Neurologic clinics
-
Intensive care unit-acquired weakness (ICUAW) is a substantial contributor to long-term disability in survivors of critical illness. Critical illness polyneuropathy, critical illness myopathy, and muscle atrophy from disuse contribute in various proportions to ICUAW. ⋯ Although some patients with ICUAW experience a full recovery, for others improvement is slow and incomplete and quality of life is adversely affected. This article examines aspects of ICUAW and identifies potential areas of further study.
-
Among patients receiving solid organ transplants, approximately one-third will develop neurologic symptoms. Most of these neurologic symptoms will occur within 30 days of their transplantation. ⋯ For example, ischemic stroke is seen more frequently in heart and kidney transplant patients compared with other solid organ transplant recipients. This article is a review of the main neurologic complications after solid organ transplantation.
-
Improvements in cardiopulmonary resuscitation and intensive care medicine have led to declining mortality rates for patients with out-of-hospital cardiac arrest, but overall it is still a minority that achieves good outcomes. Estimating neurologic prognosis for patients that remain comatose after resuscitation remains a challenge and the need for accurate and early prognostic predictors is crucial. ⋯ No decision should be made based on a single predictor. In addition to clinical examination, somatosensory evoked potentials, electroencephalogram, serum biomarkers, and neuroimaging provide complimentary information to inform prognosis.
-
Status epilepticus (SE) is a medical emergency and presents with either a continuous prolonged seizure or multiple seizures without full recovery of consciousness in between them. The goals of treatment are prompt recognition, early seizure termination, and simultaneous evaluation for any potentially treatable cause. ⋯ New data have emerged regarding the safety and efficacy of alternative agents, which are increasingly used in the management of these patients. Continuous electroencephalogram monitoring is more widely used and has revealed a higher incidence of subclinical seizures than was previously thought.
-
Headache occurring in a sports setting may be primary or secondary headache. Headache is the primary symptom reported after concussion. Cumulative incidence and prevalence of posttraumatic headache (PTH) are higher following mild traumatic brain injury (TBI) compared with moderate to severe TBI. ⋯ Management is empiric. Expert opinion recommends treating PTH according to clinical characteristics of primary headache. The most important factor in this approach is the recognition of the severity of headache.