Continuum : lifelong learning in neurology
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Continuum (Minneap Minn) · Feb 2017
Review Case ReportsManagement of Unruptured Intracranial Aneurysms and Cerebrovascular Malformations.
Unruptured intracranial aneurysms and vascular malformations are detected more frequently because of the increased use and availability of brain imaging. Management of these entities requires knowledge of which patients are at high risk for hemorrhage and what treatment options are available. This article summarizes the epidemiology, natural history, and management strategies for unruptured intracranial aneurysms, arteriovenous malformations, cavernous malformations, developmental venous anomalies, and capillary telangiectasias. ⋯ Unruptured intracranial aneurysms are a common incidental finding. The PHASES (population, hypertension, age, size of aneurysm, earlier subarachnoid hemorrhage from another aneurysm, site of aneurysm) score and Unruptured Intracranial Aneurysm Treatment Score may be useful tools for predicting natural history and treatment recommendations. The overall risk of hemorrhage for both arteriovenous malformations and cavernous malformations is about 2% to 4% per year. With both of these entities, prior hemorrhage predicts future hemorrhage. In addition, other select patient and radiologic factors influence risk of hemorrhage. The risk of future hemorrhage should be compared to the risk of treatment. Developmental venous anomalies and capillary telangiectasias are largely benign entities and rarely symptomatic.
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Continuum (Minneap Minn) · Oct 2016
Review Case ReportsPositron Emission Tomography and Single-Photon Emission Computed Tomography in Neurology.
Positron emission tomography (PET) and single-photon emission computed tomography (SPECT) are now available for routine clinical applications in neurology. This article discusses their diagnostic use in dementia, brain tumors, epilepsy, parkinsonism, cerebrovascular disease, and traumatic brain injury. ⋯ Neurologic PET and SPECT are no longer restricted to the research realm. These modalities have high diagnostic accuracy.
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Hemorrhagic stroke comprises approximately 15% to 20% of all strokes. This article provides readers with an understanding of the indications and significance of various neuroimaging techniques available for patients presenting with hemorrhagic strokes of distinct causes. ⋯ Neuroimaging studies are integral to the identification of hemorrhagic stroke, determination of the underlying etiology, prevention of hematoma expansion, treatment of acute complications, and treatment of the underlying etiology, if indicated. Neuroimaging is essential for prognostication and thus directly impacts patient care.
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Continuum (Minneap Minn) · Apr 2016
ReviewLewy Body Dementias: Dementia With Lewy Bodies and Parkinson Disease Dementia.
This article provides an overview of the clinical features, neuropathologic findings, diagnostic criteria, and management of dementia with Lewy bodies (DLB) and Parkinson disease dementia (PDD), together known as the Lewy body dementias. ⋯ DLB and PDD are important and common dementia syndromes that overlap in their clinical features, neuropathology, and management. They are believed to exist on a spectrum of Lewy body disease, and some controversy persists in their differentiation. Given the need to optimize cognition, extrapyramidal function, and psychiatric health, management can be complex and should be systematic.
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Epilepsy emergencies include acute repetitive seizures and status epilepticus. Their prognosis depends on the etiology of the seizures and the time spent in status epilepticus. This review discusses the current perspective on the diagnosis and treatment of status epilepticus and acute repetitive seizures in the intensive care unit. ⋯ Acute repetitive seizures and status epilepticus are neurologic emergencies that are being increasingly diagnosed and treated in the modern era. Rapid treatment may influence patient prognosis, future cognitive outcomes, and the long-term potential for developing epilepsy. However, little is known about the mechanisms that perpetuate seizure activity, and our ability to intervene and prevent this condition remains limited. Preventing complications during the treatment of status epilepticus plays a large role in prognosis and the chance of treatment success.