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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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.
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Continuum (Minneap Minn) · Oct 2015
Evaluating the Potential for Recovery of Consciousness in the Intensive Care Unit.
Evaluating patients in the intensive care unit (ICU) with disorders of consciousness has prognostic implications. When brainstem functions are intact, the neurologist must use ancillary testing to help determine prognosis. This article addresses the challenges of arriving at prognoses in patients with hypoxic-ischemic encephalopathy and traumatic brain injury (TBI) and discusses strategies for dealing with these challenges. This has some relevance to other conditions that are capable of causing irreversible brain damage. ⋯ To arrive at a more accurate prognosis, it is best to employ multiple pieces of evidence and incorporate the most updated information from the literature. In some cases, newer technologies can provide further insights into cortical function in behaviorally unresponsive patients.