In this issue, Guest Editor Joseph Safdieh, MD, FAAN, has assembled an expert group of authors to assist us in our diagnosis and management of a wide variety of the neurologic syndromes that can occur because of medical illness.
Neurologic disorders commonly occur in the context of— and as a consequence of—an underlying (diagnosed or as-yet-undiagnosed) systemic illness, and patients with these disorders are ubiquitously encountered in the daily practice of both inpatient and outpatient neurology. In this issue of CONTINUUM, Guest Editor Joseph Safdieh, MD, FAAN, Associate Professor of Neurology and Vice Chair for Education at Weill Cornell Medical College (and a member of the CONTINUUM Editorial Board), has assembled an expert group of authors to assist us in our diagnosis and management of a wide variety of the neurologic syndromes that can occur because of medical illness. Dr Safdieh also carefully planned for this issue to cover as many systemic topics as possible within the CONTINUUM curriculum while avoiding redundancy by excluding other important upcoming topics within this theme (such as paraneoplastic disorders, which will be covered in the 2015 Neuro-Oncology issue).
The issue begins with a thorough review by Dr Vera Bril from the University of Toronto on the current state of the art with regard to the diagnosis and management of the variety of peripheral nervous system manifestations that can occur because of diabetes. Next, Dr Jinny Tavee, from the Lerner College of Medicine and the Cleveland Clinic, and Dr Barney Stern, from the University of Maryland, provide their extensive expertise in management of patients with neurosarcoidosis to inform us in our diagnosis and management of this multifaceted illness. Dr Makoto Ishii, from Weill Cornell Medical College, provides a clear overview of not only the neurologic complications of the other endocrine disorders besides diabetes, but also includes a concise and helpful overview and summary for the neurologist about these endocrine disorders themselves.
Dr Neeraj Kumar, from the Mayo Clinic Rochester, shares his expertise in nutritional deficiencies as he thoroughly reviews the diagnosis and management of the many neurologic complications that may occur subsequent to bariatric surgery and that are relevant to any neurologic patient presenting with a possible nutritional deficiency. Next, also from the Mayo Clinic Rochester, Drs Sara Hocker and Eelco Wijdicks provide a very helpful review of the central and peripheral neurologic complications that can occur in the septic patient, a commonly encountered clinical scenario, particularly when we are asked to consult in the medical intensive care unit. Dr Steven Karceski, from Weill Cornell Medical College, discusses the medical syndromes and medications that can lead to acute symptomatic seizures that we need to keep in mind, particularly as we consult on patients with new-onset seizures in the emergency department and the medical floors.
Drs James Noble and Louis Weimer, from Columbia University, extensively review the diagnosis and management of the many central and peripheral nervous system complications (both acute and chronic) that can occur because of, or in association with, alcoholism. Continuing this theme, Dr John Brust, from Columbia—and a previous Guest Editor of an entire CONTINUUM issue (Neurologic Complications of Substance Abuse, Volume 10, Issue 5, October 2004) devoted to this topic—reviews and updates us on the neurologic complications of the variety of recreational drugs our patients may be exposed to and that we need to keep in mind as we evaluate patients of any age or socioeconomic status.
From the Hospital for Special Surgery in New York, Dr Jonathan Goldstein reviews the important and multifaceted central and peripheral neurologic complications that may occur in the setting of the rheumatologic disorders (particularly rheumatoid arthritis, systemic lupus erythematosus, and Sjo¨gren syndrome). In the final review article of this issue, Dr Halina White, from Weill Cornell Medical College, reviews the neurologic manifestations of the commonly encountered disorders of acute or chronic liver disease, including a discussion of Wilson disease as an important and treatable disorder that may initially be diagnosed by the neurologist and whose treatment options are evolving.
In this issue’s Ethical Perspectives section, Drs Joshua Willey and Benjamin Tolchin, from Columbia University, explain and analyze the complex ethical considerations that our colleagues who are involved in transplantation decisions often grapple with, using a case example of a patient with severe hepatic encephalopathy due to acute liver failure from intentional overdose of acetaminophen. In the Practice section, Drs Jessica Lee and Anna Hohler, from the University of Kentucky School of Medicine, and the Boston University School of Medicine, respectively, use an illustrative case example to remind us of the many challenges and opportunities in improving communication as we provide interdisciplinary care and neurologic consultation to our patients in the current (including the electronic health record [EHR]) era. Finally, Dr Allison Weathers and Ms Amy Premetz, from Rush University Medical Center, discuss special considerations involved in coding for patients with neurologic complications of systemic disease, including a discussion of the impact of the EHR on coding.
As with every CONTINUUM issue, a number of opportunities exist for CME. If you need to earn credits specifically approved by the American Board of Psychiatry and Neurology (ABPN) for self-assessment, submit your answers to the multiple-choice questions in the Self-Assessment Pretest that were crafted by Drs Eduardo Benarroch and Joanne Lynne before you read the issue; review your results to better tailor your learning needs; and then complete the Postreading CME Test after reading the issue. By doing so you may earn up to 12 AMA PRA Category 1 CME CreditsTM toward self-assessment. Alternatively, you may wish to receive credits toward CME only, in which case, reading the issue and submitting the Postreading CME Test will allow you to earn up to 10 AMA PRA Category 1 CME Credits. The Patient Management Problem, written by Dr Safdieh, involves the management of a particularly unlucky but very illustrative case of a 72-year-old man whose complicated neurologic course overlaps many of the topics discussed in this CONTINUUM issue. By following his case and answering multiple-choice questions corresponding to important diagnostic and therapeutic decision points along his disease course, many of the teaching points discussed in the previous articles will be reinforced, and you will have the opportunity to earn up to 2 AMA PRA Category 1 CME Credits.
My deepest thanks to Dr Safdieh and his remarkable team of clinical expert authors for putting together this multifaceted volume, covering so much material that will help us provide the most up-to-date and informed management and recommendations to our many patients with neurologic complications of systemic diseases.
—Steven L. Lewis, MD, FAAN