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Emily Johnson, Yousef Hannawi, Nirma Carballido Martinez, Eva K Ritzl
Cefepime has been associated with encephalopathy and with nonconvulsive seizure activity, primarily in patients with renal impairment. Here, we report a case of cefepime-associated encephalopathy in a patient with normal renal function with stimulus-induced rhythmic activity seen on electroencephalogram, which resolved on discontinuation of cefepime. We bring this to the attention of the neurohospitalist community, as cefepime is widely used in the hospital setting, and cefepime-related neurotoxicity may go overlooked, especially in patients with normal renal function...
October 2016: Neurohospitalist
Anna Coles, Bradley Haveman-Gould, Muhammad U Farooq, Kristopher J Selke, Philip B Gorelick
Patent foramen ovale (PFO) has been proposed as a mechanism for cardioembolic stroke, especially in younger patient populations. Complex PFOs, with tunnel lengths exceeding 8 mm, lead to a higher risk of neurological sequelae than simple PFOs and may also be harder to detect with transthoracic echocardiography (TTE). In this article, we present a 29-year-old woman who, after polypharmacy overdose, developed deep venous thrombosis and multiple pulmonary emboli (PE) and subsequent cardioembolic stroke. Initial TTE showed intact interatrial septum with late appearance of agitated saline in the left atrium after the seventh cardiac cycle...
July 2016: Neurohospitalist
Maulik Shah, Vanja Douglas, Brian Scott, S Andrew Josephson
BACKGROUND AND PURPOSE: Medicine hospitalist programs have effectively incorporated hospitalist-run discharge clinics into clinical practice to help bridge the vulnerable transition periods after hospital discharge. A neurohospitalist discharge clinic would similarly allow continuity with the inpatient provider while addressing challenges in the coordination of neurologic care. We anticipated that this would afford a greater total number of patients to be seen and at a shorter interval...
April 2016: Neurohospitalist
Robert L Dickson, Dineth Sumathipala, Jennifer Reeves
BACKGROUND: The objective of our study was to evaluate the effect of the Pulsara Stop Stroke© medical application on door-to-needle (DTN) time in patients presenting to our emergency department with acute ischemic stroke (AIS). The secondary objective was to evaluate the DTN performance of dedicated neurohospitalists versus private practice neurologists covering emergency department stroke call. METHODS: We conducted a retrospective cohort study of the Good Shepherd Health System stroke quality improvement dashboard for an 18-month period...
May 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
David J Likosky, Juan M Aragon
The rapid ascension of the neurohospitalist model has been a response to national pressures implemented around local practicalities. As such, there is no uniform or ideal neurohospitalist model; there remains tremendous variation nationally. Over time, several dominant models have emerged, each of which raises distinct issues, both clinical and financial. As the field continues to grow, neurohospitalists in both hospital-owned and private practices are developing models that are reshaping the practice of inpatient neurology...
December 2015: Seminars in Neurology
Kristen A Hudson, James G Greene
As the population ages, the prevalence of many neurologic diseases is increasing. At the same time, older patients are undergoing more surgical procedures. This confluence of events puts neurohospitalists in a unique position to provide both pre- and postoperative guidance to minimize complications, improve clinical outcomes, and decrease health care costs in patients with neurologic comorbidities. Early preoperative consultation is recommended for patients with severe, poorly controlled, or decompensated neurologic disease, a recent stroke, or those undergoing procedures with a high risk of neurologic complications...
December 2015: Seminars in Neurology
Peter D Donofrio, Gregory L Barkley, Bruce H Cohen, David A Evans, Gregory J Esper, Bryan Soronson, Jeffrey R Buchhalter, Amanda Becker
Part 1 of this series focused on factors influencing payment for patient care services and Part 2 described compensation plans for neurologists in private practice and in academic medicine. In Part 3, we review how hospital salary support and appointments to Veterans Administration hospitals contribute to the salary structure of neurologists. We also discuss neurohospitalist care and ways neurologists can potentially increase compensation from on-call pay, telemedicine, and the use of new transitional care and complex chronic care codes...
October 2015: Neurology. Clinical Practice
João Lemos, Eric Eggenberger
Neuro-ophthalmological emergencies constitute vision or life-threatening conditions if diagnosis and treatment are not promptly undertaken. Even with immediate therapy, these clinical entities carry a high rate of morbidity. They may present with diplopia, visual loss, and/or anisocoria. Arteritic anterior ischemic optic neuropathy is an ominous condition, which can cause permanent and severe vision loss, stroke, or aortic dissection, requiring immediate steroid therapy. Pituitary apoplexy may go unnoticed if only computed axial tomography is performed...
October 2015: Neurohospitalist
Stacie L Demel, Joseph P Broderick
Basilar artery occlusions (BAOs) are a subset of posterior circulation strokes. Particular issues relevant to BAOs include variable and stuttering symptoms at onset resulting in delays in diagnosis, high morbidity and mortality, and uncertain best management. Despite better imaging techniques, diagnosis, and therefore treatment, is often delayed. We will present the most common signs and symptoms of posterior circulation strokes. Data on optimal treatment strategies are gathered from multiple case series, registries, and one randomized trial, which was stopped early...
July 2015: Neurohospitalist
Cumara B O'Carroll, Mark N Rubin, Brian W Chong
Intravenous recombinant tissue plasminogen activator continues to be first-line therapy for patients with acute ischemic stroke presenting within the appropriate time window, but one potential limitation is the low rate of recanalization in the setting of large artery occlusions. Intra-arterial (IA) treatment is effective for emergency revascularization of proximal intracranial arterial occlusions, but proof of benefit has been lacking until recently. Our goal is to outline the history of endovascular therapy and review both IA thrombolysis and mechanical interventions...
July 2015: Neurohospitalist
Joshua P Klein
No abstract text is available yet for this article.
October 2015: Annals of Neurology
Edward S Claflin, Chandramouli Krishnan, Sandeep P Khot
Although numerous treatments are available to improve cerebral perfusion after acute stroke and prevent recurrent stroke, few rehabilitation treatments have been conclusively shown to improve neurologic recovery. The majority of stroke survivors with motor impairment do not recover to their functional baseline, and there remains a need for novel neurorehabilitation treatments to minimize long-term disability, maximize quality of life, and optimize psychosocial outcomes. In recent years, several novel therapies have emerged to restore motor function after stroke, and additional investigational treatments have also shown promise...
April 2015: Neurohospitalist
Stephanie Rennke, Sumant R Ranji
Hospitals are challenged with reevaluating their hospital's transitional care practices, to reduce 30-day readmission rates, prevent adverse events, and ensure a safe transition of patients from hospital to home. Despite the increasing attention to transitional care, there are few published studies that have shown significant reductions in readmission rates, particularly for patients with stroke and other neurologic diagnoses. Successful hospital-initiated transitional care programs include a "bridging" strategy with both predischarge and postdischarge interventions and dedicated transitions provider involved at multiple points in time...
January 2015: Neurohospitalist
Pravin George, Christopher R Newey, Adarsh Bhimraj
BACKGROUND AND PURPOSE: There is limited literature on tablet devices for neurohospitalists and in neurological graduate medical education. This study evaluated utilization, benefits, and limitations of customized tablets on inpatient neurology practice and resident education. The hypothesis was the perception of the tablet would be positive, given their portability, convenience to accessing point-of-care reference, and accessibility to the electronic medical record. METHODS: Second-generation iPads with neurology-specific applications and literature were provided to our in-hospital general, stroke, and consult neurology teams...
January 2015: Neurohospitalist
Kieran Walsh
No abstract text is available yet for this article.
January 2015: Neurohospitalist
Mark N Rubin, Kevin M Barrett, W David Freeman, Joyce K Lee Iannotti, Dwight D Channer, Alejandro A Rabinstein, Bart M Demaerschalk
BACKGROUND: To demonstrate the technical feasibility of interfacing transcranial Doppler (TCD) and carotid "duplex" ultrasonography (CUS) peripherals with telemedicine end points to provide real-time spectral waveform and duplex imaging data for remote review and interpretation. METHODS: We performed remote TCD and CUS examinations on a healthy, volunteer employee from our institution without known cerebrovascular disease. The telemedicine end point was stationed in our institution's hospital where the neurosonology examinations took place and the control station was in a dedicated telemedicine room in a separate building...
March 2015: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Courtney Takahashi, Conrad W Liang, David S Liebeskind, Jason D Hinman
In the 10 years since the FDA first cleared the use of endovascular devices for the treatment of acute stroke, definitive evidence that such therapy improves outcomes remains lacking. The decision to intubate patients undergoing stroke thrombectomy impacts multiple variables that may influence outcomes after stroke. Three main areas where intubation may deleteriously affect acute stroke management include the introduction of delays in revascularization, fluctuations in peri-procedural blood pressure, and hypocapnia, resulting in cerebral vasoconstriction...
2014: Frontiers in Neurology
Naymee Velez-Ruiz, Jaffar Khan, James G Greene
OBJECTIVE: We sought to better understand the potential impact of the burgeoning neurohospitalist model of inpatient care on education of neurology residents and to better define possible roles for "neurohospitalists" in residency education. METHOD: We designed a brief qualitative open-ended survey directed toward academic leaders in neurology and distributed it by e-mail to every academic neurology department in the United States and Canada. RESULTS: Of 83 respondents, 36 (43%) had an active neurohospitalist program and only 10% felt certain they would not have 1 within the next 5 years...
July 2014: Neurohospitalist
J Chad Hoyle, Courtney Jablonski, Herbert B Newton
Neurosarcoidosis is frequently on the differential diagnosis for neurohospitalists. The diagnosis can be challenging due to the wide variety of clinical presentations as well as the limitations of noninvasive diagnostic testing. This article briefly touches on systemic features that may herald suspicion of this disorder and then expands in depth on the neurological clinical presentations. Common patterns of neurological presentations are reviewed and unusual presentations are also included. A discussion of noninvasive testing is undertaken, exploring dilemmas that may be encountered with sensitivity and specificity...
April 2014: Neurohospitalist
Philip J Overby, Jules C Beal, Elissa G Yozawitz, Solomon L Moshé
Hospitalists, specializing in inpatient medicine, are increasingly being utilized in the hospital setting to improve efficiency, decrease costs and length of stay, and potentially improve outcomes. With these goals in mind and with the purpose of addressing the specific needs of patients on the inpatient pediatric neurology service, we established a pediatric neurohospitalist service in 2009. The primary purpose of this article is to describe the structure and the rationale for a pediatric neurohospitalist service with continuous electroencephalography at a pediatric teaching hospital and to discuss the categories of disease seen by the inpatient neurology service...
April 2014: Neurohospitalist
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