Continuum : lifelong learning in neurology
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Many comorbid conditions occur among people with epilepsy. These comorbid conditions can be divided into physical, psychiatric, and cognitive groups. This article examines the common comorbid conditions associated with epilepsy and identifies management strategies to mitigate these health concerns. ⋯ This article explains common comorbid conditions such as depression, anxiety, and memory difficulties; outlines treatment approaches; and discusses functional restrictions such as driving. SUDEP and the risk factors that contribute to it are also discussed.
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This article reviews the etiology, clinical manifestations, diagnosis, and treatment of neurosyphilis, with a focus on issues of particular relevance to neurologists. ⋯ The diagnosis of neurosyphilis can be challenging. A sound understanding of the clinical manifestations and the strengths and limitations of diagnostic tests are essential tools for the neurologist.
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Although Ebola virus disease and other hemorrhagic fevers are not generally considered infectious diseases of the nervous system, neurologists may be asked to participate in the management of patients with these and other dangerous communicable illnesses, including possible bioterrorism agents. It is essential for all health professionals to understand the public health, legal, and ethical frameworks behind autonomy-limiting interventions such as quarantine and isolation. ⋯ They are often disproportionately affected by the illnesses themselves as well as by the public health interventions intended to prevent spread. The global health crisis caused by the spread of Ebola virus disease has been instructional for examining these ethical issues.
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Intracranial pressure (ICP) can be elevated in traumatic brain injury, large artery acute ischemic stroke, intracranial hemorrhage, intracranial neoplasms, and diffuse cerebral disorders such as meningitis, encephalitis, and acute hepatic failure. Raised ICP is also known as intracranial hypertension and is defined as a sustained ICP of greater than 20 mm Hg. ⋯ Management of elevated ICP is, in part, dependent on the underlying cause. Medical options for treating elevated ICP include head of bed elevation, IV mannitol, hypertonic saline, transient hyperventilation, barbiturates, and, if ICP remains refractory, sedation, endotracheal intubation, mechanical ventilation, and neuromuscular paralysis. Surgical options include CSF drainage if hydrocephalus is present and decompression of a surgical lesion, such as an intracranial hematoma/large infarct or tumor, if the patient's condition is deemed salvageable. Future research should continue investigating medical and surgical options for the treatment of raised ICP, such as hypothermia, drugs that reduce cerebral edema, and operations aimed at reducing intracranial mass effect.
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Neuroprognostication following cardiac arrest is a common and challenging dilemma for neurologists and intensivists, complicated by the use of therapeutic hypothermia and targeted temperature management. Great advances have been made in understanding the mechanisms of disorders of consciousness in hypoxic-ischemic brain injury, and new diagnostic and therapeutic avenues are arising. ⋯ Predicting neurologic prognosis following cardiac arrest is an evolving field, with new prognostic methods and reevaluation of older techniques holding great promise for advancing our ability to predict outcome and improve patient care.