Neurologic clinics
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The trigeminal autonomic cephalalgias (TACs) are a group of primary headache syndromes all marked by headache and associated autonomic features. The TACs include cluster headache, paroxysmal hemicrania, hemicrania continua, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing syndrome. Diagnosis is made after looking at headache frequency, duration, and accompanying symptoms. Each TAC has its own unique treatment modality, which is discussed in depth.
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Vestibular migraine (VM) designates recurrent attacks of vertigo that are caused by migraine. VM presents with attacks of spontaneous or positional vertigo, lasting seconds to days, accompanied by migrainous symptoms. ⋯ In contrast, vestibular testing serves mainly for the exclusion of other diagnoses. Treatment is targeted at the underlying migraine.
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The emergency department (ED) is the entry point into the health care system for many stroke victims. Rapid evaluation, diagnosis and treatment of stroke in the prehospital setting as well as the ED are integral to preventing morbidity and mortality. ⋯ An organized ED approach including implementing stroke care pathways and collaborating with specialized stroke teams in the ED enhance the ability to identify and manage stroke patients effectively. This approach has the potential to improve outcomes on a large scale.
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The endovascular treatment of cerebral aneurysms has been shown to be a safe and effective treatment alternative to surgical management. Technologic advances in coil design, stents, and liquid embolic agents may revolutionize such treatment. ⋯ Therefore, a multidisciplinary approach with combination therapy should be used. As for understanding the natural history of intracranial atherosclerosis disease, it is to be hoped that the results of recently launched and future randomized clinical trials will clarify the role of intracranial percutaneous transluminal angioplasty and stenting.
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The pathophysiology of acute ischemic stroke involves occlusion of a cerebral artery; therefore, cerebral reperfusion is the primary goal of acute treatment. This article discusses established and emerging therapies for acute ischemic stroke. In addition to thrombolysis, acute treatment with antiplatelet agents and other medications and neuroprotection are reviewed. The general medical management of acute ischemic stroke patients is also reviewed.