Der Nervenarzt
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Recently, the ischemia-test (IT) had been suggested to be part of the diagnostic procedure for reflex sympathetic dystrophy (RSD). The present study investigated, for the first time whether pain suppressing, as typically occurring under the IT, would correlate in RSD to the pain relieving effect following a diagnostic guanethidine blockade. ⋯ Thus, both procedures have the same diagnostic value for pain in RSD. These results are in agreement with new pathophysiological considerations, assuming an indirectly (via the microvascular system) mediated sympathetic-afferent coupling as a cause of pain in RSD.
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Case Reports
[Rotatory seizures: a rare equivalent of focal epileptic activity. Case report and possible pathophysiology].
We report a typical case of so called "volvular epilepsy" (synonym: retatory seizures, circling epilepsy). Our 59-year-old patient exhibited the characteristic pattern of repetitive walking in small circles, always strictly contralateral to the epileptogenic focus in the right fronto-parietal region. The MRI study indicated a diagnosis of brain tumor in the same area, which was confirmed as an oligodendroglioma. ⋯ Rotatory seizures are rarely reported and usually related to pathological findings in the fronto-temporal region (infarction, neoplasma, giant aneurysm and posttraumatic lesions). Corresponding to the international classification of epileptic seizures, this is a very rare manifestation of a simple partial seizure (without impairment of the conscious state), which can extend to a complex partial seizure (with impairment of consciousness) and secondarily generalized tonic-clonic seizure. In explaining this rare epileptic phenomenon, the controversial concepts (involvement of the striatum, temporal lobe or cortical adverse fields?) are discussed.
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In winter 1992/93 the working association for neurologic intensive care medicine (ANIM) undertook the continuation of a survey concerning the situation of the neurologic intensive care medicine in Germany which was first done in 1988. Altogether 51 intensive care units with in all 281 beds were questioned. 38 were located in the old, 13 in the new federal states. ⋯ The evaluation was done covering different questions like number of beds, type of clinic, number of doctors, number and training of nurses, vacant established posts in the nursing area, number and type of ventilation apparatus and monitors, possibility to measure intracranial pressure etc. In addition detailed data were given concerning the equipment of these intensive care units, the availability of major devices like CT or a neurosurgery department, the diagnosis of the patients treated on those intensive care units and the necessary average duration of staying.