Neurologist
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Ischemic stroke and transient ischemic attack can be difficult to diagnose clinically, and both acute and preventive therapies carry some risk. Serum biomarkers could increase diagnostic certainty by helping to distinguish cerebral ischemia from common mimics such as focal seizure, complicated migraine, and psychogenic spells. Biomarkers could also identify patients at high risk for future vascular events, which would aid in management decisions. ⋯ Large series examining many candidate molecules will be needed to find valid biomarkers, and this should be followed by use in future intervention trials to prove their utility.
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Review
Neuroendocrine hormonal conditions in epilepsy: relationship to reproductive and sexual functions.
Hormones may influence susceptibility to develop seizures. The concept of the interrelation between epilepsy, hormones, and hormonotherapy is currently emerging. On the other hand, epilepsy and its medications are associated with hormonal disturbances resulting in altered endocrine reproduction and sexual functions. ⋯ Epileptic patients will benefit from regular monitoring of ovarian and testicular functions. Early characterization of reproductive abnormalities encountered in patients with epilepsy will allow neurologists to properly choose and change antiepileptic medications. This will also improve patients' sexual function.
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Review Case Reports
Adjunctive haloperidol prophylaxis reduces postoperative delirium severity and duration in at-risk elderly patients.
Delirium is a potentially life-threatening syndrome that is particularly common in elderly hospitalized patients, especially those with preexisting neurologic disorders. Nonpharmacological tactics can reduce the incidence and severity of delirium in acute care settings and antipsychotic drugs are widely used to treat established delirium. More effective preventive strategies could notably impact morbidity, mortality, and health care costs. ⋯ Adjunctive low-dose haloperidol prophylaxis reduces delirium severity, duration, and subsequent hospitalization length in elderly at-risk patients. Further study is needed to determine the optimal pharmacological approach, combination with nonpharmacological strategies, and generalizability to other settings.
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Therapeutic hypothermia (TH) has been employed as a neuroprotective strategy for a wide array of clinical problems since the late 1940s. Animal studies have determined that the neuroprotective effect of hypothermia is pleiotropic, impacting many steps in both the ischemic cascade and reperfusion injury. Interest in the neuroprotective effects of TH for ischemic brain injury has been resurgent, fueled by both recent positive and negative clinical trials. A review of preclinical and clinical reports on TH in adult patients is provided in this article. ⋯ TH is a safe, effective neuroprotective strategy for global cerebral ischemia. Because of the neuroprotective efficacy of TH in adult comatose survivors of cardiac arrest, neurologists should advocate the implementation of this strategy. TH for focal ischemia is a promising therapeutic option, but requires more basic and clinical investigation.
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Despite the correct use of antiepileptic drugs, control of seizures is not possible in 20% to 30% of people with epilepsy. This group of patients is considered to suffer from drug-resistant epilepsy, a clinical situation that can be caused by certain syndromes in which surgery can be used to bring the seizures under control. ⋯ The aim of this review is to update knowledge on the indications for surgery and electrical stimulation in the management of epilepsy.