Spotlight on Acquired human cytomegalovirus

Human cytomegalovirus, also known as human herpesvirus 5, is a common pathogen that infects a majority of the adult population. After acute infection, the virus remains in a latent state but can reactivate to generate viremia or viruria, typically in the setting of immune system dysfunction. Human cytomegalovirus infection in immunocompetent hosts is often asymptomatic or self-limited whereas immunocompromised individuals can experience a more severe, life-threatening clinical course. Human cytomegalovirus infection can have a variety of clinical neurologic presentations, including retinitis, encephalitis, or radiculitis, and has also been implicated in cancer and vascular disease in immunocompetent individuals. Diagnosis is made through serological testing and molecular assays among individuals with a compatible clinical presentation, and current treatments are typically effective at controlling clinical symptoms.

In this article, Dr. Diana Vargas, Taylor Harrison, and Dr. William Tyor of Emory University School of Medicine discuss the manifestations, diagnosis, and management of human cytomegalovirus infection, which is a public health concern due to its widespread prevalence and the increasing number of immunosuppressed individuals.

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Twitter Digest for March 15, 2019

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Spotlight on Sciatic neuropathy

Sciatic neuropathy is an important consideration in the patient with foot drop. Causes of this mononeuropathy include total hip arthroplasty, unusual forms of leg or buttock compression, neoplasms, and a heterogeneous group of other disorders. Partial sciatic nerve injuries often affect the fibular (peroneal) division out of proportion to the tibial division. Electrodiagnostic testing is crucial to evaluate for subclinical involvement of tibial innervated muscles in sciatic neuropathy, which may be only subtly involved on clinical examination.

In this article, Dr. Olivia Tong and Dr. Steven Herskovitz, both of Montefiore Medical Center, summarize the clinical, etiologic, diagnostic, and management issues regarding sciatic neuropathy.

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Twitter Digest for March 13, 2019

Twitter Digest for March 12, 2019

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Spotlight on Hereditary amyloid polyneuropathy

Hereditary amyloidosis is a disease caused by mutations in the transthyretin gene that leads to systemic deposition of amyloid protein. Although patients have multisystem involvement of amyloidosis, cardiomyopathy and peripheral neuropathy with autonomic neuropathy are typically the most prominent disease manifestations and the primary drivers of disability and mortality. New small interfering RNA and antisense oligonucleotide therapies reduce the production of transthyretin protein and slow the progression of hereditary amyloid polyneuropathy and, in some cases, improve measures of neuropathy severity and associated disability.

Although hereditary transthyretin amyloidosis is a rare disease, it is an exciting model for developing new treatments for genetic disease in neurology and in medicine broadly.

In this article, Dr. Rebecca Traub of Columbia University discusses the clinical manifestations, biological basis, diagnosis, and management of hereditary amyloid polyneuropathy.

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Twitter Digest for March 8, 2019

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