Revue médicale suisse
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Revue médicale suisse · Nov 2008
[Access to thrombolysis in stroke: place of the rescue system and of the primary care physician].
Thrombolysis is the most effective treatment improving the outcome of patients suffering from acute stroke. Moreover, its effectiveness increases when administrated as quick as possible after the onset of the first symptoms. Prehospital selection of patients and their immediate transfer to stroke center are the principal factors allowing the practice of thrombolysis within the authorized time frame. On the basis of regional Swiss French data, it seems that patients evaluated by emergency physician and their direct transfer in an acute stroke unit reduces delays and allows for a higher thrombolysis rate.
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Confusion is a frequent psychiatric and behavioural manifestation of diffuse cerebral injury found in elderly patients that are severely ill or stressed. The hyperactive form is often recognised because of the psychomotor agitation. However, the hypoactive form is most frequent and has a worse prognosis. ⋯ Among contributing factors, anticholinergic agents and drug interactions are significant. Identification and treatment of the underlying cause of delirium is essential with a focus on non pharmacological approach. Antipsychotic agents are reserved for severe forms and where non pharmacological intervention fracases.
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Revue médicale suisse · Nov 2008
Review[Herpes zoster and post-herpetic neuralgia in older adults].
Varicella-Zoster virus is responsible for chickenpox and, after reactivation, herpes zoster. Herpes zoster causes a vesicular dermatomal rash, traditionally metameric. Old adults can present severe pain during the acute phase, and late complications, such as post-herpetic neuralgia that can trying and crippling. ⋯ Complementary therapeutic drug is often necessary. However, their application in old, frail, co-morbid and often poly-medicated patients have to be carefully considered as their use may be contraindicated. A specific vaccine is enable to reduce herpes zoster-related morbidity.
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The restless legs syndrome (RLS) is a frequent, often unrecognized disorder in the elderly. The diagnosis is essentially based on the clinical history. ⋯ The RLS is a chronic disorder with high impact on sleep and quality of life. Treatment is symptomatic and recommended drugs are dopaminergic agents, opioids, and gabapentine.