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Pediatric needle procedures: Parent–child interactions, child fear, and evidence-based treatment.
This article provides an overview of my research program which focuses on three interrelated aspects of children's procedural pain: (1) the behaviour of parents while their children are in pain, (2) understanding and measuring child needle fear, and (3) evidence-based treatment. Full insight into the nature and impact of parent communicative behaviours during pain is critical as we can change them to decrease child pain and distress. Fear can influence pain perception; therefore, improved understanding of needle fear and measurement of fear in the context of painful medical procedures is important to guide effective interv...
Source: Canadian Psychology - February 25, 2013 Category: Psychiatry & Psychology Authors: McMurtry, C. Meghan Source Type: research
Positioning of infants in the neonatal intensive care unit for lumbar puncture as determined by bedside ultrasonography
Realising the paucity of data in the standardisation of the optimal position for lumbar puncture (LP) in hospitalised neonates, we have designed an observational study to measure the interspinous distance in infants in a university hospital setting. The infants were placed in two lateral recumbent and two upright positions (lateral recumbent without flexing the hips, lateral recumbent with maximal hip flexion, sitting without flexing the hips and sitting with maximal hip flexion) with concomitant heart rate (HR), transcutaneous oxygen saturation (OS) and interspinous distance (with ultrasonography) measurements. Having the...
Source: Archives of Disease in Childhood - Fetal and Neonatal Edition - February 15, 2013 Category: Perinatology & Neonatology Authors: Oncel, S., Gunlemez, A., Anik, Y., Alvur, M. Tags: Child health, Neonatal and paediatric intensive care, Neonatal health, Radiology, Neonatal intensive care, Clinical diagnostic tests, Radiology (diagnostics) Original articles Source Type: research
Evaluation of Fever in infants and young children.
Abstract Febrile illness in children younger than 36 months is common and has potentially serious consequences. With the widespread use of immunizations against Streptococcus pneumoniae and Haemophilus influenzae type b, the epidemiology of bacterial infections causing fever has changed. Although an extensive diagnostic evaluation is still recommended for neonates, lumbar puncture and chest radiography are no longer recommended for older children with fever but no other indications. With an increase in the incidence of urinary tract infections in children, urine testing is important in those with unexplained fever....
Source: American Family Physician - February 15, 2013 Category: Primary Care Authors: Hamilton JL, John SP Tags: Am Fam Physician Source Type: research
Effects of Intravenous Solanezumab 400 mg q 4 Weeks vs. Placebo on Biomarkers in Patients with Mild to Moderate Alzheimer's Disease: Results of Two Phase 3 Studies (P01.011)
CONCLUSIONS: Solanezumab target engagement is associated with alteration of amyloid biology. There was a lack of apparent effect on markers of neurodegeneration. The overall findings lend support for the amyloid cascade hypothesis and suggest that various aspects of the cascade are viable targets for treatment of Alzheimer's disease.Supported by: Eli Lilly and Co.Disclosure: Dr. Hake has received personal compensation for activities with Eli Lilly and Company as an employee. Dr. Hake holds stock in Eli Lilly and Company. Dr. Siemers has received personal compensation for activities with Eli Lilly and Company as an employee...
Source: Neurology - February 14, 2013 Category: Neurology Authors: Hake, A., Siemers, E., Carlson, C., Estergard, W., Sundell, K., Henley, D., Eads, J., Sexton, C., Liu-Seifert, H., Sethuraman, G., Chen, Y.-F., Mintun, M., Pontecorvo, M., Joshi, A., Dean, R., Willis, B., Demattos, R., Mohs, R. Tags: P01 Aging and Dementia: Therapeutics and Clinical Trials Source Type: research
Initial Findings of a Randomized Double-Blinded Placebo-Controlled Study of Intravenous Immunoglobulin in Mild Cognitive Impairment Due to Alzheimer Disease (P01.013)
CONCLUSIONS: IVIG in subjects with MCI was associated with decreased brain atrophy and improvement of cognitive function on CDR-SB. Affect on conversion rate to AD is yet to be determined. These preliminarily positive but non-statistically significant results indicate that a relatively short course of IVIG in MCI may have disease-modulating effects in AD.Supported by: Sutter Institute for Medical Research; Octapharma.Disclosure: Dr. Kile's institution has received research support from Octapharma. Dr. Au has received research support from Octapharma. Dr. Parise's institution received personal compensation for activities wi...
Source: Neurology - February 14, 2013 Category: Neurology Authors: Kile, S., Au, W., Parise, C., Low, R. Tags: P01 Aging and Dementia: Therapeutics and Clinical Trials Source Type: research
Isolated Bilateral Cranial Nerve Three Palsy as Unique Manifestation of CNS Spread of Burkitt Lymphoma (P01.058)
CONCLUSIONS: Thus, this case illustrates an atypical presentation of presumed CNS infiltration of Burkitt lymphoma, with a non-diagnostic work-up, which responded to radiation treatment. This may suggest a role for radiation therapy when CNS spread is suspected clinically despite a lack of positive confirmatory diagnostic testing.Disclosure: Dr. Damian has nothing to disclose. Dr. Lambert has nothing to disclose. Dr. Laneuville has nothing to disclose. (Source: Neurology)
Source: Neurology - February 14, 2013 Category: Neurology Authors: Damian, A., Lambert, C., Laneuville, P. Tags: P01 Neurologic Manifestations: Therapeutics Source Type: research
Intrathecal Chemotherapy (Part II): Changes in Procedures and Technique. Evaluation of Results (P01.100)
CONCLUSIONS: There was a low rate of side effects, all minor and with full resolution. The IT-ChT technique here described was safe.Supported by: Scholarship Peruilh-Menvielle, School of Medicine, University of Buenos Aires.Disclosure: Dr. Báez has nothing to disclose. Dr. Baez has nothing to disclose. Dr. Kuchkaryan has nothing to disclose. Dr. Tafur Canabal has nothing to disclose. Dr. Igirio Gamero has nothing to disclose. Dr. Gonzalez Roffo has nothing to disclose. Dr. Torres has nothing to disclose. Dr. Caffaro has nothing to disclose. Dr. Campanucci has nothing to disclose. Dr. Hurevich has nothing to disclose...
Source: Neurology - February 14, 2013 Category: Neurology Authors: Baez, A., Baez, M., Kuchkaryan, V., Tafur Canabal, J., Igirio Gamero, J., Gonzalez Roffo, A., Torres, Z., Caffaro, M., Campanucci, V., Hurevich, P., Casas-Parera, I. Tags: P01 Neuro-Oncology: Therapeutics Source Type: research
Intrathecal Chemotherapy (Part I): First 100 Sequentials Procedures and Its Acute Complications. Technique and Safety (P01.101)
CONCLUSIONS: The IT-ChT procedure following this technique was safe. We observed immediate minor complications to be aware of at the time of performing the IT-ChT.Supported by: Scholarship Peruilh-Menvielle, School of Medicine, University of Buenos Aires.Disclosure: Dr. Casas Parera has nothing to disclose. Dr. Rudy has received personal compensation for activities with Bristol-Myers Squibb Company. Dr. Cardozo-Oliver has nothing to disclose. Dr. Báez has nothing to disclose. Dr. Baez has nothing to disclose. Dr. Horsburgh has received personal compensation for activities with Roche. (Source: Neurology)
Source: Neurology - February 14, 2013 Category: Neurology Authors: Casas-Parera, I., Rudy, T., Cardozo-Oliver, J., Baez, A., Baez, M., Horsburgh, M. Tags: P01 Neuro-Oncology: Therapeutics Source Type: research
Reversible Cerebellar Ataxia Due to Ovarian Teratoma (PD2.008)
CONCLUSIONS: Our case suggests that acute cerebellar ataxia may be associated with an underlying ovarian teratoma. To our knowledge, this is the first report of such an association although another reversible disorder, anti-NMDA receptor encephalitis has been well-described. Our case may represent a new category of immune-mediated cerebellar ataxia that is reversible with treatment of the underlying tumor.Disclosure: Dr. Park has nothing to disclose. Dr. Liang has received personsal compensation for activities with Teva Neuroscience as a consultant. Dr. Liang has received research support from Allergan. (Source: Neurology)
Source: Neurology - February 14, 2013 Category: Neurology Authors: Park, J., Liang, T.-W. Tags: PD2 Movement Disorders: Ataxias Source Type: research
Office-Based Single-Shot Bolus Trial of Intrathecal Ziconotide in Patients with Painful Myelopathy and Neuropathy (P02.009)
CONCLUSIONS: Preliminary data supports efficacy and safety of outpatient ITZ SST in medically refractory painful myelopathies and neuropathies. Use of CAP technique in patients who already have IT delivery systems. These results must be interpreted cautiously and replicated in a larger sample.Supported by: Sylvia Lawry Physician Fellowship from the National Multiple Sclerosis Society (JN).Disclosure: Dr. Nicholas has received research support from National Multiple Sclerosis Society. Dr. Bartoszek has nothing to disclose. Dr. Lawson received personal compensation from Pfizer and Baxter for consulting services. Dr. O'Connel...
Source: Neurology - February 14, 2013 Category: Neurology Authors: Nicholas, J., Bartoszek, M. P., Lawson, V., O'Connell, C., Boster, A. Tags: P02 Ethics, Pain, and Palliative Care Source Type: research
A Case Report of Dihydroergotamine Administration for Status Migrainosus in a Patient on Longstanding Citalopram Causing a Fatal Reversible Cerebral Vasoconstriction Syndrome (RCVS) (P02.027)
CONCLUSIONS: We report this case report of fatal RCVS of a patient on long standing citalopram who developed this after being administered Dihydroergotamine for status migrainosus. As this is thought to be a self-limiting in terms of clinical features. However, some patients may have more severe focal neurologic symptoms and signs, including ischemic or hemorrhagic strokes as described in our patient.Disclosure: Dr. Asi has nothing to disclose. Dr. Gomes has nothing to disclose. Dr. Dani has nothing to disclose. (Source: Neurology)
Source: Neurology - February 14, 2013 Category: Neurology Authors: Asi, K., Gomes, J., Dani, D. Tags: P02 Cerebrovascular Disease II Source Type: research
Sporadic Cruzfeldt-Jakob Presenting with Fixed Focal Dystonia (P02.068)
CONCLUSIONS: Movement disorders are unusual presenting symptoms of CJD. Of these, fixed dystonia is a rare, with one case previously reported. In the majority of cases, dystonia is associated with other movement disorders, such as focal jerk myoclonus, choreoathetoid movements, postural tremor, alien limb, or bradykinesia.Disclosure: Dr. Alias has nothing to disclose. Dr. Scott has nothing to disclose. Dr. Apetauerova has nothing to disclose. (Source: Neurology)
Source: Neurology - February 14, 2013 Category: Neurology Authors: Alias, M., Scott, B., Apetauerova, D. Tags: P02 Movement Disorders: Dystonia Source Type: research
A Tale of Two Eyes (P02.187)
CONCLUSIONS: Isolated bilateral sixth nerve palsy has been described in the literature and its incidence is almost equal to unilateral sixth nerve palsy. The most common causes are tumors and demyelinating lesions. Miller fisher syndrome classically presents with a triad of ataxia, opthalmoplegia and areflexia . It may present only as acute ophthalmoperesis, however this has been described in very few case reports. Rarely is the presentation isolated bilateral sixth nerve palsy as seen in our patient. It is hypothesized that infection by microorganism expressing GQ1b epitope triggers production of IgG anti-GQ1b antibodies....
Source: Neurology - February 14, 2013 Category: Neurology Authors: Mittal, S., Imperioli, M., Silverman, I. Tags: P02 Peripheral Nerve: Basic Science and Diagnostics Source Type: research
Feasibility and Safety of Lumbar Punctures in the Parkinson Progression Marker Initiative (PPMI) (P03.068)
CONCLUSIONS: Obtaining CSF in a cohort of newly diagnosed PD and HV subjects is safe and feasible. Specific LP techniques (gauge and type of needle, subject position and level of insertion) may reduce the overall incidence of adverse events.Supported by: Michael J Fox Foundation for Parkinson's Research, GE Healthcare, Pfizer, Roche, Genentech, Merck, Abbott, Biogen Idec, Covance, Glaxo-Smith Kline, Avid Radiopharmaceuticals, Elan Corporation, plc., F. Hoffman-La Roche Ltd and Eli Lily.Disclosure: Dr. Frank has received personal compensation for activities with Lundbeck and Analysis Group as a consultant. Dr. Lasch has not...
Source: Neurology - February 14, 2013 Category: Neurology Authors: Frank, S., Lasch, S., Caspell, C., Uribe, L., Jennings, D., Marek, K., Investigators of Parkinson Progression Markers Initiative, Tags: P03 Movement Disorders: Parkinson ' s Disease Epidemiology and Biomarkers Source Type: research
CSF PKR Is a Diagnostic and Prognostic Marker in Alzheimer's Disease (P03.073)
CONCLUSIONS: The evaluation of CSF PKR and pPKR concentrations could help to improve AD diagnosis and could be an appropriate prognostic marker in AD patients.Supported by: Inserm and Assistance Publique -Hopitaux de Paris.Disclosure: Dr. Hugon has received personal compensation for activities with Novartis, Lundbeck, and Pharnext. Dr. Hugon has received research support from Sanofi-Aventis Pharmaceuticals, Inc. Dr. Mouton Liger has nothing to disclose. Dr. Dumurgier has received personal compensation for activities with Novartis. Dr. Laplanche has nothing to disclose. Dr. Paquet received personal compensation for activiti...
Source: Neurology - February 14, 2013 Category: Neurology Authors: Hugon, J., Mouton Liger, F., Dumurgier, J., Laplanche, J. L., Paquet, C. Tags: P03 Fluid and Other Biomarkers Source Type: research
Predictive Value of CSF Biomarkers for Alzheimer's Disease in an Italian Cohort of Patients with Mild Cognitive Impairment (P03.074)
CONCLUSIONS: CSF Aβ-42, T-tau, P-tau evaluation is extremely useful in patients with MCI, in order to assess the probability of progression to Alzheimer's disease. When evaluated together, these CSF biomarkers, show a sensitivity of 89%, a specificity of 77%, a PPV of 73%, and a VPN of 91% in highlighting a CSF alteration predicting AD. In particular, CSF AD profile seems to play an important role as predictive tool in MCI patients.Disclosure: Dr. Rubino has nothing to disclose. Dr. Vacca has nothing to disclose. Dr. Govone has nothing to disclose. Dr. Pinessi has nothing to disclose. Dr. Rainero has nothing to disclo...
Source: Neurology - February 14, 2013 Category: Neurology Authors: Rubino, E., Vacca, A., Govone, F., Pinessi, L., Rainero, I. Tags: P03 Fluid and Other Biomarkers Source Type: research
CSF Total and Phosphorylated Tau Biomarker Findings in a Large Rapidly Progressive Dementia Cohort (P03.077)
CONCLUSIONS: Our data suggest that a CSF TTau/PTau ratio ≥ 25 might be a better diagnostic marker than TTau alone at >1200 pg/mL.Disclosure: Dr. Forner has nothing to disclose. Dr. Bechtel has nothing to disclose. Dr. Wong has nothing to disclose. Dr. Geschwind has received personal compensation for activities with Gerson Lehrman Group, Clinical Advisors and MedaCorp, and Eisai, Inc. (Source: Neurology)
Source: Neurology - February 14, 2013 Category: Neurology Authors: Forner, S., Bechtel, K., Wong, K., Geschwind, M. Tags: P03 Fluid and Other Biomarkers Source Type: research
Proof of Principle Study: Diagnosing MS by Analyzing the CSF Cell Transcriptome (P03.231)
CONCLUSIONS: The analysis of the transcriptome of cells derived from cerebrospinal fluid samples provides meaningful findings which may lead to the discovery of new MS biomarkers.Disclosure: Dr. Yoon has nothing to disclose. Dr. Mueller has nothing to disclose. Dr. Franzova has nothing to disclose. Dr. Sadiq has nothing to disclose. (Source: Neurology)
Source: Neurology - February 14, 2013 Category: Neurology Authors: Yoon, B. H., Mueller, A., Franzova, E., Sadiq, S. Tags: P03 Multiple Sclerosis: Disease Biomarkers Source Type: research
Tear Analysis in Radiologically Isolated Syndrome as New Tool To Predict Risk to a Clinical Conversion (P03.236)
CONCLUSIONS: CSF OCB presence in RIS is considered to be predictive of conversion to a clinical event. Associated with spatial dissemination MRI criteria, their detection denotes a statistically significant increased conversion risk to clinical conversion. For OCB negative patients, a tears follow-up could help to early detection of CSF conversion. We suggest that tears OCB detection may replace CSF OCB detection as a diagnostic tool in patients with RIS. This would circumvent the practice of invasive lumbar puncture and probably will increase facilities for patients and neurologists to accept MRI T2 hypersignals investiga...
Source: Neurology - February 14, 2013 Category: Neurology Authors: Lebrun Frenay, C., Forzy, G., Collongues, N., De Seze, J., Hautecoeur, P. Tags: P03 Multiple Sclerosis: Disease Biomarkers Source Type: research
Application of a Novel Diagnostic Test to Patients with Demyelinating Disease: The Accuracy of MSPrecise ™ (P03.242)
CONCLUSIONS: Beyond advancing diagnostic evaluations, these mutation patterns will be potentially helpful for understanding the pathogenesis of multiple sclerosis.Supported by: National Multiple Sclerosis Society, DioGenix.Disclosure: Dr. Monson has received personal compensation for activities with Genentech and MedImmune. Dr. Monson has received research support from DioGenix, Inc. Dr. Ligocki has nothing to disclose. Dr. Rounds has nothing to disclose. Dr. Bigwood has received personal compensation for activities with DioGenix, Inc. Dr. Eastman has received personal compensation for activities with Gene Logic, Inc., Ver...
Source: Neurology - February 14, 2013 Category: Neurology Authors: Monson, N., Ligocki, A., Rounds, W., Bigwood, D., Eastman, E., Cowell, L., Frohman, E., Greenberg, B. Tags: P03 Multiple Sclerosis: Disease Biomarkers Source Type: research
Clinical Reasoning: Multiple cranial neuropathies in a young man
A 19-year-old man with no significant medical history noted 3 weeks of right facial numbness and slurred speech. On examination, he had decreased sensation in the right middle and lower trigeminal nerve distributions, right tongue deviation, and bilateral facial weakness. A lumbar puncture yielded CSF with a lymphocytic predominant pleocytosis (50 leukocytes/mm3, 95% lymphocytes), elevated protein (260 mg/dL), and normal glucose (49 mg/dL), without other evidence of inflammation or infection, while serum studies were normal. Brain MRI with gadolinium demonstrated a subcentimeter left frontal subcortical white matter lesion...
Source: Neurology - February 4, 2013 Category: Neurology Authors: Probasco, J. C., Munchel, A. T., McArthur, J. C., Blakeley, J. O. Tags: Meningitis, All Clinical Neurology, All Oncology, Cranial neuropathy RESIDENT AND FELLOW SECTION Source Type: research
Severe Headache After Hysterectomy – Sharon’s Story
I had a toal hysterectomy in December 2012, everything went well and I was discharged on three days later. However six days after this I was shopping in the supermarket when I was suddenly struck with a blinding headache. It started on the left side of my head and within minutes it had travelled across my whole forehead. I was sick, the pain was unbareable, I had never experienced anything like it. I took two paracetamol and went to bed in a dark room to sleep it off, after two hours the pain was still ferocious and I was crying and being sick. My husband telephoned the hospital and they admitted me. I had to have an injec...
Source: The Hysterectomy Association - February 3, 2013 Category: OBGYN Authors: Linda Parkinson-Hardman Tags: Your Stories headache migraine Source Type: news
Neurological sequelae from brachiocephalic vein stenosis.
Abstract Stenosis of central veins (brachiocephalic vein [BCV] and superior vena cava) occurs in 30% of hemodialysis patients, rarely producing intracranial pathology. The authors present the first cases of BCV stenosis causing perimesencephalic subarachnoid hemorrhage and myoclonic epilepsy. In the first case, a 73-year-old man on hemodialysis presented with headache and blurry vision, and was admitted with presumed idiopathic intracranial hypertension after negative CT studies and confirmatory lumbar puncture. The patient mildly improved until hospital Day 3, when he experienced a seizure; emergency CT scans sho...
Source: Journal of Neurosurgery - February 1, 2013 Category: Neurosurgery Authors: Herzig DW, Stemer AB, Bell RS, Liu AH, Armonda RA, Bank WO Tags: J Neurosurg Source Type: research
Incidence and risk factors for central nervous system relapse in children and adolescents with acute lymphoblastic leukemia
CONCLUSIONS: These results suggest that a leukocyte count > 50 x 10(9)/L at diagnosis seems to be a significant prognostic factor for a higher incidence of central nervous system relapse in childhood acute lymphoblastic leukemia. (Source: Revista Brasileira de Hematologia e Hemoterapia)
Source: Revista Brasileira de Hematologia e Hemoterapia - January 25, 2013 Category: Hematology Source Type: research
Pearls and Oy-sters: Tuberculous meningitis: Not a diagnosis of exclusion
A 21-year-old man presented to his local emergency department with 5 days of headache, which was dull, occipital, bilateral, nonthrobbing, and progressively worsening. It was associated with mild fever, photophobia, and neck pain and stiffness. He had no history of headache, chronic illness, recent vaccinations, cutaneous rash, cough, diarrhea, arthralgia, or myalgia. He was from Ecuador and had been living in the United States for less than 1 year. He had been incarcerated while in Ecuador. Sublingual temperature on admission was 102.6°F. Other vital signs were within normal limits. On physical examination, he appeare...
Source: Neurology - January 21, 2013 Category: Neurology Authors: Jongeling, A. C., Pisapia, D. Tags: Hydrocephalus, Encephalitis, Meningitis, Critical care RESIDENT AND FELLOW SECTION Source Type: research
Optic Nerve Sonography to Monitor Treatment Efficacy in Idiopathic Intracranial Hypertension: A Case Report
CONCLUSIONSUS of ONSD and ODE was useful to support the diagnosis of IIH and to monitor the efficacy of diet and pharmacological treatment. Further studies are required to evaluate whether this promising technique may be considered a reliable and accurate method to longitudinally evaluate patients with increased ICP secondary to IIH. (Source: Journal of Neuroimaging)
Source: Journal of Neuroimaging - January 15, 2013 Category: Radiology Authors: Piergiorgio Lochner, Raffaele Nardone, Frediano Tezzon, Lorenzo Coppo, Francesco Brigo Tags: Case Report Source Type: research
Procedural pain in neonates: the state of the art in the implementation of national guidelines in Italy
ConclusionThis survey showed that most Italian NICUs provide some form of analgesia and sedation for invasive procedures in accordance with national guidelines, but their routine adherence to best practices for pain control and monitoring is still suboptimal. (Source: Pediatric Anesthesia)
Source: Pediatric Anesthesia - January 13, 2013 Category: Anesthesiology Authors: Paola Lago, Elisabetta Garetti, Giovanna Boccuzzo, Daniele Merazzi, Anna Pirelli, Luisa Pieragostini, Simone Piga, Marina Cuttini, Gina Ancora Tags: Original Article Source Type: research
Procedural pain in neonates: the state of the art in the implementation of national guidelines in Italy.
CONCLUSION: This survey showed that most Italian NICUs provide some form of analgesia and sedation for invasive procedures in accordance with national guidelines, but their routine adherence to best practices for pain control and monitoring is still suboptimal. PMID: 23301982 [PubMed - as supplied by publisher] (Source: Paediatric Anaesthesia)
Source: Paediatric Anaesthesia - January 10, 2013 Category: Anesthesiology Authors: Lago P, Garetti E, Boccuzzo G, Merazzi D, Pirelli A, Pieragostini L, Piga S, Cuttini M, Ancora G Tags: Paediatr Anaesth Source Type: research
Unique Case of “Post‐Lumbar Puncture Headache”
We report a unique case of a spontaneous frontal epidural hematoma following a therapeutic lumbar puncture in a patient with a history of idiopathic intracranial hypertension. This case highlights the importance of symptomatology in patients following LPs by revealing a rare intracranial presentation that would be devastating if not discovered promptly and appropriately managed. (Source: Headache: The Journal of Head and Face Pain)
Source: Headache: The Journal of Head and Face Pain - January 8, 2013 Category: Neurology Authors: Bimal A. Patel, Nolan R. Williams, Paul B. Pritchard Tags: Brief Communication Source Type: research
Unique Case of "Post-Lumbar Puncture Headache"
We report a unique case of a spontaneous frontal epidural hematoma following a therapeutic lumbar puncture in a patient with a history of idiopathic intracranial hypertension. This case highlights the importance of symptomatology in patients following LPs by revealing a rare intracranial presentation that would be devastating if not discovered promptly and appropriately managed. PMID: 23298181 [PubMed - as supplied by publisher] (Source: Headache)
Source: Headache - January 8, 2013 Category: Neurology Authors: Patel BA, Williams NR, Pritchard PB Tags: Headache Source Type: research
Mythmaking in medical education and medical practice.
CONCLUSIONS: These familiar myths have maintained prominent roles in medical thinking because they represent wisdom passed down from eminent sources, they teach physiology and medical skills, and they offer physicians a sense of control in the face of uncertainty. In addition to providing scientific evidence, changing physicians' practice requires acknowledging that even meticulous care cannot always avert bad outcomes. PMID: 23312964 [PubMed - as supplied by publisher] (Source: European Journal of Internal Medicine)
Source: European Journal of Internal Medicine - January 8, 2013 Category: Internal Medicine Authors: Kaufman E, Lagu T, Hannon NS, Sagi J, Rothberg MB Tags: Eur J Intern Med Source Type: research
Structural brain imaging and multivariate analysis enable virtual lumbar punctures
Functional brain imaging has been a standard tool in the basic and clinical neurosciences for at least 2 decades, and structural brain imaging can claim an even longer track record of successful use for diagnosis of neurodegenerative disease. It is instructive to recall the ways in which brain imaging has been used to date, and this exercise will clarify why the contribution by McMillan et al.1 in the current issue of Neurology® is exciting and novel. (Source: Neurology)
Source: Neurology - January 7, 2013 Category: Neurology Authors: Habeck, C., Whitwell, J. L. Tags: Volumetric MRI, Alzheimer's disease, Frontotemporal dementia, Cerebrospinal Fluid EDITORIALS Source Type: research
Can MRI screen for CSF biomarkers in neurodegenerative disease?
Conclusion: MRI may serve as a noninvasive procedure that can screen for AD and FTLD pathology as a surrogate for CSF biomarkers. (Source: Neurology)
Source: Neurology - January 7, 2013 Category: Neurology Authors: McMillan, C. T., Avants, B., Irwin, D. J., Toledo, J. B., Wolk, D. A., Van Deerlin, V. M., Shaw, L. M., Trojanoswki, J. Q., Grossman, M. Tags: Volumetric MRI, Alzheimer's disease, Frontotemporal dementia, Cerebrospinal Fluid ARTICLE Source Type: research
Herpes simplex encephalitis following microvascular decompression for trigeminal neuralgia.
Abstract The authors present the first reported case of herpes simplex encephalitis (HSE) precipitated by trigeminal nerve microvascular decompression (MVD). The presentation of this specific case together with the pathogenesis and management of HSE are discussed, with a relevant literature review. This 29-year-old woman with treatment-resistant trigeminal neuralgia underwent a successful elective MVD of the right trigeminal nerve. She was discharged but was readmitted 1 week postoperatively with clinical signs and symptoms of meningitis. A CSF sample was obtained through lumbar puncture before she was treated ini...
Source: Journal of Neurosurgery - January 4, 2013 Category: Neurosurgery Authors: Tang H, Falcone F, Eljamel S Tags: J Neurosurg Source Type: research
Current Guideline For The Neurodiagnostic Evaluation Of The Child With A Simple Febrile Seizure
In this issue of EM Practice Guidelines Update, the 2011 American Academy of Pediatrics (AAP) update regarding neurodiagnostic evaluation of pediatric simple febrile seizures is reviewed. Simple febrile seizures are largely benign events with good prognoses, and they often do not require laboratory studies or neurodiagnostic imaging to be performed in the emergency department (ED). This update of the 1996 AAP guideline focuses on the use of lumbar puncture in children who present to the ED with a simple febrile seizure. (Source: EM Practice Guidelines Update)
Source: EM Practice Guidelines Update - December 31, 2012 Category: Emergency Medicine Source Type: research
Is It Alzheimer's Or Another Dementia? MRI Scan Can Tell
Doctors will find it easier to tell whether a patient has Alzheimer's disease or another kind of dementia with a new method of using MRI scans, researchers from Perelman School of Medicine and Frontotemporal Degeneration Center at the University of Pennsylvania explained in the journal Neurology. The scientists say they could fairly accurately identify Alzheimer's disease and frontotemporal lobar degeneration without having to carry out invasive tests, such as a lumbar puncture, which involves sticking a needle into the spine... (Source: Health News from Medical News Today)
Source: Health News from Medical News Today - December 28, 2012 Category: Consumer Health News Tags: Alzheimer's / Dementia Source Type: news
BET 2: What gauge and type of lumbar puncture needle should we be using in the paediatric population to reduce the risk of postdural puncture headaches?
A short-cut review was carried out to establish whether non-cutting point needles were better than cutting point needles at reducing the incidence of postdural puncture headache in children undergoing lumbar puncture for cerebrospinal fluid cultures. Three separate searches of Medline found 77 papers using the reported searches, of which six presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are shown in table 2. It is concluded that there is no evidence to show that...
Source: Emergency Medicine Journal - December 27, 2012 Category: Emergency Medicine Tags: EMJ Best evidence topic reports, Headache (including migraine), Pain (neurology) Source Type: research
A2799-22 LUMBAR PUNCTURE, ADULT 22G QUINCKE () Kit [Smiths Medical ASD, Inc.]
Updated Date: Dec 19, 2012 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))
Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST) - December 19, 2012 Category: Drugs & Pharmacology Source Type: news
Ocular symptoms secondary to meningeal carcinomatosis in a patient with lung adenocarcinoma: a case report
Conclusion: MC is a serious complication of systemic cancer patients, involving a poor prognosis. Early diagnosis is extremely important, although treatment is frequently aimed to reduce the symptoms and extend survival. Eye symptoms may be the chief complaint, so MC should be considered in any patient with vision loss or diplopia accompanied by neurologic symptoms and in the absence of an intraocular cause, especially in the context of systemic cancer. (Source: BMC Ophthalmology - Latest articles)
Source: BMC Ophthalmology - Latest articles - December 18, 2012 Category: Opthalmology Authors: Alfonso SabaterLuis SádabaElisa de Nova Source Type: research
CXCL13 may improve diagnosis in early neuroborreliosis with atypical laboratory findings
Conclusion: CXCL13 is a novel biomarker with high sensitivity and specificity for acute LNB. Our data show, that CXCL13 might be helpful in unclear cases and support the presumption that it might be a valuable tool for treatment monitoring. Anti-OspC antibody negativity is a rare observation, given the need of OspC for infection of the human hosts. Most likely this is due to a lack of sensitivity of OspC immunoblots that are unable to detect rare OspC variants. (Source: BMC Infectious Diseases)
Source: BMC Infectious Diseases - December 10, 2012 Category: Infectious Diseases Authors: Johannes BordeSimone MeierVolker FingerleChristiane KlierJohannes HübnerWinfried Kern Source Type: research
Communicating hydrocephalus due to cerebral venous sinus thrombosis treated with ventriculoperitoneal shunt
We describe a patient of CVT presenting with chronic headache and communicating hydrocephalus. The patient was successfully treated with ventriculoperitoneal (VP) shunt. A 40 year old man presented with moderate to severe headache since six months and progressive visual loss since two months. Head Computed tomogram showed mild hydrocephalus without obstruction. Lumbar puncture (LP) demonstrated elevated pressure but was otherwise normal. Magnetic resonance venogram showed extensive CVT. Repeated CSF drainage and thecoperitoneal shunt did not relieve the severe headache hence a VP shunt was placed. Post shunt headache subsi...
Source: Annals of Indian Academy of Neurology - December 5, 2012 Category: Neurology Authors: Rahul T ChakorSandeep JakhereBhakti Yeragi GavaiNS Santhosh Source Type: research
Otosyphilis: missed opportunities for early treatment?
Otosyphilis is one of the few potentially reversible causes of hearing loss. The diagnosis is made if a patient has audiological symptoms and positive syphilis serology after exclusion of other causes. Robust evidence for optimal management is lacking given the absence of controlled trials and audiological outcome after treatment is variable and often poor. We identified patients with otosyphilis in our unit through notes review. Seven cases were identified between 2007 and 2011. Median age was 34 (31–51) years; six (86%) were male. Six (86%) were HIV-co-infected, of whom two tested HIV-positive at syphilis diagnosis...
Source: Sexually Transmitted Infections - December 3, 2012 Category: Sexual Medicine Authors: Bradshaw, D., Pallawela, S., Nelson, M., Scott, C., Day, S. Tags: Letters Source Type: research
Visualization of spinal afferent innervation in the mouse colon by AAV8‐mediated GFP expression
Conclusions & Inferences These results demonstrate the feasibility of gene transfer to mouse colonic spinal sensory neurons using intrathecal delivery of AAV vectors and the utility of this approach for histological analysis of spinal afferent nerve fibers within colon. (Source: Neurogastroenterology and Motility)
Source: Neurogastroenterology and Motility - December 1, 2012 Category: Gastroenterology Authors: D. J. Schuster, J. A. Dykstra, M. S. Riedl, K. F. Kitto, C. N. Honda, R. S. McIvor, C. A. Fairbanks, L. Vulchanova Source Type: research
Measles encephalitis the return: mild encephalitis with reversible splenial lesion
A 20-year-old man, without a past medical history, was admitted for febrile coma (Glasgow coma scale score 9, temperature 39°C). A maculopapular rash was observed on the face, trunk, arms, and proximal portion of the legs. A cerebral computed tomography (CT) scan was normal. Lumbar puncture showed 16×106 leukocytes/l, 20×106 erythrocytes/l, a cerebrospinal fluid (CSF) protein level of 0.7g/l, and CSF glucose of 4 mmol/l (glycemia: 5.1 mmol/l). A measles-specific PCR was positive on salivary, urinary, and nasal samples. Specific PCR and culture of the CSF were all negative, including for measles. Diffusion-weighted magne...
Source: International Journal of Infectious Diseases - November 30, 2012 Category: Infectious Diseases Authors: Cléa Melenotte, Fabien Craighero, Nadine Girard, Philippe Brouqui, Elisabeth Botelho-Nevers Tags: Medical Imagery Source Type: research
Lumbar Puncture in the Neonate: Challenges in Decision Making and Interpretation
Multiple studies have provided normative ranges for cerebrospinal fluid (CSF) parameters in term and preterm infants and described changes with advancing postnatal age, as well as in special circumstances, such as traumatic lumbar puncture (LP), previous antibiotic administration, seizures, and concomitant infections at other sites. Although guidelines exist for the interpretation of CSF parameters in neonates, there appears to be no single combination of parameters that conclusively excludes meningitis. It remains important for clinicians to perform LPs early in the course of illness, ideally before the administration of ...
Source: Seminars in Perinatology - November 27, 2012 Category: Perinatology & Neonatology Authors: Lakshmi Srinivasan, Mary C. Harris, Samir S. Shah Source Type: research
Idiopathic Intracranial Hypertension Associated with Either Primary Or Secondary Aldosteronism.
CONCLUSIONS:: An association between IIH and PAL occurs in hypertensive middle-aged women, whereas normotensive girls having an inherited renal tubular defect may have IIH with SAL. Patients with IIH should be evaluated for aldosteronism and considered for spironolactone therapy. PMID: 23187300 [PubMed - as supplied by publisher] (Source: The American Journal of the Medical Sciences)
Source: The American Journal of the Medical Sciences - November 26, 2012 Category: Journals (General) Authors: Khan MU, Khalid H, Salpietro V, Weber KT Tags: Am J Med Sci Source Type: research
Cerebrospinal fluid HIV viral load may be detectable, despite serum viral load being undetectable, in patients diagnosed with syphilis
With an increasing proportion of male patients co-infected with syphilis and HIV, the management of these patients has become more relevant. HIV and syphilis both enter the central nervous system early in the course of infection, and have been shown to be present at all stages of the disease. Syphilis is reported to increase the serum HIV viral load (VL) in HIV co-infected patients;1 higher CSF HIV VLs have been demonstrated in patients with neurosyphilis compared with those without.2 HIV-positive patients newly diagnosed with syphilis (defined by seroreactive syphilis serology without prior history or a fourfold rise in r...
Source: Sexually Transmitted Infections - November 19, 2012 Category: Sexual Medicine Authors: Muldoon, E. G., Coughlan, S., Mulcahy, F. Tags: Drugs: infectious diseases, HIV/AIDS, Infection (neurology), HIV / AIDS, Syphilis, HIV infections, Competing interests (ethics), Informed consent, Research and publication ethics Editorials Source Type: research
Postpartum spontaneous intracranial hypotension
We present a case of delayed SIH 4 weeks after vaginal delivery without any spinal intervention. This case of postpartum headache was initially not recognized as SIH. The patient developed an abducens nerve palsy in the following weeks, after which additional examinations showed the diagnosis of SIH. With this case report, we want to draw attention to SIH as a cause of postpartum headache. (Source: The American Journal of Emergency Medicine)
Source: The American Journal of Emergency Medicine - November 19, 2012 Category: Emergency Medicine Authors: Agnes van Sonderen, Hille Koppen Tags: Case Reports Source Type: research
What are the Initial Cerebrospinal Fluid Findings in Different Types of Meningitis?
Discussion Meningitis is an inflammation of the meninges. While any organism or disease process can cause severe neurological sequelae or death, most feared usually are rapidly growing bacteria such as meningococcus. Aseptic meningitis is usually caused by nonbacterial organisms and other diseases including enteroviruses, measles, mumps, and mycoplasma. About 75,000 cases occur in the US each year. Organisms colonize the person usually in the nasopharyngeal mucosa, spread to the blood steam and eventually reach the meninges by the blood-brain barrier and cerebrospinal fluid after evading the person’s immunological de...
Source: PediatricEducation.org - November 11, 2012 Category: Pediatrics Authors: Donna M. D'Alessandro, M.D. Tags: Uncategorized Source Type: news
[Series] Dilemmas in the diagnosis of acute community-acquired bacterial meningitis
Rapid diagnosis and treatment of acute community-acquired bacterial meningitis reduces mortality and neurological sequelae, but can be delayed by atypical presentation, assessment of lumbar puncture safety, and poor sensitivity of standard diagnostic microbiology. Thus, diagnostic dilemmas are common in patients with suspected acute community-acquired bacterial meningitis. History and physical examination alone are sometimes not sufficient to confirm or exclude the diagnosis. Lumbar puncture is an essential investigation, but can be delayed by brain imaging. (Source: LANCET)
Source: LANCET - November 9, 2012 Category: Journals (General) Authors: Matthijs C Brouwer, Guy E Thwaites, Allan R Tunkel, Diederik van de Beek Tags: Series Source Type: research