Diagnosis and management of pediatric arterial ischemic stroke.

Pediatric stroke is among the top 10 causes of death in children and an important cause of chronic morbidity, with an incidence of 3.3/100,000 children/year. Risk factors associated with stroke in children include cardiac diseases, hematologic and vascular disorders, and infection. Clinical presentation varies depending on age, underlying cause, and stroke location. Antithrombotics and anticoagulants are used in the treatment of pediatric stroke; however, there are no established guidelines for the use of these agents in children. In this article we review the cause, pathophysiology, clinical presentation, diagnosis, acute management, secondary prevention, and outcome of children with stroke. The approach to patients with sickle cell disease and Moyamoya disease is also discussed. Up to date studies to determine the optimal acute treatment of childhood stroke and secondary prevention and risk factor modification are critically needed.

Neurologic complications in non-neurological intensive care units.

BACKGROUND: Neurologists are frequently called to evaluate patients in the intensive care units who are not waking up. This often poses a diagnostic and prognostic dilemma. REVIEW SUMMARY: The initial evaluation starts with abstracting the prehospital and in-hospital history, followed by bedside clinical and neurologic examination to establish a differential diagnosis. The subsequent work-up is based on clinical suspicion where reversible life-threatening causes should be immediately identified. After confirming the diagnosis and implementation of the appropriate medical management, a prompt family meeting and counseling is recommended. The role of neurologists in clinical diagnosis and prognostication of the coma patient, as well as diagnosing brain death is instrumental. CONCLUSIONS: In this review, we explore a practical systematic approach to patients with decreased level of consciousness. The most common causes of impaired alertness in different non-neurologic critical care units and commonly used prognostication tools are presented. Finally a brief introduction of hypothermia, a novel therapeutic approach is also discussed.

Melatonin reduces protein and lipid oxidative damage induced by homocysteine in rat brain homogenates.

Numerous data indicate that hyperhomocysteinemia is a risk factor for cardio- and cerebrovascular diseases. At least in part, homocysteine (HCY) impairs cerebrovascular function because it generates large numbers of free radicals. Since melatonin is a well-known antioxidant, which reduces oxidative stress and decreases HCY concentrations in plasma, the aim of this study was to investigate the effect of melatonin in preventing HCY-induced protein and lipid oxidation in rat brain homogenates. Brain homogenates were obtained from Sprague-Dawley rats and were incubated with or without HCY (0.01-5 mM) or melatonin (0.01-3 mM). Carbonyl content of proteins, and malondialdehyde (MDA) and 4-hydroxyalkenals (4-HDA) concentrations in the brain homogenates were used as an index of protein and lipid oxidation, respectively. Under the experimental conditions used, the addition of HCY (0.01-5 mM) to the homogenates enhanced carbonyl protein and MDA+4-HDA formation. Melatonin reduced, in a concentration-dependent manner, protein and lipid oxidation due to HCY in the brain homogenates. These data suggest that preserving proteins from oxidative insults is an additional mechanism by which melatonin may act as an agent in potentially decreasing cardiovascular and cerebrovascular diseases related to hyperhomocysteinemia.

Melatonina en Psiquiatría: Una actualización / Melatonin in Psychiatry: An update

La melatonina es una molécula sintetizada en muchos órganos y tejidos del organismo incluida la glándula pineal. La regulación de la síntesis de melatonina por la pineal se conoce bien, y depende principalmente del fotoperíodo. Durante el día, la síntesis de melatonina está inhibida, mientras que la oscuridad activa el enzima limitante de su síntesis, aumentando su producción y secreción a la sangre y el líquido cefalorraquídeo. En consecuencia, el fotoperíodo induce un ritmo circadiano de melatonina plasmática con una acrofase alrededor de las 02:00 h en humanos. Este ritmo de melatonina sincroniza una serie de ritmos endocrinos y no endocrinos tales como la reproducción estacional en animales y el ciclo sueño-vigilia. Recientemente se ha demostrado que la melatonina ejerce otras funciones incluyendo la modulación del sistema inmune. En los últimos años han aparecido una gran cantidad de publicaciones demostrando tanto in vitro como in vivo, el efecto antioxidante y depurador de radicales libres de la melatonina. Probablemente, estas funciones antioxidantes de la melatonina reflejan una función protectora frente al estrés oxidativo en aquellos órganos y tejidos que la producen. El ritmo circadiano de secreción de melatonina en plasma puede alterarse en varias enfermedades psiquiátricas y su uso terapéutico se ha planteado en patologías que cursan con alteraciones del sueño, enfermedades neurodegenerativas y cáncer. El objetivo de este trabajo es revisar el papel de la melatonina en el tratamiento del trastorno depresivo mayor y en otras patologías psiquiátricas (AU)

Melatonin is a molecule synthesized in many organs and tissues, including the pineal gland. The regulation of the melatonin synthesis by the pineal is well known, and it mainly depends on the photoperiod. During daytime, melatonin synthesis is inhibited, whereas the darkness activates the limiting enzyme of the melatonin synthesis, increasing its production and release to blood and cerebrospinal fluid. Consequently, the photoperiod induces a circadian rhythm in melatonin levels with an acrophase at 02:00 h in humans. The circadian rhythm of melatonin synchronizes a number of endocrine and non-endocrine rhythms including the seasonal periods of reproduction in animals and the sleep-wake cycle. It was recently showed that melatonin exerts other functions including the modulation of the immune system. For the last years many publications have shown the antioxidant and free radical scavenger properties of the indoleamine, either in vitro or in vivo. Probably, the antioxidant functions of melatonin reflect a protective role against oxidative damage into the organs and tissues that produce this molecule. The circadian rhythm of plasma melatonin may be altered in several psychiatric disorders. Therapeutical use of melatonin has been implicated in sleep disorders, neurodegenerative diseases and cancer. The aim of this review is to uptake melatonin's role in the treatment of mayor depressive disorder and other psychiatric disorders (AU)