Rev Neurol France
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Neurological complications of infectious mononucleosis are rare. Various disorders have been described: meningitis, encephalitis, peripheral neuropathy. Isolated cranial nerve palsy has rarely been reported. ⋯ To the best of our knowledge, only seven cases of isolated palsy of the hypoglossal nerve complicating infectious mononucleosis have been previously reported.
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It has been suggested that the H1N1 vaccine may be a trigger for the onset of narcolepsy-cataplexy, a rare disease whose autoimmune origin is suspected. ⋯ Although no formal link can be established, the unusual characteristics of the reported cases and the striking temporal relationship suggests that narcolepsy may be the result of an autoimmune reaction triggered by H1N1 vaccination in susceptible individuals.
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Peripheral neuropathies sometimes complicate bariatric surgery. ⋯ The spectrum of peripheral neuropathies complicating bariatric surgery is wide, and includes pure small fiber neuropathy, axonal polyneuropathy, and demyelinating polyradiculoneuropathy. Treatment is mainly preventive, but sometimes surgical revision is needed.
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Stroke can produce irreversible brain damage of massive proportion leading to severe disability and poor quality of life. Resuscitation and mechanical ventilation of these patients remain controversial because of the high mortality and severe disability involved. ⋯ Decisions for life-sustaining therapies in severe stroke are always difficult and often based on subjective and uncertain criteria. We have to improve prognosis estimation and our understanding of patient preferences to promote patient-centered care. An ethical approach may guide these complex decisions.
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Organ procurement practices are tending towards the use of older or more borderline donors. In the current context of steadily decreasing availability of traumatic donors, stroke victims make up the majority of donors. In France, where organ procurement activity has stabilized following a period of growth, the possibility of organ donation after a cerebral stroke is variable and uncertain. ⋯ This approach allows both support for end-of-life patients, and fulfillment of their wishes with regards to organ donation. It enables case-by-case decision-making, after relatives have agreed on transfer to the intensive care unit for organ removal. Thus, each hospital should institute a fully cooperative care procedure where all therapeutic possibilities are evaluated in order to enable the most appropriate therapeutic approach, and, if applicable, organ procurement.