eLetters

621 e-Letters

  • Neuroendocrine adaptation in large brain infarcts
    Vinod K Gupta

    Dear Editor

    Schwarz et al. report neuroendocrine alterations in critically ill patients with large infarctions of the brain.[1] They regard suppression of plasma adrenocorticotropic hormone (ACTH) and cortisol levels as indicating absence of endogenous stress response while attributing sustained elevation of prolactin levels to impaired central suprapituitary inhibition involving dopaminergic pathways. Also, t...

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  • Chlamydia pneumoniae and atherosclerosis: a speculative hypothesis.
    Vinod K Gupta

    Dear Editor

    Cagli et al.[1] did not detect Chlamydia pneumoniae (C. pneumoniae) DNA in aneurysmal sac tissue. In a process as complex as atherosclerosis that will continue throughout life in all individuals, seroepidemiological studies and direct detection of the organism in atherosclerotic plaques should not be regarded as strong links between C. pneumoniae and pathogenesis of atheroscler...

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  • Ischemic stroke in chagasic patients
    Antonio L. Teixeira Jr

    Dear Editor

    We read with interest the paper by Carod-Artal et al.[1] that showed the relevance of Chagas' disease as a stroke risk factor in patients of South American origin.

    They also confirmed a textbook view [2] (not demonstrated until this paper) that cardioembolism is the main cause of stoke in Chagas' disease (52%). This reflects in part the underlying chagasic cardiomyopathy, characterised by...

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  • Care for stroke patients: the more, the better
    Stefano Ricci

    Dear Editor

    I would like to comment on the table which appeared on page 412 of the editorial by Watson et al.[1] There is no evidence that what is needed is "access to a monitored bed with one-to-one nursing". In fact, it is not clear what monitoring means: in my country (Italy), monitoring means some mechanical control of blood pressure, heart rate, oxygen, etc; however, British colleagues seem to consid...

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  • Neuropsychiatry - however you define it, it is not just functional imaging
    Maurice Preter M.D.

    Dear Editor

    I read with interest your review of "Internet resources for psychiatry and neuropsychiatry".[1]

    I would agree that "[there] are rather fewer resources specifically dedicated to neuropsychiatry [...]. This reflects the nature of the beast - after 50 or more years of sometimes rather heavy-handed attempts to separate neurology from psychiatry (and sometimes, vice-versa) there is now a fair amount of co...

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  • Straight leg sign may be an important finding
    Robert Badgett

    Dear Editor

    This is a very nicely done study. I agree with the authors that the lack of multivariable significance of the straight leg (SLR) sign is disturbing. The authors propose a physiologic explanation for the lack of association; however, I think the results support the usefulness of the SLR.

    I urge the authors to analyze their results with recursive partitioning with weighted marginals to emphasize...

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  • Treatment arm of your research results/recommendations
    Ureen L Parker

    Dear Editor

    We have a 47 year old female who has spinal myoclonus with segmental myoclonus of the legs involving the L5 and S1 myotomes. She exhibited spinal jerking and leg tremors after herniation of L5-S1 intervertebral disc. Even after decompression and fusion of the segment the spinal and segmental myoclonus remains.

    1. We are looking for treatment approaches for the myoclonus and would appreci...

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  • Prevention is warranted?
    Wladimir Kümmer

    Dear Editor

    The findings published in this article are very interesting. They bring about two questions:

    1 - Does the triptans, being vasoconstrictors, make a migraine related stroke more likely? If so, we are doing a disservice to our patients. We need to know it now.

    2 - Do women with classical migraine need primary stroke prophylaxis? Does the prophylaxis against migraine also work for stroke?

    ...
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  • Lumping or splitting? The case of different pathologies and different tests in brain stem lesions.
    Dirk Ulbricht

    Dear Editor

    I read with pleasure the paper of Garrard et al.[1] outlining the cognitive sequels in patients with a more or less isolated brain stem lesion. Nevertheless, their results might be hampered by several potential pitfalls.

    First, a lesion is not a lesion; it depends on the pathological substrate. So the inclusion of cavernomas might be misleading, as even MRI can’t exclude the presence of a...

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  • Authors' reply
    Peter GE Kennedy

    Dear Editor

    Dr McCorry makes an intriguing point that has indeed occurred to us before. It is theoretically possible that a positive PCR HSV result in the CSF could reflect asymptomatic HSV latency in the sensory ganglia and/or CNS and not viral reactivation causing encephalitis. However, it would be difficult to explain how the virus reaches the CSF from the ganglia or brain in the absence of reactivation. Also, i...

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