[Differential diagnosis of transient ischemic attacks].
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Biomedical subjects
Publications and source records attributed to H Reisner.
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Sleep problems of the aging differ from adolescents clinicaly as well as in their EEG-pattern. They can be purely functional (exogenous or reactiv) however are frequently influenced by changes in the aging organism. Most common are cardio-vascular and pulmonary problems. The treatment of sleep disorders has to emphasize the improvement of these problems so that functional sleep difficulties can be treated successfully. It has to be recognized that elderly people can react paradoxically or overreact to all psychotropic agents including hypnotics.
1938 respectively 1978 are dates for progress of technical medicine concerning gerontoneurology. Following the discussion of the development in technical (apparatus), chemical and immunological diagnostic activities in neurology the applicability in elderly people should be described. On principle there are no methods of investigations which cannot be used in geriatric causes. Main point of interest is the correct indication. Non invasive methods can be used without somatic risk; one has to observe only the fact of psychological stress for the patient; indications of invasive methods (merely angiography of vessels within the brain) must be focused on special diagnosis of the illness. Suspicious facts of space occupying intracranial process almost everytime ask for angiography following EEG and cranial computertomography. In cases of arteriosclerosis in aged people with typical changes within the vessel system of the brain one should only use angiographical investigations if clinical findings (based on noninvasive methods) show indications for surgical treatment in extracranial regions of the brain vessels. It might be the same procedure if shunt-operation between carotis externa and interna circulation system can be expected as curative or prophylactic influence within the neurological condition. In these cases risk of selective angiography of the vessels within the brain (outgoing from arteria femoralis) are much less dangerous than in direct charges. First of all neurological status, general condition and age will be decive for medical indication. One should not use the full range of diagnostic features in gerontoneurology only to satisfy diagnostic appeasement.
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Cerebral circulatory disturbances occurred in 42 women between the ages of 17 and 52 who were taking oral contraceptives. The disturbances were primarily in the form of cerebral haemorrhages. The symptoms ranged from ephemeral neurological deficiencies to massive hemi-syndromes. Complete remission occurred in 16 patients, partial remission in 24 patients, two patients died. The patients were subdivided into two age groups, one comprising 31 persons between 17 and 39, and the other 11 persons between 41 and 52 years of age. The aim was to ascertain facts which were related to the possibility of haemorrhage in women taking ovulation inhibitors. The first finding, statistically significant, was that the possibility of a cerebro-vascular disturbance increases with the period during which the pill is taken and that this possibility is especially great in the presence of migraine which may also be existent in the family, and in the case of hypertension. The second finding, not significant however, was that the risk was higher in the presence of several factors in one person. These factors include familial factors with a predisposition to migraine and thrombosis, past illnesses of the peripheral vascular system, a predisposition to allergic reactions, obesity and kidney damage. Should one of these situations or both prevail, the patient will be advised to stop taking the pill, and the contraceptive will be discontinued if certain prodromes are observed in a general form, or if focal symptoms occur.
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