Lacunar stroke.

Expert Rev Neurother. 2009 Feb;9(2):179-96

Authors: Arboix A, Martí-Vilalta JL

Lacunar infarcts or small subcortical infarcts result from occlusion of a single penetrating artery and account for one quarter of cerebral infarctions. Patients with a lacunar infarct usually present with a classical lacunar syndrome (pure motor hemiparesis, pure sensory syndrome, sensorimotor stroke, ataxic hemiparesis or dysarthria-clumsy hand) and, less frequently, an atypical lacunar syndrome. Hypertension and diabetes mellitus are major risk factors for lacunar stroke. Lacunar infarcts show a paradoxical clinical course with a favorable prognosis in the short term, characterized by a low early mortality and reduced functional disability on hospital discharge, but with an increased risk of death, stroke recurrence and dementia in the mid- and long term. Asymptomatic progression of small-vessel disease is a typical feature of the lacunar infarcts. For this reason, lacunar infarction should be regarded as a potentially severe condition rather than a relatively benign disorder and, therefore, lacunar stroke patients require adequate and rigorous management and follow-up. Antiplatelet drugs, careful blood pressure control, the use of statins and modification of lifestyle risk factors are key elements in secondary prevention after lacunar stroke.

PMID: 19210194 [PubMed - indexed for MEDLINE]

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Treatment of status epilepticus.

Expert Rev Neurother. 2008 Dec;8(12):1817-27

Authors: Miller LC, Drislane FW

Generalized convulsive status epilepticus is a neurologic and medical emergency, with significant morbidity and mortality. First-line treatment includes administration of intravenous benzodiazepines. Second-line agents include intravenous phenytoin, phenobarbital, valproate and levetiracetam. Refractory status epilepticus necessitates the use of anesthetic agents such as pentobarbital, midazolam or propofol, with monitoring of treatment effect by continuous EEG. Nonconvulsive status epilepticus should be treated expeditiously but is not as threatening to health as convulsive status epilepticus.

PMID: 19086878 [PubMed - indexed for MEDLINE]

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