Handbook of clinical neurology
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Insight into the molecular mechanisms involved in primary headaches is important to identify drug targets for improving treatment of patients, but essentially lacking. Genetic research is increasingly successful in pinpointing these mechanisms. Most progress has been made for Familial Hemiplegic Migraine, a rare subtype of migraine with aura. ⋯ Except for the MTHFR gene no gene variant has been identified yet. Convincingly demonstrated genetic findings in other primary headaches such as cluster headache and tension-type headache are even rarer. However, with current technical possibilities of massive genotyping and international efforts to collect large well-phenotyped patient cohorts, the first gene variants for various primary headache types are likely to be discovered in the coming decade.
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Headache is relatively common in patients with cerebrovascular disorders. The reported frequency of stroke-related headache ranges from 7% to 65% and different types of headache, such as onset headache, sentinel headache, or delayed headache, may be observed in association with stroke. Headache can be attributed to ischemic stroke, transient ischemic attack, or non-traumatic intracranial hemorrhage, including intracerebral and subarachnoid hemorrhage. ⋯ The suddenness of onset and not its severity is the characteristic feature of the headache in subarachnoid hemorrhage. Referring to unruptured vascular malformations, the headache can be attributed to saccular aneurysm, arteriovenous malformation, dural arteriovenous fistula, dural cavernous angioma, and encephalotrigeminal or leptomeningeal angiomatosis (Sturge-Weber syndrome). It is very important to recognize that in the latter forms the onset of headache may indicate an upcoming bleeding complication.
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Historical Article
Chapter 8: the development of neurology and the neurological sciences in the 17th century.
Circa 1660 several favorable factors, instrumental to the invention of neurology, converged at the University of Oxford. Animals and men were believed to have a material soul whose functions throughout the nervous system were accessible to research. In 1659 inductive methods were introduced in clinical medicine by Thomas Willis, the founder of English epidemiology and biochemistry. ⋯ There was a physiological part, a textbook of neurophysiology, and a pathological part, a compendium of neurological and psychiatric syndromes, with early descriptions of myasthenia, restless legs, narcolepsy, dissociative and bipolar disease, and general paralysis of the insane. In 1667 he published a book on convulsive diseases, in which he described the blood-brain barrier, epileptic and hysterical brain disorders, and Parkinson's disease. Thus Willis recognized and presented the key themes of the future specialty.
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Bacterial meningitis is a neurological emergency. Empiric antimicrobial and adjunctive therapy should be initiated as soon as a single set of blood cultures has been obtained. ⋯ Patients with documented bacterial meningitis and those in whom the diagnosis is a strong possibility should be admitted to the intensive care unit. Timely recognition of bacterial meningitis and initiation of therapy are critical to outcome.
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The great formative event in the history of North America, the Civil War of 1861 to 1865, was the stimulus for the development of clinical neurology and the neurosciences. The first neurological research center on the continent was the US Army hospital at Turner's Lane, Philadelphia, PA. Silas Weir Mitchell and his colleagues described causalgia (reflex sympathetic dystrophy), phantom limb sensation, and Horner's syndrome (before Horner). ⋯ Early in the 20th century, neurological institutions were formed around universities; probably the most famous was the Montreal Neurological Institute founded by Wilder Penfield. The US federal government sponsored extensive research into the function and dysfunction of the nervous system through the Neurological Institute of Neurological Diseases and Blindness, later called the National Institute of Neurological Diseases and Stroke. The government officially classified the final 10 years of the 20th century as the Decade of the Brain and provided an even greater level of research funding.