Seminars in neurology
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Seminars in neurology · Feb 2006
ReviewPractice-based clinical research and ethical decision making--Part II: deciding whether to host a particular research study in your practice.
Due to the growth and expansion of clinical research, particularly research conducted in practice-based settings, all practicing physicians should have a fundamental understanding of clinical research and the differences between clinical care and clinical research. Physicians considering adding clinical research to their everyday practice of medicine should carefully assess the practical and ethical dimensions of this decision on their practice. ⋯ Such an assessment can help them determine whether they are comfortable that the study is ethical and whether they can adhere to the requirements of the protocol in an ethically appropriate manner to maintain the ethics of the study. Together with the systems-informed professionalism framework presented in the preceding article, using the seven requirements of ethical clinical research framework can help practicing physicians with ethical decision making regarding incorporating practice-based research into their everyday practice of medicine.
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Seminars in neurology · Dec 2005
ReviewPediatric stroke: what do we know and what do we need to know?
Stroke is a heterogeneous disorder and an important cause of mortality and chronic morbidity in children. Estimates of international incidence rates for childhood stroke have varied widely. Arterial ischemic stroke is reported to be more common than hemorrhagic stroke in children. ⋯ Over half of children with stroke will develop lifelong cognitive or motor disability, and up to a third will have a recurrent stroke. International studies have provided important information on stroke in children, but major gaps in our knowledge of the disorder still exist. Currently, there is a need for prospective cohort studies in diverse populations, which utilize a consensus pediatric stroke classification system and a standard evaluation of risk factors and outcome, so that treatment and prevention strategies can be developed.
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Seminars in neurology · Dec 2005
ReviewSubarachnoid hemorrhage and inflammation: bench to bedside and back.
Subarachnoid hemorrhage (SAH) is a devastating and complicated disease. The development of therapeutic interventions has been hampered by a poor understanding of the three components of the disease pathology in SAH: aneurysm rupture, cerebral edema, and vasospasm. The role of inflammation in the pathology of subarachnoid hemorrhage will be reviewed. ⋯ Evidence supports the role of inflammation in free radical formation and in perturbations in nitric oxide and endothelin-1 levels that are important mediators of the vasoconstriction in vasospasm. Targeting the inflammatory mediators associated with the three prominent events in SAH is a promising strategy for reducing the mortality and morbidity in these patients. More study is needed to determine which specific effectors in the inflammatory cascade may serve as targets for intervention.
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Heatstroke is a syndrome consisting of life-threatening central nervous system and multiple organ dysfunction from complications of hyperthermia. Additionally, there is an associated complex immunological and inflammatory component to the illness that resembles sepsis. Core body temperature exceeds 40 degrees C with associated mental status changes such as delirium and coma. ⋯ Classic heatstroke is nonexertional, environmentally related and exertional heatstroke occurs in the setting of strenuous exercise. Heatstroke is actually the most severe of a continuum of heat-related illnesses that carries a high incidence of mortality. Treatment is directed at rapidly reducing core body temperature and the management of life-threatening systemic complications.
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Neurocysticercosis is the most common helminthic disease of the nervous system and currently represents a major public health problem in developing countries of Latin America, Asia, and Africa, as well as in industrialized nations with a high immigration rate of people from endemic areas. The disease occurs when humans become the intermediate host in the life cycle of Taenia solium by ingesting its eggs from contaminated food. Neurocysticercosis is pleomorphic in its presentation due to individual differences in the number, size, and location of the parasites, as well as differences in the severity of the host's immune reaction to the parasite. ⋯ The diagnosis of neurocysticercosis is based on clinical data, neuroimaging abnormalities, and the results of immunological tests. Two drugs, albendazole and praziquantel, are cysticidal and destroy most intracranial parasites; however, surgery may be necessary in the management of some forms of the disease, particularly hydrocephalus and intraventricular cysts. Although the development of modern diagnostic tests and the introduction of potent cestocidal drugs have increased our ability to make the diagnosis of neurocysticercosis and improved prognosis, some patients still have a torpid clinical course despite prompt diagnosis and proper therapy.