Neurologic clinics
-
Patients with neuro-ophthalmologic findings and diseases commonly present in the emergency room. This article reviews the approach to acute visual loss, the abnormal optic disc, double vision, and the neuro-ophthalmologic signs of neurologic emergencies, including hydrocephalus, herniation syndromes, vascular lesions, and trauma.
-
Delirium occurs commonly in both general medical and intensive care unit (ICU) patients, with prevalence rates of up to 80% reported. A common expression of acute brain dysfunction, it is related to wide-ranging untoward outcomes such as prolonged hospitalization, increased costs, higher mortality, and, potentially long-term cognitive impairment. ⋯ Multicomponent interventions to prevent delirium, developed in the non-ICU setting, can be adapted to critically ill patients with the purpose of reducing its incidence. Future studies should evaluate target interventions to prevent delirium in the ICU.
-
Recent advances have shown much in common between epilepsy and other disorders of consciousness. Behavior in epileptic seizures often resembles a transient vegetative or minimally conscious state. ⋯ Epileptic unconsciousness has enormous clinical significance leading to accidental injuries, decreased work and school productivity, and social stigmatization. Ongoing research to better understand the mechanisms of impaired consciousness in epilepsy, including neuroimaging studies and fundamental animal models, will hopefully soon enable treatment trails to reduce epileptic unconsciousness and improve patient quality of life.
-
The causes of nontraumatic coma (NTC) vary by country, season and period of data collection. Infective diseases are among the major worldwide causes of NTC. Nonaccidental head injury must be in the differential diagnosis. ⋯ A systematic history and examination are essential for diagnosis, early recognition of herniation syndromes, and management. The management of NTC is discussed, with reference to clinical approach, treatment of seizures, and increased intracranial pressure. Public health measures, education, early diagnosis, and prompt appropriate treatment are the foundations needed to reduce incidence and improve outcome.
-
Review Case Reports
Functional neurologic symptoms: assessment and management.
Neurologic symptoms such as weakness or abnormal movements that are inconsistent and incongruent with neurologic disease can be described as functional, psychogenic, nonorganic, conversion, or dissociative symptoms. These symptoms often represent a clinical dilemma and a challenge for the clinician. This article provides practical advice on making an accurate diagnosis, options for explaining the diagnosis to the patient, and considering further treatment.