Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Multimodal approaches to pain management have arisen with the goal of improving postoperative pain and reducing opioid analgesic use. We performed a comprehensive literature review to determine grades of recommendation for commonly used agents in multimodal pain management and provide a best practice guideline. To evaluate common drugs used in multimodal treatment of pain, a search was performed on English language publications on Medline (PubMed; National Library of Medicine, Bethesda, MD, USA). ⋯ Comprehensive assessment of the effectiveness of perioperative pain control can be accomplished through the use of validated measures. Multimodal pain management protocols have consistently been demonstrated to allow for improved pain control with less reliance on opioids. There is good quality evidence that supports many of the common agents utilized in multimodal therapy, however, there is a lack of evidence regarding optimal postoperative protocols or pathways.
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We review the etiology, investigations, management and outcomes of pituitary tumor apoplexy. Pituitary tumor apoplexy is a clinical syndrome which typically includes the acute onset of headache and/or visual disturbance, cranial nerve palsy and partial or complete endocrine dysfunction. It is associated with either infarction or hemorrhage of a pre-existing pituitary adenoma and is associated with significant morbidity and potential fatality. Not all patients will present with classic signs and symptoms, therefore it is pertinent to appreciate the clinical spectrum in which this condition can present.
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Case Reports
Chorea associated with nonketotic hyperglycemia: An uncommon patient with bilateral movements.
We report a 74-year-old woman who presented with bilateral chorea and no known history of diabetes. Movement disorders such as chorea can be observed in patients presenting with hyperglycemia. The occurrence of hemichorea-hemiballism has been increasingly associated with nonketotic hyperglycemia in the medical literature. The chorea disappeared completely after correction of the hyperglycemia.