摘要:

BACKGROUND-Certain central nervous system (CNS) lesions can be misconstrued histopathologically as high-grade or aggressive neoplasms when they are, in fact, low-grade processes for which surgery alone may be adequate therapy. Reactive lesions such as demyelinating disease can be misinterpreted as well and when diagnosed as a glioma, may be treated with radiotherapy. Complications of treatment, e.g., radionecrosis, are fostered by the long post-therapy survival periods permitted by low-grade neoplasms and, especially, nonneoplastic entities.REVIEW SUMMARY-As a benchmark against which any diagnosis of a CNS tumor should be reconciled is a set of neuroradiological findings that usually indicate a low-grade neoplasm or a reactive nonneoplastic entity. These eight specific radiological features are illustrated in the context of representative low-grade or nonneoplastic CNS lesions.CONCLUSIONS-An interdisciplinary approach, with reconciliation of any discrepancies between neuroimaging features and the pathological diagnosis, can minimize the possibility that patients with suspected CNS tumors will be overtreated.

ISSN:1074-7931    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BACKGROUND-An accurate diagnosis of Parkinson's disease (PD) depends on identification of the cardinal clinical manifestations of the disorder. The parkinsonisms are those conditions that resemble PD clinically but have a different histological basis, prognosis, and response to treatment. This review details the clinical signs and symptoms that can aid the clinician in differentiating these mimicking conditions from true PD.REVIEW SUMMARY-A variety of diagnostic criteria have been proposed to establish a diagnosis of PD. Most require that at least two of the cardinal motoric signs of PD (akinesia, rigidity, and rest tremor) be present. Even when experienced clinicians apply these criteria, comparisons of clinical diagnoses with autopsy data suggests that there is a relatively high rate of diagnostic error resulting in other akinetic rigid syndromes being mistaken for PD. The possibility that a patient may be suffering from a form of parkinsonism other than PD is often suggested by the appearance of clinical signs and symptoms that are distinctly unusual in PD, such as early falling, early or severe autonomic disturbance, early dementia, lack of response to levodopa, absence of rest tremor, profound asymmetry of motoric signs, recent exposure to dopamine blocking drugs, and isolated involvement of gait. The presence of atypical signs and symptoms not only alert the clinician that a patient may not have PD but, in addition, may suggest which of the other specific parkinsonian disorders, such as progressive supranuclear palsy, multiple system atrophy, or corticobasal degeneration, is present. Laboratory aides are not usually useful in distinguishing between PD and other parkinsonian syndromes, but neuroimaging studies may be of some use in making this distinction because several of the parkinsonisms can be associated with relatively specific magnetic resonance imaging or positron emission tomography scan abnormalities, especially late in their course.CONCLUSION-Careful analysis of the mode of onset, sequence of appearance of symptoms, and response to therapeutic intervention combined with identification of atypical neurologic signs and symptoms can remarkably enhance the clinician's ability to distinguish PD from other akinetic rigid syndromes and disorders of gait that mimic it.

ISSN:1074-7931    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BACKGROUND-Therapy for acute ischemic stroke is rapidly evolving. The introduction of the use of thrombolytics along with an increased physician and community awareness of stroke has created a demand for earlier and more aggressive interventions. As a result, there is increased interest in meeting the unique cardiovascular, pulmonary, and neurologic needs of these patients in specialized intensive care and stroke units.REVIEW SUMMARY-This article will review indications for admission of ischemic stroke patients to an intensive care or stroke unit; airway, respiratory, and cardiovascular management; thrombolytic therapy; and general medical issues such as nutrition, temperature management, deep venous thrombosis prophylaxis, and control of blood glucose. In addition, specific management issues for patients with large hemispheric stroke, cerebellar stroke, and basilar artery thrombosis will be reviewed.CONCLUSIONS-Stroke units and intensive care units with specially trained neurologic intensivists are becoming increasingly involved in the initial management of patients with acute ischemic stroke. The main non-neurologic indications for admission to these units are airway management and cardiovascular monitoring. In addition, new therapies such as the use of intravenous and intra-arterial thrombolytics and decompressive craniectomy have increased the need for close neurologic and hemodynamic monitoring in specialized units.

ISSN:1074-7931    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BACKGROUND-The classical early description of cerebral venous thrombosis (CVT) was based on findings at autopsy, and bilateral or alternating focal deficits, seizures, and coma were described as constant features. In the last 30 years, progress in neuroimaging has made the diagnosis of CVT easier, and the clinical spectrum of the disease has greatly expanded. However, despite increased awareness of the disorder, CVT is still a disease in which the correct diagnosis is frequently overlooked or delayed.REVIEW SUMMARY-CVT is an infrequently recognized condition that is extremely variable in its clinical presentation, mode of onset, imaging appearance, and outcome. Its prognosis, although much better than classically thought, remains largely unpredictable. The combination of magnetic resonance imaging and magnetic resonance venography is currently the best method for diagnosis and follow-up of CVT. It should be performed as the first line of investigation in cases with a high clinical suspicion. Treatment of CVT is based primarily on symptomatic treatment of seizures and intracranial hypertension, associated with etiological treatment whenever possible, and antithrombotics. Heparin remains the first-line treatment for CVT, and although its systematic use remains debated, recent studies have confirmed its safety even in patients with large hemorrhagic infarcts. The addition of local thrombolysis is indicated in the rare cases of worsening despite adequate anticoagulation and optimal symptomatic and etiologic treatment.CONCLUSION-The better recognition of CVT has greatly modified our knowledge of this condition, and the range of underlying causes has also expanded. Because of its large variety of presentations, its highly variable mode of onset, its numerous causes, and its unpredictable outcome, CVT remains a diagnostic and therapeutic challenge.

ISSN:1074-7931    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:1999

数据来源: OVID