ИМХО - интересно: медицинские ссылки.

[FRSM]

BMJ 2011; 342
Editorial


Autoimmune encephalitis



Treatable syndromes with characteristic clinical features

It is essential not to miss potentially treatable causes of new onset confusion or amnesia. Once toxic and metabolic causes have been excluded, infectious encephalitis must be considered and treated. However, the results of a recent surveillance study in the United Kingdom found that only 42% of patients with encephalitis had an identifiable infectious cause. 1 Even just a decade ago, the cause of encephalitis in those without an identifiable infection may well have remained obscure. There is now unequivocal evidence that specific autoantibodies directed against neuronal proteins crucial to the control of neurotransmission are responsible for a proportion (~8% in one series 1) of such cases.2 Importantly, these autoimmune encephalitides may be treatable with immunotherapy.345678

Antibodies against two targets, the voltage gated potassium channel (VGKC) complex and the N-methyl-D-aspartic acid (NMDA) receptor, have emerged as important causes—more than 100 related or relevant articles have been published in the past two years alone. These autoimmune encephalitides have distinctive clinical features and can be diagnosed by simple serological tests. Despite almost certainly being underdiagnosed, about 400 patients with clinically relevant raised VGKC complex or NMDA antibody titres have been …

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[MKMED]

Кстати, радиологам:
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[easl]

When LP Is Not Necessary to Detect Subarachnoid Bleed

CT performed within 6 hours of symptom onset in neurologically intact patients had 100% negative predictive value in this prospective multicenter study.

Standard teaching is that lumbar puncture (LP) is essential in patients with suspected subarachnoid hemorrhage (SAH) despite normal head computed tomography (CT) scans. Researchers prospectively enrolled 3132 consecutive neurologically intact patients older than 15 who underwent head CT with third-generation multislice scanners to evaluate nontraumatic acute headache or headache with syncope at 11 tertiary emergency departments in Canada from 2000 to 2009. LP was performed at the discretion of the treating physician. Experienced radiologists who were blinded to the study interpreted all CT scans. SAH was defined by subarachnoid blood on CT, aneurysm on cerebral angiography, or xanthochromia in cerebrospinal fluid.

Mean headache peak pain severity was 8.7 on a 0–10 scale. LP was performed in 49% of patients after negative CT scans. Overall, 240 patients (7.7%) were diagnosed with SAH. The sensitivity of head CT for SAH was 92.9%, and the negative predictive value (NPV) was 99.4%. Emergency physicians identified all but three cases of SAH; all three patients were scanned >6 hours after headache onset. Among 953 patients who were scanned within 6 hours of symptom onset, head CT had 100% sensitivity and 100% NPV. Follow-up at 1 and 6 months did not identify any cases of missed SAH.

Comment: Because subarachnoid blood diffuses and hemolyzes within hours, CT might not be able to distinguish cerebrospinal fluid from blood as time passes. Patients with histories that raise concern for SAH should be prioritized to undergo CT within 6 hours of symptom onset. If CT is performed with a modern scanner and is interpreted as negative for SAH by an experienced radiologist, LP is unnecessary, unless it is being performed to detect other causes of headache.

— Kristi L. Koenig, MD, FACEP

Published in Journal Watch Emergency Medicine August 5, 2011

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[cactus1972]

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Опубликован в Annals of Internal Medicine, 2011, vol.155, №6.

[cactus1972]

Гайдлайн от American Academy of Neurology

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[cactus1972]

Несколько гайдов от American Academy of Neurology

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Опубликовано в Neurology. 2012;78:139-145.

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Опубликовано в Neurology. 2011;77:2128-2134.

[tambofff]

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[cactus1972]

Простейший опросник для выявления признаков когнитивной дисфункции как раннего фактора риска развития болезни Альцгеймера, предлагают американские исследователи

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[cactus1972]

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[cactus1972]

Новый гайдлайн АНА/ASA по ведению нетравматического САК

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Положения, добавленные и/или обновленные по сравнению с предыдущей версией

The 5 new class I (level B) recommendations are as follows:

-After any aneurysm repair, immediate cerebrovascular imaging is generally recommended to identify remnants or recurrence of the aneurysm that may require treatment.

-Digital subtraction angiography with 3-dimensional rotational angiography is indicated for detection of aneurysm in patients with aSAH (except when the aneurysm was previously diagnosed by noninvasive angiography) and for planning treatment (to determine whether an aneurysm is amenable to coiling or to expedite microsurgery).

-Between the time of aSAH symptom onset and aneurysm obliteration, blood pressure should be controlled with a titratable agent to balance the risk for stroke, hypertension-related rebleeding, and maintenance of cerebral perfusion pressure.

-In the absence of a "compelling" contraindication, patients who undergo coiling or clipping of a ruptured aneurysm should have delayed follow-up vascular imaging (timing and modality to be individualized), and re-treatment, by repeat coiling or clipping, should be strongly considered if there is a clinically significant (eg, growing) remnant.

-Heparin-induced thrombocytopenia and deep venous thrombosis are both infrequent but not uncommon occurrences after aSAH. Early identification and targeted treatment are recommended, but further research is needed to identify the ideal screening paradigms.

The 9 revised recommendations are as follows:

-For patients with an unfavorable delay in obliteration of aneurysm, a significant risk for rebleeding, and no compelling medical contraindications, short-term ( < 72 hours) therapy with tranexamic acid or aminocaproic acid is reasonable to reduce the risk for early aneurysm rebleeding. (Class IIa, Level B)

-Experienced cardiovascular surgeons and endovascular specialists should determine a multidisciplinary treatment approach based on characteristics of the patient and the aneurysm. (Class I, Level C)

-For patients with ruptured aneurysms judged to be technically amenable to both endovascular coiling and neurosurgical clipping, endovascular coiling should be considered. (Class I, Level B)

-Low-volume hospitals should consider early transfer of patients with aSAH to high-volume centers. (Class I, Level B)

-Maintaining euvolemia and normal circulating blood volume is recommended to prevent disseminated intravascular coagulation (DCI). (Revised, Class I, Level B)

-Induction of hypertension is recommended for patients with DCI unless blood pressure is elevated at baseline or cardiac status precludes it. (Class I, Level B)

-Cerebral angioplasty and/or selective intra-arterial vasodilator therapy is "reasonable" in patients with symptomatic cerebral vasospasm, particularly those who are not rapidly responding to hypertensive therapy. (Class IIa, Level B)

-aSAH-associated acute symptomatic hydrocephalus should be managed by cerebrospinal fluid diversion (external ventricular drainage or lumbar drainage, depending on the clinical scenario). (Class I, Level B)

-aSAH-associated chronic symptomatic hydrocephalus should be treated with permanent cerebrospinal fluid diversion. (Class I, Level B)

[nebel]

Статья из CONTINUUMа по эпилептическому статусу :
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[smolin]

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Вот оно как, оказывается. Бедные мы бедные. У кого что болит, тот о том и говорит?

Migraine Among Norwegian Neurologists

Background.— Previous studies have shown a high prevalence of migraine among neurologists. The main objective of this study was to assess the prevalence of migraine and its subtypes among neurologists in Norway.

Method.— Questionnaire-based cross-sectional study among every Norwegian neurologist registered on March 19, 2010.

Results.— Among the 384 neurologists, 245 (64%) participated. Of these, 95 (39%) reported having experienced migraine aura, and 86 having experienced migraine headache (35%). By employing the International Headache Society criteria for migraine with regard to the number of attacks, the gender-adjusted lifetime and 1-year prevalence was 38.7% (95% CI 30.3-47.7) and 33.8% (95% CI 25.9-47.2), respectively. Age-adjusted 1-year prevalence of migraine headache (not including subjects experiencing visual aura only) for men was 15.9% and for women 36.7%, which gives an overall age and gender-adjusted prevalence of 26.3% (95% CI 18.5-34.2). Solitary auras were experienced by 83 (34%), of which 73 (30%) had experienced this twice or more frequently. The majority of the neurologists thought that migraine was underdiagnosed and undertreated, 70% and 68%, respectively.

Conclusion.— The study confirms the results of previous studies, indicating that migraine, including visual aura, is more common among neurologists than what would be expected from population-based studies. Because this group, through professional experience with the condition, can make accurate diagnoses in themselves, and will have fewer problems with recalling headache episodes, the prevalence figures obtained may give the most precise estimate of the true population prevalence.

[nebel]

Acute and Preventive Treatment of Migraine опять из CONTINUUMa
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[nebel]

Уважаемые коллеги, есть бесплатный доступ к статьям журнала "Clinical Practice Neurology" от AAN, как долго они будут бесплатно доступны мне неизвестно, имеет смысл поторопиться со скачиванием.
ссылки привожу ниже:
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[nebel]

Recurrent Spontaneous Attacks of Dizziness: [Ссылки доступны только зарегистрированным пользователям ]