- Insomnia in adults
Essential Evidence Topics, 4-Jan-2023
Overall Bottom Line: Cognitive behavioral therapy is the recommended initial treatment for patients with chronic insomnia. Sedative hypnotics (zolpidem, ramelteon, zaleplon, eszopiclone) as well as dual orexin receptor antagonists (lemborexant, suvorexa - Intellectual disabilities (adult)
Essential Evidence Topics, 31-Dec-2021
Overall Bottom Line: In caring for adults with intellectual disability (ID), assess their capacity for decision making using a tool adapted to the patient, consider their need for accommodations and supports, and identify with them a support person who ca - Intracerebral hemorrhage
Essential Evidence Topics, 24-Dec-2021
Overall Bottom Line: Any patient with aphasia/focal neurological defect should be considered for stroke diagnosis. Urgent CT or MRI should be ordered to distinguish between ischemic and hemorrhagic stroke. Intracranial pressure (ICP) should be promptl - Meningitis (adult)
Essential Evidence Topics, 24-Jun-2022
Overall Bottom Line: Suspect meningitis in patients with fever, headache, neck stiffness, neurologic symptoms, and/or altered consciousness. It is very unlikely in persons without fever, altered mental status and neck stiffness. Obtain a CBC, blood cult - Meningitis (child)
Essential Evidence Topics, 10-Feb-2023
Overall Bottom Line: The meningococcal, pneumococcal, and H. influenza type B vaccines are safe and prevent meningitis due to those pathogens. The initial treatment and management of meningitis in infants and children depends on early suspicion and recog - Morton's neuroma
Essential Evidence Topics, 9-Aug-2021
Overall Bottom Line: Patients with Morton's neuroma typically present with interdigital plantar foot pain that becomes worse with walking. They also have pain with pressure to the intermetatarsal space and may have a Mulder's click on exam. Diagnosis is - Motion sickness
Essential Evidence Topics, 23-Jan-2023
Overall Bottom Line: Any combination of the following symptoms after exposure to motion stimulus (e.g., automobile, airplane, boat, space ship) strongly suggests motion sickness: nausea, vomiting, pallor, cold sweats, hypersalivation, hyperventilation, an - Multiple sclerosis
Essential Evidence Topics, 26-Jul-2021
Overall Bottom Line: The diagnosis of multiple sclerosis (MS) is made by establishing the occurrence of multiple episodes of neurologic dysfunction that are disseminated in time and location within the central nervous system (see ). Acute attacks (episo - Myasthenia gravis
Essential Evidence Topics, 10-Jul-2021
Overall Bottom Line: No universally accepted and validated diagnostic criteria exist for myasthenia gravis (MG). The diagnosis is made when patients have fatigability and weakness of muscles and have abnormal diagnostic tests. Anticholinesterase drugs s - Myelomeningocele
Essential Evidence Topics, 23-Nov-2021
Overall Bottom Line: Ninety-five percent of myelomeningoceles are diagnosed prenatally with the combination of ultrasound and alpha-fetoprotein on maternal serum. Patients are prone to neurogenic bladder and pathologic bone fractures. Periconceptual fol - Narcolepsy
Essential Evidence Topics, 24-Jun-2022
Overall Bottom Line: The diagnosis of narcolepsy can be made solely on a history of excessive daytime sleepiness and cataplexy. If there is no cataplexy, order an overnight polysomnogram followed by a multiple sleep latency test. A decreased CSF hypoc - Neural tube defects
Essential Evidence Topics, 1-Nov-2022
Overall Bottom Line: Low-risk women should take 400 μg of folic acid daily for at least 1 month prior to conception to reduce the rate of neural tube defects (NTDs) by 70%; high-risk women should take 4 mg of folic acid daily for at least 1 month prior to - Neuroleptic malignant syndrome
Essential Evidence Topics, 25-Sep-2021
Overall Bottom Line: Neuroleptic malignant syndrome (NMS) is a rare and potentially fatal reaction to a neuroleptic or antipsychotic drug, or to the withdrawal of a patient from dopaminergic medication. Patients typically present with fever, altered men - Normal pressure hydrocephalus
Essential Evidence Topics, 10-Jul-2021
Overall Bottom Line: Suspect NPH in any adult patient presenting with an insidious onset of gait disturbance, cognitive impairments, and/or urinary incontinence. MRI of the head, with or without contrast, is the recommended initial imaging study for pat - Optic neuritis
Essential Evidence Topics, 8-Apr-2021
Overall Bottom Line: Suspect optic neuritis in a young patient (especially a white female) with visual loss, pain with eye movements, and loss of color vision. Obtain a brain and orbits MRI with gadolinium to assess for areas of demyelination. If the - Pain management (chronic non-malignant)
Essential Evidence Topics, 17-Mar-2023
Overall Bottom Line: There is no test to measure pain. Imaging correlates poorly with symptoms. The patient’s report of pain is your guide. Consider the safest therapies first: acetaminophen, cognitive behavioral therapy, and exercise. Effective optio - Parkinson disease
Essential Evidence Topics, 10-Feb-2023
Overall Bottom Line: The cardinal physical signs of Parkinson disease (PD) are distal resting tremor, rigidity, bradykinesia, and asymmetric onset. Levodopa (L-dopa) is the primary treatment, but its long-term use is limited by motor complications and d - Peripheral neuropathy (diagnostic approach)
Essential Evidence Topics, 24-Mar-2023
Overall Bottom Line: Consider peripheral neuropathy in patients with sensory symptoms such as numbness, tingling, burning or pinprick-like pain. With a distal-symmetric pattern of symptoms and decreased or absent ankle reflexes and decreased distal sens - Progressive multifocal leukoencephalopathy
Essential Evidence Topics, 11-Oct-2022
Overall Bottom Line: Suspect progressive multifocal leukoencephalopathy (PML) in immunocompromised patients with gait disorder, limb weakness, visual symptoms, altered mental status, or other neurologic symptoms. If clinically suspected, the diagnosis - Regional pain syndrome
Essential Evidence Topics, 19-Jul-2022
Overall Bottom Line: Complex regional pain syndrome (CRPS) is a rare disorder that typically develops four to six weeks after direct trauma, such as an injury or surgery; pain is usually out of proportion to the inciting injury. The diagnosis is clinica
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