Neurologic clinics
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Advances in the fields of molecular and translational research, oncology, and surgery have emboldened the medical community to believe that intrinsic brain tumors may be treatable. Intraoperative imaging and brain mapping allow operations adjacent to eloquent cortex and more radical resection of tumors with increased confidence and safety. Despite these advances, the infiltrating edge of a neoplasm and distant microscopic satellite lesions will never be amendable to a surgical cure. Indeed, it is continued research into the delivery of an efficacious chemobiologic agent that will eventually allows us to manage this primary cause of treatment failure.
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This article reviews the usefulness of the electrodiagnostic examination in patients who have suspected cervical and lumbosacral radiculopathy. This study can verify the presence and severity of radiculopathy, determine which levels are involved, and provide an electrodiagnostic correlate to imaging abnormalities. A practical approach for conducting the nerve conduction portion and needle electrode examination in these patients is discussed.
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Surgical intervention for neck pain and low back pain may be of benefit to some patients. It should be considered, however, only in cases where medical management has failed and there is a clearly identifiable anatomic lesion that likely is the pain generator. Indications, preoperative evaluation, and common surgical procedures are reviewed.
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In this article, non-neurologic causes of neck and back pain are reviewed. Musculoskeletal pain generators include muscle, tendon, ligament, intervertebral disc, articular cartilage, and bone. ⋯ Atlantoaxial instability and atlanto-occipital joint pain are additional causes of neck pain. Back pain resulting from vertebral compression fracture, Scheuermann's disease, spondylolysis and spondylolisthesis, pregnancy, Baastrup's disease, sacroiliac joint dysfunction, and sacral stress fracture is discussed.
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The classification of vasculitis and the clinical features of vasculitic neuropathy are reviewed. Vasculitic neuropathy usually presents with painful mononeuropathies or an asymmetric polyneuropathy of acute or subacute onset. ⋯ Steroids and cytotoxic agents have been the mainstay of therapy for most forms of vasculitic neuropathy. Dosing, potential side effects, and management recommendations of conventional therapies are provided.