Reviews in neurological diseases最新文献

Delirium is a term used variously to characterize a change in behavior. Neurologists most often use the term to describe a patient who has acutely developed a hyperactive agitated state. In many patients, agitation and overactivity are explained by toxic and metabolic factors and infections. Lesions, especially strokes, in some brain regions have been reported to cause sudden agitation and a hyperactive state, often with an increased amount of speech output, the topics of which flit from one subject to another. Strokes and other lesions that involve the temporal lobes, fusiform and lingual gyri, caudate nucleus, and anterior cingulum have been reported to cause an acute hyperactive state similar to that found in patients with delirium tremens related to alcohol withdrawal.

In general practice, the sex-specific consultation rate for headache is only slightly lower for men than it is for women. Headache is 2 to 3 times more common in women than it is in men, and women outnumber men in general practice by 2-fold. However, in headache practice they seem to outnumber men by 4- to 5-fold, suggesting a specific barrier to seeking specialty care. Although there is extensive literature specifically concerning headache in women, a PubMed search did not reveal any publications specifically addressing the problem in men, with the exception of cluster headache, a well-known headache condition that is more frequent in men. As a first attempt at filling this void, we analyzed the headache features, associated symptoms, and precipitating, aggravating, and relieving factors in 100 randomly selected men from a headache practice. Our results indicate that headache is a significant medical problem in men, and they seem to be underrepresented when it comes to seeking expert headache care.

Many treatments for acute ischemic stroke are vessel and blood based, but brain-based therapies also hold great promise. Acute neuroprotective therapies block the molecular elaboration of injury in hypoxic environments. Prehospital trials of magnesium sulfate are demonstrating the feasibility of delivering potentially brain-protective agents in the first minutes after stroke onset. Subacute neurorestoration therapies enhance neuroplasticity and brain reorganization following stroke. The greatest clinical experience with agents that can potentiate brain repair has been gained with choline precursors. Therapies that target the brain in stroke patients will increasingly complement and enhance traditional vasotherapeutics.

On the occasion of the 125th anniversary of the Philadelphia Neurologic Society, 3 short talks were given that highlighted accomplishments by Philadelphia's neurologists over the past 30 years. The theme for the celebration was "Contributions to Neurology by Philadelphia Neurologists, 1980-2008." Each of the 3 speakers was chosen because of his contributions and the sequential time frames in which they occurred. Dr. Arthur K. Asbury detailed the original description of the Lewis-Sumner syndrome, Dr. Michael R. Sperling summarized the growth of epilepsy surgery in Philadelphia, and Dr. Geoffrey K. Aguirre depicted the roots of functional magnetic resonance imaging in Philadelphia.

An 85-year-old man was hospitalized after developing sudden weakness on his right side and mild expressive aphasia. He had undergone γ knife stereotactic radiosurgery to the left thalamus 7.5 years earlier for a disabling essential tremor; the surgery had led to remarkable improvement in his ability to write and use utensils. He was being treated with warfarin for chronic atrial fibrillation. A computed tomography scan of the brain revealed a 2-cm left thalamic hemorrhage in the precise region of the prior thalamotomy.

The field of sleep medicine has grown exponentially worldwide. Sleep apnea is linked to the obesity epidemic, which, in some regions of the United States, affects more than one-third of the population. Sleep alterations increase the risk of cardiovascular and cerebrovascular pathology through a diversity of direct and indirect mechanisms. Recent investigations have found a clinical correlation between sleep disorders and diabetes. Obese pregnant women are at high risk for development of sleep apnea and preeclampsia. New studies have uncovered that restless legs syndrome and periodic limb movements may increase the risk of hypertension and vascular disease. Sudden death in sleep may be preventable if conditions that lead to sudden death are investigated. New neuroimaging techniques during sleep in patients with insomnia have uncovered metabolic overactivity in areas of the brain related to maintenance of wakefulness. Sleep neuroimaging promises to have research and clinical diagnostic applications.

Frequent headache is defined as headaches ≥ 15 days/month and daily headache operationally as headaches ≥ 5 days/week. In this article, we review the outcome of frequent/ daily headache in the general population and in medical practice. In the general population, within 1 year fewer than half of those with frequent/daily headache will still have frequent/daily headache, with a gradual further decrease over subsequent years. In medical practice, the results of studies suggest a one-third reduction in headache days/month over 6 to 12 months, with nearly 40% of patients with frequent/daily improving ≥ 50% in headache days/month over the same time period (50% responder rate). In terms of predictors of poor outcome, no clear picture emerges.