Continuum : lifelong learning in neurology
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Continuum (Minneap Minn) · Jun 2017
Review Case ReportsEndocrine Emergencies With Neurologic Manifestations.
This article provides an overview of endocrine emergencies with potentially devastating neurologic manifestations that may be fatal if left untreated. Pituitary apoplexy, adrenal crisis, myxedema coma, thyroid storm, acute hypercalcemia and hypocalcemia, hyperglycemic emergencies (diabetic ketoacidosis and hyperglycemic hyperosmolar state), and acute hypoglycemia are discussed, with an emphasis on identifying the signs and symptoms as well as diagnosing and managing these clinical entities. ⋯ Early diagnosis and prompt treatment of endocrine emergencies are essential but remain challenging because of a lack of objective diagnostic tools. The optimal management is also unclear as prospective and randomized studies are lacking. Additional research is needed for these clinical syndromes that can be fatal despite intensive medical intervention.
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Continuum (Minneap Minn) · Apr 2017
Case ReportsPractical Considerations in Addressing Physician Burnout.
Physician burnout is an epidemic impacting patient care, career satisfaction, and physician health and well-being. Symptoms may result in potentially damaging consequences for physicians' professional and personal lives. ⋯ Empowering physicians to identify symptoms of burnout and engage with their organization to reduce triggers will lead to healthier physician-organization and physician-patient relationships. It is imperative that the medical community continue to raise awareness, recognize symptoms early, and provide techniques and resources to address physician burnout.
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Neuropathic pain is a frequently encountered condition that is often resistant to treatment and is associated with poor patient satisfaction of their treatment. Several medications have been shown to be effective in treating neuropathic pain associated with diabetic neuropathy and postherpetic neuralgia, and these medications are often used to treat neuropathic pain associated with other conditions as well. This article summarizes the diagnosis and assessment of patients with neuropathic pain as well as available pharmacologic and interventional treatment options. ⋯ The management of chronic neuropathic pain is challenging and is best achieved with the use of a multidisciplinary team. Pain is a subjective experience, and it is important to validate a patient's pain, address psychosocial comorbidities, and set realistic treatment goals. Evidence-based guidelines are available to guide treatment, but frequently, high-quality evidence-based recommendations are lacking.
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Continuum (Minneap Minn) · Feb 2017
Review Case ReportsArterial Ischemic Stroke in Children and Young Adults.
This article reviews risk factors, recurrence risk, evaluation, management, and outcomes of arterial ischemic stroke in children and young adults. ⋯ Childhood and young adult stroke survivors survive for many more years than older patients with stroke. To ensure that these survivors maximize the productivity of their lives, neurologists must not only optimize medical management but also recognize that impairments in cognition and mood may be remediable barriers to long-term functional independence.
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This article provides an update on the state of the art of the emergency treatment of acute ischemic stroke with particular emphasis on the alternatives for reperfusion therapy. ⋯ Timely successful reperfusion is the most effective treatment for patients with acute ischemic stroke. Systems of care should be optimized to maximize the number of patients with acute ischemic stroke able to receive reperfusion therapy.