Current opinion in neurology
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Current opinion on "neuropathic" pain is chaotic and divided. This review is a summary attempt at describing the principal hypotheses that are currently entertained and at interpreting the basic underlying mechanisms of these pains. ⋯ Issues such as the concept of "centralization" of neuropathic pain mechanisms, which dwell excessively upon extrapolation from animal experiment to human clinical reality, are highlighted as questionable. Psychogenic pseudoneuropathy, an entity of high clinical prevalence and low appreciation by basic scientists and the reflex sympathetic dystrophy establishment, is also given the emphasis it deserves.
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Curr. Opin. Neurol. · Jun 1994
ReviewContributions of neuroimaging to diagnosis and monitoring of multiple sclerosis.
Recent advances in magnetic resonance neuroimaging have resulted in an increased ability to distinguish acute, potentially reversible lesions from chronic, irreversible lesions in multiple sclerosis. Refinements of magnetic resonance imaging techniques, such as fluid-attenuated inversion recovery, diffusion imaging, and magnetization transfer imaging, as well as magnetic resonance spectroscopic imaging, are providing increased sensitivity and allowing detection of changes in multiple sclerosis white matter that appears normal on standard spin-echo magnetic resonance images. Increased neuroimaging specificity and sensitivity enhance the ability to diagnose, monitor, and understand the progression of multiple sclerosis. Magnetic resonance spectroscopy and magnetic resonance spectroscopic imaging detect metabolites in vivo and have even greater potential for elucidating the biochemical pathology of demyelination in multiple sclerosis.
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Curr. Opin. Neurol. · Dec 1993
ReviewMagnetic resonance imaging in demyelinating, infectious, metabolic, and congenital diseases.
A mere 5 to 7 years ago, the majority of literature on demyelinating, infectious, metabolic, and congenital diseases of the brain focused on comparison between computed tomography and magnetic resonance imaging (MRI). MRI has become not only the foremost diagnostic tool in imaging of the central nervous system, but also a key research instrument. This is displayed by the recent increase in papers concerning magnetic resonance spectroscopy. ⋯ A review of neuroimaging in infectious diseases places a heavy emphasis on AIDS-related infections. The ongoing development of new scan sequences, contrast agents, and fast scanning techniques are broadening our image of the brain and, indeed, our understanding of pathophysiologic mechanisms of disease states. Excellent examples of this are the metabolic and congenital diseases where, based on the knowledge of metabolic pathways and embryology, MRI has become the modality of choice.
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Interventional neuroradiology continues to play an increasing role in the treatment of intracranial aneurysms, the treatment of vasospasm related to subarachnoid hemorrhage, and the treatment of vascular malformations and fistulae of the brain and spine. New techniques for aneurysm embolization are examined, such as detachable coil systems, as are reports of intracranial angioplasty and superselective papaverine infusion for vasospasm following aneurysm rupture. ⋯ New approaches to tumor embolization are presented, and there are new data on angioplasty for cerebral atherosclerotic disease. Local fibrinolytic therapy in the treatment of patients with acute intracranial arterial or venous sinus thrombosis is evaluated.
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Curr. Opin. Neurol. · Dec 1993
ReviewCerebrospinal fluid circulation, cerebral edema, and intracranial pressure.
Cerebrospinal fluid (CSF) circulation plays an important role in acute and chronic disorders of the central nervous system. Correction of impaired CSF circulation by medical or surgical means carries important risks as well as lifesaving benefits. CSF circulation is intimately associated with intracranial pressure, cerebral edema, cerebral perfusion pressure, and cerebral blood flow. Clinical and experimental aspects of the CSF circulation are examined to provide insight into the often subtle physiological interactions that must be considered when treating patients with altered CSF circulation.