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At least 19 recordsLinked to original sources
PubMed1999

[Continuing medical education (CME) in neurology. Concept of the German Society of Neurology (DGN) and the Neurology Section of the Professional League of German Neurologic Medicine (BVDN)].

Continuous medical education in Neurology (CME-Neurology) has been promoted in a concept organized by both the German society of neurology, German association for occupational interests of neurologists and psychiatrists). CME-Neurology has been started in January 1999 and is closely adapted to the CME guidelines of neurology section of UEMS and EFNS. The program shall serve to the maintenance and upgrading of knowledge skills and competence of postgraduate training in neurology.

Education, Medical, Continuing↗
PubMed1999

Neurological outcomes in late HIV infection: adverse impact of neurological impairment on survival and protective effect of antiviral therapy. AIDS Clinical Trial Group and Neurological AIDS Research Consortium study team.

OBJECTIVE: In a large multi-center clinical trial of combination reverse transcriptase inhibitors (RTIs), we assessed the impact of antiretroviral therapy on neurological function, the relationship between neurological and systemic benefit, and the prognostic value of neurological performance in late HIV-1 infection. DESIGN: Neurological evaluations incorporated in a randomized, multi-center trial of combination antiretroviral therapy. SETTING: Forty-two AIDS Clinical Trials Group sites and seven National Hemophilia Foundation sites. PATIENTS: Adult HIV-infected patients (n = 1313) with CD4 counts < 50 x 10(6) cells/l. INTERVENTIONS: Four combinations of reverse transcriptase inhibitors consisting of zidovudine (ZDV), alternating monthly with didanosine (ddl), or in combination with zalcitabine (ddC), ddl or ddl and nevirapine. MAIN OUTCOME MEASURES: Mean change from baseline of a four-item quantitative neurological performance battery score, the QNPZ-4, administered to 1031 subjects. RESULTS: Triple therapy and ZDV/ddl combination preserved or improved neurological performance over time compared with the alternating ZDV/ddl and ZDV/ddC regimens (P < 0.001), paralleling their impact on survival in the same trial as previously reported. QNPZ-4 scores were predictive of survival (P < 0.001), after adjusting for CD4 counts and HIV-1 plasma RNA concentrations. CONCLUSIONS: Combination antiretroviral therapy can have a salutary effect on preserving or improving neurological function. Superior systemic treatments may likewise better preserve neurological function. The significant association of poor neurological performance with mortality, independent of CD4 counts and HIV-1 RNA levels indicates that neurological dysfunction is an important cause or a strong marker of poor prognosis in late HIV-1 infection. This study demonstrates the value of adjunctive neurological measures in large therapeutic trials of late HIV-1 infection.

AIDS Dementia Complex↗
PubMed1978

Differentiation of neurologic and pseudo-neurologic patients with combined MMPI mini-mult and pseudo-neurologic scale.

Patients who were complaining of neurologic symptomagology completed the MMPI Mini-Mult plus the Shaw and Matthews Pseudo-Neurologic Scale to determine whether Pseudo-Neurologic and Neurologic patients could be separated. This was done with statistical significance, but not with clinical utility. There were no significant differences among the mean Mini-Mult profiles for the neurologic subcategory groups. Mean profiles for the Neurologic, Pseudo-Neurologic, and Mixed groups also were not significantly different, but analyses of the individual profiles in the Neurologic and Pseudo-Neurologic groups produced statistical and clinical significance. Presenting complaints of all Ss were investigated to see whether the Scale could predict differentially for patients in each of these groups. Only the complaint of weakness predicted with statistical significance and clinical utility. Attempts to create a new, more effective scale were disappointing despite statistical significance as misclassification decreased clinical utility.

Adult↗
PubMed1991

[The neurologic department of the Neurologic Clinic--establishment of the Heidelberg Chair for Neurology 1881-1969].

During the 20th century clinical neurology developed to a fully established discipline being descended from Psychiatry and Internal Medicine. In this paper the development of clinical neurology at the University of Heidelberg from a Nervenabteilung at the clinic for internal medicine to a chair with separate clinic of neurology is outlined as an example for the controversy which accompanied the institutionalization of the discipline in Germany. Pointing out motives and arguments of the persons involved in this process the specific circumstances of the development of neurology in Germany are stated more precisely.

Germany↗
PubMed1999

Expanding the neurological examination using functional neurologic assessment: part II neurologic basis of applied kinesiology.

Functional Neurologic Assessment and treatment methods common to the practice of applied kinesiology are presented. These methods are proposed to enhance neurological examination and treatment procedures toward more effective assessment and care of functional impairment. A neurologic model for these procedures is proposed. Manual assessment of muscular function is used to identify changes associated with facilitation and inhibition, in response to the introduction of sensory receptor-based stimuli. Muscle testing responses to sensory stimulation of known value are compared with usually predictable patterns based on known neuroanatomy and neurophysiology, guiding the clinician to an understanding of the functional status of the patient's nervous system. These assessment procedures are used in addition to other standard diagnostic measures to augment rather than replace the existing diagnostic armamentarium. The proper understanding of the neurophysiologic basis of muscle testing procedures will assist in the design of further investigations into applied kinesiology. Accordingly, the neurophysiologic basis and proposed mechanisms of these methods are reviewed.

Gait↗
PubMed1996

Are neurologic events occurring during carotid artery surgery predictive of postoperative neurologic complications?

BACKGROUND: Per- and postoperative neurologic complications occurring during carotid artery surgery may be related to different mechanisms. Nevertheless, recent studies suggest that they are related and that patients who develop reversible neurologic events peroperatively are at risk of postoperative neurologic complications. We, therefore, studied 265 patients operated under regional anaesthesia to assess the incidence and the pathogenesis of per- and postoperative neurologic disorders and their relationship. METHOD: Neurologic function was adequately assessed in 261 patients during surgery. The operation was uneventful in 234 patients, while 27 suffered from transient ischaemic neurologic deficit occurring mainly during carotid artery clamping. RESULTS: Postoperative neurologic complications occurred in 6 (2.5%) of the patients who were symptom-free during surgery and in 1 (3.7%) of the patients who experienced neurologic deficit during surgery (NS). In this group, two additional patients had peroperative neurologic deficit which lasted a few hours postoperatively so that the total incidence of postoperative neurologic deficit (11.1%) was significantly higher than in the other group (P < 0.05). Emboli (N = 3) and carotid artery thrombosis (N = 3) were the main causes of postoperative neurologic deficit. CONCLUSION: We conclude that patients who have suffered from a peroperative neurologic complication were more frequently in an unstable neurologic condition postoperatively. However, the incidence of "new" neurologic deficit, separated by a free interval from the one occurring peroperatively, was not significantly different in this group.

Adult↗
PubMed2002

[Status and perspectives in modern neurology. Problems of organization of neurologic services worldwide and in Croatia].

Modern neurology has completely changed in its concepts of science and medical discipline regarding the etiologies and the capabilities in the diagnostics, management, rehabilitation and prevention of neurological diseases. Advances in neurological sciences produced a rapid growth in the number of neurologists, new subspecialties and neurological institutions worldwide, opening questions on their possible application due to financial restrictions in many countries. Neurology in Croatia followed the modern tendencies in the world: in line with its humanistic tradition its orientation to the patient early appeared. From this experience developed a care on the optimal organization of neurological services, later on initiated in the Research Group on the Organization and Delivery of Neurological Services, founded in the World Federation of Neurology. The main activities and the Recommendations related to Neurology in Public Health are described, with the proposed levels of organization of neurological services, aiming at the optimal and rational neurological care. Problems of international collaboration on cost-effectiveness in neurology are accentuated.

Croatia↗
PubMed1996

Opportunities and challenges in academic neurology: report of the Long Range Planning Committee of the American Neurological Association.

By most measures, academic neurology is thriving as never before, yet convening forces are changing the face of academic neurology. This report focuses on changes that academic neurology and the American Neurological Association could undertake to seize new opportunities and resist damaging potential changes. These proposals can be categorized in the following four major goals: (1) enhance the quality of a smaller neurology workforce and augment the recruitment of gifted young neuroscientists into neurology; (2) foster new diversity in neurological investigation, including clinical research in neurology; (3) document the benefits and relative costs of neurological care, in general, and of academic neurology, in particular; and (4) foster the role of neurologists as teachers to medical caregivers at all levels, including medical students, nonneurological house staff, and primary practitioners.

Education, Medical, Graduate↗
PubMed1994

[Anesthetic management and neurological outcomes of patient for open heart surgery with infective endocarditis and neurological complications].

No reports have focused on neurological outcomes after open heart surgery of patients with infective endocarditis (IE) and neurological complications. We evaluated parameters related to anesthetic management and neurological outcomes. The subjects analyzed were 24 patients who had undergone valvular surgeries under hypothermic cardiopulmonary bypass from April 1978 to December 1990. The patients were divided into two groups according to the interval between onset of neurological complication and the time of operation: 1) acute group (within one month before the surgery: n = 11, 9.4 +/- 9 days; means +/- SD) and 2) chronic group (more than one month before the surgery: n = 13, 120 +/- 80 days). After heart surgery, 5 patients in the acute group showed newly developed neurological abnormality including death from hemorrhagic transformation, hemiplegia or aphasia. No patients in the chronic group had newly developed neurological abnormality related to the surgery. In the neurologically deteriorated patients of the acute group, interval from the onset of neurological complication to surgery was 3.5 +/- 4.5 days, whereas that of the remainders of the acute group was significantly longer (14.4 +/- 9.0 days). Intraoperative events and anesthetic management of these patients were also analyzed. However, there were no significant differences in the parameters such as cerebral perfusion pressure, arterial PaCO2, doses of anesthetics and use of vasopressors. Our results suggest that the most important factor which may influence neurological outcome was the interval between the onset of neurological abnormality and the time of operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

[A nation-wide survey for neurologic and hepato-neurologic type of Wilson disease: clinical features and hepatic copper content].

A nation-wide survey for Wilson disease was performed from 1990 to 1991. We studied clinical features and copper content in liver for the neurologic and hepato-neurologic types. A questionnaire was sent to more than five thousand hospitals in Japan. Thirty-three percent of physicians completed the questionnaire. Four hundred and twenty-five cases were studied for the onset age, primary symptoms, prognosis and hepatic copper content. The onset age of neurologic and hepato-neurologic type of Wilson disease was usually 6 years or older. The most common initial symptom was dysarthria. Gait disturbance, flapping tremor and Kayser-Fleischer rings were also very common symptoms. We conclude that in patients with dysarthria and/ or extra pyramidal symptoms over 6 years of age, Wilson disease should be considered. The prognosis quod vitam of patients with neurologic and hepato-neurologic Wilson disease is not always fatal. However, many patients required prolonged treatment at either a hospital, sanatorium or at home due to irreversibility of their severe neurological defects. This result shows that early detection is the most important factor for a promising prognosis. Copper content in liver was examined for each type of Wilson disease. Neurologic type of Wilson disease had the highest copper content, followed by hepato-neurologic type. Hepatic type had the lowest copper level out of these three forms of the disease. The mechanism of onset for each type of Wilson disease should be studied using these results.

Adolescent↗
PubMed2000

[Clinical neurological examination of patients referred to a neurological department].

BACKGROUND: We studied reports of clinical neurological status in patients referred from primary and secondary health service to a neurological department. MATERIAL AND METHOD: We evaluated referrals consecutively during 6 months. By using parametric and categorical statistical methods, we studied characteristics in examined patients compared with others. RESULTS: Of a total of 912 patients, 431 (47%) had been examined neurologically. Among the women, 267 women (51%) had been examined; among the 164 men (43%). Patients with musculoskeletal disorders were more often examined, p = 0.0001, while those with faint or seizure disorders were significantly less frequently examined compared with other patients, p = 0.009. Clinical neurological examinations were performed more often in women compared with men, p = 0.03. The mean age was higher in the examined group (49.7 years) compared with others (46.5 years), p = 0.006. INTERPRETATION: Clinical neurological examination in patients referred to a neurological department had more often been performed in women, in higher age groups, and in those with musculoskeletal symptoms. In more than half of the patients, the decision of referring patients to the department of neurology was not based on results obtained from clinical neurological examination.

Adolescent↗
PubMed2003

Utility of the neurologic intensive care evaluation (NICE) in detecting neurologic deficit after cardiac operations--a pilot study.

BACKGROUND: Neurocognitive changes are common after cardiac operations. The acute post-operative period is a critical time when significant neurologic changes may be detected and appropriate therapy initiated promptly. Formal neuropsychologic testing in this situation however is impractical so other means of early detection are required. The goal of this preliminary study was to determine whether simple, standardized, serial nursing neurologic evaluations using the Neurologic Intensive Care Evaluation (NICE) could be helpful in screening patients for neurologic injury in the immediate post-operative period. MATERIAL/METHODS: Details of the intra-operative and post-operative anesthetic management were obtained during report and nurses subsequently scored acute post-operative patients in the CTSICU using the NICE every half hour for the first five hours. Finally, a chart review was performed to determine the neurologic outcome of the patients. RESULTS: The time to achieve the lower NICE scores which reflect mainly brainstem function was the same whereas the time to achieve NICE scores>4 was prolonged in patients with neurocognitive dysfunction. The effect of intra-operative factors on the times to achieve NICE scores was different for the higher and lower scores. The times to reach NICE scores correlated with outcome variables including the time in ICU and time of intubation. CONCLUSIONS: Standardized, serial nursing neurologic assessments of post-operative cardiac patients may be a useful tool for early identification of patients with neurologic injury. They may also provide useful information complementing the data obtained from detailed neuropsychologic testing on the neurologic effects of cardiac operations.

Adult↗
PubMed1998

Roots and routes of Russian neurosurgery (from surgical neurology towards neurological surgery).

Regular and purposeful neurosurgical interventions started at the end of the nineteenth century. Both surgical and neurological roots of the emerging speciality could be traced. The surgical roots of neurosurgery were the invention of anaesthesia, aseptics and antiseptics which made brain operations relatively safe and markedly reduced postoperative mortality. The neurological roots were the improvement of topical diagnosis in neurology and the understanding of the anatomy and physiology of the nervous system. The first operating room at the neurology department of the Russian Military Medical Academy was established in 1897 by the famous Russian neurologist and psychiatrist Vladimir Bekhterev (1857-1927). According to Bekhterev, neurology should become a surgical speciality like gynaecology or opthalmology and "neurologists will take a knife in their hands and do what they should do". Bekhterev's pupil Ludwig Puusepp (1875-1942) became the first full-time Russian neurosurgeon ("surgical neurologist"). He headed the first university course in surgical neurology in the world organised in 1909 at Bekhterev's Psychoneurological Institutte in St. Petersburg and bacame professor of surgical neurology in 1910. The role of neurologist might be illustrated by the development of a sterotactic instrument named "encephalometer" designed by D. Zernov in 1889 and improved by G. Rossolimo in 1907. The idea was to map cerebral structures in degrees of latitude and longitude similar to mapping the terrestrial globe in order to localise the brain lesion and enhance its minimally invasive removal....

History, 19th Century↗
PubMed1986

Neurologic abnormalities in schizophrenic patients and their families. II. Neurologic and psychiatric findings in relatives.

Neurologic abnormalities in 21 nonschizophrenic siblings and parents of schizophrenics, 24 DSM-III schizophrenics, and 24 normal "control" subjects were assessed by experienced neurologists blind to the subjects' psychiatric status. Medication artifacts and other neurologic signs likely to be etiologically irrelevant to psychiatric illness were excluded. Psychiatric diagnostic assessments of subjects were made blind to neurologic results. The prevalence of neurologic abnormalities in relatives was significantly greater than in controls, but similar to that among the schizophrenics. Relatives and controls differed even more markedly on signs involving motor system abnormalities of localizing significance. Finally, the relatives showed a suggestive dissociation of psychopathology and neurologic signs. The results appear most consistent with the hypothesis that overt schizophrenia may often result from the combined operation of two independent familial factors--one "psychopathologic," the other "neurologic".

Adult↗
PubMed2002

Quantification of circulating anti-Hu antibody in serial samples from patients with paraneoplastic neurological syndromes: possible correlation of antibody concentration and course of neurological symptoms.

Serial samples, spanning an observation period of 4 to 10 years, from five patients with anti-Hu associated paraneoplastic neurological syndromes (PNS) were investigated with an enzyme linked immunosorbent assay (ELISA) employing recombinant HuD protein as antigen. In one patient the anti-Hu antibody concentration converted from negative to highly positive levels after the onset of neurological symptoms. These findings argue in favour of the idea that an autoimmune process, which is generated at the beginning of the neurological disease, causes the anti-Hu associated PNS. Serum samples obtained shortly after the beginning of the PNS were available from two other patients. The anti-Hu antibody levels in these latter patients increased from modest to highly positive anti-Hu antibody in follow up samples. In two patients a clear decrease of the anti-HuD antibody concentration together with an improvement of paraneoplastic neurological symptoms after successful tumour treatment were seen. Overall these data suggest that there might be a correlation between the anti-HuD antibody level and the clinical course of paraneoplastic neurological symptoms which supports further the hypothesis that an autoimmune process is responsible for the anti-Hu associated paraneoplastic neurological symptoms.

Aged↗