摘要:

BACKGROUNDPrimary central nervous system lymphoma (PCNSL) is an uncommon primary brain tumor that is being diagnosed with increased frequency in both the immunocompetent population and the population infected with human immunodeficiency virus (HIV).REVIEW SUMMARYPCNSL is an important diagnostic consideration in any patient with an enhancing lesion on neuroimaging, particularly in older adults and patients infected with HIV. Because this tumor has a propensity for widespread dissemination throughout the central nervous system, initial evaluation should include cerebrospinal fluid cytology and a slit lamp ophthalmologic examination. The addition of methotrexate‐based chemotherapy to whole brain radiotherapy has improved disease control and long‐term survival for patients diagnosed with PCNSL but may have significant associated neurologic toxicity for patients older than 60 years of age.CONCLUSIONSThe present challenge is to additionally improve the outcome of PCNSL patients, both in regards to disease control and treatment‐related toxicity. To this end, several ongoing and planned studies are examining new therapeutic strategies for the treatment of PCNSL.(THE NEUROLOGIST 6:245‐254, 2000)

ISSN:1074-7931    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BACKGROUNDCentral pontine myelinolysis can cause pseudobulbar palsy, quadriplegia, and death attributable to symmetric myelin damage in the center of the basis pontis. Extrapontine myelinolysis symmetrically affects thalamocapsular regions, neostriatum, and other territories. Myelinolysis usually results from the rapid correction of hyponatremia.REVIEW SUMMARYThe clinical spectrum of myelinolysis includes seemingly asymptomatic cases, transient encephalopathies, mutism, behavioral changes, stupor, and coma in addition to the classic syndrome of spastic quadriparesis and pseudobulbar palsy. As paralysis resolves, movement disorders or ataxia may become evident. Magnetic resonance imaging is the best diagnostic test, but the lesions may not be visible until 1 to 2 weeks after the onset of the illness. Myelinolysis can follow a rapid (≥10 mEq/L/d) rise in sodium regardless of the cause of hyponatremia and method of therapy. It is more to occur after correction of chronic hyponatremia (≥48‐hour duration) than acute hyponatremia.CONCLUSIONSTo minimize the incidence of myelinolysis, the therapeutic rise in sodium associated with the management of hyponatremia should be less than 10 mEq/L on the first day of treatment whenever possible. An even slower rate of correction is adequate after hyponatremic symptoms are controlled. Because the rise in sodium is unpredictable in a given individual, frequent monitoring of the sodium level is necessary. Should the sodium rise more quickly than anticipated, relowering of the sodium level may help minimize morbidity. The administration of dilute fluid and deamino‐8‐Darginine vasopressin has been used for this purpose in the initial days of myelinolytic symptoms. When severe symptoms of myelinolysis are established despite all efforts, supportive care may allow good recovery over the following months.(THE NEUROLOGIST 6:255‐266, 2000)

ISSN:1074-7931    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BACKGROUNDThe idiopathic inflammatory myopathies are clinically, histologically, and pathogenically distinct. In addition, the prognoses and response to treatment of the various forms of inflammatory myopathy are different. Most patients with inflammatory myopathy require aggressive immunosuppressive treatment. Clinicians need to be aware of the treatment options, which can be challenging and associated with various complications.REVIEW SUMMARYIn this article, we review the clinical, electrophysiological, laboratory, and histological features of the major categories of idiopathic inflammatory myopathy (dermatomyositis, polymyositis, and inclusion body myositis) and some of the less common disorders (eosinophilic polymyositis, granulomatous or giant cell myositis, myositis secondary to sarcoidosis and Behcet's disease, and focal myositis). Recent advances in understanding the pathogenesis of these disorders are discussed. In addition, we detail our approach to diagnosing and managing patients with inflammatory myopathy.CONCLUSIONSDiagnosis and management of patients with inflammatory myopathy can be difficult. Better under‐standing of the pathogenic basis for these distinct myositises hopefully will result in better treatment options. Prospective, double‐blind, controlled trials are necessary to define the best treatment options.(THE NEUROLOGIST 6:267‐287, 2000)

ISSN:1074-7931    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BACKGROUNDThe purpose of this study is to provide information on the spectrum of injuries to the nervous system incurred during athletics.REVIEW SUMMARYA review of recent literature coupled with the author's experience is used to provide examples of common problems associated with athletes incurring injuries to their nervous systems and the subsequent management of these injuries. The recognition of seemingly minor injuries to the nervous system is of great importance for preventing subsequent injuries that are more severe. No athlete with an injury to the nervous system should participate in sports until he or she is asymptomatic from the injury during full exertion.CONCLUSIONSAthletes represent a highly motivated, healthy population that, when injured, requires not only appropriate therapy for their injuries but enforcement of restraint until it is safe to return to competition.(THE NEUROLOGIST 6:288‐297, 2000)

ISSN:1074-7931    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

BACKGROUNDInfantile spasms are epileptic seizures that are unique to a very limited time frame during infancy. The triad of West syndrome consists of infantile spasms, hypsarrhythmic electroencephalography, and arrested psychomotor development.REVIEW SUMMARYSpasms may consist of flexor, extensor, or mixed flexor‐extensor types. Infantile spasms are broadly classified into symptomatic and cryptogenic. The list of causes in the symptomatic category is extensive. The severity of the outcome is, in large part, determined by the underlying abnormality, but even in cryptogenic cases the risk of abnormal mental development is high. The mainstay of treatment of infantile spasms remains intramuscular injection with adrenocorticotropin hormone, although there are reports of the successful use of vigabatrin, particularly in cases of infantile spasms secondary to tuberous sclerosis. Other medications have also been reported to be effective in children with infantile spasms.CONCLUSIONSMuch remains unknown about the developmental aspects of the syndrome accounting for its age‐specific nature. Similarly, the mechanism of action of adrenocorticotropin hormone therapy remains enigmatic. Prospective, multicenter studies comparing different treatment regimens are needed to determine the optimal management of this condition.(THE NEUROLOGIST 6:298‐301, 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