CONTINUUM Lifelong Learning in Neurology最新文献

Objective: This article reviews neurologic complications associated with pregnancy and menopause, the influence of pregnancy and menopause on preexisting neurologic disorders, and the management of neurologic disorders during pregnancy and menopause.

Latest developments: Pregnancy and menopause can significantly impact neurologic health. Neurologic consultation regarding mode of delivery and anesthesia in patients with neurologic conditions is common, and very few neurologic conditions warrant cesarean delivery. Pregnancy is not a contraindication to acute ischemic stroke therapies or targeted temperature management after cardiac arrest. Both pregnancy complications and earlier age at menopause are associated with worse cognitive and cerebrovascular outcomes later in life. Hormone therapy is approved by the US Food and Drug Administration (FDA) for the treatment of vasomotor symptoms, osteoporosis prevention, and genitourinary syndrome of menopause, all of which are conditions that may be exacerbated by underlying neurologic conditions or their treatments. The American Academy of Neurology (AAN) Women's Neurology curriculum provides core competencies guiding neurologic care through the lens of sex and gender across the lifespan.

Essential points: Neurologic care during pregnancy and menopause requires careful attention to the dynamic interplay between hormonal transitions, evolving evidence on diagnostic and treatment safety, and the lifelong neurologic risks associated with neurologic complications of pregnancy.

The history and evolution of neurologic education span from Hippocratic concepts of the brain as the center of thought to modern innovations in digital and arts-based learning. Nineteenth-century pioneers established neurology as a distinct discipline, and contemporary advances in neuroimaging, genetics, and telemedicine continue to reshape both what and how we teach. In today's fast-paced clinical environments, educators can still be effective at teaching by using learner-centered strategies such as prebriefing, microteaching, and structured feedback frameworks like the One-Minute Preceptor and the SNAPPS (summarize, narrow, analyze, probe, plan, select) model. These methods are central to integrating high-impact instruction into demanding settings of clinical care. In addition to traditional methods of teaching, emerging modalities, including simulation, blended learning, and intentional team-based methods, further enhance diagnostic reasoning and interprofessional collaboration. Technology-driven innovations such as teleneurology, virtual reality, and gamification expand access and engagement, whereas arts and humanities approaches foster observation, empathy, and reflective capacity. Together, these strategies illustrate that even amid clinical demands, neurologic education can remain central to the work. By intentionally planning for and integrating education into our clinical care, we are preparing the next generation of neurologists to think critically, act compassionately, and teach adaptively.

Objective: This article discusses the pathophysiology, diagnosis, and management of neurologic complications of hepatic and gastrointestinal diseases.

Latest developments: Hepatic and gastrointestinal diseases such as hepatitis C, Wilson disease, inflammatory bowel disease, and celiac disease can initially present with neurologic symptoms, and neurologic syndromes may be the only manifestations of these conditions. Renal replacement therapy to decrease ammonia levels reduces mortality in patients with acute hepatic encephalopathy. Patients with chronic liver disease should be screened for covert cognitive changes to facilitate earlier initiation of ammonia-lowering therapies to decrease episodes of overt hepatic encephalopathy.

Essential points: Hepatic encephalopathy has different clinical presentations and management depending on whether it is due to acute or chronic liver disease. Rare complications of chronic liver disease include hepatic myelopathy and acquired hepatocellular degeneration. Gastrointestinal disorders and bariatric surgery can cause malabsorption, leading to vitamin and mineral deficiencies that can present as neurologic disorders such as neuropathy, myelopathy, and neuropsychiatric symptoms. Celiac disease can cause neurologic symptoms such as ataxia without associated gastrointestinal symptoms and should therefore be considered in the differential diagnosis of ataxia. Inflammatory bowel disease increases the risk of thrombotic events, and treatment of inflammatory bowel disease with tumor necrosis factor-α inhibitor therapy can cause central and peripheral nervous system inflammatory complications.

Objective: This article reviews the neurologic syndromes associated with substance use and suggests an approach for identifying and managing substance use disorders.

Latest developments: Substance use and overdose mortality, largely associated with fentanyl, rose sharply during the COVID-19 pandemic. Although recent data indicate modest decreases, current rates of overdose remain higher than before the pandemic. A wide variety of opioid-related toxic encephalopathies have been identified recently. Many novel psychoactive substances are unregulated and easily obtained online or in stores; several have been associated with seizures and other neurologic complications. The use of cannabis and hallucinogens is rising as more states legalize or decriminalize their use, and some studies suggest an independent association between cannabis use and ischemic stroke.

Essential points: Neurologists often encounter severe complications of substance use and have an opportunity to guide patients with substance use disorders toward treatment.

Objective: This article reviews the neurologic complications of common cardiac conditions and cardiac procedures.

Latest developments: During the past two decades, there has been an expansion of pharmacologic and procedural strategies to reduce stroke risk in patients with atrial fibrillation (eg, direct oral anticoagulants, left atrial appendage occlusion, and catheter ablation), patent foramen ovale (ie, percutaneous closure in selected patients), and those undergoing cardiac surgery (eg, embolic protection devices).

Essential points: Because stroke is the most common neurologic complication associated with cardiac disease, most newer pharmacologic agents and interventions have been designed to reduce the risk of cardioembolism, particularly from atrial fibrillation, the most prevalent cardiac arrhythmia. Common cardiac procedures such as coronary artery bypass grafting and valve replacement surgery can result in stroke and cognitive decline. Neurologists must be aware of the evolving evidence and tools to mitigate neurologic risks in these patients.

Objective: This article reviews the neurologic manifestations of endocrine disorders with respect to pathophysiology, clinical presentation, diagnosis, and treatment.

Latest developments: Studies have further elucidated the mechanisms by which endocrine disorders affect neurologic function, from peripheral nervous system manifestations of diabetes to central nervous system complications of pituitary apoplexy. Glucagon-like peptide-1 (GLP-1) receptor agonists used to treat obesity and diabetes are associated with an increased risk of developing diabetic lumbosacral radiculoplexus neuropathy and common peroneal neuropathy.

Essential points: Neurologic complications of endocrine disorders are diverse and may arise before systemic manifestations. Therefore, neurologists should consider endocrine diseases in the differential diagnosis of syndromes such as altered mental status, coma, peripheral neuropathy, and myopathy, and be familiar with the appropriate evaluation for these disorders.