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Fungal Infections of the Central Nervous System
This article summarizes current knowledge on the epidemiology, clinical presentations, diagnosis, and management of selected fungal infections of the central nervous system (CNS). Key syndromes, differential diagnoses, and therapeutic interventions according to host immune status and exposure are reviewed. Recent Findings:: Advancements in imaging of the brain and spinal cord, and molecular DNA and antigen-based laboratory diagnostics afford improved sensitivity for CNS mycoses. Newer therapeutic strategies may improve outcomes if provided early and host immunosuppression is abrogated. Adjunctive corticosteroid use for dis...
Source: CONTINUUM - December 1, 2015 Category: Neurology Tags: Review Articles Source Type: research

Varicella-Zoster Virus Infections
This article describes the clinical features and laboratory and imaging abnormalities of the protean neurologic disorders produced by varicella-zoster virus (VZV) reactivation. Diseases include not only zoster, but also chronic pain (postherpetic neuralgia), meningoencephalitis and cerebellitis, single or multiple cranial nerve palsies (polyneuritis cranialis), myelopathy (myelitis and spinal cord infarction), and VZV vasculopathy of intracerebral and extracerebral arteries that causes ischemic or hemorrhagic stroke, aneurysm, subarachnoid and intracerebral hemorrhage, arterial ectasia, and dissection. The article addresse...
Source: CONTINUUM - December 1, 2015 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

Rheumatologic Disorders and the Nervous System
This article describes the neurologic manifestations of systemic autoimmune diseases. RECENT FINDINGS Systemic autoimmune diseases can be associated with a wide spectrum of neurologic comorbidities involving the central and peripheral nervous systems. Systemic lupus erythematosus (SLE) can be associated with a number of manifestations predominantly affecting the central nervous system (CNS), whereas peripheral neuropathy is less common. Sjögren syndrome can be associated with peripheral neuropathy in 10% of cases and CNS disease in 2% to 5% of cases. The risk of stroke is increased in SLE, rheumatoid arthritis, tempora...
Source: CONTINUUM: Lifelong Learning in Neurology - June 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Obstructive Sleep Apnea
PURPOSE OF REVIEW Obstructive sleep apnea (OSA) is often overlooked by clinicians; however, undiagnosed OSA can lead to negative outcomes for patients, including patients with underlying neurologic conditions. Clinicians should be aware of what questions to ask, what diagnostic tests to use, and what treatments to consider in patients with OSA. RECENT FINDINGS OSA influences many neurologic conditions, including stroke, epilepsy, headache, and neuromuscular conditions. Treatment of OSA is effective, especially with patient-tailored options, the correct education, and support. SUMMARY OSA is a serious medical condit...
Source: CONTINUUM: Lifelong Learning in Neurology - August 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Neurologic Complications in Patients With Cancer
PURPOSE OF REVIEW Neurologic complications in patients with cancer can significantly impact morbidity and mortality. Although these complications can be seen in patients without cancer as well, the purpose of this review is to highlight how the presentation, etiology, and management of delirium, seizures, cerebrovascular disease, and central nervous system infections may be different in patients with cancer. RECENT FINDINGS Some of the newer anticancer therapies are associated with neurologic complications. Delirium and seizures have been described in patients receiving chimeric antigen receptor (CAR) T-cell the...
Source: CONTINUUM: Lifelong Learning in Neurology - December 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Headache in Women
PURPOSE OF REVIEW Women are greatly overrepresented among patients seeking treatment for symptoms of headache pain in general and migraine in particular. Understanding the presentation of headache in women in relation to hormonal changes both during the menstrual cycle and throughout the life span is essential for appropriate diagnosis and treatment. RECENT FINDINGS Although perimenstrual migraine attacks are generally without aura, the diagnosis of migraine with aura has been added to the headache classification for menstrual migraine to account for women with the diagnosis of migraine with aura who experience ...
Source: CONTINUUM: Lifelong Learning in Neurology - June 1, 2021 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

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