Seminars in Neurology最新文献_第2页

Disparities in Delirium across the Continuum of Care and Associations with Social Determinants of Health. 谵妄在整个护理过程中的差异以及与健康的社会决定因素之间的关联。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-08-29 DOI: 10.1055/s-0044-1788976

Anu Khanna, Malvika Govil, Nohamin Ayele, Altaf Saadi

引用次数: 0

Pharmacologic Treatment Strategies for Delirium in Hospitalized Adults: Past, Present, and Future. 住院成人谵妄的药物治疗策略：过去、现在和未来。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-09-23 DOI: 10.1055/s-0044-1791246

John W Devlin

引用次数: 0

The Framing and Scope of Altered Mental Status and Delirium. 精神状态改变和谵妄的定义和范围。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-11-12 DOI: 10.1055/s-0044-1790198

Catherine S W Albin, Eyal Y Kimchi

引用次数: 0

Altered Mental Status in Cancer. 癌症患者的精神状态改变。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-08-05 DOI: 10.1055/s-0044-1788806

John Y Rhee, Vihang Nakhate, Christy Soares, Zachary Tentor, Jorg Dietrich

{"title":"Altered Mental Status in Cancer.","authors":"John Y Rhee, Vihang Nakhate, Christy Soares, Zachary Tentor, Jorg Dietrich","doi":"10.1055/s-0044-1788806","DOIUrl":"10.1055/s-0044-1788806","url":null,"abstract":"Patients with cancer experience high rates of alterations in mental status. The mechanisms for altered mental status (AMS) in this population are manifold. The cancer itself may cause AMS through direct invasion of the central nervous system or as metastatic leptomeningeal spread. However, cancer patients are also vulnerable to tumor-associated complications such as seizures, cerebral edema, strokes, or cancer treatment-related complications such as infections, direct neural injury from radiation or chemotherapy, edema, or dysregulated autoimmune response from immunotherapies. Both during treatment and as sequelae, patients may suffer neurocognitive complications from chemotherapy and radiation, medications or opportunistic infections, as well as toxic-metabolic, nutritional, and endocrine complications. In this review, we describe a clinical approach to the cancer patient presenting with AMS and discuss the differential drivers of AMS in this patient population. While common etiologies of AMS in noncancer patients (toxic-metabolic or infectious encephalopathy, delirium) are also applicable to cancer patients, we additionally provide a cancer-specific differential diagnosis that warrants special consideration in the cancer patient with AMS.","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"652-669"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894730","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 Pathophysiology and Biomarkers of Delirium. 谵妄的病理生理学和生物标志物。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-12-01 Epub Date: 2024-10-17 DOI: 10.1055/s-0044-1791666

Camryn J Smith, Dasia Hodge, Fiona E Harrison, Shawniqua Williams Roberson

{"title":"The Pathophysiology and Biomarkers of Delirium.","authors":"Camryn J Smith, Dasia Hodge, Fiona E Harrison, Shawniqua Williams Roberson","doi":"10.1055/s-0044-1791666","DOIUrl":"10.1055/s-0044-1791666","url":null,"abstract":"Delirium is a major disturbance in the mental state characterized by fluctuations in arousal, deficits in attention, distorted perception, and disruptions in memory and cognitive processing. Delirium affects approximately 18% to 25% of hospital inpatients, with even higher rates observed during critical illness. To develop therapies to shorten the duration and limit the adverse effects of delirium, it is important to understand the mechanisms underlying its presentation. Neuroimaging modalities such as magnetic resonance imaging (MRI), positron emission tomography, functional MRI, and near-infrared spectroscopy point to global atrophy, white matter changes, and disruptions in cerebral blood flow, oxygenation, metabolism, and connectivity as key correlates of delirium pathogenesis. Electroencephalography demonstrates generalized slowing of normal background activity, with pathologic decreases in variability of oscillatory patterns and disruptions in functional connectivity among specific brain regions. Elevated serum biomarkers of inflammation, including interleukin-6, C-reactive protein, and S100B, suggest a role of dysregulated inflammatory processes and cellular metabolism, particularly in perioperative and sepsis-related delirium. Emerging animal models that can mimic delirium-like clinical states will reveal further insights into delirium pathophysiology. The combination of clinical and basic science methods of exploring delirium shows great promise in elucidating its underlying mechanisms and revealing potential therapeutic targets.","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":"720-731"},"PeriodicalIF":1.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478990","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

A Practical Approach to Diagnosing Peripheral Neuropathies. 诊断周围神经病的实用方法》。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-10-21 DOI: 10.1055/s-0044-1791721

Nuri Jacoby, Yaacov Anziska

引用次数: 0

The Evolving Landscape of Small Fiber Neuropathy. 小纤维神经病不断演变的格局。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-10-21 DOI: 10.1055/s-0044-1791823

Grazia Devigili, Raffaella Lombardi, Giuseppe Lauria, Daniele Cazzato

{"title":"The Evolving Landscape of Small Fiber Neuropathy.","authors":"Grazia Devigili, Raffaella Lombardi, Giuseppe Lauria, Daniele Cazzato","doi":"10.1055/s-0044-1791823","DOIUrl":"https://doi.org/10.1055/s-0044-1791823","url":null,"abstract":"Small fiber neuropathy (SFN) belongs to a heterogeneous group of disorders in which thinly myelinated Aδ and unmyelinated C-fibers are primarily affected, leading to neuropathic pain and autonomic symptoms. SFN can be associated with systemic conditions such as diabetes, autoimmune diseases, exposure to drugs and toxins, and infection, with the list of associated diseases continuing to expand. Variants in the SCN9A, SCN10A, and SCN11A genes encoding Nav 1.7, Nav 1.8, and Nav 1.9 sodium channel subunits, as well as in the TRPA1 gene, have been found in SFN patients, expanding the spectrum of underlying conditions and enhancing our understanding of pathophysiological mechanisms. There is also growing interest in immune-mediated forms that could help identify potentially treatable subgroups. According to international criteria, diagnosis is established through clinical examination, the assessment of intraepidermal nerve fiber density, and/or quantitative sensory testing. Autonomic functional tests allow for a better characterization of dysautonomia in SFN, which can be subclinical. Other tests can support the diagnosis. Currently, the management of SFN prioritizes treating the underlying condition, if identified, within a multidisciplinary approach that combines symptomatic pain therapy, lifestyle changes, and biopsychological interventions. Emerging insights from the molecular characterization of SFN channelopathies hold promise for improving diagnosis, potentially leading to the discovery of new drugs and refining trial designs in the future. This article reviews the clinical presentation, diagnostic workup, and advancing knowledge of associated conditions and interventional management of SFN.","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478989","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 Role of Neuromuscular Ultrasound in the Diagnosis of Peripheral Neuropathy. 神经肌肉超声在诊断周围神经病中的作用。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-10-21 DOI: 10.1055/s-0044-1791577

Nicholas J Miller, James B Meiling, Michael S Cartwright, Francis O Walker

引用次数: 0

Immune-Mediated Neuropathies: Top 10 Clinical Pearls. 免疫介导的神经病：十大临床珍珠。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-10-17 DOI: 10.1055/s-0044-1791579

Elizabeth M Monohan, Thomas H Brannagan

引用次数: 0

Top 10 Clinical Pearls in Paraproteinemic Neuropathies. 副蛋白性神经病的 10 大临床珍珠。

IF 1.8 4区医学

Seminars in Neurology Pub Date : 2024-10-17 DOI: 10.1055/s-0044-1791769

Benjamin Becker, Amro Stino

{"title":"Top 10 Clinical Pearls in Paraproteinemic Neuropathies.","authors":"Benjamin Becker, Amro Stino","doi":"10.1055/s-0044-1791769","DOIUrl":"https://doi.org/10.1055/s-0044-1791769","url":null,"abstract":"Paraproteinemic neuropathies represent an important subset of peripheral neuropathies. Once identified, further evaluation into the paraproteinemic subtype, clinical exam pattern, and electrodiagnostic phenotype helps clarify if the paraproteinemia is coincidental or causal of the neuropathy, as not all paraproteinemias cause neuropathy. Of all paraproteinemias, immunoglobulin M (IgM)-associated peripheral neuropathy, or IgM neuropathy, is of particular importance as half of IgM neuropathies also harbor anti-myelin-associated glycoprotein antibodies, which produce a characteristic demyelinating pattern on nerve conduction testing. Immunoglobulin G and immunoglobulin A paraproteinemias are less strongly associated with peripheral neuropathy, except in the setting of multiple myeloma or osteosclerotic myeloma (POEMS syndrome), which have characteristic systemic features. In multiple myeloma, chemotherapy is more likely to result in neuropathy than the myeloma itself. Finally, the presence of systemic features (e.g., cardiomyopathy, nephropathy, recurrent carpal tunnel syndrome, and autonomic insufficiency) should raise concern for hereditary or acquired light (AL) chain amyloidosis. AL amyloidosis can occur in the setting of any light or heavy chain paraproteinemia. Central to the proper evaluation of paraproteinemic neuropathy is electrodiagnostic testing, which helps delineate axonal versus demyelinating paraproteinemic neuropathy, the latter often misdiagnosed as chronic inflammatory demyelinating polyradiculoneuropathy.","PeriodicalId":49544,"journal":{"name":"Seminars in Neurology","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142478993","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