摘要:

BACKGROUND–Many autoantibodies with reactivity to glycoconjugate components of peripheral nerve have been described in the last two decades. Serum autoantibodies to gangliosides and glycoproteins have received the most attention and have been implicated in a variety of sensory and motor neuropathy syndromes. Detection of these autoantibodies raises the possibility that the peripheral nerve disturbance is immune-mediated and that immunosuppressive therapy may be of benefit.REVIEW SUMMARY–This review summarizes the peripheral nerve syndromes associated with autoantibodies to glycoconjugates. The potential role for these autoantibodies in diagnosing peripheral nerve syndromes as well as predicting treatment response and immunopathogenesis is discussed. Autoantibody panels promoted by commercial laboratories for the evaluation of peripheral neuropathies are analyzed.CONCLUSIONS–Despite the fact that a pathogenic role for many peripheral nerve autoantibodies remains in question, several have evolved into helpful serologic markers for certain neuropathy syndromes. A rational approach to autoantibody testing in routine practice is presented, with an argument that testing should be individualized and tailored to the clinical setting, avoiding the use of larger screening panels.

ISSN:1074-7931    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BACKGROUND–Subcortical ischemic vascular disease (SIVD) is a major cause of vascular cognitive impairment and dementia, particularly among ethnic minorities, such as Asian and African American populations.REVIEW SUMMARY–Two pathways, occlusion and hypoperfusion, lead to brain ischemia, complete versus incomplete infarction, and cognitive impairment associated with cerebral small artery disease. Lacunes and deep white matter changes, visualized by computed tomographic scanning or magnetic resonance imaging, provide sensitive and respective markers for these two ischemic pathways. Brain atrophy and deep white matter changes predict severity of dementia. The value of other clinical features for diagnosis of dementia attributable to SIVD is reviewed using evidence-based metrics (e.g., odds ratios and likelihood ratios). The importance of recognizing and managing hypertension and diabetes mellitus, the two major risk factors for SIVD, is emphasized.CONCLUSIONS–Progress in understanding and treating vascular dementia may be accelerated by focusing on more homogeneous subtypes, such as those caused by SIVD.

ISSN:1074-7931    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BACKGROUND–Autonomic complications may result from many central and peripheral nervous system conditions. Understanding the anatomy and the spectrum of presentations of autonomic neuropathy is crucial to its recognition and management.REVIEW SUMMARY–This study will review the anatomy of the parasympathetic and sympathetic systems, describe the appropriate history and physical examination to be performed in a patient with suspected autonomic dysfunction, and list disorders that give rise to autonomic failure. Within the context of the autonomic physical examination, the measurement of positional blood pressures and bedside techniques for the detection of autonomic failure will be stressed. Most emphasized will be three easily performed electrophysiologic procedures that quantify the integrity of the parasympathetic and sympathetic output. Their use can be helpful in verifying the presence of autonomic dysfunction and serially following the response to therapy. The discussion of treatment will primarily focus on lifestyle changes and pharmacologic approaches to the management of orthostatic hypotension, neurogenic bladder, sexual dysfunction, and gastrointestinal disorders.CONCLUSIONS–The diagnosis and management of autonomic disorders require a knowledge of the anatomy, physiology, and pharmacology of the autonomic nervous system and the array of the central and peripheral neurologic disorders that give rise to autonomic symptoms and signs. Laboratory testing of the autonomic nervous system substantiates the presence of autonomic dysfunction and can be used to monitor disease progression or improvement after therapy.

ISSN:1074-7931    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BACKGROUND–Ophthalmoscopy allows for direct visualization of the central nervous system and close inspection of arterioles and venules. Available since the last part of the 18th century, the skills of ophthalmoscopy and the fundus appearance are not commonly well taught.REVIEW SUMMARY–This review will focus on ophthalmoscopy for the neurologist and, more specifically, direct ophthalmoscopy. Observation of the fundus is a difficult examination to perform. This review will serve to provide helpful techniques to become more proficient with the direct ophthalmoscope as well as demonstrate a selection of normal and abnormal ophthalmoscopic findings pertinent to the clinical neurologist.CONCLUSIONS–The ophthalmoscope is an invaluable instrument for the diagnosis of disease. Learning to properly use the direct ophthalmoscope to recognize significant ophthalmoscopic changes can be one of the clinician’s best tools to help make a clinical diagnosis.

ISSN:1074-7931    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

BACKGROUND–Dementia and depression are both common disorders of the elderly. It may be difficult to differentiate dementia from depression, and the two conditions commonly coexist. Understanding the relationship between the two disorders is critically important for diagnosis and optimal management of older patients with cognitive impairment and mood changes.REVIEW SUMMARY–Depression may produce cognitive impairment. This cognitive decline, known as the dementia syndrome of depression (DOD), usually is reversed by treatment of the depressive disorder. However, some patients with DOD develop dementia in the following few years. Depression might be a risk factor for Alzheimer disease (AD) or a harbinger of its occurrence. It also may co-occur with AD. Patients with AD and depression differ biologically from those without mood changes. Neuroimaging studies in patients with depression and AD show impaired metabolism in the frontal lobes. Depression exaggerates the functional impairment, decreases quality of life, and increases caregiver distress of patients with AD. In patients presenting with dementia and depression, metabolic imbalances and toxic side effects of drugs should be ruled out. Depression in dementia is treatable with appropriate antidepressant therapy.CONCLUSIONS–Depression and dementia are closely related. Depression can precede, be a risk factor for, or coexist as a part of the clinical presentation of dementia. There are syndrome-specific histopathologic and neurochemical changes in the brains of patients with depression and AD. Depression in dementia is treatable. Treatment of mood changes may help improve functional activity, reduce caregiver distress, and enhance the quality of life of patients.

ISSN:1074-7931    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:2001

数据来源: OVID