Neurologic clinics
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Postherpetic pain persisting 1 month or longer occurs in only a small percentage of all patients with herpes zoster. In most patients, PHN tends to diminish with time. The incidence is, however, directly related to age. ⋯ One uncontrolled study reported benefit from epidural steroids. DREZ lesions are a possibility in failed medical cases, but other surgical procedures appear to be of little or no use. Although the measures described here will benefit a number of patients, PHN remains an intractable problem in some cases.(ABSTRACT TRUNCATED AT 400 WORDS)
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Pain is a common feature of well-established multiple sclerosis. Acute, subacute, and chronic pain syndromes have been defined. ⋯ The major chronic pain syndromes are dysesthetic extremity pain, back pain, and painful leg spasms. Treatment involves a variety of pharmacologic and nonpharmacologic approaches, but therapy must be individualized for each specific pain syndrome according to its own pathophysiology.
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Pituitary adenomas represent the only true adenomas of the cranial cavity. In 1000 asymptomatic pituitary glands examined at autopsy, there was a 22.4 per cent incidence of undetected microadenomas. Advances in diagnostic endocrinology, in radiologic imaging, and in surgical and medical treatments have brought many more patients to the attention of the authors. Over the last 10 years, their treatment approaches have evolved to those presented in this article.
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Treatment of SE has improved considerably during the last decade. Mortality from SE itself should be minimal if effective treatment is delivered rapidly. ⋯ If seizures persist, phenobarbital 10 to 20 mg per kg should be used. If convulsive SE continues for more than 1 hour, pentobarbital coma is necessary.
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Our recommendations for the evaluation of the patient with suspected cardiogenic syncope are as follows: An initial thorough history and physical examination of the patient will suggest the diagnosis of cardiogenic syncope in at least 50 per cent of patients. A sudden occurrence of syncope, or "drop attack", is most suggestive of an arrhythmic cause for syncope. If there is no evidence of neurologic, metabolic, or obvious cardiac (for example, aortic stenosis) cause for syncope, a 24-hour ambulatory ECG should be performed. ⋯ Echocardiography and exercise stress testing are not routinely indicated in the evaluation of syncope unless the clinical history and examination suggest valvular or coronary disease. Rarely, an atrial myxoma will be visualized by echocardiography that is not apparent clinically. Those patients who still have unexplained recurrent syncopal episodes, despite all noninvasive studies, can benefit from invasive electrophysiologic studies, although the expected yield from electrophysiologic testing is low.