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Spinal Cord Trauma

Spinal cord injury (SCI) is a major problem in today’s clinical practice. It is a condition presently handled by a multidisciplinary team of neurologists, neurosurgeons, neurointensivists, physiatrists, anesthesiologists, and trauma surgeons. Even though newer diagnostic techniques and our growing understanding of the pathophysiology and management of SCIs enable us to treat these patients more effectively, traumatic insult to the spinal cord often leads to a permanent…

Craniocerebral Trauma

Epidemiology Traumatic brain injury (TBI) is a silent epidemic in developed nations and one of the leading causes of death and disability, accounting for almost one-third of all trauma-related deaths. In the United States, a TBI occurs every 7 seconds and results in a death every 5 minutes. More than 50,000 Americans die of TBI annually, and approximately 5.3 million live with TBI-related disabilities such as…

Concussion in Sports and Performance

Epidemiology Sports-related concussion (SRC) is a type of mild traumatic brain injury (mTBI) that continues to garner increasing concern worldwide ( ). In the United States alone, estimates of sports and recreation-related concussion range from 1.6 to 3.8 million annually ( ). Concussion occurs in 9% of all US high school sports injuries ( ) and, because many of the clinical findings are subjective, it is…

Basic Neuroscience of Neurotrauma

Traumatic brain injury (TBI) is a leading cause of death and disability among children and young adults. In addition, head injury in older adults, as a result of falls, is a growing clinical concern. To investigate the pathophysiology of brain injury and develop novel therapeutic strategies to treat this condition, experimental models of TBI have been established. Although no experimental model completely mimics the human condition,…

Neurological Complications of Systemic Disease: Children

This chapter addresses a complex and diverse topic: the neurological complications of systemic disease in children. Although some clinical features are similar in children and adults, others vary according to the child’s age and stage of development. Cardiac Disorders and the Nervous System Congenital Heart Disease Children with congenital heart disease (CHD) are at risk for neurological complications, including cerebrovascular accidents (CVAs), cerebral abscess, seizures, developmental…

Neurological Complications of Systemic Disease: Adults

Cardiac Disorders and the Nervous System Neurological complications are an important cause of morbidity in patients with cardiac disease. Cardiogenic emboli may result from cardiac disease or its treatment, and cardiac dysfunction can cause global cerebral hypoperfusion, which—depending on its severity and duration—leads to syncope, stroke, anoxic-ischemic encephalopathy, or death. Cardiogenic Embolism Cardiogenic emboli are most prevalent in patients with atrial fibrillation with or without mitral…

Palliative and End-of-Life Care in Neurological Disease

Introduction Neuropalliative care represents both a growing subspecialty among neurologists as well as a set of palliative care skills that are relevant to all clinicians caring for patients with serious, chronic, advanced, or terminal neurological diseases ( ). Patients with neurological disease have high symptom burden, experience functional and cognitive disability, and typically a decline over time, as well as significant caregiver needs. Palliative medicine is…

Transition to Adult Care for Youth with Chronic Neurological Disorders

Youth with chronic neurological disorders eventually need to move to adult health care. Transition is a process beginning in early adolescence to help these youth to be successful in managing their disorder in adulthood. Transfer is the process of passing responsibility for health care from a pediatric to adult healthcare provider. This chapter reviews the goals of transition and why the process may be difficult. Listed…

Neurological Rehabilitation

Goals and Structure of Rehabilitation Rehabilitation training focuses on reducing physical and cognitive impairments and their related disabilities and limitations on activity in an effort to increase functional independence and health-related quality of life. Training of movements and skills involves an active learning process as well as self-management techniques that draw on motivation, guidance, goal setting, progressive practice, feedback, and social support. National guidelines for neurological…

Principles of Neuroendovascular Therapy

Neuroendovascular therapies consist of minimally invasive, catheter-based interventions for disorders affecting blood vessels (arteries and veins) of the brain and spine that are performed from within the vessel. For the past decade, the field of neuroendovascular therapies has been characterized by continuous and substantial growth through transformative technological advancements and multidisciplinary collaboration. Previously inaccessible lesions have become treatable with minimally invasive techniques; abnormalities that were once…

Neurointensive Care

Neurocritical care is a discipline devoted to the application of critical care principles to seriously ill patients with acute neurological or neurosurgical conditions and has become one of the most rapidly growing subspecialties of neurology in recent years. Neurological-neurosurgical (or neuroscience) intensive care units (NICUs) are staffed by clinicians with solid knowledge of the principles of intensive care unit (ICU) management (mechanical ventilation, hemodynamic monitoring, nutrition,…

Pain Management

Definition and Challenge Pain is the most common neurological complaint. Chronic pain constitutes a major public health burden. Over 116 million patients suffer with chronic pain. The economic burden of chronic pain is quite significant, at an annual cost of 560–635 billion dollars in direct treatment costs and lost productivity ( ). Given the enormous nature of this challenge, chronic pain management warrants a multidisciplinary approach…

Management of Neurological Disease

How an experienced neurologist uses the history of the patient’s illness, the neurological examination, and investigations to diagnose neurological disease is discussed in Chapter 1, Chapter 33 . This chapter presents some general principles guiding the management of neurological disease. Chapter 52, Chapter 53, Chapter 54, Chapter 55, Chapter 56 cover individual areas of neurological management such as pain management, neuropharmacology, intensive care, neurosurgery, neurological rehabilitation,…

Neuroendocrinology

Neuroendocrinology, in its broadest sense, is the study of the coordinated interaction of the nervous, endocrine, and immune systems to maintain the constancy of the internal milieu (homeostasis). This chapter concentrates on the functions of the hypothalamus and its interaction with the pituitary gland. Neuropeptides, Neurotransmitters, and Neurohormones One of the features of the neuroendocrine system is that it uses neuropeptides as both neurotransmitters and neurohormones.…

Neuroimmunology

The past decade has seen a rich interaction between the fields of neurology and immunology. This has provided further insight into the mechanisms of immunologically mediated neurological diseases and given rise to new therapies for many neuroimmunological diseases, including multiple sclerosis (MS). To understand and effectively employ these emerging neuroimmunologically based therapies, a solid grasp of immunology is required. Here we provide an overview of the…

Clinical Neurogenetics

Genetics in Clinical Neurology Since the discovery of the structure of deoxyribonucleic acid (DNA) and the elucidation of the genetic mechanisms of heredity, clinical neurology has benefited from advances in genetics and neuroscience. This clinically relevant basic research has permitted dissection of the cellular machinery supporting the function of the brain and its connections while establishing causal relationships between such dysfunction, human genetic variation, and various…

Neuroepidemiology

Neurological disorders as a group are the leading cause of disability worldwide, and their contribution to the overall burden from all health conditions is increasing ( ). Aging of the population, population growth, and the ongoing epidemiological transition are occurring in many countries and regions, and surveillance of the burden of neurological disorders is required to optimize healthcare planning and resource allocation. Epidemiology is the scientific…

Sexual Dysfunction in Neurological Disorders

Acknowledgment The authors wish to thank Anabelle Grenier-Genest PhD(c) and Geneviève Leblanc MA(c) for their help in preparing this chapter and Thomas Lefebvre for the figures. Neurological disorders have many effects on sexual function that are often dismissed by rehabilitation professionals. They have been classified into primary, secondary, and tertiary impacts. Primary impacts refer to the direct effects of the neurological lesion on sexual function. Secondary…

Neurourology

Urogenital dysfunction can result from a variety of neurological disorders, and the impact of lower urinary tract (LUT) dysfunction on a patient’s health, dignity, and quality of life is increasingly becoming recognized. The investigation and management of disorders of urogenital function have traditionally been regarded as the preserve of urologists. More recently, neurologists and specialists in rehabilitation have become involved in assessment as well as with…

Neuropsychology

Neuropsychology is the scientific study of neural correlates for cognition and behavior, with a specific clinical interest in patients presenting with a range of medical, neurological, and psychiatric illnesses. Neuropsychologists are specialized clinicians who receive extended fellowship training (with available board certification) in functional neuroanatomy, neurobiology, psychopharmacology, neurological illness or injury, neuroimaging, psychometric and statistical principles of neurocognitive measures, and clinical psychology. Neuropsychological evaluation refines neuroimaging…