Continuum : lifelong learning in neurology
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Epilepsy emergencies include acute repetitive seizures and status epilepticus. Their prognosis depends on the etiology of the seizures and the time spent in status epilepticus. This review discusses the current perspective on the diagnosis and treatment of status epilepticus and acute repetitive seizures in the intensive care unit. ⋯ Acute repetitive seizures and status epilepticus are neurologic emergencies that are being increasingly diagnosed and treated in the modern era. Rapid treatment may influence patient prognosis, future cognitive outcomes, and the long-term potential for developing epilepsy. However, little is known about the mechanisms that perpetuate seizure activity, and our ability to intervene and prevent this condition remains limited. Preventing complications during the treatment of status epilepticus plays a large role in prognosis and the chance of treatment success.
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This article reviews the etiology, clinical manifestations, diagnosis, and treatment of neurosyphilis, with a focus on issues of particular relevance to neurologists. ⋯ The diagnosis of neurosyphilis can be challenging. A sound understanding of the clinical manifestations and the strengths and limitations of diagnostic tests are essential tools for the neurologist.
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Although Ebola virus disease and other hemorrhagic fevers are not generally considered infectious diseases of the nervous system, neurologists may be asked to participate in the management of patients with these and other dangerous communicable illnesses, including possible bioterrorism agents. It is essential for all health professionals to understand the public health, legal, and ethical frameworks behind autonomy-limiting interventions such as quarantine and isolation. ⋯ They are often disproportionately affected by the illnesses themselves as well as by the public health interventions intended to prevent spread. The global health crisis caused by the spread of Ebola virus disease has been instructional for examining these ethical issues.
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Status epilepticus, which is simultaneously a neurologic and systemic emergency, often results in significant disability and may be fatal. This article presents a pragmatic approach to the evaluation and management of status epilepticus in adults for the practicing clinician. ⋯ This article reviews the guidelines and up-to-date information on the use of both pharmacologic and nonpharmacologic therapies in status epilepticus and discusses the shifts in our understanding of the balance between the need for aggressive control of seizures and the risks of treatment. This article also presents a suggested approach to the evaluation and management of common types of status epilepticus and explores future directions.
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Continuum (Minneap Minn) · Oct 2015
Evaluating the Potential for Recovery of Consciousness in the Intensive Care Unit.
Evaluating patients in the intensive care unit (ICU) with disorders of consciousness has prognostic implications. When brainstem functions are intact, the neurologist must use ancillary testing to help determine prognosis. This article addresses the challenges of arriving at prognoses in patients with hypoxic-ischemic encephalopathy and traumatic brain injury (TBI) and discusses strategies for dealing with these challenges. This has some relevance to other conditions that are capable of causing irreversible brain damage. ⋯ To arrive at a more accurate prognosis, it is best to employ multiple pieces of evidence and incorporate the most updated information from the literature. In some cases, newer technologies can provide further insights into cortical function in behaviorally unresponsive patients.