摘要:

BACKGROUND- Although cardiac embolism has long been recognized as a cause of cerebral ischemia, relatively “new” potential sources of embolism have been recently documented, particularly with the advent of transesophageal echocardiography.REVIEW SUMMARY- In this review, we explore the data and controversies concerning patent foramen ovale and paradoxical embolism, aortic arch atheroma, atrial septal aneurysm, spontaneous echo contrast, valvular strands, and valvular calcification.CONCLUSIONS- Although much has been learned about these potential causes of stroke, considerable uncertainty remains as to underlying mechanism leading to stroke as well as optimal therapy.

ISSN:1074-7931    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BACKGROUND- Lewy Body disorders extend beyond Parkinson's disease (PD). Lewy bodies may be found in the brain in cortical as well as subcortical areas, termed diffuse Lewy body disease (DLBD). DLBD may underlie dementia with Lewy bodies (DLB), a syndrome with prominent cognitive and behavioral symptoms.REVIEW SUMMARY- In DLB, dementia precedes Parkinsonism, or the two appear simultaneously. Clinical criteria for DLB include dementia, core features of fluctuation, visual hallucinations and spontaneous Parkinsonism, and supporting features. Each core feature may result from other conditions. DLB may resemble Alzheimer's disease (AD) clinically and often is found in association with AD pathology. Roughly 1/3 of patients with PD eventually develop dementia (PDD), and many show the pathology of DLBD. Many patients with DLB show a neuropsychological profile of relatively severely impaired psychomotor speed, executive function, and visuo-spatial abilities, with relative preservation of language, a pattern also seen in PD and PDD. Treatment of patients with DLB is difficult. These patients are very sensitive to neuroleptics; therefore, atypical antipsychotic drugs are preferable. Parkinsonism in DLB may respond to L-dopa or dopamine agonists. Acetylcholinesterase inhibitors such as donepezil may lead to improvement of cognition, hallucinations, and alertness.CONCLUSIONS- DLB is a relatively common cause of dementia in the elderly. Cognitive, motor, and behavioral features help to distinguish it from AD and other conditions. The key clinical features may stabilize or improve with careful pharmacologic treatment.

ISSN:1074-7931    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BACKGROUND- Traumatic brain injury can result in a variety of neurobehavioral changes. The development of agitation in the early stages after injury is frequently disruptive to patient care, distressing to family members, and potentially harmful to the patient.SUMMARY- Advances regarding the pathophysiology of biomechanical and neurochemical events after brain injury have lead to better understanding of the neurobehavioral changes that may occur. Increasing awareness of the alterations in neurotransmitter function after cerebral trauma has resulted in more rational pharmacologic interventions during the rehabilitation process. These efforts must be tempered by awareness that any pharmacologic intervention has the potential for adverse effects on both functional and cognitive recovery. These adverse effects should be considered and therapy targeted to specific areas of dysfunctional behavior.CONCLUSION- This article will focus on a discussion of management options for posttraumatic agitation based on behavioral symptoms. It will also briefly discuss the effects of psychopharmacologic interventions on cognitive and motor recovery after traumatic brain injury.

ISSN:1074-7931    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BACKGROUND- The field of neurorehabilitation involves the provision of rehab services to promote functional recovery in patients with disabling neurologic conditions, including stroke, traumatic brain and spinal cord injuries, multiple sclerosis, Parkinson's disease, cerebral palsy, and neuromuscular disorders.REVIEW SUMMARY- This article reviews the specific role of the rehabilitation physician and other team members in the management of patients with chronic neurologic diseases. The goals and objectives of a comprehensive rehabilitation program are discussed. The impact of rehabilitation strategies on neuronal plasticity and the use of pharmacologic agents and therapy strategies in promoting neurologic recovery are reviewed. As well, the role of functional outcome measures in directing rehabilitation services is detailed.CONCLUSIONS- Further research should be directed at determining the molecular and structural changes that underlie recovery after neurologic injury; this should allow for the development of even more effective therapeutic interventions to optimize functional recovery for patients with chronic, disabling neurologic disorders.

ISSN:1074-7931    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BACKGROUND- Serotonin syndrome (SS) results from drug-induced hyperserotonergic states. Although clinically SS appears similar to neuroleptic malignant syndrome (NMS), in SS there is a history of exposure to serotonergic agents. Unfortunately, treatments for NMS and SS are different, and misdiagnosis may result in recurrent disease or inappropriate, possibly harmful, therapies. Despite an increasing incidence, SS has received little attention in the neurology literature.REVIEW SUMMARY- To review the history, diagnosis, mechanism, and treatment of SS, we completed a MEDLINE search to identify possible SS cases previously diagnosed as other entities to illustrate the need for more clinical awareness of SS. Our MEDLINE search revealed 17 cases between 1987–1991 of possible or probable SS diagnosed as other entities.CONCLUSIONS- Many of these patients in whom the diagnosis of SS was not considered were on serotonergic agents for neurologic disease. SS was not mentioned as a potential cause in any of the cases. The nature of SS symptoms will bring patients to the attention of a neurologist. Given the multitude of serotonergic agents now in use, there is need for heightened awareness of SS among neurologists.

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