Primary care
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Patients who present with mixed clinical neurologic signs and symptoms can be sorted into groups based on the symptom format. Targeted physical examination and evaluation of laboratory results can help quickly segment patients into groups for further workup or admission. The possibility of medication- or toxin-induced neurologic causes must be considered. Medication- and toxin-induced neurologic syndrome is a combination of several symptoms that are induced either by the exposure to or withdrawal of various medications or by toxins, and the symptoms are sometimes difficult to fit into a nice, neat diagnostic package.
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Guillain-Barré syndrome and its clinical variants are a group of rapidly progressing, potentially debilitating neurologic disorders that may have significant morbidity/mortality if left unrecognized or untreated. The most common symptoms include ascending limb weakness and paralysis, which may progress to respiratory failure. ⋯ Several treatment options exist, including plasma exchange and intravenous immunoglobulin administration. Most cases may resolve without sequelae, but those that do not may leave behind significant persistent debility.
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Multiple sclerosis (MS) is a chronic, debilitating disease that can have devastating effects. Presentation varies widely in symptoms, pace, and progression. ⋯ Although the disease is not curable presently, quality of life can be improved by minimizing the frequency and severity of disease burden. Disease modification, symptom management, preservation of function, and treatment of psychosocial issues are paramount to enhance the quality of life for the patient affected with MS.
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Parkinson disease (PD) is a progressive neurodegenerative disease with motor, nonmotor, and behavioral findings. Imaging technology advances have allowed the characterization of the underlying pathologic changes to the brain and identification of specific lesions in dopaminergic neurons. ⋯ Current treatments are directed at optimizing symptomatic management. Referral to a movement disorder specialist familiar with PD should be considered for providers with limited familiarity in diagnosis or treatment.
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Motor neuron diseases can cause progressive impairment of voluntary muscles of movement, respiration, speech, and swallowing. This review discusses the most common motor neuron disease, amyotrophic lateral sclerosis (ALS). It reviews the evaluation, diagnosis, and management of ALS, and its epidemiology, pathophysiology, and management. A coordinated approach by the primary care physician and neurologist is necessary with a focus on treatment options, durable medical equipment needs, and end-of-life discussions.