European neurology
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Romantic operas provide a useful tool for historians to understand the perception of some medical disorders that existed during the nineteenth century. Somnambulism was still a mysterious condition during this time, since its pathogenesis was unknown. Hence, it comes as no surprise that somnambulism features in a number of operas, the best known of which are Verdi's 'Macbeth' and Bellini's 'La Sonnambula', both the subject of recent scholarship. ⋯ Dating from 1824, 'Il Sonnambulo' by the Italian composer Michele Carafa is based on a libretto by Felice Romani. Although it shares some features with the Verdi and Bellini operas, it also presents original elements. Our analysis of this forgotten opera supports the contention that studying operas can shed light on medical theories and practices, and on how ideas about mind and body disorders were transmitted to the laity in times past.
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Review
Impact of Mechanical Thrombectomy on the Organization of the Management of Acute Ischemic Stroke.
Several trials and meta-analyses have recently demonstrated the superiority of endovascular therapy over standard medical treatment in patients presenting with acute ischemic stroke. In order to offer the best possible treatment to a maximum number of patients, many stroke care networks probably have to be reorganized. After analyzing the reliability of data in the literature, an algorithm is suggested for a pre-hospital and in-hospital alert system to improve the timeliness of subsequent treatment: a drip-and-ship approach. ⋯ After 20 years of rt-PA, this new evidence-based therapy is a revolution in stroke medicine that will benefit patients. However, a new robust and multi-disciplinary care strategy is necessary to transfer the scientific data into clinical practice. It will require reorganization of the stroke infrastructure, which will include comprehensive stroke centers and secondary and primary stroke centers. The winners will be patients with severe stroke.
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Randomized Controlled Trial
Influence of Previous Failed Antispasticity Therapy on the Efficacy and Tolerability of THC:CBD Oromucosal Spray for Multiple Sclerosis Spasticity.
Sativex® (THC:CBD oromucosal spray) is indicated as add-on treatment for patients with moderate to severe multiple sclerosis (MS) spasticity. We aimed to determine whether antispasticity treatment history influenced the efficacy and safety of add-on THC:CBD oromucosal spray in MS spasticity patients. ⋯ THC:CBD oromucosal spray provided consistent relief with good tolerability in MS spasticity patients irrespective of their antispasticity pre-treatment history.
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We investigated white matter integrity utilizing diffusion tensor imaging in patients with idiopathic normal-pressure hydrocephalus (INPH) who had a positive response to the cerebrospinal fluid tap test and in age- and gender-matched Alzheimer's disease (AD) patients. We enrolled 28 patients with INPH, 28 patients with AD and 20 healthy controls. ⋯ And gait dysfunction was significantly correlated with decreased FA in the splenium of the corpus callosum and right external capsule in INPH patients. Our findings may suggest a possibility for considering microstructural changes in white matter integrity in elderly patients as potential imaging markers for differentiation between INPH and AD and may help us understand the potential pathophysiology of gait disturbances associated with INPH.
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Biography Historical Article
Édouard Manet's Tabes Dorsalis: From Painful Ataxia to Phantom Limb.
Édouard Manet (1832-1883) is considered the 'father' of Impressionism and even of XXth century modern art. Manet's genius involved getting away from the classical narrative or historical topics and replacing them by the banality of daily life. Technically, he erased volumes into flat two-dimensional coloured planes, and distorted conventional perspective with often gross brushstrokes intentionally giving an 'unfinished' aspect to the work. ⋯ Having become bedridden, he had to be amputated of one leg, which was developing gangrene probably associated with ergot overuse. While he died shortly thereafter, we have some witness anecdotes suggesting that he experienced a phantom limb: when Claude Monet (1840-1926) visited him and sat down on his bed, Manet violently shouted at him that he was just sitting on his (absent) leg, which provoked terrible pains. With its facts and mysteries, the subtle interaction between Manet's illness and his work output remains one of the most intriguing stories in neurology of art.