Neurogenic stunned myocardium following hemorrhagic cerebral contusion

Neurogenic stunned myocardium [NSM] is a well-known complication of subarachnoidal hemorrhage, but has been reported rarely in association with other central nervous system disorders. A case of NSM is described in a patient with hemorrhagic brain contusion associated with cerebral edema. An 18-year-old man was admitted with severe cranial trauma following a car roll-over. Six days after admission, he developed findings suggestive for NSM. The troponin T and creatine kinase-MB level were elevated and echocardiogram showed apical and inferoposterior hypokinesis and diffuse left ventricular akinesis with severely reduced ejection fraction [18%]. Invasive measurements confirmed low cardiac output. His cardiac function resolved completely within 6 days after decompressive craniotomy. This case supports the presumed unifying role of the increased intracranial pressure, probably triggering a vigorous sympathetic outflow hyperactivity leading to NSM

Neurogenic stunned myocardium following hemorrhagic cerebral contusion

Neurogenic stunned myocardium NSM is a well-known complication of subarachnoidal hemorrhage, but has been reported rarely in association with other central nervous system disorders. A case of NSM is described in a patient with hemorrhagic brain contusion associated with cerebral edema. An 18-year-old man was admitted with severe cranial trauma following a car roll-over. Six days after admission, he developed findings suggestive for NSM. The troponin T and creatine kinase-MB level were elevated and echocardiogram showed apical and inferoposterior hypokinesis and diffuse left ventricular akinesis with severely reduced ejection fraction 18%. Invasive measurements confirmed low cardiac output. His cardiac function resolved completely within 6 days after decompressive craniotomy. This case supports the presumed unifying role of the increased intracranial pressure, probably triggering a vigorous sympathetic outflow hyperactivity leading to NSM

evidence-based review of dopamine receptor agonists in the treatment of Parkinson's disease

Apomorphine and certain ergot alkaloids [bromocriptine, lisuride and pergolide] have been available for several decades; for the last few years, they were joined by newer dopamine agonists [cabergoline, pramipexole and ropinirole] most of them are non-ergolines. Each of these dopamine agonists has its own pharmacological characteristics and occupies a place in the pharmacotherapy of Parkinsons disease. In this evidence-based review, emphasis is put on the clinical efficacy of dopamine agonists in early and advanced Parkinsons disease, and where possible comparative evidence regarding their efficacy and safety is provided. In addition, their clinical pharmacokinetics, adverse effect profiles and most relevant interactions will be summarized

Geographical distribution of biomedical publications from the Gulf Corporation Council countries

It was our purpose to perform a geographical analysis for the number of biomedical and clinical research publications from the six countries of the Gulf Cooperation Council over the past decade [1990-1999]. Medline was searched with the aid of the Internet provider PubMed. By using the advanced search option, entries were based on the country name for each of the Gulf Cooperation Council countries and the time period considered. The number of Medline-listed biomedical research papers published in the Gulf Cooperation Council countries over the last 10 years totaled 6,960 and increased by 14% over the past decade. The Kingdom of Saudi Arabia followed by Kuwait was by far the most prolific and accounted for 67 and 16% of publications. The research output from the United Arab Emirates and Oman grew steadily over the past decade, while it appeared to plateau for both Bahrain and Qatar. Taking into account that Gulf Cooperation Council countries have a relatively short history of research, the data show that the Gulf Cooperation Council countries are very prolific in terms of Medline-indexed biomedical research publications

Guidelines for the prevention of migraine

Treatment of migraine has traditionally been divided into managing acute attacks and prophylactic treatment. Treatment of acute migraine has been the subject of many research papers and review articles in recent literature partly at the cost of prophylactic treatment, which is the focus of this review. The objective of prophylactic therapy is to reduce frequency, duration and severity of attacks in addition to optimize the patient's ability to function normally. Preventive therapy is usually undertaken in patients who have more than two migraine episodes per month or when less frequent have severely disabling headaches resistant to usual treatment. Beta-blocking drugs without intrinsic sympathomimetic activity [e.g. propranolol] are usually the first drugs of choice followed by tricyclic antidepressant agents [e.g. amitriptyline], non-steroidal anti-inflammatory drugs [e.g. naproxen], calcium antagonists [e.g. flunarizine] or valproate. The use of serotonin antagonists [e.g. methysergide] is limited because of their potential serious side effects. Migraine refractory to standard prophylactic therapy is very often the result of overuse of abortive antimigraine drugs. The choice of medication clearly depends on the patient's profile [age, co-morbid medical conditions] and the contraindication and side effect profile of the drug

Guidelines for the prevention of migraine

Treatment of migraine has traditionally been divided into managing acute attacks and prophylactic treatment. Treatment of acute migraine has been the subject of many research papers and review articles in recent literature partly at the cost of prophylactic treatment, which is the focus of this review. The objective of prophylactic therapy is to reduce frequency, duration and severity of attacks in addition to optimize the patient's ability to function normally. Preventive therapy is usually undertaken in patients who have more than two migraine episodes per month or when less frequent have severely disabling headaches resistant to usual treatment. Beta-blocking drugs without intrinsic sympathomimetic activity [e.g. propranolol] are usually the first drugs of choice followed by tricyclic anti depressant agents [e.g. ami triptyline], non-steroidal anti-inflammatory drugs [e.g. naproxen], calcium antagonists [e.g. flunarizine] or valproate. The use of serotonin antagonists [e.g. methysergide] is limited because of their potential serious side effects. Migraine refractory to standard prophylactic therapy is very often the result of overuse of abortive antimigraine drugs. The choice of medication clearly depends on the patient's profile [age, co-morbid medical conditions] and the contraindication and side effect profile of the drug

Current and emerging strategies in the management of Parkinson's disease: a critical reappraisal

The pharmacological treatment of Parkinson's disease [PD] can be subdivided into symptomatic treatment [e.g. levodopa combined with a peripheral decarboxylase inhibitor [PDI], direct-acting dopamine receptor agonists, amantadine, centrally-acting antimuscarinic drugs and catechol-0-methyltransferase [COMT] inhibitors] aimed at restoring striatal dopamine function and reversing functional disability, and neuroprotective treatment [e.g. monoamine oxidase-B [MAO-B] inhibitors] aimed at interfering either with the cause of the disease or pathophysiologic mechanism of substantia nigral cell death. Despite the controversy about the development of long-term side effects levodopa/PDI remains the gold standard for the symptomatic treatment of PD. Direct-acting dopamine receptor agonists are usually recommended as adjuvants to levodopa/PDI. There is no compelling evidence that newer generation dopamine receptor agonists have a greater therapeutic effect than existing ones. Amantadine has limited effectiveness and loss of its beneficial effect after several months seriously limits its usefulness. Centrally-acting antimuscarinic drugs all have low efficacy and high toxicity and should be restricted for young patients with tremor-predominant PD. COMT inhibitors improve the pharmacokinetic properties of levodopa, however data are still lacking about their long-term efficacy and safety. The neuroprotective effect claimed by MAO-B inhibitors can well be offset by the increased mortality reported in patients treated with these drugs. The clinical and pharmacokinetic properties of the current and emerging drugs used in the treatment of PD are reviewed and guidelines are provided for the management of early and advanced PD