Seminars in neurology
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The initial management of a patient with suspected stroke necessitates a rapid and focused evaluation. Establishing the time of symptom onset, performing a focused neurologic examination, and interpreting ancillary tests facilitates delivery of acute stroke therapies to eligible patients. ⋯ Results from randomized clinical trials of intravenous thrombolysis, glucose management, and blood pressure management in acute ischemic stroke patients will be highlighted. External ultrasound as an adjunct to intravenous thrombolysis and treatment of those patients that wake up with stroke symptoms will also be discussed.
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The incidence of anticoagulant-associated intracerebral hemorrhage (AAICH) quintupled during the 1990 s, probably due to increased warfarin use for the treatment of atrial fibrillation. Anticoagulant-associated intracerebral hemorrhage now accounts for nearly 20% of all intracranial hemorrhage (ICH). Among patients using warfarin for atrial fibrillation, the annual risk of ICH in trials is 0.3 to 1.0%. ⋯ Recommended methods of warfarin reversal are administration of intravenous vitamin K and either prothrombin complex concentrates or fresh frozen plasma. Reversal of unfractionated heparin is accomplished with intravenous protamine sulfate. Surgical treatment of intracranial hemorrhage may be life saving in select cases, but has not reduced morbidity or mortality in large randomized trials.
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Seminars in neurology · Nov 2010
ReviewTelestrokologists: treating stroke patients here, there, and everywhere with telemedicine.
Telemedicine is the use of electronic communication methods, such as the telephone, the Internet, and videoconferencing, to exchange medical information from one geographic site to another. Telestroke is the use of telemedicine specifically for stroke care. ⋯ A telestrokologist is a strokologist who is proficient with telemedicine tools and techniques necessary for remote stroke practice. In this article, the author discusses how enabling telemedicine technologies facilitate novel healthcare delivery modes for telestrokologists and the stroke patients they treat, here, there, and everywhere.
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The authors discuss the techniques and use of electrodiagnosis to help fully characterize peripheral neuropathies, including electrodiagnostic principles, normal findings, correlations between underlying nerve pathology that leads to abnormal electrodiagnostic findings, and how to detect and interpret electrodiagnostic findings.
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Seminars in neurology · Sep 2010
ReviewNerve conduction pitfalls and pearls in the diagnosis of peripheral neuropathies.
Nerve conduction studies are an integral component of the evaluation of a peripheral neuropathy. While routine in nature, they require attention to detail. This article focuses on operator and machine errors that can affect the correct interpretation of nerve conduction data and the nature of a neuropathy.