I remember years ago being told that a huge percentage of patients present to their physicians with symptoms that are either neurologic or dermatologic. Experience has confirmed the frequency of neurologic symptoms irrespective of the underlying primary condition. In this issue of CONTINUUM, guest editor José Biller has chosen a potpourri of subjects from a huge array of possibilities that illustrate the breadth and depth of knowledge that a neurologist must possess in order to approach patients with primarily non-neurologic ailments.
Drs Bassel Raad and Cathy Sila appropriately kick off the issue with a discussion of the cardiac manifestations of neurologic disorders. This is the converse of the more familiar direction of the two-way street between the heart and the nervous system, as neurologists are, of course, very cognizant of the potential of cardiac disorders to influence neurologic function. Continuing the vascular theme, Dr Michael Schneck and Dr Biller review deep venous thrombosis and pulmonary embolism in neurologic and neurosurgical disease. While neurologists are well aware of these conditions, they will benefit from a better understanding of the new developments related to pathogenesis and treatment that are featured in this article.
Although the tragedy and drama of the neurologic picture associated with full-blown uremia is mostly part of medical history, renal disease continues to be characterized by a variety of neurologic manifestations affecting both the central and peripheral nervous systems. In addition, the widespread use of dialysis and renal transplantation has created other situations that mandate neurologic attention. Dr Kevin Barrett assures that we are up to speed on this important subject.
The next two articles in this issue relate to conditions that lie primarily in the province of hematologists. First, Drs Christine Holmstedt and Robert Adams address the neurologic complications of hemoglobinopathies, particularly sickle cell disease. This subject should particularly command the attention of pediatric neurologists, but, with improvements in the care of children with sickle cell disease, adult neurologists also increasingly encounter such patients. Following this, Drs Matthew McCoyd and Gregory Gruener review the neurologic aspects of lymphoma and leukemia. These conditions, whose distinction has blurred, can involve the central or peripheral nervous system directly or indirectly. You will be better prepared to encounter these challenging patients after reading this article. Continuing this neoplastic theme, Dr Edward Dropcho examines the neurologic side effects of chemotherapeutic agents. This area of medicine becomes increasingly complex with the steady addition of novel drugs, and it is important for us to keep pace with these advances.
Parasitic diseases, including malaria, are not usually in the forefront of Western neurologists' thoughts. However, as international travel has become commonplace, consideration of these entities has become increasingly important. Dr Gustavo Román brings us up-to-date on this subject.
A large number of hospital neurologic consultations involve surgical patients. Often the question arises about the possible role of anesthesia in the patient's condition. In his article on the neurologic complications of anesthesia, Dr Alejandro Rabinstein examines issues of anesthesia in both patients with neurologic conditions and in those undergoing surgery for other reasons. These situations are often very complex, but you will be much better equipped to understand them after perusing this article.
Other features of this issue complement the information conveyed in the review articles. Patient autonomy is the touchstone of bioethics in the Western world. But what voice should children, and especially adolescents, have in determining their care? Drs Janine Penfield Winters and Pedro Weisleder tackle this important question in their article focused on ethical perspectives in neurology. Dr Steven Lewis, Associate Editor of CONTINUUM, contributes an important discussion of the common situation in which the neurologist is asked to provide consultation for a patient undergoing non-neurologic surgery. Dr Laura Powers provides a table of useful codes related to the subject matter of this issue.
This issue offers an additional way of earning CME, with the introduction of a new iteration of CONTINUUM's Patient Management Problem. Now you may earn up to 2 AMA PRA Category 1 Credits™ by completing the questions on this extended case in each issue. This simplified opportunity replaces the previously offered Quintessentials modules, which were available just twice a year. In this issue, Drs Biller and Schneck help you consolidate your knowledge of several of the topics by working through the Patient Management Problem.
Finally, Drs Douglas Gelb and D. Joanne Lynne have contributed the multiple-choice questions that will be so valuable in helping you evaluate your understanding of the topics covered in this issue. As always, you may earn up to 10 AMA PRA Category 1 Credits™ by completing these questions.
Many of our readers have already been completing CONTINUUM's multiple-choice questions online at www.aan.com/continuum/cme. In order to comply with changing requirements for the American Board of Psychiatry and Neurology's Maintenance of Certification program, CME participants will now receive a peer comparison report with their results. In order to provide these reports, CME must now be completed online, and we are no longer including the faxable scorecard at the back of each issue. Instead, you will find updated instructions for completing CME on page 171, along with an optional tally sheet that can be used to answer the questions while reading the print issue that we hope will make it easier to submit responses later online.
Our readers may notice some additional changes in this issue, in addition to the new opportunity to gain additional CME credits by completing the Patient Management Problem. We are very proud of the content and presentation of CONTINUUM articles and have made no changes to these. However, we have made some alterations to the cover page and table of contents that we believe will enhance readers' ability to access the material they want to review.
As always, we welcome your comments and suggestions.
I am sure you will appreciate the efforts of Guest Editor Biller and the other contributors in preparing this issue. They had many possible subjects from which to choose, and I believe they have selected wisely. Finally, I want to thank Associate Editor Lewis for his extra assistance in readying this issue for publication. Read. Think. Reflect. Enjoy.
-Aaron E. Miller, MD