Central nervous system (CNS) infections are uncommon amongst the immunocompetent population. A state of immuno-incompetency increases susceptibility of the CNS to infection. CNS infections incur serious burden on the morbidity and mortality of cancer patients
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare immune-mediated disorder affecting the peripheral nervous system. Typical manifestations include proximal and distal sensory and motor impairment in four limbs, developing over more than eight weeks.
A rare progressive myelinoclastic disorder of CNS affecting younger adulthood (between 7 and 12 years of age) and considered to be the variant of multiple sclerosis.
Parkinson’s disease is a neurodegenerative diseases chronic and progressive functional loss of the neurons resulting in motor and sensory deficits. Adequate nourishment can improve the quality of life. Focusing on diet as a whole has been shown as more beneficial compared to micronutrient management. Nutritional management may improve other neurological disorders
Digital, decentralized, virtual, global clinical trials are the future. Digital transformation of clinical trials will decrease cost, redundancy and improve efficiency.
Anterior cord syndrome is the most common cause of spinal cord infarction. It is an incomplete cord syndrome that involves infarction of anterior 2/3rd of spinal cord.
Quantitative Electroencephalography (qEEG) is the digital analysis of the raw EEG data with the application of mathematical and analytical techniques to characterize the EEG signal.
Absence of collateral function due to hypoplasia or stenosis of collateral arteries may lead to a higher risk of stroke in patients with severe internal carotid artery occlusive disease
Multiple Sclerosis (MS) is an immune-mediated demyelinating inflammatory disease of the central nervous system that can cause loss of function and debilitating effects in different neurological systems.
It is an Autosomal Recessive trait, also known as Progressive Hepatolenticular Degeneration. Liver biopsy is the single most sensitive and accurate investigation for the disease. Males are more likely to develop neuropsychiatric disease, whereas females are more likely to develop acute liver failure due to Wilson's disease.
mHealth also known as the Internet of Things has advanced over the years. Policy for Device Software Functions and Mobile Medical Applications was first issued by FDA in 2013, later on, mHealth Task Force and HIPAA set goals in order to provide care using wireless technology. Many applications approved by FDA and Epilepsy foundation have been introduced to monitor patient symptom diaries and aid clinical trials. Effective delivery of mHealth (telehealth) services will decrease accident & emergency admissions by 15%.
Digital health is an intersection between technology and healthcare that uses computing platforms, connectivity, software, and sensors. With the increased amount of data being produced Artificial Intelligence as a Service and Ecosystem as a service for cAI open doors for the global coalition of AI clinicians, individual hospitals, networking, and training opportunities. WHO, FDA, and NHS have been continuously releasing guidelines to cope with digital health transformation.
Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy caused by the median nerve compression at the wrist level. Early symptoms include pain, numbness, and tingling, mainly in hand. Those symptoms, unfortunately, are often being overlooked by patients and even physicians, resulting in hang hypotrophy in the later stage. Rapid response has been observed in response to short-term oral corticosteroids. Other measures include splinting, local steroid injection, and carpel ligament release surgery.
To provide a better understanding of CTS, this chapter highlights the etiology, clinical features, diagnostic evaluation, management, and prognosis of this condition
20 minutes of artifact-free recording of epileptiform activity that consists of synchronized depolarization and repolarization of thalamic and cortical neurons. 20-electrode placement system along with bipolar and referential montages allows comparison of epileptiform activity on both sides of the brain as well as localization of seizure. Many provocative techniques such as hyperventilation, intermittent photic stimulation, and sleep are used to produce epileptiform waves.
Also known as Weston-Hurst syndrome most commonly affects the cerebrum followed by the cerebellum, brain stem, or spinal cord. As its pathogenesis involves progressive hemorrhagic demyelination of white matter, MRI is considered the diagnostic test of choice to detect any diffuse edema, confluent lesions, or petechial hemorrhage. Failure to provide early treatment will result in a poor prognosis or even death in a few days.
A stroke that occurs along with a migraine headache affects more commonly younger women. Overdose of Ergotamine and dihydroergotamine, high dose Oral contraceptives Pills, propranolol, and serotonergic medications are among the most common precipitating factors. The patient should meet the ICHD criteria for migrainous infarction for the diagnosis.
Retinal vein occlusion is the blockage of one of the main veins of the retina and is one of the commonest retinal vascular occlusive disorders, usually associated with a variable degree of visual loss
Inflammatory disorder in which injury to spinal cord results in rapid onset of neurological symptoms such as weakness, sensory loss and autonomic dysfunction.
Parkinson's Disease is a neurodegenerative disorder that has historically been seen as a motor disorder. However, there are significant non-motor symptoms in almost all of the patients with PD. Including frequent Psychiatric Co-morbidities both in early and late PD
There are three major categories of seizures: 1) Epileptic seizures (ES), 2) Psychogenic Nonepileptic Seizures (PNES), 3) Physiologic nonepileptic events (NEEs). PNES/NESS are can be difficult to distinguish from ES.
Hemiplegic migraine is a rare form of migraine with aura. Hemiplegia in hemiplegic migraine is an aura symptom i.e. patients experience unilateral weakness in addition to the migraine headache attack
Encephalitis is defined as the inflammation of the brain parenchyma. The inflammatory changes can lead to headache, stiffness in neck, sensitivity to light, confusion, seizures and focal neurologic deficits. Viral encephalitis is the most common type of encephalitis and often coexists with viral meningitis.
Sudden, unexpected, non-traumatic, non-drowning, witnessed or unwitnessed death, in any individual who has history of epilepsy, excludes documented status epilepticus and post-mortem examination does not reveal any cause (anatomical or toxicological) of death.
Central Retinal Artery Occlusion (CRAO) is an ophthalmologic emergency that may result in a complete vision loss that is frequently irreversible. It is considered as having a stroke of the eye
Acute disseminated encephalomyelitis (ADEM) Is an immune-mediated demyelinating disease of CNS involving white matter in the brain and spinal cord. Grey matter (basal ganglia, thalamus, and even cortical grey matter) may be involved.
Stroke is defined as “rapidly developed clinical signs of focal (or global) disturbance of cerebral function, lasting more than 24 h or leading to death, with no apparent cause other than of vascular origin”
Symptoms of panic attacks such as flashes, paresthesia, anxiety, fear , derealization and depersonalization presenting in an ictal or interictal period
Facial (nerve) palsy is a neurological condition that is commonly categorized as central or peripheral based on the location of the lesion. Symptoms and signs experienced by the patient help in diagnosing the area of the lesion. In idiopathic facial nerve palsy, the extent of nerve damage determines the outcome. In this chapter, we focus on discussing symptoms to distinguish both types of facial palsy along with management and prognosis of the disease
Acute Parkinsonism (AP) is a relatively uncommon phenomenon in which signs and symptoms evolve over a period of a few hours to weeks. Common causes include structural/vascular abnormalities, infections, psychiatric manifestations, intake of drugs, and autoimmune disorders. This chapter emphasizes the clinical manifestations, pathogenesis, diagnosis, treatment, and prognosis of each etiological factor involved in causing acute parkinsonism.
The most common cause of Parkinsonism is Parkinson's disease (PD), but this is a neurodegenerative process and presents in a chronic manner. In contrast, Secondary Parkinsonism (SP) may present in an acute, subacute, or chronic manner. Factors favoring a diagnosis of SP include sudden onset of symptoms at a young age, rapid progression with atypical findings on examinations as well as poor response to dopamine therapy. This chapter provides great insight into the causes of secondary parkinsonism along with a diagnostic approach and management.
Recurrent migraine significantly impairs the quality of life and the patient's functionality, despite prompt treatment of acute attacks demands prophylactic treatment to be provided to the patients. Medication should be started on a low dose with adequate monitoring for 2-3 months. The safest drug to use in pregnant is metoprolol. This chapter emphasizes prophylactic treatment in migraine patients and also gives insight into preferred drugs to be used
Tension-type headache is characterized as a diffuse, dull pain or tightness around the forehead also called muscle contraction headache or stress headache. ICHD diagnostic criteria should be used to categorize the headache. Chronic tension-type headache at baseline, coexisting migraine disorder, and sleep disorders are associated with poor outcomes. A physician needs proper insight into provoking and preventing factors to best educate the patients.
Cluster headache, also called trigeminal autonomic cephalgia is defined as a sudden onset, extremely painful, unilateral headache with at least one autonomic symptom ipsilateral to the headache. Verapamil, starting dose 240 mg with increments of 80mg is considered to be first-line treatment for this headache.
Classifying the type of status epilepticus is important in determining morbidity and aggressiveness of treatment required. Clinical manifestations vary according to the type of seizure the patient experiences and yet diagnosis is made clinically based on those clinical manifestations. This chapter will help you understand the classification and how to diagnose patient based on clinical features.
Pathology of the spine and meninges covering the spinal cord is termed myelopathy being classified as compressive and non-compressive myelopathy. Workup for acute myelopathy involves a stepwise approach from history taking to the investigations.
The traumatic spinal cord injury often results from a gunshot wound (10.4%), accidental trauma to the head, neck, and back region (31.5%), falling (25.3%), and spinal sports injuries (4.3%) while non-traumatic spinal cord injuries can vary. The main purpose of this chapter is to help you understand the difference between complete and incomplete cord transection and different types of spinal injuries.
Also known as Status Dystonicus is a rare life-threatening movement disorder emergency, characterized by marked exacerbations of dystonia that requires immediate intervention and ICU admission. It usually appears after weeks or months in the patients who have already been diagnosed with Dystonia and initial stabilization measures include intubation, mechanical ventilation, fluid resuscitation, antibiotics, nasogastric or parenteral nutrition, and antipyretics.
A rare hyperkinetic autoimmune movement disorder affecting children results in brief, involuntary, jerky, uncontrollable movements of the face, arms, legs, and trunk muscles. The patient is diagnosed clinically but high blood titers of streptococcal antibodies such as ASO are also helpful in making the diagnosis. The prognosis is good in most cases but the duration of symptoms usually varies between 3-6 weeks.
When patients fail first-line therapy which is a sufficient dose of benzodiazepines and at least one AED as second-line therapy, irrespective of time this is termed refractory status epilepticus. Primary drugs being used for refractory status epilepticus are Midazolam, Propofol, and Ketamine while other interventions include DBS, surgery, VNS, etc. This chapter focuses on the treatment strategies being involved to treat patients with refractory status epilepticus
Whenever a person experiences a headache, the first step involved is to categorize the type of headache by the neurologist. A great majority of headaches arise due to benign conditions. ICHD-3 criteria should be used to recognize the type of headache a patient is experiencing. This chapter will not just give you insight into diagnostic criteria but also the management of each type of headache.
The worldwide incidence of cryptococcal meningitis alone in HIV/AIDS patients was estimated at 223,100 cases per year worldwide. CSF analysis plays a vital role in making diagnoses in patients with fungal meningitis. For Prevention, the immunocompromised individual must take measures as they are more prone to have fungal meningitis.
During cerebral autoregulation, optimal perfusion pressure is maintained by changes in Cerebrovascular resistance. CBF is kept relatively constant through the change in vessel diameter at the CPP range of 40-140 mmHg. It is controlled by means of myogenic, metabolic, and neurogenic factors, and partial pressure of arterial blood gases (CO2 and O2), cerebral metabolism, and the autonomic nervous system are primary determinants of CBF.
Risk of DVT in at-risk medical patients without anticoagulant prophylaxis is10–15%. PE occurs in up to 50% of patients with DVT. While giving prophylaxis of venous thrombosis, a physician needs to know about contraindication and should use Neurocritical Care Society Guideline Recommendation.
Short term (7-10 days) prophylaxis with ASM is recommended for Severe TBI. Prophylactic administration of Anti-Seizure Medications (ASMs) is used as a measure to decrease the risks of post-traumatic seizures and progression into post-traumatic epilepsy (PTE) and most commonly used are Phenytoin or Levetiracetam.
Permanent, irreversible termination of cerebral and brainstem functions including the ability to regulate respiratory activities. American Academy of Neurology has provided criteria to diagnose brain death but most states and hospitals have their own criteria so make sure to use your local criteria if that is available.
The 2017 ILAE classification of seizures, epilepsies, and epilepsy syndromes aims to group seizures according to clinical presentation and its origin in the brain. and epilepsies according to seizure type, age of onset, probability of remission, EEG findings, radiologic findings, and genetics.
Continuous EEG monitoring device with a video camera for at least 24 hours in a conscious patient reflecting cortical synaptic activity. CEEG is most commonly performed in ICU settings in order to monitor critically ill patients. Neuronal activity depends on the blood supply hence it makes EEG monitoring reliable to check for brain ischemia. Automated displays help to interpret raw EEG effectively. Commonly used techniques for these displays are Color density spectral array and Amplitude-integrated EEG.
This chapter will help you understand the concepts of continuous EEG, it’s indications, and utilization in different settings along with the emphasis on the advantages to use this technique.
The classic triad for bacterial meningitis includes Fever, Neck stiffness, and Altered mental status, however, it is present in less than 50% of the patients with bacterial meningitis. Proof of bacteria in CSF by either Gram staining or positive culture is key to the diagnosis of bacterial meningitis. Delayed initiation of antibiotic therapy has been shown to significantly increase mortality and adverse outcomes at 3 months.
CNS vasculitis is classified as Primary angiitis of CNS, Systemic vasculitis involving CNS, Secondary (Secondary CNS vasculitis). Treatment is aggressive for the first 6-8 months and then tapered depending upon the resolution of symptoms. Monitoring of treatment is necessary. MRI should be done after 4-6 weeks of initiation of therapy and afterward done every 3-4 months in the first year of treatment.
The most common cause of Hemiballismus is Stroke and Non-ketotic hyperglycemia being the second most common. Damage in the basal ganglia structures leads to decreased excitatory transmission of the globus pallidus internus (GPi) resulting in disinhibition of the thalamus. This creates an overactivation of the corticospinal and corticobulbar tracts with random firing.
To provide a better understanding of hemiballismus, this chapter highlights the etiology, clinical features, diagnostic evaluation, management, and prognosis of this condition.
Acute seizures are a common complication following spontaneous intracerebral hemorrhage (sICH). The incidence of post ICH seizures rate is estimated to be between 4%-16%. Current guidelines have limited recommendations due to the paucity of data.
Spinal cord originates from brainstem, pass through foramen magnum and continues distally through cervical and thoracic regions of the spinal column before terminating as a tapering structure known as the conus medullaris. Spinal cord ends at the level of L1 or L2 in adults and L3 in children
Spontaneous intracerebral hemorrhage is defined as focal bleeding from the blood vessel into parenchyma of the brain in the absence of trauma or surgery. ICH is a medical emergency requiring immediate treatment. Less common than ischemic stroke but is more serious.
Extravasation of blood into the subarachnoid space between the arachnoid membrane and the pia mater. It is a neurological emergency associated with high morbidity and mortality. It can be due to Trauma (most common) or vascular malformation.
Change in level of consciousness associated with altered cognition and/or perception appearing over hours/days that is not secondary to prior/developing chronic dementia. Encephalopathy results in acute structural brain changes to non-structural, metabolic, toxic, infection related brain dysfunction
Slow extravasation of blood into the subdural space between the dura and arachnoid membranes. Commonly seen neurosurgical condition associated with high morbidity and mortality
Extravasation of blood into the subdural space between the dura and arachnoid membranes. Most common neurosurgical emergency associated with high morbidity and mortality. A potentially life-threatening condition requiring urgent surgical evacuation for good clinical outcomes
Tardive Dysknesia is a movement disorder generally induced by anti-psychotic medications. Antipsychotics are a group of drugs used primarily to treat psychosis, schizophrenia, mania and agitation. Extrapyramidal symptoms, which include acute dystonia, akathisia, pseudoparkinsonism and tardive dyskinesia, are the most common side effects of first-generation antipsychotics, but can also occur with second-generation antipsychotics.
Idiopathic intracranial hypertension (IIH) is also referred to as pseudotumor cerebri. Elevated intracranial pressure with unknown pathogenesis. Syndrome of intracranial hypertension without structural brain or CSF abnormalities and without identifiable cause.
Status epilepticus (SE) is defined as ≥5 minutes of continuous clinical and/or electrographic seizure activity or recurrent seizure activity without recovery (returning to baseline) between seizures
Neuroleptic Malignant Syndrome (NMS) is a life-threatening neurological disorder requiring emergent care. It is associated with the use of antipsychotic agents also called neuroleptics. The incidence rate for NMS in patients taking antipsychotics is 0.02 to 3%
Myasthenia crisis is a complication of myasthenia gravis. It is defined as worsening of myasthenic weakness requiring intubation or noninvasive ventilation. Myasthenia crisis has a mortality rate of 5%
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