Neurology
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Case Reports
Teaching NeuroImages: Comatose patient with bilateral thalamic infarct due to internal carotid artery occlusion.
An 88-year-old woman with a medical history of diabetes, hypertension, and atrial fibrillation presented to the emergency room after being found unresponsive with a NIH Stroke Scale score of 23 and Glasgow Coma Scale score of 3. She was unresponsive to painful stimuli. Noncontrast CT demonstrated bilateral thalamic infarcts (figure 1A).
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Randomized Controlled Trial
Hyperdopaminergic crises in familial dysautonomia: a randomized trial of carbidopa.
The purpose of this study was to determine whether carbidopa (Lodosyn), an inhibitor of dopa-decarboxylase that blocks the synthesis of dopamine outside the brain, is an effective antiemetic in patients with familial dysautonomia (FD) and hyperdopaminergic nausea/retching/vomiting attacks. ⋯ This study provides Class II evidence that carbidopa is effective in reducing nausea/retching/vomiting in patients with FD.
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Education research: changing practice. Residents' adoption of the atraumatic lumbar puncture needle.
The atraumatic needle is recommended over the cutting needle to prevent complications related to lumbar puncture and to reduce costs to the health care system. However, very few practicing neurologists use the atraumatic needle, which in turn limits the teaching of its use to neurology residents. Despite this, neurology residents may be able to adopt the atraumatic needle for lumbar punctures. ⋯ Neurology residents can successfully adopt the atraumatic needle as standard of care for lumbar punctures.
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To assess eyes with neuromyelitis optica (NMO) for morphologic retinal abnormalities utilizing high-definition optical coherence tomography (OCT) imaging. ⋯ We have identified a pattern of retinal morphologic abnormalities in NMO that is associated with severe retinal axonal and neuronal loss and corresponding visual disability. MME may contribute to poor visual outcomes following NMO-associated ON or alternatively represent a marker of ON severity. Additionally, our results support that subclinical involvement of the anterior visual pathway may occur in NMO spectrum disorders.
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This observational study aimed to explore the pathophysiology of idiopathic normal-pressure hydrocephalus (iNPH) and to evaluate the diagnostic and prognostic value of CSF biomarkers. ⋯ We interpret our data as iNPH pathophysiology to be characterized by a reduced periventricular metabolism and axonal degeneration but no major cortical damage.