Arch Neurol Chicago
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Arch Neurol Chicago · Apr 1987
Case ReportsAkinetic mutism in a bone marrow transplant recipient following total-body irradiation and amphotericin B chemoprophylaxis. A positron emission tomographic and neuropathologic study.
We describe a case of akinetic mutism associated with diffuse cerebral leukoencephalopathy, which developed in a bone marrow transplant recipient following total-body irradiation and amphotericin B chemoprophylaxis. A trial of high-dose bromocriptine did not stimulate purposeful verbal or motor activity. Fluorine 18-fluorodeoxyglucose/positron emission tomographic studies, performed before and during bromocriptine therapy, demonstrated cerebral hypometabolism and treatment-related decreases in regional cerebral blood volume. We conclude that whole-brain or total-body irradiation may increase blood-brain barrier permeability to polyene antibiotics, and that high-dose therapy with dopamine agonists is unlikely to benefit patients with akinetic mutism due to diffuse white-matter lesions.
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Postherpetic pain persisting one month or longer occurs in 9% to 14% of patients with herpes zoster, diminishing with time. The incidence and duration are directly related to age. The pathologic features have been described but the pathogenesis of postherpetic neuralgia is unknown. ⋯ There is some support for the use of local physical modalities. Neurosurgical procedures are a possibility in failed medical cases. Controlled studies of newer approaches are necessary.
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Current diagnostic workup and surgical management of stretch injuries, gunshot wounds, lacerations, iatrogenic injuries, tumors, and thoracic outlet syndromes involving the brachial plexus are reviewed. Use of appropriate radiologic and electrodiagnostic studies to work up such patients is summarized as is selected literature concerning the more controversial aspects of their management. Some of the arguments both for and against operation on stretch injuries are presented and it is concluded that surgery can be of value for well-selected patients. ⋯ Timing for repair of lacerating injuries to the plexus, as well as iatrogenic injuries, selection of the few patients with thoracic outlet syndrome who require operation, and a brief review of plexus neuropathy are also presented. Importance of evaluating individual plexus injuries in terms of how complete or incomplete loss is in the distribution of each individual element is stressed. Development of intraoperative stimulation and recording methods to help sort out lesions, use of magnification for repair, and improved grafting techniques where gaps result from resection have helped to restimulate interest in managing these patients.