Skip to main content
Volume 7, No 1 - Winter 2010

Volume 7, No 1 - Winter 2010

Table of Contents

New Oral Anticoagulants in Development: Potential for Improved Safety Profiles Treatment Review
Venous thromboembolism is the most frequent preventable cause of death in hospitalized patients. Currently available anticoagulants have limitations that restrict their widespread use, particularly in long-term indications. Vitamin K antagonists require frequent monitoring and dose adjustment, and have a narrow therapeutic window with the risk of bleeding. The low-molecular-weight heparins have more predictable pharmacokinetics and pharmacodynamics, and coagulation monitoring is not required.However, their subcutaneous administration limits their suitability for long-term use.Consequently, many patients fail to receive effective preventive therapy. Rivaroxaban, apixaban, and dabigatran are new anticoagulants in late-stage clinical development that inhibit a single, specific coagulation factor, unlike the Vitamin K antagonists and low-molecular-weight heparins. Studies suggest that they provide effective, predictable anticoagulation with a low bleeding risk and will potentially offer an improved clinical profile and wider safety margin compared with currently available therapies.[Rev Neurol Dis. 2010;7(1):1-8 doi:10.3909/rind0240]
A Review of Frontiers in Clinical Sleep Medicine Diagnosis and Treatment Update
The field of sleep medicine has grown exponentially worldwide. Sleep apnea is linked to the obesity epidemic, which, in some regions of the United States, affects more than one-third of the population. Sleep alterations increase the risk of cardiovascular and cerebrovascular pathology through a diversity of direct and indirect mechanisms. Recent investigations have found a clinical correlation between sleep disorders and diabetes. Obese pregnant women are at high risk for development of sleep apnea and preeclampsia. New studies have uncovered that restless legs syndrome and periodic limb movements may increase the risk of hypertension and vascular disease. Sudden death in sleep may be preventable if conditions that lead to sudden death are investigated. New neuroimaging techniques during sleep in patients with insomnia have uncovered metabolic overactivity in areas of the brain related to maintenance of wakefulness. Sleep neuroimaging promises to have research and clinical diagnostic applications.[Rev Neurol Dis. 2010;7(1):9-18 doi: 10.3909/rind0245]
Swallowing and Dysphagia in Neurological Disorders Diagnosis and Evaluation Update
Neurologists are often confronted with swallowing disorders in routine practice. Swallowing impairments carry serious health consequences if they are overlooked or inappropriately managed. Swallowing problems usually develop in patients with established neurological conditions, although on occasion they may be a presenting symptom of a neurological disorder. Prompt recognition of dysphagia and early diagnosis can often be accomplished through a systematic clinical history and examination. This article reviews the physiology and neuroanatomy of normal swallowing and discusses pertinent clinical approaches toward evaluating a patient with neurogenical dysphagia. Important neurological conditions causing dysphagia are also discussed in this context.[Rev Neurol Dis. 2010;7(1):19-27 doi: 10.3909/rind0248]
New Findings in the Study of Neuromuscular Disorders Meeting Review
Highlights from the 56th Annual Meeting of the American Association of Neuromuscular and Electrodiagnostic Medicine, October 7-10, 2009, San Diego, CA[Rev Neurol Dis. 2010;7(1):28-31 doi: 10.3909/rind0253]
A Child With Progressive Dystonia, Dysarthria, and Spasticity Case Review: Presentation
Children presenting with progressive neurologic symptoms including dystonia, dysarthria, and spasticity can represent a diagnostic challenge. Here we describe the case of a 14-year-old boy who presented to our center with an 11-year history of gradual worsening neurologic symptoms. Diagnostic strategies focus on the use of neuroimaging and genetic testing to help establish the underlying diagnosis. Therapeutic options are also discussed.[Rev Neurol Dis. 2010;7(1):32-33 doi: 10.3909/rind0239a]
A Case of Progressive Ataxia Followed by Cognitive and Behavioral Changes Case Review: Presentation
The patient is a 60-year-old man who initially presented to his local hospital with complaints of gait difficulties that started suddenly after waking. Results of brain magnetic resonance imaging performed 1 week later were normal. Three weeks after that he developed blurred vision and he complained of a severe headache in the posterior head and neck regions at the onset of symptoms, which necessitated several visits to his local emergency room. The patient presented to our institution 1 month later, with progressive gait difficulty and truncal instability over a 2-week period.[Rev Neurol Dis. 2010;7(1):34-36 doi:10.3909/rind0241a]