Continuum : lifelong learning in neurology
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Continuum (Minneap Minn) · Aug 2014
Review Case ReportsPapilledema and idiopathic intracranial hypertension.
Papilledema is one of the most concerning physical examination findings in neurology: it has a broad differential diagnosis of intracranial (and occasionally spinal) pathology associated with increased intracranial pressure. Papilledema impairs axoplasmic flow within the optic nerves and compresses the optic nerves externally; it may lead to profound visual loss. Thus, detection of papilledema and assessment of visual function are essential to patient management. This article reviews the treatment of papilledema-related visual loss in pseudotumor cerebri syndrome, one of the most common causes of papilledema encountered by neurologists. ⋯ A detailed ophthalmic examination, including perimetry, is critical to the evaluation, treatment, and assessment of treatment response in patients with papilledema.
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This article provides an update on the evaluation and treatment of neurosarcoidosis. ⋯ Advances in the diagnosis and management of neurosarcoidosis may benefit the patient and clinician faced with this multifaceted disease.
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Thrombosis of the dural sinus and/or cerebral veins (CVT) is a rare but potentially devastating type of stroke that tends to occur in young adults, especially women. In this article, the abbreviation CVT refers to either cerebral venous thrombosis or dural sinus thrombosis. The purpose of this review is to review the most up-to-date literature on the epidemiology, diagnosis, management, and prognosis of CVT. In addition, illustrative cases that represent the spectrum of CVT are provided. ⋯ CVT is an important diagnosis to keep in mind when evaluating patients with headache in the emergency department, and it is important that it not be overlooked because it is treatable.
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This review provides an overview of emergent evaluation of the stroke patient with an emphasis on practical issues regarding ischemic stroke treatment. ⋯ Effective emergent evaluation of a stroke patient requires well-organized systems that maximize speed of assessment and administration of appropriate therapies, including IV rtPA and endovascular therapies.
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Continuum (Minneap Minn) · Apr 2014
Telephone consultations for tissue plasminogen activator administration in acute stroke.
Effective treatment for acute ischemic stroke has been available for 17 years, but wide geographic variability remains in timely access to neurologic expertise and other components of stroke systems of care. Telemedical technology can be used to improve such access, but it is debatable whether neurologists have an ethical obligation to provide consultation regarding tissue plasminogen activator use via the telephone. This article examines whether neurologists are ethically obligated to provide telephone-mediated acute stroke consultation.