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The paroxysmal disorders present neurologists and other medical professionals with diagnostic problems across a range of disorders, including multiple sclerosis, migraine and epilepsy. This new English language edition of a compendium of the paroxysmal disorders, originally published in German as Paroxysmale Störugen in der Neurologie, is an informative and practical resource for clinicians, which provides invaluable help with differential diagnosis and management. Fully updated throughout, this new edition comprehensively covers the entire spectrum of the paroxysmal disorders, including sudden falls, headache, vertigo attacks, memory loss, visual disturbances, seizures and anxiety. Each chapter is practice oriented, covering definitions, etiology, epidemiology, diagnosis, examination techniques and therapy. Detailed guidelines for gathering case-histories, essential for accurate diagnosis, are also provided. Important reading for clinicians, professionals and academic researchers working in neurology, psychiatry, epilepsy, internal medicine and ENT.
The gold standard case history is of particularly high importance in paroxysmal disorders because many seizures may comprise a variety of subjective symptoms or may even consist exclusively of these symptoms. Taking a seizure history is primarily for diagnostic purposes, largely to differentiate epilepsy from other seizure-like disorders but also to distinguish between different types of epileptic seizures and to understand the anatomy and etiology of these events. Hypotheses are formed, followed-up or refuted, and they determine the subsequent course of the interview. Such an in-depth dialogue also opens up perspectives beyond diagnostics. Beyond providing diagnostic clues and anatomical understanding, another frequent consequence of these interviews is indications for the best further therapeutic strategy. Verbal communication is only successful when the partners in dialogue find a common language. A dialogue is frequently necessary to get the full picture of all subjective seizure symptoms and their sequence.
Clinical symptoms and signs as well as management of patients with ischemia in t¥he posterior circulation are far less well defined than of patients with ischemia in the anterior circulation. Several studies have addressed the issue of extended, space-occupying infarcts in the cerebellum and their management, but there exist only few data on extended or multiple infarcts in the brainstem and their prognosis. Only few attempts have been made to correlate extended infarcts in the brainstem and the cerebellum with the underlying causes and mechanisms. The following sections will review the clinically important factors on the frequency and causes of extended and multiple infarcts in the brainstem and cerebellum with special attention to particular topographic patterns and etiological mechanisms as well as existing data on management and prognosis of these types of infarcts.
Extended or multiple infarcts in the brainstem
Patients with extended brainstem ischemia of sudden onset have often very severe to life-threatening neurological symptoms and signs depending on the localization of the lesion. The neurological symptoms of isolated mesencephalic, pontine or medullary ischemia have been presented in the last chapters. Infarctions involving several brainstem levels are likely to be caused by either basilar artery thrombosis or occlusion of both intracranial vertebral arteries.
Basilar artery occlusion can give rise to a variety of clinical pictures. Many years ago it was thought that basilar artery thrombosis was a life-threatening disease in all patients but now it is known that, if it occurs slowly over time, basilar artery thrombosis can be survived without major disability in some patients (Caplan, 1979; Bogousslavsky et al., 1986; Berlit et al., 1994).
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