Journal of the neurological sciences
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Review Historical Article
The pioneers of clinical neurology in South America.
The field of neurology in South America (SA) began to emerge towards the end of the nineteenth century, following the origin of the specialty in Europe. There was a consistent and long-standing admiration for European training, which led to the birth of the discipline in South America. The first steps took place almost simultaneously with European countries in Argentina, Brazil, Uruguay, Chile and Peru. ⋯ The first institute of neurology in Latin America, the Instituto Neurológico de Montevideo, was founded in 1926 under Américo Ricaldoni's direction. Seventeen years later, the Arquivos de Neuropsiquiatria from San Pablo was created, and is still in existence. Up until the present, South America has made dozens of important research contributions, the most important in the diagnosis and treatment of regional endemic diseases.
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In acute stroke patients, mild and moderate hypothermia with a body temperature (T core) target of 32 degrees C to 34 degrees C is being tested and has shown some promising results. The feasibility of MH to control of ICP increases in patients with malignant ischemic stroke has been proven, but controversy as to its effectiveness and safety still continues. The most recent results of clinical trials and possible future applications of MH in acute stroke patients are analyzed in this review. DESIGN, METHODS AND MATERIAL: A search in MEDLINE/PubMed was performed. The references of selected articles were investigated and the Cochrane Library searched. Articles including severe, massive, malignant or hemispheric ischemic stroke, induced hypothermia, and animal studies with focal cerebral or brain ischemic models were considered. ⋯ Moderate hypothermia ameliorates ischemic injury by multiple mechanisms. Treatment of acute ischemic stroke patients is feasible, and additional studies, including randomized clinical trials, are warranted.
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Carbon monoxide (CO), a highly toxic gas produced by incomplete combustion of hydrocarbons, is a relatively common cause of human injury. Human toxicity is often overlooked because CO is tasteless and odorless and its clinical symptoms and signs are non specific. The brain and the heart may be severely affected after CO exposure with carboxyhemoglobin (COHb) levels exceeding 20%. ⋯ Diagnosis requires clinical acumen and a high index of suspicion, combined with epidemiological data, clinical examination, analysis of ambient air CO and patient COHb levels; also required are cardiology evaluation including ECG as well as neurological evaluation including brain imaging (CT and/or MRI, MR spectroscopy), and neuropsychological testing. Although immediate O(2) breathing is sometimes an adequate treatment, hyperbaric oxygen therapy (HBO) is favored. Subsequently, only symptomatic therapy is available for the long-term sequelae of CO poisoning.
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Outcome after aSAH depends on several factors, including the severity of the initial event, perioperative medical management, surgical variables, and the incidence of complications. Cerebral vasospasm (CV) is ure to consistently respond to treatment, emphasizing the need for further research into the underlying mechanisms of SAH-induced cerebrovascular dysfunction. ⋯ Current management of this condition consists of maximal medical therapy, including triple H regimen and oral administration of calcium antagonists, followed by endovascular balloon angioplasty and/or injection of vasodilatory agents for refractory cases. As the precise pathophysiology of CV is further elucidated, the development of promising investigational therapies will follow.
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Hypothermia is a potent neuroprotectant and induced hypothermia holds great promise as a therapy for acute neuronal injury. Thermoregulatory responses, most notably shivering, present major obstacles to therapeutic temperature management. A review of thermoregulatory physiology and strategies aimed at controlling physiologic responses to hypothermia is presented.