Frontiers in neurology
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Frontiers in neurology · Jan 2013
Clostridium difficile Associated Disease in a Neurointensive Care Unit.
Critically ill patients are at high risk for acquiring Clostridium difficile infection. The aim of this study was to investigate the prevalence, severity, and outcome of neurointensive care unit (NICU) acquired Clostridium difficile associated disease (CDAD). ⋯ The prevalence rate (0.4%) and morbidity of CDAD in the unit are low. A larger database is needed to better analyze the associated risk factors in this subgroup of patients. A possible increase in disease burden due to a delay in discharge from the ICU merits further evaluation.
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Frontiers in neurology · Jan 2013
Amyloid-β Peptides and Tau Protein as Biomarkers in Cerebrospinal and Interstitial Fluid Following Traumatic Brain Injury: A Review of Experimental and Clinical Studies.
Traumatic brain injury (TBI) survivors frequently suffer from life-long deficits in cognitive functions and a reduced quality of life. Axonal injury, observed in many severe TBI patients, results in accumulation of amyloid precursor protein (APP). Post-injury enzymatic cleavage of APP can generate amyloid-β (Aβ) peptides, a hallmark finding in Alzheimer's disease (AD). ⋯ The heterogeneity of animal models, clinical cohorts, analytical techniques, and the complexity of TBI in the available studies make the clinical value of tau and Aβ as biomarkers uncertain at present. Additionally, the link between early post-injury changes in tau and Aβ peptides and the future risk of developing AD remains unclear. Future studies using methods such as rapid biomarker sampling combined with enhanced analytical techniques and/or novel pharmacological tools could provide additional information on the importance of Aβ peptides and tau protein in both the acute pathophysiology and long-term consequences of TBI.
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Frontiers in neurology · Jan 2013
The Complex Clinical Issues Involved in an Athlete's Decision to Retire from Collision Sport Due to Multiple Concussions: A Case Study of a Professional Athlete.
The issue of retirement from athletic participation due to repetitive concussive injuries remains controversial. The complexity of providing recommendations to elite athletes is highlighted by the prospect that offering inappropriate advice may foreseeably lead to engagement in a medico-legal challenge. Currently no evidenced-based, scientifically validated guidelines for forming the basis of such a decision exist. ⋯ A number of central issues to consider when discussing athlete retirement revolve around the player's medical and concussion histories, the current clinical profile, the athlete's long-term life goals, and understanding of the potential long-term risks. Ensuring that thorough investigations of all possible differential diagnosis, that may explain the presenting symptoms, are conducted is also essential. Discussion pertaining to recommendations for guiding the clinical approach to the retirement issue for athletes with a history of multiple concussions is presented.
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Despite the advent of and exciting advances in novel endovascular therapies, t-PA remains the only proven treatment for acute ischemic stroke to date. Although a variety of reasons likely underlie why past trials of endovascular strategies have been unsuccessful, we address in this perspective piece one critical unknown for which a solution is undoubtedly necessary if future ones are to meet with success: determination and selection of patients that are "just right" for endovascular treatments, or the Goldilocks dilemma. ⋯ We provide and examine three clinical cases to illustrate this proposal towards solving the Goldilocks dilemma and advancing treatment in acute ischemic stroke. Further, we address our field's ongoing challenge and mission in the meantime to best care for the "not-so-right" patients, by far the majority of the affected stroke population.