What's New | Decker

Barbara Dworetzky, MD, Jong Woo Lee, MD, PhD

Brain imaging has made significant progress in recent years and is a cornerstone of diagnosis and characterization of epilepsy.
The diagnosis and management of psychogenic non-epileptic seizures has significantly evolved in recent years.
Current practice is to use the drug as monotherapy. The dose is progressively increased until seizures are controlled or adverse effects develop. If seizure control cannot be achieved without significant adverse effects, the drug is considered a failure, and a second drug is chosen and the process is repeated. If the second drug fails, either a third monotherapy trial or a combination therapy can be attempted.

Brain imaging has made significant progress in recent years and is a cornerstone of diagnosis and characterization of epilepsy.
The diagnosis and management of psychogenic non-epileptic seizures has significantly evolved in recent years.
Current practice is to use the drug as monotherapy. The dose is progressively increased until seizures are controlled or adverse effects develop. If seizure control cannot be achieved without significant adverse effects, the drug is considered a failure, and a second drug is chosen and the process is repeated. If the second drug fails, either a third monotherapy trial or a combination therapy can be attempted.

Brain imaging has made significant progress in recent years and is a cornerstone of diagnosis and characterization of epilepsy.
The diagnosis and management of psychogenic non-epileptic seizures has significantly evolved in recent years.
Current practice is to use the drug as monotherapy. The dose is progressively increased until seizures are controlled or adverse effects develop. If seizure control cannot be achieved without significant adverse effects, the drug is considered a failure, and a second drug is chosen and the process is repeated. If the second drug fails, either a third monotherapy trial or a combination therapy can be attempted.

Computed tomographic angiography (CTA) has the advantage of being noninvasive, but there are very limited data to compare a CTA approach with the current standard diagnostic approach. A methodological review supported CTA in patients presenting within 48 hours of symptoms and with a neurologically intact examination. CTA has not replaced the current approach but has gained more acceptance; its use is center specific and more prevalent in continued management than initial diagnosis. CTA sensitivity decreases with aneurysms less than 4 mm in size and carries the risk of contrast-induced nephropathy, especially if digital subtraction angiography is performed after CTA.
Current data suggest that very short courses of antifibrinolytics may reduce rebleeding without causing ischemia. Rapid diagnosis of SAH and early definitive repair probably remain the best strategy for prevention. Fibrinolytics should be used in consultation with the neurosurgeon and may be most beneficial in instances of delayed definitive repair.
The mortality from aSAH appears to have declined in industrialized nations over the past 25 years. The case-fatality rate for aSAH, although still high worldwide, appears globally to be minimally on the decline despite significant regional differences in reporting of mortality.

Emphasizes bayesian approach to testing and treatment for infectious and noninfectious diarrheal illnesses
Identifies and directs readers to reliable online resources that are kept current by trusted entities (e.g., CDC.gov)
Encourages the use of smartphone and Web-based tools for calculations rather than providing formulae that lead to mistakes
Describes a modern approach to diarrhea in patients with acute exacerbations of chronic conditions, such as HIV, inflammatory bowel disease, and others who may be immunocompromised
Provides modern information on symptomatic treatment of diarrhea (including probiotics and traditional modalities), with special attention to contraindications
Special focus on diarrhea caused by medications and overdoses
Includes a section on natural and human-made disasters, zoonotic infections, and travel medicine that reflects modern practices
Provides guidance on reconciling government guidelines and patient safety when in conflict

CRRT is indicated to correct metabolic or fluid derangements associated with acute renal failure in hemodynamically unstable patients
Continuous venovenous hemofiltration (CVVH) is the most common mode used in surgical intensive care units
The right internal jugular vein is the first choice for CRRT catheter access, followed by the femoral vein and the left jugular vein
Anticoagulation of the CRRT circuit with citrate has been found to be superior in terms of safety, efficacy, and cost compared to heparin
Criteria for terminating CRRT: spontaneous urine output > than 400 mL/day, correction of metabolic derangements, no need for clearance, and stabilization of fluid balance

CRRT is indicated to correct metabolic or fluid derangements associated with acute renal failure in hemodynamically unstable patients
Continuous venovenous hemofiltration (CVVH) is the most common mode used in surgical intensive care units
The right internal jugular vein is the first choice for CRRT catheter access, followed by the femoral vein and the left jugular vein
Anticoagulation of the CRRT circuit with citrate has been found to be superior in terms of safety, efficacy, and cost compared to heparin
Criteria for terminating CRRT: spontaneous urine output > than 400 mL/day, correction of metabolic derangements, no need for clearance, and stabilization of fluid balance

CRRT is indicated to correct metabolic or fluid derangements associated with acute renal failure in hemodynamically unstable patients
Continuous venovenous hemofiltration (CVVH) is the most common mode used in surgical intensive care units
The right internal jugular vein is the first choice for CRRT catheter access, followed by the femoral vein and the left jugular vein
Anticoagulation of the CRRT circuit with citrate has been found to be superior in terms of safety, efficacy, and cost compared to heparin
Criteria for terminating CRRT: spontaneous urine output > than 400 mL/day, correction of metabolic derangements, no need for clearance, and stabilization of fluid balance

Cognitive and Behavioral Neurology