Seminars in neurology
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Seminars in neurology · Mar 2004
ReviewAnesthesia issues in the perioperative management of myasthenia gravis.
Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction. Current anesthetic practice may require the use of neuromuscular blocking (NMB) drugs that act at this junction to facilitate control of the airway and allow procedures to be performed on a motionless MG patient. This competes with the goals of rapid emergence and recapture of preoperative muscle strength following anesthesia. ⋯ If necessary, postoperative mechanical ventilation is accomplished with the use of specialized monitoring devices that help monitor awareness and depth of sedation. Currently used intravenous sedatives allow titrated depth of sedation and rapid emergence when extubation is appropriate. Communication to the patient, family, and other caregivers of the goals of the anesthetic plan and of the patient's evolving status are also very important duties of the anesthesiologist.
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Seminars in neurology · Sep 2003
Review Comparative StudyDiagnosis and management of stroke (brain attack).
Clinicians commonly encounter patients with cerebrovascular disorders in the hospital. Now, as never before, there are many effective diagnostic and therapeutic modalities. Several examples of typical cases of stroke and transient ischemic attack are presented in order to illustrate a rational approach to diagnosis and treatment. A redefinition of transient ischemic attack and stroke, salient elements of the neurological history and examination, localization techniques, stroke mimickers, mechanisms of infarction and hemorrhage, acute stroke teams, thrombolysis, and secondary prevention are highlighted.
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In recent years, the usefulness of interferon beta and glatiramer acetate in the treatment of relapsing-remitting multiple sclerosis (RRMS) has been established. Interferon beta has also been shown to be efficacious in secondary-progressive multiple sclerosis (SPMS) as well as in patients with isolated syndromes at risk to develop clinically definite multiple sclerosis (MS). ⋯ The clinical utility of disease-modifying agents in MS will be reviewed with respect to the anti-inflammatory, immunomodulatory, and immunosuppressive treatments that are currently available. Symptomatic therapies will not be considered.
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Seminars in neurology · Jun 2003
ReviewThe treatment of chronic inflammatory demyelinating polyradiculoneuropathy.
Chronic inflammatory demyelinating polyradiculoneuropathy is an inflammatory disorder of nerve that usually presents with slowly progressive weakness and sensory loss and areflexia. It is among the most treatable of the peripheral nerve disorders, and several modalities have been shown to be effective in prospective, randomized controlled trials. ⋯ The cumulative effects of the neuropathic impairments, along with side effects from long-term immunosuppressive treatment, combine to produce significant long-term morbidity and loss of function. This review will cover the epidemiology, clinical features, laboratory findings, and pathogenesis of chronic inflammatory demyelinating polyradiculoneuropathy; the current status of the treatment of this disorder will be reviewed, highlighting those therapies shown to be effective in randomized controlled trials.
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Seminars in neurology · Mar 2003
Review Case ReportsWarning signs of imminent respiratory failure in neurological patients.
Critically ill neurological patients often need ventilatory assistance. After acute central nervous system insults, the inability to protect the airway and impaired central respiratory drive can only be managed with endotracheal intubation and mechanical ventilation. ⋯ Simple respiratory function tests performed at the bedside should be used to monitor patients with progressive neuromuscular respiratory insufficiency. Noninvasive positive pressure ventilation plays an important role in the management of respiratory failure in patients with neuromuscular respiratory failure, and its indications may be expanded in the future.