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Neurologic Complications of Cardiac and Aortic Disease
This article discusses neurologic complications that can arise from cardiac and aortic disease and dysfunction. Recent Findings: Advances in the care of patients with cardiac or aortic disease include the use of prolonged cardiac monitoring in cryptogenic stroke and the approval of the use of left atrial appendage closure devices for stroke prevention in patients with atrial fibrillation who are not candidates for anticoagulation. Continuing controversy surrounds patent foramen ovale closure, and new evidence indicates that cognitive impairment following coronary artery bypass grafting surgery may be less common than prev...
Source: CONTINUUM: Lifelong Learning in Neurology - June 1, 2017 Category: Neurology Tags: Review Articles Source Type: research

Hypoxic-Ischemic Encephalopathy and Other Neonatal Encephalopathies
ABSTRACTPURPOSE OF REVIEWNeonatal encephalopathy is the most common condition in neonates encountered by child neurologists. The etiology is most often global hypoxia-ischemia due to failure of cerebral perfusion to the fetus caused by uterine, placental, or umbilical cord compromise prior to or during delivery. Other etiologies of neonatal encephalopathy include ischemic stroke and intracranial hemorrhage, infection, developmental anomalies, and inborn errors of metabolism.RECENT FINDINGSTherapeutic hypothermia is standard of care for the treatment of neonatal encephalopathy presumed to be caused by hypoxia-ischemia. The ...
Source: CONTINUUM: Lifelong Learning in Neurology - February 1, 2018 Category: Neurology Tags: Review Articles Source Type: research

Neurologic Complications in the Pediatric Intensive Care Unit
This article discusses an approach to the recognition and management of seizures, stroke, and cardiac arrest as complications of other critical illnesses in the pediatric intensive care unit.RECENT FINDINGSConvulsive and nonconvulsive seizures occur frequently in children after cardiac arrest or traumatic brain injury and during extracorporeal membrane oxygenation. Seizures may add to neurologic morbidity, and continuous EEG monitoring is needed for up to 24 hours for detection. Hypothermia has not been shown to improve outcome after cardiac arrest in children, but targeted temperature management with controlled normotherm...
Source: CONTINUUM: Lifelong Learning in Neurology - February 1, 2018 Category: Neurology Tags: Review Articles Source Type: research

Apraxia, Neglect, and Agnosia
PURPOSE OF REVIEW In part because of their striking clinical presentations, disorders of higher nervous system function figured prominently in the early history of neurology. These disorders are not merely historical curiosities, however. As apraxia, neglect, and agnosia have important clinical implications, it is important to possess a working knowledge of the conditions and how to identify them. RECENT FINDINGS Apraxia is a disorder of skilled action that is frequently observed in the setting of dominant hemisphere pathology, whether from stroke or neurodegenerative disorders. In contrast to some previous teaching, ...
Source: CONTINUUM: Lifelong Learning in Neurology - June 1, 2018 Category: Neurology Tags: Review Articles Source Type: research

Subarachnoid Hemorrhage
This article reviews the epidemiology, clinical presentation, diagnosis, and management of patients with aneurysmal subarachnoid hemorrhage (SAH). SAH is a type of hemorrhagic stroke and is a neurologic emergency with substantial morbidity and mortality. This article reviews the most common and potentially life-threatening neurologic and medical complications to promote their early recognition and prevent secondary brain injury. RECENT FINDINGS Over the past 30 years, the incidence of SAH has remained stable; yet, likely because of improved care in specialized neurocritical care units, discharge mortality has considerab...
Source: CONTINUUM: Lifelong Learning in Neurology - December 1, 2018 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Cardiac and Pulmonary Disorders and the Nervous System
This article reviews the neurologic complications encountered with cardiac and pulmonary disorders, specifically focusing on endocarditis, cardiac arrest, heart failure, hypercapnia, hypoxia, and cystic fibrosis. As neurologic dysfunction is one of the most frequent complications of these diseases and may even be the presenting symptom, it is important to be familiar with these complications to foster early recognition and intervention. RECENT FINDINGS Advances have been made in the identification of which patients can safely undergo valvular surgery for treatment of infective endocarditis in the setting of stroke, whic...
Source: CONTINUUM: Lifelong Learning in Neurology - June 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

The Mental Status Examination in Patients With Suspected Dementia
This article describes a comprehensive approach to the mental status examination and diagnostic workup of patients suspected of having an emerging neurodegenerative dementia. Key strategies for obtaining a history and bedside examination techniques are highlighted. Recent Findings: Classic descriptions of behavioral neurology syndromes were largely based on clinicopathologic correlations of strategic lesions in stroke patients. While still very important, advances in neuroimaging have expanded our armamentarium of cognitive evaluations to include assessments of findings in nonstroke anatomic distributions of disease. Thes...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2016 Category: Neurology Tags: Review Articles Source Type: research

Discussing Life-sustaining Therapy With Surrogate Decision Makers
This article presents a case, discusses definitions of medical futility, and summarizes recommended steps for mediating conflict regarding potentially inappropriate treatment.
Source: CONTINUUM: Lifelong Learning in Neurology - February 1, 2017 Category: Neurology Tags: Ethical and Medicolegal Issues Source Type: research

Sleep-Disordered Breathing
ABSTRACT: Purpose of Review: Sleep-disordered breathing encompasses a broad spectrum of sleep-related breathing disorders, including obstructive sleep apnea (OSA), central sleep apnea, as well as sleep-related hypoventilation and hypoxemia. Diagnostic criteria have been updated in the International Classification of Sleep Disorders, Third Edition and the American Academy of Sleep Medicine Manual for Scoring Sleep and Associated Events. Neurologic providers should have basic knowledge and skills to identify at-risk patients, as these disorders are associated with substantial morbidity, the treatment of which is largely reve...
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2017 Category: Neurology Tags: Review Articles Source Type: research

The Migraine Aura
This article discusses the basic mechanisms of migraine aura and its clinical significance based upon evidence from human studies and animal models. RECENT FINDINGS Prospective clinical studies have reinforced the understanding that migraine aura is highly variable from one individual to the next as well as from attack to attack in an individual. While migraine with aura clearly has a higher heritability than migraine without aura, population studies have not identified specific genes that underlie this heritability for typical migraine with aura. Imaging studies reveal hypoperfusion associated with migraine aura, altho...
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2018 Category: Neurology Tags: Review Articles Source Type: research

Neurologic Complications of Human Immunodeficiency Virus Infection
This article reviews the presentation, diagnosis, and management of the most common neurologic conditions associated with HIV infection and ART.
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2018 Category: Neurology Tags: Review Articles Source Type: research

Approach to Diplopia
This article provides a foundation for formulating an approach to the patient with diplopia and includes practical examples of developing the differential diagnosis, effectively using confirmatory examination techniques, determining an appropriate diagnostic strategy, and (where applicable) providing effective treatment. RECENT FINDINGS Recent population-based analyses have determined that diplopia is a common presentation in both ambulatory and emergency department settings, with 850,000 such visits occurring annually. For patients presenting to an outpatient facility, diagnoses are rarely serious. However, potentially...
Source: CONTINUUM: Lifelong Learning in Neurology - October 1, 2019 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

A Stroke Watershed
No abstract available
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2020 Category: Neurology Tags: EDITOR’S PREFACE Source Type: research

Cerebral Small Vessel Disease
This article reviews the clinical significance and neuroimaging characteristics of cerebral small vessel disease and the impact on neurologic disease and current and potential therapeutic approaches. RECENT FINDINGS Cerebral small vessel disease is increasingly prevalent and highly heterogeneous in neuroimaging and clinical presentation. Small subcortical infarcts, lacunes, cerebral microbleeds, cortical microinfarcts, and white matter hyperintensity of presumed vascular origin represent the major neuroimaging markers of small vessel disease. Increasing small vessel disease burden is associated with risk of incident str...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Legal Liability Associated With rtPA Administration and Surrogate Decision Makers
This article examines the issues of surrogate decision makers and the physician’s potential legal liability in the context of the administration or nonadministration of recombinant tissue plasminogen activator (rtPA) in a common emergency department scenario.
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2020 Category: Neurology Tags: MEDICOLEGAL ISSUES Source Type: research

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