Neurología : publicación oficial de la Sociedad Española de Neurología
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Review
Neurological patient care in emergency departments. A review of the current situation in Spain.
We are currently seeing many changes in urgent neurological care, in the context of the progressive development of the specialty and of the increasing population and care demand. ⋯ Urgent neurological disease is common, complex, and in many cases, potentially serious. The role of the neurologist in the ED is important for its optimum management. On-call neurologists, still absent in many Spanish hospitals, can improve both the quality of care and its efficiency.
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Neurologists should anticipate and recognize the onset of respiratory failure in patients with neuromuscular diseases. Symptoms vary according to the speed of onset of respiratory muscle weakness. Catastrophic situations usually occur in three clinical scenarios: 1) incorrect management of acute respiratory failure of neuromuscular origin, autonomic dysfunction or during general anaesthesia of patients with neuromuscular diseases ; 2) incorrect prognosis and treatment due to the lack of a correct diagnosis. This situation is more common in ventilated patients with associated muscular weakness, acute neuropathies or motor neuron disease, and 3) inappropriate medical intervention in patients with neuromuscular disease with a definitive diagnosis but longstanding disease (amyotrophic lateral sclerosis, spinal muscular atrophy, myotonic dystrophy and other muscular dystrophies).
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Acute intracranial hypertension is a syndrome with multiple etiologies. Diagnosis and treatment must be performed urgently to save the patient's life and prevent the development of significant disabilities. The appearance of this syndrome is due to intracraincreased volumes and -in turn- the pressure of the intracranial contents, either through an increase in the physiological components (blood, cerebrospinal fluid and brain parenchyma), or through the appearance of a volume in the form of added mass. ⋯ Treatment depends on the etiology and will generally require medical and surgical care. Patient management is usually carried out in neurocritical units and involves intracranial pressure monitoring to guide treatment. Correction of all hemostasis disorders is also crucial to patient survival.
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Surgical activity is one of the major causes of iatrogeny. All surgery carries an inherent risk of complications, whether in emergency surgery or in simpler elective procedures. Because of the progressive increase in life expectancy, surgical techniques are increasingly used in the elderly, with a consequent rise in the possibility of catastrophic complications. ⋯ The present article reviews the most frequent neurological complications of anesthetic techniques and the types of surgery most commonly associated with central or peripheral nervous system complications. Neurologists are well versed in the complications associated with neurosurgery and carotid artery surgery. Other types of surgery, such as cardiac surgery, liver transplantation, bariatric surgery or aortic aneurism surgery, are also potential sources of complications.
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Chemotherapy-induced peripheral neuropathy (CIPN) is the most prevalent neurological complication of cancer treatment, affecting a third of all patients who undergo chemotherapy. CIPN impairs functional capacity, compromises the quality of life and results in dose reduction or cessation of chemotherapy, representing a dose-limiting side effect of many antineoplastic drugs. In addition to classic, novel agents, bortezomib and oxaliplatin have been shown to have a significant risk of CIPN. ⋯ Early recognition and subsequent dose reduction/discontinuation of the offending agent is the only way to minimise the development of this potentially debilitating complication. Due to the lack of effective prophylactic or symptomatic treatments up to now, neurological monitoring should be recommended in patient candidates to be treated with neurotoxic antineoplastic agents, mainly when they present baseline neuropathy. Development of reliable methods for CIPN assessment is essential.