Current neurology and neuroscience reports
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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.
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Stroke carries a severe toll in terms of loss of life and disability for patients and their families. Until 10 years ago, physicians, and in particular neurologists, had a conservative, non-aggressive approach to this devastating disease. The advent of thrombolytic therapy not only proved that acute ischemic stroke is treatable, but also that early reperfusion can dramatically change the outcome of acute stroke patients. ⋯ Emerging therapies will soon be available to increase the therapeutic windows for thrombolysis both by better screening patients using MRI or CT and by new IV and IA treatments. Several multicenter controlled trials in both imaging-guided decisions and therapeutic agents are either completed or being performed. We review data on advancement in imaging and treatment of acute ischemic stroke, in particular focusing on pharmacologic and mechanical IA thrombolysis.
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Curr Neurol Neurosci Rep · Jan 2006
ReviewImaging of the brain and cerebral vasculature in patients with suspected stroke: advantages and disadvantages of CT and MRI.
Although neuroimaging remains the foundation for the diagnosis of cerebrovascular disease, ongoing technologic advances have now opened up new frontiers for stroke evaluation and treatment. Neuroimaging studies can provide crucial information regarding tissue injury (size, location, and degree of reversibility of ischemic injury as well as presence of hemorrhage), vessel status (site and severity of stenoses and occlusions), and cerebral perfusion (size, location, and severity of hypoperfusion). This information can be combined to identify patients with salvageable penumbral tissue who may benefit most from acute therapies. The multimodal combinations of advanced imaging techniques, particularly in the realm of CT and MRI, have emerged as the most promising noninvasive approaches to acute stroke evaluation.
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The term post-infectious encephalomyelitis (PIEM) is frequently used interchangeably with acute disseminated encephalomyelitis (ADEM), although technically PIEM occurs after a known infection whereas with ADEM there is no antecedent infection. PIEM represents one of the primary demyelinating disorders of the central nervous system, along with multiple sclerosis and Devic's disease. ⋯ Some patients improve spontaneously; most improve with methylprednisolone. If that fails, plasma exchange or intravenous immunoglobulin may be effective.
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Curr Neurol Neurosci Rep · Nov 2005
ReviewUpdate on respiratory management of critically ill neurologic patients.
Respiratory failure complicates a number of acute neurologic conditions, most notably neuromuscular diseases (eg, Guillain-Barré syndrome and myasthenia gravis) and stroke. In addition, pulmonary complications, particularly pneumonia and atelectasis, are fairly common in patients with these diagnoses; their prevention and early recognition are crucial to avoid detrimental consequences. This review discusses recent studies related to predictors of respiratory failure and pneumonia, strategies of respiratory care and ventilatory support, functional prognosis, and withdrawal of mechanical ventilation in patients with acute neuromuscular respiratory failure and stroke.