European neurology
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In Japan, MRI-based thrombolysis after CT screening is the most common imaging strategy prior to intravenous thrombolysis (IVT) with tissue plasminogen activator (tPA) within 3 h after ischemic stroke. A choice of MRI with MR angiography (MRA) provides a higher diagnostic accuracy, but may delay an initiation of thrombolysis. ⋯ The imaging strategy of initial CT screening with optional MRI/MRA scans prior to IVT was feasible. However, it resulted in an additional 30 min in-hospital delay of tPA administration, which may affect clinical outcomes.
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Lumbar puncture is a frequent procedure performed by physicians from several disciplines to help establish a diagnosis and treatment for several diseases. Post-lumbar puncture headache (PLPH) is a frequent complication that typically lasts for a couple of days and can be severe enough to immobilize the patient and to require therapy. There are several risk factors identified, pain characteristics, and characteristic findings on spinal and head magnetic resonance imaging. ⋯ Epidural blood patch is a safe and rapidly effective treatment in experienced hands. Furthermore, patients who developed PLPH should be advised to contact the medical staff in case of changes in the characteristics of headaches. When a patient who was diagnosed with PLPH has a change in the pain character, or additional neurological manifestations appear, an urgent brain CT/head MRI should be performed to exclude rarer life-threatening intracranial complications.
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To examine the incidence of post-lumbar puncture headache (PLPH) in patients admitted for cognitive disturbances. ⋯ The incidence of PLPH in patients with cognitive disturbances is low and CSF analyses can thus be part of the diagnostic work-up at memory clinics.
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Pain in patients with chronic idiopathic axonal polyneuropathy (CIAP) has never been studied in detail. The aim of the study was to investigate the pain experienced by patients with CIAP, and to determine whether pain is associated with health-related quality of life (HRQoL). ⋯ Neuropathic and non-neuropathic pain syndromes should be distinguished in patients with CIAP who experience pain, to enable appropriate tailoring of treatment.
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Historical Article
Sleepwalking in Italian operas: a window on popular and scientific knowledge on sleep disorders in the 19th century.
There is little knowledge on sleepwalking in ancient times even though it is a very common condition. The aim of this report is to describe the backgrounds of medical knowledge on somnambulism in the 19th century, a key period in the development of neurosciences, by analysing its representation in two famous Italian operas: La Sonnambula by Vincenzo Bellini and Macbeth by Giuseppe Verdi. The 19th-century operas may be considered as a crossing point between the popular and intellectual world because they mirror popular answers to phenomena that were still awaiting scientific explanations. ⋯ The analysed Italian operas provide two different views on sleepwalking, probably because they are based on texts belonging to different periods. Their examination allows one to understand the gradual evolution of theories on sleepwalking, from demoniac possession to mental disorder and sleep disease. At the same time, this analysis throws some light on the history of psychological illnesses.