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Biomedical subjects

L B Lehman

Publications and source records attributed to L B Lehman.

At least 19 recordsLinked to original sources
PubMed1991

Of dead brains, living wills, and autonomy.

Recent court decisions have clarified many important bioethical and medicolegal issues. Brain death, living wills, and patient autonomy are being defined by the rulings.

Adult↗
PubMed1991

Neurologic complications of alcoholism.

The neurologic effects of alcohol on physical and mental function vary in severity and reversibility. When primary care physicians recognize and treat these conditions, recovery from alcoholism is made easier for patients and their families. Dr Lehman summarizes the central nervous system effects of alcohol abuse and makes recommendations for diagnosis and treatment during both acute intoxication and withdrawal.

Alcoholism↗
PubMed1991

Successful management of an adult lightning victim using intracranial pressure monitoring.

Serious central nervous system injuries after lightning strikes are fortunately rare. Optimal neurological and neurosurgical management has not been firmly established. We describe the successful neurological resuscitation and critical care management using intracranial pressure monitoring of an adult who sustained a lightning strike. The role of intracranial pressure monitoring in this setting is discussed.

Coma↗
PubMed1990

Cervical spondylotic myelopathy. A diagnostic challenge in aging patients.

Cervical spondylotic myelopathy remains a diagnostic and therapeutic challenge to physicians in a number of specialties. The diagnostic evaluation consists of a comprehensive neurologic and orthopedic examination supplemented by appropriate neurophysiologic and neuroradiologic studies. Currently, magnetic resonance imaging and myelography with computed tomography are the imaging methods of choice. Conservative therapy helps one half of patients with cervical spondylotic myelopathy, and surgery may benefit up to three quarters. Although this condition is entirely benign pathologically, its clinical manifestations appear malicious and deleterious. As new diagnostic and therapeutic techniques are refined, management of the disease should become even more successful.

Aged↗
PubMed1990

Intracranial pressure monitoring and treatment: a contemporary view.

ICP monitoring and recording provide another important parameter in the intensive care management of many critically ill patients and have been shown to augment the clinical neurologic examination, particularly in comatose patients suffering from severe head trauma, toxic and metabolic encephalopathies, massive cerebral infarctions, and many other central nervous system insults. Once considered an experimental tool restricted exclusively to sophisticated specialty neurosurgical and neuroanesthesia intensive care units, this straightforward and rapidly evolving technology is readily available and relatively easy to apply as a bedside intensive care procedure for selected patients. Many indications of particular interest to emergency physicians are indicated. The precise role of ICP monitoring in the prehospital management of patients has not been established. At this time, the conventional treatments for presumed ICP elevations, as outlined, are the mainstays of prehospital care. ICP monitoring may have a role in more extended or lengthy interinstitutional transfers of some critically ill patients.

Emergency Service, Hospital↗
PubMed1990

Closed head injuries in athletes.

Nervous system sports-related injuries constitute a major source of serious morbidity and mortality in athletes. In particular, acute closed head injuries account for some 6000 potentially preventable deaths and literally millions of episodes of less severe head injuries each year. The long-term significance of chronic head injuries resulting from repetitive blows to the brain is only now being fully appreciated. Similarly subtle neuropsychological changes are being increasingly recognized resulting from milder head injuries. Although head injuries are almost inevitable and unavoidable sequelae of most contact and competitive sports, much can and should be done to reduce the serious acute and chronic neurologic complications inherent in these activities. Prevention of catastrophic sports injuries by careful preseason examination, education, training, and conditioning, and ongoing counseling of the athlete is of paramount importance. The use of carefully fitted protective headgear, and avoidance of maneuvers that may directly result in serious head injuries are also key. The immediate evaluation, evacuation, and triage of the injured athlete must take place carefully and expeditiously. Skillful, experienced, and compassionate definitive care must then ensue. In the long term, the complications and analysis of accurate statistical data on the magnitude of sports injuries in general, and nervous system involvement in particular, must be studied. Presently, only a few sports have accumulated such data, such as in the National Football Head and Neck Injury Registry. In the final analysis, it is the cooperative responsibility of the medical and athletic communities to strive to reduce these tragic injuries.

Athletic Injuries↗
PubMed1989

Paraparesis during myelography associated with a ruptured thoracic intervertebral disc.

Serious or permanent neurological complications following routine lumbar myelography are uncommon in clinical practice. We describe the sudden and dramatic onset of a symmetrical dense paraparesis in a patient after an uneventful lumbar puncture performed during myelography. A herniated thoracic intervertebral disc was subsequently diagnosed and successfully treated.

Humans↗
PubMed1989

Preventing nervous system sports injuries.

Physical fitness and sports remain integral components of overall good health and a cornerstone of preventive medicine. When performed safely, under adequate supervision, and with appropriate protective gear, most of these activities are enjoyable, healthful and psychologically gratifying. When not performed safely by trained athletes, these same activities can be treacherous, injurious and permanently disabling. The goals of this article are to review and describe low-risk and high-risk sports activities. A number of underlying mechanisms responsible for a particularly alarming amount of morbidity in sports will be reviewed. Fundamentals of the diagnosis and emergency treatment of many injuries will be discussed. Most important, a series of steps to be taken to improve upon sports safety will be outlined. The responsibility for the prevention, diagnosis, evaluation and management of patients with nervous system sports injuries is one shared by participating athletes, coaches, trainers and the entire health care community.

Athletic Injuries↗
PubMed1988

Head trauma in the elderly.

Head trauma in the elderly is a major source of morbidity and mortality in this population. Prevention of the primary injury is ideal and requires that the primary care physician understands the neurosensory changes of aging. Failing prevention, rapid diagnosis and efficient management of the traumatized patient are of greatest concern. With the increasing life expectancy and improved overall healthcare in the United States, greater numbers of elderly patients will be seen for traumatic injuries. All physicians dealing with older patients would be wise to become familiar with the presentations, underlying causes, neurodiagnostic evaluation, and early management of head trauma in these patients.

Aged↗