Latest Articles
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Med. Clin. North Am. · Mar 2025
Review Case ReportsTherapeutic Options for Disabling Acute Ischemic Stroke.
Ischemic stroke affects up to 3% of the US population and is the leading cause of disability nationwide. This article outlines the evidence to support the use of intravenous thrombolytic, including tenecteplase, in the setting of acute ischemic stroke, along with thrombectomy for up to 24 hours, even in those patients with a large ischemic core and in those with an acute basilar artery occlusion. A clinical case of a patient with large ischemic core who received thrombectomy is included, along with images.
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Med. Clin. North Am. · Mar 2025
ReviewUrgent Issues in Multiple Sclerosis: A Practical Guide for Non-Neurologists.
This review provides essential knowledge for internists regarding multiple sclerosis (MS). It begins with an overview of the different types of MS, guidance on recognizing early symptoms, and criteria for referral to a neurologist based on commonly used diagnostic standards and epidemiologic data. The authors then summarize the most used disease-modifying therapies, including their side effects, monitoring requirements, and guidelines for inpatient and pre-procedural management. Finally, the authors address the management of common MS-related symptoms that may require the attention of an internist.
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Pain profiles (e.g. pro- and anti-nociceptive) can be developed using quantitative sensory testing (QST) but substantial variability exists. This study describes the variability in temporal summation of pain (TSP) and conditioned pain modulation (CPM) in chronic musculoskeletal pain patients, proposes cut-off values, and explores the association with clinical pain intensity. ⋯ This analysis shows that there is variability when assessing TSP and CPM in both pain-free subjects and patients with chronic pain. A cut-off for determining when a person is pain-sensitive is proposed, and data based on this cut-off approach suggest that significantly more patients with osteoarthritis and fibromyalgia are pain-sensitive (i.e. higher TSP and lower CPM) compared to pain-free subjects. This analysis does not find an association between pain sensitivity and clinical pain.
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Vocal cord disorders present with a variety of symptoms including dysphonia, respiratory symptoms, and stridor. When evaluating symptoms, a complete history and through head, neck, and neurologic examinations are necessary. ⋯ Most masses of the vocal folds are benign and resolve with voice hygiene and speech therapy. Surgery is reserved for persistent symptomatic nodules and cancerous lesions.
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Status epilepticus is a time-sensitive neuro-emergency, linked to poor functional outcomes and higher mortality rates. Prompt diagnosis and treatment are crucial to reduce its morbidity and mortality. ⋯ A standardized treatment protocol should include prompt and adequately dosed first benzodiazepines as line therapy. Treatment approaches for second-line and third-line management continue to evolve as new anti-seizure medications become available.