The Medical clinics of North America
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Med. Clin. North Am. · Mar 2025
ReviewUrgent Issues in Multiple Sclerosis: A Practical Guide for Non-Neurologists.
This review provides essential knowledge for internists regarding multiple sclerosis (MS). It begins with an overview of the different types of MS, guidance on recognizing early symptoms, and criteria for referral to a neurologist based on commonly used diagnostic standards and epidemiologic data. The authors then summarize the most used disease-modifying therapies, including their side effects, monitoring requirements, and guidelines for inpatient and pre-procedural management. Finally, the authors address the management of common MS-related symptoms that may require the attention of an internist.
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Status epilepticus is a time-sensitive neuro-emergency, linked to poor functional outcomes and higher mortality rates. Prompt diagnosis and treatment are crucial to reduce its morbidity and mortality. ⋯ A standardized treatment protocol should include prompt and adequately dosed first benzodiazepines as line therapy. Treatment approaches for second-line and third-line management continue to evolve as new anti-seizure medications become available.
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Med. Clin. North Am. · Mar 2025
Review Case ReportsTherapeutic Options for Disabling Acute Ischemic Stroke.
Ischemic stroke affects up to 3% of the US population and is the leading cause of disability nationwide. This article outlines the evidence to support the use of intravenous thrombolytic, including tenecteplase, in the setting of acute ischemic stroke, along with thrombectomy for up to 24 hours, even in those patients with a large ischemic core and in those with an acute basilar artery occlusion. A clinical case of a patient with large ischemic core who received thrombectomy is included, along with images.
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Med. Clin. North Am. · Mar 2025
ReviewEvaluation and Management of Acute Transient Loss of Consciousness.
Transient loss of consciousness (TLOC) is among the most common complaints encountered by clinicians across specialties. Possible etiologies of acute TLOC can be classified as neurologic, systemic, and functional. ⋯ Functional neurologic disorders (also known as conversion disorders or psychogenic spells) refer to clinical conditions in which clinical presentation can mimic but does not completely fit with any specific neurologic or systemic disorder and conventional diagnostic testing reveals normal neurologic and systemic structures. The focus of this review will be on the diagnostic process and tools to differentiate between the multitudes of causes of TLOC.
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A clinician's goal when encountering acute headaches is to distinguish primary and secondary headache disorders. A comprehensive history, screening for warning signs of secondary headache, and a physical examination can help determine if further workup is necessary. ⋯ Secondary headaches should be treated for their underlying cause. Primary headache disorders have specific evidence-based treatments that can help with acute pain relief.