Neurologist
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This review discusses a variety of causes of stupor and coma and associated electroencephalographic (EEG) findings. These include metabolic disturbances such as hepatic or renal dysfunction, which are often characterized by slowing of background rhythms and triphasic waves. Hypoxia and drug intoxications can produce a number of abnormal EEG patterns such as burst suppression, alpha coma, and spindle coma. ⋯ This entity, nonconvulsive status epilepticus (NCSE), is difficult to diagnose in obtunded/comatose patients, and an EEG is required to verify the diagnosis and to monitor treatment. Several EEG patterns and their interpretation in suspected cases of NCSE such as periodic lateralized epileptiform discharges (PLEDs), bilateral independent periodic lateralized epileptiform discharges (BIPLEDs), generalized periodic epileptiform discharges (GPEDs), and triphasic waves are reviewed. Other entities discussed include the locked-in syndrome, neocortical death, persistent vegetative state, brainstem death, and brain death.
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Reviews of the use of intravenous tissue type plasminogen activator (IV tPA) for acute stroke in community hospitals have raised questions regarding its safe use in community practice settings outside major academic stroke centers. Many neurologists have been reluctant to use IV tPA in their practices. We therefore analyzed the experience of this community neurology practice in treating acute strokes with IV tPA. ⋯ IV tPA for acute ischemic stroke can be given safely and effectively by physicians in an independent neurology practice in the community hospital setting.
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Cardiac arrest has a high mortality rate. Postresuscitation encephalopathy is commonly associated with significant morbidity. ⋯ The authors discuss the physiology, pathology, and consequences of cardiac arrest to the central nervous system, and the use of various parameters in prognostication. Induced hypothermia is a new therapeutic development.
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Massive cerebral infarcts cause brain edema with midline shifts and impingement on vital structures producing coma and death. The mortality rate is estimated at 80% with standard medical treatment. Surgical decompression with hemicraniectomy has proved to be life saving, but the impact on functional outcomes is largely unknown. The focus of this review is to discuss the treatment options for massive cerebral infarcts. ⋯ Hemicraniectomy is emerging as a promising treatment of patients with massive cerebral infarcts, but only select patients benefit from this procedure. Further information from randomized controlled trials is required to elucidate the best treatment options for this kind of stroke.
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Herpes simplex encephalitis (HSE) still carries a high morbidity and mortality. ⋯ The safety of anticoagulation in HSE has not been raised in the literature previously, and it needs further study.