Journal of neurology
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Journal of neurology · Feb 2009
Randomized Controlled Trial Comparative StudyMagnesium and aspirin treatment in patients with subarachnoid haemorrhage. Comparison of effects after endovascular and neurosurgical aneurysm occlusion.
Aneurysm treatment with endovascular coiling is associated with a better outcome than neurosurgical clipping in patients with subarachnoid haemorrhage (SAH). The better outcome after coiling may decrease the risk reduction from other treatments in these patients, and thus may increase sample sizes for current or future neuroprotective trials. The influence of the method of aneurysm treatment was studied in our randomised MASH trial, which assessed in a factorial design the efficacy of magnesium and aspirin in preventing delayed cerebral ischaemia (DCI) and poor outcome. ⋯ This post hoc analysis does not suggest that medical treatments are less effective after endovascular than after neurosurgical treatment in patients with SAH, and thus do not support a need for adjusting sample size calculations in future trials.
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Chronic meningitis is an inflammation of the meninges with subacute onset and persisting cerebrospinal fluid (CSF) abnormalities lasting for at least one month. Several non-infectious and infectious etiologies are known to be causative. The wide range of different etiologies renders the approach to patients with this syndrome particularly difficult. ⋯ This review aims to present the current knowledge on etiology, neurological course of disease, diagnostic and therapeutic management steps of patients presenting with clinical signs and symptoms of chronic meningitis and meningoencephalitis. Still, the etiology of one third of patients remains unclear, reflecting the diagnostic challenge of this syndrome for each physician or neurologist, respectively. However, most patients with idiopathic chronic meningitis have a relatively good outcome.
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The terms amyotrophic lateral sclerosis (ALS) or motor neuron disease (MND) refer to a condition characterized by motor system degeneration with relative preservation of other pathways. Although there have been advances in symptomatic treatment, ALS remains an incurable condition. Advances in ALS management prolong survival but simultaneously raise challenging ethical dilemmas for physicians, patients and their families. Here, we review current practice in the management of ALS including pharmacological treatment, nutritional management, respiratory care, and evolving strategies in the management of cognitive impairment.
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Journal of neurology · Jan 2009
Multicenter StudyRisk stratification of non-traumatic headache in the emergency department.
To determine the diagnostic accuracy of an algorithm structured in four clinical scenarios to discriminate benign primary headaches from serious secondary non-traumatic headaches (NTH) in the emergency department (ED). ⋯ An algorithm based on four clinical scenarios can be administered to the majority of patients presenting to the ED with the chief complaint of NTH. The algorithm showed a good accuracy in identifying patients with non-life threatening causes of headache and could be used as a risk stratification tool to improve clinical decision- making. Further studies are required to validate this diagnostic algorithm.
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Journal of neurology · Jan 2009
Psychiatric morbidity and comorbidity in different vestibular vertigo syndromes. Results of a prospective longitudinal study over one year.
High rates of coexisting vestibular deficits and psychiatric disorders have been reported in patients with vertigo. Hence, a causal linkage between the vestibular system and emotion processing systems has been postulated. The aim of this study was to evaluate the impact of vestibular function and vestibular deficits as well as preexisting psychiatric pathologies on the course of vestibular vertigo syndromes over 1 year. ⋯ A positive history of psychiatric disorders is a strong predictor for the development of reactive psychiatric disorders following a vestibular vertigo syndrome. Especially patients with vestibular migraine are at risk of developing somatoform dizziness. The degree of vestibular dysfunction does not correlate with the development of psychiatric disorders.