Entries Tagged as 'Neurologist'
The evaluation and management of bacterial meningitis: current practice and emerging developments.
Neurologist. 2010 May;16(3):143-51
Authors: Lin AL, Safdieh JE
BACKGROUND AND OBJECTIVE: Bacterial meningitis is a serious neurologic illness with significant morbidity and mortality if not recognized and treated promptly and appropriately. The presentation and management are influenced by host factors and the pathogenic organism; the purpose of this review is to highlight those differences and to survey the literature on current practices and emerging developments in evaluation and management. REVIEW SUMMARY: Clinicians must have a high index of suspicion for bacterial meningitis. The classic symptoms of bacterial meningitis are fever, neck stiffness, altered mental status, and headache. Certain patient populations, such as the young and the immunocompromised, may have a blunted presentation, and for these patients, clinicians must have an especially low threshold for obtaining a lumbar puncture. When bacterial meningitis is suspected, antibiotic therapy should be initiated as soon as possible because early treatment is associated with a better outcome. In addition, the use of the corticosteroid dexamethasone has been shown to be helpful as an adjuvant therapy in specific clinical situations. New adjuvant therapies are being developed to lower the high rate of complications that currently occur in patients with bacterial meningitis. CONCLUSIONS: Recent studies have altered the evaluation and management of bacterial meningitis. In addition, they have elucidated the mechanisms through which bacterial meningitis causes complications and have identified new targets for treatment.
PMID: 20445424 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Neurologist
The clinical utility of high resolution magnetic resonance imaging in the diagnosis of giant cell arteritis: a critically appraised topic.
Neurologist. 2008 Sep;14(5):330-5
Authors: Khoury JA, Hoxworth JM, Mazlumzadeh M, Wellik KE, Wingerchuk DM, Demaerschalk BM
BACKGROUND: Giant cell arteritis (GCA) is a relatively common form of systemic vasculitis, known for its predisposition to affect extracranial branches of the carotid artery and associated potential for causing visual loss and stroke. Neurologists need to be vigilant for this disorder, diagnose it early, and institute effective corticosteroid therapy. The differential diagnosis can be broad. Unfortunately, all clinical and laboratory features of GCA are limited by either low sensitivity or low specificity. Temporal artery biopsy remains the gold standard, but it has its own limitations. Noninvasive imaging techniques, like magnetic resonance imaging (MRI), may be capable of detecting the occurrence of GCA. OBJECTIVE: How useful is high resolution MRI as a diagnostic test in establishing the diagnosis of GCA? METHODS: We addressed the question through development of a structured critically appraised topic. Participants included consultant and resident neurologists, clinical epidemiologists, medical librarian, and clinical content experts in the field of neuroradiology, rheumatology, and vascular neurology. Participants started with a clinical scenario and a structured question, devised search strategies, located and compiled the best evidence, performed critical appraisals, synthesized the results, summarized the evidence, provided commentary, and declared bottom-line conclusions. RESULTS: A single study which assessed the diagnostic value of MRI against a reference standard in GCA was appraised. For the MRI, the estimated sensitivity was 81% (95% CI 67-95), specificity was 97% (91-100), positive likelihood ratio (LR) was 26.6 (95% CI 3.8-184.8), negative LR was 0.20 (95% CI 0.10-0.41). The study exhibited several methodological weaknesses which interfered with its validity. CONCLUSIONS: The specificity and positive LR of high resolution MRI are sufficiently high that a positive MRI combined with other clinical and laboratory data consistent with GCA may be useful in diagnosing GCA. Given the relatively low sensitivity of the test, a negative MRI would not be sufficient to rule out the diagnosis of GCA.
PMID: 18784606 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Neurologist
10 questions about acute stroke imaging: CT versus MRI–”the controversy”.
Neurologist. 2009 Mar;15(2):105-7
Authors: Hsia AW
PMID: 19276790 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Neurologist
Atraumatic lumbar puncture needles: after all these years, are we still missing the point?
Neurologist. 2009 Jan;15(1):17-20
Authors: Arendt K, Demaerschalk BM, Wingerchuk DM, Camann W
BACKGROUND: Cutting needles remain the most commonly used needle design for lumbar puncture in the neurology community, although atraumatic (noncutting) needles have become common and popular for anesthesiologists performing spinal anesthesia. REVIEW SUMMARY: The use of atraumatic spinal needles for lumbar puncture has been shown to significantly reduce the incidence of postdural puncture headache compared with cutting needles, without loss of efficacy or ease of use. CONCLUSION: The use of noncutting or pencil-point spinal needles should become the standard for performing diagnostic lumbar puncture.
PMID: 19131853 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Neurologist
Multiple system atrophy.
Neurologist. 2008 Jul;14(4):224-37
Authors: Bhidayasiri R, Ling H
BACKGROUND: It has been almost 4 decades since the descriptions of the 3 parts of multiple system atrophy (MSA) have taken place, characterized clinically by dysautonomia, parkinsonism, and cerebellar dysfunction. The discovery of a distinctive pathologic maker has finally provided the conceptual synthesis of these 3 entities into the universal designation of MSA as a distinct disease process with a complex combination of clinical presentations. Although advances have been made in terms of awareness and knowledge concerning the clinical features and pathophysiology of MSA, it remains challenging for neurologists who treat these patients to differentiate MSA from its mimics as well as providing them with effective treatment. REVIEW SUMMARY: The aim of this review is to provide an overview of the advances in the knowledge of the disease, to highlight typical features useful for the recognition of its entity, and to enlist different treatment options. CONCLUSION: Despite the fact that there is still no treatment modality that can alter the disease progression, a number of useful symptomatic treatment measures are available and should be offered to patients to ameliorate the nonmotor features of MSA and even the motor features that may at least transiently respond to treatment.
PMID: 18617848 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Neurologist
Establishing a diagnosis of benign paroxysmal positional vertigo through the dix-hallpike and side-lying maneuvers: a critically appraised topic.
Neurologist. 2008 May;14(3):201-4
Authors: Halker RB, Barrs DM, Wellik KE, Wingerchuk DM, Demaerschalk BM
BACKGROUND: Many patients consult neurologists because of vertigo. Benign paroxysmal positional vertigo (BBPV) is one of the most common types of vertigo. Although the clinical presentation of this common condition is straightforward, the diagnosis and diagnostic maneuvers can be challenging. OBJECTIVES: How useful is the Dix-Hallpike test in establishing the diagnosis of BPPV? How useful is an alternative positional test, such as the side-lying maneuver, in the diagnosis of BPPV? METHODS: We addressed the question through development of a structured critically appraised topic. Participants included consultant and resident neurologists, clinical epidemiologists, medical librarian, and clinical content expert in the field of otolaryngology. Participants started with a clinical scenario and structured questions, devised search strategies, located and compiled the best evidence, performed critical appraisals, synthesized the results, summarized the evidence, provided commentary, and declared bottom-line conclusions. RESULTS: A single study comparing the Dix-Hallpike and side-lying tests was identified. For the Dix-Hallpike test, the estimated sensitivity was 79% [95% confidence interval (CI) 65-94], specificity was 75% (33-100), positive likelihood ratio (LR) was 3.17 (95% CI 0.58-17.50), negative LR was 0.28 (95% CI 0.11-0.69). For the side-lying test, the estimated sensitivity was 90% (95% CI 79-100), specificity was 75% (33-100), positive LR was 3.59 (95% CI 0.65-19.67), negative LR was 0.14 (95% CI 0.04-0.46). The study employed very weak methodology, and therefore the results had limited validity. CONCLUSIONS: The Dix-Hallpike test is the standard from which the diagnosis of posterior semicircular canal BPPV is made. Hence evaluations of its diagnostic test properties and utility are challenging. For patients unable to move into the Dix-Hallpike test positions, alternative tests such as the side-lying test can be attempted. These modifications, however, are rarely necessary.
PMID: 18469678 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Neurologist
Neurologic complications of hepatitis C.
Neurologist. 2008 May;14(3):151-6
Authors: Acharya JN, Pacheco VH
BACKGROUND: Hepatitis C virus (HCV) infection is a common and chronic disorder with numerous extrahepatic manifestations. We review the neurologic complications in this article. REVIEW SUMMARY: Neurologic complications can involve the peripheral or the central nervous system. The most frequently reported complication is a subacute, distal, symmetric, sensorimotor polyneuropathy in the presence of mixed cryoglobulinemia (MC). HCV infection is the most common cause of MC. In HCV-infected patients without MC, mononeuropathy or mononeuropathy multiplex is more common. Both ischemic and hemorrhagic strokes, probably related to MC and vasculitis, have been described. More recently, transverse myelopathy and cognitive impairment have been linked to HCV infection, but the association is less certain and needs to be confirmed in larger studies. HCV has also been reported as a possible cause of encephalomyelitis in some cases. Although there are no definite treatment guidelines, immunomodulating agents and antiviral therapy are most often used with favorable outcomes. CONCLUSIONS: HCV infection should be considered in the differential diagnosis of a variety of neurologic disorders. Further studies are necessary to establish the full spectrum of the neurologic complications, identify specific pathophysiologic mechanisms, and provide clear guidelines for management.
PMID: 18469672 [PubMed - indexed for MEDLINE]
[Read more →]
Tags: Neurologist
