Journal of the neurological sciences
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German Society of Neurology's stroke-unit concept includes a specialized stroke-unit team and advanced monitoring facilities in the early phase of stroke. Our aim was to evaluate the effectiveness of this semi-intensive stroke-unit (SI-SU) concept as compared with conventional care (CC) for patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA). Over a 20-month period starting in March 2001, 755 patients with AIS or TIA were treated under SI-SU (n=393) or CC (n=362) conditions within an observational study. ⋯ In multivariate analysis, AIS patients (n=453) treated under SI-SU had significantly lower 1-year mortality and disability compared with the CC-treated patients (odds ratio [OR]: 0.47, 95% confidence interval [CI]: 0.27-0.83 and OR: 0.44, 95% CI: 0.22-0.87; respectively). For TIA patients, (n=262) SI-SU care showed no significant effect in any outcome variable. Our prospective study provides evidence that SI-SU with advanced early monitoring and treatment for patients suffering from AIS results in a better outcome 1 year after ischemic stroke if compared with conventional care.
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Some patients with brain arteriovenous malformation (BAVM) present with focal neurological deficits (FNDs) unrelated to clinically discernable seizure activity or hemorrhage. The aim of this study is to determine demographic and morphological AVM characteristics associated with FNDs. ⋯ Focal neurologic deficits unrelated to seizures or hemorrhage are a rare initial presentation of BAVMs. The predominance of FNDs among brainstem and deeply located BAVMs and the lack of a significant association of BAVM size with FNDs indicate selective white matter pathway-specific vulnerability, the association with patient age a time dependent effect. The higher frequency of FNDs among women suggests gender-specificity of brain tissue vulnerability.
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Abnormalities in cerebello-thalamo-cortical pathways have been suggested as a basis for essential tremor (ET). Two voxel-based morphometry (VBM) studies, each using a 1.5-T magnet, evaluated ET patients, leading to contradictory results. Using a 3-T magnet, we assessed whether white or gray matter changes occurred in ET patients vs. controls. ⋯ Structural white and gray abnormalities may be detected in ET patients using VBM and a high-field MRI scanner. Such changes may be related to the pathological substrates associated with this disease.
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Case Reports
Fluorodeoxyglucose positron emission tomography (FDG-PET) is useful in the diagnosis of neurosarcoidosis.
A 45-year-old man presented with a progressive transverse spinal cord syndrome. MRI scanning revealed bitemporal and multiple spinal lesions with significant enhancement after gadolinium administration mimicking an acute disseminated encephalomyelitis. CSF analyses showed a lymphocytic pleocytosis. ⋯ Pathology was consistent with the diagnosis of sarcoidosis. The usual diagnostical tools to evaluate a sarcoidosis, such as serum angiotensin converting enzyme (ACE) and computed tomography of the chest were performed initially and revealed no pathological results. Therefore, in this case FDG-PET was crucial for the diagnostic work-up leading to an accessible inflammatory lesion outside the CNS for biopsy and the final diagnosis of sarcoidosis.
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Nonmotor symptoms (NMSs) are common in patients with Parkinson disease (PD), but little is known about the burden of the full range of NMSs in de novo PD patients. ⋯ Untreated de novo PD patients have more nonmotor problems than controls, and these NMSs are not ameliorated by dopaminergic medication.