Current opinion in neurology
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Curr. Opin. Neurol. · Apr 2005
ReviewTherapeutic hypothermia for hypoxic-ischaemic encephalopathy in the newborn infant.
This review examines recent findings from experimental models and clinical trials of induced hypothermia as treatment after cerebral hypoxia-ischaemia in term newborn infants. ⋯ In term infants with HIE there is emerging evidence that both selective head cooling and whole body cooling are neuroprotective and safe. This is consistent with a wealth of experimental animal data and adult trials. Neuroprotection seems to be lost if cooling is started after 6 h. The challenge now is to complete ongoing trials. If meta-analysis confirms a therapeutic effect, then this may lead to selection criteria and treatment protocols for very early hypothermia in HIE at term.
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This review on traumatic brain injury consolidates the substantial current literature available on the pathophysiology, mechanisms, developments, and their subsequent effects on outcome. In particular, it tries to conceptualize why our greatly improved understanding of pathophysiology and neurobiology in traumatic brain injury has not translated into clear outcome improvements. ⋯ The evidence base for current therapies in this heterogeneous patient group is being refined, with greater emphasis on long-term functional outcomes. Improved monitoring techniques emphasize the need for individualization of therapeutic interventions.
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Curr. Opin. Neurol. · Dec 2004
ReviewFunctional reorganization of the cerebral motor system after stroke.
Recovery of function after stroke is now widely considered to be a consequence of central nervous system reorganization. Non-invasive techniques such as functional magnetic resonance imaging, transcranial magnetic stimulation, electroencephalography and magnetoencephalography now allow the study of the working human brain. Studies in stroke patients can now address how cerebral networks in the human brain respond to focal injury and whether these changes are related to functional recovery. This understanding may in turn lead to the development of techniques that will drive cerebral reorganization in a way that promotes functional improvement. ⋯ Functionally relevant adaptive changes occur in the human brain following focal damage. A greater understanding of how these changes are related to the recovery process will allow the development of novel therapeutic techniques that are based on neurobiological principles and which are designed to minimize impairment in appropriately targeted patients suffering from stroke.
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Clinical investigations of peripheral nerve lesions routinely involve nerve conduction studies and electromyography. Imaging studies are often used to exclude focal mass lesions or external compression and to visualize muscle atrophy. More recently, it has been recognized that magnetic resonance imaging can identify changes in peripheral nerves and secondary neurogenic alterations in skeletal muscle, which may significantly enhance its use in the differential diagnosis of peripheral nerve disease. ⋯ Magnetic resonance imaging supplements the differential diagnosis of peripheral nerve disease. An advantage over clinical neurophysiological investigations is that it is operator independent and painless. It can identify axonal damage and may thus help to identify a lesion site precisely, where fractionated nerve conduction studies are not applicable. Novel contrast media may potentially be used to detect pathophysiologically relevant mechanisms such as infiltration of the nerve by macrophages. Magnetic resonance imaging also has the advantage of providing a lasting detailed topographical picture of regional variations and avoids localization errors of muscles in electromyography.