bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Severe Traumatic Brain Injury in the Scandinavian Countries, with Special Emphasis on the Lund Concept
Authors: Olivecrona Magnus , Grände Per-Olof
Published: January 2019

The Lund concept (LC) and the Brain Trauma Foundation (BTF) guidelines are used in Scandinavia and the Nordic countries to treat severe brain trauma (s-TBI). In this chapter, the authors focus on the LC developed in Scandinavia. When introduced in 1992, it was a theoretical approach, based mainly on principles of brain volume control and of optimization of brain perfusion. The BTF guidelines presented in 1996 were based on meta-analytic approaches. The LC gives relatively strict outlines regarding cerebral perfusion pressure, fluid therapy, ventilation, sedation, nutrition, the use of vasopressors, and osmotherapy. The treatment is standardized, with less need for individualization.
Disorders of Consciousness: Common Findings in Brain Injury
Authors: Machado Calixto , Estévez Mario , Rodríguez Rafael , Chinchilla Mauricio , Pérez-Nellar Jesús
Published: January 2019

The disorders of consciousness (DOC) discussions are actual and permanent subjects for debate in the media and scientific discussion in any forum. Controversies exist in the use of present-day clinical terminology, including terms that may be pejorative in describing patients. Thw European Task Force on Disorders of Consciousness has proposed a new term, unresponsive wakefulness syndrome (UWS), to assist society in avoiding the depreciatory term “vegetative state” (VS). The author has submitted a response to the paper by Giacino et al., proposing the use of the term minimally aware state instead of minimally conscious state (MCS). The main finding in VS-UWS is the preservation of wakefulness with apparent loss of awareness. The diagnosis of VS-UWS has been made more difficult by recognition of the MCS as a transitional phase in the partial recovery of self-awareness or environmental awareness while emerging from the PVS-UWS, leading to a relative high proportion of errors. Neuroimaging techniques have expansively contributed to the study of DOC. In this area, the assessment of brain connectivity is essential to explain the pathophysiology of DOC. Magnetic resonance imaging (MRI) DW-MRT techniques have being widely used to estimate the nervous fiber pathways connecting brain regions of We propose to use graph theoretical approaches to differentiate the topological organization of white matter network in DOC. An accurate and reliable assessment of consciousness pathophysiology in DOC is critical for the subsequent management and rehabilitation, as well as medical, legal, and ethical decision-making.
The TRACK-TBI Approach: Redefining Severity and Outcome Assessments
Authors: Yue John K. , Winkler Ethan A. , Deng Hansen , Markowitz Amy J. , Wang Kevin K. W. , Manley Geoffrey T.
Published: January 2019

Advances in traumatic brain injury (TBI) research have been limited by imprecise classification and diagnostic approaches and insensitive outcome measures. The National Institute of Neurological Disorders and Stroke TBI Common Data Elements (CDEs) project aimed to standardize data collection across TBI research, discover new diagnostic tools, and develop a multidimensional outcomes endpoint sensitive to differential profiles of recovery. Progress from implementing the TBI CDEs is described via the Transforming Research and Clinical Knowledge in Traumatic Brain Injury Pilot (TRACK-TBI Pilot) study. Refinements to the TBI CDEs are incorporated into several ongoing large-scale prospective trials comprising a comprehensive, harmonized dataset capable of refining severity markers and outcome endpoints.
Challenges in Neurotrauma Management in India and Rapidly Growing Developing Countries
Authors: Sinha Virendra Deo , Prusty G. K. , Chakrabarty Amit
Published: January 2019

Despite the availability of prehospital care, the standard of this care is still unsatisfactory in India and in low- and middle-income countries. This is a challenge for hospital administration, medical professionals, and the masses. To a large extent, improvements can be accomplished by providing physical resources for prehospital care, training first responders and paramedics, integrating prehospital services with hospitals, and providing a centralized reporting mechanism. Rehabilitation of neurotrauma victims is another dark side in the developing world. Rehabilitation should start during the course of a hospital stay and carry on actively after discharge. The role of psychosocial rehabilitation with the aid of role models and constant encouragement needs to be taught at the community level.
Chronic TBI in Veterans and Service Members: Clinical Assessment, Interventions, and Differentiation from PTSD
Authors: Levin Harvey S. , Scheibel Randall S. , Troyanskaya Maya , Thompson Karin , Henson Helene
Published: January 2019

This chapter presents an overview of the epidemiology of traumatic brain injury (TBI) sustained by military personnel, including its prevalence, the chronic effects in veterans, and subacute injury in service members. The distribution of acute severity TBI and the contribution of blast and non-blast mechanisms are discussed. A separate section describes the clinical assessment of combat-related TBI, including the chronic effects and the comorbidities of posttraumatic stress disorder and depression which are frequently present and complicate recovery. Neuropsychological assessment is described, including testing the validity of symptoms and the effort expended by the patient in performing the tests. The role of neuroimaging is discussed, as are TBI pathophysiology and a neurobiological model of military TBI. The chapter concludes with a section on directions for clinical management of TBI and research.
Return to Play, School, or Work After Concussion
Authors: Tator Charles H.
Published: January 2019

Improvements have been made in the management of concussions, and this includes the methods for advising concussed patients about the processes to be followed for return to play (RTP) in sports, return to learn (RTL) in schools, and return to work (RTW) on the job. The aim of management is to facilitate return by a graduated process of steps during which an individual’s thresholds for exacerbation of symptoms are used as a guide, with advice given not to exceed these thresholds. There are no available objective biomarkers to guide these processes and so advice and monitoring are based on clinical findings.
The Link Between Traumatic Brain Injury and Neurodegenerative Diseases
Authors: Rubenstein Richard
Published: January 2019

Traumatic brain injury (TBI) is a physical impact to the head usually in the form of a single or repetitive closed head injury. TBI is classified as mild, moderate, and severe based on neurological assessment which may include neuroimaging. TBI is a heterogeneous injury, with most cases being mild and difficult to diagnose. TBI can be separated into a primary injury and secondary injury. Primary injury is a result of the physical head impact, whereas secondary injury can occur as long as months to years later and is the result of pathophysiological changes in the central nervous system. TBI is considered a risk factor for chronic neurodegenerative diseases (Alzheimer disease, Parkinson disease, amyotrophic lateral sclerosis, frontotemporal dementia, chronic traumatic encephalopathy) in spite of each disease having unique clinical symptoms, pathologies, and specific discriminating proteins. To date, little is known about the pathological changes responsible for linking TBI to neurodegenerative diseases.
Neuroimaging and Its Application in the Diagnosis and Early Prognostication of TBI
Authors: Bai Lijun , Wang Shan , Sun Chuanzhu
Published: January 2019

Traumatic brain injury (TBI) is a substantial public health problem. Differences in the progress of recovery make it a heterogeneous injury and limit effective diagnostic tools that depend on patients’ clinical manifestation. Neuroimaging methods have been widely applied in published reports, especially advanced neuroimaging techniques such as diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI). fMRI is a widely used diagnostic imaging method for task-related dysfunction after TBI and in the assessment of cognitive. It can measure the fluctuations that exist in human brains during either active task states or a resting state. DTI, a relatively new MRI technique that is sensitive to microstructural abnormalities shows great advantages on visualizing axonal injury and major pathology in white matter tracts following TBI. It can be a significant early indicator for TBI, providing prognostics for later injury.
The Role of Inflammation in Traumatic Brain Injury
Authors: Hellewell Sarah C. , Semple Bridgette D. , Ziebell Jenna M. , Bye Nicole , Morganti-Kossmann Cristina
Published: January 2019

Inflammation occurring following brain trauma represents a significant constituent of complex secondary responses that dictate patients’ outcome. Although a few decades have passed since its discovery, new aspects of this intriguing phenomenon are still being uncovered, ranging from the multiple roles of mediators regulating the inception, progression, and resolution of neuroinflammation, to the development of antiinflammatory therapies. This review provides a summary of the vast research on traumatic brain injury inflammation. The authors describe the fundamental aspects of cytokine and immune cell functions, the orchestrated collaboration of chemokines and leukocytes, the phenotypic distinction of macrophage populations, and the contribution of glial cells. Among the beneficial properties of neuroinflammation, they briefly discuss cytokines’ impact on neurogenesis; the chapter concludes by touching on the implications of antiinflammatory therapies.
Glutamate Receptor Peptides in Acute Neurotrauma
Authors: Dambinova S. A. , Mullins J. D. , Gennarelli Thomas
Published: January 2019

This chapter presents data supporting the hypothesis that glutamate neuroreceptor peptides are specific biomarkers of diffuse axonal injury (DAI) and compromised cerebral blood flow following neurotrauma. Specifically, the authors propose that three key brain biomarkers might be utilized to improve diagnostic certainty of the consequences of acute neurotrauma: α‎-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA), N-methyl-D-aspartate (NMDA), and kainate receptor peptides. AMPA receptor peptides are associated with subcortical DAI, while NMDA and kainate receptors peptides predominantly reflect arterial and venous circulations in cortical and brainstem areas, respectively. Feasibility studies of these biomarkers in the blood of patients with neurotrauma are presented in conjunction with neuroimaging and Glasgow Coma Scale (GCS) scores.
MicroRNA Biomarkers in Traumatic Brain Injury
Authors: Bhomia Manish , Balakathiresan Nagaraja S. , Wang Kevin K. W. , Knollmann-Ritschel Barbara
Published: January 2019

Traumatic brain injury (TBI) is currently considered one of the major causes of disability and death worldwide. The cellular and molecular changes of TBI pathology are dynamic and complex in nature. MicroRNAs (miRNA) are small endogenous RNA molecules that regulate gene expression at the posttranscriptional level. Several studies have shown a critical role of miRNAs in the development of long- and short-term TBI pathology. Circulating miRNAs are of great interest as blood-based biomarkers in TBI diagnosis. In this chapter, the authors review recent reports that aim to understand the role of miRNAs in TBI pathophysiology and their potential use as a therapeutic target. Additionally, the authors discuss the potential use of miRNAs as blood-based diagnostic markers for TBI and their possible association with other neurodegenerative diseases.
Military-Relevant Rodent Models of Blast-Induced Traumatic Brain Injuries
Authors: Cernak Ibolja
Published: January 2019

Explosive weaponry is the main cause of injuries in current military actions and terrorist attacks. Blast injuries and blast-induced neurotrauma (BINT) are caused by blast waves generated during an explosion. In both civilian and military environments, exposure to a blast may cause instant death, injuries with immediate manifestation of symptoms, and latent injuries that are initiated at the time of exposure and may manifest over a period of hours, months, or even years. Chronic health impairments due to blast often remain un- or underdiagnosed and represent significant challenges for treatment and rehabilitation. We need to advance our understanding of the mechanisms of these injuries to develop better preventive, diagnostic and treatment approaches. This could be achieved through research using clinically and militarily relevant and scientifically reliable models. This chapter provides an overview on rodent BINT models and discusses the generalizable and blast-specific factors that every rodent BINT model should fulfill.
Neuroprotection in TBI
Authors: Muresanu Dafin , Barle Codruta Birle , Muresanu Ioana , Costin Cezara , Vester Johannes , Rafila Alexandru , Rosu Olivia , Slavoaca Dana
Published: January 2019

Neuroprotection represents an important scientific objective in traumatic brain injury (TBI) due to the limited treatment options and the importance of the extent of secondary injury in determining short- and long-term complications. Neuroprotection in TBI targets secondary neuronal injury, a multidimensional molecular cascade that includes excitotoxicity, immune response imbalances, oxidative stress, and apoptotic-like processes. These molecular processes lead to dysfunction of the blood–brain barrier and alterations of neurotransmitter and hormonal systems. The result is an imbalance of the interplay between endogenous defense activity and damage mechanisms. The disappointment over the failure of most randomized clinical trials to produce a neuroprotective therapy for improving outcomes has led to the development of a critical, constructive view of the current understanding of the complexity of secondary injury pathways, how these pathways could be modulated, and how a clinical trial should be designed to detect the multidimensional aspects of TBI outcomes.
Bioengineering in Brain Trauma Research
Authors: LaPlaca Michelle C.
Published: January 2019

The study of traumatic brain injury (TBI) encompasses research spanning from injury prevention to clinical interventions, all of which have been influenced by bioengineering. Bioengineering uses quantitative analyses and problem-solving skills to approach the complexity of many areas of neurotrauma research including injury biomechanics, imaging, biomarkers, and data analytics. This chapter presents basic bioengineering concepts, highlights significant contributions to neurotrauma research, and discusses opportunities in the field that may lend themselves to bioengineering solutions. The intention of the author is to promote an appreciation of engineering and to catalyze problem-solving among readers, engineers and non-engineers alike.
Why Do We Not Have a Drug to Treat Acute Spinal Cord Injury?
Authors: Geddes James W.
Published: January 2019

More than 100 years ago, Alfred Reginald Allen developed the weight-drop model of graded, reproducible contusion injury to the dorsal spinal cord. Allen also introduced the concept of secondary injury mechanisms, hypothesizing that hemorrhage and elevated intraspinal pressure contribute to the destruction of the spinal cord and functional deficits. Our understanding of the secondary injury cascade has advanced tremendously over the past 100 years, with numerous therapeutic targets identified. Yet we lack an effective drug treatment for acute spinal cord injury. Reasons for the failure to translate promising preclinical findings to successful clinical trials include concerns regarding the quality of preclinical studies, including possible bias and inappropriate statistical analysis; questions regarding the suitability of animal models; and the complexity of secondary mechanisms following spinal cord injury. Perhaps, however, we have overlooked the targets identified by Allen, namely the intraspinal hemorrhage and elevations in intraspinal pressure.
Recent Developments in Regenerative Strategies to Treat Spinal Cord Injuries
Authors: Sun Wenjing , Tedeschi Andrea , Shi Riyi
Published: January 2019

Trauma to the adult mammalian central nervous system (CNS) causes diffuse axonal injury that results in devastating long-term disabilities due to limited sprouting and axon regeneration failure. No therapeutic strategy that restores neurological function is currently available for individuals who have suffered damage to their spinal cords. The past few decades have witnessed major advances in the technology used to study CNS development, homeostasis, and disease. A better understanding of the cellular and molecular mechanisms underlying axonal growth and regeneration failure has allowed the development of several regenerative strategies that may change the way we treat spinal cord injury (SCI) in the near future. This chapter summarizes recent progress in spinal cord repair and regeneration, including combinatorial strategies promoting axonal sprouting, regeneration, formation, and consolidation of neuronal circuits as well as cellular replacement after injury.
Stem Cell Therapy for Spinal Cord Injury
Authors: Wu Ping , Yang Mingliang , Hao Yan , Feng Shiqing , Li Jianjun
Published: January 2019

Traumatic spinal cord injury (SCI), a devastating disorder that severely affects the quality of life in patients, currently lacks effective therapies. Stem cell research offers a promising option to facilitate spinal cord repair. This chapter provides an overview of the major types of stem cells being used in preclinical animal studies and clinical trials to treat SCI, including mesenchymal, neural, hematopoietic, embryonic, and induced pluripotent stem cells. The authors summarize the beneficial effects of stem cells as a potential new therapeutic approach, but also raise the concerns of the limitation and challenges the field is facing, and suggest future directions.
Functional MRI in Pediatric Neurodevelopmental and Behavioral Disorders
Authors: Kommu John Vijay Sagar , Kaku Sowmyashree Mayur
Published: January 2019

This chapter addresses functional magnetic resonance imaging (fMRI) of brain in children with neurodevelopmental and behavioral disorders. Common challenges of pediatric fMRI studies are related to acquisition and processing. In children with disruptive behavior disorders, deficits in affective response, empathy, and decision-making have been reported. Resting-state fMRI studies in attention-deficit hyperactivity disorder (ADHD) have shown altered activity in default mode and cognitive control networks. Task-based fMRI studies in ADHD have implicated frontoparietal cognitive and attentional networks. The role of stimulants in restoring the altered brain function has been examined using fMRI studies. In children with autism spectrum disorder, fMRI studies using face-processing tasks, theory-of-mind tasks, imitation, and language processing (e.g., sentence comprehension), as well as studies of gaze aversion, interest in social faces, and faces with emotions have implicated cerebellum, amygdala, hippocampus, insula, fusiform gyrus, superior temporal sulcus, planum temporale, inferior frontal gyrus, basal ganglia, thalamus, cingulate cortex, corpus callosum, and brainstem. In addition, fMRI has been a valuable research tool for understanding neurobiological substrates in children with psychiatric disorders (e.g., psychosis, posttraumatic stress disorder, and anxiety disorders).
Functional MRI in Pain Management
Authors: Becker Christopher J. , Vogt Keith M. , Ibinson James W.
Published: January 2019

Functional MRI (fMRI) studies in pain management examine the potential clinical role of fMRI in the diagnosis and treatment of acute and chronic pain conditions. In this chapter, the unique spatial and temporal properties of the brain’s response to pain are discussed first, because they provide the basis for potential clinical applications of fMRI. The second section considers several specific clinical roles that could be filled by fMRI. These include: detecting acute pain using a combination of machine learning and task-based fMRI, detecting chronic pain using functional connectivity MRI (fcMRI), predicting the development of chronic pain using fcMRI, monitoring the treatment of pain using fMRI, and treating pain directly using fMRI-based biofeedback. The possibility of translating fMRI findings to less expensive, more mobile technologies that could facilitate widespread clinical implementation is also discussed.
Functional MRI in Anesthesia and Resting-State Networks
Authors: Mortazavi Nasim , Staquet Cecile , Vanhaudenhuyse Audrey , Soddu Andrea , Faymonville Marie-Elisabeth , Bonhomme Vincent
Published: January 2019

This chapter reviews current knowledge of the effects of hypnotic anesthetic agents on brain resting-state networks (RSNs) that sustain consciousness. Although full exploration of the networks under anesthesia is not yet available, current evidence indicates that anesthetic agents with hypnotic properties dose-dependently modulate RSN functioning. Each anesthetic agent has specific effects that are not uniform within a given network and probably correlate with the specific clinical features observed when one agent or another is used. Observations made on RSNs during anesthesia are supplementary arguments to link the networks with specific aspects of consciousness and connectedness to the environment and to confirm their physiological functions. The precise link between observations made on RSNs during anesthesia and known biochemical targets of anesthetic agents, or their effects on systems that regulate the sleep–wake cycle, is not established yet. PET studies using radiolabeled probes that specifically target a neurotransmission system offer insights into the links. New technological advances and modes of functional data analysis, such as Granger causality and dynamic causal modeling, will help in obtaining a more in-depth exploration of the complex interactions between brain regions, their modulation by anesthesia, and their role in information processing by the brain. Effects of hypnosis on RSNs also have been studied. The hypnotic state is useful for performing surgical procedures and explorations without general anesthesia. The hypnotic state is associated with specific changes in the activity of RSNs that confirm hypnosis as a specific brain state, different from normal wakeful consciousness and anesthetic states.
Functional MRI in the Intensive Care Unit
Authors: Marra Annachiara , Pandharipande Pratik P.
Published: January 2019

Magnetic resonance imaging (MRI) technology has revolutionized medical and scientific imaging, has had an important effect on research, and has become a great source of valuable information on the functioning of the major organs of the human body. The role of fMRI (functional MRI) in the intensive care unit is growing, and different fMRI techniques have been used to assess the brain, the lung, and the abdomen of patients. fMRI has been used to assess the brain of an acutely comatose or delirious patient and to detect subtle pathological changes in traumatic brain injury from the acute phase to the chronic phase. Pulmonary MRI is used for the assessment of regional functional changes (perfusion, ventilation, and oxygen diffusion) in patients with airway diseases and, due to better spatial and temporal resolution, for regional functional assessment and for evaluation of the possibility of morphologic changes in a single examination. Cardiac MRI has shown high reproducibility and accuracy, allowing detailed functional assessment and characterization of myocardial tissue and providing information on surrogate outcome measures and complications. Functional imaging techniques also have been applied to the study of the liver and the kidney.
Surgical Treatment of Neuropathic Pain
Authors: Cheng Jianguo , Wang Wenbao
Published: January 2019

Surgical treatment of intractable neuropathic pain has evolved significantly during the past few decades. Early treatments focus on neuroablation of the pain pathways. Although these techniques still have a role in specific indications, they have largely fallen out of favor due to causing irreversible destructive damage to the brain and/or spinal cord. Spinal cord stimulation, peripheral nerve stimulation, and intrathecal drug delivery system using programmable pump have become more popular treatment options for patients who do not respond to pharmaceutical and interventional procedures. These methods have reasonable safety profiles and can be efficacious and cost-effective, especially for patients with failed back surgical syndrome and complex regional pain syndrome. Deep brain stimulation and motor cortex stimulation are options for central pain. Microvascular decompression surgery and Gamma Knife radiosurgery are excellent options in selected patients with refractory trigeminal neuralgia or glossopharyngeal neuralgia.
Herpes Zoster and Postherpetic Neuralgia
Authors: Cheng Jianguo
Published: January 2019

Herpes zoster is caused by reactivation of the latent varicella zoster virus (VZV) that causes chicken pox. VZV remains dormant in the dorsal root and cranial ganglia and can reactivate later in a person’s life and cause herpes zoster, which appears predominantly in older adults, but may also occur in those that are immunocompromised. Postherpetic neuralgia (PHN) is defined as pain in the affected dermatome that is still present 1 month after development of the vesicles. Adults older than 50 should receive the herpes zoster vaccine as part of routine medical care. Shingrix is a new vaccine recently approved and recommended by the FDA, which is a non-live, subunit vaccine. In contrast to Zostavax, Shingrix is 97% effective against shingles and 91% effective against PHN for people 50 and older. The diagnosis of herpes zoster can be made on the basis of characteristic skin lesions and pain and itching in the involved dermatome. During the acute phase, an antiviral given within 72 hours of onset helps reduce pain and complications and shorten the course of the disease. The diagnosis of PHN is based on a history of herpes zoster, typical dermatomal distribution of the pain, and hyperalgesia and/or allodynia on physical examination. First-line pharmacotherapy includes gabapentin or pregabalin, tricyclic antidepressants, and SNRIs. Combination therapies are often necessary. Interventional options such as epidural injections, paravertebral blocks, selective nerve root blocks, sympathetic nerve blocks, intercostal nerve blocks, trigeminal nerve blocks, spinal cord or dorsal root ganglion stimulation, and intrathecal therapy may be considered in refractory cases.
Spinal Cord Injury
Authors: Averna Justin F. , Bautista Alexander , Chang Chien George C. , Saulino Michael
Published: January 2019

Pain from spinal cord injury (SCI) is one of the pain syndromes that is recalcitrant to treatment. It is often a result of injury associated with mechanical trauma and vascular compromise of the spinal cord parenchyma. SCI pain is associated with substantial impact on the patient’s life, interfering with activities of daily living, effective rehabilitation, and quality of life. The underlying mechanism for the development of SCI pain includes neuronal hyperexcitability, reduced inhibition, neuronal reorganization, and plasticity. The diverse factors associated with SCI pain warrant the need for an interdisciplinary approach tailored to the individual patient. The goals of treatment should encompass four domains: pain management, spinal rehabilitation, psychological treatment, and social and environmental modification.
Tumors of the Central Nervous System
Authors: Ligon Keith L. , Santagata Sandro , Bielle Franck
Published: January 2019

This chapter presents the most up-to-date classification of tumors of the nervous system, based on the histological appearance of the neoplasm and on information derived from cytogenetics and molecular biology, which are now recognized worldwide as increasingly important for more precise diagnosis, prognosis, and therapeutic guidance. The chapter provides a detailed morphological description of each major tumor type, with numerous illustrations of macroscopic and microscopic lesions. First considered are primary tumors of the nervous system, including those derived from neuroepithelial tissue (astrocytic, oligodendroglial, ependymal, neuronal, and glioneuronal); pineal tissue; peripheral nerve sheath; and meninges. Next, lymphomas, hematopoietic neoplasms, and secondary (metastatic) neoplasms are described.
Central Nervous System Trauma
Authors: Smith Colin , Reichard R. Ross
Published: January 2019

This chapter covers the pathological changes seen in the nervous system, both the brain and spinal cord, as a result of the application of forces, including blunt force, penetrating, and blast head injuries. Forces can result in both focal pathology, such as contusions and subdural hemorrhage, and disseminated pathology, such as diffuse traumatic axonal injury; the macroscopic and microscopic changes of these lesions are discussed. In addition, the age-dependent pathology that may be seen, including abusive head trauma in infants, is discussed. While many of the changes associated with head injury are acute and cause immediate clinical problems, there is discussion of chronic traumatic encephalopathy, an evolving entity possibly associated with the long-term complications of head injury in some individuals.
Multiple Sclerosis and Related Inflammatory Demyelinating Diseases
Authors: Lassmann Hans , Seilhean Danielle
Published: January 2019

This chapter describes the basic neuropathology of multiple sclerosis and other inflammatory demyelinating diseases. It specifically addresses the nature of multiple sclerosis lesions, characterized by inflammation, selective primary demyelination with partial preservation of axons, remyelination, and reactive astroglial scar formation. Attention is paid to the importance of demyelinated lesions in the gray matter, and it discusses the differences of the pathology between the relapsing and the progressive stage of the disease. Finally, it summarizes the similarities and differences between multiple sclerosis and other inflammatory demyelinating diseases, such as acute multiple sclerosis, Baló concentric sclerosis, neuromyelitis optica, myelin oligodendrocyte glycoprotein antibody-associated disease and acute disseminated encephalomyelitis.
Pathology of Degenerative Diseases of the Nervous System
Authors: Duyckaerts Charles
Published: January 2019

Degenerative diseases of the nervous system are characterized by lesions involving specific systems of functionally related neurons. The abnormality is manifest by neuronal loss with variable astrocytic and microglial reactive changes. Accumulation of specific protein aggregates (e.g., Aβ‎, tau, α‎-synuclein, TAR-DNA binding protein 43, polyglutamine) is a common feature giving rise to distinctive intracellular inclusions or extracellular deposits. For some diseases, there are well-characterized genetic abnormalities. This chapter describes and illustrates the morphological changes and genetic data in the different diseases. These are classified, per the dominant clinical features, into five categories: degenerations of the cerebral cortex (dementia), movement disorders, cerebellar ataxia, motor neuron disease, and conditions associated with autonomic failure.
Acquired Diseases of the Nervous System
Authors: Chimelli Leila , Gray Françoise
Published: January 2019

This chapter describes and illustrates the different neuropathological changes observed in a wide range of systemic acquired metabolic diseases that affect the central or peripheral nervous systems: hypoxia, hypoglycemia, hyperthermia, disorders of serum electrolytes, vitamin deficiencies, and exogenous intoxications, particularly alcoholism and intoxications by drugs, methanol, and heavy metals. In the central nervous system, lesions may find expression via selective involvement of some brain regions, with simultaneous complete preservation of others. The pathogenesis of the predisposition to injury for a particular anatomic region or for some specific set of cell types (neurons mostly) varies considerably form one disease to another and is undoubtedly multifactorial. The chapter also considers central nervous system abnormalities secondary to systemic diseases, including respiratory encephalopathies, hepatic encephalopathy, multifocal necrotizing leukoencephalopathy, and paraneoplastic encephalomyelopathies.
Hereditary Metabolic Diseases
Authors: Anthony Douglas C. , Goebel Hans H.
Published: January 2019

This chapter describes and illustrates the morphological central nervous system changes in hereditary metabolic disorders. In some disorders, the metabolic derangements are most prominent in the cytosol and are linked to the dysfunction of a single cellular organelle. In these disorders, there may be intracellular accumulation of an intermediate metabolite, resulting in “storage” or accumulation of the abnormal substance within the cell. The organelles most commonly involved in these disorders are lysosomes, peroxisomes, mitochondria, and the cytoplasmic compartment. Other disorders are defined by an enzyme deficiency; by the biochemical pathways involved (metabolic disorders of sugars, copper, amino acids, or structural protein); or only by morphologic/clinical features.
Congenital Malformations and Perinatal Diseases
Authors: Adle-Biassette Homa , Harding Brian , Golden Jeffrey A.
Published: January 2019

This chapter describes and illustrates the changes of the central nervous system in congenital malformations and perinatal diseases; it also provides insights in the genetic abnormalities associated with these conditions. Congenital malformations include neurulation failure resulting in neural tube closure defects; disorders of development of the prosencephalon; malformations of the cortical plate (neuronal heterotopia, polymicrogyria, lissencephaly, and focal cortical dysplasia [a frequent cause of epilepsy in children]); and disorders of hindbrain development, particularly malformations of the cerebellum. Destructive lesions of developing brain are described in association with a variety of situations generally resulting in “hypoxia-ischemia.” They may affect the neocortex, causing porencephaly or hydranencephaly; the basal ganglia (status marmoratus); or the white matter (perinatal telencephalic leukoencephalopathy and periventricular leukomalacia).
Pathology of Skeletal Muscle
Authors: Gherardi Romain , Amato Anthony A. , Lidov Hart G. , De Girolami Umberto
Published: January 2019

This chapter describes and illustrates the pathology of skeletal muscle as evaluated on muscle biopsy. After an introduction to processing techiques and the normal appearance of skeletal muscle, the basic pathologic reactions in muscle disease are described. The different categories of muscular disorders are subsequently considered and their specific morphological and eventually genetic features underlined. Involvement of the muscle secondary to denervation (neurogenic atrophies) or to neuromuscular transmission defects are first presented, followed by an account of the primary myopathies. Genetically determined diseases of skeletal muscle include muscular dystrophies, congenital myopathies, myofibrillar myopathies, and metabolic myopathies. Inflammatory myopathies may be divided into two groups, depending on whether the causative agent is a known microorganism or if the inflammatory process is believed to be an autoimmune phenomenon.
Pathology of Peripheral Nerves
Authors: Vallat Jean-Michel , Anthony Douglas C. , De Girolami Umberto
Published: January 2019

This chapter describes and illustrates the pathology of peripheral nerve as it may be evaluated on nerve biopsy. After a description of the indications for the biopsy, of the special techniques commonly used, and of the normal anatomy of peripheral nerve, the general reactions of peripheral nerve to injury (primary axonal degeneration and primary segmental demyelination) are described. Neuropathies can be separated into acquired and hereditary neuropathies. Inflammatory neuropathies include immunopathologic disorders of unknown cause (inflammatory demyelinating polyradiculoneuropathy) and neuropathies due to infectious agents (leprosy) or associated with systemic vasculitis. Several neuropathies occur in association with hematologic diseases and neoplasms. Metabolic (diabetic) and toxic neuropathies are frequent. Recent advances in molecular genetics have greatly enhanced the understanding of hereditary neuropathies. These include hereditary motor and sensory neuropathies, hereditary sensory and autonomic neuropathies, and familial amyloid polyneuropathies.
Cutaneous Disorders
Authors: Wu Fred
Published: January 2019

Dermatology can be a challenging subject in emergency medicine. While most dermatologic complaints are benign, the clinician must be able to distinguish them from life-threatening conditions. This chapter reviews some of the most common skin disorders seen in the emergency department (ED), including adult and pediatric pathology. Patients typically present to the ED with a rash. Visual cues and the patient history are helpful in leading to the diagnosis. Knowing the distribution of common rashes and the age groups in which they typically occur can help the clinician reach the correct answer. These conditions range from an inconvenience, such as dermatitis, to the severe in the case of Stevens-Johnson syndrome.
Immunologic Emergencies
Authors: Bengiamin Deena , Matos Jannifer
Published: January 2019

The immune system is a complex defense mechanism designed to protect human beings from infection and other invasion from outside sources. It usually works perfectly, but at times it can over respond, causing disease and even assault on the tissues of the body that it is designed to protect. Emergency providers will face immunologic emergencies that range from mild allergic reactions to life-threatening anaphylaxis. Immunosuppressive drugs, used in a variety of situations, including in transplant recipients, can place patients at risk for infection and other disease processes. The pediatric population can also present to an emergency department with their first episode of an immunologic disorder, such as Kawasaki disease or juvenile rheumatoid arthritis.
Thoracic and Respiratory Emergencies
Authors: Diamond Nelson , Lee Janelle , Tolia Vaishal , Tresenriter Megan
Published: January 2019

Thoracic and respiratory disorders cover many of the common respiratory and thoracic complaints and pathology that bring both pediatric and adult patients to the emergency department (ED). The etiologies can range from infectious to traumatic to malignancy. It is important to be able to recognize patients who need admission to the hospital and those who can be sent home for outpatient management. Interventions like needle decompression and intubation may need to be done emergently on some patients. This chapter presents questions related to the diagnosis, clinical effects, best response in the ED, and most appropriate treatment of a wide range of these thoracic and respiratory emergencies.
Nutrition
Authors: Mackowiak Philip A.
Published: January 2019

Chapter 1 (“Nutrition”) features works of art depicting patients with nutritional disorders. Examples of both overnutrition and undernutrition are included. The final work considered is one by Johann J. Hasselhorst, titled Dissection of a Young Woman, in which an 18-year-old suicide victim is being dissected by a male surgeon to determine the ideal measurements of the female form. Her ideal from is contrasted earlier in the chapter with that of subjects, such as the Venus of Willendorf (a Paleolithic statuette discovered in the village of Willendorf, Austria in 1908 C.E.), with various forms of morbid obesity, and others, such as the Starving Buddha (a 2nd century B.C.E. bronze statue located in the Lahore Museum), that depict Kwashiorkor, cretinism, scurvy, pellagra, and other ravages of undernutrition.
Diagnostics
Authors: Mackowiak Philip A.
Published: January 2019

Chapter 2 (“Diagnostics”) traces the evaluation of the patient as depicted in art from the earliest times to the present. Although ancient physicians had none of the vast array of sophisticated laboratory tests that are now so important in diagnosing diseases, little has actually changed in the initial evaluation of the patient for over 4000 years. In fact, the principles underlying today’s concept of a proper medical history and physical examination were clearly articulated by the Egyptians in medical papyri produced as early as 1950 B.C.E. The works featured in this chapter transport the reader from some of the earliest records of how to take a medical history, perform a proper physical examination, and examine clinical specimens such as blood and urine to employing the imaging techniques of the modern era.
Artists as Patients
Authors: Mackowiak Philip A.
Published: January 2019

Although artists reveal much about themselves in their works, rarely do they give even a glimpse into their medical histories. The following self-portraits are notable exceptions. They reflect the disorders with which eleven artists struggled and yet only vaguely understood. Chapter 10 (“Artists as Patients”) considers the disorders reflected in self-portraits of eleven artists—Dürer, Rembrandt, Goya, van Gogh, Munch, Toulouse-Lautrec, Klee, Ket, Kahlo, John Bellany, and Dr. Muhammad Asim Khan. Each portrait is an autobiography of sorts, which arouses a host of deep, vague, generalized reminiscences of what it means to be a patient, and how tenuous one’s hold on health is, regardless of one’s accomplishments.
Care at the End of Life
Authors: Marks Adam D.
Published: January 2019

This chapter guides the reader on managing the end of life in hospitalized patients.
Preventing Hospital-Acquired Complications
Authors: Meddings Jennifer
Published: January 2019

This chapter guides the reader on the approaches to preventing hospital-acquired complications for inpatient care.
Electrocardiogram Interpretation
Authors: Kenaan Mohamad , Eagle Kim
Published: January 2019

This chapter guides the reader on the systematic and consistent methodologies of interpreting electrocardiograms.
Arrhythmias
Authors: Kenaan Mohamad , Eagle Kim
Published: January 2019

This chapter guides the reader on the general principles, diagnosis, and treatment of arrhythmias for inpatient care.
Atrial Fibrillation
Authors: Kenaan Mohamad , Eagle Kim
Published: January 2019

This chapter guides the reader on the diagnosis and management of atrial fibrillation.
Chest Pain
Authors: Kenaan Mohamad , Eagle Kim
Published: January 2019

This chapter guides the reader on the approaches to dealing with chest pain in hospitalized patients.
Angina
Authors: Kenaan Mohamad , Eagle Kim
Published: January 2019

This chapter guides the reader on the approaches to diagnosing and managing angina for inpatient care.
Heart Failure
Authors: Kenaan Mohamad , Eagle Kim
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of heart failure in hospitalized patients.
Shock
Authors: Kenaan Mohamad , Eagle Kim
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of shock in hospitalized patients.
Hemoptysis
Authors: Mendez Michael P.
Published: January 2019

This chapter guides the reader on the diagnosis and management of hemoptysis in hospitalized patients.
Hypoxemia
Authors: Mendez Michael P.
Published: January 2019

This chapter guides the reader on the approach to hypoxemia in hospitalized patients.
Pulmonary Function Tests
Authors: Mendez Michael P.
Published: January 2019

This chapter guides the reader on the approaches to using and interpreting pulmonary function tests.
Obstructive Lung Disease
Authors: Mendez Michael P.
Published: January 2019

This chapter guides the reader on the diagnosis and management of obstructive lung disease in hospitalized patients.
Pulmonary Hypertension
Authors: Mendez Michael P.
Published: January 2019

This chapter guides the reader on the diagnosis and management of pulmonary hypertension in hospitalized patients.
Pleural Effusion
Authors: Mendez Michael P.
Published: January 2019

This chapter guides the reader on the approach to pleural effusion in hospitalized patients.
Acute Diarrhea
Authors: Saini Sameer D. , Waljee Akbar K.
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of acute diarrhea in hospitalized patients.
Splenomegaly
Authors: Saini Sameer D. , Waljee Akbar K.
Published: January 2019

This chapter guides the reader on the diagnosis and management of splenomegaly in hospitalized patients.
Ascites
Authors: Saini Sameer D. , Waljee Akbar K.
Published: January 2019

This chapter guides the reader on the diagnosis and management of ascites in hospitalized patients.
Acute Kidney Injury
Authors: McGuire Matthew , Pennathur Subramaniam
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of acute kidney injury in hospitalized patients.
Nephrotic Syndrome
Authors: McGuire Matthew , Pennathur Subramaniam
Published: January 2019

This chapter guides the reader on the diagnosis and management of nephrotic syndrome in hospitalized patients.
Hyponatremia
Authors: McGuire Matthew , Pennathur Subramaniam
Published: January 2019

This chapter guides the reader on the diagnosis and management of hyponatremia in hospitalized patients.
Hypernatremia
Authors: McGuire Matthew , Pennathur Subramaniam
Published: January 2019

This chapter guides the reader on the diagnosis and management of hypernatremia in hospitalized patients.
Hypokalemia
Authors: McGuire Matthew , Pennathur Subramaniam
Published: January 2019

This chapter guides the reader on the diagnosis and management of hypokalemia in hospitalized patients.
Hyperkalemia
Authors: McGuire Matthew , Pennathur Subramaniam
Published: January 2019

This chapter guides the reader on the diagnosis and management of hyperkalemia in hospitalized patients.
Approach to Fever
Authors: Shuman Emily
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of fever in hospitalized patients.
Fever and Rash
Authors: Shuman Emily
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of fever and rash in hospitalized patients.
Fever of Unknown Origin
Authors: Shuman Emily
Published: January 2019

fThis chapter guides the reader on the general principles, clinical manifestations, and management of fever of unknown origin in hospitalized patients.
Acute Rheumatic Fever
Authors: Shuman Emily
Published: January 2019

This chapter guides the reader on the diagnosis and management of acute rheumatic fever in hospitalized patients.
Infective Endocarditis
Authors: Shuman Emily
Published: January 2019

This chapter guides the reader on the diagnosis and management of infective endocarditis in hospitalized patients.
Complications of HIV Infection
Authors: Shuman Emily
Published: January 2019

This chapter guides the reader on the approaches and considerations in managing complications of HIV infection.
Pulmonary Disease in HIV-Infected Patients
Authors: Shuman Emily
Published: January 2019

This chapter guides the reader on the diagnosis and management of pulmonary disease in HIV-infected patients.
Neurologic Manifestations of HIV Disease
Authors: Shuman Emily
Published: January 2019

This chapter guides the reader on the general principles and management of neurologic manifestations in HIV disease.
Pancytopenia
Authors: Bixby Dale
Published: January 2019

This chapter guides the reader on the diagnosis and management of pancytopenia in hospitalized patients.
Thrombocytopenia
Authors: Devata Sumana
Published: January 2019

This chapter guides the reader on the diagnosis and management of thrombocytopenia in hospitalized patients.