Spotlight on Sleep and cardiac disorders

Sleep in normal subjects is characterized by physiological changes in cardiovascular parameters (blood pressure, heart rate), but sleep and, in particular, sleep disorders can also be related to cardiovascular diseases. Patients with cardiovascular diseases may complain of sleep disturbances such as sleep fragmentation, insomnia, and breathing disorders. Conversely, patients with sleep disorders seem to be more frequently affected by cardiovascular disorders, so it is often difficult to determine which is the cause and which is the effect. In this clinical summary, Dr. Carolina Lombardi, Dr. Paola Mattaliano, Dr. Gianfranco Parati of San Luca Hospital and IRCCS Instituto Auxologico Italiano, in Milan, Italy summarize the evidence concerning the link between sleep disorders and cardiovascular diseases and the effects of specific treatment.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Ectopic neurohypophysis

Ectopic neurohypophysis is a posterior pituitary gland displaced distally in the infundibulum. This “incidental finding” in MRI may be associated with cerebral defects, including periventricular heterotopia, septo-optic-pituitary dysplasia, and perisylvian syndrome that may be epileptogenic. Panhypopituitarism and isolated growth hormone deficiency are frequent; diabetes insipidus is rare. The etiology is genetic, with several genes implicated. In this clinical summary, Drs. Harvey B Sarnat, Xing-Chang Wei, and Laura Flores-Sarnat of the University of Calgary and Alberta Children’s Hospital review the neuroimaging features of ectopic neurohypophysis and make clinical, genetic, and pathological correlations.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Psychogenic movement disorders

Psychogenic movement disorders represent a challenge for the clinical practitioner, as the diagnosis and treatment are usually difficult and the prognosis may be poor in some patients. Sometimes also referred to as “functional,” “conversion,” or “psychogenic,” these disorders must be differentiated from “organic” disorders. New evidence from imaging and neurophysiological studies suggests that these patients may have an increased connectivity between the supplementary motor area and the amygdala but lower functional connectivity with the dorsolateral prefrontal cortex. In this clinical summary, Dr. Baizabal-Carvallo of the Parkinson’s Disease Center and Movement Disorders Clinic at Baylor College of Medicine discusses current advances in the diagnosis, pathophysiology, and treatment of psychogenic movement disorders.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Thalamic hemorrhage

The thalamus is particularly vulnerable to non-traumatic intracerebral hemorrhages. Due to its participation in a large number of neuroanatomic loops, a rich and complex spectrum of clinical abnormalities and clinicopathological correlations occurs when bleeding involves this midline paired structure. In this updated clinical summary, Dr. Julien Bogousslavsky of the Genolier Swiss Medical Network and Dr. Jorge Moncayo-Gaete of the Hospital de los Valles in Quito, Ecuador thoroughly address the clinical spectrum, epidemiology, etiology, diagnostic workup, and the latest medical and surgical treatment options for thalamic hemorrhages.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Subjective tinnitus

In this clinical summary, Dr. Douglas Lanska, staff neurologist at the VA Medical Center in Tomah, Wisconsin, explains the clinical presentation, pathophysiology, diagnostic work-up, and management of subjective tinnitus. Studies have demonstrated that subjective tinnitus is associated with hyperactivity of the auditory cortices integrated in a global network of long-range cortical connectivity involving the prefrontal cortex, orbitofrontal cortex, and the parieto-occipital region; signals from the global network on the temporal areas correlate with the subjective strength of the tinnitus distress. Although pharmacologic treatments have generally been disappointing in patients with subjective tinnitus, anecdotal reports suggest that low-dose carbamazepine can relieve symptoms in patients with specific auditory hyperactivity disorders of the eighth nerve (eg, so-called “typewriter tinnitus” and “paroxysmal staccato tinnitus”) possibly resulting from neurovascular compression akin to trigeminal neuralgia and hemifacial spasm.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Epidural hematoma

In this clinical summary, Dr. Saul S Schwarz of the University of Colorado Health Sciences and Kaiser Permanente in Denver, Colorado describes cranial epidural hematoma primarily as a result of traumatic head injury. It represents a hemorrhage between the dura mater and the inner table of the skull. Focal and global neurologic deficits are common, and the mainstay of treatment is surgical decompression. In this review, the authors describe the pathophysiology, diagnosis, and management of epidural hematoma. Updates to this summary include a review of newer imaging techniques that assist with evaluating the extent of associated brain injury and prognosis in patients with traumatic epidural hematoma.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Meningiomas

Meningiomas are the most common intracranial tumors. Although most are benign, morbidity can be high, and in some cases the tumor is fatal. In this clinical summary, Drs. Wendy Sherman and Jeffrey Raizer of Northwestern University review the pathophysiology, presentation, and treatment of this tumor, including new prognostic indicators in atypical and malignant meningiomas.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Mitochondrial disorders

In this review of what is probably the most heterogeneous group of human diseases (the mitochondrial encephalomyopathies), Dr. Salvatore DiMauro of Columbia University tries to offer the clinician a rational diagnostic framework. After reminding the reader of the basic concepts of mitochondrial genetics, he offers examples of disorders due to mutations in mitochondrial DNA and mutations in nuclear DNA. He discusses commonly accepted pathogenic mechanisms, although pathogenesis is still largely unknown. Finally, he presents therapeutic strategies, including palliative and research-based approaches.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Schizophrenia

In this clinical summary, Dr. Rohit Shankar of Cornwall Partnership NHS Foundation Trust and Dr. Virupakshi Jalihal of MS Ramaiah Medical College and Hospitals discuss schizophrenia, a major mental disorder that through centuries has been feared, revered, and misunderstood. It is a disorder of the mind that is complex and has the potential to affect not only individuals but also their families and at times the larger society. There are significant implications in terms of health costs given the chronic and associated life-long morbidity of this disorder. The mainstay of current treatment is pharmacological, which focuses on modulating the neurotransmitter pathways in the brain, especially the dopaminergic pathways. Psychosocial interventions are considered essential in supplementing the medical model of schizophrenia. Recent advances in neurobiology, brain imaging, and genetics have given us a window of understanding the complexity of the concept of schizophrenia and will hopefully help further treatment mechanisms in the near future.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.

Spotlight on Acute motor axonal neuropathy

Acute motor axonal neuropathy is the most frequent axonal variant of Guillain-Barré syndrome (GBS) and is often used synonymously with the term axonal GBS. In this clinical summary, Dr. Sheikh and colleagues from the University of Texas Houston Health Science Center describe clinical and electrodiagnostic features of acute motor axonal neuropathy and compare it with the acute inflammatory demyelinating polyradiculoneuropathy variant of Guillain-Barré syndrome. Pathology and pathogenesis of this disorder is discussed to highlight the theme of molecular mimicry.

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MedLink Neurology authors are always at work to bring you broad and up-to-date coverage of neurology topics. We are pleased to highlight clinical summaries that have been recently added or updated and to introduce the authors who write these authoritative articles. We hope you enjoy these overviews and appreciate the contributions of our more than 450 authors who keep MedLink Neurology the premier information resource for neurologists.