Dr Neeraj Kumar has expertly crafted a weighty issue that will be of great benefit to us as we encounter patients with the large variety of disorders that occur in association with, or as a complication of, systemic (medical) disorders or their treatments.
At the risk of using another outdated (and to some, incomprehensible) pop-culture reference, I want to use the preface to this Continuum issue to discuss my editorial vision for Continuum that has had an obvious outcome in the increasing girth of our issues. There has, in fact, been an increase in the number of pages per issue under my tenure as editor-in-chief: from 2009 to 2012, the average number of pages per issue was 252, while from 2013 to 2016, subsequent to my becoming editor, the average number of pages per issue grew to 312, a 24% increase.
This has been purposeful, primarily due to my editorial intention to provide more articles per issue so that each issue is as inclusive as possible of the information we each need as we see our many patients. In addition, it is my intent to ensure that the actual topic-based themes of each issue are as broad as possible (eg, the recent issue Muscle and Neuromuscular Junction Disorders rather than an issue devoted entirely to a single disorder or two within this subject area [eg, myasthenia gravis]) to allow for inclusion of as much information as possible in each 3-year Continuum curriculum cycle. The result of this editorial direction has been thicker individual issues while allowing for more breadth in the entire curriculum. In summary, I feel that by being more encompassing of many topics in the curriculum and including more (albeit sometimes large) individual articles per issue, Continuum becomes more useful as our source of practical office and bedside information regarding the many entities we see daily, even at the risk of diminishing the ease of cover-to-cover reading. On the other hand, while ensuring that the content is as thorough, diverse, and practical as possible, we will continue to seek practical solutions, such as making some content online only (eg, some Coding articles and supplementary content) and removing much of the previous redundancy in the CME pages of each issue.
In this issue, Guest Editor Dr Neeraj Kumar, Professor of Neurology at the Mayo Clinic, Rochester, Minnesota, has expertly crafted a weighty issue that will be of great benefit to us as we encounter patients with the large variety of disorders that occur in association with, or as a complication of, systemic (medical) disorders or their treatments. The issue begins with the article by Drs W. Oliver Tobin and Sean J. Pittock, who provide us with the most up-to-date information regarding the diagnosis and management of the evolving spectrum of autoimmune neurologic disorders. Next, Dr James P. Klaas reviews the many neurologic complications that can occur in our patients with cardiac and aortic diseases. Dr Michelle L. Mauermann then summarizes the neurologic complications of lymphomas, leukemias, and paraproteinemias and includes an overview of the diagnostic tests that inform our diagnosis of these disorders. Next, Dr Elliot L. Dimberg discusses the many rheumatologic disorders and their various potential associated neurologic complications and associations.
Dr Sara E. Hocker reviews the overlap between renal disease and disorders of the nervous system, including the conditions that affect both the renal and the nervous systems, the neurologic disorders that occur as a consequence of renal failure, and the neurologic complications of dialysis. Dr Ronald F. Pfeiffer then discusses the neurology of gastrointestinal disorders, highlighting the neurologic complications of inflammatory bowel diseases and Whipple disease and providing a clear and up-to-date discussion of the somewhat controversial concept of neurologic complications of celiac disease and gluten-related disorders.
Drs Robert N. Schwendimann and Alireza Minagar review the neurologic signs and symptoms that occur in patients with chronic and acute liver diseases. Dr Makoto Ishii next summarizes for the neurologist the various endocrine emergencies and their neurologic manifestations to broaden our differential diagnosis as we encounter patients with these signs and symptoms.
Dr Amy A. Pruitt next reviews the many neurologic complications that can, and often do, occur in patients who have undergone hematopoietic cell or solid organ transplantation. Dr Pruitt’s article is an example of a single article and single expert author providing all the important critical, relevant, and contemporary information that has previously filled an entire issue devoted to the topic. Dr Kumar next provides a truly encyclopedic and authoritative review of the many nutrients that, primarily in deficiency but some in excess, cause neurologic dysfunction. In the final review article of the issue, Dr Rodolfo Savica discusses the neurologic complications that can arise from environmental injuries, including thermal and electrical injuries and injuries related to aviation, altitude, and diving.
In this issue’s Ethical and Medicolegal Issues section, Dr Adam Webb discusses the ethical, legal, regulatory, and practical considerations regarding providers’ appropriate reporting and disclosing of medical errors to our patients. In the Practice Issues article, Drs Marcus Ponce de Leon and Anna D. Hohler provide an illustrative case example to review the safety considerations that are important for us to address during transitions of our patients’ care from inpatient to outpatient settings. In the Coding article (accessed online and on the Continuum apps), Dr Melissa Yu reviews diagnostic coding for medication-related poisoning and adverse effects.
As with every issue of Continuum, several opportunities exist for CME. After reading the issue and taking the Postreading Self-Assessment and CME Test written by Drs D. Joanne Lynn and Joseph E. Safdieh, you may earn up to 12 AMA PRA Category 1 Credits™ toward self-assessment and CME. The Patient Management Problem, written by Dr Hocker, describes the case of a 74-year-old man who develops restlessness, diaphoresis, tremors, and tachycardia in the postoperative period. By following his case and answering 12multiple-choice questions corresponding to diagnostic, management, and prognostic decision points along the course of his disorder, you will have the opportunity to earn up to 2 AMA PRA Category 1 CME Credits. Canadian participants can now claim a maximum of 14 hours toward the Self-Assessment Program (Section 3) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada and approved by the Office of Continuing Medical Education and Professional Development, University of Calgary, for completing the Postreading Self-Assessment and CME Test and the Patient Management Problem.
My sincere gratitude to Dr Kumar for his expert and meticulous stewardship of this issue. I would like to extend a similar thank-you to the authors who have so thoughtfully and carefully provided us with the benefit of their substantial expertise to guide us as we consult on the many patients with neurologic signs and symptoms that occur in the setting of systemic disease.
—Steven L. Lewis, MD, FAAN