Neurologic clinics
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Ethanol abuse is associated with a variety of neurologic disturbances. These disturbances result from direct drug effects, drug withdrawal, nutritional deficiency, organ system failure, and other, unidentified factors. In contrast, abuse of sedative-hypnotic drugs produces a more limited spectrum of neurologic involvement, consisting primarily of overdose and withdrawal syndromes. Recent advances in pathophysiology, diagnosis, and treatment are beginning to influence the clinical approach to some of these disorders.
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The adverse effects of fetal drug exposures are well documented. Evidence for FAS, impaired intrauterine growth, birth defects, and mental retardation related to alcohol is compelling; evidence for alcohol-induced adverse behaviors and impaired speech is tenuous. Teratogenic, cognitive, or behavioral effects associated with prenatal exposure to marijuana, cigarettes, cocaine, or opiates have not been well established. ⋯ Impaired fetal growth, especially of brain, may indirectly mediate drug effects on cognition. The abnormal neonatal neuro-behaviors described herein have no apparent impact on subsequent development. The development of opiate-exposed children, particularly those with withdrawal symptoms, however, appears to be more vulnerable to the adverse effects of an impoverished environment.
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Review Case Reports
The postconcussion syndrome and the sequelae of mild head injury.
The postconcussion syndrome refers to a large number of symptoms and signs that may occur alone or in combination following usually mild head injury. The most common complaints are headaches, dizziness, fatigue, irritability, anxiety, insomnia, loss of consciousness and memory, and noise sensitivity. Mild head injury is a major public health concern because the annual incidence is about 150 per 100,000 population, accounting for 75% or more of all head injuries. ⋯ Contrary to a popular perception, most patients with litigation or compensation claims are not cured by a verdict. Treatment is individualized depending on the specific complaints of the patient. Although a variety of medication and psychologic treatments are currently available, ongoing basic and clinical research of all aspects of mild head injury are crucial to provide more efficacious treatment in the future.
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Converging lines of research suggest that RSD is a form of reflex neurogenic inflammation. Early the sympathetic nervous system appears to have an initiating and sustaining role. ⋯ Neuropeptides and EAAs released from thin or unmyelinated nociceptive afferents may produce both the inflammation and the suspected central sensitization of DH neurons seen in later stages of the disease. Effective treatment will follow a clearer understanding of the physiology of each stage of the disease.
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Underwater diving may cause several unique neurologic injuries because of exposure to rapid changes in pressure and volume. DCS, which results from extended deep dives and too rapid ascent, is a systemic disease that frequently causes spinal cord injury but may involve other organs as well. ⋯ Definitive treatment includes administration of oxygen and recompression in a chamber. Permanent neurologic injury may result.