Category Archives: Neurology

Public release date: 6-Feb-2012
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Contact: Rachel Seroka
rseroka@aan.com
651-695-2738
American Academy of Neurology

ST. PAUL, Minn. ? A new scoring method can help doctors quickly decide which stroke patients will respond well to the clot-busting drug alteplase, according to a study published in the February 7, 2012, print issue of Neurology?, the medical journal of the American Academy of Neurology.

The DRAGON score was 86 percent accurate in predicting the outcome three months after people had the stroke and received the drug within four-and-a-half hours after their first stroke symptoms.

"The DRAGON score is simple and fast to perform, it has no cost, and it consists solely of factors that are known when the patient is admitted to the hospital or soon after," said study author Daniel Strbian, MD, PhD, of Helsinki University Central Hospital in Finland. "We found that we could determine the score in less than a minute. This can help the doctor, the patient, and the family to evaluate the situation, make choices and give the most relevant treatment with the greatest speed."

Strbian said the score can help with the decision to try additional therapies when the likelihood is high that alteplase alone will not provide a good outcome.

The study involved 1,319 people with ischemic stroke with an average age of 69 who were treated with alteplase. Participants were given a score of zero to 10 based on their age, glucose level, time since stroke symptoms started, the severity of the stroke and other factors. The higher the score was, the more likely the person was to have a bad outcome three months later. A bad outcome was defined as being dead or being bedridden, incontinent and requiring constant nursing care and attention.

A total of 96 percent of those with scores of zero to two had a good outcome three months later. A good outcome was defined as being independent in daily activities. None of the people with DRAGON scores of eight to 10 had good outcomes three months later.

The score was also tested on a second group of 333 people at a hospital in Switzerland, with similar results.

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The study was supported by Helsinki University Central Hospital, the Sigrid Juselius Foundation, the Finnish Medical Foundation and the Yrj? Jahnsson Foundation.

Learn more about stroke at http://www.aan.com/patients.

The American Academy of Neurology, an association of more than 25,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson's disease and multiple sclerosis.

For more information about the American Academy of Neurology, visit http://www.aan.com or find us on Facebook, Twitter, Google+ and YouTube.

Media Contacts:
Rachel Seroka, rseroka@aan.com, (651) 695-2738
Angela Babb, APR, ababb@aan.com, (651) 695-2789

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Who will benefit from stroke drug? New score can help decide

This is another recent review from Am Fam Physician:

Chronic kidney disease (CKD) affects 27 million adults in the U.S. It increases risk of cardiovascular disease and stroke.

Patients should be assessed annually to determine whether they are at increased risk of developing chronic kidney disease (CKD).

Risk factors for CKD include:

- diabetes mellitus
- hypertension
- older age
- cardiovascular disease
- family history of chronic kidney disease
- ethnic and racial minority status

Tests for CKD:

- Serum creatinine levels can be used to estimate the glomerular filtration rate (GFR)
- Spot urine testing can detect proteinuria

Staging of CKD is based on estimated glomerular filtration rate (GFR). Evaluation should focus on the specific type of CKD and identifying complications related to the disease stage.

When to refer to a nephrologist?

The patients with the following characteristics should be referred to a nephrologist:

- estimated glomerular filtration rates less than 30 mL per minute per 1.73 m2
- significant proteinuria
- rapid loss of kidney function

References:

Chronic Kidney Disease: Detection and Evaluation. Baumgarten M, Gehr T. Am Fam Physician. 2011 Nov 15;84(10):1138-1148.
Nephrology Cases

Source:
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Heath Frisby lands the first snowmobile front flip in competition:

This is what happens when the things don't go as planned: Colten Moore flies 120 feet into the air and then hits the snow hard in Snowmobile Freestyle Finals... (video below). He not only survived but went on to win Winter X Games Gold later.

Not all extreme winter sport champions are so lucky though, and some of them have barely escaped death, with life-altering injuries: Kevin Pearce reflects on Sarah Burke's death (USA Today).

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Chronic diarrhea is defined as a decrease in stool consistency (loose BM) for more than 4 weeks (Am Fam Physician, 2011).

It can be divided into 3 categories:

- watery
- fatty (malabsorption)
- inflammatory

Watery diarrhea

Watery diarrhea may be subdivided into:

- osmotic
- secretory
- functional, e.g. IBS

Watery diarrhea includes irritable bowel syndrome (IBS), which is the most common cause of functional diarrhea. Another example of watery diarrhea is microscopic colitis, which is a secretory diarrhea affecting older persons.

Laxative-induced diarrhea is often osmotic.

Malabsorptive diarrhea

Malabsorptive diarrhea is characterized by excess gas, steatorrhea, or weight loss. Giardiasis is a classic infectious example of malabsorptive diarrhea.

Celiac disease (gluten-sensitive enteropathy) is also malabsorptive, and typically results in weight loss and iron deficiency anemia.

Inflammatory diarrhea

Inflammatory diarrhea, such as ulcerative colitis (UC) or Crohn disease, is characterized by blood and pus in the stool and an elevated fecal calprotectin level.

Invasive bacteria and parasites also produce inflammation. Infections caused by Clostridium difficile (C. diff.) subsequent to antibiotic use have become increasingly common and virulent.

Image source: Escherichia coli, Wikipedia, public domain.

Not all chronic diarrhea is strictly watery, malabsorptive, or inflammatory, because some categories overlap.

References:

Evaluation of Chronic Diarrhea. Juckett G, Trivedi R. Am Fam Physician. 2011 Nov 15;84(10):1119-1126.
Skin patch vaccine to prevent travelers' diarrhea
Image source: Colon (anatomy), Wikipedia, public domain.

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30-01-2012 11:09 University of Colorado School of Medicine Neurology Grand Rounds 12.16.2011

The rest is here:
CU School of Medicine Neurology Grand Rounds 12.16.2011 - Video

31-01-2012 05:28 History Taking and Neurology Symptoms Clinical Neurology Series Prof.Dr.Abdel Latef Osman Professor of Neurology, Azhar University

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Dr.Abdel Latef Osman | History Taking