Continuum : lifelong learning in neurology
-
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.
-
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.
-
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.
-
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.
-
Sports neurology is an emerging area of subspecialty. Neurologists and non-neurologists evaluating and managing individuals participating in sports will encounter emergencies that directly or indirectly involve the nervous system. Since the primary specialty of sports medicine physicians and other practitioners involved in the delivery of medical care to athletes in emergency situations varies significantly, experience in recognition and management of neurologic emergencies in sports will vary as well. This article provides a review of information and elements essential to neurologic emergencies in sports for the practicing neurologist, although content may be of benefit to readers of varying background and expertise. ⋯ Neurologists and others involved in the care of athletes should consider neurologic emergencies in sports when planning and providing medical care.