ISSN:1074-7931    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BACKGROUND- Increased intracranial pressure (ICP) is a pathological state common to a variety of serious neurological illnesses, all of which are characterized by the addition of volume to the intracranial vault. Hence, all ICP therapies (e.g., ventricular drainage, hyperventilation, mannitol) are directed toward reducing intracranial volume.REVIEW SUMMARY- Elevated ICP can lead to brain damage or death by two principle mechanisms: 1) global hypoxic-ischemic injury, which results from reduction of cerebral perfusion pressure (CPP) and cerebral blood flow; and 2) mechanical distortion, compression, and herniation of brain tissue, which results from mass effect associated with compartmentalized ICP gradients. In unmonitored patients with acute neurologic deterioration, head elevation, hyperventilation, and mannitol (1 g/kg) can lower ICP within minutes. Fluid-coupled ventricular catheters and intraparenchymal fiberoptic transducers (i.e., Camino system) are the most accurate and reliable devices for measuring ICP. In a monitored patient, treatment of critical ICP elevation (>20 mm Hg) should proceed in the following steps: 1) consideration of repeat CT scanning to assess the need for a definitive neurosurgical procedure; 2) intravenous sedation to attain a quiet, motionless state; 3) reduction of blood pressure if CPP is >120 mm Hg or pressor infusion if CPP is <70 mm Hg; 4) administration of mannitol; 5) moderate hyperventilation (PCO226 to 30 mm Hg); and 6) high-dose pentobarbital therapy. Applied moderate hypothermia (32 to 33°C) shows promise as a newer method for treating refractory ICP.CONCLUSIONS- Placement of an ICP monitor is the critical first step in effectively treating intracranial hypertension. ICP elevation is best managed using a stepwise protocol, with careful attention to sedation and CPP control before mannitol and hyperventilation are administered.

ISSN:1074-7931    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

OBJECTIVE- To review clinical and basic research on progressive supranuclear palsy.METHODS- MEDLINE literature review search from 1966 to 1997.CONCLUSIONS- Significant progress has occurred since Steele, Richardson, and Olzewski first described this disorder as a specific clinicopathologic entity 33 years ago. Clinical features, laboratory testing, and therapeutic strategies are discussed. In addition, hypothesized pathogenetic mechanisms that may help in the search for appropriate biologic therapies are considered.

ISSN:1074-7931    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BACKGROUND- Leprosy affects millions worldwide and is surprisingly common in the United States. Leprous neuritis is the most common treatable neuropathy.REVIEW SUMMARY- Leprosy is the only disease in which bacteria regularly invade peripheral nerves, with a predilection for Schwann cells. Because of a low temperature optimum for mycobacterial growth, nerve damage occurs in cool areas, leading to a unique temperature-linked neuropathy. Recognition of the neurologic features permits early diagnosis and effective treatment with rifampin, dapsone, and clofazimine. Leprosy occurs in high-, medium-, and low-resistance forms. Superimposed reactions are immunologic phenomena that profoundly affect the degree of nerve damage. Stigma and rehabilitation are important aspects of leprosy.CONCLUSION- Leprosy produces a characteristic neuropathy easily recognizable by a neurologist.

ISSN:1074-7931    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

BACKGROUND- Behçet's disease is a multisystem vasculitis with ocular involvement, arterial, lesions and neurologic disease as its major complications. Neurological involvement is reported in 5.3 to 49% of patients with Behçet's disease in different series. The clinical course is characterized by exacerbations and remissions of unpredictable duration and frequency. The disease occurs most commonly in patients from the Mediterranean, the Middle East, and Asian countries.REVIEW SUMMARY- A complicated case of Behçet's disease is presented. Neurological manifestations are discussed based on our experiences and the literature. Epidemiology, diagnostic criteria, etiopathogenesis, clinical manifestations, laboratory findings, treatment, prognosis, and differential diagnosis are reviewed.CONCLUSION- Behçet's disease may present with neurological findings or they can occur during the course of the disease. It can mimic other diseases, and overlapping conditions may make the diagnosis difficult. Lack of accurate history, incomplete or inadequate physical examination, and lack of recognition of an underlying systemic syndrome may delay the proper diagnosis.

ISSN:1074-7931    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:1074-7931    

出版商:OVID    

年代:1998

数据来源: OVID