Neurologist
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Neurologists are frequently called to evaluate patients in the intensive care units who are not waking up. This often poses a diagnostic and prognostic dilemma. ⋯ In this review, we explore a practical systematic approach to patients with decreased level of consciousness. The most common causes of impaired alertness in different non-neurologic critical care units and commonly used prognostication tools are presented. Finally a brief introduction of hypothermia, a novel therapeutic approach is also discussed.
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Malignant middle cerebral artery (MCA) infarction is a devastating disease affecting a minority of stroke victims. The mortality rate from malignant MCA infarction managed with conservative medical treatment is estimated at 80%. Standard medical management includes physiologic support, osmotherapy, intubation and mechanical ventilation, and intracranial pressure monitoring. Decompressive hemicraniectomy has been viewed with skepticism because of lack of evidence from randomized controlled trials. ⋯ Hemicraniectomy for malignant MCA infarction is a life saving procedure. Further data on quality of life outcomes and patient and caregiver burden are required. Until that time, selection of patients for hemicraniectomy still requires an individual approach.
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Patients with acute brain injury from various etiologies commonly develop increased intracranial pressure. Acute intracranial hypertension resulting from elevation of intracranial pressure is a medical emergency requiring prompt diagnosis and management. Appropriate and timely management strategies result in better patient outcome in an otherwise severely debilitating or fatal disease process. ⋯ Clinicians treating patients with acute brain injury should be familiar with the principles of management of increased intracranial pressure. Since acute intracranial hypertension is a potentially reversible condition, high index of suspicion, and low threshold for diagnostic and therapeutic strategies will improve patient care.
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Primary headaches are known to be associated with multiple sclerosis. We aimed to determine headaches using ICHD-II in different phases of relapsing-remitting multiple sclerosis, and the correlation between headaches and several features of the disease. ⋯ The high frequency of PSHs in relapse was notable, and, to the best of our knowledge, PSH was not reported in relapsing-remitting multiple sclerosis before. Further studies with larger samples are recommended.
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Recent studies suggest that insulin resistance is more common in patients with migraine. Insulin resistance underlies the pathogenesis of obesity, diabetes, and hypertension that are components of metabolic syndrome. As migraine is associated with an increased risk of vascular disorders, such as stroke, and migraine patients have higher diastolic blood pressure than healthy individuals, we aimed to investigate the 1-year prevalence of migraine in metabolic syndrome. ⋯ Our results demonstrate that migraine prevalence in metabolic syndrome was higher than in the general population.