Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Feb 2009
Review Case ReportsManagement of subdural hematoma in immune thrombocytopenic purpura: report of seven patients and a literature review.
Intracranial hemorrhage is a devastating complication of immune thrombocytopenic purpura (ITP). Subdural hematoma (SDH) is rare and the optimal management unsettled. We report a series of seven patients of ITP who developed isolated SDH and subsequently review the literature. ⋯ Reports of isolated SDH in ITP are infrequent. Compared to those developing intracerebral hemorrhage, SDH occurs more in patients who are older, having chronic ITP and having a higher platelet count. Medical management with close monitoring of neurological parameters is a viable treatment option in patients of ITP developing SDH.
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Clin Neurol Neurosurg · Jan 2009
Review Case ReportsLeber's optic neuropathy associated with disseminated white matter disease: a case report and review.
Leber's hereditary optic neuropathy (LHON), a mitochondrial disease, is clinically characterized by a bilateral subacute loss of central vision consecutive to optic nerve involvement. In some cases of LHON, neurological features are reported including multiple sclerosis-like (MSL) phenotype. ⋯ We discuss the respective roles of inflammation and energetic metabolism dysregulation in the development of brain lesions. We propose to treat these patients early with both antioxidative and immunosuppressive drugs in order to avoid further handicap.
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Clin Neurol Neurosurg · Nov 2008
ReviewThe therapy of multiple sclerosis with immune-modulating or immunosuppressive drug. A critical evaluation based upon evidence based parameters and published systematic reviews.
Today many different drugs are available for treatment of multiple sclerosis (MS). Interferons, glatiramer acetate, mitoxantrone, and natalizumab have been approved by the regulatory authorities of many countries for the treatment of MS. Evidence based medicine (EBM) principles allow physicians to better address the correct treatment for patients. ⋯ Due to its lower efficacy, glatiramer acetate should be used as a second choice in case of intolerable side effects or toxicity of interferon beta. Great efficacy has been demonstrated for mitoxantrone and natalizumab. These drugs should be, however, used with particular attention for their potential toxic effects.
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Clin Neurol Neurosurg · May 2008
Review Case ReportsHereditary hemorrhagic telangectasia and spinal cord infarct: case report with a review of the neurological complications of HHT.
Hereditary hemorrhagic telangectasia (HHT), also known as Osler-Weber-Rendu disease, is an autosomal dominant vascular dysplasia with high penetrance and variable expressivity. A wide variety of neurological complications have been reported in association with this condition. We report the first case of spinal cord infarction likely due to paradoxical embolization with HHT and review the literature on the neurological complications of this disorder. ⋯ HHT should be considered in the differential diagnosis of any patient with cutaneous or mucosal telangiectasia or a history of unexplained epistaxis. HHT is associated with a diverse array of neurological disorders; most commonly ischemic and hemorrhagic stroke, transient ischemic attack, and brain abscess. While myelopathy secondary to arteriovenous malformation with HHT has been previously reported, this is the first instance of spinal cord infarction due to paradoxical embolization in this disorder.
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Clin Neurol Neurosurg · Apr 2008
ReviewHistologically benign intraventricular meningioma with concurrent pulmonary metastasis: case report and review of the literature.
Only 1-2% of all meningiomas are intraventricular in location. Metastasis from a histologically "benign" meningioma is a rare, but well-documented event. ⋯ The tumors in these reports had a frankly malignant histology or were associated with surgical manipulation and recurrence of the primary lesion. In this report, the authors present a rare case of the concurrent presentation of a histologically benign intraventricular meningioma and a solitary lung lesion which proved to be metastatic meningioma.