ABSTRACT
An adequate treatment of ischaemic stroke in the early phase (28-48 h) is the most important factor for a better outcome. Thrombolysis with rTPA (within 3 h) and oral ASA 300 mg/days are the first therapeutic misures. Continuous monitoring of cardiological and haemodinamic parameters allows early detection of cardiac disturbances. Treatment of hypertension, low haematic oxigenation, hyperglicaemia, seizures and hypertermia is basic to improve outcome. Pharmacological therapy is only one of the components of effective multidisciplinary integrated management of ischaemic stroke; we remind also the precocity of rehabilitation procedures and an accurate psychological assessment.
Subject(s)
Brain Ischemia/drug therapy , Fibrinolytic Agents/therapeutic use , Thrombolytic Therapy/methods , Tissue Plasminogen Activator/therapeutic use , Acute Disease , Emergency Treatment , Humans , Rehabilitation , Time Factors , Treatment OutcomeABSTRACT
We studied repeated cerebrospinal fluids of patients with Devic's neuromyelitis optica (NMO) and multiple sclerosis (MS). Variations of oligoclonal bands (OBs) had opposite trends in the two groups. In MS, OBs were detected in 399 of 411 patients (97%) and never disappeared. In NMO, OBs were detected in three of 11 patients (27%) and always disappeared. The hypothesis that NMO and MS follow distinct pathogenetic pathways is supported by our findings, which can be useful for the differentiation of NMO from MS.
Subject(s)
Multiple Sclerosis/cerebrospinal fluid , Neuromyelitis Optica/cerebrospinal fluid , Oligoclonal Bands/cerebrospinal fluid , Adult , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Multiple Sclerosis/diagnosis , Neuromyelitis Optica/diagnosis , Retrospective StudiesABSTRACT
The authors report on an Italian family with eight affected members who show autosomal dominant migraine with prolonged visual, sensory, motor, and aphasic aura. These symptoms are associated with white matter abnormalities on brain MRI. All living affected members carry a Notch3 mutation (Arg153Cys) previously reported in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). White matter abnormalities occur in a variable percentage of the general migraine population; CADASIL should be suspected in migraineurs with prolonged atypical aura and white matter abnormalities.
Subject(s)
Chromosome Aberrations/genetics , Dementia, Multi-Infarct/genetics , Genes, Dominant/genetics , Migraine Disorders/genetics , Mutation, Missense/genetics , Proto-Oncogene Proteins/genetics , Receptors, Cell Surface , Brain/pathology , Chromosome Disorders , Dementia, Multi-Infarct/diagnosis , Female , Humans , Magnetic Resonance Imaging , Middle Aged , Migraine Disorders/diagnosis , Pedigree , Receptor, Notch3 , Receptors, NotchABSTRACT
Previous studies of possible prognostic indicators for multiple sclerosis have been based on "classic" Cox's proportional hazards regression model, as well as on equivalent or simpler approaches, restricting their attention to variables measured either at disease onset or at a few points during follow-up. The aim of our study was to analyse the risk of reaching secondary progression in MS patients with a relapsing-remitting initial course, using two different statistical approaches: a Cox's proportional-hazards model and a Bayesian latent-variable model with Markov chain Monte Carlo methods of computation. In comparison with a standard statistical approach, our model is advantageous because, exploiting all the information gleaned from the patient as it is gradually made available, it is capable to detect even small prognostic effects.