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Neurologic Clinics

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https://read.qxmd.com/read/30952420/vasculitis-of-the-nervous-system
#1
EDITORIAL
David S Younger
No abstract text is available yet for this article.
May 2019: Neurologic Clinics
https://read.qxmd.com/read/30952419/dermatologic-aspects-of-systemic-vasculitis
#2
REVIEW
David S Younger, Andrew Carlson
Systemic and localized vasculitis affects the skin and subcutis, due to large vascular beds and hemodynamic factors, such as stasis in lower extremities, and environmental influences, as occur in cold exposure. Initial cutaneous manifestations of vasculitides include diverse and dynamic patterns of discoloration, swelling, hemorrhage, and necrosis. One-half of affected patients present with localized, self-limited disease to the skin without any known trigger or associated systemic disease, known as idiopathic cutaneous leukocytoclastic vasculitis...
May 2019: Neurologic Clinics
https://read.qxmd.com/read/30952418/central-nervous-system-vasculitis-due-to-infection
#3
REVIEW
David S Younger, Patricia K Coyle
Several pathogens have the propensity to involve blood vessels during central nervous system infection, which can lead to cerebrovascular complications. Infection is a recognized cause of secondary central nervous system vasculitis. It is important not to miss the diagnosis of infection-related central nervous system vasculitis because specific antimicrobial therapy may be necessary; this article reviews the major implicated organisms.
May 2019: Neurologic Clinics
https://read.qxmd.com/read/30952417/central-nervous-system-vasculitis-due-to-substance-abuse
#4
REVIEW
David S Younger
Illicit drug abuse is a common differential diagnosis of acquired central nervous system vasculitis even though there are only a handful of histopathologically confirmed patients in the literature from among the many potential classes of abused drugs traditionally implicated in this disease. This article considers the major classes of illicit drugs in those with and without human immunodeficiency virus type-1 infection and acquired immune deficiency syndrome.
May 2019: Neurologic Clinics
https://read.qxmd.com/read/30952416/treatment-of-vasculitis-of-the-nervous-system
#5
REVIEW
David S Younger
The diagnosis of primary central and peripheral nerve vasculitides should be established with certainty if suspected before commencing potent immunosuppressive therapy. The aim of induction therapy is to rapidly control the underlying inflammatory response and stabilize the blood-brain and blood-nerve barriers, followed by maintenance immunosuppression tailored to the likeliest humoral and cell-mediated autoimmune inflammatory vasculitic processes.
May 2019: Neurologic Clinics
https://read.qxmd.com/read/30952415/neuroophthalmologic-aspects-of-the-vasculitides
#6
REVIEW
David S Younger
There have been significant advances in the understanding of the vasculitides in the past several years, leading to more precise classification and nosology. Ophthalmologic manifestations may be the presenting feature of and a clue to the diagnosis of vasculitis, or develop in the course of the illness owing to a common disease mechanism. Precise diagnosis and prompt treatment prevents short- and long-term ophthalmologic sequela.
May 2019: Neurologic Clinics
https://read.qxmd.com/read/30952414/autoimmune-encephalitides
#7
REVIEW
David S Younger
Autoimmune encephalitis is a severe inflammatory disorder of the brain with diverse causes and a complex differential diagnosis. Recent advances in the past decade have led to the identification of new syndromes and biological markers of limbic encephalitis, the commonest presentation of autoimmune encephalitis. The successful use of serum and intrathecal antibodies to diagnose affected patients has resulted in few biopsy and postmortem examinations. In those available, there can be variable infiltrating inflammatory T cells with cytotoxic granules in close apposition to neurons, consistent with an inflammatory autoimmune basis, but true vasculitis is rarely seen...
May 2019: Neurologic Clinics
https://read.qxmd.com/read/30952413/polyarteritis-nodosa-neurologic-manifestations
#8
REVIEW
Hubert de Boysson, Loïc Guillevin
Polyarteritis nodosa (PAN) is a necrotizing vasculitis affecting medium-sized vessels whose main manifestations are weight loss, fever, peripheral neuropathy, renal, musculoskeletal, gastrointestinal tract and/or cutaneous involvement(s), hypertension and/or cardiac failure. Peripheral neuropathy is one of the most frequent and earliest symptoms, affecting 50% to 75% of PAN patients. Central nervous system involvement affects only 2% to 10% of PAN patients, often late during the disease course. Treatment relies on combining corticosteroids and an immunosuppressant (mainly cyclophosphamide) in patients with poor prognoses...
May 2019: Neurologic Clinics
https://read.qxmd.com/read/30952412/giant-cell-arteritis
#9
REVIEW
David S Younger
"Giant cell arteritis (GCA) is a chronic, idiopathic, granulomatous vasculitis of medium and large arteries comprising overlapping phenotypes of cranial arteritis and extracranial GCA. Vascular complications are generally due to delay in diagnosis and initiation of effective treatment. Advancements in MRI and MR angiography, computed tomography angiography, 18fluoro-deoxyglucose/PET, and color duplex ultrasonography have led to improved diagnosis. Corticosteroids are the mainstay of therapy in GCA; however, their use is associated with predictable and occasionally serious side effects...
May 2019: Neurologic Clinics
https://read.qxmd.com/read/30952411/peripheral-nerve-vasculitis-classification-and-disease-associations
#10
REVIEW
Kelly G Gwathmey, Jennifer A Tracy, P James B Dyck
"The vasculitic neuropathies encompass a wide range of disorders characterized by ischemic injury to the vasa nervorum. Patients with vasculitic neuropathies develop progressive, painful sensory or sensorimotor deficits that are typically multifocal or asymmetric. Depending on the underlying etiology, the vasculitis may be confined to the peripheral nervous system; may be one manifestation of a primary systemic vasculitis; or one manifestation of a systemic vasculitis that is secondary to underlying connective tissue disease, drug exposure, viral infection, or paraneoplastic syndrome...
May 2019: Neurologic Clinics
https://read.qxmd.com/read/30952410/stroke-due-to-vasculitis-in-children-and-adults
#11
REVIEW
David S Younger
The vasculitides are diseases characterized by inflammation of blood vessels and inflammatory leukocytes in vessel walls. There is an increased propensity for ischemic stroke, resulting from compromise of vessel lumina with distal tissue ischemia; and hemorrhagic or nonhemorrhagic stroke, and aneurysmal formation and bleeding, due to loss of vessel integrity.
May 2019: Neurologic Clinics
https://read.qxmd.com/read/30952409/granulomatous-angiitis-twenty-years-later
#12
REVIEW
David S Younger
Granulomatous inflammation, the prototypical histopathology of adult and childhood vasculitis, is characterized by inflammation of blood vessels accompanied by giant cells and epithelioid cells in the walls of cerebral vessels ranging from small leptomeningeal veins to large named cerebral arteries. Headache, hemiparesis, mental changes, abnormal cerebrospinal fluid protein content, and pleocytosis are suggestive features that warrant brain and leptomeningeal biopsy to make the diagnosis certain and begin cytotoxic therapy to improve outcome...
May 2019: Neurologic Clinics
https://read.qxmd.com/read/30952408/imaging-the-vasculitides
#13
REVIEW
David S Younger
"Neuroimaging plays a vital role in the diagnosis of primary and secondary vasculitic disorders. There multiple neuroimaging options available to accurately describe the underlying clinical deficits of involved cases. Noninvasive neuroimaging modalities provide less risk and when interdigitated, form the basis for a more conclusive understanding of the disease process. There are instances in which invasive cerebral angiography may be needed to image the intricate and at times, small involved vessels. Neuroradiologists should be included in the multidisciplinary team of physicians caring for patients with vasculitides and in research to provide more sensitive and safe modalities for accurate diagnosis...
May 2019: Neurologic Clinics
https://read.qxmd.com/read/30952407/the-blood-brain-barrier-implications-for-vasculitis
#14
REVIEW
David S Younger
There has been extraordinary research in the blood-brain barrier. Once considered a static anatomic barrier to the traffic of molecules in and out of the central nervous system when fully developed in adults, the blood-brain barrier is now known to be not only fully functional in development but also vital in cerebrovascular angiogenesis. Blood-brain barrier breakdown has been recognized as an important factor in a variety of primary neurologic diseases; however, such disturbances have yet to be critically analyzed...
May 2019: Neurologic Clinics
https://read.qxmd.com/read/30952406/genetic-basis-of-vasculitides-with-neurologic-involvement
#15
REVIEW
Francisco David Carmona, Raquel López-Mejías, Ana Márquez, Javier Martín, Miguel A González-Gay
"Vasculitides are a heterogeneous group of inflammatory diseases of blood vessels in which genetic variation plays an important role in their susceptibility and clinical spectrum. Because of the use of novel technologies and the increase of the sample size of the study cohorts, the knowledge of the genetic background of vasculitides has considerably expanded during the last years. However, few insights have been obtained regarding the genetics underlying severe clinical phenotypes, such as those related to the nervous system...
May 2019: Neurologic Clinics
https://read.qxmd.com/read/30952405/epidemiology-of-the-vasculitides
#16
REVIEW
David S Younger
The epidemiology of vasculitis has witnessed extraordinary advances in the past decade influenced by the worldwide increased recognition and accurate classification and diagnosis of the vasculitides, and insights brought by genome-wide association studies and online genetic biological repositories that permit researchers to freely access a wide array of genetic and clinical resources that contribute to the understanding of the heritable factors of the systemic vasculitides. This article reviews the current knowledge of the epidemiology of vasculitides in different global regions...
May 2019: Neurologic Clinics
https://read.qxmd.com/read/30952404/overview-of-the-vasculitides
#17
REVIEW
David S Younger
The systemic vasculitides are heterogeneous clinicopathologic disorders that share the common feature of vascular inflammation. The resulting disorder can vary depending on involvement of specific organs, caliber of blood vessels, the underlying inflammatory process, and individual host factors. The cumulative result is diminished blood flow, vascular alterations, and eventual occlusion with variable ischemia, necrosis, and tissue damage. An international revised nomenclature system provides the necessary nosology and findings relevant to classify each of the vasculitides...
May 2019: Neurologic Clinics
https://read.qxmd.com/read/30952403/eleven-themes-in-the-history-of-systemic-and-nervous-system-vasculitides
#18
REVIEW
David S Younger
Vasculitis is defined as inflammation of blood vessel walls for at least some time during the course of the disease, and affects arteries and veins of varying caliber. Two Chapel Hill Consensus Conferences, in 1994 and 2012, provide consensus on nosology and definitions for the commonest forms of vasculitis. The category of single-organ vasculitis, suggesting the limited expression of a systemic vasculitis, includes primary central nervous system vasculitis and nonsystemic peripheral nervous system vasculitis...
May 2019: Neurologic Clinics
https://read.qxmd.com/read/30470278/introduction-to-neurology-of-pregnancy
#19
EDITORIAL
Mary Angela O'Neal
No abstract text is available yet for this article.
February 2019: Neurologic Clinics
https://read.qxmd.com/read/30470277/neuro-ophthalmic-disorders-in-pregnancy
#20
REVIEW
Aubrey L Gilbert, Sashank Prasad, Robert M Mallery
The physiologic changes that accompany pregnancy can have important implications for neuro-ophthalmic disease. This article discusses pregnancy-related considerations for meningioma, pituitary disorders, demyelinating disease, myasthenia gravis, thyroid eye disease, idiopathic intracranial hypertension, cerebral venous sinus thrombosis, stroke, migraine, and cranial neuropathies. The article also details the potential neuro-ophthalmic complications of preeclampsia and eclampsia and reviews the use of common diagnostic studies during pregnancy...
February 2019: Neurologic Clinics
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