Seminars in neurology
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Seminars in neurology · Dec 2015
ReviewCurrent Trends in Treatment of Status Epilepticus and Refractory Status Epilepticus.
Status epilepticus is a heterogeneous disorder with varied definitions and presentations. Taken together, all forms of status epilepticus carry significant morbidity and mortality, much of which is dictated by the underlying etiology. Generalized convulsive status epilepticus, which represents a common form, is a true neurologic emergency that requires emergent management. ⋯ For other forms of status epilepticus including nonconvulsive and focal status epilepticus, the goal remains early seizure termination, but the use of intravenous medications should be weighed against the risks associated with these therapies. The diagnostic evaluation of status epilepticus is guided by the patient's history and should be broad, including a screen for toxins, electrolytes, structural abnormalities, and central nervous system infectious and autoimmune/inflammatory etiologies. Considerable research is still needed to improve our understanding of the mechanisms, consequences, and therapy of status epilepticus.
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Seminars in neurology · Dec 2015
ReviewMoving Beyond Metabolic Encephalopathy: An Update on Delirium Prevention, Workup, and Management.
Delirium is a condition that frequently complicates hospitalization and consists of an acute decline in orientation and attention, often accompanied by other cognitive changes. Delirium is tied to multiple detrimental outcomes both in the short and long term, including cognitive and functional decline, inpatient complications, and mortality. ⋯ In general, instituting a system of active screening of at-risk populations and nonpharmacologic interventions for prevention and treatment seems to be the most effective method of addressing delirium. More research is needed to clarify the etiology of delirium and develop safe therapeutic options that address the underlying pathophysiology.
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Ischemic stroke is a leading cause of death and disability worldwide. Recent advances in acute treatment provide hope that the impact of this disease will be reduced. ⋯ Acute hospitalization management requires multiple strategies including initiation of secondary prevention measures. In addition to preventing further stroke, physicians can also improve long-term survival by preventing the complications of stroke in the hospital and ensuring longitudinal poststroke care and rehabilitation following discharge.
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Seminars in neurology · Dec 2015
ReviewInpatient Neurologic Consultation in Solid Organ Transplant Patients.
A third of solid organ transplant recipients experience neurologic complications after transplantation. In this article the author reviews common and uncommon complications of the perioperative period including stroke and peripheral neuropathy, neurotoxicity associated with immunosuppressant medications such as calcineurin inhibitors, and opportunistic infections that target the nervous system. A careful clinical history, neurologic examination, and medication review are vital in generating a differential diagnosis that will guide diagnostic testing and decisions regarding treatment and management, and early recognition of many disorders is imperative to prevent irreversible neurologic morbidity and death.
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Seminars in neurology · Dec 2015
ReviewApproach to the Workup and Management of Headache in the Emergency Department and Inpatient Settings.
The challenge of headache management in the hospital can be divided into the diagnostic and management issues encountered in the emergency department, and the issues involved in the inpatient management of chronic refractory headaches. The two endeavors are different but linked because of overlapping diagnostic and treatment options. In addition, the problem of the intractable acute headache encountered in the emergency department can evolve into inpatient care of the same patient who has failed to respond to acute treatment. Here the author presents an approach to the patient with severe acute headache in the emergency department and explores the options available for managing intractable headaches in the inpatient setting.