Seminars in Neurology最新文献

Altered Mental Status in the Solid-Organ Transplant Recipient. 实体器官移植受者的精神状态改变

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-08-24 DOI: 10.1055/s-0044-1789004

Nicolas Weiss, Henning Pflugrad, Prem Kandiah

{"title":"Altered Mental Status in the Solid-Organ Transplant Recipient.","authors":"Nicolas Weiss, Henning Pflugrad, Prem Kandiah","doi":"10.1055/s-0044-1789004","DOIUrl":"10.1055/s-0044-1789004","url":null,"abstract":"Patients undergoing solid-organ transplantation (SOT) face a tumultuous journey. Prior to transplant, their medical course is characterized by organ dysfunction, diminished quality of life, and reliance on organ support, all of which are endured in hopes of reaching the haven of organ transplantation. Peritransplant altered mental status may indicate neurologic insults acquired during transplant and may have long-lasting consequences. Even years after transplant, these patients are at heightened risk for neurologic dysfunction from a myriad of metabolic, toxic, and infectious causes. This review provides a comprehensive examination of causes, diagnostic approaches, neuroimaging findings, and management strategies for altered mental status in SOT recipients. Given their complexity and the numerous etiologies for neurologic dysfunction, liver transplant patients are a chief focus in this review; however, we also review lesser-known contributors to neurological injury across various transplant types. From hepatic encephalopathy to cerebral edema, seizures, and infections, this review highlights the importance of recognizing and managing pre- and posttransplant neurological complications to optimize patient outcomes.","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"670-694"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Relationship between Delirium and Dementia. 谵妄与痴呆之间的关系。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-10-11 DOI: 10.1055/s-0044-1791543

Mfon E Umoh, Dennis Fitzgerald, Sarinnapha M Vasunilashorn, Esther S Oh, Tamara G Fong

引用次数: 0

Catherine S.W. Albin, MD, and Eyal Y. Kimchi, MD, PhD. 凯瑟琳-阿尔宾（Catherine S.W. Albin）医学博士和埃亚尔-基姆奇（Eyal Y. Kimchi）医学博士。Kimchi, MD, PhD.

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-11-12 DOI: 10.1055/s-0044-1790197

David M Greer

引用次数: 0

Altered Mental Status and Delirium in Pediatric Patients. 儿科患者的精神状态改变和谵妄。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-09-30 DOI: 10.1055/s-0044-1791227

Ewa D Bieber, Heidi A B Smith, D Catherine Fuchs, Maalobeeka Gangopadhyay

引用次数: 0

Diagnostic Approach to the Patient with Altered Mental Status. 精神状态改变患者的诊断方法。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-10-01 DOI: 10.1055/s-0044-1791245

Ori J Lieberman, Aaron L Berkowitz

引用次数: 0

Psychiatric Etiologies and Approaches in Altered Mental Status Presentations: Insights from Consultation Liaison Psychiatry. 精神状态改变的精神病病因和治疗方法：来自会诊联络精神病学的见解。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-10-03 DOI: 10.1055/s-0044-1791226

Brandon Hamm, Lisa J Rosenthal

{"title":"Psychiatric Etiologies and Approaches in Altered Mental Status Presentations: Insights from Consultation Liaison Psychiatry.","authors":"Brandon Hamm, Lisa J Rosenthal","doi":"10.1055/s-0044-1791226","DOIUrl":"10.1055/s-0044-1791226","url":null,"abstract":"Consultation liaison psychiatrists are frequently asked to evaluate patients with altered mental status (AMS). Psychiatrists have unique perspectives and approaches to care for confused patients, particularly optimizing facilitation of care and maintaining vigilance for diagnostic overshadowing. Psychiatrists also offer expertise in primary psychiatric illnesses that can overlap with AMS, and the most common etiology of AMS is delirium. In this article, we provide a consultation liaison psychiatrist perspective on AMS and related psychiatric conditions in addition to delirium. Manic and psychotic episodes have primary and secondary etiologies, with some symptoms that can overlap with delirium. Catatonia, neuroleptic malignant syndrome, and serotonin syndrome are potentially fatal emergencies, and require prompt index of suspicion to optimize clinical outcomes. Trauma sequelae, functional neurologic disorders, and dissociative disorders can present as puzzling cases that require psychiatric facilitation of care. Additionally, AMS is sometimes due to substance intoxication and withdrawal in the hospital. A nonstigmatizing approach to evaluation and management of delirium and AMS can ensure optimal patient care experiences and outcomes.","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"606-620"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Approach to Altered Mental Status in the Intensive Care Unit. 在重症监护室中处理精神状态改变的方法。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-08-13 DOI: 10.1055/s-0044-1788894

Catherine S W Albin, Cheston B Cunha, Timlin P Glaser, Micaela Schachter, Jerry W Snow, Brandon Oto

{"title":"The Approach to Altered Mental Status in the Intensive Care Unit.","authors":"Catherine S W Albin, Cheston B Cunha, Timlin P Glaser, Micaela Schachter, Jerry W Snow, Brandon Oto","doi":"10.1055/s-0044-1788894","DOIUrl":"10.1055/s-0044-1788894","url":null,"abstract":"Altered mental status (AMS) is a syndrome posing substantial burden to patients in the intensive care unit (ICU) in both prevalence and intensity. Unfortunately, ICU patients are often diagnosed merely with syndromic labels, particularly the duo of toxic-metabolic encephalopathy (TME) and delirium. Before applying a nonspecific diagnostic label, every patient with AMS should be evaluated for specific, treatable diseases affecting the central nervous system. This review offers a structured approach to increase the probability of identifying specific causal etiologies of AMS in the critically ill. We provide tips for bedside assessment in the challenging ICU environment and review the role and yield of common neurodiagnostic procedures, including specialized bedside modalities of diagnostic utility in unstable patients. We briefly review two common etiologies of TME (uremic and septic encephalopathies), and then review a selection of high-yield toxicologic, neurologic, and infectious causes of AMS in the ICU, with an emphasis on those that require deliberate consideration as they elude routine screening. The final section lays out an approach to the various etiologies of AMS in the critically ill.","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"634-651"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Approach to Altered Mental Status in Pregnancy and Postpartum. 妊娠期和产后精神状态改变的处理方法。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-08-16 DOI: 10.1055/s-0044-1788977

Adam J Kroopnick, Eliza C Miller

{"title":"Approach to Altered Mental Status in Pregnancy and Postpartum.","authors":"Adam J Kroopnick, Eliza C Miller","doi":"10.1055/s-0044-1788977","DOIUrl":"10.1055/s-0044-1788977","url":null,"abstract":"The evaluation and diagnosis of altered mental status in the pregnant or postpartum patient largely parallels the approach used for any other patient; however, there are several critical differences including that some neuroobstetric diagnoses require emergent delivery of the fetus. Being familiar with the physiological changes and medical complications of pregnancy and delivery is therefore essential. This review first addresses pregnancy-specific disorders that may result in altered mental status, such as the hypertensive disorders of pregnancy and pregnancy-related metabolic and endocrinopathies. The focus then shifts to the complex physiologic changes in pregnancy and how these changes contribute to the distinct epidemiology of pregnancy-related cerebrovascular complications like intracranial hemorrhage, ischemic stroke, and reversible cerebral vasoconstriction syndrome. Medical disorders that are not unique to pregnancy, such as infections and autoimmune conditions, may present de novo or worsen during pregnancy and the peripartum period and require a thoughtful approach to diagnosis and management. Finally, the unique nervous system complications of obstetric anesthesia are explored. In each section, there is a focus not only on diagnosis and syndrome recognition but also on the emergent treatment needed to reverse these complications, bearing in mind the unique physiology of the pregnant patient.","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"695-706"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141996770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Nonpharmacological Prevention and Management of Delirium: Past, Present, and Future. 谵妄的非药物预防和管理：过去、现在和未来。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-10-22 DOI: 10.1055/s-0044-1791696

Sophia L Ryan

{"title":"Nonpharmacological Prevention and Management of Delirium: Past, Present, and Future.","authors":"Sophia L Ryan","doi":"10.1055/s-0044-1791696","DOIUrl":"10.1055/s-0044-1791696","url":null,"abstract":"Delirium has been recognized, documented, and examined for centuries. In 500 BC Hippocrates described hyper- and hypoactive forms of delirium. As medicine, surgery, and critical care have accelerated over the last century, so too has our understanding of delirium and its profound risks to patients, families, and health care teams. It has also been increasingly understood that it is the accumulation of risk factors that ultimately precipitates delirium and nonpharmacological interventions to reduce these risks remain the cornerstone of delirium prevention and management. However, over the last three decades, these nonpharmacological strategies have moved from a single-component approach to a multicomponent approach, targeting multiple risk factors. Additionally, our understanding of what constitutes a risk factor for delirium has evolved, and in particular, it has been recognized that delirium can sometimes be a byproduct of our interventions and health care systems. In the surgical setting, for example, optimization of risk factors prior to surgery, when possible, is now seen as a key way to prevent postoperative delirium. Similarly, critical care medicine now operates with the appreciation of the profound risk to patients of prolonged mechanical ventilation, sedation, and immobilization and seeks to minimize each to reduce the risk of delirium, among other negative effects. The future of delirium prevention and management lies in both better implementation of best practices that have been defined over the last three decades as well as taking more of a whole patient view. This includes harnessing the electronic medical record, artificial intelligence, and so on to risk assess and individualize care for each patient; restructuring care to reduce deliriogenic practices and care environments; redefining what usual care looks like (e.g., utilizing music and involving loved ones, etc.); policy changes to change systematic priorities. In this paper, we will explore the past, present, and future of nonpharmacological prevention and management of delirium across care settings.","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"777-787"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Altered Mental Status at the Extreme: Behavioral Evaluation of Disorders of Consciousness. 极端精神状态改变：意识障碍的行为评估。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-08-05 DOI: 10.1055/s-0044-1788807

Neha Dhadwal, Kyle Cunningham, William Pino, Stephen Hampton, David Fischer

引用次数: 0