Journal of the neurological sciences
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Case Reports
Carotid artery pseudoaneurysm resulting from an injury to the neck by a fouled baseball.
Blunt carotid artery injury resulting in either dissection or pseudoaneurysm is a rare entity that can result in significant morbidity and mortality if undiagnosed. Although unavoidable in certain traumatic situations such as motor vehicle collisions, direct neck trauma in sports may be preventable with the use of proper protective equipment. ⋯ The use of standard protective equipment did not adequately cover the patient's neck in the region of the cervical carotid artery. This case illustrates that modification in current catcher and umpire equipment could potentially avoid this rare but significant vascular injury.
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Relapses in multiple sclerosis (MS) have wide-ranging consequences for patients and should be actively controlled with an appropriate immunomodulating agent provided soon after the diagnosis of MS. Several agents with varying mechanisms of action are approved for use in treating MS. Here we take a brief look at several short- and long-term comparative trials, examining the established strengths and weaknesses of the available immunomodulators. By reviewing the existing comparisons, clinicians will better understand the factors determining when to initiate therapy with an immunomodulator and how to determine which of these treatments may best suit their patients' needs.
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We examined the relationship between the CMCT and features of spinal cord evoked potentials (SCEPs) among 25 patients with compressive cervical myelopathy to elucidate the mechanism underlying the prolonged central motor conduction time (CMCT) in patients with compressive cervical myelopathy. CMCT values were calculated by measuring motor evoked potentials from the abductor digiti minimi muscles (ADMs) and abductor hallucis muscles (AHs) following transcranial magnetic stimulation and peripheral conduction times determined in the ulnar and tibial nerves. SCEPs following transcranial electrical stimulation were recorded intraoperatively from C2-3, C6-7 and T11-12. ⋯ The percentage ratio of the amplitude of the D-wave at C6-7 or T11-12 to that at C2-3 was 19.4+/-14.2 or 3.2+/-3.1%, respectively. The CMCT value was significantly correlated with the attenuation of SCEP amplitude, but not with SCEP latency both at C6-7 and T11-12, suggesting that CMCT prolongation is primarily due to corticospinal conduction block rather than conduction delay. Spinal motor neurons might need more time to fire in patients with compressive cervical myelopathy when corticospinal potentials, but not conduction, are attenuated, thereby resulting in prolonged CMCT.
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Quantitation of epidermal nerve fiber (ENF) density is an objective diagnostic test of small fiber neuropathy (SFN). For a diagnostic test to be clinically useful it should correspond well with clinically meaningful physical findings. ⋯ We found a high concordance between reduced foot ENF density and loss of pinprick sensitivity in this patient population. Our findings indicate that ENF density determination is a clinically relevant objective test in patients undergoing evaluation for possible SFN.
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It is unclear whether hyperglycemia on admission in patients with acute intracerebral hemorrhage (ICH) increases the risk of early death. ⋯ Admission hyperglycemia may independently increase the risk of early death in acute spontaneous intracerebral hemorrhage.