Journal of neurology, neurosurgery, and psychiatry
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J. Neurol. Neurosurg. Psychiatr. · Oct 2003
ReviewNeuroimaging tools to rate regional atrophy, subcortical cerebrovascular disease, and regional cerebral blood flow and metabolism: consensus paper of the EADC.
Neuroimaging is a mainstay in the differential diagnosis of patients with cognitive impairment. The often equivocal clinical pictures, the prognostic uncertainty of the earliest stages of mild cognitive impairment, and the subtle brain changes mean that neuroimaging techniques are of potentially great incremental diagnostic value. ⋯ The choice of the method is not obvious, and current guidelines provide no indications on which tools should be preferred. In this paper, we give indications for tools with demonstrated accuracy for detecting regional atrophy, cerebrovascular disease, and regional brain function, and discuss these according to increasing technological complexity, ranging from those with high feasibility that can be used at the patient's bedside to highly technological ones that require trained personnel and specific hardware and software.
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J. Neurol. Neurosurg. Psychiatr. · Oct 2003
Multicenter StudyMulticentre European study of thalamic stimulation in essential tremor: a six year follow up.
Thalamic stimulation is an efficient treatment for disabling essential tremor, as previously shown, but follow up has mostly been short term. ⋯ Good reduction in tremor can be maintained for more than six years in the majority of these severely disabled patients. Thalamic stimulation can be recommended in essential tremor where there is insufficient response to drug treatment. Surgical procedures and follow up should be concentrated in relatively few centres, which will thereby acquire a high degree of expertise.
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The past few years have seen significant progress towards understanding the mechanisms of immune surveillance and inflammation in the nervous system. In this review, the milestones of scientific discovery in this field are discussed, and the strengths and limitations of the different ways of examining the molecular pathogenesis of neuro-inflammation examined. The review is limited to the inflammatory reactions of the central nervous system that occur in multiple sclerosis and experimental autoimmune encephalomyelitis.
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J. Neurol. Neurosurg. Psychiatr. · Oct 2003
Apolipoprotein E genotypes and outcome from out of hospital cardiac arrest.
Genetic factors may influence outcome from cardiac arrest. In Seattle, WA, paramedics collected blood specimens from patients who had suffered cardiac arrest outside of a medical institution (out of hospital cardiac arrest). ⋯ Specifically, having one or two alleles of APOE epsilon4 or having APOE epsilon3/epsilon3 was not related to outcome, even after controlling for age, sex, race, and initial rhythm. We failed to confirm previous studies and found no significant associations between APOE genotype and outcome from out of hospital cardiac arrest.
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J. Neurol. Neurosurg. Psychiatr. · Oct 2003
Case ReportsEarly cognitive decline in Creutzfeldt-Jakob disease associated with human growth hormone treatment.
Most cases of Creutzfeldt-Jakob disease (CJD) in recipients of human cadaveric growth hormone present with a cerebellar syndrome. Dementia is thought to occur late and as a minor feature of the illness. However, neuropsychology data published on these cases are largely qualitative and anecdotal. The first published case does include a neuropsychological assessment seven months after the onset of a cerebellar syndrome, showing evidence of intellectual decline. Subsequent reports hint that cognitive problems may be present in the initial stages of the illness. ⋯ These findings suggest that, although not the presenting feature, mild cognitive decline may be evident in the early stages of CJD associated with human cadaveric growth hormone treatment.