Clinically unresponsive patients can have electroencephalographic (EEG) or magnetic resonance imaging (MRI) evidence of brain activation in response to spoken commands. A meta-analysis has reported that 14% of chronically unresponsive patients may have a dissociation between behavior and brain…
For decades, the comfort and safety of patients who are undergoing mechanical ventilation in the intensive care unit (ICU) entailed deep sedation, the nearly ubiquitous administration of opiates, and the liberal use of neuromuscular blockade. Concomitant with rising demands on ICU resources and…
Responding to a verbal command such as "move your hand" with the appropriate motor action shows that a person can hear instructions, understand their meaning, engage regions of the brain to plan volitional movement, activate the motor cortex, and contract the appropriate muscles. Patients who do…
Sedation is a component of the care of critically ill patients who are undergoing mechanical ventilation, but the appropriate choice of a primary sedative agent remains uncertain. Propofol and midazolam, which act mainly through pathways mediated by γ-aminobutyric acid, are widely used for this…
Multiple sclerosis is a progressive demyelinating, inflammatory, and neurodegenerative autoimmune disease that results in the formation of lesions in the protective layer around nerves in the brain and spinal cord. Goals in the treatment of patients’ disabling symptoms include reducing the…
Pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or [is] described in terms of such damage" when there is no physical derangement. The function of pain is to protect the body by making the organism aware of damaging events and to promote…
The existing paradigm for diagnosing infections relies on the physician formulating a differential diagnosis on the basis of a patient’s history, clinical presentation, and imaging findings, followed by serial laboratory testing. This traditional approach is particularly challenging for…
Huntington’s disease is a progressive neurodegenerative disorder inherited as an autosomal-dominant trait, with onset typically occurring in mid-adult life and characterized by movement disorder, cognitive decline, and behavioral symptoms. Huntington’s disease is caused by CAG trinucleotide repeat…
Since the Centers for Disease Control and Prevention (CDC) released its Guideline for Prescribing Opioids for Chronic Pain in 2016, the medical and health policy communities have largely embraced its recommendations. A majority of state Medicaid agencies reported having implemented the guideline in…
Huntington’s disease is a severe autosomal-dominant neurodegenerative disorder that involves chorea, cognitive decline, and psychological problems such as depression, delusions, and impulsive behavior. Nowhere are the manifestations more striking than around Lake Maracaibo in northwestern…
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information by sharing relevant background and reasoning with the reader (regular type). The authors’ commentary follows. Stage. A 29-year-old woman…
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