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From the Guest EditorAs a primary care physician in the South Metro area of Denver, I feel very fortunate to have a neurologic resource of the caliber of the Colorado Neurological Institute in my backyard. It is a privilege to have physicians from CNI write articles on neurologic topics that are targeted for primary care physicians. Such articles in this journal will help all physicians in primary care deal with a variety of common problems and complaints that they will face on a regular basis. Everyone who contributed to this journal did so in a most gracious manner, in much the same way that they are happy to answer questions about patients whenever they are asked. They have a passion for and a tremendous grasp of their particular field and are happy to share that knowledge and expertise. The articles in this journal are presented in a readable, understandable, and helpful fashion. When the primary care physician is faced with a patient with a movement disorder, in order to determine what disorder the patient has, and what treatment options are available, it is important to be able to first characterize what is present. Dr. O’Brien’s article, Movement Disorders for the Primary Care Physician, provides a nice overview of movement disorders and categorizes them in a way that simplifies understanding. Dr. O’Brien’s article provides guides on how to first define and therefore categorize what kind of movement disorder the patient has. This then helps to determine the correct diagnosis, and subsequently what treatment options would be appropriate for the primary care physician, prior to needing to refer the patient to a specialist. He also provides some useful resources for further information. In Dr. Kramer’s article, Excessive Sleepiness: Diagnosis and Management, he does an excellent job addressing a common presenting complaint of patients, and his article does not put the reader to sleep. He does an outstanding job in identifying and describing the many specific diagnoses that can present with this symptom. He explains these diagnoses with examples, describes appropriate work-up or evaluation, as well as discusses treatment. He goes into some of the more common conditions in more detail, such as Narcolepsy, Obstructive Sleep Apnea, and Periodic Limb Movement Disorder (differentiated from Restless Legs). Dr. Kelsall’s article, Common Causes of Dizziness, addresses a very common patient complaint, which is frequently encountered in a primary care office. He breaks dizziness into several categories, which serve as a great tool to help target and define the differential diagnoses for the presenting complaints of a particular patient. He defines the various categories of dizziness including: Vertigo, Presyncope, Dysequilibrium, and Lightheadedness. He provides and explains several common diagnoses for each category, as well as pointers on their evaluation and treatment. Dementia is a condition frequently encountered in primary care, and Alzheimer’s disease (AD), the most common cause of dementia. Alzheimer’s disease is a topic that is often presented in the lay media, which stimulates a multitude of questions from patients and their families. Dr. Bowling’s article, Update on Dementia: Evaluation and Treatment, does a nice job in reviewing Alzheimer’s disease, as well as other causes of dementia or pseudodementia. He discusses the epidemiology, as well as points out how this is often under-diagnosed in primary care. Clinical manifestations of Alzheimer’s disease are discussed, as well as its impact on families and society. He outlines the appropriate work-up for diagnosing AD, as well as helping to rule out other potential causes of dementia. He discusses some of the various risk factors, including the genetic causes which have been discovered. He also does a nice job in discussing treatment options with regard to what is available, what is currently recommended, as well as other things that are used, but not currently recommended, but which are being looked at more closely in studies. After reading this article, primary care physicians should be able to answer their patient’s and families questions on this subject in a more informed way. Dr. Smith’s article, Brain Attack: A Personal Reflection, is a refreshing article using a unique style of personal reflection to shed insight into how new technological advances in medicine take place. Dr. Smith, who is a national leader in advancements in Stroke/Brain Attack sheds light on how new technologies start as an idea. When the idea may be contrary to existing thinking, there is luck involved, needing early successes for people to be willing to go forward in exploring that idea. This is how we came to the advancement of using intravenous or intra-arterial thrombolytics in treating acute strokes, when the patient is seen soon after the onset of symptoms, and meets inclusion criteria. As Dr. Smith points out, this is a field that is in its infancy, and is still in a phase of significant research and development. He mentions a number of areas of research where a variety of ways to achieve improvement in stroke outcomes are being explored. It takes doctors, like Dr. Smith, who are willing to be forward thinking, to make advancements in medicine that we all may benefit from in the future. I have enjoyed the opportunity to participate in the Fall 1999 edition of the CNI Review: Family Practice Issues in Neurology. The articles are readable, pertinent, and valuable to the primary care physician. All of the authors, who are leaders in their fields, are gracious and willing to share their knowledge with primary care physicians. They demonstrate this both in their eager participation in the creation of this edition, as well as their willingness to help whenever they are asked a question about a patient.
Kenton I. Voorhees, MD From the Editor, The CNI thanks Dr. Voorhees for being our guest editor. We appreciate the relationship that CNI has with Dr. Voorhees and his colleagues in Family Practice at Swedish Medical Center. The CNI REVIEW has always been directed to the primary care physicians and usually focuses on one area of neurology. This issue is very special because it focuses on what primary care physicians want to hear. Enjoy.
Gary D. VanderArk, MD
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CNI REVIEW Library · CNI PublicationsColorado Neurological Institute (CNI),
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