Neurologist
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Control of hypertension is a well-established goal of primary prevention of stroke, but management of blood pressure in patients with a previous stroke or in the setting of acute stroke is complicated by the effect blood pressure changes may have on cerebral perfusion. ⋯ Current data support the use of blood pressure reduction in the secondary prevention of stroke in patients with cerebrovascular disease. In the setting of acute stroke, however, data are limited and blood pressure management must be tailored to the specific clinical situation.
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Case Reports
Epidural abscess of the cervical spine with atypical manifestations: a report of two cases.
Epidural abscess of the cervical spine is a medical and surgical emergency, especially when it is located at cervical area, considering this critical anatomic location. Although there is the so-called triad of epidural abscess (fever, local pain, and neurologic deficits), these are not sensitive enough to detect spinal abscess early and prevent significant morbidity and mortality. ⋯ A high index of suspicion is most important in making a rapid, correct diagnosis of spinal epidural abscess (SEA) when a patient presents with local spinal pain and has risk factors like DM. The classic symptom triad of SEA is not sensitive enough for early detection, so a erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and CRP can be used to improve the accurate diagnosis. Spinal MRI should be performed as soon as possible. When patients present with neurologic deficits, surgical intervention is essential if there is no contraindication.
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Early hemicraniectomy reduces mortality in malignant middle cerebral artery (MCA) infarctions to 16%, although the benefit on functional outcome is still unclear. We treat patients with malignant MCA infarction younger than 60 years. Epidural or subgaleal hemorrhages are relatively common complications. Only 1 trial described parenchymal hemorrhage as a complication of hemicraniectomy. ⋯ The reported patient is the first in the literature that suffered from deep hemorrhage after hemicraniectomy. Hemorrhagic transformation might be a risk factor for clinically relevant hemorrhage after hemicraniectomy.
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Neuromyelitis optica (NMO) is an uncommon CNS demyelinating syndrome often mistaken for severe multiple sclerosis (MS). Several clinical, laboratory, and neuroimaging characteristics may accurately distinguish NMO from MS early in the disease course. ⋯ NMO can be reliably differentiated from MS at an early stage using validated diagnostic criteria. The spectrum of NMO is wider than previously appreciated. Accurate, early diagnosis is critical to facilitate initiation of immunosuppressive therapy for attack prevention.