Neurologic clinics
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Epidemiologic trends causing infections of the nervous system remain a significant source of morbidity and mortality one half-century after the introduction of penicillin. This article outlines common causes of bacterial meningitis, aseptic meningitis syndrome, encephalitis, abscess, spinal cord syndromes, and cranial and peripheral nerve problems. ⋯ The protean manifestations of varicella-zoster virus and Lyme diseases are outlined. In addition, special considerations in the immunocompromised host, including organ transplant recipients, cancer patients, and HIV-positive persons are explained, and antimicrobial therapy is discussed.
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This article discusses the assessment and management of rapidly progressive weakness due to neuromuscular disorders. The authors review elements helpful in determining the causes of weakness including pertinent history and laboratory studies. ⋯ In addition, respiratory function assessment is reviewed. The latter part of this article is devoted to evaluation and management of two of the most common disorders, Guillain-Barré syndrome and myasthenia gravis.
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Neurologic emergencies are common among cancer patients and their incidence is increasing as patients live longer as a result of improved antineoplastic therapy. This article reviews acute neurologic complications in cancer patients. Among those complications reviewed are brain metastases, epidural spinal cord compression, leptomeningeal metastases, cerebrovascular disorders, complications of antineoplastic therapy, and paraneoplastic syndromes.
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Coma and confusion signal a failure of brain function with many possible causes. Since many of the potential causes may quickly lead to death or severe disability, it is important to develop a focused and ordered approach to facilitate the rapid diagnosis and early institution of proper therapies. This requires an understanding of the localizing features of the neurologic examination and of the syndromes likely to cause coma and confusion, a predetermined plan for empiric therapies in certain cases of doubt when diagnostic confirmation will be delayed, and a careful consideration of cases when the diagnosis is not revealed by the initial neuroimaging, lumbar puncture, or EEG.
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There is often a fine line between medical malpractice and maloccurrance. Physicians need to develop techniques and skills that enhance the patient-physician relationship based on honesty and informed consent. ⋯ Failure to follow programs which maintain the integrity of patients' records often has negative consequences. The cases discussed illustrate areas in which the neurologist has come into conflict with the legal system.