Current neurology and neuroscience reports
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Curr Neurol Neurosci Rep · Jan 2008
ReviewDevelopment of regional programs to speed treatment of stroke.
The pathophysiology of ischemic stroke dictates that treatments be administered shortly after symptom onset to be beneficial. Intravenous tissue plasminogen activator is the only drug proven to be effective in stroke; it is approved for administration within a 3-hour window. ⋯ Due to a lack of stroke specialists in many communities, some hospitals may not be prepared to provide intravenous thrombolytic therapy around the clock, and time lost transporting patients to tertiary centers may mitigate the benefits of thrombolysis. Telestroke may be the best alternative in this scenario, extending acute stroke therapies to patients who would otherwise not receive treatment.
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Recent advances in the development and administration of chemotherapy for malignant diseases have led to prolonged survival of patients and the promise of a return to normal lives. The cost of progress comes with a price, however, and the nervous system is frequently the target of therapy-induced toxicity. Unlike more immediate toxicities that affect the gastrointestinal tract and bone marrow, chemotherapy-induced neurotoxicity is frequently delayed in onset and may progress over time. In the peripheral nervous system, the major brunt of the toxic attack is directed against the peripheral nerve, targeting the neuronal cell body, the axonal transport system, the myelin sheath, and glial support structures, resulting in chemotherapy-induced peripheral neuropathy.
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Delirium is a common condition, especially in hospitalized patients. It is also associated with increased morbidity and mortality. Several studies have investigated risk factors for the development of delirium during hospitalization. This article reviews the clinical features, etiology, clinical evaluation, and treatment of this syndrome.
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Osmotherapy is the mainstay in the medical management of cerebral edema with or without elevations in intracranial pressure. Several osmotic agents have been utilized in clinical practice over the past five decades in a variety of brain injury paradigms. The over-riding premise for their beneficial effects has been via egress of water from the brain into the vascular compartment. ⋯ Although there is a paucity of large, randomized clinical trials that compare various osmotic agents, data are emerging from prospective clinical case series. This article provides a historical perspective of osmotherapy, examines characteristics of osmotic agents, and discusses caveats in their use in the clinical setting. Furthermore, this review highlights the utility of osmotic agents as tools to understand emerging mechanistic concepts in the evolution of brain edema, which are yielding important data of translational significance from laboratory-based research.
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The field of epilepsy has contributed significantly to localization of neurologic function, particularly in the neocortex. Methodologies such as cortical stimulation, positron emission tomography, functional MRI, trans-cranial magnetic stimulation, surgical resection, and magnetoencephalography have been used successfully in patients with epilepsy to locate specific functions, primarily for the purpose of defining eloquent cortex before surgical resections. The left hemisphere serves language-related functions and verbal memory in most people, whereas the right hemisphere serves some language function in addition to perceiving most components of music and other forms of nonverbal material. ⋯ Studies in patients with developmental abnormalities have enriched our understanding of localization of function within the cortex. Future studies may help us understand the sequence in which specific regions are activated during specific tasks and determine which regions are necessary for tasks and which are supplementary. The ability to predict preoperatively the effect of removal of specific tissues would benefit surgical planning for all patients who undergo cortical resections, including those with epilepsy.