Neurologist
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Intracerebral hemorrhage (ICH) occurs from the rupture of small vessels into the brain parenchyma and accounts for approximately 10% of all strokes in the United States, and carries with it a significantly high morbidity and mortality. ⋯ The morbidity and mortality associated with ICH remain high despite recent advances in our understanding of the clinical course of ICH. Novel preventive and acute treatment therapies are needed and may be on the horizon.
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Weakness in the ICU may be caused by a number of disorders. Guillain-Barré syndrome (GBS) and myasthenia gravis (MG) are examples of conditions that might lead to an ICU admission. The most likely cause of weakness after ICU admission is critical illness polyneuropathy/myopathy (CIP/M). ⋯ Research to advance our knowledge of the pathogenesis of GBS, MG, and CIP/M is clearly needed to develop more specific and more effective treatments in the future. In the meantime, measures that optimize medical management can be instituted to improve outcomes in patients with these conditions, preferably in a specialized neuroscience ICU setting.
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Nonconvulsive status epilepticus (NCSE) is a state of ongoing seizure activity for at least 30 minutes, with cognitive or behavioral changes, but without convulsive clinical manifestations. It requires EEG for confirmation. It has been categorized into groups having focal or generalized EEG epileptic activity; and by etiology and level of consciousness (which predict outcome). Points of contention include the evolving definition of what constitutes NCSE, various reasons for a delayed, missed, or misidentified diagnosis, and the optimal management of these conditions.