Current opinion in neurology
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Curr. Opin. Neurol. · Feb 2016
ReviewManagement of patients with aneurysmal subarachnoid haemorrhage.
Outcome of patients with aneurysmal subarachnoid haemorrhage (ASAH) has improved, but is still poor. After the introduction of endovascular treatment of intracranial aneurysms, much attention has been given to indications for and advances in endovascular and microneurosurgical techniques to occlude aneurysms, but management of patients with ASAH encompasses much more than occluding the aneurysm. ⋯ In patients with a head computed tomography scan performed less than 6 h after headache onset and reported negative by a staff radiologist, lumbar puncture can be withheld. Patients with ASAH should preferably be treated in a tertiary care centre that treats more than 100 ASAH patients per year. Currently, the only treatment strategy to reduce the risk of delayed cerebral ischaemia remains nimodipine; there is no place for statins or magnesium sulphate, nor for lumbar drainage. Hypervolaemia and induced hypertension may be less beneficial than presumed, and further trials are urgently needed. Very early and short treatment with antifibrinolytic drugs may also be beneficial, but data from ongoing trials should be awaited before this treatment strategy can be implemented.
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Curr. Opin. Neurol. · Feb 2016
ReviewImaging-based selection for revascularization in acute ischemic stroke.
With the positive results of recent endovascular thrombectomy (EVT) trials, intravenous thrombolysis (IVT) and EVT provide physicians with two majorly effective acute treatment options for patients with acute ischemic stroke. IVT and EVT can be used as a single treatment or as a combined IVT/EVT treatment approach. This review summarizes how imaging findings can help in selecting stroke patients who are likely to benefit from these revascularization therapies. ⋯ Pretherapeutic imaging findings help in identifying stroke patients who are likely to benefit from endovascular stroke therapies, and may identify patients who benefit from revascularization therapies in later time windows.
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We discuss the role of bilingualism as a source of cognitive reserve and we propose the putative neural mechanisms through which lifelong bilingualism leads to a neural reserve that delays the onset of dementia. ⋯ Lifelong bilingualism represents a powerful cognitive reserve delaying the onset of dementia by approximately 4 years. As to the causal mechanism, because speaking more than one language heavily relies upon executive control and attention, brain systems handling these functions are more developed in bilinguals resulting in increases of gray and white matter densities that may help protect from dementia onset. These neurocognitive benefits are even more prominent when second language proficiency and exposure are kept high throughout life.
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Chemotherapy-induced peripheral neurotoxicity (CIPN) is clinically relevant because it is frequent, it might be dose-limiting, it affects the cancer survivors' quality of life, and no treatment is available. Better understanding of CIPN might lead to an improvement in its management. ⋯ Precise definition of CIPN clinical features can be obtained by only using validated outcome measures. Therefore, a major aim of clinical research is to standardize CIPN assessment, also considering that healthcare providers and patients frequently have a different perception of CIPN severity. A second major aim in clinical research is to maintain a high level of attention to the possible neurotoxicity of drugs more recently introduced into clinical practice. Preclinical studies are of pivotal importance to identify druggable targets for pharmacological intervention in order to prevent or limit CIPN.
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Curr. Opin. Neurol. · Aug 2015
ReviewA field guide to current advances in paediatric movement disorders.
Recent advances in neurogenetics, neuroimmunology and nonpharmacological treatments have reshaped the field of paediatric movement disorders. In this review, we put recent findings into context providing a framework to enable navigation of the expanding literature in this field. ⋯ The rapid advance of translational medicine has had major impacts on the field of paediatric movement disorders including diagnosis and treatment of these conditions.