摘要:

BACKGROUND‐Optic neuritis is one of the most common neuro‐ophthalmologic diseases that neurologists encounter in their practice. This inflammatory optic neuropathy may occur as an isolated entity or as the initial manifestation of multiple sclerosis. In addition to the well‐defined clinical syndrome of optic neuritis, the cause is becoming more well understood and the management of this disorder is constantly improving.REVIEW SUMMARY‐The important clinical aspects of optic neuritis are detailed for the clinician, which includes an outline of diagnostic pitfalls and appropriate laboratory tests to be ordered. The natural history of optic neuritis is described to give an understanding of the prognosis and outcome of this disease. Furthermore, new findings in the pathogenesis of multiple sclerosis and current treatment recommendations are presented.CONCLUSIONS‐Optic neuritis is an acute inflammatory optic neuropathy. It is the most common type of optic neuropathy causing acute visual loss in young adults (peak age at 30 to 40 years), especially among women. Patients usually present with acute reduced visual acuity, pain exacerbated by eye movements, dyschromatopsia, an afferent pupil defect, and swelling of the optic nerve head. Visual field testing often reveals central, centrocecal, arcuate, altitudinal, or nasal step defects. Magnetic resonance image scanning of the brain should be ordered in all cases of acute optic neuritis for diagnostic and prognostic purposes. The brain lesions of multiple sclerosis are commonly seen as T2 ovoid high‐signal white matter lesions on magnetic resonance image scans of the brain located in perivenular regions perpendicular to ventricles with variable enhancement. Other laboratory tests, such as cerebrospinal fluid analysis, serologic tests, and visual evoked potentials, add little to the workup of typical optic neuritis. For atypical presentations of optic neuritis, such tests prove to be useful in the diagnosis and treatment of the patient. The recommended treatment for optic neuritis is intravenous steroids. Other promising therapies include intravenous &ggr;‐globulin and some interferons, but studies so far have not resulted in any new treatment guidelines.(THE NEUROLOGIST 6:205‐213, 2000)

ISSN:1074-7931    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BACKGROUND‐Adrenoleukodystrophy is a rare inherited disorder of lipid metabolism. Patients may present in the pediatric age group or as adults. The clinical picture is variable, and the pathology affects many organs in the body, though primarily the adrenal cortex and the CNS white matter. In the cerebral form, the disease is fatal after several years of severe neurologic dysfunction. In the spinal form, it is a progressive, disabling disease. Diagnosis can reliably be made by measuring very long chain fatty acids in the serum.REVIEW SUMMARY‐This review studies the different aspects of adrenoleukodystrophy. The genetics behind the inheritance of this disease is presented first, followed by a discussion of the pathophysiology of the disease and a detailed description of the different presentations, classifications, and symptoms. The diagnostic tests are explained with emphasis on their specificities and reliability. A detailed description of the different modes of therapy available is presented.CONCLUSIONS‐Adrenoleukodystrophy is a rare and fatal disease. Its presentation is variable, making clinical diagnosis difficult. Reliable diagnosis can be performed with the present laboratory tests. Genetic counseling is of utmost importance as there is no effective therapy.(THE NEUROLOGIST 6:214‐219, 2000)

ISSN:1074-7931    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BACKGROUND‐Acute treatment of ischemic stroke with tissue plasminogen activator requires confident diagnosis of ischemic stroke, a negative CT scan, and administration of the drug within 3 hours of onset of symptoms.REVIEW SUMMARY‐We report four cases that presented to our Emergency Department with apparent focal neurological deficits within 3 hours of onset. The Stroke Team was called, but all four patients turned out to have conditions other than ischemic stroke. One had a metastatic tumor that could be identified on the CT scan.CONCLUSIONS‐Other conditions can produce focal neurological signs of apparently acute onset. A physician who is experienced in the diagnosis of ischemic stroke, as well as in the interpretation of acute CT scans, should be involved in the evaluation of patients who have acute stroke for intravenous thrombolytic therapy.(THE NEUROLOGIST 6:220‐223, 2000)

ISSN:1074-7931    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BACKGROUND‐The idea that much of our mental life proceeds without conscious awareness has been accepted by philosophers for centuries. After a brief detour in the form of psychoanalytic theory, the idea has in recent decades reemerged as a proper subject of study by cognitive scientists.REVIEW SUMMARY‐Studies of patients who have language disturbance reveal that semantic information and visual word forms of which the patients are consciously unaware are nonetheless capable of producing appropriate behavioral responses. Patients who have severe amnestic disorders are able to learn tasks with no recollection of having been taught. Similar unconscious processing is encountered in patients who have prosopagnosia, blindsight, commissurotomy, and anosognosia and, in normal subjects, in the study of subliminal perception, hypnosis, and the automatic behaviors of daily activity. Such observations are relevant to current notions of parallel distributed processing (connectionism) and of consciousness itself.CONCLUSIONS‐Cognitive science, which includes cognitive psychology, neurobiology, computer science, and linguistics, has replaced psychoanalytic theory as the proper means of studying the mind, and current insights into unconscious cognitive processing are helping to explain unusual clinical phenomena encountered by neurologists.(THE NEUROLOGIST 6:224‐231, 2000)

ISSN:1074-7931    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BACKGROUND‐Few cases of isolated cerebral mucormycosis have been reported, but this entity can be recognized and treated.REVIEW SUMMARY‐Primary cerebral mucormycosis occurs in young individuals who abuse drugs intravenously, in contrast to the rhinocerebral form of mucormycosis, which occurs in diabetics. Patients who have primary cerebral mucormycosis present with headache, fever, hemiparesis, and altered mental status. CT or magnetic resonance imaging commonly demonstrates an irregularly enhancing basal ganglia mass with edema. Microscopic examination of material obtained by stereotaxic biopsy reveals nonseptate hyphae branching at right angles. Sixty percent of the patients who are treated with amphotericin B survive. Abscess was excised in some of the survivors. In the absence of appropriate treatment, all patients died.CONCLUSIONS‐Isolated cerebral mucormycosis should be suspected in patients who have abused drugs intravenously, who present with a clinical picture of brain abscess, and whose imaging studies reveal irregular, enhancing basal ganglia masses. These patients should undergo a biopsy of the lesion, treatment with amphotericin B, and, if possible, abscess excision.(THE NEUROLOGIST 6:232‐237, 2000)

ISSN:1074-7931    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:2000

数据来源: OVID