Current neurology and neuroscience reports
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For many neurologists, seizures in critically ill patients represent a difficult problem. Etiology can be elusive because of the complexity of the environment, and treatment decisions can be compromised by the paucity of evidence-based guidelines. Emerging data support a higher than previously thought incidence of nonconvulsive epileptic activity in this patient population, which is another important consideration. ⋯ Although there is no reason to believe that late seizures after severe head trauma cannot be prevented with prophylactic treatment, such an approach may be useful during the first week after the injury. Physicians, however, have to individualize the treatment to the critical patient after stroke or trauma based on the presence of additional factors that increase the risk for seizures, including structural cortical injuries and medications used in critical illness with epileptogenic potential. A general therapeutic scheme for seizures in the intensive care unit and the role newer antiepileptic drugs can play are also presented in this review.
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Curr Neurol Neurosci Rep · Nov 2004
ReviewDiagnosis and management of brain abscess and subdural empyema.
Advances in the diagnosis and treatment of brain abscess and subdural empyema with neuroimaging techniques such as computerized tomography, magnetic resonance imaging, magnetic resonance spectroscopy, the availability of new antimicrobials, and the development of novel surgical techniques have significantly contributed to the decreased morbidity and mortality associated these infections. Determination of point of entry and source of infection is paramount to adequate treatment. A high index of suspicion along with typical clinical presentation of headache, seizures, or focal neurologic signs can lead to early diagnosis so that effective therapy can be instituted as soon as possible. This review discusses etiology and pathology of brain abscess and subdural empyema, neuroimaging techniques useful in the diagnosis, and optimal treatment, including use of antimicrobials and surgical procedures.
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Traumatic brain injury often affects people in their most productive years, inflicting a significant burden on families and society. The advances in modern critical care have improved survival of patients; thus more patients live after traumatic brain injury, which raises an important issue about their neurologic outcome. ⋯ In this review, we try to bring information from different sources to show new approaches to achieve that goal. Some of the techniques employed are investigational and some are waiting to find broader application in intensive care units across the country.
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Patients with large hemispheric strokes frequently develop neurologic deterioration secondary to cerebral edema. Regardless of the medical and surgical management of cerebral edema, there is high morbidity and mortality. This article reviews the clinical and radiographic features of large hemispheric strokes and examines the various therapeutic options for management of cerebral edema.