Copper deficiency may be a differential diagnosis for hematologic abnormalities like pancytopenia, even if a disorder of intestinal resorption or a proteinuria occurs. Myeloneuropathy is a rare complication of this deficiency. Hemograms may become normal after treatment with oral copper gluconate, but at least in the case presented here, neurologic symptomes did not show any improvement.
▼The German Neurological Society conducts a biannual survey to assess the structure of neurological inpatient care. The present survey covering the year 2011 addressed 307 hospital departments. Although several measures were taken to enhance response rates, only 179/307 departments (58 %) responded. With few exceptions, neurological departments have stroke units. Even though the majority of neurological departments actively participate in emergency room services, only very few operate their own intensive care unit. Also, many neurological departments do not have around-the-clock access to diagnostic facilities such as MRI and angiography. As compared to the preceding survey in 2009, performance benchmarks indicated a rise in patient numbers, decrease in length of stay, and decreasing average case proceeds. Allocation of personnel was diffi cult to compare between participating departments, but staff shortage was a common problem, with regional diff erences. 1 out of 3 departments was forced to reduce services due to a shortage of physicians, nurses, or both. Neurological departments can obtain a multitude of certifi cations, but only half of the head physicians felt that these helped to improve the quality of patient care. Moreover, only 15 % evaluated the eff ects of certifi cation processes. Consequently, this lack of affi rmation challenges the present concept of certifying neurological inpatient facilities.
ZusammenfassungUnter dem Begriff der immunvermittelten Neuropathien werden das Guillain-Barré Syndrom (GBS), die chronische inflammatorische demyelinisierende Polyneuropathie (CIDP), die multifokale motorische Neuropathie (MMN), die Polyneuropathien bei Paraproteinämie und die vaskulitische Neuropathie zusammengefasst. Wichtige diagnostische und therapeutische Schritte werden dargestellt. Intravenöse Immunglobuline (IVIG) und Plasmapherese sind beim GBS gleichwertige Therapieoptionen. Bei der CIDP können auch Kortikosteroide zum Einsatz kommen. Polyneuropathien bei Paraproteinämien vom Typ IgM sprechen zumeist nur unzureichend auf eine Therapie mit Immunsuppressiva oder Plasmapheresen an. Der monoklonale Antikörper gegen Rituximab ist möglicherweise besser wirksam. Bei multifokaler motorischer Neuropathie (MMN) sind IVIG die Behandlungsmethode der Wahl. Die primären systemischen Vaskulitiden bedürfen in der Regel einer langzeitigen Kombinationstherapie mit Kortikosteroiden und Immunsuppressiva. Isolierte Vaskulitiden des peripheren Nervensystems können häufig mit niedrigeren oralen Dosen von Kortison erfolgreich behandelt werden. Auf Komplikationen der Langzeittherapie ist bei allen immunvermittelten Neuropathien zu achten.
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