An introduction to neuropalliative care: A growing need.

Palliative care (PC) defined as 'an approach improving the quality of life of patients and their families facing problems associated with life-limiting illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual' aims to enhance the improve the remaining time that patients have, emphasising choice for patients and families.1 Patients with neurological disease such as Parkinson's (PD) and motor neurone disease (MND) benefit from PC earlier in disease with increasing emphasis over time. Understanding and communicating uncertain trajectories, honest prognostic communication when patients are ready and careful symptom control has been shown to enhance quality of life in patients and caregivers, giving greater autonomy to these patients when supported in decision-making by a palliative approach. Although obstacles to palliative care are frequent, there are strategies which can help overcome them.

Unusual cause of treatable Parkinsonism.

A 78-year-old woman presented with features of bilateral, asymmetric Parkinsonism for 1 year, with prominent difficulties with continence, swallowing and apathy. Brain imaging showed evidence of chronic venous sinus thrombosis with dilated serpiginous vessels over the brain surface in keeping with a dural arteriovenous fistula, together with high T2 signal on MRI in the basal ganglia. Having responded only modestly to levodopa, she received 6 months of anticoagulation followed by embolisation of the dural arteriovenous fistula, with good response. Cerebral dural arteriovenous fistula is a rare, structural cause of atypical Parkinsonism.