Skip to main content
Volume 8, No 3/4 - 2011

Volume 8, No 3/4 - 2011

Table of Contents

The Neurology of Decreased Activity: Abulia Disease State Review
Delirium is sometimes defined as acute onset of either overactivity or underactivity. This article reviews the nature and clinico-anatomical locations of lesions in patients with reduced activity. The term abulia is used to describe global underactivity. Abulia is customarily explained by interruptions in frontal-subcortical circuitry. These interruptions can occur with lesions in the frontal lobes, caudate nuclei, midbrain, and thalamus. The article describes the anatomy of frontal and subcortical circuits and reviews in detail individual cases and series of patients with reduced initiative and activity who have had localized central nervous system lesions. [Rev Neurol Dis. 2011;8(3/4):e55-e67 doi: 10.3909/rind0286] © 2011 MedReviews®, LLC
An Update on the Diagnosis and Management of Dementing Conditions Diagnosis and Management Update
Worsening memory is a common complaint in the elderly and predictably causes affected individuals and their families to wonder whether the underlying cause is Alzheimer disease, the most common form of dementia. Alzheimer disease is a devastating illness that unavoidably leads to a complete loss of independence and, as a result, substantial emotional, physical, and financial distress for patients and their families. The causes and severity of memory impairment in the elderly are diverse, however, so any given case might not necessarily be secondary to a neurodegenerative disorder such as Alzheimer disease. Consequently, it is critical to rule out potentially reversible causes of dementia and to initiate treatment while cognitive and functional deficits are still mild and more likely to respond to treatment. Furthermore, identifying the etiology and defining a suitable treatment plan early in the course of dementia allows patients to be more actively involved in the management of their disease and is more likely to improve quality of life for both patients and caregivers. This review presents the etiology of dementia in the elderly, describes the diagnostic process, and discusses current therapeutic strategies, including pharmacological agents, nonpharmacological interventions, safety assessments, legal issues, and caregiver needs. [Rev Neurol Dis. 2011;8(3/4):e68-e87 doi: 10.3909/rind0272] © 2011 MedReviews®, LLC
Orofacial Pain Following An Invasive Dental Procedure Diagnosis and Management Update
Worsening memory is a common complaint in the elderly and predictably causes affected individuals and their families to wonder whether the underlying cause is Alzheimer disease, the most common form of dementia. Alzheimer disease is a devastating illness that unavoidably leads to a complete loss of independence and, as a result, substantial emotional, physical, and financial distress for patients and their families. The causes and severity of memory impairment in the elderly are diverse, however, so any given case might not necessarily be secondary to a neurodegenerative disorder such as Alzheimer disease. Consequently, it is critical to rule out potentially reversible causes of dementia and to initiate treatment while cognitive and functional deficits are still mild and more likely to respond to treatment. Furthermore, identifying the etiology and defining a suitable treatment plan early in the course of dementia allows patients to be more actively involved in the management of their disease and is more likely to improve quality of life for both patients and caregivers. This review presents the etiology of dementia in the elderly, describes the diagnostic process, and discusses current therapeutic strategies, including pharmacological agents, nonpharmacological interventions, safety assessments, legal issues, and caregiver needs. [Rev Neurol Dis. 2011;8(3/4):e68-e87 doi: 10.3909/rind0272] © 2011 MedReviews®, LLC
Narcolepsy: Clinical Approach to Etiology, Diagnosis, and Treatment Diagnosis and Treatment Update
Narcolepsy is a neurologic disorder characterized by excessive daytime sleepiness and manifestations of disrupted rapid eye movement sleep stage. The pathologic hallmark is loss of hypocretin neurons in the hypothalamus likely triggered by environmental factors in a susceptible individual. Patients with narcolepsy, in addition to excessive daytime sleepiness, can present with cataplexy, sleep paralysis, sleep fragmentation, and hypnagogic/hypnopompic hallucinations. Approximately 60% to 90% of patients with narcolepsy have cataplexy, characterized by sudden loss of muscle tone. Only 15% of patients manifest all of these symptoms together. Narcolepsy can be misdiagnosed as a psychiatric disorder or even epilepsy. An appropriate clinical history, polysomnogram, Multiple Sleep Latency Test, and, at times, cerebrospinal fluid hypocretin levels are necessary for diagnosis. The treatment of narcolepsy is aimed toward the different symptoms that the patient manifests. Excessive daytime sleepiness is treated with amphetamine-like or non–amphetamine-like stimulants. Cataplexy is treated with sodium oxybate, tricyclic antidepressants, or selective serotonin and norepinephrine reuptake inhibitors. Sleep paralysis, hallucinations, and fragmented sleep may be treated with benzodiazepine hypnotics or sodium oxybate. Patients with narcolepsy should avoid sleep deprivation, sleep at regular hours, and, if possible, schedule routine napping. [Rev Neurol Dis. 2011;8(3/4):e-97-e106 doi: 10.3909/rind0279] © 2011 MedReviews®, LLC
Illusion of Stroke: Intravascular Lymphomatosis Diagnosis and Management Update
We describe an unusual case of cerebral intravascular lymphomatosis wherein the patient presented with multiple embolic strokes predominantly in the posterior circulation. Using this case as an illustration, we review the literature of this malignancy, which consists of extranodal diffuse large B-cell lymphoma. For patients with recurrent stroke-like events without cardiac risk factors, the accurate diagnosis requires a high index of suspicion by the neurologist and a brain biopsy specimen demonstrating lymphoma cells within the lumen of cerebral blood vessels. Intravascular lymphomatosis can be treated with systemic chemotherapies, but the response rate and pattern of relapse remain unknown. [Rev Neurol Dis. 2011;8(3/4):e107-e113 doi: 10.3909/rind0284] © 2011 MedReviews®, LLC
Highlights of the 63rd Annual Meeting of the American Academy of Neurology, April 9-16, 2011, Honolulu, Hawaii NULL
[Rev Neurol Dis. 2011;8(3/4):e114-e119 doi: 10.3909/rind0280] © 2011 MedReviews®, LLC
A Rare Cause of Headache Presentation
[Rev Neurol Dis. 2011;8(3/4):e121-e122 doi: 10.3909/rind0282a] © 2011 MedReviews®, LLC
Progressive Personality and Language Changes in a 62-Year-Old Woman Presentation
[Rev Neurol Dis. 2011;8(3/4):e121-e122 doi: 10.3909/rind0282a] © 2011 MedReviews®, LLC
News and Views From the Literature Noninvasive Vascular Imaging Technologies, Neuro-Ophthalmology
[Rev Neurol Dis. 2011;8(3/4):e123-e130 doi: 10.3909/rind0273] © 2011 MedReviews®, LLC
A Rare Cause of Headache Discussion
Slow-developing masses with or without pain are the prognostications of temporalis muscle hemangiomas. Hemangiomas localized on the temporalis muscle may rarely play a role in the etiology of chronic headache. Surgical treatment is necessary for an exact diagnosis and for resolution of the symptoms. [Rev Neurol Dis. 2011;8(3/4):e131-e134 doi: 10.3909/rind0275b] © 2011 MedReviews®, LLC
Progressive Personality and Language Changes in a 62-Year-Old Woman Discussion
The clinical findings led to the working impression of behavioral-variant frontotemporal dementia (bvFTD), a diagnosis under the umbrella of the histologic diagnosis of frontotemporal lobar degeneration (FTLD). FTLD is a neurodegenerative disease with three prototypic syndromes described: behavioral-variant, progressive nonfluent aphasia, and semantic dementia. The most common clinical manifestation is the behavioral variant, originally called frontotemporal dementia (FTD), with profound personality and social conduct changes.1 Our patient fulfilled the five core criteria for the diagnosis, namely insidious onset and gradual progression, early decline in social conduct, early impairment in regulation of personal conduct, early emotional blunting, and early loss of insight. [Rev Neurol Dis. 2011;8(3/4):e135-e137 doi: 10.3909/rind0282b] © 2011 MedReviews®, LLC