Der Nervenarzt
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Approximately 10-15% of acute strokes are caused by non-aneurysmatic intracerebral hemorrhage (ICH) and incidences are expected to increase due to an aging population. Studies from the 1990s estimated mortality of ICH to be as high as 50%. However, these figures may partly be attributed to the fact that patients suffering from ICH frequently received only supportive therapy and the poor prognosis may therefore be more a self-fulfilling prophecy. ⋯ Likewise the value of surgical hematoma evacuation remains uncertain. In the largest randomized controlled trial on surgical treatment in ICH so far, only a small subgroup of patients with superficial hemorrhages seemed to benefit from hematoma evacuation. Whether improved intensive care can contribute to improved outcome after ICH will be shown by data obtained in the coming years.
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Over 100,000 heart surgeries are performed in Germany annually. Although severe neurological complications like ischaemic strokes have meanwhile become rare occurrences, subtle neuropsychological changes are still frequently recognized after major heart surgeries. ⋯ A variety of neuroprotective strategies such as intraoperative microemboli filtration have been suggested to minimize cerebral risks. The utility of neuroprotective methods has recently been verified in randomized studies.
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Approximately every fourth stroke results from cardiac embolism. Atrial fibrillation has been recognized as a common cause for thromboembolic stroke. Detection of unknown atrial fibrillation is an important clinical challenge, as anticoagulation may effectively reduce the risk of recurrent ischemic stroke. ⋯ In addition, it is useful to pay attention to atrial fibrillation during continuous bedside ECG monitoring on the stroke unit and in pacemaker interrogation. The indication for longer ECG monitoring by implantable loop recorders may be considered individually based on the expected probability of atrial fibrillation. The potential benefit of these devices is currently being evaluated in clinical trials.
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Comparative Study
[Violent offenders with or without antisocial personality disorder. A comparison].
The influence of legal offences on the diagnosis of antisocial personality disorder (ASPD) is a common discussion. A population of imprisoned delinquents diagnosed with ASPD was compared to delinquents without ASPD concerning sociodemographic, criminological and clinical characteristics to determine if ASPD can differentiate delinquents apart from committing legal offences. ⋯ Some features are suitable for the discrimination between offenders with or without ADPD, but our results indicate that samples are better distinguished by a dimensional approach, oriented toward their degree of characteristics.