Neurologic clinics
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Selecting appropriate laboratory tests in diagnosing peripheral neuropathies is important because it increases the yield of correct diagnoses and is cost effective. A large number of tests are available. This article provides a guide to selecting appropriate tests and reviews the clinical situations that suggest specific tests. ⋯ On occasion, routine blood tests may discover metabolic disorders causing a patient's neurologic disorder. A number of antibody assays for neuropathies are available commercially, with the most useful being anti-MAG, anti-GM1, anti-GQ1b, anti-Hu, and anticalcium channel antibodies, but only in very select situations and not as "screening studies". The role of cutaneous nerve and skin biopsies in selected disorders is discussed.
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The diagnosis of movement disorders is essentially clinical. Work-up depends on patient age, part of the body affected, drug response, and presence of other systemic or neurologic symptoms and signs. ⋯ Brain magnetic resonance imaging/computed tomography, positron emission tomography and single photon emission computed tomography, and DNA studies are promising diagnostic tools. Exclusion of Wilson's disease and neuroacanthocytosis is emphasized in children and young adults with movement disorders.
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Headaches are one of the most common symptoms that neurologists evaluate. Although most are caused by primary disorders, the list differential diagnoses is one of the longest in all of medicine, with over 300 different types and causes. The cause or type of most headaches can be determined by a careful history supplemented by a general and neurologic examination. ⋯ The diagnosis of TA is based on a high index of clinical suspicion that usually but not always is confirmed by laboratory testing. The erythrocyte sedimentation rate can be normal in 10% to 36% of patients with TA. A superficial temporal artery biopsy can give a false-negative result in 5% to 44% of patients.
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The number of available diagnostic tests for patients with back and neck pain has grown dramatically over the past two decades, and their cost has increased as well. The impact of managed care and an increased understanding of the natural history of these conditions have led to close evaluation of the sensitivity and specificity of these tests and their effect on patient outcomes. ⋯ Guidelines for the testing of patients with chronic back and neck pain have yet to be developed. Stronger emphasis on psychosocial issues and the assurance that pathologic progression has not been missed without the use of repetitive testing form the mainstay of diagnostic protocols in this population.
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Significant advances in the management of neurosurgical disorders during the past decade have enhanced the safety of intracranial surgery, resulting in the ability of most patients with brain tumors to undergo successful resection now. Among these advances are stereotactic surgical procedures and intraoperative monitoring devices; future directions in neurosurgery include the application of advances in robotics and virtual reality. The surgical considerations and complications that accompany these advances are factors that the neurosurgeon must evaluate along with the choice of management.