CONTINUUM Lifelong Learning in Neurology最新文献_第4页

Traumatic Brain Injury and Traumatic Spinal Cord Injury. 创伤性脑损伤和创伤性脊髓损伤。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-06-01 DOI: 10.1212/CON.0000000000001423

Jamie E Podell, Nicholas A Morris

{"title":"Traumatic Brain Injury and Traumatic Spinal Cord Injury.","authors":"Jamie E Podell, Nicholas A Morris","doi":"10.1212/CON.0000000000001423","DOIUrl":"10.1212/CON.0000000000001423","url":null,"abstract":"Objective: This article reviews the mechanisms of primary traumatic injury to the brain and spinal cord, with an emphasis on grading severity, identifying surgical indications, anticipating complications, and managing secondary injury.Latest developments: Serum biomarkers have emerged for clinical decision making and prognosis after traumatic injury. Cortical spreading depolarization has been identified as a potentially modifiable mechanism of secondary injury after traumatic brain injury. Innovative methods to detect covert consciousness may inform prognosis and enrich future studies of coma recovery. The time-sensitive nature of spinal decompression is being elucidated.Essential points: Proven management strategies for patients with severe neurotrauma in the intensive care unit include surgical decompression when appropriate, the optimization of perfusion, and the anticipation and treatment of complications. Despite validated models, predicting outcomes after traumatic brain injury remains challenging, requiring prognostic humility and a model of shared decision making with surrogate decision makers to establish care goals. Penetrating injuries, especially gunshot wounds, are often devastating and require public health and policy approaches that target prevention.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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List of Abbreviations. 缩写表。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-06-01 DOI: 10.1212/01.CON.0001024616.05589.d1

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Teleneurology and Artificial Intelligence in Clinical Practice. 远程神经学和人工智能在临床实践中的应用。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-06-01 DOI: 10.1212/CON.0000000000001430

Elaine C Jones, Benjamin R Kummer, Jayne R Wilkinson

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Emergent Management of Status Epilepticus. 癫痫状态的紧急处理。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-06-01 DOI: 10.1212/CON.0000000000001445

Clio Rubinos

{"title":"Emergent Management of Status Epilepticus.","authors":"Clio Rubinos","doi":"10.1212/CON.0000000000001445","DOIUrl":"10.1212/CON.0000000000001445","url":null,"abstract":"Objective: Status epilepticus is a neurologic emergency that can be life- threatening. The key to effective management is recognition and prompt initiation of treatment. Management of status epilepticus requires a patient-specific-approach framework, consisting of four axes: (1) semiology, (2) etiology, (3) EEG correlate, and (4) age. This article provides a comprehensive overview of status epilepticus, highlighting the current treatment approaches and strategies for management and control.Latest developments: Administering appropriate doses of antiseizure medication in a timely manner is vital for halting seizure activity. Benzodiazepines are the first-line treatment, as demonstrated by three randomized controlled trials in the hospital and prehospital settings. Benzodiazepines can be administered through IV, intramuscular, rectal, or intranasal routes. If seizures persist, second-line treatments such as phenytoin and fosphenytoin, valproate, or levetiracetam are warranted. The recently published Established Status Epilepticus Treatment Trial found that all three of these drugs are similarly effective in achieving seizure cessation in approximately half of patients. For cases of refractory and super-refractory status epilepticus, IV anesthetics, including ketamine and γ-aminobutyric acid-mediated (GABA-ergic) medications, are necessary. There is an increasing body of evidence supporting the use of ketamine, not only in the early phases of stage 3 status epilepticus but also as a second-line treatment option.Essential points: As with other neurologic emergencies, \"time is brain\" when treating status epilepticus. Antiseizure medication should be initiated quickly to achieve seizure cessation. There is a need to explore newer generations of antiseizure medications and nonpharmacologic modalities to treat status epilepticus.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Neuromuscular Emergencies. 神经肌肉急症

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-06-01 DOI: 10.1212/CON.0000000000001424

Catherine S W Albin

{"title":"Neuromuscular Emergencies.","authors":"Catherine S W Albin","doi":"10.1212/CON.0000000000001424","DOIUrl":"10.1212/CON.0000000000001424","url":null,"abstract":"Objective: This article aims to familiarize the reader with the clinical approach, diagnostic considerations, and treatment strategies for patients presenting with abrupt-onset or acutely worsening weakness due to neuromuscular disorders.Latest developments: Neuromuscular weakness is often the result of an inflammatory process. In recent years, there has been growing recognition of pathologic antibodies that cause neuromuscular injury. This has allowed clinicians to make a more accurate diagnosis. Additionally, neuromuscular junction disorders and myopathies are increasingly identified as the adverse effects of novel anticancer therapies, namely immune checkpoint inhibitors. More data are being incorporated into frameworks for neuroprognostication after neuromuscular emergencies, especially for commonly encountered disorders such as Guillain-Barré syndrome.Essential points: Care of patients with neuromuscular emergencies requires prompt attention to respiratory status. Once supportive measures are in place to protect the airway and facilitate effective ventilation, diagnostic considerations should hinge on appropriate neurologic localization. Aggressive immunosuppression is often required for immune-mediated neuromuscular disorders, and clinicians must be thoughtful in selecting a strategy that best aligns with each patient's risk factors and comorbidities.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Learning Objectives and Core Competencies. 学习目标和核心能力。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-06-01 DOI: 10.1212/CON.0000000000001442

引用次数: 0

Emergent Management of Hypoxic-Ischemic Brain Injury. 缺氧缺血性脑损伤的紧急处理。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-06-01 DOI: 10.1212/CON.0000000000001426

Alexis Steinberg

{"title":"Emergent Management of Hypoxic-Ischemic Brain Injury.","authors":"Alexis Steinberg","doi":"10.1212/CON.0000000000001426","DOIUrl":"10.1212/CON.0000000000001426","url":null,"abstract":"Objective: This article outlines interventions used to improve outcomes for patients with hypoxic-ischemic brain injury after cardiac arrest.Latest developments: Emergent management of patients after cardiac arrest requires prevention and treatment of primary and secondary brain injury. Primary brain injury is minimized by excellent initial resuscitative efforts. Secondary brain injury prevention requires the detection and correction of many pathophysiologic processes that may develop in the hours to days after the initial arrest. Key physiologic parameters important to secondary brain injury prevention include optimization of mean arterial pressure, cerebral perfusion, oxygenation and ventilation, intracranial pressure, temperature, and cortical hyperexcitability. This article outlines recent data regarding the treatment and prevention of secondary brain injury. Different patients likely benefit from different treatment strategies, so an individualized approach to treatment and prevention of secondary brain injury is advisable. Clinicians must use multimodal sources of data to prognosticate outcomes after cardiac arrest while recognizing that all prognostic tools have shortcomings.Essential points: Neurologists should be involved in the postarrest care of patients with hypoxic-ischemic brain injury to improve their outcomes. Postarrest care requires nuanced and patient-centered approaches to the prevention and treatment of primary and secondary brain injury and neuroprognostication.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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The Neurocritical Care Examination and Workup. 神经重症监护检查和评估。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-06-01 DOI: 10.1212/CON.0000000000001438

Sarah Wahlster, Nicholas J Johnson

{"title":"The Neurocritical Care Examination and Workup.","authors":"Sarah Wahlster, Nicholas J Johnson","doi":"10.1212/CON.0000000000001438","DOIUrl":"10.1212/CON.0000000000001438","url":null,"abstract":"Objective: This article provides an overview of the evaluation of patients in neurocritical care settings and a structured approach to recognizing and localizing acute neurologic emergencies, performing a focused examination, and pursuing workup to identify critical findings requiring urgent management.Latest developments: After identifying and stabilizing imminent threats to survival, including respiratory and hemodynamic compromise, the initial differential diagnosis for patients in neurocritical care is built on a focused history and clinical examination, always keeping in mind critical \"must-not-miss\" pathologies. A key priority is to identify processes warranting time-sensitive therapeutic interventions, including signs of elevated intracranial pressure and herniation, acute neurovascular emergencies, clinical or subclinical seizures, infections of the central nervous system, spinal cord compression, and acute neuromuscular respiratory failure. Prompt neuroimaging to identify structural abnormalities should be obtained, complemented by laboratory findings to assess for underlying systemic causes. The indication for EEG and lumbar puncture should be considered early based on clinical suspicion.Essential points: In neurocritical care, the initial evaluation is often fast paced, requiring assessment and management to happen in parallel. History, clinical examination, and workup should be obtained while considering therapeutic implications and the need for lifesaving interventions.","PeriodicalId":52475,"journal":{"name":"CONTINUUM Lifelong Learning in Neurology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141238822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Learning Objectives and Core Competencies. 学习目标和核心能力。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-04-01 DOI: 10.1212/CON.0000000000001406

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Issue Overview. 问题概述。

CONTINUUM Lifelong Learning in Neurology Pub Date : 2024-04-01 DOI: 10.1212/01.CON.0001011740.88650.d1

引用次数: 0