Arch Neurol Chicago
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Physicians may not talk to comatose patients for several reasons. Comatose patients do not seem to hear or respond. Speaking may not affect their clinical outcome; time spent with them takes time away from other, more "viable" patients. ⋯ Not talking to comatose patients may promote the notion that they are dead or nearly dead; not talking may become a self-fulfilling prophecy, influencing physicians to inappropriately withhold or withdraw therapy. Because comatose patients are especially vulnerable, and because some comatose patients may recover, physicians should consider talking to these patients. Our analysis suggests that families, medical students, and house staff would benefit from the humane example modeled by those clinicians who care for and talk to all patients.
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Neuroretinitis, a form of optic neuritis, is characterized by papillitis and a stellate macular exudate, or "macular star." The star implies the presence of a disc vasculopathy and secondary leakage of lipoproteinaceous material into the macula. Demyelinating optic neuritis would not be expected to produce a secondary macular exudate. We reviewed the literature on the risk of multiple sclerosis developing in a patient after an attack of optic neuritis, and rarely found a comment on the presence of a macular star. ⋯ We also noted that in our patients, neuroretinitis may be accompanied by other neurologic manifestations; neuroretinitis may be bilateral and may be staggered; papillitis may present without a macular star, only to have typical exudates develop up to two weeks later; and the macular exudate may take up to 12 months to resolve. We suggest that patients who demonstrate acute papillitis with a normal macula be reevaluated within two weeks for the development of a macular star. Its presence militates strongly against the subsequent development of multiple sclerosis.
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Arch Neurol Chicago · Sep 1987
Comparison of two screening tests in Alzheimer's disease. The correlation and reliability of the Mini-Mental State Examination and the modified Blessed test.
The Mini-Mental State Examination (MMSE) and the Blessed Orientation-Memory-Concentration test (BOMC), a six-item derivative of the Blessed Information-Memory-Concentration Test, were each administered to 36 patients with a clinical diagnosis of Alzheimer's disease. In 24 patients, both tests were readministered a month later. ⋯ These factors are conceptually similar to the components of the BOMC, and so may explain the substantial correlation between the two tests. Since these cognitive status tests seem to be equivalent for Alzheimer patients, the briefer measure (BOMC), which offers additional advantages, may be preferred.
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In a series of patients with trigeminal neuralgia (TN) who were treated with radiofrequency electrocoagulation of the gasserian ganglion and retrogasserian rootlets, either alone or with glycerol, 16 patients with TN and multiple sclerosis (TNMS) are compared with 219 patients with TN without MS. Patients with TNMS were younger and more likely to have bilateral facial pain than those with TN alone. Probability of ipsilateral recurrence was calculated on the basis of Kaplan and Meier product-limit estimates and showed no significant differences in the two groups.