Current neurology and neuroscience reports
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With significant advances in surgical technology and methodology, mortality from congenital heart surgery has been significantly reduced in recent decades. Therefore, focus has naturally turned towards predicting, evaluating, and preventing the neurodevelopmental morbidity associated with congenital heart disease and its treatment. This paper reviews recent publications evaluating preoperative neurologic abnormalities and injuries, current neurodevelopmental outcomes of congenital heart repair, and various neuromonitoring modalities that can be used to monitor neurologic function/dysfunction perioperatively. The rapidly advancing field of clinical neuromonitoring holds the promise of providing modalities that can detect injurious processes acutely to allow for intervention.
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A comprehensive review of the neurotologic manifestations of migraine is presented, focusing on the most recent publications regarding the epidemiology, clinical presentation, pathophysiology, diagnosis, and management of migraine-related vertigo (MV). A strong association exists between vertigo and migraine, with MV being the most common cause of spontaneous (nonpositional) episodic vertigo. Symptoms can be quite variable among patients and within individual patients over time, creating a diagnostic challenge. ⋯ Operational diagnostic criteria have been proposed but are not included in the most recent International Headache Society classification of migraine. Better elucidation of the neurologic linkages between the central vestibular pathways and migraine-related pathways and the discovery of ion channel defects underlying some causes of familial migraine, ataxia, and vertigo have furthered the understanding of MV pathophysiology. Treatment of MV currently parallels that of migraine headache, as proper studies of optimal MV management are just beginning.
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Curr Neurol Neurosci Rep · Mar 2006
ReviewControversies in the care of children with acute brain injury.
Care of children with acute brain injury is evolving from mere observation to active intervention that requires intensive care units focused on the nervous system primarily and other organs secondarily. The physical examination supplemented by neuroimaging, invasive monitoring, and an improved understanding of the mechanisms of injury allows for the development of rational therapies. This paper reviews common bedside controversies in care, including initial assessments and outcomes, as well as the prevention of secondary injury through the maintenance of brain oxygen and energy and the treatment of cerebral edema. The advantages and disadvantages of frequently utilized techniques are identified.