Continuum : lifelong learning in neurology
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Continuum (Minneap Minn) · Aug 2015
Emergency Department and Inpatient Management of Status Migrainosus and Intractable Headache.
This article discusses the treatment of status migrainosus in the emergency department and the treatment of intractable migraine in an inpatient setting. ⋯ Treatment of status migrainosus and intractable migraine should focus on adequate fluid hydration and combination IV therapy with multiple nonopioid medications from multiple drug classes. Dopamine receptor antagonists appear to have some of the highest medical evidence for efficacy.
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A thunderclap headache is a very severe headache that reaches its maximum intensity within 1 minute. Patients with thunderclap headache must be evaluated emergently and comprehensively to rule out underlying disorders that can be associated with high mortality and morbidity, determine the cause for the thunderclap headache, and initiate targeted therapy. This review presents an up-to-date summary on the clinical presentation, diagnostic evaluation, and causes of thunderclap headache. ⋯ Patients with thunderclap headache require an emergent and comprehensive evaluation to identify the underlying cause and to initiate appropriate therapy.
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Continuum (Minneap Minn) · Apr 2015
Case ReportsWhen religious beliefs prohibit a surgical patient's acceptance of blood transfusion.
A 49-year-old man who was a Jehovah's Witness presented with intractable epilepsy due to a brain tumor. The neurologist wanted to refer him for tumor resection but was concerned about requesting surgery for someone who would not accept blood products. The neurologist must balance his obligation of beneficence and nonmaleficence with respect for the patient's autonomous decision not to receive blood products. Good communication between patient and doctor is crucial to allow patients to make informed decisions about a choice to refuse transfusion, and doctors must accept the patient's autonomy, even when it conflicts with the moral imperative to provide treatment if it is available.
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Cauda equina syndrome is an important neurologic disorder characterized by lower back pain, sciatica, perineal numbness, and sphincter dysfunction. This article reviews the anatomy, clinical presentation, evaluation, and treatment of cauda equina dysfunction, focusing on diskogenic cauda equina syndrome. ⋯ In the absence of high-quality data indicating otherwise, urgent evaluation and intervention are required for diskogenic cauda equina syndrome. Other etiologies of cauda equina dysfunction including neoplastic, infectious, and iatrogenic causes must also be considered, especially in the setting of normal neuroimaging studies.
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This article reviews some of the unusual sports-related neurologic disorders within the new and rapidly growing field of sports neurology that neurologists may encounter. ⋯ The syndromes described in this article range from relatively minor syndromes that cause discomfort or abnormal movement to potentially devastating cerebrovascular or myelopathic syndromes. Although the disorders described in this article are not common, they can affect individuals involved in sports at all levels, from the novice to the elite athlete, and may present to any neurologist. Neurologists should be aware of the potential for these syndromes to occur as a consequence of athletic activities in order to provide the most appropriate diagnosis, management, and counseling.