Fortschritte der Neurologie-Psychiatrie
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Fortschr Neurol Psychiatr · Feb 2009
Case Reports[Manipulative treatment of the cervical spine and stroke].
Manipulative therapy of the cervical spine is associated with a considerable risk of stroke. We evaluated all cases with the diagnosis of arterial dissection submitted between 1996 and 2005 to the Schlichtungsstelle für Arzthaftpflichtfragen der Norddeutschen Arztekammern for assessment of the accusations brought against the therapists who conducted the manipulation. Neither in the 7 carotid nor in the 9 vertebral artery cases could a causal link be made between the dissection and the manipulation. ⋯ Stroke after manipulative therapy was due to embolisation of thrombotic material from the dissected artery. As both cervical arterial dissection and cervical spine disorder usually cause similar signs and symptoms physicians must differentiate between these two entities prior to any manipulative therapy. Clinical indicators of pre-existent dissection and the medicolegal implications are discussed in this paper.
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Fortschr Neurol Psychiatr · Jul 2008
[Reasons for underuse of oral anticoagulation in atrial fibrillation-associated stroke: prospective study of German stroke patients].
Oral anticoagulation in atrial fibrillation (AF) is effective in primary and secondary prevention of cardioembolic stroke, but is often underused in practice. The detailed reasons for non-use of oral anticoagulation are less well known. We prospectively analyzed 105 consecutive cases of acute ischemic stroke associated with atrial fibrillation. ⋯ There was good agreement between patients and physicians views about nonuse or aborted use of oral anticoagulation (kappa 0.64 and 0.93, respectively). Unknown atrial fibrillation is the most prevalent cause of underutilization of oral anticoagulation in acute stroke patients. Since atrial fibrillation is easy to detect in most cases, it could be worthwhile to screen elderly patients without contraindications for anticoagulation.
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While in the midth the 19th century Griesinger and 80 years later Mayer-Gross regarded schizophrenia as a brain disease, a far-reaching change in the view of schizophrenia found expression in the review of Manfred Bleuler in 1951: All classical assumptions of the schizophrenia doctrine and especially, that schizophrenia could be classified a somatically conditioned illness and not psychogenic, would be, as he wrote, shaken severely. On the 1st International Meeting of Neuropathology in Rome (1952) the opinion became generally accepted that pathological changes of the brain could not be expected in schizophrenias. The neuropathological research into psychoses, considered as unfruitful, has been practically stopped. ⋯ According to Dewan for the first time a correlation between psychopathological and brain morphological findings in schizophrenics with the component of pure residual syndrome has been found by our studies, as well as a parallel progression of the cerebral atrophy and the psychopathological changes. Quantitative-morphometric and MRI changes of regions of the limbic system and neurophysiological findings are hints that disorders in limbic key structures are able to explain the basic symptoms and the first rank symptoms, developing out of distinct transition relevant basic symptoms. Finally, the process activity concept and its criteria and its meaning for the studies with functional brain imaging methods are described.
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Fortschr Neurol Psychiatr · Dec 2007
Review Meta Analysis[Creative therapy options for patients with dementia--a systematic review].
The specifics of creative therapies aim at activating the creative potential of the patients in the sense of acceptance, orientation and coping with their illness "dementia" and at improving their quality of life. Creative therapies in the treatment of dementia offer the advantage of working with these patients, whose cognition and often also verbal communication skills are affected in a nonverbal way. This article presents a systematic review of studies and case studies, which could be found on the subject of the implementation of active creative therapies "music-, art-, drama- and dance-therapy" within the following databases (05/05): Medline, Psyndex Plus, PsychInfo and Cochrane. ⋯ This survey of studies on creative therapies for patients with dementia shows positive effects like the improvement of interaction skills. The data supplied thus supports the approach of using creative therapies in order to help patients accept dementia as their illness and finally to cope with it. The methodical approach to the registration of the therapies' effects and process-orientated contents of the therapy create a field of tension, leading to the request for a further development and validation of instruments, which allow the quantitative evaluation of parameters like liveliness, agility and interaction skills.