The Neurologist最新文献

{"title":"Herpes simplex virus type 1 in saliva of patients with vestibular neuronitis: a preliminary study.","authors":"Lea Pollak,&nbsp;Mazal Book,&nbsp;Zehava Smetana,&nbsp;Marina Alkin,&nbsp;Zvia Soupayev,&nbsp;Ella Mendelson","doi":"10.1097/NRL.0b013e318235a0e7","DOIUrl":"https://doi.org/10.1097/NRL.0b013e318235a0e7","url":null,"abstract":"<p><strong>Objectives: </strong>Vestibular neuronitis (VN) is an inflammatory disease of the vestibular nerve, presumably caused by reactivation of the herpes simplex virus type l (HSV-1). We hypothesized that HSV-1 might be detected in saliva of patients with VN due to migration of the reactivated virus from the vestibular ganglia to the parotid gland.</p><p><strong>Methods: </strong>Twenty-one patients with VN and 15 healthy controls participated. HSV-1 DNA detection was performed using the real-time polymerase chain reaction method. Sera were collected and stored to be later analyzed for immunoglobulin (Ig) G and IgM antibody titers against HSV-1 by immunofluorescence and enzyme linked immunosorbent assay methods, respectively.</p><p><strong>Results: </strong>HSV-1 was detected in saliva of 14% of VN patients and in 6% of controls (P>0.05). Serological testing revealed borderline IgM (optical density±10% average of 2 cut off serums) antibodies to HSV-1 in 75% of patients versus 13% of controls (P=0.01). The IgG antibody test was positive in 17 of 20 patients and borderline (IgG ≤1:16) in 2 of 20 patients tested whereas 13 of 15 controls had positive IgG test results (P>0.05).</p><p><strong>Conclusions: </strong>In this preliminary study we found serological evidence of higher exposure of patients with VN to HSV-1 in the past. We were not able to demonstrate that the virus can be detected in saliva of VN patients as evidence for herpetic infection or reactivation.</p>","PeriodicalId":519230,"journal":{"name":"The Neurologist","volume":" ","pages":"330-2"},"PeriodicalIF":1.2,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/NRL.0b013e318235a0e7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40122514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two cases of delayed-onset transient global amnesia after saline-contrast transthoracic echocardiography.","authors":"Guha K Venkatraman,&nbsp;Andrew Bauerschmidt","doi":"10.1097/NRL.0b013e318220c67f","DOIUrl":"https://doi.org/10.1097/NRL.0b013e318220c67f","url":null,"abstract":"<p><strong>Introduction: </strong>We present 2 cases of transient global amnesia (TGA) with delays of 1 and 2 hours after saline-contrast transthoracic echocardiography. The unique presentation in these cases may help elucidate the possible mechanisms underlying TGA.</p><p><strong>Cases: </strong>(1) A 63-year-old woman admitted for lower extremity arterial thrombosis with TGA onset 1 hour after saline-contrast echocardiography. (2) A 75-year-old woman admitted to rule out myocardial infarction with TGA onset 2 hours after saline-contrast echocardiography.</p><p><strong>Conclusions: </strong>The precipitating events of TGA are varied and an understanding of the mechanism(s) underlying the phenomenon is incomplete. However, the presence of a delay after the trigger event as described in these cases is unique and informative in that it lends strength to some proposed mechanisms over others in this subset of TGA presentations.</p>","PeriodicalId":519230,"journal":{"name":"The Neurologist","volume":" ","pages":"338-9"},"PeriodicalIF":1.2,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/NRL.0b013e318220c67f","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40122516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of ultrasound-enhanced thrombolysis in the treatment of acute middle cerebral artery infarction: a critically appraised topic.","authors":"Christopher Kramer,&nbsp;Maria I Aguilar,&nbsp;Charlene Hoffman-Snyder,&nbsp;Kay E Wellik,&nbsp;Dean M Wingerchuk,&nbsp;Bart M Demaerschalk","doi":"10.1097/NRL.0b013e318236e041","DOIUrl":"https://doi.org/10.1097/NRL.0b013e318236e041","url":null,"abstract":"<p><strong>Background: </strong>Despite appropriate therapy with intravenous (IV) tissue plasminogen activator (tPA), a significant proportion of patients with acute middle cerebral artery (MCA) infarction continue to suffer residual disability or death. The therapeutic use of transcranial Doppler ultrasonography (TCD) concomitantly with IV tPA is speculated to increase recanalization rates and improve clinical outcomes in patients with acute MCA stroke.</p><p><strong>Objective: </strong>To critically appraise the evidence concerning the safety and efficacy of the simultaneous delivery of IV tPA and continuous TCD monitoring as an acute therapy in patients with MCA territory infarction.</p><p><strong>Methods: </strong>The objective was addressed through the development of a structured, critically appraised topic. This incorporated a clinical scenario, background information, a structured question, literature search strategy, results, critical appraisal, clinical bottom line, and expert commentary from vascular neurology.</p><p><strong>Results: </strong>In a multicenter phase II randomized controlled study, 126 patients with acute MCA stroke were randomized to receive treatment with IV tPA and continuous TCD monitoring or placebo monitoring. Complete recanalization or dramatic clinical recovery within 2 hours after the administration of a tPA bolus occurred in 31 patients in the target group (49%), as compared with 19 patients in the control group (30%); P=0.03. At 3 months, of the patients eligible for follow-up, 22 of 53 (42%) in the target group and 14 of 49 (29%) in the control group had favorable outcomes; P=0.20. Four symptomatic intracerebral hemorrhages were noted in each group.</p><p><strong>Conclusions: </strong>Therapeutic use of continuous TCD monitoring concomitantly with IV tPA increases recanalization rates in patients with acute MCA stroke relative to treatment with IV tPA alone without increasing the complication of intracerebral hemorrhage.</p>","PeriodicalId":519230,"journal":{"name":"The Neurologist","volume":" ","pages":"346-51"},"PeriodicalIF":1.2,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/NRL.0b013e318236e041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40122518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}