Journal of neurology
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Journal of neurology · May 2013
Cognitive outcome of survivors of space-occupying hemispheric infarction.
In patients with space-occupying hemispheric infarction, surgical decompression within 48 h after stroke onset increases the chance of a good functional outcome, but also the chance of survival with severe disability. Until now, cognitive outcome in these patients has not been reported in a consecutive series. Participants of the hemicraniectomy after middle cerebral artery infarction with life-threatening edema trial (HAMLET; ISRCTN94237756) underwent detailed neuropsychological examination at a median of 14.5 months after stroke onset. 'Global cognitive impairment' was defined as a score on the Cambridge cognitive examination (CAMCOG) ≤ 83. ⋯ The majority of survivors of space-occupying hemispheric infarction suffered from long-term global cognitive impairment. Isolated focal neuropsychological deficits were found in only a quarter. Impaired cognitive outcome was associated with worse functional outcome.
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Journal of neurology · May 2013
Long-term outcome in patients with Guillain-Barré syndrome requiring mechanical ventilation.
We aimed to determine long-term disability and quality of life in patients with Guillain-Barré syndrome (GBS) who required mechanical ventilation (MV) in the acute phase. Our retrospective cohort study included 110 GBS patients admitted to an intensive care unit and requiring MV (01/1999-08/2010) in nine German tertiary academic medical centers. Outcome was determined 1 year or longer after hospital admission using the GBS disability scale, Barthel index (BI), EuroQuol-5D (EQ-5D) and Fatigue Severity Scale. ⋯ Outcome was statistically significantly correlated with age, type of therapy and number of immunoglobulin courses. In GBS-patients requiring MV in the acute phase in-hospital, and long-term mortality are lower than that in previous studies, while long-term quality of life is compromised in a large fraction of patients, foremost by immobility and chronic pain. Efforts towards improved treatment approaches should address autonomic dysfunction to further reduce hospital mortality while improved rehabilitation concepts might ameliorate long-term disability.
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Journal of neurology · May 2013
Time trends in incidence of Parkinson's disease diagnosis in UK primary care.
To examine time trends and the influence of socio-demographic and geographic factors on incidence of Parkinson's disease (PD) diagnosis in a large UK population-based cohort from The Health Improvement Network (THIN), a UK primary care database. All patients aged over 50 years and contributing data to THIN between January 1999 and December 2009 were extracted and the incidence rates of PD diagnoses were determined by age, gender, time period, social deprivation score and urban/rural status. The overall incidence of PD diagnosis for people over 50 years was 84 per 100,000 person years (95 % CI 82-85). ⋯ With the broader definition, the adjusted incidence rates remained significantly higher in men compared to women and in urban areas compared with rural areas but not in socially deprived areas. The PD diagnosis rates in the primary care setting were, as expected, higher in men, and slightly higher in urban areas, but not different between socio-economic groups. There was a decline in PD diagnosis in the primary care setting, which may largely represent changes in diagnosis and/or coding rather than a true decline in incidence.
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Journal of neurology · May 2013
Gastrointestinal manifestations in Parkinson's disease: prevalence and occurrence before motor symptoms.
To assess the prevalence of gastrointestinal symptoms (GIS) in Parkinson's disease (PD) compared to control subjects and their timing of appearance in relationship to the onset of motor symptoms. There is a rostrocaudal gradient of alpha-synuclein (α-SYN) neuropathology in the enteric nervous system at early stages of PD with higher burden in the upper than the lower gut. However, only constipation has been recognized as a premotor gastrointestinal manifestation of PD. 129 PD patients and 120 controls underwent a structured questionnaire to assess the presence of GIS and, in PD patients, the time of their appearance respect to the onset of motor manifestations. ⋯ Constipation and defecatory dysfunction preceded motor manifestations. Whereas gastroparesis symptoms preceded motor manifestations, their prevalence was not significantly different from controls. Despite evidence of a higher α-SYN burden in the upper gut, only constipation and defecatory dysfunction were prominent premotor GIS of PD.
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Journal of neurology · May 2013
Interdisciplinary treatment of unruptured intracranial aneurysms: impact of intraprocedural rupture and ischemia in 563 aneurysms.
This study was conducted to determine the risk factors and the clinical impact of intraprocedural aneurysm rupture (IAR) and periprocedural ischemia in the treatment of symptomatic and asymptomatic unruptured intracranial aneurysms (UIAs). A single-center retrospective data analysis of 563 UIAs treated between 2000 and 2010 was conducted. Treatment assignment was made on the basis of individual aneurysmal criteria in an interdisciplinary neurovascular conference with attending neurosurgeons, neuroradiologists and neurologists. ⋯ Treatment of UIAs can be conducted with an equivalent low rate of permanent morbidity for clipping and coiling-treatment of symptomatic aneurysms elevates the procedural risk. IAR was less frequent during coiling, but was associated with relevant mortality. IAR and periprocedural ischemia represent significant treatment-associated risks, which should be taken into account in interdisciplinary treatment planning and patient counseling.