Der Nervenarzt
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We report on the history and clinical findings of an injecting drug abuser in the Canton of Zurich who presented with multiple deep abscesses in the arms and legs. A diagnosis of wound botulism was made based on his clinical presentation with a rapidly progressing descending paralysis starting at the cranial nerves, a neuromuscular junction disorder on neurophysiologic testing, and normal findings on lumbar puncture. ⋯ We suspect subcutaneous injections of contaminated heroin containing Clostridium spores as sites of entry. Wound botulism caused by Clostridium botulinum is a rare cause of rapidly progressing, generalized, flaccid paralysis and should be considered in patients with a history of i.v. drug abuse presenting with descending paralysis.
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Neurological diseases during and following pregnancy represent a small subgroup of all neurological diseases. They can be divided into three groups. 1) Diseases which existed already before pregnancy or which appear just by chance during this phase like migraine, multiple sclerosis, myasthenia gravis, epilepsy, brain tumors or Guillain-Barre syndrome. 2) Diseases that can appear without pregnancy but which display a higher incidence in connection with pregnancy. ⋯ The pregnancy itself can imply some restrictions or even a contraindication concerning diagnosis and therapy of these diseases. The decision in favour or against diagnostic or therapeutic approaches is determined by possible effects on the fetus and by potential danger resulting from not recognizing or not treating such a disease.
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The mammalian brain is capable of a substantial functional reorganization, manifesting on a cortical somatotopical and on a behavioral level. Possible mechanisms are reviewed based on the work by others and ourselves on somatosensory reorganization in humans. The somatosensory system is characterized by divergent projections from the periphery to the cerebral cortex. ⋯ Plastic changes can be temporary or persistent. Modulating factors like pain and certain drugs seem to induce a permissive state in the cortex resulting in enhanced reorganization. Thus, specific physical training combined with pharmacoceutical modulation holds promise to improve functional recovery after brain lesions.
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Review Case Reports
[Pseudoaneurysm of the extracranial internal carotid artery. Treatment by stent and coil implantation].
Pseudoaneurysms of the extracranial internal carotid artery (ICA) can be caused by external injury or may be due to spontaneous dissection. Pseudoaneurysms bear an increased risk of arterio-arterial embolism. Treatment of pseudoaneurysms is influenced by the location and the type of injury, associated injuries, collaterals to the ipsilateral hemisphere, neurological signs and symptoms, growth of the lesion and patient age. ⋯ Pseudoaneurysms of the ICA adjacent to the skull base require a major surgical procedure. If there are contra-indications for vessel occlusion conservative or medical treatment used to be the only therapeutic alternatives. We report the treatment of two patients with extracranial ICA pseudoaneurysms after blunt injury with stent placement (in one case combined with coil embolization) as a further treatment option.