Hashimoto's Encephalopathy (HE) is a very rare condition characterized by psychosis, seizures, cognitive fluctuations, and myoclonus. In a few published cases, plasma exchange has been used due to the theoretical removal of antithyroid peroxidase antibodies (anti-TPO), one of the postulated causes of the condition. We report a case of HE treated by plasma exchange where no clinical or neurophysiologic improvement was observed despite documented reduction of the anti-TPO antibody to levels below the limits of laboratory detection. We discuss these findings in the context of the known literature for this disease process.

Seventy-five consecutive patients with clinical symptoms and signs of meralgia paresthetica underwent bilateral somatosensory evoked potential (SEP) studies involving stimulation of skin areas innervated by the lateral and anterior femoral cutaneous nerves of the thighs. The most common abnormality was an absolute lateral femoral cutaneous SEP latency Ͼ 40 ms in 35 patients (47%), followed by an absent response in 14 patients (19%), an absolute latency Ͻ 40 ms but amplitude reduction Ͼ 50% compared with the contralateral response in 8 patients (11%), and an absolute latency Ͻ 40 ms but Ͼ 5 ms interside latency difference in 5 patients (7%). Anterior femoral cutaneous SEPs were of value in distinguishing meralgia paresthetica from a proximal lumbar radiculopathy in an additional 4 patients and confirming bilateral meralgia paresthetica in 10 patients.

Introduction & Problem StatementThe matriculation from internal medicine to neurology residency can be challenging. The most cogent approach to address this transition has yet to be identified. Studies show that simulation is highly effective at reinforcing knowledge and skills while improving learner confidence. We present the design and outcomes of an annual acute neurology simulation program.ObjectivesWe hypothesized that incoming neurology residents would (1) report improved confidence with managing acute neurologic emergencies, (2) cite a high degree of educational value with the program, and (3) demonstrate improvement in their technical knowledge.Methods & Curriculum DescriptionOur military, level 1 trauma institution's simulation laboratory and staff were used to develop and execute simulations for rising neurology residents based on the Accreditation Council for Graduate Medical Education neurology milestones. Three simulations were designed including a case of acute ischemic stroke (AIS), status epilepticus (SE) in an austere environment, and brain death evaluation with family counseling. Residents completed matched pre‐ and post assessments to gauge confidence, technical knowledge, and perceived educational value.Results & Assessment DataOver 3 years, 15 rising neurology residents from 2 training programs completed 3 high-fidelity acute neurology cases. Self-reported confidence with acute neurology skills improved after each simulation. Confidence ratings included assessing for and identifying contraindications to tissue plasminogen activator, identifying AIS, identifying clot retrieval candidates, identifying clinical and electrographic SE, diagnosing and treating SE, identifying contraindications to and confounders of brain death diagnosis, performing the examination, and delivering bad news to families (allp< 0.05). Technical knowledge also statistically improved in the stroke (p= 0.046) and brain death simulation (p= 0.039), but not the SE simulation (p= 0.296). Participants reported an average perceived personal value of 4.8, 4.3, and 4.7 (out of a maximum of 5) for AIS, SE, and brain death simulations, respectively.Discussion & Lessons LearnedHigh-fidelity simulation of neurologic emergencies enhances confidence and knowledge of rising neurology residents. Satisfaction with the simulation cases was high. Academic hospitals can consider incorporating acute neurology simulations into their residency training.

Patients with Ehlers–Danlos syndrome (EDS) have many associated symptoms of unclear cause, most recently suggested to be due to small fiber neuropathy (SFN). Small fiber neuropathies are sorely underestimated and with minimal treatment options. We report 2 cases of patients with EDS with presumed immune-mediated SFN, successfully treated with IV immunoglobulins. There is a stark need for further investigational studies into immunosuppressant treatments for immune-mediated SFN as well as the link between EDS and immune-mediated SFN.