The Medical clinics of North America
-
Movement disorder urgencies present as an acute-to-subacute-onset primary movement disorder. Emergencies can lead to patient morbidity or mortality if not readily recognized. Many of these presentations have no standard diagnostic criteria or definitive laboratory tests, and thus relying on phenomenology is a clinician's best way to approach these challenging disorders. This section describes the phenomenology, presentation, complications, and management of movement disorder urgencies and emergencies.
-
Concussion falls under mild traumatic brain injury. Discussion of clinical diagnosis, brief mention of pathophysiology, critical appraisal of current science on the topic of concussion is explored and organized into phases throughout the article. Evaluation of patient-based, functional outcomes should help with the conceptual framework to approach patients with a broad constellation of symptoms that can be frustrating and confounding to suffer from, deal with, and ultimately manage. Pitfalls in management across different age groups and current legal precedent are considered, as well as some opening dialogue on pharmacologic options that are commonly used in initial concussion management.
-
Autoimmune encephalitides (AE) constitute a broad group of inflammatory brain disorders characterized by prominent neuropsychiatric symptoms, frequently in association with autoantibodies against neural (neuronal or glial) antigens. The most frequent AE are anti-NMDA receptor encephalitis, acute disseminated encephalomyelitis (associated with MOG antibodies in 60% of patients), and limbic encephalitis (with several immunologic subtypes, anti-LGI1 encephalitis being the most frequent). The first 2 predominantly affect children and young adults, whereas limbic encephalitis usually affects patients older than 50 years. Despite the severity of symptoms, prompt diagnosis and treatment lead to substantial recovery in most patients.
-
Med. Clin. North Am. · Mar 2025
ReviewSecondary Risk Reduction after Transient Ischemic Attack and Minor Stroke.
This article discusses the evolving definitions of transient ischemic attack and minor strokes, highlighting the shared risk factors and the similarities in approach and early management. It emphasizes the importance of early identification and basic workup for these patients, as well as the most effective early antithrombotic therapies to date. The article also emphasizes the significance of controlling risk factors and concludes with a discussion of treatment strategies based on specific stroke etiologies.
-
Med. Clin. North Am. · Mar 2025
ReviewAdvances in Diagnosis and Management of Atypical Demyelinating Diseases.
The last two decades have seen tremendous progress in understanding central nervous system (CNS) demyelinating diseases, heralding an exciting new era for the diagnosis and treatment of patients with a variety of non-multiple sclerosis neuroinflammatory diseases. This article comprehensively reviews atypical CNS demyelinating diseases, beginning with the general approach to CNS demyelination, continuing with suggestions to facilitate the initial evaluation, and followed by a discussion about specific diseases (neuromyelitis optica, myelin oligodendrocyte glycoprotein antibody disease, acute disseminated encephalomyelitis, iatrogenic CNS demyelination, and transverse myelitis). MRI examples of these disorders are provided to illustrate key radiographic findings. The article concludes with recommendations for treatment.