Articles: treatment.
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The treatment of childhood headaches requires a thorough investigation of the underlying etiology, including the use of standardized diagnostic criteria, and neurologic and comprehensive examinations. If secondary headaches are identified, the headaches should resolve with treatment of the underlying cause. ⋯ This includes acute therapy, preventative therapy, and biobehavioral therapy. All of these components need to be addressed in the treatment of childhood headaches, and clear goals of treatment must be discussed with the patient and parents.
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We report an acute thrombosis of an abdominal aortic aneurysm presenting with paralysis of a lower extremity. The usual presentation of such thrombosis is vascular compromise of the lower extremities. When the thrombus obstructs the artery of Adamkiewicz, the main blood supply to the lower spinal cord, spinal ischemia and paralysis can occur. Mechanisms of aortic occlusion and treatment of aortic thrombosis are briefly outlined.
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In past years, important advances have been made in the treatment of idiopathic headache disorders. New controlled trials have been published for the acute and the prophylactic drug and non-drug therapies. Furthermore, new headache entities have been described by the International Headache Society for which treatment recommendations can be given. ⋯ Recent advances in headache treatment comprise growing evidence for an appropriate drug administration and for differential drug therapy rather than the development of new drugs or procedures. Surgical and other non-drug treatment procedures are under discussion and might be an additional tool for headache treatment in future years.
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Curr Opin Anaesthesiol · Oct 2005
Postoperative pain, nausea and vomiting in neurosurgical patients.
Postoperative pain and postoperative nausea and vomiting are significant problems for neurosurgical patients and their carers. The treatment of these problems is widely perceived to be inadequate, however, especially in patients undergoing craniotomy, and there are few large, randomized controlled trials. The main issue has been fear of side effects, especially those masking neurological signs. A review of the recent literature therefore is justified. ⋯ There is still a lot of scope to research and refine pain and postoperative nausea and vomiting management in cranial and spinal neurosurgical patients. Large-scale studies are required to define the current state of practice, determine effective treatments and define the incidence of side-effects.
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In this article we aim to review the recent literature concerning the management of traumatic brain injury patients, summarize the main findings, and discuss the impact of these findings on clinical practice. ⋯ The key term for the management of traumatic brain injury patients in the early twenty-first century will clearly be 'individualized therapy'. The search of an ideal cerebral perfusion pressure target that would fit every head-injured patients is a utopia. More energy should be focused on the development of reliable tools for outcome prediction and outcome assessment for traumatic brain injured patients. That, and a better targeting of patients entering brain protective trials, should increase the likelihood of demonstrating a significant salvaging effect of a particular treatment in humans.