Update in Neurology

Update in Neurology

Martin A. Samuels, MD

From Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.

2004–2005 Series: Update Sessions from ACP's 2004 Annual Session

Rather than focus on a few seminal papers, this Update broadly describes what the field of neurology has achieved, where it is going, and how its accomplishments and direction will affect internists. The Update incorporates an overview of articles on stroke, transient ischemic attack (TIA), and cerebrovascular disease; hypertension; multiple sclerosis; inflammation; infectious diseases; neurocardiogenic syncope; dementia; seizures; language and autism; myelopathies; Hashimoto encephalopathy; intracranial hypotension or headache; back and neck pain; restless legs syndrome; and drugs and toxins. The summaries are adapted from those in Journal Watch Neurology, with permission from the Massachusetts Medical Society.

Stroke, TIA, and Cerebrovascular Disease

Redefining Transient Ischemic Attacks

Easton JD, Albers GW, Caplan LR, et al. Discussion: Reconsideration of TIA terminology and definitions. Neurology. 2004;62:S29-34. [PMID: 15111655]

Most physicians learned that a TIA was a neurologic deficit that began rapidly, disappeared within 24 hours, was located in a vascular territory, and was caused by underlying cerebrovascular disease. We have now learned, by using diffusion-weighted magnetic resonance imaging (MRI), that many spells that were formerly called TIAs are actually strokes. Most true TIAs (that is, not strokes) last less than 15 minutes. The diagnosis of a TIA now requires a negative diffusion-weighted MRI scan. Fortunately for the many physicians and patients who live in areas where MRI is not immediately accessible, distinguishing TIA from stroke has little practical clinical significance.

Encephalopathy Was More Common than Stroke after Bypass Surgery

McKhann GM, Grega MA, Borowicz LM Jr, et al. Encephalopathy and stroke after coronary artery bypass grafting: incidence, consequences, and prediction. Arch Neurol. 2002;59:1422-8. [PMID: 12223028]

Technical advances have made coronary artery bypass grafting almost routine. The most important remaining serious morbidity is neurologic. McKhann and colleagues examined 2711 patients who underwent cardiac surgery by using neuropsychological testing and clinical examinations and found that encephalopathy (defined as an abnormality in the level of consciousness, such as confusion, delirium, and alternation in thinking) was about twice as common as stroke (6.9% of the patients had encephalopathy and 2.7% had a stroke). Images of the brains of patients with no focal deficit after coronary artery bypass grafting showed that almost …

[Full Text of this Article]