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Diagnosis and Management of Subarachnoid Hemorrhage
Purpose of Review:: The purpose of this article is to present the epidemiology, clinical presentation, and management of patients with subarachnoid hemorrhage (SAH). SAH is a neurologic emergency that carries high morbidity and mortality. Patients with SAH are at risk for several significant neurologic complications, including hydrocephalus, cerebral edema, delayed cerebral ischemia, rebleeding, seizures, and neuroendocrine abnormalities that lead to impaired body regulation of sodium, water, and glucose. Recent Findings:: The incidence of SAH has remained stable, but mortality of hospitalized patients has significantly de...
Source: CONTINUUM - October 1, 2015 Category: Neurology Tags: Review Articles Source Type: research

Management of Intracranial Pressure
Purpose of Review:: Intracranial pressure (ICP) can be elevated in traumatic brain injury, large artery acute ischemic stroke, intracranial hemorrhage, intracranial neoplasms, and diffuse cerebral disorders such as meningitis, encephalitis, and acute hepatic failure. Raised ICP is also known as intracranial hypertension and is defined as a sustained ICP of greater than 20 mm Hg. Recent Findings:: ICP must be measured through an invasive brain catheter, typically an external ventricular catheter that can drain CSF and measure ICP, or through an intraparenchymal ICP probe. Proper recognition of the clinical signs of elevated...
Source: CONTINUUM - October 1, 2015 Category: Neurology Tags: Review Articles Source Type: research

Management of Hemispheric Infarction and Ischemic Swelling
This article provides an overview of large territory hemispheric infarction, with an emphasis on recent developments and practical issues related to its evaluation, diagnosis, monitoring, and treatment. Swelling after large infarction results in severe morbidity and often death. Early vigilance for the development of swelling is critical to optimize patient outcome. Comprehensive management is highly dependent on a strong multidisciplinary, collaborative approach. Recent Findings:: Several advances in the last decade have led to an increasingly standardized approach to the patient with significant brain swelling after stro...
Source: CONTINUUM - October 1, 2015 Category: Neurology Tags: Review Articles Source Type: research

Retinal and Optic Nerve Ischemia
Purpose of Review:This review focuses on aspects of retinal and optic nerve ischemia that may be encountered by neurologists. Recent Findings:Recent guidelines have emphasized the similarities between cerebral and retinal ischemia in terms of etiologic workup, acute management, and subsequent stroke risk. However, although ischemic optic neuropathies reflect optic nerve ischemia, they result from local small vessel disease and are not associated with a higher risk of cerebral infarction. Their management is therefore very different from acute cerebral ischemia. It is essential to rule out giant cell arteritis in all patien...
Source: CONTINUUM - August 1, 2014 Category: Neurology Tags: Review Articles Source Type: research

Visual Loss Due to Optic Chiasm and Retrochiasmal Visual Pathway Lesions
This article updates current understanding of vision loss localizing to the optic chiasm, including pituitary adenoma, sellar meningiomas, and aneurysms. Important causes of retrochiasmal vision loss, including stroke and posterior reversible encephalopathy syndrome, are also presented. Summary:The optic chiasm and retrochiasmal visual pathways are susceptible to various forms of injury, with resultant patterns of vision loss that can be precisely localized on the basis of clinical and neuroimaging findings. Accurate localization, in association with other clinical features, allows for consideration of relevant differentia...
Source: CONTINUUM - August 1, 2014 Category: Neurology Tags: Review Articles Source Type: research

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