Continuum : lifelong learning in neurology
-
Continuum (Minneap Minn) · Apr 2013
Review Case ReportsNonpharmacologic treatment and prevention strategies for dementia.
Epidemiologic studies can provide critical evidence to inform the timing and duration of nonpharmacologic interventions. Although more studies are needed to further determine long-term efficacy, the evidence supporting modifiable risk factors for prevention is compelling, and prevention strategies that incorporate multidomain nonpharmacologic factors may have the most impact. ⋯ Potential modifiable strategies for dementia prevention include cardiovascular risk factors; lifestyle risk factors such as physical, cognitive, and social activity as well as nutrition, smoking, and alcohol use; and sleep quality. Results of randomized controlled trials for the treatment of cardiovascular risk factors have not been consistent, while interventions that increase physical, cognitive, and social activity have demonstrated protective effects for dementia risk. Trials of single-nutrient dietary supplementation have also been conflicting, but focus on multinutrient supplementation shows promise. Observational data also indicate that sleep quality may be a modifiable risk factor for dementia prevention.
-
Continuum (Minneap Minn) · Feb 2013
Review Historical ArticleSleep and fatigue countermeasures for the neurology resident and physician.
Fragmented sleep, prolonged work hours, misalignment of sleep-wake cycles, and an expectation to make medical decisions when alertness levels are reduced are pervasive in neurology residency training. Sleep loss in residency training can lead to cognitive and psychosocial impairment and accidents, compromise patient care, and reduce the trainee's quality of life. Neurology residents experience levels of hypersomnolence similar to residents in surgical specialties and have comparable subjective levels of sleepiness as persons with pathologic sleep disorders such as narcolepsy and obstructive sleep apnea. Over the past 2 decades, work-hour limitations were established to alleviate fatigue and sleepiness. However, the implementation of work-hour limitations alone does not guarantee alleviation of fatigue and may be insufficient without additional key measures to prevent, counteract, and control sleepiness when it strikes. This article provides effective strategies to combat sleepiness, such as modification of the on-call structure (night float), power naps, and caffeine, in neurologists in training and those who are at risk for excessive sleepiness. ⋯ Historically, sleepiness and fatigue place both residents and patients at risk. Excessive sleepiness in residency training occurs because of sleep deprivation and a spectrum of other factors, such as mood disorders or even the anxiety of anticipating being woken up. An effective model to counteract sleep deprivation and its consequences is a multiplayer approach that uniquely targets and addresses the needs of all the stakeholders. A sleep medicine perspective is proposed along with other interventions to prevent adverse consequences.
-
Neurocysticercosis occurs when humans become intermediate hosts in the life cycle of Taenia solium by ingesting its eggs directly from a taenia carrier or, less often, by contaminated food. Within the nervous system, cysticerci may lodge in the brain parenchyma, subarachnoid space, ventricular system, or spinal cord, causing a number of pathologic changes that are responsible for the pleomorphism of neurocysticercosis. This article discusses the clinical manifestations, diagnosis, and treatment of neurocysticercosis. ⋯ Neurocysticercosis is the most common helminthic infection of the CNS and a major cause of acquired epilepsy worldwide. Diagnosis of neurocysticercosis is possible after interpretation of clinical data together with findings of neuroimaging studies and results of immunologic tests in a proper epidemiologic context. The use of cysticidal drugs reduces the burden of infection in the brain and improves the clinical course of most patients. Further efforts must be directed to eradicate the disease through the implementation of control programs against all interrelated steps in the life cycle of T. solium, including human carriers of the adult tapeworm, infected pigs, and eggs in the environment.
-
This article describes the background, clinical presentation, diagnosis, and treatment of selected etiologies of subacute and chronic meningitis. Key diagnostic considerations when evaluating a patient presenting with chronic inflammation of the CNS are discussed, and several specific infectious, neoplastic, and autoimmune etiologies are reviewed in detail. ⋯ Meningitis is defined as inflammation involving the meninges of the brain and spinal cord. Meningitis can be categorized as acute, subacute, or chronic based on duration of inflammation. This article focuses on the most common causes of subacute and chronic meningitis. Chronic meningitis is commonly defined as inflammation evolving during weeks to months without resolution of CSF abnormalities. Determining the time course of meningitis is important for creating a differential diagnosis. Most organisms causing acute meningitis rarely persist more than a few weeks. Although numerous etiologies of subacute and chronic meningitis have been identified, this article focuses on the most common etiologies: (1) infectious, (2) autoimmune, and (3) neoplastic.
-
Continuum (Minneap Minn) · Dec 2012
Review Case ReportsEncephalitis and postinfectious encephalitis.
Encephalitis and postinfectious encephalitis represent two important conditions for the neurologist, both in terms of their presentations as neurologic emergencies and their potential to cause death or serious neurologic impairment. This article reviews the major infectious and noninfectious causes of encephalitis and discusses postinfectious encephalitis as an indirect effect of systemic illness. ⋯ Encephalitis and postinfectious encephalitis present as neurologic emergencies requiring prompt diagnosis and initiation of treatment. Important concerns are to identify infectious conditions requiring antibiotic or antiviral therapy and postinfectious or other autoimmune encephalitides requiring immunosuppression.