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Biomedical subjects

M P Earnest

Publications and source records attributed to M P Earnest.

At least 19 recordsLinked to original sources
PubMed1996

Report of the AAN Task Force on access to health care: the effect of no personal health insurance on health care for people with neurologic disorders. Task Force on Access to Health Care of the American Academy of Neurology.

Access to medical care is limited for people with no health insurance. In the United States, an estimated 31 to 41 million people under age 65 have no health insurance. Among the uninsured, an estimated 340,000 new cases of neurologic disorders occur annually. The Task Force on Access to Health Care of the Academy analyzed data from four nationwide health surveys to describe the national population of people with neurologic disorders (PWND) by insurance status and to examine access to care, utilization of services, and expenses for health care of PWND. Health insurance status significantly affected access to and utilization of health care services. Compared with insured PWND, the uninsured less often had a usual source of medical care, saw a particular doctor, or visited a neurologist. The uninsured had fewer doctor's office visits and fewer hospital admissions than privately insured PWND. In the doctor's office they got fewer tests, fewer referrals for therapies, but more medications. In the hospital they received more diagnostic and therapeutic procedures overall, but those with cerebrovascular disease received fewer angiograms and endarterectomies. National health care reform may improve access to care for PWND if they are equitably included in the new systems. However, neurologists should assertively advocate for the needs of PWND to have adequate insurance and appropriate access to neurologic consultations, neurologic tests, and treatments.

Adult↗
PubMed1993

Seizures.

Alcohol-related seizures have been recognized since the time of Hippocrates. Most such seizures are related to acute abstinence from chronic, high doses of alcohol use. Increasing use of illicit drugs, especially cocaine, has dramatically increased the incidence of acute drug-toxicity-related seizures. In cases of alcohol- or drug-related seizures, occult structural and infectious causes must be ruled out. Treatment usually focuses on management of the alcohol or drug abuse. Rarely are anticonvulsants indicated.

Amphetamines↗
PubMed1992

Intracranial aneurysms in autosomal dominant polycystic kidney disease.

BACKGROUND AND METHODS: Intracranial aneurysms are a feature of autosomal dominant polycystic kidney disease, but their prevalence is uncertain. We studied 92 subjects with autosomal dominant polycystic kidney disease who had no symptoms or signs of any neurologic disorder. To determine the prevalence of intracranial aneurysms, we performed high-resolution computed tomography (CT) in 60 subjects, four-vessel cerebral angiography in 21, and both procedures in 11. RESULTS: Four of the 88 subjects in whom the radiologic studies were successfully completed had intracranial aneurysms (4 percent; 95 percent confidence interval, 0.1 to 9 percent), as compared with the prevalence of 1 percent reported for an angiographic study of the general population. Three of the four subjects had multiple aneurysms. Seven subjects for whom the results of CT studies were suspicious underwent cerebral angiography: two had aneurysms, and five had normal vascular structures that accounted for the suspicious results of tomography. Four subjects who had normal CT imaging studies also had normal angiographic examinations. Eight of the 32 subjects who underwent angiography (25 percent) had transient complications, as compared with 22 of 220 control subjects (10 percent) who did not have polycystic kidney disease (P less than 0.05). We could not identify any risk factor in these subjects that was related to the occurrence of aneurysm. CONCLUSIONS: Asymptomatic intracranial aneurysms appear to be more frequent in people with polycystic kidney disease than in the general population, although our 95 percent confidence interval includes the possibility of no difference. Because cerebral angiography is associated with increased morbidity in people with polycystic kidney disease, we recommend high-resolution CT as a screening test.

Adolescent↗
PubMed1992

Grand mal seizures temporally related to cocaine use: clinical and diagnostic features.

STUDY OBJECTIVES: To determine the appropriate diagnostic workup of the emergency department patient with an uncomplicated cocaine-related grand mal seizure. DESIGN SETTING: Retrospective analysis. A city and county ED with 45,000 selected visits per year. TYPE OF PARTICIPANTS: Thirty-seven patients with acute grand mal seizure after cocaine exposure were studied. All had historical or laboratory evidence of cocaine use and no history of prior seizure disorder. INTERVENTIONS: The diagnostic workup varied among patients. Most received computed head tomography (35), whereas fewer received-ECG (18), EEG (16), and lumbar puncture (six). MEASUREMENTS AND MAIN RESULTS: Thirty-three patients with an uncomplicated cocaine-related seizure had an unremarkable series of diagnostic tests. The four patients with remarkable neurologic manifestations were compared with the remainder of patients who were without neurologic abnormalities. Comparison of groups by route of cocaine intake revealed no significant difference in the time interval to seizure (P = .761). CONCLUSION: Diagnostic workup probably is not indicated for the patient experiencing a cocaine-related generalized seizure who will recover promptly and have a normal postictal examination.

Adolescent↗
PubMed1991

Access to health care. One neurologist's perspective.

Millions of residents of the United States have difficulty obtaining health care. Barriers impeding access to care include poverty, physical unavailability of health care services, absence of health insurance, and physicians unwilling to care for uninsured patients. Many patients do not successfully use health services because of educational, cultural, and language barriers. A major access barrier is lack of health insurance. Over 30 million people in the United States have none, the so-called medically indigent. Among them are over 3 million people with neurologic disorders. They have additional barriers to overcome because often they cannot work, cannot drive, have difficulty using public transportation, and have major cognitive and communication impairments. Medical and governmental bodies are debating solutions to the health care access crisis. Physicians should actively participate in this national debate. Neurologists should address the special needs of patients with neurological disorders.

Health Services Accessibility↗
PubMed1990

Access to health care in the United States: barriers for neurologic patients, challenges for neurologic physicians.

Approximately 34 million people in the United States have no health insurance. Up to 80 million people have insurance inadequate to provide care for severe or long-term illness (the underinsured). In 1986, an estimated 1 million persons in the US could not obtain needed health care for financial reasons, and another 18.8 million had difficulty obtaining care. There probably are 3.2 million people with neurologic disorders among the 34 million uninsured, and more among the underinsured. Those patients probably have difficulty obtaining health care, including neurologic consultations, laboratory tests, and radiologic procedures. Congress and many state legislatures are considering various proposals to address the problems of the un- and underinsured. Several national medical professional societies have developed programs to improve access to care for their patients. The American Academy of Neurology Task Force on Access to Health Care is studying access to care for neurologic patients and will recommend a course of action to the Academy. The Task Force welcomes suggestions concerning appropriate steps to improve access to health care for patients with neurologic disorders.

Delivery of Health Care↗
PubMed1989

Stroke in patients with fusiform vertebrobasilar aneurysms.

We studied seven patients with brainstem infarction and large fusiform vertebrobasilar (VB) aneurysms to clarify the clinical, radiologic, and pathologic features. All presented with pontine infarcts; one also had a cerebellar infarct. VB TIAs preceded brainstem infarction in four patients. Angiography and CT documented VB fusiform aneurysmal dilatation. Four had intraluminal thrombi and one had severe basilar artery stenosis. Two distinct clinical pictures emerged: unilateral pontine infarcts with favorable outcome, presumably related to obstruction of a pontine penetrating artery at its origin from the posterior wall of the aneurysmal basilar artery, and major fatal bilateral pontine infarcts from basilar artery occlusion. Two patients came to autopsy. One had thrombus in the dilated basilar artery and a posterior cerebral artery branch embolus with hemorrhagic occipital infarction; the other had basilar artery thrombus with aneurysmal rupture and subarachnoid hemorrhage. Fusiform VB aneurysms caused brainstem stroke by intraluminal thrombus, local embolism, atherostenosis, and obstruction of paramedian penetrating arteries. Subarachnoid hemorrhage is an uncommon complication.

Adult↗
PubMed1988

Pentoxifylline in acute nonhemorrhagic stroke. A randomized, placebo-controlled double-blind trial.

The efficacy and safety of pentoxifylline were assessed in 297 adult patients with ischemic stroke in a multicenter, double-blind, randomized and placebo-controlled trial. Treatment was started within 12 hours after the stroke onset. Study medication was administered intravenously continuously (16 mg/kg/day, maximum 1,200 mg/day) for 3 days and per os (400 mg t.i.d.) for the remainder of 28 days. Demographic data were comparable, and functional impairment and mortality (pentoxifylline 12%, placebo 10%) were not different between the two groups. Neurologic deficit scores improved from baseline admission scores during the 4-week study in both groups but did not differ between groups at admission or throughout the study except during the first few days when the consciousness level (Days 1 and 2), motor function (Days 1 and 2), cranial nerve function (Days 1-4), and total neurologic deficit scores (Days 1 and 2) were better in the pentoxifylline group than in the placebo group, especially in a subset of patients with severe deficits at admission. Laboratory values and side effects were also comparable between groups. Our study indicates that pentoxifylline can be given safely in patients with acute ischemic stroke. Although pharmacologic effects were present during the first few days, the clinical benefits were small and not sustained.

Acute Disease↗
PubMed1988

Intracranial lesions shown by CT scans in 259 cases of first alcohol-related seizures.

We obtained CTs in 259 patients with a first alcohol-related convulsion. Each subject had generalized convulsions, recent abstinence from alcohol abuse, and no obvious etiology for seizures other than alcohol withdrawal. Patients with only focal seizures, major head injury, coma, or a severe toxic-metabolic disorder were excluded. We recorded history and signs of minor head injury, presence of headache, level of consciousness, neurologic signs, routine medical examination findings, and subsequent clinical course. Sixteen patients (6.2%) had intracranial lesions on CT. Eight had subdural hematomas or hygromas, two had vascular malformations, two had neurocysticercosis, and one each showed a Berry aneurysm, possible tumor, skull fracture with subarachnoid hemorrhage, and probable cerebral infarction. In ten cases (3.9%), clinical management was altered because of the CT result. History or signs of minor head trauma, headache, level of consciousness, or focal neurologic signs did not significantly correlate with CT abnormality.

Adult↗
PubMed1987

Impact of computed tomography on stroke management and outcome.

Computed tomographic (CT) scanning is effective to show cerebrovascular lesions causing the symptoms and signs of a stroke. However, CT scanning may not change stroke morbidity or mortality. A retrospective medical chart review compared 93 patients with cerebral infarctions treated before CT scanning was available with 92 patients who had undergone scanning. The two groups showed no difference in type of treatment given or in subsequent severity of disability, mortality, or discharge destination. However, the post-CT group had a significant reduction in the total number of neurodiagnostic procedures, but estimated total charges for all diagnostic procedures were not significantly reduced. Computed tomographic scanning may not be beneficial for stroke patients who have a clear history of acute onset, are alert, and have no findings indicating an intracranial mass.

Aged↗
PubMed1986

Testing for apnea in suspected brain death: methods used by 129 clinicians.

Neurologists in Colorado and California were asked the methods they use to test for apnea when determining brain death. Most (65.1%) of 129 respondents simply observed the patient for respiratory efforts for 3 minutes or less while off the ventilator. Only 22.5% measured arterial carbon dioxide, 12.4% used a published recommended rigorous method for testing for apnea, and 11.6% did not test for apnea. Clinicians in full-time academic practice more frequently used the rigorous method. The data indicate that methods used most often in the communities surveyed are less rigorous than published guidelines.

Brain Death↗
PubMed1984

Generalized seizures and cocaine abuse.

Cocaine is a commonly abused drug. We report three patients who had generalized seizures immediately following intravenous injection of cocaine. Previous experimental and clinical literature have documented a relationship between cocaine and convulsions. The rising incidence of cocaine use may be associated with a rising incidence of cocaine-associated seizures.

Adult↗
PubMed1984

Brain infarction and hemorrhage in young and middle-aged adults.

Of 131 young (17 to 44 years) and middle-aged (45 to 55 years) adults who had brain infarction or hemorrhage, the most common etiologic factors were rheumatic heart disease, migraine and oral contraceptive use among the younger group. In contrast, atherosclerotic, hypertensive and diabetes-associated cerebrovascular were the most common causes in the middle-aged group. Patients who have a stroke before age 45 should have prompt, complete laboratory and radiologic testing to define a possible treatable cause.

Adolescent↗
PubMed1983

Complications of intravenous phenytoin for acute treatment of seizures. Recommendations for usage.

Intravenous (IV) phenytoin sodium in small volumes of normal saline was administered in a municipal hospital emergency department for treatment of convulsions in 200 patients. A total of 72 complications developed in 51 patients. Twenty-nine complications were burning pain at the IV site, and 36 were related to excessive total dose of phenytoin and resultant drug intoxication. Seven other patients had cardiovascular complications, including hypotension and arrhythmias. These seven complications were related to high concentrations of drug administered at a rapid rate. Both the IV and cardiovascular complications promptly resolved when the IV rate was slowed or temporarily stopped. No patient died, and none was hospitalized because of a complication. The authors propose specific guidelines for the safe administration of IV phenytoin.

Adolescent↗
PubMed1982

Neurologic manifestations of podophyllin toxicity.

A young woman presented with podophyllin intoxication following topical application of podophyllin resin to genital condylomata acuminata. The disorder was marked by hallucinatory psychosis, bone marrow depression, and mild hepatic dysfunction. The psychosis and systemic disturbances resolved within 3 weeks, but were followed by autonomic and sensorimotor peripheral neuropathy. This case illustrates the transient central neurotoxicity and persistent peripheral neurotoxicity of podophyllin.

Adult↗
PubMed1980

Long-term survival and neurologic status after resuscitation from out-of-hospital cardiac arrest.

Thirty-eight survivors from among 117 patients hospitalized after out-of-hospital cardiac arrest were evaluated approximately 3 1/2 years later. Twenty patients were living; 18 had died. Fifty-three percent had resumed independent social activities, but only 32% had returned to work. Eight of 14 patients tested were normal on limited neuropsychologic tests. Satisfactory long-term outcome was associated statistically with the patient's being awake on admission or awakening to follow simple commands within 2 days, and with good neurologic status at the time of discharge from the hospital. None of nine patients with poor neurologic function at discharge subsequently resumed working or independent living.

Follow-Up Studies↗