Journal of neurology, neurosurgery, and psychiatry
-
J. Neurol. Neurosurg. Psychiatr. · Jul 2010
Rabies viral encephalitis: clinical determinants in diagnosis with special reference to paralytic form.
Rabies is an important public health problem in developing countries such as India where an alarmingly high incidence of the infection is reported every year despite the availability of highly effective, potent and safe vaccines. In clinical practice, diagnosis of the furious (encephalitic) form of rabies poses little difficulty. In contrast, the paralytic form poses a diagnostic dilemma, to distinguish it from Guillain-Barré syndrome. The problem is further compounded in the absence of a history of dog bite, clinical features resembling a psychiatric syndrome. ⋯ Fever, distal paresthaesias, fasciculation, alteration in sensorium, rapid progression of symptoms and pleocytosis in cerebrospinal fluid should alert the neurologist to consider rabies encephalomyelitis. Detection of the viral antigen in the corneal smear and a skin biopsy from the nape of the neck had limited usefulness in the ante-mortem diagnosis. Although a few clinical signs may help indicate rabies encephalomyelitis antemortem, confirmation requires neuropathological/neurovirological assistance. The preponderance of atypical/paralytic cases in this series suggests that neurologists and psychiatrists need to have a high index of clinical suspicion, particularly in the absence of a history of dog bite.
-
J. Neurol. Neurosurg. Psychiatr. · Jun 2010
Clinical TrialAbusive behaviour experienced by family carers from people with dementia: the CARD (caring for relatives with dementia) study.
The authors report the first study of abusive behaviour by people with dementia towards their family carers. The authors hypothesised that while abusive behaviour would be associated with the carer reporting a less rewarding relationship, this could be mediated by the carer's coping style. ⋯ Over a third of family carers reported significant abuse from the people they cared for. Carers who reported more abuse also reported a greater deterioration in their relationship with the person with dementia. The extent to which carers used dysfunctional coping strategies partially explained this, suggesting that interventions to change the carers' coping styles might alleviate the impact of abusive behaviour.
-
J. Neurol. Neurosurg. Psychiatr. · Jun 2010
Case ReportsIntracranial dural arteriovenous fistula successfully treated by combined open-endovascular procedure.
Intracranial dural arteriovenous fistulas constitute a rare though potentially devastating disease. Because the arterial (high-pressure) blood flow drains directly into the low-pressure venous system, there is a high risk of bleeding and associated neurological deficit. ⋯ This case report illustrates how combining forces between the neurosurgical and endovascular team benefits outcome. Simultaneously, this contributes to the growing amount of evidence that a new endovascular technique with transarterial ONYX embolisation enables complete obliteration of the vascular malformation.