Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Jan 2017
Case ReportsMarked EEG worsening following Levetiracetam overdose: How a pharmacological issue can confound coma prognosis.
Levetiracetam is an anti-epileptic drug commonly used in intensive care when seizure is suspected as a possible cause of coma. We propose to question the cofounding effect of Levetiracetam during the prognostication process in a case of anoxic coma. We report the story of a young woman presenting a comatose state following a hypoxic cardiac arrest. ⋯ This report proposes that Levetiracetam tolerance might not be straightforward after brain lesions and engages us to avoid confounding factors during the awakening prognostication, which is mainly based on the severity of the EEG. Hence, prognosis should not be decided on an isolated parameter, especially if the dynamic is atypical after a new prescription, even for well-known drugs. For any suspicion, the drug's dosage and replacement should be managed before any premature care's withdrawal.
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Clin Neurol Neurosurg · Jan 2017
Clinical characteristics of headache or facial pain prior to the development of acute herpes zoster of the head.
When physicians encounter patients with headache or facial pain (preeruptive pain) associated with acute herpes zoster of the head, especially before the appearance of characteristic skin eruptions (preeruptive phase), they typically find it difficult to make clinical impressions and apply appropriate diagnostic or therapeutic procedures. The objectives of this study were to describe the clinical characteristics of headache or facial pain associated with acute herpes zoster of the head and to elucidate the association between the manifestation of these symptoms in the preeruptive phase and incoming herpes zoster. ⋯ These results suggest that the typical pain of acute herpes zoster of the head has a stabbing quality, is felt unilaterally, is moderate to severe, often awakens patients from sleep, and has not been previously experienced by most patients. When encountering patients with these features accompanied by pain onset of less than one week, acute herpes zoster of the head should be considered, even without characteristic vesicles, after excluding other secondary causes by appropriate diagnostic workup.
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Clin Neurol Neurosurg · Jan 2017
Effects of cerebrolysin on functional recovery in patients with severe disability after traumatic brain injury: A historical cohort study.
To determine the effects of cerebrolysin on functional recovery in patients with severe disability after traumatic brain injury (TBI). ⋯ Cerebrolysin administration in patients with severe disability after TBI is associated with improved functional recovery, decreased mortality rate and increased favorable outcome. Seizure is important side effect of cerebrolysin administration in TBI patients.
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Clin Neurol Neurosurg · Dec 2016
Randomized Controlled TrialManagement of postoperative pain after Lumbar surgery-pregabalin for one day and 14 days-a randomized, triple-blinded, placebo-controlled study.
Despite the progress in understanding acute pain physiology during recent decade, eighty percent of patients still suffer from post-operative discomfort. Pregabalin is an anticonvulsant agent that is approved for painful neuropathies in diabetic patients and post herpetic neuralgia. The main objective of the present study was to compare the improvement in post-operative pain management and patient lifestyle in 3 groups, as first group received placebo, second who received Pregabalin for one day and the last group those who received it for 14 days. ⋯ The results of this study indicate that 1day and 2 weeks post-operative 300mg pregabalin administration may not improve acute pain, morphine consumption and quality of life of patients after surgery. It seems that the diseases cause chronic pain that requires long-term treatment with higher doses.