Approach to Radiculopathy
Semin Neurol 2021; 41: 760-770 DOI: 10.1055/s-0041-1726363Low back pain and neck pain, often with associated radiculopathy, are two of the most common reasons for referral to the outpatient neurology clinic. A thorough clinical evaluation remains paramount in establishing an accurate diagnosis and subsequently an appropriate treatment plan. In this article, we review anatomic considerations for spondylotic radiculopathy; outline the clinical approach for the evaluation of these patients, including discussion of electrodiagnostic and imaging modalities; and address treatment options based on a stratified treatment approach....
Source: Seminars in Neurology - November 26, 2021 Category: Neurology Authors: Mustafa, Rafid Kissoon, Narayan R. Tags: Review Article Source Type: research
Approach to Neuropathic Pain
Semin Neurol 2021; 41: 744-759 DOI: 10.1055/s-0041-1726361Neuropathic pain is a common chief complaint encountered by neurologists and primary care providers. It is caused by disorders involving the somatosensory nervous system. The clinical evaluation of neuropathic pain is challenging and requires a multifaceted systematic approach with an emphasis on a thorough history and physical examination to identify characteristic signs and symptoms. Ancillary laboratory investigations, targeted imaging, and electrodiagnostic studies further help identify underlying etiologies to guide specific treatments. Management of neuropathi...
Source: Seminars in Neurology - November 26, 2021 Category: Neurology Authors: Malhotra, Ashwin Weaver, Joshua Tags: Review Article Source Type: research
Approach to Tremor Disorders
Semin Neurol 2021; 41: 731-743 DOI: 10.1055/s-0041-1726356Tremor disorders are diverse and complex. Historical clues and examination features play a major role in diagnosing these disorders, but diagnosis can be challenging due to phenotypic overlap. Ancillary testing, such as neuroimaging or laboratory testing, is driven by the history and examination, and should be performed particularly when there are other neurological or systemic manifestations. The pathophysiology of tremor is not entirely understood, but likely involves multiple networks along with the cerebello-thalamo-cortical pathways. Treatment options include m...
Source: Seminars in Neurology - November 26, 2021 Category: Neurology Authors: Lee, Andrea Sarva, Harini Tags: Review Article Source Type: research
Approach to the Patient with Gait Disturbance
We present the framework to mirror the outpatient visit with the patient, highlighting (1) important features of the gait history, including the most common gait-related chief complaints and common secondary (medical) causes of gait dysfunction; (2) gait physiology and a systematic approach to the gait examination allowing appropriate characterization of gait phenomenology; (3) an algorithmic approach to ancillary testing for patients with gait dysfunction based on historical and examination features; and (4) definitive and supportive therapies for the management of patients presenting with common neurological disorders of...
Source: Seminars in Neurology - November 26, 2021 Category: Neurology Authors: Tarolli, Christopher G. Lizarraga, Karlo J. Tags: Review Article Source Type: research
Approach to Common Visual Complaints Presenting to the Outpatient Neurologist
Semin Neurol 2021; 41: 699-716 DOI: 10.1055/s-0041-1726362Visual complaints are commonly encountered by the practicing neurologist. We review assessment of vision loss, diplopia, and positive visual phenomena, all of which require a thoughtful evaluation to localize disease and refine management. While many causative entities are unlikely to cause poor visual outcomes, including dry eyes, migraine, and congenital strabismus, others may threaten vision, life, or both, such as posterior communicating artery aneurysms, pituitary apoplexy, or temporal arteritis. A systematic approach to vision loss and diplopia is reviewed alo...
Source: Seminars in Neurology - November 26, 2021 Category: Neurology Authors: Greer, Christine Dinkin, Marc Tags: Review Article Source Type: research
A Neurologist's Practical Approach to Cognitive Impairment
Semin Neurol 2021; 41: 686-698 DOI: 10.1055/s-0041-1726354The global prevalence of dementia is expected to triple by the year 2050. This impending health care crisis has led to new heights of public awareness and general concern regarding cognitive impairment. Subsequently, clinicians are seeing more and more people presenting with cognitive concerns. It is important that clinicians meet these concerns with a strategy promoting accurate diagnoses. We have diagramed and described a practical approach to cognitive impairment. Through an algorithmic approach, we determine the presence and severity of cognitive impairment, sys...
Source: Seminars in Neurology - November 26, 2021 Category: Neurology Authors: Tipton, Philip W. Day, Gregory S. Graff-Radford, Neill Tags: Review Article Source Type: research
Approach to Facial Weakness
Semin Neurol 2021; 41: 673-685 DOI: 10.1055/s-0041-1726358Facial palsy is a common neurologic concern and is the most common cranial neuropathy. The facial nerve contains motor, parasympathetic, and special sensory functions. The most common form of facial palsy is idiopathic (Bell's palsy). A classic presentation requires no further diagnostic measures, and generally improves with a course of corticosteroid and antiviral therapy. If the presentation is atypical, or concerning features are present, additional studies such as brain imaging and cerebrospinal fluid analysis may be indicated. Many conditions may present with f...
Source: Seminars in Neurology - November 26, 2021 Category: Neurology Authors: Wang, Yujie Cruz, Camilo Diaz Stern, Barney J. Tags: Review Article Source Type: research
Approach to Loss of Consciousness: Distinguishing Epileptic Seizures, Psychogenic Nonepileptic Seizures, and Syncope
Semin Neurol 2021; 41: 667-672 DOI: 10.1055/s-0041-1726359Transient loss of consciousness (TLOC) is a common emergent neurological issue, which can be attributed to syncope, epileptic seizures, and psychogenic nonepileptic seizures. The purpose of this article is to outline an approach to diagnosing the most common etiologies of TLOC by focusing on the importance of the history and physical examination, as well as targeted diagnostic tests. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents | Abstract | Full text (Source: S...
Source: Seminars in Neurology - November 26, 2021 Category: Neurology Authors: Ebong, Ima Haghighat, Zahra Bensalem-Owen, Meriem Tags: Review Article Source Type: research
Approach to Limb Weakness
This article provides the clinical pearls needed to identify different patterns of weakness and accurately localize the level of weakness. It offers important pointers that help distinguish among the different etiologies of weakness at each level, as well as various diagnostic approaches and treatments of diseases that lead to limb weakness. The diagnoses discussed are meant to be representative and not exhaustive, as a complete differential for each pattern of weakness is beyond the scope of this article. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJourna...
Source: Seminars in Neurology - November 26, 2021 Category: Neurology Authors: Bhagavan, Sachin M. Ramaswamy, Swathi B. Mehta, Tejas R. Govindarajan, Raghav Tags: Review Article Source Type: research
Approach to Headache
Semin Neurol 2021; 41: 633-643 DOI: 10.1055/s-0041-1726360There is a very high prevalence of headache in both outpatient and inpatient settings, in the United States and worldwide, due to an abundance of possible causes. Having a practical and systematic approach to evaluating and treating headache is, therefore, key to making the correct diagnosis, or possibly overlapping diagnoses. Taking a thorough and methodical headache history is the mainstay for diagnosis of both primary and secondary headache disorders. Evaluation and workup should include a complete neurological examination, consideration of neuroimaging in specif...
Source: Seminars in Neurology - November 26, 2021 Category: Neurology Authors: Bobker, Sarah M. Safdieh, Joseph E. Tags: Review Article Source Type: research
Outpatient Issues in Neurology
Semin Neurol 2021; 41: 632-632 DOI: 10.1055/s-0041-1735894 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents | Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - November 26, 2021 Category: Neurology Authors: Stitt, Derek Safdieh, Joseph E. Tags: Preface Source Type: research
Derek Stitt, MD, and Joseph E. Safdieh, MD
Semin Neurol 2021; 41: 631-631 DOI: 10.1055/s-0041-1735893 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents | Full text (Source: Seminars in Neurology)
Source: Seminars in Neurology - November 26, 2021 Category: Neurology Authors: Greer, David M. Tags: Introduction to the Guest Editors Source Type: research
Neuropalliative Care in the Inpatient Setting
Semin Neurol 2021; 41: 619-630 DOI: 10.1055/s-0041-1731071The palliative care needs of inpatients with neurologic illness are varied, depending on diagnosis, acuity of illness, available treatment options, prognosis, and goals of care. Inpatient neurologists ought to be proficient at providing primary palliative care and effective at determining when palliative care consultants are needed. In the acute setting, palliative care should be integrated with lifesaving treatments using a framework of determining goals of care, thoughtfully prognosticating, and engaging in shared decision-making. This framework remains important ...
Source: Seminars in Neurology - October 7, 2021 Category: Neurology Authors: Goss, Adeline L. Creutzfeldt, Claire J. Tags: Review Article Source Type: research
Neuroprognostication after Cardiac Arrest: Who Recovers? Who Progresses to Brain Death?
Semin Neurol 2021; 41: 606-618 DOI: 10.1055/s-0041-1733789Approximately 15% of deaths in developed nations are due to sudden cardiac arrest, making it the most common cause of death worldwide. Though high-quality cardiopulmonary resuscitation has improved overall survival rates, the majority of survivors remain comatose after return of spontaneous circulation secondary to hypoxic ischemic injury. Since the advent of targeted temperature management, neurologic recovery has improved substantially, but the majority of patients are left with neurologic deficits ranging from minor cognitive impairment to persistent coma. Of tho...
Source: Seminars in Neurology - October 7, 2021 Category: Neurology Authors: Carroll, Elizabeth Lewis, Ariane Tags: Review Article Source Type: research
Neurologic Complications in Patients with Cancer
Semin Neurol 2021; 41: 588-605 DOI: 10.1055/s-0041-1733788Neurologic symptoms are commonly seen in patients with cancer and can be among the most challenging to diagnose and manage. It is often difficult to determine if new neurologic symptoms are secondary to direct effects of a malignant lesion, systemic complications of disease, paraneoplastic disorders, or side effects of cancer treatment itself. However, early diagnosis and treatment of each of these conditions can improve patients' quality of life and long-term functional outcomes. In this review, we describe a systematic approach to the diagnosis of new neurologic s...
Source: Seminars in Neurology - October 7, 2021 Category: Neurology Authors: Holroyd, Kathryn B. Rubin, Daniel B. Vaitkevicius, Henrikas Tags: Review Article Source Type: research
