European journal of neurology : the official journal of the European Federation of Neurological Societies
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Review Case Reports
Isolated sixth nerve palsy secondary to spontaneous intracranial hypotension.
We report the case of a 43-year-old gentleman who presented with an isolated left sixth nerve palsy in association with postural headache. Magnetic resonance imaging showed dural enhancement with downward displacement of the brainstem. ⋯ Treatment was successful with epidural blood patching. The case is discussed and the relevant literature reviewed.
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Acquired neuromuscular weakness due to critical illness polyneuropathy and myopathy (CIPNM) frequently develops in patients hospitalized in the intensive care unit for more than 1 week. CIPNM may present with muscle weakness and failure to wean from mechanical ventilation, but is discovered more often and earlier by electrophysiological examination. In this review, the incidence, clinical and electrophysiological features, differential diagnosis and prognosis of CIPNM will be described. ⋯ Presence of CIPNM is associated with higher mortality rate, prolonged duration of mechanical ventilation and prolonged rehabilitation. The majority of survivors with CIPNM have persistent functional disabilities and a reduced quality of life. There is need for new therapeutic strategies to prevent or minimize CIPNM in critically ill patients.
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Practice Guideline
EFNS guidelines on pharmacological treatment of neuropathic pain.
Neuropathic pain treatment remains unsatisfactory despite a substantial increase in the number of trials. This EFNS Task Force aimed at evaluating the existing evidence about the pharmacological treatment of neuropathic pain. Studies were identified using first the Cochrane Database then Medline. ⋯ The main peripheral pain conditions respond similarly well to tricyclic antidepressants, gabapentin, and pregabalin, but some conditions, such as HIV-associated polyneuropathy, are more refractory. There are too few studies on central pain, combination therapy, and head-to-head comparison. For future trials, we recommend to assess quality of life and pain symptoms or signs with standardized tools.