Abstract：
:Neurologically critically ill patients, more often than others, are unable to communicate and, for a crucial period of time, have the vital functions of their brains hidden in the "black box" of the cranial vault behind a curtain of ambiguity and immobility. Customarily--and naively--we have relied upon beside clinical observations to pierce these barriers. Recent insights lead us to conclude that these "neurochecks" no longer suffice. This article has surveyed four major monitoring systems relied upon by neurointensivists to evaluate the pathophysiology of their patients. Of these, ICPM has the longest clinical track record. It provides a quantitative measure of the brain's capacity to withstand ICP and helps us monitor interventions to reduce it. To utilize this information intelligently requires an understanding of the principles of ICC, CPP, ICP wave morphology, and the hardware available. NICU-CEEG is a more recent introduction but, in principle, it transfers from the laboratory and operating suite to the ICU bedside, established correlations among electrophysiology, CBF, and CM. Digital EEG has allowed us to overcome significant logistical barriers and made NICU-CEEG a practical ICU tool. Early but impressive data suggest that NICU-CEEG has a significant clinical impact in patients with ACI, uncontrolled seizures, or coma. It also has revealed that NICU patients have a surprisingly high incidence of NCS, which may adversely affect their outcome. TCD has contributed greatly to diagnosis and management of SAH vasospasm. It also can be applied with benefit to patients with increased ICP, and has promising value in patients with ACI. It may prove beneficial in monitoring unstable cerebral embolization. Several bedside methods for monitoring CBF are available, but they require refinement to become true monitoring systems. These methods have revealed clinically important insights in patients with head trauma, SAH vasospasm, and ACI. Methods for directly monitoring CM and CMRo2 are improving our understanding of the brain's responses to injury, and becoming increasingly relevant to bedside management. SjvO2 can detect cerebral ischemia caused by overzealous hyperventilation and accelerated ICP. ICO holds promise as a noninvasive transcranial method for assessing Scvo2. We soon may see a scalp array of such detectors, similar to an EEG "montage," that allows us to assess multiregional Scvo2. To be useful, a clinical method should raise questions for further investigation. If the neurophysiologic monitoring systems described here provide us with some answers and lead us to ask useful new questions, they will prove their benefit to our patients.
journal_name
Neurol Clinjournal_title
Neurologic clinicsauthors
Jordan KGsubject
Has Abstractpub_date
1995-08-01 00:00:00pages
579-626issue
3eissn
0733-8619issn
1557-9875journal_volume
13pub_type
杂志文章,评审abstract：:Channelopathies, neuromuscular junction disorders, and myopathies represent multiple mechanisms by which toxins can affect the peripheral nervous system. These toxins include ciguatoxin, tetrodotoxin, botulinum toxin, metabolic poisons, venomous snake bites, and several medications. These toxins are important to be aw...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ncl.2020.07.001
更新日期：2020-11-01 00:00:00
abstract：:CTS is a clinically defined syndrome; however, there is value added by an evidence-based electrodiagnostic approach to (1) efficiently confirm the diagnosis (particularly before invasive interventions), (2) to identify neurogenic mimickers or superimposed processes that may influence the response to treatment, and (3)...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ncl.2011.12.001
更新日期：2012-05-01 00:00:00
abstract：:The calcineurin inhibitors cyclosporine and tacrolimus are used for their immunosuppressive effects. Neurotoxic side effects include tremor, paresthesia, and headache. Rarer neurotoxicities include seizure, posterior reversible encephalopathy syndrome, and encephalopathy. Tacrolimus tends to be more neurotoxic than cy...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ncl.2020.07.009
更新日期：2020-11-01 00:00:00
abstract：:Psychiatric disorders occurring in patients with epilepsy are complications, not an essential part of the illness, and may be prevented or ameliorated. Outlined are risk factors and medical treatment and the need for education concerning epilepsy and for encouragement of the patient by the physician. ...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：
更新日期：1984-02-01 00:00:00
abstract：:Tuberous sclerosis is a multisystem disorder characterized by changes primarily involving the skin, eye, and central nervous system. Although the disease often produces mental retardation and seizures, this is not universal, and some patients with tuberous sclerosis lead a relatively normal life. ...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：
更新日期：1987-08-01 00:00:00
abstract：:Idiopathic intracranial hypertension is a syndrome of increased intracranial pressure of unknown cause that most often occurs in women of childbearing age. Most patients are overweight or obese with a history of recent weight gain. Following a brief review of the symptoms and signs, we discuss the approach to assessme...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ncl.2020.09.008
更新日期：2021-02-01 00:00:00
abstract：:Nerve conduction studies and needle electromyography provide important and complementary information as part of an electrodiagnostic study. Potential technical problems that are encountered during the studies may interfere with accurate and reliable acquisition of information and interpretation of the data. Recognitio...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ncl.2011.12.008
更新日期：2012-05-01 00:00:00
abstract：:Metabolic and mitochondrial myopathies encompass a heterogeneous group of disorders that result in impaired energy production in skeletal muscle. Symptoms of premature muscle fatigue, sometimes leading to myalgia, rhabdomyolysis, and myoglobinuria, typically occur with exercise that would normally depend on the defect...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ncl.2014.05.001
更新日期：2014-08-01 00:00:00
abstract：:Glycogen is a crucial source of energy in the initial stages of muscle activity and during exercise of high intensity. There are 10 well-defined biochemical defects of glycogen metabolism expressed in muscle and affecting the following enzymes: alpha 1,4 glucosidase (glycogenesis type II), debrancher enzyme (III), bra...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：
更新日期：1989-02-01 00:00:00
abstract：:Stroke involving the brainstem and cerebellum frequently presents acute vestibular syndrome. Although vascular vertigo is known to usually accompany other neurologic symptoms and signs, isolated vertigo from small infarcts involving the cerebellum or brainstem has been increasingly recognized. Bedside neuro-otologic e...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ncl.2015.04.006
更新日期：2015-08-01 00:00:00
abstract：:Traumatic brain injury is a common and complex clinical entity that deserves better and continued research on interventions and initial treatment postinjury. Current medical management of traumatic brain injury is articulated on minimizing secondary injury by optimizing cerebral perfusion and oxygenation and preventin...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ncl.2008.02.001
更新日期：2008-05-01 00:00:00
abstract：:Recognizing and treating the cause of pain in the patient with cancer should be the initial approach to the management of this common symptom. Careful analysis of patients with cancer and pain has led to the elucidation of common neurologic pain syndromes unique to this disease process. Pain in patients with cancer is...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：
更新日期：1989-05-01 00:00:00
abstract：:Diagnostic testing is of limited value among patients with migraine who present to an emergency department. Various nonopioid, disease-specific treatments are available for patients who present to an emergency department with migraine headache and associated features. Emergency physicians should recognize that the acu...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ncl.2019.07.005
更新日期：2019-11-01 00:00:00
abstract：:The substantial societal and individual burdens associated with tension-type headache (TTH) constitute a previously overlooked major public health issue. TTH is prevalent, affecting up to 78% of the general population, and 3% suffer from chronic TTH. Pericranial myofascial nociception probably is important for the pat...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ncl.2008.11.010
更新日期：2009-05-01 00:00:00
abstract：:Botulinum toxin therapy has emerged as a treatment modality for a variety of spastic- or contracture-related muscle diseases. Its safety has been proven for long-term use in the treatment of benign essential blepharospasm, hemifacial spasm, and certain types of strabismus. Recent approval from the Federal Drug Adminis...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：
更新日期：1991-02-01 00:00:00
abstract：:Sports-related concussions (SRCs) are common among athletes in the United States. Most athletes who sustain an SRC recover within 7 to 10 days; however, many athletes who sustain the injury do not recover as expected and experience prolonged, persistent symptoms. In this document, the authors provide an overview of th...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ncl.2017.03.008
更新日期：2017-08-01 00:00:00
abstract：:Neurologic emergencies are common among cancer patients and their incidence is increasing as patients live longer as a result of improved antineoplastic therapy. This article reviews acute neurologic complications in cancer patients. Among those complications reviewed are brain metastases, epidural spinal cord compres...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：10.1016/s0733-8619(05)70072-4
更新日期：1998-05-01 00:00:00
abstract：:The natural history of MS is highly variable. There is substantial heterogeneity in the clinical manifestations but, at this point, it is reasonable to consider all idiopathic inflammatory demyelinating diseases of the central nervous system as representing a spectrum of the same disease. In large populations, 20% to ...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：
更新日期：1995-02-01 00:00:00
abstract：:Our recommendations for the evaluation of the patient with suspected cardiogenic syncope are as follows: An initial thorough history and physical examination of the patient will suggest the diagnosis of cardiogenic syncope in at least 50 per cent of patients. A sudden occurrence of syncope, or "drop attack", is most s...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：
更新日期：1986-08-01 00:00:00
abstract：:Disorders of the autonomic and small nerve fibers comprise a wide spectrum of disease states that cross a multitude of clinical specialties.The evaluation of these disorders allows the investigator to determine the presence or absence of abnormalities in the lightly myelinated and unmyelinated nerve fibers with minima...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ncl.2004.03.002
更新日期：2004-08-01 00:00:00
abstract：:Primary brain tumors consist of neoplasms with varied molecular defects, morphologic phenotypes, and clinical outcomes. The genetic and signaling abnormalities involved in tumor initiation and progression of the most prevalent adult primary brain tumors, including gliomas, meningiomas, and medulloblastomas, are descri...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ncl.2007.07.014
更新日期：2007-11-01 00:00:00
abstract：:Psychogenic movement disorders (PMDs) can present with varied phenomenology that may resemble organic movement disorders. The diagnosis is based on clinical evaluation with a supporting history and classic features on neurologic examination. Ancillary testing, such as imaging and neurophysiologic studies, can provide ...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ncl.2014.09.013
更新日期：2015-02-01 00:00:00
abstract：:Mortality and morbidity from kidney disease and the spectrum of renal-associated neurologic disease have changed markedly since the introduction of renal dialysis and with the advent of renal transplantation. This article includes historical studies of the neurologic complications of acute uremia, now fairly uncommon,...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：10.1016/s0733-8619(03)00052-5
更新日期：2002-02-01 00:00:00
abstract：:Different types of conduction defects, avenues available for functional recovery after demyelination, therapeutic and diagnostic measures, and electrophysiologic testing are covered. ...
journal_title：Neurologic clinics
pub_type： 杂志文章
doi：
更新日期：1983-08-01 00:00:00
abstract：:SEPs may be recorded over the spine and scalp to stimulation of any accessible mixed or sensory nerve in the extremities. SEP abnormalities are useful in detecting lesions in central somatosensory pathways. They do not establish a specific diagnosis, but they may suggest or support a diagnosis made on clinical grounds...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：
更新日期：1988-11-01 00:00:00
abstract：:Classifications and definitions are essential to facilitate communication; promote accurate diagnostic criteria; develop, test, and use effective therapies; and specify knowledge gaps. This article describes the development of the International Classification of Vestibular Disorders (ICVD) initiative. It describes its...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ncl.2015.04.010
更新日期：2015-08-01 00:00:00
abstract：:We believe that our present understanding of these syndromes is insufficient to separate CIDP from MMN clearly and consider MMN to be a remarkably multifocal, predominantly motor variant of CIDP with the very unusual electrophysiologic feature of conduction block confined to motor axons. Further studies are clearly ne...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：
更新日期：1992-08-01 00:00:00
abstract：:This article reviews the evidence for comorbidity of migraine with psychiatric disorders, particularly the affective and anxiety disorders. Studies of the association between migraine and depression in both clinical and community studies have provided consistent evidence regarding a substantial degree of comorbidity b...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：10.1016/s0733-8619(05)70298-x
更新日期：1997-02-01 00:00:00
abstract：:Reflex sympathetic dystrophy (RSD) and causalgia appear to reflect identical pictures even though the latter is related to nerve injury and the former is not. Overriding past and present skepticism about a role for the sympathetic system in their cause and treatment, the International Association for the Study of Pain...
journal_title：Neurologic clinics
pub_type： 杂志文章,评审
doi：
更新日期：1995-05-01 00:00:00
abstract：:Communication skills are frequently regarded as innate and intuitive. Many studies, however, now show that most components of communication techniques can be taught and that these learned skills have an impact on the physician's ability to communicate. This article sets out two fundamental protocols that act as templa...
journal_title：Neurologic clinics
pub_type： 杂志文章
doi：10.1016/s0733-8619(05)70057-8
更新日期：2001-11-01 00:00:00
