Neurologic clinics
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Insomnia is a common disorder, with individual and societal consequences. Advances have been made in the understanding of insomnia and its treatment options. However, cognitive behavioral therapy and Food and Drug Administration-approved pharmacologic therapies have limitations, the former primarily involving access and the latter involving potential side effects. Further research is needed to optimize management strategies.
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Sleep disturbance is common after traumatic brain injury (TBI). Insomnia, fatigue, and sleepiness are the most frequent post-TBI sleep complaints with narcolepsy (with or without cataplexy), sleep apnea (obstructive or central), periodic limb movement disorder, and parasomnias occurring less commonly. ⋯ Treatment is disorder-specific and includes the use of medications, continuous positive airway pressure, or behavioral modifications. Unfortunately, treatment of sleep disorders associated with TBI often does not improve sleepiness or neuropsychologic function.
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Sleep is characterized by changes in neural firing and chemistry compared with wakefulness. Many neurologic diseases affect pathways that regulate control of sleep state and some primary sleep disorders have abnormalities of this circuitry. ⋯ Recent findings have expanded understanding of the control of sleep state, and will facilitate development of novel therapeutics to assist patients with a variety of disorders of sleep and wakefulness. Treatment of sleep and wake disorders can assist patients with a variety of neurologic problems.
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Neurologic deficits during or following labor and delivery often occur as a result of obstetric trauma. They can also be caused by neuraxial (epidural or spinal) anesthesia. ⋯ Injury can result from direct trauma to the spinal cord, epidural hematoma, as well as other causes that are discussed in this article. These injuries are less common than those of birth trauma.
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Throughout pregnancy and the puerperium, a variety of hormonal and physiologic changes occur that are associated with pregnancy-specific neurologic conditions, which may also influence known preexisting medical conditions or bring previously unknown neurologic conditions to clinical attention. This article reviews the imaging of a spectrum of neurologic conditions that may be encountered in the pregnant or puerperal patient, the key physiologic changes that are most germane to the imaging of neurologic conditions, and the important safety considerations that are made when choosing and performing a diagnostic imaging test for the pregnant and puerperal patient.