Neurology Clinical Feature Archive

Critical Illness and the Brain: Managing Risk for Cognitive Adverse Effects

Critical Illness and the Brain: Managing Risk for Cognitive Adverse Effects

The results highlight the importance of evaluating and monitoring cognitive function in individuals with recent critical illness or major infections, especially if they are already at risk for dementia.

New Diagnostic Criteria for Neurosarcoidosis: What You Need to Know

New Diagnostic Criteria for Neurosarcoidosis: What You Need to Know

The new guidelines will facilitate the design and development of clinical trials to test new therapies to minimize the burden of neurologic disability produced by neurosarcoidosis.

Multiple System Atrophy: A Common Form of Atypical Parkinsonism

Multiple System Atrophy: A Common Form of Atypical Parkinsonism

Multiple system atrophy is a rare, progressive neurodegenerative condition for which there is currently no cure.

Pediatric Migraine: Evidence-Based Alternative Management

Pediatric Migraine: Evidence-Based Alternative Management

Recent high-quality clinical trial evidence has demonstrated that medications commonly prescribed for migraine prevention in pediatric patients were not superior to placebo for reducing headache symptoms.

Case Study: Worsening Headache After Giving Birth

Case Study: Worsening Headache After Giving Birth

A 32-year-old woman presents to the emergency department with gradually worsening generalized headache 8 days after giving birth to her second child.

Raising Awareness of Pseudobulbar Affect: Knowing the Signs, Symptoms, and Treatment for Patients With Uncontrollable Laughing or Crying

Raising Awareness of Pseudobulbar Affect: Knowing the Signs, Symptoms, and Treatment for Patients With Uncontrollable Laughing or Crying

Pseudobulbar affect is a significant national health issue in the United States, with approximately 2 million individuals affected.

Weighing the Risks of Deep Brain Stimulation

Weighing the Risks of Deep Brain Stimulation

DBS has been known to generate other movement-related disorders such as dyskinesias, blepharospasm, and hypokinesia.

Hormonal Contraceptives and Migraine: Is It Time to Revisit Stroke Risk?

Hormonal Contraceptives and Migraine: Is It Time to Revisit Stroke Risk?

Current oral contraceptive products contain lower doses of estrogen than those used in the past, prompting reconsideration of risks and benefits.

Obstructive Sleep Apnea in Asthma: Gaining Control by Losing Weight

Obstructive Sleep Apnea in Asthma: Gaining Control by Losing Weight

Poor control of asthma and obstructive sleep apnea can feed off one another, according to Michelle Zeidler, MD, pulmonologist at the University of California, Los Angeles, and director of the UCLA Sleep Fellowship Program.

Managing Pediatric Migraine: Current Therapies and Future Directions

Managing Pediatric Migraine: Current Therapies and Future Directions

Migraine is highly prevalent in children and adolescents, affecting almost 10% of children between 5 and 15 years old and 30% of adolescents between 15 and 19 years old.

Amyotrophic Lateral Sclerosis: Update for the Primary Care Clinician

Amyotrophic Lateral Sclerosis: Update for the Primary Care Clinician

Patients with ALS require multidisciplinary care and rehabilitative interventions; maximizing independent function and quality of life are the goals.

Hans Asperger, Leading Autism Researcher, Tied to Nazi Child Euthanasia Program

Hans Asperger, Leading Autism Researcher, Tied to Nazi Child Euthanasia Program

Medical records of 48 children examined by Asperger show that he specifically called for 12 of the children to be transferred to the Am Spiegelgrund facility, the 'euthanasia' institution founded in 1940.

Case Study: Dizziness in a 42-year-old man

Case Study: Dizziness in a 42-year-old man

A 42-year-old man presents to the emergency department with vertigo that is worse with head motion as well as vomiting, but has no headache or abdominal pain.

Case Study: Headache, neck stiffness, and fever

Case Study: Headache, neck stiffness, and fever

A 55-year-old man with a history of hypertension and migraines is sent by his primary care provider to the emergency department for a spinal tap to rule out meningitis.

Case Study: A subdural hematoma after a fall

Case Study: A subdural hematoma after a fall

A 65-year-old Hispanic man presents to the emergency department via EMS after an unwitnessed fall from a presumed standing height.

Necrotizing myopathy: muscle weakness

Necrotizing myopathy: muscle weakness

Clinicians in all settings are in a position to identify patients with potential myopathic processes and complete an initial diagnostic work-up.

Case Study in Urgent Care: Head injury

Case Study in Urgent Care: Head injury

A 71-year-old man is brought to the emergency department by his family after he tripped and fell in his backyard 30 minutes before presentation.

Regular proton pump inhibitor use associated with an increased risk of dementia in the elderly

Regular proton pump inhibitor use associated with an increased risk of dementia in the elderly

Regular proton pump inhibitor use in the elderly was associated with an increased risk of incident dementia compared with no proton pump inhibitor use, according to researchers.

Cannabis health risks and benefits: a report from NASEM

Cannabis health risks and benefits: a report from NASEM

Cannabis health end points include therapeutic effects, cardiometabolic risk, mental health, respiratory disease, and substance abuse.

Lead poisoning: Current practice guidelines

Lead poisoning: Current practice guidelines

An aging national infrastructure and paint in old homes increase the risk for lead poisoning and significant health-related problems in children and adults.

Unchecked MRI results

Unchecked MRI results

A clinician sends an 18-year-old patient for a same-day MRI but forgets to review the results with the same urgency.

Managing concussion in primary care

Managing concussion in primary care

The incidence of concussion is increasing in children and adults, as is the demand for clinicians who can diagnose and treat both patient groups.

Pesticides and 
Parkinson's disease

Pesticides and 
Parkinson's disease

Increasing evidence has shown a link between pesticide exposure and the risk for Parkinson's disease. How real is this link on the golf course?

Glasgow Coma Scale may underestimate severity of isolated traumatic brain injury in patients aged ≥65 years

Glasgow Coma Scale may underestimate severity of isolated traumatic brain injury in patients aged ≥65 years

Study results suggest that GCS may be less accurate in predicting the extent of injury in elderly adults.

Insomnia—Using 
natural modalities and OTC treatments

Insomnia—Using 
natural modalities and OTC treatments

Insomnia can be treated via nonprescription medications and modalities.

How to distinguish bradykinesia from psychomotor retardation

How to distinguish bradykinesia from psychomotor retardation

If a patient is truly bradykinetic, their blink rate will be decreased.

Integrative and OTC treatment of headache

Integrative and OTC treatment of headache

Headache is one of the most common complaints in outpatient practice. There are 10 things that clinicians need to know to help treat their patients with headache.

Possible traumatic brain injury 
in a veteran

Possible traumatic brain injury 
in a veteran

A nurse practitioner asks about a 21-year-old man who reports that his family is telling him that he is forgetful.

Patient with a history of erratic nighttime episodes

Patient with a history of erratic nighttime episodes

After consulting a neurologist, the nurse practitioner determined a diagnosis of REM sleep behavior disorder.

Clinical prediction rule helps rule out abusive head trauma

Clinical prediction rule helps rule out abusive head trauma

Misdiagnosing abuse can have tragic consequences, as children returned to abusive situations may experience additional abuse or even death.

Insomnia: Using cognitive behavioral therapy in primary care

Insomnia: Using cognitive behavioral therapy in primary care

Cognitive behavioral therapy may have long-term positive effects 
in patients with insomnia who have chronic use of hypnotic drugs.

'Addicted' babies are misclassified

'Addicted' babies are misclassified 


Referring to infants as "addicted" to opiates is clinically incorrect and creates stigma surrounding treatment.

Vertigo, then headache: what is 
the diagnosis?

Vertigo, then headache: what is 
the diagnosis?


A man, aged 56, presented with complaints about episodes of vertigo and disabling headaches.

Adolescent risk-taking: salt and ice challenge

Adolescent risk-taking: salt and ice challenge

Young people might not understand the health consequences of participating in stunts that help them feel like part of the crowd.

B vitamins ineffective in treating cognitive decline

B vitamins ineffective in treating cognitive decline

Most aspects of cognitive function declined during the studies evaluated and vitamin B supplementation reduced circulating homocysteine concentrations, as expected.

Identifying obstructive sleep apnea

Identifying obstructive sleep apnea


Airflow disturbances during sleep need to be recognized and evaluated before harm comes to the patients themselves or those around them.

An understanding of 
substance use disorder

An understanding of 
substance use disorder


Effective treatment requires the recognition of addiction as a brain disease and an understanding of its underlying physiology and pathophysiology.

Severe hemorrhaging after eclampsia and stroke

Severe hemorrhaging after eclampsia and stroke

A family faces a life and death decision when a patient is given a poor prognosis after experiencing a major stroke from eclampsia.

Deciphering a stroke patient's message

Deciphering a stroke patient's message

A patient is visibly frustrated after a stroke results in expressive aphasia.

A lawn-mowing accident requires neurosurgery

A lawn-mowing accident requires neurosurgery

A reluctant, asymptomatic patient visits an ophthalmology clinic for a 'minor' injury at his wife's prompting.

Traumatic brain injury in youth athletes

Traumatic brain injury in youth athletes

Accurate identification, assessment and evaluation of concussions will enable clinicians to determine when it is safe for young athletes to return to competition.

Treatment options for shift work disorder

Treatment options for shift work disorder

Behavioral, nonpharmacologic and pharmacologic interventions are 
available to facilitate restorative sleep and ensure sustained alertness.

Versed a good alternative to Ativan for seizure first responders

Versed a good alternative to Ativan for seizure first responders

IV benzodiazepine is the preferred treatment for prolonged epileptic seizures in the ED, but it can be difficult for first responders to administer.

ADHD Medication Chart

ADHD Medication Chart

A chart of medications available to treat Attention Deficit Hyperactivity Disorder (ADHD).

Testing for closed head injury

Testing for closed head injury

What is a good screening test for evaluation of closed head injury?

Can pediatric neuroenhancement be justified?

Can pediatric neuroenhancement be justified?

Proponents regard neuroenhancements as "study aids," with potentially positive academic benefits. Opponents cite lack of safety and efficacy evidence and serious risks.

Reducing intracranial pressure after head injury

Reducing intracranial pressure after head injury

Does the concentration of hypertonic saline affect intracranial pressure reduction in patients with traumatic brain injury?

Evaluation and treatment of acute cerebral ischemia

Evaluation and treatment of acute cerebral ischemia

To ensure that therapeutic interventions begin in time, providers must be able to recognize the clinical presentation of an acute ischemic stroke.

A collaborative approach to myasthenia gravis

A collaborative approach to myasthenia gravis

This chronic autoimmune disorder is caused by antibodies that block muscle cells from receiving neurotransmitters from the nerve cell.

Rosemary boasts cognitive and anti-inflammatory benefits

Rosemary boasts cognitive and anti-inflammatory benefits

Rosmarinus officinalis is rich in iron, calcium and vitamin B6, and has been credited with improving cognition and memory.

Case Report: High-Dose Methylphenidate for Adult ADHD

Case Report: High-Dose Methylphenidate for Adult ADHD

Long-acting ADHD medications improve adherence and demonstrate efficacy similar to that of immediate-release dose formulations.

Osteoporosis in a patient taking anti-seizure medication

Osteoporosis in a patient taking anti-seizure medication


Are dual-energy x ray absorptiometry scans safe for patients taking anti-seizure medication?

Sudden neurologic symptom onset 
in an adolescent

Sudden neurologic symptom onset 
in an adolescent

Dizziness, photophobia, nausea and 
an unsteady gait develop following a 
routine annual check up.

DHEA: Improves anxiety and depressive symptoms in schizophrenics

DHEA: Improves anxiety and depressive symptoms in schizophrenics

Dehydroepiandrosterone may help ease anxiety and depressive symptoms, and medication-induced extrapyramidal symptoms in schizophrenics.

ADHD & antisocial personality disorder: Minimizing the risks

ADHD & antisocial personality disorder: Minimizing the risks

Around 20% of pediatric patients with ADHD will develop antisocial personality disorder in adulthood.

When is surgical intervention advisable for Parkinson disease?

When is surgical intervention advisable for Parkinson disease?

Is there a window of opportunity when surgical intervention is most successful for patient's with Parkinson disease?

Decreasing secretions following tracheostomy

A patient with a tracheostomy for severe obstructive sleep apnea has not responded to several treatments to decrease secretions from the plastic tube. What's the next step?

Halting migraine in someone with coronary artery disease

What treatment would you recommend for aborting a migraine in a patient with known coronary artery disease?

Confirming suspicions of hepatic encephalopathy

A patient is suspected of having hepatic encephalopathy (HE) attributable to liver failure from alcoholism.

Serotonin syndrome in depressed patients with migraine

How concerned should clinicians be about serotonin syndrome when prescribing a triptan with a selective serotonin reuptake inhibitor (SSRI)?

Is there one pill to treat hypertension and migraine?

A hypertensive patient with migraines experienced undesirable side effects (irritability and weight gain) while taking the nonselective beta-blockers nadolol (Corgard) and propranolol (Inderal).

New strategies against obesity comorbidities

New strategies against obesity comorbidities

Obese adults are at risk for many serious health conditions, including diabetes, coronary heart disease, hypertension, stroke, obstructive sleep apnea (OSA), depression and liver disease.

The effects of two boat trips linger even after coming ashore

The effects of two boat trips linger even after coming ashore

After vacationing on a houseboat, a woman could not stop feeling like she was rocking, especially when walking.

Advice for managing insomnia in patients with dementia

Experts are not certain why reversed sleep-wake cycles occur in patients with dementia, but it may be related to late-day confusion, end-of-day exhaustion and reduced lighting, among other factors.

Acute onset of recent memory loss

Acute onset of recent memory loss

Suddenly unable to remember the year or the president's name, an otherwise healthy man is admitted for observation.

Treatment guidelines for Alzheimer-type dementia

Treatment guidelines for Alzheimer-type dementia

The most common dementia in the elderly, Alzheimer disease places tremendous physical and emotional strain on patient and caregiver alike.

An update on treatments for sleep disorders

An update on treatments for sleep disorders

Insomnia affects the mind as well as the body. Treatment should combine psychological intervention, behavioral change, and possibly drug therapy.

Is a patient in pain or seeking drugs?

How should a clinician treat a patient with recurring migraines, that also has a history of drug seeking behavior?

Can acetylcholinesterase inhibitors help students cram?

The acetylcholinesterase inhibitors have produced excellent results in patients with Alzheimer's disease or dementia, but are they also beneficial for students preparing for exams?

Psuedoseizure dilemma

Clinician seeks advice on handling a patient with dramatic psuedoseizures that are provoked by nontoxic environmental stimuli.

Patient haunted by misdiagnosis

Patient haunted by misdiagnosis

A middle-aged man suffers a devastating stroke when his clinicians fail to pick up on his symptoms.

The role of myofascial trigger points in migraine therapy

What is the relationship between myofascial trigger points and migraine headaches?

Medicinal lullaby

Treatments for elderly patients who have dementia and sleep disorders.

Cognitive behavioral therapy may improve adult ADHD symptoms

Medications are often used for treatment of adults with attention-deficit hyperactivity disorder (ADHD), but many patients remain symptomatic despite treatment with stimulants or other drugs.

Soldier's seizures mistakenly thought to be caused by poisonous powder

Physician assistant evaluation revealed disorder's true source.

Migraine medication concerns

Is it okay to combine promethazine with migraine medications?

Throat pain causes a patient to divulge his lifelong secret

Throat pain causes a patient to divulge his lifelong secret

The man's heretofore unknown neurologic condition calls the original diagnosis into question.

Misuse and abuse of ADHD medication

Misuse and abuse of ADHD medication

When used as prescribed, these drugs are not addictive. However, abuse is on the rise, and clinicians need to be able to identify the signs.

Tai Chi beneficial for fibromyalgia

A randomized trial of 66 patients with fibromyalgia suggests that Tai Chi might be helpful for both pain and sleep disturbance symptoms.

Guide to caring for patients with dementia

Guide to caring for patients with dementia

Given the importance of long-term treatment and management of this population, primary-care clinicians are ideally suited to play a lead role.

Brain injury guidelines

Is loss of consciousness no longer a must for a concussion diagnosis?

An effective natural remedy for migraine and allergies

An effective natural remedy for migraine and allergies

Butterbur, once discouraged because of its potential to cause liver damage, is now widely used in Europe to combat allergic rhinitis, asthma, and migraine.

New drug options for dementia and Parkinson's disease

New drug options for dementia and Parkinson's disease

A thorough understanding of the therapies available to patients with dementia or Parkinson's disease is essential to improving outcomes.

Strategies for patients suffering insomnia

Strategies for patients suffering insomnia

Evaluation and management of chronic insomnia, the most prevalent sleep disorder, may require behavioral as well as pharmacologic therapies.

Does fibromyalgia require sleep testing?

Should all patients with fibromyalgia undergo sleep studies?

New onset of lower extremity weakness after a viral illness

New onset of lower extremity weakness after a viral illness

Upper respiratory infection triggers complications in a healthy college student.

Bell's palsy

Bell's palsy

The most up-to-date evidence on Bell's palsy

Eyes wide open: Update on sleep disorders

Illness, medications, shift work, and other factors may interfere with normal sleep patterns. New techniques can indicate the best treatment.

Restless legs syndrome is too often ignored

It's surprisingly common, yet both patients and clinicians tend to think there's little that can be done. That used to be true — but not anymore.

Memory lapse and sleep disturbance in a depressed alcoholic

Memory lapse and sleep disturbance in a depressed alcoholic

Seeking neurologic treatment for fatigue and headaches, the patient's poor liver function pointed in another direction.

Treating ADHD through diet

Foods with with artificial coloring, flavoring, and preservatives stimulate hyperactivity

Epileptic seizures in older adult patients

Epileptic seizures in older adult patients

The conclusion of this two-part report looks into the management and therapeutic options available to clinicians treating this population.

Epilepsy in the elderly

Epilepsy in the elderly

Seizures in the elderly often mimic other conditions, such as transient ischemic attack or dementia. Don't be fooled into a misdiagnosis.

Tardive dyskinesia

Tardive dyskinesia

The most recent findings on tardive dyskinesia

Lemon balm

Lemon balm, known for its calmative effects, is frequently recommended for patients with insomnia, anxiety, and other nervous system-related conditions.

A man's temporary vision loss leads to an unexpected diagnosis

A man's temporary vision loss leads to an unexpected diagnosis

With no past medical history of note, the sudden onset of his condition necessitated a trip to the emergency department.

Adjunctive treatment for severe epilepsy

Rufinamide is for patients with Lennox-Gastaut syndrome.

New pain drug approved

Progressive symptoms with family ties

Hoarseness and slowed ocular movements were the first signs in a yearlong hunt for a diagnosis.

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