Neurologic clinics
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Classification, pathophysiology, and endovascular treatment of intracranial dural arteriovenous fistulas are discussed. Risk for neurologic deterioration is based on the presence and extent of cortical venous reflux. ⋯ Recent advances in endovascular materials have facilitated the treatment and cure of many of these lesions via transarterial approaches. Penetration of liquid embolic agent into the nidus and foot of the draining vein is crucial for long-term angiographic cure.
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Eye movement abnormalities constitute an important clinical sign that can be a manifestation of dysfunction of cranial nerves III, IV, and VI (the 3 ocular motor nerves). Specific motility deficits often have highly localizing value within the neuroaxis, serving to refine a differential diagnosis and guide management. This article reviews the key anatomic concepts, clinical presentation, differential diagnosis, and management of ocular motor nerve palsies. Dysfunction of an ocular motor nerve must be distinguished from other causes of abnormal eye movements, such as myasthenia gravis or thyroid eye disease, which are outside the scope of this article.
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Virtually all abnormalities of the orbit can result in neuro-ophthalmic findings: optic neuropathies, motility disorders, and changes in sensation. Subtle orbital disease, presenting with neuro-ophthalmic findings, is frequently overlooked on initial evaluation. ⋯ This article focuses on those disorders more commonly encountered or that come with more serious consequences if misdiagnosed. Orbital trauma, hemorrhage, neoplasm, and inflammation are covered in some detail.
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A medical practice, whether operated by a solo physician or by a group, is a business. For a neurology practice to be successful, it must meet performance measures that ensure its viability. ⋯ Crucial medical practice metrics that should be measured are financial performance, staffing efficiency, physician productivity, and patient access. Such measures assist a physician or practice in achieving the goals and objectives that each determines are important to providing quality health care to patients.
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Neurosarcoidosis is a diagnostic consideration in diverse clinical settings. Efforts should be made to secure pathologic confirmation of systemic sarcoidosis; only rarely is central nervous system (CNS) pathologic confirmation available. CNS infection and malignancy should be reasonably excluded before making a diagnosis of CNS sarcoidosis. Corticosteroid therapy alone may not be sufficient to treat neurosarcoidosis; adjunct immunosuppressive agents are increasingly used to achieve an optimal clinical outcome.