Rehab Centers: Acute Viral Infections of the Central Nervous System in Immunocompetent Adults: Diagnosis and Management.

Acute Viral Infections of the Central Nervous System in Immunocompetent Adults: Diagnosis and Management.

Filed under: Rehab Centers

Drugs. 2013 Feb 2;
Studahl M, Lindquist L, Eriksson BM, Günther G, Bengner M, Franzen-Röhl E, Fohlman J, Bergström T, Aurelius E

Patients with viral infections of the central nervous system (CNS) may present with a variety of neurological symptoms, most commonly dominated by either encephalitis or meningitis. The aetiological panorama varies in different parts of the world as well as over time. Thus, virological first-line diagnostics must be adapted to the current epidemiological situation and to the individual patient history, including recent travels. This review focuses on the diagnostics and treatment of viral CNS infections in the immunocompetent host from a Northern European perspective. Effective vaccines are available for viruses such as poliovirus and tick-borne encephalitis virus (TBEV) and for the childhood diseases morbilli (measles), rubella (German measles), parotitis (mumps) and varicella (chickenpox). However, cases do appear due to suboptimal immunization rates. In viral CNS infections, epidemiological surveillance is essential for establishing preventive strategies and for detecting emerging viruses. Knowledge of the possibilities and limitations of diagnostic methods for specific viral CNS infections is vital. A positive cerebral spinal fluid (CSF) polymerase chain reaction (PCR) finding is usually reliable for aetiological diagnosis. The demonstration of intrathecal antibody synthesis is useful for confirming the aetiology in a later stage of disease, hitherto sufficiently evaluated in herpes simplex encephalitis (HSE) and tick-borne encephalitis (TBE). Despite improved virological and differential diagnostic methods, aetiology remains unknown in about half of the cases with suspected viral encephalitis. Antiviral treatment is available chiefly for infections caused by herpesviruses, and acyclovir (aciclovir) is the drug of choice for empirical therapy in suspected viral encephalitis. However, randomized, controlled antiviral trials have only been conducted for HSE, while such studies are lacking in other viral CNS infections. Viral cytolysis and immune-mediated mechanisms may contribute to varying extents to neurological damage. Although the brain damage is believed to depend, to a varying degree, on the intrathecal host immune response, the use of corticosteroids in viral CNS infections is scarcely studied, as is specific treatment for neuroinflammation. Improved antiviral and immunomodulating treatment is desirable. Since neurological sequelae are still abundant, follow-up after severe viral CNS disease must include a neuropsychological assessment and an individually adapted rehabilitation plan.
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Delayed electrophysiological recovery after carpal tunnel release for advanced carpal tunnel syndrome: a two-year follow-up study.

Filed under: Rehab Centers

J Clin Neurophysiol. 2013 Feb; 30(1): 95-7
Kanatani T, Fujioka H, Kurosaka M, Nagura I, Sumi M

SUMMARY:: Advanced carpal tunnel syndrome presents severe thenar atrophy with the absence of electrophysiological motor and sensory responses. Because of severity of these conditions, a substantial period of recovery after surgery is required before improvement becomes evident. In this electrophysiological-based study, the reappearance of distal motor latency (DML) at the abductor pollicis brevis and/or sensory nerve conduction velocity (SCV) after wrist stimulation were evaluated 1 year and 2 years after carpal tunnel release . To categorize outcomes, the following grading scale was used: stage I, normal DML and SCV; stage II, DML ? 4.5 ms and normal SCV; stage III, DML ? 4.5 ms and SCV < 40.0 ms; stage IV, DML ? 4.5 ms and nonmeasurable SCV; stage V: nonmeasurable DML and SCV. The authors found measurable DML and/or SCV and significant improvement both 1 year and 2 years postoperatively. Furthermore, the percentage of patients who recovered to the extent that they presented as mild carpal tunnel syndrome (stage I or II) increased significantly. They conclude that electrophysiological assessment of DML and SCV of advanced carpal tunnel syndrome using the above grading scale was effective as an objective evaluation tool of recovery after carpal tunnel release. HubMed – rehab

Central correlates of impaired information processing in people with spinal cord injury.

Filed under: Rehab Centers

J Clin Neurophysiol. 2013 Feb; 30(1): 59-65
Lazzaro I, Tran Y, Wijesuriya N, Craig A

SUMMARY:: This investigation examined the impact of spinal cord injury (SCI) on task-relevant processing using event-related potentials. Thirty-seven participants with chronic SCI and 37 healthy able-bodied controls were tested in this study. An auditory two-tone button press oddball discrimination paradigm was used to evoke the N100, P200, N200, and P300 components of the event-related potential. During the early sensory/perceptual stages of target stimulus processing, the SCI group showed an earlier right posterior P200 latency relative to the controls. In the later more cognitive stages, a pattern of diminished left and right posterior P300 amplitude was also evident. This was further coupled with increased false-positive errors and greater variability of response time in the SCI group. The results of this study indicate that people with SCI show disturbances in inhibitory function and alterations in both early perceptual encoding processes and in later executive functioning that engages contextual/memory-updating operations.
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Sexuality Following Burn Injuries: A Preliminary Study.

Filed under: Rehab Centers

J Burn Care Res. 2013 Jan 31;
Marie Connell K, Coates R, Melanie Wood F

Responses to the sexuality and body image subdomains of the Burn Specific Health Scale – Brief Version (BSHS-B) were analysed, to identify the incidence of sexuality and body image changes in burn survivors from hospital discharge – 12 months post injury. Data was collected through examination of Burn specific Health Scale Brief Version questionnaires (BSHS-B), from burns patients at hospital discharge and one, three, six and twelve month time points post burn injury. The results demonstrate that burn injuries have a significant negative impact on sexuality and body image satisfaction for burn survivors. The results raises concerns regarding potential long term quality of life (QoL) issues for burn survivors in these domains. Sexuality and body image following burn injuries are important QoL domains that should be addressed during post injury rehabilitation. This preliminary study shows that further empirical research regarding changes to sexuality and body image in the burns population is required.
HubMed – rehab

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