Neuro-Ophthalmic Emergencies
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
Neuro-Oncologic Emergencies
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
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 obser...
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
Therapy in Neurology
NEUROLOGIC CLINICS (Source: Neurologic Clinics)
Source: Neurologic Clinics - November 20, 2020 Category: Neurology Authors: Jos é Biller Source Type: research
