Neurology
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Practice Guideline Guideline
Practice parameter: diagnostic assessment of the child with cerebral palsy: report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society.
The Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society develop practice parameters as strategies for patient management based on analysis of evidence. For this parameter the authors reviewed available evidence on the assessment of a child suspected of having cerebral palsy (CP), a nonprogressive disorder of posture or movement due to a lesion of the developing brain. ⋯ Neuroimaging results in children with CP are commonly abnormal and may help determine the etiology. Screening for associated conditions is warranted as part of the initial evaluation.
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Comparative Study
Characteristics of intracranial aneurysms in patients with familial subarachnoid hemorrhage.
Compared with sporadic aneurysms, familial aneurysms rupture at an earlier age and are more often located at the middle cerebral artery. Other characteristics of familial aneurysms may also differ from sporadic aneurysms. The authors compared the size of ruptured aneurysms and the number of aneurysms between patients with familial subarachnoid hemorrhage (SAH) and those with sporadic SAH. ⋯ Familial aneurysms are generally larger at time of rupture and more likely to be multiple than sporadic aneurysms. The development of large and multiple aneurysms may be related to genetic factors that determine defects of the arterial wall.
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Acute stroke therapy is heavily dependent on the diagnostic acumen of the physician in the emergency department (ED). ⋯ Physicians practicing in the ED are sensitive for stroke/TIA diagnosis. The modest positive predictive value argues for a systems approach with neurology support so that proper decisions regarding acute stroke therapy can be made.
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To characterize the frequency and severity of incidental findings in brain MRIs of young and older adult research volunteers, and to provide an evaluation of the ethical challenges posed by the detection of such findings. ⋯ The significant presence but different characteristics of incidental findings in young and older subjects presumed to be neurologically healthy suggest that standards of practice are needed to guide investigators in managing and communicating their discovery.
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Central pain syndromes represent a form of neuropathic pain that is associated with lesions of the brain or the spinal cord after a stroke or other traumatic injury. Although spinal cord injury (SCI) pain and central post-stroke pain (CPSP) are both classified as central pain syndromes, they may have differing etiologies. The pathophysiology of SCI pain and CPSP has yet to be completely elucidated, but both spinal and supraspinal pathways may be involved. ⋯ Pharmacologic interventions that have demonstrated efficacy in central pain syndromes include iv lidocaine and opioids as well as the tricyclic antidepressant amitriptyline and the AEDs gabapentin and lamotrigine. Nonpharmacologic interventions have also demonstrated benefit in some patients who are refractory to pharmacologic treatments. Additional studies are needed to further evaluate the efficacy and safety of both pharmacologic and nonpharmacologic treatments for central pain syndromes.