Neurologist
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Cutting needles remain the most commonly used needle design for lumbar puncture in the neurology community, although atraumatic (noncutting) needles have become common and popular for anesthesiologists performing spinal anesthesia. ⋯ The use of noncutting or pencil-point spinal needles should become the standard for performing diagnostic lumbar puncture.
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Despite a large body of resuscitation research, the optimal timing and approach to prognosticating futility after nontraumatic cardiac arrest remains controversial. Postresuscitation anoxic-ischemic encephalopathy may leave patients cognitively disabled and dependent, minimally conscious, or in a persistent vegetative state. Neurologists are frequently called upon to assess comatose postcardiac arrest patients to communicate accurate prognostic information and to assist in planning the most appropriate level of care. Serum neuron specific enolase (NSE), when used in conjunction with other available prognostic tools, may be a useful tool for predicting clinical outcome in this patient population. ⋯ The specificity of serum NSE levels >80 ng/mL is sufficiently high that, when it is used with other clinical and electrophysiological data, it could be useful as a prognostic indicator of neurologic outcome after cardiac arrest. Although serum NSE is an appealing, simple, readily available test, prediction of neurologic outcome after resuscitation from cardiac arrest must not rely solely on a serum biomarker, but must be determined in the context of other patient characteristics and neurologic examination findings.
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Dizziness is a common complaint among patients seen by primary care physicians, neurologists, and otolaryngologists. The most common causes of dizziness are peripheral vestibular disorders, but central nervous system disorders must be excluded. This article provides an overview of the epidemiology of dizziness, differentiating between central and peripheral vertigo, and central causes of dizziness. ⋯ Epidemiologic studies indicate that central causes are responsible for almost one-fourth of the dizziness experience by patients. The patient's history, neurologic examination, and imaging studies are usually the key to differentiation of peripheral and central causes of vertigo. The most common central causes of dizziness and vertigo are cerebrovascular disorders related to the vertebrobasilar circulation, migraine, multiple sclerosis, tumors of the posterior fossa, neurodegenerative disorders, some drugs, and psychiatric disorders.
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Review Case Reports
Does prophylactic postoperative hypervolemic therapy prevent cerebral vasospasm and improve clinical outcome after aneurysmal subarachnoid hemorrhage?
Delayed cerebral vasospasm is a common cause of morbidity and mortality after acute aneurysmal subarachnoid hemorrhage. Hypovolemia and fluid restriction are risk factors for delayed vasospasm; hypervolemic therapeutic approaches are commonly used in patients with subarachnoid hemorrhage to prevent and to treat cerebral vasospasm. ⋯ Available evidence is insufficient to support use of prophylactic hypervolemic therapy after surgery in patients with aneurysmal subarachnoid hemorrhage. Although completed studies may be insufficiently sensitive (underpowered) to detect a treatment effect, the magnitude of any as yet undetected benefit of prophylactic hypervolemic therapy is likely modest and its risks have not been systematically evaluated.