of network members, we are planning our first collaborative research project.
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