Neurologic clinics
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Of the four major PNS plexuses, disorders of the brachial plexus are encountered far more frequently than those of the others. The EDX examination is probably the best procedure available by which to evaluate brachial plexus lesions. It provides localizing, pathologic, pathophysiologic, severity, and prognostic information. ⋯ Among the various EDX study components, the sensory NCS are the most useful for brachial plexus element localization. One drawback of the sensory NCS for localization occurs in the setting of concomitant carpal tunnel syndrome; the latter negates the utility of the median sensory NCS for brachial plexus localization. The motor NCS and NEE often overcome this drawback and, regardless of sensory NCS findings, are always performed.
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Amyotrophic lateral sclerosis (ALS) is the most common degenerative motor neuron disease in adults. The clinical picture consists of generalized fasciculations, progressive atrophy and weakness of the skeletal muscles, spasticity and pyramidal tract signs, dysarthria, dysphagia, and dyspnea. Pseudobulbar affect is common. ⋯ Respiratory insufficiency can be effectively treated by non-invasive home mechanical ventilation. The terminal phase of the disease should be discussed at the latest when symptoms of dyspnea appear, in order to prevent unwarranted fears of "choking to death." Psychological and spiritual care of patients and families are important. Collaboration with hospice institutions and completion of advance directives can be of invaluable help in the terminal phase.
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Approximately 30-40% of patients with focal epilepsy continue to have seizures despite appropriate medical therapy. Surgical treatments should be considered in this important subset of patients. ⋯ The goal of the presurgical evaluation (video EEG monitoring, neuroimaging, and neuropsychological assessment) is to delineate the epileptogenic zone. Surgery is recommended when this has been adequately identified and the proposed procedure is expected to result in a high likelihood of seizure freedom and a low risk of neurologic and cognitive morbidity.
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Review
Neurobehavioral and neuropsychiatric symptoms in Alzheimer's disease: characteristics and treatment.
Neuropsychiatric symptoms are common in Alzheimer's disease. Personality changes, mood disturbance, and psychosis are frequently seen and may coexist in the same patient. ⋯ These symptoms are associated with a more rapid cognitive and functional decline that can lead to institutionalization. Cholinergic therapy, disease-modifying therapy, and psychotropic medications can improve these symptoms.
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Meningitis can be subdivided based on time course of onset and duration, cerebrospinal fluid (CSF) profile, and underlying origins into acute aseptic and septic meningitis, recurrent meningitis, and chronic meningitis. These are distinct syndromes that require different management strategies. ⋯ The causal agent is generally predictable based on the type of meningitis, host factors, and clues from the history and examination. CSF examination remains the critical diagnostic test.