Neurologist
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Cerebral venous thrombosis (CVT) is less frequent than arterial thrombosis, presents in an atypical fashion, and is an uncommon cause of stroke. Although the functional outcome from CVT is better than arterial strokes, the outcome of CVT remains unpredictable and may lead to sequelae or even death if not recognized and treated early. ⋯ Further clinical trials are needed to address optimal treatment of this infrequent but potentially serious condition.
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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.
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Chronic pain is one of the most common and challenging medical problems facing our society. The specialty of pain medicine has grown steadily in recent years, largely because of the recognition that multiple factors contribute to chronic pain. ⋯ Research in the last 30 years has developed a variety of alternatives or adjuncts to opiates for chronic pain, including neuroactive medications, counterstimulation methods, and cognitive-behavioral therapies. Pain medicine specialists have provided leadership in the development of the practice, with the application of a wide verity of central and peripheral nerve blocks, sympathetic and neurolytic blocks, intradiscal procedures, neuromodulation techniques, intrathecal infusion systems, and other technical procedures that are firmly linked to a biomedical model of pain.