Journal of the neurological sciences
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Post-lumbar puncture headaches (PLPHs) are a common complication of diagnostic lumbar punctures (LPs) caused by a persistent leak of spinal fluid from the dural puncture site. We conducted a prospective study to determine risk factors associated with PLPHs in the neurology outpatient setting. ⋯ Our outpatient findings support the American Academy of Neurology recommendations to use smaller non-traumatic needles to reduce the risk of PLPH.
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Spirometry is the most common test recommended to monitor respiratory dysfunction in patients of amyotrophic lateral sclerosis (ALS). However, the test depends on the patient's efforts and may be difficult to conduct in patients with faciobulbar weakness. We aimed to study the role of phrenic nerve-electrophysiological studies to predict respiratory dysfunction and correlate it with the forced vital capacity (FVC) in patients of ALS. ⋯ We conclude that respiratory dysfunction, as determined by spirometry, is common in patients of ALS. However, only about one-third of patients show symptoms of respiratory distress. Clinical symptoms of respiratory distress are unreliable predictors of respiratory failure in ALS. Measurement of PN-AMP at the time of presentation may be an additional tool to assess respiratory dysfunction in ALS. Reduced PN-AMP values may be indicative of low FVC and may have some role in the assessment of respiratory function in patients in whom a routine spirometry is not possible due to limitations arising from the illness. Both low FVC and reduced PN-AMP at the time of presentation are predictors of poor outcome for patients at the end of 6 months.
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Delirium is an independent risk factor for cognitive impairment and development of dementia in medical patients. It has never been thoroughly studied whether this association is also present in the stroke population. Our aim was to evaluate the effects of delirium in the acute phase after stroke on cognitive functioning two years later. ⋯ Delirium in the acute phase after stroke is an independent predictor for severe cognitive impairment two years after stroke. These findings emphasize the importance of both rapid detection and treatment of delirium after stroke. Furthermore, periodic monitoring and evaluation of cognitive functioning in these vulnerable patients in the years after stroke is strongly recommended.
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Review Meta Analysis
Association of 5-HTT gene polymorphisms with migraine: a systematic review and meta-analysis.
Serotonin is known to play an important role in the pathogenesis of migraine, but individual genetic association studies that examine the relationship between polymorphisms of serotonin transporter (5-HTT) gene and migraine have yielded inconsistent results. This study aimed to evaluate the association between 5-HTT gene variants (including 5-HTTLPR, VNTR and SNP) and migraine using systematic review with meta-analysis. ⋯ Existing evidence indicates that the 5-HTT VNTR polymorphism (mainly the STin2.12 genotype) is associated with an increased risk of migraine in the general population. Future studies with larger sample sizes will be necessary to confirm the present results.
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Biochemical markers, e.g. NSE or S100B, and somatosensory evoked potentials (SSEP) are considered promising candidates for neurological prognostic predictors in patients after cardiac arrest (CA). The Utstein Templates recommend the use of the Glasgow-Pittsburgh Cerebral Performance Categories (GP-CPC) to divide patients according to their neurological outcome. ⋯ In analogy, the average sensitivity of SSEP to predict poor outcome was higher in group A (76 ± 11%) than in group B (50 ± 15%), while the specificity was similar in both groups. Conclusively, inclusion of deaths without certified brain damage after CA in neurological outcome studies will lead to underestimation of the prognostic power of biochemical or electrophysiological markers for brain damage. A modified GOS and GP-CPC score might help to avoid this bias.