The Medical clinics of North America
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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
ReviewWho Do I Call?: Newer Models of Neurologic Care Delivery in a Resource-Limited Age?
The demand for neurologic consultation has continued to outpace the number of neurologists available to complete in-person evaluations. As a result, different modalities have been employed to address this ever-growing need. Some of these solutions utilize communication between the referring provider and specialist via telephone consultations or electronic consultations, while others continue to utilize face-to-face interactions, either virtually with video visits, or with traditional in-person evaluations. This article outlines some of the advantages and disadvantages of each format while also providing a few examples of questions that may be answered with each type of consult.
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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.
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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.