Neurologist
-
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.
-
Sjögren syndrome is among the most common autoimmune diseases affecting adults in the United States, and is frequently regarded as an immune-mediated exocrinopathy exclusively causing dry eyes and dry mouth. However, as a systemic rheumatic disease, there can be various "extraglandular" complications. The eclectic permutation of peripheral nervous system (PNS) syndromes which occur in Sjögren patients are among the most common and severe extraglandular complications. ⋯ The application of the traditional armamentarium used for neuropathic pain can be especially challenging. Sjögren patients can suffer from debilitating fatigue, sicca symptoms, and autonomic findings; as such manifestations can be complications of various neuropathic agents, neurologists should understand how to minimize such iatrogenic complications. Therefore, this article will empower neurologists to more effectively collaborate with rheumatologists, in the diagnosis and treatment of Sjögren patients with PNS complications.
-
Since the beginning of the conflicts in Iraq and Afghanistan, there has been a dramatic increase in the number of military service members with single and multiple-limb amputations. Phantom limb pain (PLP) frequently develops in these individuals. As a result, identifying the best methods to treat PLP is critical. The review highlights areas of inquiry related to phantom pain, with a focus on PLP. ⋯ Although more research has been done in previous years, this review identifies the need for continuing investigations. The etiology of PLP needs to be determined through more vigorous investigation, and a focus must be placed on defining treatment options in addition to mirror therapy that will improve the quality of life of those who suffer from this condition.
-
Even in milder cases, neurologic complications related to cardiac surgery increase mortality, hospitalization time, and rehabilitation costs, and so contribute to the decrease in quality of life. The incidence of neurologic complications has remained unchanged during the last years, despite age and comorbidity increasing. Improvement in technical approaches has probably contributed to maintain these percentages. ⋯ In a population progressively older and presumably affected by an increasing number of diseases, preventive strategies should be focused on 3 aspects: first, technical improvements in cardiac surgery and cerebral protection; second, pharmacologic therapy; and, finally, identification of reliable techniques to evaluate neuropsychological dysfunction after cardiac surgery. Future efforts will be necessary to identify surrogate markers of neurologic damage and its functional outcome, perhaps related to genetic susceptibility. Only with all of these instruments, really effective preventive or palliative strategies could be planned and applied.
-
Review
Seizures and CNS hemorrhage: spontaneous intracerebral and aneurysmal subarachnoid hemorrhage.
Convulsive and nonconvulsive seizures frequently complicate acute brain injury particularly central nervous system hemorrhages and both have been associated with poor outcome. No randomized controlled trials have been conducted to guide decisions on seizure prophylaxis or treatment. The magnitude of additional injury from nonconvulsive seizures remains controversial and some argue that these epileptiform patterns primarily represent surrogate markers of severely injured brain. The deleterious effects of seizures on brain recovering from a recent injury have to be weighed against the deleterious effects of antiepileptic medications when making decisions on prophylaxis and treatment. ⋯ Convulsive and nonconvulsive seizures are frequent after central nervous system hemorrhage and treatment is controversial, particularly for nonconvulsive seizures. Randomized controlled trials need to be conducted to better allow evidence-based guidelines for these common neurologic conditions.