Current opinion in neurology
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Curr. Opin. Neurol. · Feb 2010
ReviewCraniectomy for acute ischemic stroke: how to apply the data to the bedside.
Malignant hemispheric infarction is associated with a high mortality rate, approximately 80%, as a result of the development of intracranial pressure gradients, brain tissue shift, and herniation. By allowing the brain to swell outwards and equalizing pressure gradients, decompressive craniectomy appears to significantly reduce the mortality to approximately 20%. This review takes a comprehensive look at the evidence highlighting the benefits and limits of decompressive craniectomy in malignant cerebral infarction. ⋯ Early decompressive hemicraniectomy (
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Tissue-type plasminogen activator is the only pharmacological treatment approved for acute ischemic strokes but is administered to less than 5% of the patients. Excessive prehospital and in-hospital delays and lack of stroke center coverage are major issues that negatively impact stroke care. New strategies are being developed and evaluated to increase the number of tissue-type plasminogen activator-treated patients. ⋯ The shortening of prehospital delays requires education of patients and health professionals and optimization of transport strategies. Future developments may include video conferencing offering telestroke expertise, strategies (i.e. therapeutic interventions) that might help to treat acute stroke patients with tissue-type plasminogen activator, and prehospital selection of candidates for endovascular therapies.
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Curr. Opin. Neurol. · Dec 2009
ReviewManagement of cervical spondylotic myelopathy with insights from metabolic imaging of the spinal cord and brain.
Cervical spondylotic myelopathy (CSM) is a potentially debilitating disorder primarily related to spinal cord injury caused by degenerative changes of the spine. As the population continues to age and live longer, it is likely that this disorder will be encountered with increasing frequency. ⋯ CSM is a complex disorder whose incidence is likely to increase in coming years. Prospective, randomized studies are required to help establish the optimal treatment paradigm. Recent advances such as novel neuroimaging techniques and the continued development of neural repair strategies to treat the secondary biological injury associated with this disorder are likely to play key roles in the future management of CSM.
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Curr. Opin. Neurol. · Dec 2009
ReviewPseudoprogression and pseudoresponse in the treatment of gliomas.
Treatment response of brain tumours is typically evaluated with gadolinium-enhanced MRI using the Macdonald criteria. These criteria depend on changes in the area of enhancement. However, gadolinium enhancement of brain tumours primarily reflects impairment of the blood-brain barrier. ⋯ Both pseudo-phenomenona confuse the assessment of outcome of brain tumours in clinical practice and in clinical trials. To overcome these issues, alternative endpoints and response criteria are being developed by an international working party [response assessment in neuro-oncology (RANO)]. It is as yet unclear to what extent alternative imaging tools (positron emission tomography and MRI techniques) provide more reliable indicators of outcome.
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This review briefly discusses the definition and clinical presentation of neuropathic pain and highlights recent advances in the treatment of neuropathic pain. ⋯ Treating neuropathic pain remains a great challenge, and the treatment has to be individualized to the single patient, taking into account side effects, pain type, comorbidities, and drug interactions.