The bare essentials Uro-Neurology

Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK.
Practical Neurology 06/2010; 10(3):178-85. DOI: 10.1136/jnnp.2010.213892
Source: PubMed
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    • "Increased age, impaired functional status, increased duration of disease, diabetes and cholinesterase inhibitors are associated with an increased frequency of urinary incontinence [16]. Functional incontinence is a condition related to dementia and/or gait disturbance interfering with independent toileting skills. "
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    ABSTRACT: Idiopathic normal pressure hydrocephalus (INPH) is a syndrome of ventriculomegaly, gait impairment, cognitive decline and incontinence that occurs in an elderly population prone to many types of comorbidities. Identification of the comorbidities is thus an important part of the clinical management of INPH patients. In 2011, a task force was appointed by the International Society for Hydrocephalus and Cerebrospinal Fluid Disorders (ISHCSF) with the objective to compile an evidence-based expert analysis of what we know and what we need to know regarding comorbidities in (INPH). This article is the final report of the task force. The expert panel conducted a comprehensive review of the literature. After weighing the evidence, the various proposals were discussed and the final document was approved by all the task force members and represents a consensus of expert opinions. Recommendations regarding the following topics are given: I. Musculoskeletal conditions; II. Urinary problems; III. Vascular disease including risk factors, Binswanger disease, and white matter hyperintensities; IV. Mild cognitive impairment and Alzheimer disease including biopsies; V. Other dementias (frontotemporal dementia, Lewy body, Parkinson); VI. Psychiatric and behavioral disorders; VII. Brain imaging; VIII. How to investigate and quantify. The task force concluded that comorbidity can be an important predictor of prognosis and post-operative outcome in INPH. Reported differences in outcomes among various INPH cohorts may be partly explained by variation in the rate and types of comorbidities at different hydrocephalus centers. Identification of comorbidities should thus be a central part of the clinical management of INPH where a detailed history, physical examination, and targeted investigations are the basis for diagnosis and grading. Future INPH research should focus on the contribution of comorbidity to overall morbidity, mortality and long-term outcomes.
    Fluids and Barriers of the CNS 06/2013; 10(1):22. DOI:10.1186/2045-8118-10-22
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    ABSTRACT: Amyotrophic lateral sclerosis (ALS) related disorders are considered to be uncommon. We hypothesize that urinary dysfunction may occur in ALS patients in the context of spasticity of pelvic floor musculature. We recorded data on 54 subjects with ALS. All subjects were evaluated with ALSFRS and M-Ashworth Scale for lower limbs. Bladder scan procedure was performed to asses post void residual (PVR) in all subjects. Forty-one percent of subjects were symptomatic for urinary disorders and 35% of subjects had a PVR > 50 ml. Linear correlation was found between PVR and ALSFRS with a R(2) 0.95 and p = 0.025; a linear correlation was also noted between PVR and lower limbs Ashworth Scale. We conclude that urinary retention is common in ALS. Urological evaluation is indicated in ALS patients with prominent spasticity.
    Amyotrophic Lateral Sclerosis 04/2011; 12(5):352-5. DOI:10.3109/17482968.2011.574141 · 2.37 Impact Factor

  • Practical Neurology 08/2011; 11(4):259-67. DOI:10.1136/practneurol-2011-000069
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