Neurologist
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Seizures are a complication of aneurysmal subarachnoid hemorrhage (aSAH). ⋯ There are insufficient data to support or refute the prophylactic use of AED therapy after aSAH. Randomized, controlled trials are needed to address the efficacy and risks of AEDs in this setting and should take into account factors such as aneurysmal factors (location, hemorrhage grade, degree of parenchymal injury), type of aneurysm surgery (clip vs. coil), and evaluate the timing and duration of AED use.
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Obstructive sleep apnea (OSA) is gaining recognition as a cardiovascular and cerebrovascular risk factor. Sleep apnea is now implicated in the etiopathogenesis of stroke, coronary artery disease, hypertension, and congestive heart failure. ⋯ Neurologists should familiarize themselves with the symptoms and signs of OSA and the pathophysiology of the association between untreated OSA and cardiovascular disease, including stroke. OSA should be ruled out in patients with cardiovascular disease and be regarded as an important modifiable risk factor. Knowledge of this association is of prime public health importance and can result in primary and secondary prevention of cardiovascular events. This study will also help neurologists in providing patient education and treatment.
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Hyperkalemia has been described as a rare and under recognized cause of acute quadriplegia. ⋯ Hyperkalemia is a rare but treatable cause of acute flaccid paralysis that requires immediate treatment. Late diagnosis can delay appropriate treatment leading to cardiac arrhythmias and arrest.
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Myasthenia gravis presenting as a neurologic emergency warrants management in a critical care unit. In resource poor settings which typify much of Africa, this can be very challenging even in tertiary centers with consequently unfavorable outcomes. ⋯ Sepsis is a major factor contributing to poor outcomes among patients with myasthenia gravis managed in critical care units in Nigeria. Vigorous and concerted efforts should be made to make intensive care units more effective in Africa.