Journal of neurology, neurosurgery, and psychiatry
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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.
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J. Neurol. Neurosurg. Psychiatr. · Oct 2003
Clinical TrialPlacing nasogastric tubes in stroke patients with dysphagia: efficiency and tolerability of the reflex placement.
Temporary dysphagia affects up to 50% of stroke patients in the acute stage of their illness and often necessitates tube feeding. In these patients, the placing of nasogastric tubes is often difficult or impossible. ⋯ A comparison of the cardiovascular responses to both methods in another 12 patients revealed significantly smaller increases in heart rate and systolic blood pressure during application of the new method. We therefore suggest the use of reflex placement in patients who have suffered a stroke and need tube feeding due to dysphagia.
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J. Neurol. Neurosurg. Psychiatr. · Oct 2003
Spinal dural arteriovenous fistulas: clinical features in 80 patients.
The aim of this study was to describe the clinical spectrum of spinal dural arteriovenous fistulas (SDAF) in a large group of patients. We studied the records of 80 patients who were diagnosed with an SDAF in six hospitals over a 15 year period (1985-2001). We extracted data on demographic variables, initial symptoms, symptoms at the time of diagnosis, level of SDAF, and medical history. ⋯ Fifteen patients (19%) had become wheelchair bound. SDAF is difficult to diagnose, and the delay between first symptoms and treatment is often long. In middle aged men who present with disturbances of gait with ascending motor and sensory deficits, and who subsequently report impaired voiding or other sphincter disturbance, SDAF is one of the first diagnoses that should spring to mind.