Curr Treat Option Ne
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Curr Treat Option Ne · Feb 2013
Idiopathic intracranial hypertension (pseudotumor cerebri): recognition, treatment, and ongoing management.
Idiopathic intracranial hypertension (IIH, pseudotumor cerebri) is a syndrome of elevated intracranial pressure of unknown cause that occurs predominantly in obese women of childbearing age. It is a diagnosis of exclusion and, therefore, other causes of increased intracranial pressure must be sought with history, imaging, and cerebrospinal fluid examination before the diagnosis can be made. IIH produces symptoms and signs of increased intracranial pressure, including papilledema. ⋯ The choice of intervention depends on the relative severity of symptoms and visual loss, as well as local expertise. At present, the role of transverse venous sinus stenting remains unclear. Although there are no evidence-based data to guide therapy, there is an ongoing randomized double-blind placebo-controlled treatment trial, investigating diet and acetazolamide therapy for IIH.
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Hemiplegic migraine (HM) is a rare subtype of migraine with aura, characterized by transient hemiparesis during attacks. Diagnosis is based on the International Classification of Headache Disorders criteria (ICHD-II). Two types of HM are recognized: familial (FHM) and sporadic hemiplegic migraine (SHM). ⋯ In no strictly preferred order, flunarizine, sodium valproate, lamotrigine, verapamil, and acetazolamide can be tried. While less evidence is available for prophylactic treatment with topiramate, candesartan, and pizotifen, these drugs can also be considered. The use of propranolol in HM is more controversial, but evidence of adverse effects is insufficient to contraindicate beta-blockers.
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Neonatal Hypoxic-ischemic encephalopathy in full term infants has been associated with a high risk for morbidity and mortality. The patho-physiology of brain injury following hypoxia-ischemia, noted in preclinical models, is a cascade of events resulting from excitotoxic and oxidative injury culminating in cell death. Hypothermia has been noted to be protective by inhibiting various events in the cascade of injury. ⋯ All infants should have magnetic resonance brain imaging studies within 1 to 2 weeks of age. Information from the neurological examination, aEEG and MRI studies will be helpful in discussing prognosis with parents. All infants should be followed for a minimum of 18 months to evaluate growth parameters and neurodevelopment al outcome.
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Therapeutic hypothermia has proven neuroprotective effects in global cerebral ischemia. Indications for hypothermia induction include cardiac arrest and neonatal asphyxia. The two general methods of induced hypothermia are either surface cooling or endovascular cooling. ⋯ Specifying core practitioners who are well-versed in established guidelines can help integrate the multidisciplinary team that is needed to successfully implement cooling protocols. Reducing shivering to make heat exchange more efficient with tighter temperature control enables quicker time to target temperature and avoids rewarming which can lead to inadvertent increase in intracranial pressure and cerebral edema. Promising applications but yet to be determined is whether hypothermia treatment can improve outcomes in acute ischemic stroke or traumatic brain injury.
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Curr Treat Option Ne · Sep 2009
Current treatment options for depression after mild traumatic brain injury.
Mild traumatic brain injury (MTBI) is the most common neurologic condition in the United States; about 503 of every 100,000 persons visiting the emergency department have this diagnosis. A complex cluster of neurologic signs and symptoms are associated with an acceleration-deceleration mechanism of injury. Unfortunately, many persons do not seek treatment for MTBI. ⋯ Thus, evidence-based treatment of post-MTBI depression is quite limited. Because depressive symptoms can develop as early as 1 week after injury and can be exacerbated by stress, pain, and comorbidities, it seems prudent to begin early interventions focused on managing pain and stress, along with providing psychoeducational and problem-solving therapies. Efficacy studies are needed to determine whether telemedicine approaches, group interventions, or peer counseling may be helpful methods of delivering such interventions during the early months as ways to attenuate the development of a major depressive disorder.