Seminars in neurology
-
Seminars in neurology · Jun 2002
ReviewCervical myelopathy associated with degenerative spine disease and ossification of the posterior longitudinal ligament.
Cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament are two of the leading etiologies of spinal cord damage in older patients. For most patients, the natural history is one of slow stepwise decline in function. ⋯ Surgical options include anterior and posterior surgical decompression, spinal canal expansion, and spinal column stabilization. Prospective, randomized trials with standardized outcome measures are needed to clarify the benefit of surgery conclusively.
-
Seminars in neurology · Dec 2001
ReviewPearls and pitfalls in the intensive care management of Guillain-Barré syndrome.
Approximately one third of patients with Guillain-Barré syndrome (GBS) need to be admitted to the intensive care unit (ICU) because of respiratory failure. A significant proportion of patients require ICU admission because of dysautonomia or because of medical or iatrogenic complications. ⋯ Recognition of autonomic dysfunction and of the rare need for intervention is important to avoid iatrogenic complications. Prognosis determination in GBS is based on the clinical history, epidemiological factors, and neurologic examination.
-
Amyotrophic lateral sclerosis (ALS) is a devastating paralytic disorder caused by motor neuron degeneration. A subgroup of familial cases arises from mutations in the gene encoding cytosolic superoxide dismutase (SOD1). ⋯ Also discussed are the status of other genetic forms of ALS and the elusive question of why this disorder so specifically targets motor neurons. Ultimately, it is hoped that insights from these types of studies will improve the prospects for developing meaningful therapies of ALS.
-
Ocular myasthenia gravis is a not uncommon autoimmune disorder causing diplopia, ptosis, and weakness of lid closure. The predilection of myasthenia for the ocular muscles may be related to differences between limb and extraocular muscles in either physiological function or antigenicity. Clinically, ocular myasthenia can mimic any form of pupil-sparing ocular motility disorder. ⋯ Treatment consists of symptomatic use of acetylcholinesterase inhibitors and immunosuppression with steroids or azathioprine. Between 50 and 70% of patients with ocular myasthenia will eventually develop generalized disease: there is some retrospective data that steroids or azathioprine may reduce this by about 75%. The role of thymectomy in ocular myasthenia remains unclear.
-
Seminars in neurology · Jan 2000
ReviewMycobacterium tuberculosis meningitis and other etiologies of the aseptic meningitis syndrome.
Mycobacterium tuberculosis is one of the most common infectious agents in the world. It causes an insidious form of meningitis characterized by headache, low-grade fever, stiff neck and cranial nerve palsies, and an acute meningoencephalitis characterized by coma, raised intracranial pressure, seizures, and focal neurological deficits. This review focuses on the diagnosis and therapy of the insidious form of tuberculous meningitis and discusses the differential diagnosis of infectious and noninfectious etiologies of the aseptic meningitis syndrome.