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

摘要:

Epilepsy surgery has become an important therapeutic option for children with medically resistant epilepsy. Localization-related seizures with or without secondary generalization are treatable by temporal lobectomy, extratemporal resection, or hemispherectomy, with the choice of procedure dictated by the location and extent of the epileptogenic zone. Extratemporal resections are much more common in children than in adults. Favorable rates of postoperative freedom from seizures are possible in all of the childhood excisional procedures. Although prenatally acquired malformations of cortical development are the most prevalent histologic abnormality in children undergoing resection, in a significant proportion, seizures occur in the setting of recognizable epilepsy syndromes. In contrast, the generalized epilepsies are not amenable to resective procedures. Although experimentally justified, corpus callosotomy is palliative except in some cases of atonic seizures, but other seizure types are unimproved, and ongoing medication is the rule. The preoperative evaluation relies on high-resolution magnetic resonance and functional imaging with single photon emission computed tomography, positron emission tomography, and spectroscopy to help to define the epileptogenic region, especially in extratemporal nonlesional cases. Subdural EEC monitoring often contributes definitive localizing information and facilitates cortical mapping. Earlier surgery improves psychosocial and rehabilitative status, whereas medical intractability predisposes patients to psychosocial deterioration.

ISSN:1074-7931    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BACKGROUND- Moyamoya disease (spontaneous occlusion of the circle of Willis) is a rare disease, previously thought to be confined to Japan and other Asian countries, but now known to occur worldwide, although at a lower frequency. Information about its correct diagnosis and appropriate treatment is frequently requested, especially in Europe and the United States.REVIEW SUMMARY- The clinical features of Moyamoya disease are now well established, as is its treatment, which is directed against cerebral ischemia. It is possible that Asian, American, and European patients differ in some ways in the clinical expression of the disease. Similar clinical features associated with other systemic diseases should be referred to as Moyamoya syndrome, rather than Moyamoya disease. The prognosis with regard to life expectancy is relatively favorable, but the associated impairment of intellectual development is currently drawing more attention. Revascularization procedures reportedly improve the prognosis in this regard. The optimal choice of revascularization procedure remains under discussion. Recent scientific developments include the application of molecular biological techniques, such as testing for basic fibroblastic growth factor in the vascular wall and in the cerebrospinal fluid, and genetic analysis of familial cases, which account for approximately 10% of all cases, in the search for the still unknown etiology of the disease.CONCLUSION- The principal clinical manifestations of Moyamoya disease are cerebral ischemia in children and in-tracranial bleeding in adults. These are caused by the severe stenosis or occlusion of the internal carotid artery at its terminal portion bilaterally, which induces the formation of abnormal vasculature (Moyamoya) in the basal ganglia. It is treated by the administration of aspirin to prevent progression of the disease and by a revascularization procedure to augment the cerebral blood flow.

ISSN:1074-7931    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BACKGROUND- Cardiac and pulmonary complications are by far the most common cause of secondary morbidity and mortality in patients with cerebrovascular disease.REVIEW SUMMARY- Immobility, dysphagia, and autonomic instability occur frequently in stroke patients and can predispose them to serious medical complications such as pneumonia, pulmonary embolism, and myocardial infarction. Cerebrovascular and coronary artery disease have similar risk factors and often co-exist; thallium stress testing of selected patients with ischemic stroke can identify patients at risk of secondary cardiac events. Neurogenic cardiac injury that presents with characteristic electrocardiographic changes and reversible left ventricular dysfunction on echocardiography occurs in nearly 10% of patients with aneurysmal subarachnoid hemorrhage. Aspiration pneumonia is a direct cause of mortality in 6% of stroke patients. Modified barium swallow with videofluoroscopy can identify patients at high risk of aspiration. The prevention, early detection, and treatment of deep venous thrombosis and pulmonary embolism can significantly reduce morbidity and mortality in patients who are immobilized after stroke.CONCLUSIONS- Early recognition and treatment of cardiac and pulmonary complications can lead to significant improvement in morbidity and mortality in patients with cerebrovascular disease.

ISSN:1074-7931    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BACKGROUND- Whipple's disease may predominantly manifest with neurologic symptoms, especially myorhythmia and ocular movement disorders. Oculomasticatory myorhythmia and oculofacial-skeletal myorhythmia are well documented pathognomonic signs unique to CNS Whipple's disease. Vertical supranuclear ophthalmoparesis has been reported in many afflicted patients. Blepharospasm has not been reported as a presenting symptom.REVIEW SUMMARY- We report a patient with systemic Whipple's disease who exhibited almost exclusively CNS symptoms. The patient developed both ocular and skeletal myorhythmia without recognizable facial involvement. Later, despite aggressive antibiotic treatment, this patient developed severe aseptic meningitis, although polymerase chain reaction (PCR) for Tropheryma whippelii in the cerebrospinal fluid (CSF) was negative. The movement disorders did not respond to antibiotics or to agents such as carbidopa-levodopa, valproate, carbamazepine, indomethacin, or clonaze-pam.CONCLUSIONS- This case documents the difficulty of early recognition, the spectrum of cardinal neurologic symptoms and complications, and the difficulty in managing of such patients. The role of CSF-PCR for Tropheryma whippelii remains controversial as a means to diagnose CNS Whipple's disease.

ISSN:1074-7931    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BACKGROUND- Rabies is a fatal disease transmitted through bites of animals harboring the virus in their saliva. Rabies continues to be a scourge in developing countries.SUMMARY- The virus is initially transported from the site of inoculation to the central nervous system and is subsequently transported back to peripheral neural and extraneural sites via the axoplasm of the peripheral nerves. Encephalitic rabies is characterized by prominent limbic dysfunction. Paralytic rabies manifests as ascending paralysis resulting in quadriparesis. It can occur independently, or encephalitis may supervene terminally. Antemortem diagnosis is dependent on demonstration of the rabies antigen by fluorescent antibody technique in nuchal skin biopsies and corneal impression smears. The postmortem diagnosis of rabies is confirmed by demonstration of Negri bodies on histopathological examination of the brain. Treatment includes prophylactic administration of vaccine and rabies immunoglobulin. There is no known cure for the disease.CONCLUSIONS- Rabies often poses a diagnostic challenge to unsuspecting clinicians because of its varied and deceptive clinical manifestations. Early confirmation of the diagnosis is mandatory for obvious reasons. Education of the public and health workers is mandatory to decrease the ravages of this disease.

ISSN:1074-7931    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

1. What are the neurologic manifestations of Lyme disease?

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