Seminars in neurology
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Seminars in neurology · Jan 2000
ReviewIdiopathic intracranial hypertension: mechanisms of visual loss and disease management.
Idiopathic intracranial hypertension (IIH) is a disorder of increased intracranial pressure of unknown cause. It is a disorder, predominantly of overweight women in the childbearing years. The major morbidity of the disease is visual loss. ⋯ Patients failing medical therapy have optic nerve sheath fenestration performed if visual loss is the main morbidity. Shunting procedures are considered if headache is the main symptom. Most patients respond well to therapy, but idiopathic intracranial hypertension may recur throughout life.
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In the past 10 years the epidemiology of bacterial meningitis has changed, with a decreased incidence of meningitis caused by Haemophilus influenzae and an increasing incidence of meningitis caused by penicillin- and cephalosporin-resistant strains of Streptococcus pneumoniae. Meningococcal meningitis has become an increasing threat to college students. ⋯ In this article, the pathophysiology, etiology, clinical presentation, differential diagnosis, and management of acute bacterial meningitis are reviewed. The present recommendations for the use of dexamethasone in the treatment of this infection, the use of chemoprophylaxis, and the indications for vaccinations are included.
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The diagnosis of an acquired vertical strabismus is not always straightforward. There is no one specific test that will diagnose a vertical deviation. The clinical presentation, signs, and symptoms are the driving forces that will help lead to the correct diagnosis. ⋯ The differential diagnosis for vertical diplopia includes oculomotor nerve palsy, superior oblique palsy, restrictive ophthalmopathies, myasthenia gravis, and skew deviation. This differential diagnosis is best used to sort out signs and symptoms in a patient with a vertical misalignment and diplopia. Because most clinicians feel more comfortable addressing the patient with complaints of horizontal diplopia, this paper will discuss the causes of vertical diplopia so that recognition will be easier, thus leading to more accurate diagnoses.
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Seminars in neurology · Jan 1999
Historical ArticleEarly observations on muscular dystrophy: Gowers' textbook revisited.
Early clinical observations on Duchenne muscular dystrophy can be traced through the works of Meryon, Little, Duchenne, Gowers, and Erb. Gowers sites Sir Charles Bell with its earliest clinical description. Gowers' phenomenal textbook provides vivid descriptions of Duchenne dystrophy, clinical features which are herein revisited.
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Seminars in neurology · Jan 1998
Review Clinical TrialRecanalization therapies for acute ischemic stroke.
Angiographic studies performed within 6 hours of stroke onset have demonstrated that 75-80% of patients with an acute ischemic stroke have an angiographically visible occlusion of an extracranial and/or intracranial artery that is the cause of the ischemic stroke. The NINDS t-PA Stroke Study demonstrated that recanalization of occluded brain arteries can successfully salvage ischemic brain if intravenous tissue plasminogen activator (t-PA) is initiated within 3 hours of stroke onset. The effectiveness and safety of intravenous t-PA beyond 3 hours has yet to be shown. ⋯ Thrombolytic therapy and other pharmacologic treatments of clot in cerebral vessels will likely remain a two-edged sword. Pharmacologic therapies that increase the likelihood of clot lysis and recanalization, such as thrombolytic agents, the platelet GIIbIIIa receptor blockers, defibrinogenating agents, and even the newer more potent thrombolytic agents, also concomitantly increase the risk of bleeding into the brain. What we will be searching for in the coming decade is the correct mechanical strategy, dose of a given pharmacologic agent, or combination of agents that maximizes recanalization and minimizes the risk of intracerebral hemorrhage.