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Volume 6  No 1 - Winter 2009

Volume 6 No 1 - Winter 2009

Table of Contents

Nervous System Lyme Disease: Diagnosis and Treatment Treatment Review
Lyme disease, the multisystem infectious disease caused by the tickborne spirochete Borrelia burgdorferi, frequently affects the peripheral and central nervous systems. The earliest indication of Lyme disease infection is usually erythema migrans. This large, typically macular erythema, often with a target-like pattern of concentric pale and red circles, gradually enlarges day by day, potentially reaching many centimeters in diameter. In a significant proportion of infected individuals, an acute disseminated phase leads to seeding elsewhere in the body. Up to 5% of patients develop cardiac involvement. In about 10% to 15% of patients, the nervous system becomes symptomatically involved. Current serologic diagnostic tools are quite useful, and standard treatment regimens are highly effective. Oral antimicrobials have been shown to be effective in European neuroborreliosis and presumably are equally potent in North American patients. Long-term antibiotic treatment does not provide any additional lasting improvement, but it is frequently associated with significant morbidity. [Rev Neurol Dis. 2009;6(1):4-12]
Neurologic and Ophthalmic Manifestations of Fetal Alcohol Syndrome Diagnosis Update
Fetal alcohol syndrome (FAS) is a leading cause of preventable birth defects and developmental disability with numerous neurologic and ophthalmic manifestations. FAS is identified by the presence of a characteristic facies, growth deficiency, and central nervous system abnormalities. A wide variety of ocular and neuro-ophthalmic conditions occur in FAS and result in lifelong visual impairment. Neurologists are frequently called upon to evaluate and recommend treatment for children with developmental delay or neurologic manifestations of FAS. We review the neuro-ophthalmic literatureon FAS to alert neurologists to the ocular disease seen in patients with this condition. Timely ophthalmic referral and early intervention for treatable ophthalmic conditions, such as refractive errors, strabismus, and amblyopia, can prevent irreparable harm to the developing visual system and improve the overall neurologic development, long-term functioning, and quality of life for these patients.[Rev Neurol Dis. 2009;6(1):13-20]
Deep Venous Thrombosis Prophylaxis in Cerebral Hemorrhage Treatment Update
Deep vein thrombosis (DVT) is a risk factor for patients with acute stroke. Subclinical DVT is more common than clinically apparent DVT. DVT manifests with lower extremity swelling that might be associated with pain. Venous duplex ultrasound is a simple diagnostic procedure for detection of a DVT. However, as many as 30% of patients with acute pulmonary embolism show no evidence of lower extremity DVT, and thus a negative venous duplex ultrasound does not exclude the diagnosis of acute pulmonary embolism. Data suggest that heparin, of any type, may reduce the risk of venous thromboembolism in neurosurgical patients. One trial has shown thatmechanical devices, such as intermittent pneumatic compression, significantly decrease the occurrence of asymptomatic DVT for patients with intracerebral hemorrhage as compared with elastic stockings alone, although this advantage was not found in ameta-analysis of prospective studies. Limitations in DVT prophylaxis raise a question about the need for more aggressive DVT surveillance.[Rev Neurol Dis. 2009;6(1):21-25]
Advances in Genetic Testing for Alzheimer’s Disease Diagnosis Update
As the prevalence of Alzheimer’s disease (AD), the most common dementia in the elderly, continues to increase, neurologists will encounter a growing number of questions about genetic testing for dementia patients, their relatives, and people concerned about memory or cognitive function who have no apparent risk except advancing age. Until recently, clinical gene testing only included apolipoprotein E genotyping and testing for presenilin 1 mutations. In 2008, testing expanded to include the presenilin 2 and amyloid precursor protein genes. Despite these advances, genetic testing is currently not appropriate for most individuals diagnosed with AD and has limited utility for predictive purposes. Further research, however, is likely to expand the usefulness of this testing for both dementia patients and their relatives. If genetic testing is undertaken, thorough counseling, whether by the physician or a qualified genetic counselor, is an integral component of the testing process for both affected individuals and their families.[Rev Neurol Dis. 2009;6(1):26-32]
Highlights of the 55th Annual Meeting of the American Association of Neuromuscular and Electrodiagnostic Medicine, September 17-20, 2008, Providence, RI Neuromuscular and Electrodiagnostic Medicine
Highlights of the 55th Annual Meeting of the American Association of Neuromuscular and Electrodiagnostic Medicine, September 17-20, 2008, Providence, RI[Rev Neurol Dis. 2009;6(1):33-36]
A Patient With Epilepsy and New Onset of Nocturnal Symptoms Presentation
A patient with a 14-year history of complex partial seizures presented with new onset of nocturnal symptoms consisting of hallucinations, vivid dreams, and gross motor activity. These episodes were not consistent with his previous seizures, which had consisted of a foul smell, automatisms, and an altered stage of consciousness. Prior to this presentation, the patient had been seizure-free for 3 years while taking antiepileptic medications.[Rev Neurol Dis. 2009;6(1):37-38]
A Patient With Epilepsy and New Onset of Nocturnal Symptoms: Discussion Discussion
A patient with a 14-year history of complex partial seizures presented with new onset of nocturnal symptoms consisting of hallucinations, vivid dreams, and gross motor activity. These episodes were not consistent with his previous seizures, which had consisted of a foul smell, automatisms, and an altered stage of consciousness. Prior to this presentation, the patient had been seizure-free for 3 years while taking antiepileptic medications.[Rev Neurol Dis. 2009;6(1):37-38]