Can J Neurol Sci
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The management of the pregnant epileptic requires close cooperation between the neurologist and obstetrician. To prevent complications, knowledge is required about the natural history of epilepsy during pregnancy, the possible teratogenic effects of antiepileptic drugs, and changes in their absorption, biotransformation, and excretion. Close plasma antiepileptic drug monitoring is required because of the change in the handling of antiepileptic drugs during pregnancy. ⋯ Drug interactions which may lead to toxic plasma levels of some drugs and subtherapeutic plasma levels of others should be anticipated. The risk of problems resulting from antiepileptic drug therapy during pregnancy appears to be minor, provided that proper medical supervision is available. Newer antiepileptic drugs should not be administered to the pregnant epileptic until their safety in pregnancy is fully established.
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Various examples of foreign body embolization of cerebral arteries, usually followed by serious consequences, have been reported (Lindberg et al., 1961; Chason et al., 1963; Steele et al., 1972; Wetli et al., 1972). However, a shotgun pellet entering the left atrium of the heart through a gunshot wound of the chest with subsequent embolic occlusion of one of the carotid arteries appears to be unique. It is the subject of this short communication.
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The effect of general anesthesia on 42 multiple sclerosis (MS) patients who underwent 88 episodes of general anesthesia was analyzed. One patient experienced a relapse after a procedure under general anesthesia, which is compatible with the natural history of the disease. ⋯ In the evaluation of the former our limited data suggested that spinal anesthesia is less preferable than other alternatives in MS. Local anesthetics had a benign effect on the course of MS.
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The object of this study was to determine if traumatic brain edema (BE) and increased intracranial pressure (ICP) reduce cerebral blood flow (CBF). Two groups of patients were studied, one with slight BE and ICP less than 20 mm Hg., the other with pronounced BE and ICP over 20 mm Hg. ⋯ Since traumatic BE does not increase resistance to blood flow through the brain, cerebral perfusion can be maintained if an adequate perfusion pressure is established. This in turn, demands the monitoring and control of ICP.