Der Nervenarzt
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Biography Historical Article
[Eugen Bleuler (1857-1939) and German psychiatry].
Eugen Bleuler was born 150 years ago, and about 100 years ago he published his "Schizophrenia" for the very first time-giving rise to a retrospective view especially concerning German psychiatry. Together with Emil Kraepelin, who was more or less of the same epoch as Freud, E. Bleuler is one of the fathers of modern psychiatry. ⋯ Bleuler was not a psychoanalyst himself but rather a pluridimensional psychiatrist in the best sense of the word and at the same time sympathetic to psychoanalysis. The reception and historical effect of Bleuler's work are described. Another important subject that Bleuler himself regarded as the central field in his work is pointed out: the fight against alcoholism.
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Adhesive lumbar arachnoiditis is essentially an unknown, unreported, and unrecognised disease. It was better known at a time when oil-based dye was used for myelography. The factors causing this pathogenesis remain unknown. In addition, diagnosis is hard to achieve and frequently attained only by an exclusion process. Only in severe cases, using high-resolution MRI, is evidence for the diagnosis obtainable. ⋯ Adhesive lumbar arachnoiditis is no longer a devastating diagnosis. Due to a novel endoscopic treatment of the local CSF disturbances that restores physiologic pathways, the chance exists for long-lasting improvement of the clinical condition.
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This article covers three major topics of acute stroke therapy: extension of the time window for thrombolysis with desmoteplase, decompressive surgery after malignant middle cerebral artery infarction, and the effect of hemostatic therapy with recombinant activated factor VII (rFVIIa) in patients with spontaneous primary intracerebral hemorrhage. Thrombolytic therapy with recombinant tissue or tissue-type plasminogen activator is still the only approved acute stroke therapy within a 3-h time window. Imaging-based patient selection seems to help extending this time window. ⋯ Hematoma growth occurs within 4 h in one third of patients who suffer from intracerebral hemorrhage. Prospective, placebo-controlled, multicenter trials have shown that intravenous application of rFVIIa reduces volume increase. We present preliminary results of the latest phase III trial (FAST: recombinant factor VIIa in acute hemorrhagic stroke), which tried to find whether the hemostatic effect will translate into clinical effect.
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Headaches are one of the most common disorders and symptoms in daily medical practice. There has been dramatic progress of knowledge in the fields of epidemiology, pathophysiology, acute treatment, and preventive therapy over the past 100 years. Triptans have been the breakthrough in the treatment of acute migraine attacks. ⋯ Cluster headache is part of the group of trigemino-autonomic headaches. Headache from medication overuse plays an increasingly important role. New medical care structures such as integrated headache care provide better support for patients with chronic headache disorders.
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The state of organized care of neurologic pain patients in Germany was to be established with the the help of our survey. ⋯ Structures exist concerning diagnostics and therapy for neurological in- and outpatients with pain. Care procedures for inpatients with pain need improvement. Outcome is seldom documented.