Neurologic clinics
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This article reviews aspects of management of traumatic brain and spinal cord injury. A discussion of management of intracranial pressure after traumatic brain injury is followed by a discourse on cerebrovascular trauma and pediatric injuries. ⋯ Spinal cord injuries are discussed in the final section. With an increasing number of patients surviving after devastating spinal cord injuries, the special issues in their management are evaluated.
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Seizures and status epilepticus are epilepsy emergencies with high morbidity and mortality. Early treatment is crucial, and the identification of an underlying etiology informs both continued treatment and prognosis. ⋯ Timely EEG can be useful for diagnosis, management, optimizing treatment response, and determining prognosis in these patients. Refractory conditions can be quite complicated with limited evidence-based guidance, but treatment should not be restricted by nihilism even in the most prolonged cases, especially if there is not widespread irreversible brain injury.
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The nervous system can be significantly affected by cancer. Neurologic symptoms are present in 30% to 50% of oncologic patients presenting to the emergency department or in neurologic consultation at teaching hospitals. ⋯ These complications cause significant morbidity and mortality and require prompt and accurate diagnostic and treatment measures. This article reviews the common neurologic emergencies affecting patients with cancer and discusses epidemiology, clinical presentation, diagnosis, and treatment modalities.
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The past 40 years have seen the evolution of acute ischemic stroke management from unproven therapies du jour, such as steroids, heparin for stroke in evolution, and hypervolemic-hemodilution, to more of a scientific basis for our decision-making process. This evolution is directly related to the advancements in imaging of stroke. It is also related to carefully designed, controlled clinical trials of potential therapies, which have led to the recognition of the benefits of thrombolytic therapy in the acute setting but have also caused confusion and frustration over the lack of benefit for potential neuroprotective agents that once seemed promising.
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The cause of dizziness in patients seen in the emergency room can usually be determined by a focused evaluation that consists of identifying three key features in the history and five key elements of the clinical examination. This article discusses the most common causes of dizziness, how to use this approach, and management of these cases in the emergency room.