Seminars in neurology
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Seminars in neurology · Feb 2011
Review Case ReportsOffice evaluation of spine and limb pain: spondylotic radiculopathy and other nonstructural mimickers.
Low back and neck pain, with or without radiculopathy, are one of the most common reasons for referral to an outpatient neurology practice. Determining appropriate treatment relies on establishing an accurate diagnosis of the etiology of the spine or limb pain. The author reviews structural radiculopathies as a result of diskogenic and spondylotic etiologies with an emphasis on the clinical approach and evaluation of these patients (including imaging and electrodiagnostics), identifying management altering neurogenic mimickers of structural radiculopathies (such as infectious, inflammatory, and neoplastic myeloradiculitis and radiculoplexopathies), and stratifying patients for treatment.
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"Dizziness" is a common presenting symptom to a neurologist in the outpatient setting. Dizziness can occur as a result of a vestibular disorder involving the peripheral or central vestibular pathways or nonvestibular centers as the result of a disorder of balance, proprioceptive input, or autonomic nervous system dysfunction. A careful clinical history and examination along with ancillary testing can usually lead to determination of the underlying disorder and implementation of the appropriate treatment. The authors review the general approach to the "dizzy" patient in an office-based neurology practice, focusing on the clinical diagnostic features that may help to determine the etiology and treatment options for the dizzy patient.
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Seminars in neurology · Nov 2010
ReviewAcute stroke management: endovascular options for treatment.
The management of acute ischemic stroke has advanced greatly over the past 2 decades. New interventions, including intravenous and endovascular treatment strategies, have evolved to recanalize arteries and salvage the ischemic brain. ⋯ The major techniques that have defined the current field of interventional acute stroke management and the relevant past and current data, and ongoing clinical trials on interventional stroke therapy will be reviewed. New issues, such as futile recanalization, and time to microcatheter, will also be discussed.
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Intracranial aneurysms (IAs) are acquired lesions, with a genetic predisposition in selected patients. They are very common in the population, occurring in ~2% of people in the United States. Intracranial aneurysms may present with subarachnoid hemorrhage, the most feared complication of IA, but most commonly they are detected on brain imaging performed for reasons unrelated to the IA. ⋯ This decision is complex and is dependent on numerous factors, including the natural history of the unruptured intracranial aneurysm, in comparison to the risk of unruptured intracranial aneurysm treatment. For those not treated with interventional treatment, repeat imaging at some intermittency may be recommended. In this article, the data regarding the natural history of unruptured intracranial aneurysm and the procedure-associated morbidity and mortality are reviewed, as well as the predictors of hemorrhage, and the likelihood of unruptured intracranial aneurysm growth should conservative management with intermittent repeat imaging be recommended.
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Seminars in neurology · Nov 2010
ReviewAneurysmal subarachnoid hemorrhage: an overview for the practicing neurologist.
Subarachnoid hemorrhage (SAH) accounts for ~5% of strokes, but causes high rates of morbidity and mortality and occurs at a relatively young age. The rupture of an intracranial aneurysm is the leading cause of nontraumatic SAH and will be the subject of this review. Rebleeding remains the most imminent danger until the aneurysm is secured (i.e., excluded from the cerebral circulation). ⋯ Hemodynamic augmentation therapy remains the mainstay of medical treatment, but various agents are being tested as means to prevent or ameliorate vasospasm, including magnesium sulfate, statins, and an endothelin antagonist. Medically refractory vasospasm demands angioplasty of the affected vessel or intraarterial infusion of vasodilators. In this review, the authors provide an overview of the diagnosis and management of aneurysmal SAH with an emphasis on these main topics.