Seminars in neurology
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Seminars in neurology · Dec 2005
ReviewSubarachnoid hemorrhage and inflammation: bench to bedside and back.
Subarachnoid hemorrhage (SAH) is a devastating and complicated disease. The development of therapeutic interventions has been hampered by a poor understanding of the three components of the disease pathology in SAH: aneurysm rupture, cerebral edema, and vasospasm. The role of inflammation in the pathology of subarachnoid hemorrhage will be reviewed. ⋯ Evidence supports the role of inflammation in free radical formation and in perturbations in nitric oxide and endothelin-1 levels that are important mediators of the vasoconstriction in vasospasm. Targeting the inflammatory mediators associated with the three prominent events in SAH is a promising strategy for reducing the mortality and morbidity in these patients. More study is needed to determine which specific effectors in the inflammatory cascade may serve as targets for intervention.
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Heatstroke is a syndrome consisting of life-threatening central nervous system and multiple organ dysfunction from complications of hyperthermia. Additionally, there is an associated complex immunological and inflammatory component to the illness that resembles sepsis. Core body temperature exceeds 40 degrees C with associated mental status changes such as delirium and coma. ⋯ Classic heatstroke is nonexertional, environmentally related and exertional heatstroke occurs in the setting of strenuous exercise. Heatstroke is actually the most severe of a continuum of heat-related illnesses that carries a high incidence of mortality. Treatment is directed at rapidly reducing core body temperature and the management of life-threatening systemic complications.
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Neurocysticercosis is the most common helminthic disease of the nervous system and currently represents a major public health problem in developing countries of Latin America, Asia, and Africa, as well as in industrialized nations with a high immigration rate of people from endemic areas. The disease occurs when humans become the intermediate host in the life cycle of Taenia solium by ingesting its eggs from contaminated food. Neurocysticercosis is pleomorphic in its presentation due to individual differences in the number, size, and location of the parasites, as well as differences in the severity of the host's immune reaction to the parasite. ⋯ The diagnosis of neurocysticercosis is based on clinical data, neuroimaging abnormalities, and the results of immunological tests. Two drugs, albendazole and praziquantel, are cysticidal and destroy most intracranial parasites; however, surgery may be necessary in the management of some forms of the disease, particularly hydrocephalus and intraventricular cysts. Although the development of modern diagnostic tests and the introduction of potent cestocidal drugs have increased our ability to make the diagnosis of neurocysticercosis and improved prognosis, some patients still have a torpid clinical course despite prompt diagnosis and proper therapy.
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Seminars in neurology · Jun 2005
ReviewEvaluation and treatment of painful peripheral polyneuropathy.
Pain is a common component of sensory peripheral polyneuropathy and occurs primarily as a consequence of injury to small, unmyelinated C-fiber nerve axons. This class of fibers is particularly vulnerable to metabolic injury, and the neuropathy manifests in a length-dependent pattern. ⋯ Treatment of painful neuropathy should be directed at removing the offending metabolic injury, if possible. Antiepileptic drugs, tricyclic antidepressants, opiates, and other treatments have shown efficacy in clinical trials for symptomatic relief of neuropathic pain.
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Breathing is the most important executive function of sleep. Compromise of the ventilatory mechanism is the principal consequence of a neuromuscular dysfunction in the individual who is asleep. This includes alterations of the lower motor neuron, the neuromuscular junction, and muscle. ⋯ Any dysfunction of the diaphragm, whether neurogenic or neuromuscular, will interfere with breathing during REM sleep. So prevalent are sleep respiratory difficulties in patients with neuromuscular disorders that there should be a low threshold to obtain nocturnal polysomnography in these patients with sleep complaints. In patients with a neuromuscular disorder and nocturnal ventilatory compromise, positive airway pressure ventilation improves the quality of sleep and in doing so improves the overall quality of life.