Der Nervenarzt
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The developments of cardiopulmonary resuscitation and intensive care medicine have made possible survival after cardiac arrest. However, only 10-30% of patients with initially successful resuscitation later reach a state without severe neurological impairment. Ethical and socioeconomic reasons therefore make early prognosis important for certain patients. ⋯ The same result can be predicted if brain imaging shows severe hypoxemic changes or if a myoclonic status occurs on the first day. In summary, the prognosis in patients with cerebral anoxy and cardiopulmonary resuscitation remains poor. Treatment with hypothermia for 24 h is recommended.
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The term carotid rete mirabile refers to an anatomic structure common in several lower mammals (e.g., swine). The blood supply for the intracranial arteries originates from branches of the external carotid artery, predominantly the ascending pharyngeal and internal maxillary arteries. In these animals the intracranial internal carotid artery forms from a dense network of numerous converging, small-caliber vessels. ⋯ In both patients the rete mirabile was found in only one carotid system. The affected carotid canal in the skull base was hypoplastic. Human carotid rete mirabile probably has no inherent pathologic significance, but its frequent association with other intra- and extracranial vascular pathologies should be kept in mind.
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Stalking is a widespread phenomenon describing a pattern of intrusive and threatening behaviour that leads to the victim's perception of being harassed and of him or her being rendered fearful. Physical assault and even homicide may occur in the context of stalking. Anglo-Saxon studies have revealed a lifetime prevalence of being a victim of stalking ranging from 4-7% in men and 12-17% in women. ⋯ Consequences for the forensic psychiatric assessment according to section 20, 21 StGB are outlined. It should be pointed out that stalking is not a new diagnostic category, but only involves, at a descriptive level, deviation from a normal behavioural pattern. The central components of the forensic psychiatric assessment remain the known diagnostic categories, the effects of which on behaviour can be analysed.
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The present paper discusses possible solutions to the problem of personal identity and intends to demonstrate criteria enabling us to view a person as the same at different time points in his life. Of special interest are the so-called memory criterion and the criterion of physical identity/continuity: a person remains the same if he is able to remember his past "states" or if he continues to have his former body (brain). The philosophical discussion of the last decades made clear that all attempts to reduce personal identity to memory or physical continuity are contradictory. In this paper we propose regarding personal identity as a normative phenomenon that evades a purely descriptive or neurobiological approach.
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As a result of active immunisation, tetanus has become a rare but still severe neurological disease in the developed world. Despite modern intensive care management, mortality ranges between 20 and 50%. Introduction of mechanical ventilation dramatically reduced mortality; the life-threatening vegetative dysfunctions with cardiovascular instability are now the main reasons for the remaining poor prognosis. This report provides information about clinical features, diagnosis and prophylaxis of the disease and gives an overview of the therapeutic principles of generalized tetanus, focusing on the management of autonomic instability.