James C Johnston, MD, JD, FCLM, FACLM, FAAN - Global Neurology Consultants

James C Johnston

MD, JD, FCLM, FACLM, FAAN

Global Neurology Consultants

Auckland | New Zealand

Main Specialties: Neurology

Additional Specialties: Neurology and Global Health

James C Johnston, MD, JD, FCLM, FACLM, FAAN - Global Neurology Consultants

James C Johnston

MD, JD, FCLM, FACLM, FAAN

Introduction

Consultant Neurologist. Diplomate American Board of Psychiatry and Neurology, Board-Certified in Neurology. Additional Certification in Neurorehabilitation. Barrister of the High Court of New Zealand. Partner, GlobalNeurology. Director, Global NeuroCare, a non-profit accredited by WHO, in Special Consultative Status with United Nations ECOSOC, and affiliated with the Office of the Special Adviser on Africa.

Primary Affiliation: Global Neurology Consultants - Auckland , New Zealand

Specialties:

Additional Specialties:

Education

Texas Medical Center
Fellowship - Neurorehabilitation
Texas Medical Center
Residency - Neurology
UTHSC
Internship - Surgery
JD
MD

Experience

Jan 2008
Director, Global NeuroCare
Jul 1988
Consultant Neurologist

Publications

43Publications

673Reads

125Profile Views

273PubMed Central Citations

Diagnostic Accuracy of Stool Xpert MTB/RIF for Detection of Pulmonary Tuberculosis in Children: a Systematic Review and Meta-analysis.

J Clin Microbiol 2019 Jun 24;57(6). Epub 2019 May 24.

Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada

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http://jcm.asm.org/lookup/doi/10.1128/JCM.02057-18
Publisher Site
http://dx.doi.org/10.1128/JCM.02057-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6535592PMC
June 2019
7 Reads
3.993 Impact Factor

Predicting tuberculosis relapse in patients treated with the standard 6-month regimen: an individual patient data meta-analysis.

Thorax 2019 03 12;74(3):291-297. Epub 2018 Nov 12.

TB Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.

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http://dx.doi.org/10.1136/thoraxjnl-2017-211120DOI Listing
March 2019
7 Reads
8.290 Impact Factor

Screening for Latent Tuberculosis Infection in Migrants With CKD: A Cost-effectiveness Analysis.

Am J Kidney Dis 2019 Jan 28;73(1):39-50. Epub 2018 Sep 28.

Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada. Electronic address:

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https://linkinghub.elsevier.com/retrieve/pii/S02726386183087
Publisher Site
http://dx.doi.org/10.1053/j.ajkd.2018.07.014DOI Listing
January 2019
13 Reads
5.900 Impact Factor

Advancing Sustainable Access to Healthcare

E/CN.5?2019/NGO/33

United Nations

This statement provides specific recommendations to improve healthcare access in resource limited areas as a strategy for promoting healthy lives, reducing poverty, and addressing inequalities and challenges to social inclusion, thereby improving all forms of social protection.

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November 2018
9 Reads

Neuroimaging in headache: a time for change

Med Law 2017;36(2):202

Medicine and Law

The most common diagnostic error in neurology over the past three decades is the misdiagnosis of headache with failure to diagnose brain tumor or other intracranial structural disease. This recurring error is partially attributable to guidelines promulgated by the American Academy of Neurology and six other professional organizations under the auspices of the United States Headache Consortium, which state that neuroimaging is not usually warranted in patients with migraine and a normal examination. These guidelines, however, were based on outdated studies with serious methodological flaws underestimating the incidence of intracranial abnormalities in patients with migraine headache. Unfortunately, two American Board of Internal Medicine Foundation Choosing Wisely societies parroted these stale guidelines, leading several investigators to suggest further restricting neuroimaging for patients with headache. This intransigent adherence to outdated, flawed guidelines is contrary to an acceptable standard of care. It is detrimental to patient care, eviscerates any meaningful informed consent and exposes the practitioner to potential malpractice lawsuits. The authors propose that the current guidelines be deleted and further research undertaken to correlate intracranial abnormalities with individual patient data, headache patterns, underlying diseases, associated conditions, imaging protocols, and related factors in order to provide practitioners with rational imaging guidelines. In the intervening time, it would be prudent to consider imaging all patients presenting with a new headache, or a headache with increasing frequency or changing pattern, or any other warning sign, even when the neurological examination is normal. Magnetic resonance imaging is preferable to computerized tomography in this setting.

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September 2018
8 Reads

Improving healthcare access in sub-Saharan Africa

Med and Law 2018; 37(2:2):74-75

Medicine and Law

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September 2018
9 Reads

Fetal monitoring in Africa: a public health threat

Med and Law 2018;37(2:2):73

Medicine and Law

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September 2018
11 Reads

Continuous electronic fetal monitoring during labor: a critique and reply to contemporary proponents

4(1):e23-e28

Surg J

A half century after continuous electronic fetal monitoring (EFM) became the omnipresent standard of care for the vast majority of labors in the developed countries, and the cornerstone for cerebral palsy litigation, EFM advocates still do not have any scientific evidence justifying EFM use in most labors or courtrooms. Yet, these EFM proponents continue rationalizing the procedure with a rhetorical fog of meaningless words, misleading statistics, archaic concepts, and a complete disregard for medical ethics. This article illustrates the current state of affairs by providing an evidence-based review penetrating the rhetorical fog of a prototypical EFM advocate.

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March 2018
388 Reads

Demographic predictors of active tuberculosis in people migrating to British Columbia, Canada: a retrospective cohort study.

CMAJ 2018 02;190(8):E209-E216

Division of Respiratory Medicine, Faculty of Medicine (Ronald, Cook, Johnston), University of British Columbia; BC Centre for Disease Control (Ronald, Balshaw, Romanowski, Roth, Cook, Johnston); Faculty of Pharmaceutical Sciences (Campbell, Marra), University of British Columbia, Vancouver, BC

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http://dx.doi.org/10.1503/cmaj.170817DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5826706PMC
February 2018
25 Reads
1 Citation
5.960 Impact Factor

Continuous Electronic Fetal Monitoring during Labor: A Critique and a Reply to Contemporary Proponents.

Surg J (N Y) 2018 Jan 7;4(1):e23-e28. Epub 2018 Mar 7.

Global Neurology Consultants, USA and Auckland, New Zealand.

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http://dx.doi.org/10.1055/s-0038-1632404DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5842073PMC
January 2018
12 Reads

A half century of electronic fetal monitoring and bioethics: Silence speaks louder than words

Maternal Health, Neonatology and Perinatology 2017; 3(21):1-8.

Maternal Health, Neonatology and Perinatology

Bioethics abolished the prevailing Hippocratic tenet instructing physicians to make treatment decisions, replacing it with autonomy through informed consent. Informed consent allows the patient to choose treatment after options are explained by the physician. The appearance of bioethics in 1970 coincided with the introduction of electronic fetal monitoring (EFM), which evolved to become the fetal surveillance modality of choice for virtually all women in labor. Autonomy rapidly pervaded all medical procedures, but there was a clear exemption for EFM. Even today, EFM remains immune to the doctrine of informed consent despite continually mounting evidence which proves the procedure is nothing more than myth, illusion and junk science that subjects mothers and babies alike to increased risks of morbidity and mortality. And ethicists have remained utterly silent through a half century of EFM misuse. Our article explores this egregious ethical failure by reviewing EFM’s lack of clinical efficacy, discussing the EFM related harm to mothers and babies, and focusing on the reasons that this obstetrical procedure eluded the revolutionary change from the Hippocratic tradition to autonomy through informed consent.

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November 2017
129 Reads

Global health: advancing North-South partnerships

Med and Law 2017;36(2):157

Medicine and Law

Neurological diseases and disorders represent the greatest single threat to global public health and, if not properly addressed, the resultant morbidity and mortality will have profound effects on the economic, social and political stability of developing countries. The most effective means of preventing and treating these conditions is to increase the recruitment, training and retention of local medical staff in developing regions. This mandates forming self-sufficient local training centres to ensure sustainable staff development, which is necessary to advance health care, expand medical services and direct proper management of funding, equipment and medications to meet local needs. Establishing these types of centres requires support from the North, which would seemingly be increasingly available with the unprecedented growth of global health programs. However, these programs have resulted in an uncoordinated scramble for Africa characterized by brief medical missions that are highly advantageous to the sending institutions, but lead to international medical paternalism, doctor tourism and ethical imperialism with harmful practices affecting patient care and impeding development of local health care in the very regions where it is most needed. As the number of global health programs continues to grow, so too will the dangerous practices engendered by these self-serving medical missions. Based on the authors' experience in Ethiopia over the past decade, the most effective way to ensure sustainable growth, avert harmful practices and avoid exploiting the South is to establish formal universal guidelines for North-South collaborative partnerships engaging in global health activities.

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August 2017
9 Reads

Electronic fetal monitoring, cerebral palsy and medical ethics: Nonsense of a high order

MLI 2017; 1-2:43-64

Medical Law International

Electronic fetal monitoring (EFM) was predicted by its inventors to be the long-sought cerebral palsy (CP) nemesis. Rather than prevent CP or any other birth problems, 40 years of EFM use has done substantial harm to mothers and babies and created a worldwide CP-EFM litigation industry that enriches only trial lawyers. Physicians, frightened by the ever-expanding and costly CP-EFM litigation crisis, and focused on avoiding lawsuits at all costs, embraced ethical relativism—charitably called defensive medicine— and continued EFM use even in the face of overwhelming evidence that EFM is merely junk science. In doing so, physicians completely abandoned the bedrock bioethics principles of autonomy, beneficence, and nonmaleficence. This daily ethical drama has played itself out for the past almost half century with little protest from obstetricians and no protest from ethicists. This article reviews EFM harms, the CP-EFM litigation crisis, and the resulting abandonment of bioethics principles and explores why the CP-EFM paradigm has failed utterly to follow the Kuhnian model of the scientific, technology, medical paradigm shift.

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May 2017
11 Reads

Neuroimaging overuse is more common in Medicare compared with the VA

Neurology 2017; 88(6):807

Neurology

We strongly encourage Drs. Burke and Callaghan to reread our comment, since it has nothing to do with the number of lawsuits filed, but the number of patients harmed (and claims made and settled before a suit is filed) due to substandard care by the intransigent adherence to outdated guidelines. The recommendation by Burke et al.1 to limit neuroimaging based on these flawed guidelines is contrary to an acceptable standard of care. There is no reason to fear incidental findings on neuroimaging since these often warrant further evaluation (e.g., stroke), continued monitoring (e.g., aneurysm), or treatment (e.g., arachnoid cyst). Failure to offer patients the option of neuroimaging disregards the ethical mandate of providing informed consent. We hope most neurologists recognize that following outdated flawed guidelines, whether for headache or any other condition, does not translate to “using the best evidence,” and will not provide “the best patient outcomes.”

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February 2017
11 Reads

The ethics of teaching physicians electronic fetal monitoring: And now for the rest of the story

Surg J 2017: 3:e42-47

Surgery Journal

Electronic fetal monitoring (EFM) does not predict or prevent cerebral palsy (CP), but this myth remains entrenched in medical training and practice. The continued use of this ineffectual diagnostic modality increases the cesarean section rate with concomitant harms to mothers and babies alike. EFM, as it is used in defensive medical practice, is a violation of patient autonomy and raises serious ethical concerns. This review addresses the need for improved graduatemedical education so that physicians and medical residents are taught both sides of the EFM–CP story.

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January 2017
10 Reads

Neonatal encephalopathy 2015: opportunity lost and words unspoken.

J Matern Fetal Neonatal Med 2016 11;29(9):1372-5. Epub 2015 Jun 11.

b Legal Medicine Consultants , Seattle , WA , USA.

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http://dx.doi.org/10.3109/14767058.2015.1051526DOI Listing
December 2016
15 Reads
3 Citations

Neurological Fallacies Leading to Malpractice: A Case Studies Approach.

Neurol Clin 2016 08;34(3):747-73

Deans and Lyons, LLP, 1001 Fannin, Houston, TX 77002, USA.

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http://dx.doi.org/10.1016/j.ncl.2016.04.011DOI Listing
August 2016
46 Reads
1.610 Impact Factor

Electronic fetal monitoring, cerebral palsy and bioethics: The evils in Pandora's Box

J Ped Care 2016; 2(2:14):1-10.

Journal of Pediatric Care

Pandora opened the box releasing death and all other evils into the world. She hastened to close the lid but the whole content had escaped except for one thing at the bottom of the box - HOPE. Paraphrase of the Greek Myth in Hesiod’s Works and Days. Edward Hon opened the Electronic Fetal Monitoring (EFM) Pandora’s Box in the 1950s. Although perhaps noble in original purpose, the unintended EFM consequences over the last half century resulted in more harm than good to mothers and babies in most of the industrialized world. EFM became the standard of care not because it was scientifically efficacious, but because it was promoted by physicians with undisclosed conflicts of interests and because obstetricians desperately wanted to believe that a machine would solve the age old cerebral palsy malady and at the same time protect physicians and hospitals from the then new and costly cerebral palsy birth injury lawsuits. EFM became the standard of care at the same time that bioethics became medical reality replacing the medical profession’s Hippocratic paternalistic ethic with patient autonomy and informed consent in virtually all aspects of medical practice except for the use of EFM. The use of EFM without informed consent has continued for fifty years with no outcry from the bioethical world. This article explores this ongoing medical and ethical calamity, and discusses why even today EFM use continues disguised as a safety device when in fact its use is primarily as protection for physicians and hospitals from cerebral palsy lawsuits.

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August 2016
12 Reads

Tuberculosis and chronic kidney disease: an emerging global syndemic.

Kidney Int 2016 07 10;90(1):34-40. Epub 2016 May 10.

Faculty of Medicine, Division of Respirology, University of British Columbia and TB Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.kint.2016.01.034DOI Listing
July 2016
88 Reads
5 Citations
8.563 Impact Factor

Imaging the Patient With Migraine: A Question Answered.

Authors:
James C Johnston

Headache 2015 Nov-Dec;55(10):1442-3. Epub 2015 Aug 28.

321 High School Road, NE Suite D3, 750, Seattle, WA, USA.

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http://dx.doi.org/10.1111/head.12653DOI Listing
May 2016
8 Reads
2.710 Impact Factor

Cerebral palsy and electronic fetal monitoring: Rearranging the Titanic's deck chairs

J Child Dev Disord 2016; 2(2:5):1-10

Journal of Childhood and Developmental Disorders

Electronic fetal monitoring (EFM) has repeatedly proven clinically ineffectual, caused more harm than good to mothers and babies alike, and trapped obstetricians into daily violations of fundamental medical ethics. EFM is also the foundation for the continuing worldwide cerebral palsy (CP) birth injury litigation crisis which routinely results in lottery-like verdicts and settlements which only benefit trial lawyers. Birth-related professional organizations (BRPOs) have had the power to stop EFM’s clinical proliferation, deal with the ethical violations, and put an end to the undeserved verdicts and settlements against physicians unjustly blamed for causing CP. These organizations have done nothing. This article reviews the myths behind EFM, explains why CP-EFM litigation is so successful, outlines the ethical dichotomy created by this scientifically flawed procedure, and proposes a solution to change the clinical standard of care, linking EFM to the Daubert exclusionary evidence doctrine recognized throughout the world’s courts, thereby ending CPEFM litigation.

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April 2016
10 Reads

Perpetuating myths, fables and fairytales: A half century of electronic fetal monitoring

Surg J 2015; 1:e28-e34

Surgery Journal

Electronic fetal monitoring (EFM) entered clinical medical practice at the same time bioethics became reality. Bioethics changed the medical ethics landscape by replacing the traditional Hippocratic benign paternalism with patient autonomy, informed consent, beneficence, and nonmaleficence. But EFM use represents the polar opposite of bioethics’ revered principles—it has been documented for half a century to be completely ineffectual, used without informed consent, and harmful to mothers and newborns alike. Despite EFM’s ethical misuse, there has been no outcry from the bioethical world. Why? This article answers that question, discussing EFM’s history and the reasons it was issued an ethics pass. And it explores the reason that even today mothers are still treated with blatant medical paternalism, deprived of autonomy and informed consent, and subjected to real medical risks under the guise that EFM is an essential safety device when in fact it is used almost solely to protect physicians and hospitals from cerebral palsy lawsuits.

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November 2015
11 Reads

Cerebral palsy litigation: change course or abandon ship.

J Child Neurol 2015 Jun 2;30(7):828-41. Epub 2014 Sep 2.

Legal Medicine Consultants, LLC, Seattle, WA, USA

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http://dx.doi.org/10.1177/0883073814543306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4431995PMC
June 2015
19 Reads
7 Citations
1.670 Impact Factor

Reducing relapse in tuberculosis treatment: is it time to reassess WHO treatment guidelines?

Int J Tuberc Lung Dis 2015 Jun;19(6):624

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

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http://dx.doi.org/10.5588/ijtld.15.0224DOI Listing
June 2015
13 Reads
1 Citation
2.315 Impact Factor

Tuberculosis in HIV-infected persons in British Columbia during the HAART era.

Can J Public Health 2014 May 30;105(4):e258-62. Epub 2014 May 30.

University of British Columbia and BC Centre for Disease Control.

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http://dx.doi.org/10.17269/cjph.105.4260DOI Listing
May 2014
17 Reads
1 Citation

Neuroimaging of Ethiopian patients with epilepsy: a retrospective review.

Ethiop Med J 2014 Apr;52(2):57-66

Department of Neurology, Addis Ababa University, Ethiopia.

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April 2014
20 Reads

Legal Issues in Neurology

42:1237-1264

Legal and Forensic Medicine

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June 2013
14 Reads

The expert witness in medical malpractice litigation: through the looking glass.

J Child Neurol 2013 Apr;28(4):484-501

Legal Medicine Consultants, LLC, Seattle, WA 98110, USA.

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http://dx.doi.org/10.1177/0883073813479669DOI Listing
April 2013
15 Reads
4 Citations
1.670 Impact Factor

Syphilitic aortic aneurysm with spastic paraparesis: a novel presentation and review of the literature.

J Neurol Sci 2012 Dec 24;323(1-2):241-4. Epub 2012 Aug 24.

Department of Neurology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.

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http://dx.doi.org/10.1016/j.jns.2012.07.058DOI Listing
December 2012
11 Reads
2.474 Impact Factor

Attentional limits in memory retrieval-revisited.

J Exp Psychol Hum Percept Perform 2011 Aug;37(4):1083-98

Human–Systems Integration Division, NASA Ames Research Center, Moffett Field, California 94035-0001, USA.

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http://dx.doi.org/10.1037/a0023095DOI Listing
August 2011
12 Reads
2 Citations
3.360 Impact Factor

Patient satisfaction with outpatient neurology services: a momentum for improvement.

J Neurol Sci 2011 Apr 26;303(1-2):128-32. Epub 2011 Jan 26.

Department of Neurology, Medical Faculty, Addis Ababa University, Addis Ababa, Ethiopia.

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http://dx.doi.org/10.1016/j.jns.2010.12.017DOI Listing
April 2011
15 Reads
2.474 Impact Factor

Migraine and medical malpractice.

Headache 2011 Mar;51(3):434-440

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http://dx.doi.org/10.1111/j.1526-4610.2011.01850.xDOI Listing
March 2011
10 Reads
2 Citations
2.710 Impact Factor

Neurological malpractice and nonmalpractice liability.

Authors:
James C Johnston

Neurol Clin 2010 May;28(2):441-58

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http://dx.doi.org/10.1016/j.ncl.2009.11.008DOI Listing
May 2010
13 Reads
1.610 Impact Factor

Bilaterally symmetric cervical spondylotic amyotrophy: a novel presentation and review of the literature.

J Neurol Sci 2010 Mar 31;290(1-2):142-5. Epub 2009 Dec 31.

Department of Neurology, Addis Ababa University, Addis Ababa, Ethiopia.

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http://dx.doi.org/10.1016/j.jns.2009.12.009DOI Listing
March 2010
30 Reads
3 Citations
2.474 Impact Factor

Life threatening intracerebral hemorrhage with isometheptene mucate, dichlorophenazine and acetaminophen combination therapy.

Authors:
James C Johnston

J Forensic Leg Med 2009 Nov 13;16(8):489-91. Epub 2009 Aug 13.

Legal Medicine Consultants, Seattle, WA, USA.

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http://dx.doi.org/10.1016/j.jflm.2009.07.006DOI Listing
November 2009
28 Reads
1 Citation
0.990 Impact Factor

Apraxia of eyelid opening secondary to right hemispheric infarction

Ann Neurol 1989; 25:622-624

Annals of Neurology

A variety of eyelid movement abnormalities have been attributed to lesions of the central nervous system. Apraxia of lid movements, and especially of lid opening, has received the least attention. We present 2 cases of lid opening apraxia and propose that this abnormality may be due to right hemisphere dysfunction.

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June 1989
10 Reads

Top co-authors

Victoria J Cook
Victoria J Cook

University of British Columbia

7
Jonathon R Campbell
Jonathon R Campbell

University of British Columbia

6
Kamila Romanowski
Kamila Romanowski

University of British Columbia

6
Fawziah Marra
Fawziah Marra

University of British Columbia

4
Lisa A Ronald
Lisa A Ronald

University of British Columbia

3
Dick Menzies
Dick Menzies

McGill University

3
Robert F Balshaw
Robert F Balshaw

University of British Columbia

3
Faiz Ahmad Khan
Faiz Ahmad Khan

Montreal Chest Institute

3