Clinical diagnosis of LGI1 antibody encephalitis in an 83-year-old woman.

An 83-year-old woman was referred to hospital with a 2-week history of short-lived episodic unpleasant sensations in her head and running down her body. This was accompanied by new short-term memory impairment and arm spasms. Initial investigations including blood tests and brain imaging did not reveal the diagnosis. The patient developed an increasing frequency of abnormal movements of her face and arm. These were clinically recognised as faciobrachial dystonic seizures (FBDS). FBDS are pathognomonic of an autoimmune encephalitis caused by an antibody directed against leucine-rich glioma-inactivated 1 (LGI1). The clinical diagnosis resulted in treatment with immunotherapy, leading to cessation of seizures and rapid cognitive recovery. Later, the predicted serology was confirmed. This reversible and under-recognised cause of cognitive impairment, typically affecting elderly patients, can be diagnosed clinically to enable early and effective treatment.

Mixed Olfactory Neuroblastoma and Adenocarcinoma with In Situ Neuroendocrine Hyperplasia.

Olfactory neuroblastoma (ONB) is a rare malignant neoplasm arising from the superior aspect of the nasal vault. Cases are characterised by insidious clinical presentation and high rates of recurrence despite surgical resection and adjuvant radiotherapy. There are a small number of reports showing ONB with divergent epithelial or ganglionic differentiation, and ONB has also been found to coincide with adenocarcinoma. We present a case of mixed ONB with adenocarcinoma. The clinical presentation was unusual, with a tonic-clonic seizure preceded by chronic headache and anosmia. Imaging revealed a mass extending from the olfactory recess of the left nasal cavity through the cribriform plate to the anterior cranial fossa. The pathology demonstrated intraepithelial neuroendocrine cell hyperplasia in the left olfactory groove. This finding provides a unique insight into the cellular origin of this rare tumour, and appears to confirm the theory that ONB arises from neural stem cells in the olfactory neuroepithelium. Despite radical treatment, the patient suffered a distant recurrence within 1 year of treatment, which underlines the aggressive nature of this tumour.

Evaluation of nationwide referral pathways, investigation and treatment of suspected cauda equina syndrome in the United Kingdom.

Purpose: Cauda equina syndrome (CES) is a spinal emergency with clinical symptoms and signs that have low diagnostic accuracy. National guidelines in the United Kingdom (UK) state that all patients should undergo an MRI prior to referral to specialist spinal units and surgery should be performed at the earliest opportunity. We aimed to evaluate the current practice of investigating and treating suspected CES in the UK. Materials and Methods: A retrospective, multicentre observational study of the investigation and management of patients with suspected CES was conducted across the UK, including all patients referred to a spinal unit over 6 months between 1st October 2016 and 31st March 2017. Results: A total of 28 UK spinal units submitted data on 4441 referrals. Over half of referrals were made without any previous imaging (n = 2572, 57.9%). Of all referrals, 695 underwent surgical decompression (15.6%). The majority of referrals were made out-of-hours (n = 2229/3517, 63.4%). Patient location and pre-referral imaging were not associated with time intervals from symptom onset or presentation to decompression. Patients investigated outside of the spinal unit experienced longer time intervals from referral to undergoing the MRI scan. Conclusions: This is the largest known study of the investigation and management of suspected CES. We found that the majority of referrals were made without adequate investigations. Most patients were referred out-of-hours and many were transferred for an MRI without subsequently requiring surgery. Adherence to guidelines would reduce the number of referrals to spinal services by 72% and reduce the number of patient transfers by 79%.

A Comparison of Change Blindness in Real-World and On-Screen Viewing of Museum Artefacts.

Change blindness is a phenomenon of visual perception that occurs when a stimulus undergoes a change without this being noticed by its observer. To date, the effect has been produced by changing images displayed on screen as well as changing people and objects in an individual's environment. In this experiment, we combine these two approaches to directly compare the levels of change blindness produced in real-world vs. on-screen viewing of museum artefacts. In the real-world viewing condition, one group of participants viewed a series of pairs of similar but slightly different artefacts across eye saccades, while in the on-screen viewing condition, a second group of participants viewed the same artefacts across camera pans on video captured from a head-mounted camera worn by the first set of participants. We present three main findings. First, that change blindness does occur in a museum setting when similar ancient artefacts are viewed briefly one after another in both real-world and on-screen viewing conditions. We discuss this finding in relation to the notion that visual perceptual performance may be enhanced within museums. Second, we found that there was no statistically significant difference between the mean levels of change blindness produced in real-world and on-screen viewing conditions (real-world 42.62%, on-screen 47.35%, X2 = 1.626, p > 0.05 1 d.f.). We discuss possible implications of these results for understanding change blindness, such as the role of binocular vs. monocular vision and that of head and eye movements, as well as reflecting on the evolution of change detection systems, and the impact of the experimental design itself on our results. Third, we combined the data from both viewing conditions to identify groups of artefacts that were independently associated with high and low levels of change blindness, and show that change detection rates were influenced mainly by bottom-up factors, including the visible area and contrast of changes. Finally, we discuss the limitations of this experiment and look to future directions for research into museum perception, change blindness, real-world and on-screen comparisons, and the role of bottom-up and top-down factors in the perception of change.