Drug-resistant epilepsy warrants referral to an epilepsy surgery center for consideration of alternative treatments including epilepsy surgery. Advances in technology now allow for minimally invasive neurophysiologic monitoring and surgical interventions, approaches that are attractive to families because large craniotomies and associated morbidity are avoided. This work reviews the presurgical evaluation process and discusses the use of invasive stereo-electroencephalography monitoring to localize seizure onset zones. Minimally invasive surgical techniques are described for the treatment of focal and generalized epilepsie...
Source: Neurologic Clinics - June 9, 2021 Category: Neurology Authors: Elaine S. Seto, Rohini Coorg Source Type: research
Inflammatory Diseases of the Central Nervous System
Pediatric neuroinflammatory conditions are a complex group of disorders with a wide range of clinical presentations. Patients can present with a combination of focal neurologic deficits, encephalopathy, seizures, movement disorders, or psychiatric manifestations. There are several ways that pediatric neuroinflammatory conditions can be classified, including clinical presentation, pathophysiologic mechanism, and imaging and laboratory findings. In this article, we group these conditions into acquired demyelinating diseases, immune-mediated epilepsies/encephalopathies, primary rheumatologic conditions with central nervous sy...
Source: Neurologic Clinics - June 9, 2021 Category: Neurology Authors: Nikita Malani Shukla, Timothy Lotze, Eyal Muscal Source Type: research
Central nervous system (CNS) tumors are the most common solid tumor in pediatrics and represent the largest cause of childhood cancer –related mortality. With advances in molecular characterization of tumors, considerable developments have occurred impacting diagnosis and management, and refined prognostication. Advances in management have led to better survival, but mortality remains high and significant morbidity persists. Nov el therapeutic approaches targeting the biology of these tumors are being investigated to improve overall survival and decrease treatment-related morbidity. Further molecular understanding of...
Source: Neurologic Clinics - June 9, 2021 Category: Neurology Authors: Fatema Malbari Source Type: research
Neurocritical Care and Brain Monitoring
This article reviews pediatric NCC, the various physiologic parameters used, especially continuous electroencephalographic monitoring. (Source: Neurologic Clinics)
Source: Neurologic Clinics - June 9, 2021 Category: Neurology Authors: James J. Riviello, Jennifer Erklauer Source Type: research
Neurology of Sleep
Healthy sleep, including proper amounts in the 24-hour day/night period, is crucial for developing children. Sleep development in infants and children is characterized by increased amounts of sleep, including rapid eye movement and non –rapid eye movement (NREM) slow-wave sleep. Expected changes as well as deviations may contribute to sleep problems, which are common in typically developing children and very common in those with neurodevelopmental disorders and often are chronic. Periodic screening of children for sleep problems is important for timely and effective management of these. (Source: Neurologic Clinics)
Source: Neurologic Clinics - June 9, 2021 Category: Neurology Authors: Samiya F. Ahmad, Ashura W. Buckley, Daniel G. Glaze Source Type: research
Evidence-Based Protocols in Child Neurology
This article shall focus on the current treatment guidelines used for inpatient pediatric neurology. (Source: Neurologic Clinics)
Source: Neurologic Clinics - June 9, 2021 Category: Neurology Authors: James J. Riviello, Jennifer Erklauer Source Type: research
An acutely comatose patient constitutes a medical emergency until proved otherwise. Managing these emergencies requires organized teamwork to recognize and treat life-threatening situations and reversible causes of coma. Once vital functions have been stabilized, information from the history and physical examination should be used to rationally guide subsequent testing. Identifying causes of coma for which emergency treatment is possible should be the priority. The treatment and prognosis depend on the cause. (Source: Neurologic Clinics)
Source: Neurologic Clinics - April 23, 2021 Category: Neurology Authors: Amra Sakusic, Alejandro A. Rabinstein Source Type: research
Headache is a common reason for seeking medical attention. Most cases are benign primary headache disorders; however, there is significant overlap between symptoms of these disorders and secondary headaches. Differentiating these clinical scenarios requires a careful history with attention to red flag symptoms and a neurologic examination. These details can identify dangerous disorders: subarachnoid hemorrhage, reversible cerebral vasoconstriction syndrome, elevated intracranial pressure, hydrocephalus, cerebral venous sinus thrombosis, arterial dissection, central nervous system infection, and inflammatory vasculitis. Old...
Source: Neurologic Clinics - April 23, 2021 Category: Neurology Authors: David Kopel, Crandall Peeler, Shuhan Zhu Source Type: research
Evaluation and Management of Seizures and Status Epilepticus
Seizures are frequently triggered by an inciting event and result from uninhibited excitation and/or decreased inhibition of a pool of neurons. If physiologic seizure abortive mechanisms fail, the ensuing unrestrained synchronization of neurons —status epilepticus—can be life-threatening and is associated with the potential for marked morbidity in survivors and high medical care costs. Prognosis is intimately related to etiology and its response to therapeutic measures. Timely implementation of pharmacologic therapy while concurrently performing a stepwise workup for etiology are paramount. Neurodiagnostic test...
Source: Neurologic Clinics - April 23, 2021 Category: Neurology Authors: Pouya Alexander Ameli, Abdalla A. Ammar, Kent A. Owusu, Carolina B. Maciel Source Type: research
Neuromuscular Respiratory Failure
Neuromuscular respiratory failure can result from any disease that causes weakness of bulbar and/or respiratory muscles. Once compensatory mechanisms are overwhelmed, hypoxemic and hypercapnic respiratory failure ensues. The diagnosis of neuromuscular respiratory failure is primarily clinical, but arterial blood gases, bedside spirometry, and diaphragmatic ultrasonography can help in early assessment. Intensive care unit (ICU) admission is indicated for patients with severe bulbar weakness or rapidly progressing appendicular weakness. Intubation should be performed electively, particularly in patients with dysautonomia. Pa...
Source: Neurologic Clinics - April 23, 2021 Category: Neurology Authors: Tarun D. Singh, Eelco F.M. Wijdicks Source Type: research
Vascular and infectious causes are rare but important causes of spinal cord injury. High suspicion for these processes is necessary, as symptoms may progress over hours to days, resulting in delayed presentation and diagnosis and worse outcomes. History and clinical examination findings can assist with localization of the affected vascular territory and spinal level, which will assist with focusing spinal imaging. Open and/or endovascular surgical management depends on the associated vascular abnormality. Infectious myelopathy treatment consists of targeted antimicrobial therapy when possible, infectious source control, an...
Source: Neurologic Clinics - April 23, 2021 Category: Neurology Authors: Caleb R. McEntire, Richard S. Dowd, Emanuele Orru ’, Carlos David, Juan E. Small, Anna Cervantes-Arslanian, David P. Lerner Source Type: research
Emergency Care of Patients with Acute Ischemic Stroke
Stroke is a leading cause of morbidity and mortality and a major cause of long-term disability. Management of acute ischemic stroke in the first hours is critical to patient outcomes. This review provides an overview of acute ischemic stroke management, with a focus on the golden hour. Additional topics discussed include prehospital considerations and initial evaluation of the patient with history, examination, and imaging as well as treatment options, including thrombolysis and endovascular therapy. (Source: Neurologic Clinics)
Source: Neurologic Clinics - April 23, 2021 Category: Neurology Authors: Adeel S. Zubair, Kevin N. Sheth Source Type: research
Neurological Emergencies During Pregnancy
This article serves as a comprehensive review of neurologic emergencies in pregnancy. Common initial presentations of neuroemergencies are reviewed with a clinical algorithm. Neurovascular disorders in pregnancy are reviewed, including acute ischemic strokes with data on tPA and thrombectomy; cerebral venous sinus thrombosis diagnosis and management; posterior reversible encephalopathy syndrome management; reversible cerebral vasoconstriction syndrome; and intracerebral hemorrhage. Attention is paid to management of cerebral edema and safety of osmotic therapies. A review of seizures in pregnancy is provided, including new...
Source: Neurologic Clinics - April 23, 2021 Category: Neurology Authors: Elizabeth Macri, Diana Greene-Chandos Source Type: research
Bringing Order to the Chaos of Neurologic Emergencies Amid the Chaos of a Pandemic
Successfully caring for patients with neurologic emergencies presents significant challenges. The rapidity with which the emergency must be handled and the necessarily deliberate nature of the neurology involved are difficult to reconcile. The difficulty is compounded by the unforgiving nature of the injured nervous system and rapidly increasing body of knowledge about the conditions that cause these emergencies. Yet, the challenge is welcome. These patients are vulnerable, and our ability to meaningfully treat many previously devastating neurologic emergencies has improved dramatically in recent years. (Source: Neurologic Clinics)
Source: Neurologic Clinics - April 23, 2021 Category: Neurology Authors: Joseph D. Burns, Anna M. Cervantes-Arslanian Tags: Preface Source Type: research
NEUROLOGIC CLINICS (Source: Neurologic Clinics)
Source: Neurologic Clinics - April 23, 2021 Category: Neurology Authors: Joseph D. Burns, Anna M. Cervantes-arslanian Source Type: research
Neuromonitoring After Cardiac Arrest
This article reviews the pathophysiology of hypoxic-ischemic brain injury, provides an overview of the neuromonitoring tools available to identify risk profiles for secondary brain injury, and highlights the importance of an individualized approach to post cardiac arrest care. (Source: Neurologic Clinics)
Source: Neurologic Clinics - March 31, 2021 Category: Neurology Authors: Rachel Beekman, Carolina B. Maciel, Ramani Balu, David M. Greer, Emily J. Gilmore Source Type: research
This article provides a framework for approaching patients with neuro-ophthalmic symptoms and reviews the presentation, evaluation, and treatment of select emergent conditions that can cause them. Emergent causes of blurry vision, transient vision loss, papilledema, and diplopia, including giant cell arteritis, cardioembolic disease, and aggressive infection, are discussed. (Source: Neurologic Clinics)
Source: Neurologic Clinics - March 31, 2021 Category: Neurology Authors: Samuel J. Spiegel, Heather E. Moss Source Type: research
Movement Disorder Emergencies
Acute presentation of new movement disorders and acute decompensation of chronic movement disorders are uncommon but potentially life-threatening. Inadvertent or purposeful overdose of many psychiatric medications can result in acute life-threatening movement disorders including serotonin syndrome, neuroleptic malignant syndrome, and malignant catatonia. Early withdrawal of potentiating medications, treatment with benzodiazepines and other diagnosis-specific drugs, and providing appropriate supportive care including airway and breathing management, hemodynamic stabilization, fluid resuscitation, and renal support including...
Source: Neurologic Clinics - March 31, 2021 Category: Neurology Authors: Diana Apetauerova, Pritika A. Patel, Joseph D. Burns, David P. Lerner Source Type: research
Autoimmune Neurologic Emergencies
This article discusses manifestations and management of various autoimmune neurologic emergencies. (Source: Neurologic Clinics)
Source: Neurologic Clinics - March 31, 2021 Category: Neurology Authors: Pooja Raibagkar, Anil Ramineni Source Type: research
Anesthesia Considerations in Neurological Emergencies
This article provides a summary of the unique airway management and anesthesia considerations and controversies for neurologic emergencies in general, as well as for specific commonly encountered conditions: elevated intracranial pressure, neuromuscular respiratory failure, acute ischemic stroke, and acute cervical spinal cord injury. (Source: Neurologic Clinics)
Source: Neurologic Clinics - March 31, 2021 Category: Neurology Authors: Anil Ramineni, Erik A. Roberts, Molly Vora, Sohail K. Mahboobi, Ala Nozari Source Type: research
Cancer and cancer therapies have the potential to affect the nervous system in a host of different ways. Cerebral edema, increased intracranial pressure, cerebrovascular events, status epilepticus, and epidural spinal cord compression are among those most often presenting as emergencies. Neurologic side-effects of cancer therapies are often mild, but occasionally result in serious illness. Immunotherapies cause autoimmune-related neurologic side-effects that are generally responsive to immunosuppressive therapies. Emergency management of neuro-oncologic problems benefits from early identification and close collaboration am...
Source: Neurologic Clinics - March 31, 2021 Category: Neurology Authors: Zachary D. Threlkeld, Brian J. Scott Source Type: research
Intracerebral hemorrhage is a stroke subtype with high mortality and poor functional outcome in survivors. Its main causes are hypertension, cerebral amyloid angiopathy, and anticoagulant treatment. Hematomas have a high frequency of expansion in the first hours after symptom onset, a process associated with neurologic deterioration and poor outcome. Control of severe hypertension, reversal of anticoagulant effect, and management of increased intracranial pressure are the mainstays of management of intracerebral hemorrhage in the acute phase. Surgical evacuation of the hematoma by conventional craniotomy does not improve o...
Source: Neurologic Clinics - March 31, 2021 Category: Neurology Authors: Carlos S. Kase, Daniel F. Hanley Source Type: research
Neuroinfectious Disease Emergencies
Neuroinfectious diseases can affect immunocompetent and immunosuppressed individuals and cause a variety of emergencies including meningitis, encephalitis, and abscess. Neurologic infections are frequently complicated by secondary injuries that also present emergently such as cerebrovascular disease, acute obstructive hydrocephalus, and seizure. In most cases, timely recognition and early treatment of infection can improve the morbidity and mortality of infectious neurologic emergencies. (Source: Neurologic Clinics)
Source: Neurologic Clinics - March 31, 2021 Category: Neurology Authors: Caleb R.S. McEntire, Pria Anand, Anna M. Cervantes-Arslanian Source Type: research
Acute Traumatic Spinal Cord Injury
Traumatic spinal cord injury is a common neurologic insult worldwide that can result in severe disability. Early stabilization of the patient ’s airway, breathing, and circulation as well as cervical and thoracolumbar spinal immobilization is necessary to prevent additional injury and optimize outcomes. Computed tomography (CT) scan and magnetic resonance imaging (MRI) of the spinal column can assist with determining the extent of bony and ligamentous injury, which will guide surgical management. With or without surgical intervention, patients with spinal cord injury require intensive care unit management and close o...
Source: Neurologic Clinics - March 31, 2021 Category: Neurology Authors: Ilyas Eli, David P. Lerner, Zoher Ghogawala Source Type: research
Brain Herniation and Intracranial Hypertension
This article introduces the basic concepts of intracranial physiology and pressure dynamics. It also includes discussion of signs and symptoms and examination and radiographic findings of patients with acute cerebral herniation as a result of increased as well as decreased intracranial pressure. Current best practices regarding medical and surgical treatments and approaches to management of intracranial hypertension as well as future directions are reviewed. Lastly, there is discussion of some of the implications of critical medical illness (sepsis, liver failure, and renal failure) and treatments thereof on causation or w...
Source: Neurologic Clinics - March 31, 2021 Category: Neurology Authors: Aleksey Tadevosyan, Joshua Kornbluth Source Type: research
Aneurysmal Subarachnoid Hemorrhage
Aneurysmal subarachnoid hemorrhage is a neurologic emergency that requires immediate patient stabilization and prompt diagnosis and treatment. Early measures should focus on principles of advanced cardiovascular life support. The aneurysm should be evaluated and treated in a comprehensive stroke center by a multidisciplinary team capable of endovascular and, operative approaches. Once the aneurysm is secured, the patient is best managed by a dedicated neurocritical care service to prevent and manage complications, including a syndrome of delayed neurologic decline. The goal of such specialized care is to prevent secondary ...
Source: Neurologic Clinics - March 31, 2021 Category: Neurology Authors: David Y. Chung, Mohamad Abdalkader, Thanh N. Nguyen Source Type: research
Blunt and Penetrating Severe Traumatic Brain Injury
Severe traumatic brain injury is a common problem. Current practices focus on the importance of early resuscitation, transfer to high-volume centers, and provider expertise across multiple specialties. In the emergency department, patients should receive urgent intracranial imaging and consideration for tranexamic acid. Close observation in the intensive care unit environment helps identify problems, such as seizure, intracranial pressure crisis, and injury progression. In addition to traditional neurologic examination, patients benefit from use of intracranial monitors. Monitors gather physiologic data on intracranial and...
Source: Neurologic Clinics - March 31, 2021 Category: Neurology Authors: Courtney E. Takahashi, Deepti Virmani, David Y. Chung, Charlene Ong, Anna M. Cervantes-Arslanian Source Type: research
Acute Dizziness, Vertigo, and Unsteadiness
Vestibular symptoms, including dizziness, vertigo, and unsteadiness, are common presentations in the emergency department. Most cases have benign causes, such as vestibular apparatus dysfunction or orthostatic hypotension. However, dizziness can signal a more sinister condition, such as an acute cerebrovascular event or high-risk cardiac arrhythmia. A contemporary approach to clinical evaluation that emphasizes symptom duration and triggers along with a focused oculomotor and neurologic examination can differentiate peripheral causes from more serious central causes of vertigo. Patients with high-risk features should get b...
Source: Neurologic Clinics - March 30, 2021 Category: Neurology Authors: Barbara Voetsch, Siddharth Sehgal Source Type: research
Neurologic Emergencies during the Coronavirus Disease 2019 Pandemic
Although minor neurologic complications of coronavirus disease 2019 are common, life-threatening neurologic emergencies are rare. Acute ischemic stroke, intracerebral hemorrhage, venous sinus thrombosis, seizures, and posterior reversible encephalopathy syndrome have been described. Hospitals have seen significant changes in the volume of patients presenting with neurologic emergencies. We review what has thus far been published about the intersection of coronavirus disease 2019 and neurologic emergencies with particular attention to cerebrovascular disease and seizure. Considerations in managing the acute presentations of...
Source: Neurologic Clinics - March 26, 2021 Category: Neurology Authors: Julie G. Shulman, Thomas Ford, Anna M. Cervantes-Arslanian Source Type: research
Advances in Treatments in Muscular Dystrophies and Motor Neuron Disorders
This article reviews advances in gene therapies, newly approved drugs, and therapeutic promises in muscular dystrophies and MNDs. (Source: Neurologic Clinics)
Source: Neurologic Clinics - November 20, 2020 Category: Neurology Authors: Bhaskar Roy, Robert Griggs Source Type: research
Update on Calcitonin Gene-Related Peptide Antagonism in the Treatment of Migraine
The discovery of calcitonin gene-related peptide (CGRP) and its role in migraine has promoted a new era in migraine treatment: CGRP antagonism. Two classes of medications are currently available: small molecules targeting the CGRP receptor and monoclonal antibodies targeting the CGRP receptor or CGRP ligand. The revolution of these medications is represented by blurring the borders between acute and preventive treatments, episodic and chronic migraine, na ïve and refractory patients and even between migraine and other headache disorders. (Source: Neurologic Clinics)
Source: Neurologic Clinics - November 7, 2020 Category: Neurology Authors: Edoardo Caronna, Amaal J. Starling Source Type: research
Advances in the Treatment of Multiple Sclerosis
This article reviews data on available treatments along with a discussion of future treatment targets under investigation. (Source: Neurologic Clinics)
Source: Neurologic Clinics - November 7, 2020 Category: Neurology Authors: Carolyn Goldschmidt, Marisa P. McGinley Source Type: research
Advances in the Treatment of Neuromyelitis Optica Spectrum Disorder
Neuromyelitis optica spectrum disorder (NMOSD) is a rare, relapsing-remitting neuroinflammatory disorder of the central nervous system. Advances in the understanding of NMOSD pathogenesis and identification of the NMO-specific pathogenic anti-AQP4 autoantibody have led to the development of highly effective disease-modifying strategies. Five placebo-controlled, randomized trials for NMOSD have been successfully completed as of 2020. These trials support the efficacy of rituximab and tocilizumab and led to the FDA approval of eculizumab, satralizumab and inebilizumab for NMOSD. Our review provides an update on these evidenc...
Source: Neurologic Clinics - November 7, 2020 Category: Neurology Authors: Asya Izraelit Wallach, Matthew Tremblay, Ilya Kister Source Type: research
Advances and Future Directions of Neuromodulation in Neurologic Disorders
“Deep brain stimulation is a safe and effective therapy for the management of a variety of neurologic conditions with Food and Drug Administration or humanitarian exception approval for Parkinson disease, dystonia, tremor, and obsessive-compulsive disorder. Advances in neurophysiology, neuroimagin g, and technology have driven increasing interest in the potential benefits of neurostimulation in other neuropsychiatric conditions including dementia, depression, pain, Tourette syndrome, and epilepsy, among others. New anatomic or combined targets are being investigated in these conditions to imp rove symptoms refractory...
Source: Neurologic Clinics - November 7, 2020 Category: Neurology Authors: Matthew R. Burns, Shannon Y. Chiu, Bhavana Patel, Sotiris G. Mitropanopoulos, Joshua K. Wong, Adolfo Ramirez-Zamora Source Type: research
Advances in the Management of Small Fiber Neuropathy
Small fiber neuropathy (SFN) is a prevalent neurologic syndrome. Testing methods have emerged in recent years to better diagnose it, including autonomic tests and skin punch biopsy. SFN can present in a non –length-dependent fashion and can be mistaken for syndromes such as fibromyalgia and complex regional pain syndrome. SFN is caused by a variety of metabolic, infectious, genetic, and inflammatory diseases. Recently treatments have emerged for TTR amyloid neuropathy and Fabry disease, and novel bio markers have been found both in genetic and inflammatory SFN syndromes. Ongoing trials attempt to establish the effica...
Source: Neurologic Clinics - November 7, 2020 Category: Neurology Authors: Lawrence A. Zeidman Source Type: research
Update in the Management of Myasthenia Gravis and Lambert-Eaton Myasthenic Syndrome
This article focuses on advances in management of autoimmune MG and LEMS. (Source: Neurologic Clinics)
Source: Neurologic Clinics - November 7, 2020 Category: Neurology Authors: Cynthia Bodkin, Robert M. Pascuzzi Source Type: research
Update in the Management of Idiopathic Intracranial Hypertension
Idiopathic intracranial hypertension is a syndrome of increased intracranial pressure of unknown cause that most often occurs in women of childbearing age. Most patients are overweight or obese with a history of recent weight gain. Following a brief review of the symptoms and signs, we discuss the approach to assessment and monitoring of this condition. We then present a practical approach to treatment. Because patients frequently struggle with weight loss and can also have refractory headaches and coexisting psychosocial issues, we emphasize the importance of a multidisciplinary approach to the management of this common c...
Source: Neurologic Clinics - November 7, 2020 Category: Neurology Authors: Matthew J. Thurtell, Aki Kawasaki Source Type: research
What is New in Neuro-oncology?
Neuro-oncology is a rapidly developing field. A continuous evolution in the understanding of the molecular underpinnings of central nervous system tumors has helped reconfigure the classification of brain tumors. More importantly, it has laid the path forward for the development and investigation of new therapeutics. The authors discuss the classification of brain tumors and novel therapies in brain tumors as well as promising treatments underway. (Source: Neurologic Clinics)
Source: Neurologic Clinics - November 7, 2020 Category: Neurology Authors: Jigisha P. Thakkar, Vikram C. Prabhu, Katherine B. Peters, Rimas V. Lukas Source Type: research
Advances in the Surgical Management of Epilepsy
This article discusses the advances in surg ical treatment of DRE in adults with focal seizures. (Source: Neurologic Clinics)
Source: Neurologic Clinics - November 7, 2020 Category: Neurology Authors: Gregory D. Cascino, Benjamin H. Brinkmann Source Type: research
Treatment of Viral Encephalitis
Viral encephalitis is difficult to treat. Herpes simplex encephalitis has been successfully treated with acyclovir, but is still a cause for significant morbidity even with that treatment. A rare form of autoimmune encephalitis related to NMDA receptor antibody after infection by herpes simplex can be treated with corticosteroid therapy. Arthropod-borne encephalitides, such as West Nile virus encephalitis and Eastern equine encephalitis, are primarily treated with supportive measures. Attempts have been made to use immunoglobulin therapy with limited effects. Progressive multifocal leukoencephalopathy has been treated with...
Source: Neurologic Clinics - November 7, 2020 Category: Neurology Authors: Allen J. Aksamit Source Type: research
Cannabinoids in Neurologic Illnesses
Marijuana has been used to treat medical disease since well before the 1800s. Recently, increased use of cannabinoids, the chemical components of marijuana, have been seen to treat neurologic illness in children and adults. Unfortunately, data are lacking in treating most neurologic illnesses except in the field of epilepsy and pain from spasticity in multiple sclerosis. Therefore, formal conclusions about the potential efficacy, benefit, and adverse effects for most marijuana based products cannot be made at this time. Further research using gold standard scientific methodology should be performed to help address potentia...
Source: Neurologic Clinics - November 7, 2020 Category: Neurology Authors: Anup D. Patel Source Type: research