Archives of neurology
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Archives of neurology · Feb 2009
Contribution of white matter lesions to gray matter atrophy in multiple sclerosis: evidence from voxel-based analysis of T1 lesions in the visual pathway.
The biological basis of gray matter (GM) atrophy in multiple sclerosis is not well understood, but GM damage seems to be the most critical factor leading to permanent disability. ⋯ Focal WM damage is associated with upstream GM atrophy, suggesting that retrograde damage of the perikarya from axonal injury in multiple sclerosis plaques is one of the significant factors in the genesis of GM atrophy, although other neurodegenerative processes are probably at work as well.
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Archives of neurology · Feb 2009
Case ReportsVentricular wall granulations and draining of cerebrospinal fluid in chronic giant hydrocephalus.
In rare cases, adults with normal or almost normal cognition may have giant brain ventricles surrounded by a sliver of brain. Because the usual flow of cerebrospinal fluid (CSF) is interrupted in these individuals, they may develop alternative CSF pathways to preserve brain function. ⋯ These previously unreported (to our knowledge) ventricular wall granulations may facilitate draining of CSF into the venous system when CSF outflow from the ventricular system is occluded. The presence of these ventricular structures illustrates biologic adaptation to anomalous conditions and successful compensation.
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Archives of neurology · Jan 2009
Association of subdural hematoma with increased mortality in lobar intracerebral hemorrhage.
To determine the prevalence of subdural hematoma (SDH) in patients presenting with primary nontraumatic lobar intracerebral hemorrhage (ICH) and characteristics associated with the presence of SDH. ⋯ Nontraumatic SDH frequently accompanies primary lobar ICH and is associated with higher 30-day mortality, particularly when the ICH volume is relatively low. Rupture of an amyloid-laden leptomeningeal vessel, with extravasation into the brain parenchyma and subdural space, may be the pathogenic mechanism.
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Archives of neurology · Jan 2009
Neoplastic meningitis-related prognostic significance of the Karnofsky performance status.
The prognostic significance of Karnofsky performance status in neoplastic meningitis (NM) has not been demonstrated in patient groups similarly matched for known prognostic variables. ⋯ A low Karnofsky performance status score predicts poor survival in patients with NM. Patients with a low Karnofsky performance status score may be best served by offering supportive care.
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Archives of neurology · Nov 2008
ReviewReview of tissue plasminogen activator, ischemic stroke, and potential legal issues.
The use of tissue plasminogen activator in ischemic stroke is controversial. Many practicing physicians believe that its usefulness is established, while others, including professional specialty societies, are less sanguine. ⋯ These findings may implicate important potential legal issues. Informed consent concerns and, potentially, medical malpractice claims may result, particularly in the context of evidence-based practice, pay for performance, and the currently limited use of tissue plasminogen activator for eligible patients.