Acute withdrawal: diagnosis and treatment.

Symptoms of alcohol withdrawal range in severity from mild "hangover" to fatal delirium tremens (DTs). Tremor, hallucinosis, and seizures usually occur within 48 hours of abstinence. Seizures tend to be generalized without focality, occurring singly or in a brief cluster, but status epilepticus is not unusual.

Neurologic complications of illicit drug abuse.

Purpose Of Review: This review familiarizes clinicians with the symptoms of overdose and withdrawal, as well as neurologic complications, associated with particular illicit drugs.

Recent Findings: Recent arrivals on the recreational drug scene include synthetic cathinone analogs, synthetic cannabinoid agonists, and a variety of novel hallucinogens.

Summary: Clinicians need to be aware of neurologic disorders associated with particular illicit drugs and should consider drug abuse in any patient with unexplained symptoms and signs.

Systematic review: efficacy and safety of medical marijuana in selected neurologic disorders: report of the Guideline Development Subcommittee of the American Academy of Neurology.

Objective: To determine the efficacy of medical marijuana in several neurologic conditions.

Methods: We performed a systematic review of medical marijuana (1948-November 2013) to address treatment of symptoms of multiple sclerosis (MS), epilepsy, and movement disorders. We graded the studies according to the American Academy of Neurology classification scheme for therapeutic articles.

Spice, pot, and stroke.

The endocannabinoid system includes 2 types of G-protein coupled receptors: CB1 (mostly in the brain) and CB2 (in peripheral lymphoid tissue). The major cannabinoid ligands are arachidonylethanolamine ("anandamide," the Sanskrit word for bliss) and 2-arachidonylglycerol ("2AG"). It is by binding to CB1 receptors that δ-9-tetrahydrocannabinol (THC), the principal psychoactive ingredient in marijuana ("pot"), produces its intended subjective effects.

Substance abuse and movement disorders.

An array of movement disorders is associated with ethanol, illicit drugs, and tobacco. Heavy ethanol users experience withdrawal tremor and, less often, withdrawal parkinsonism, chorea, and myoclonus. Asterixis is a feature of hepatic failure.

Ethanol and cognition: indirect effects, neurotoxicity and neuroprotection: a review.

Ethanol affects cognition in a number of ways. Indirect effects include intoxication, withdrawal, brain trauma, central nervous system infection, hypoglycemia, hepatic failure, and Marchiafava-Bignami disease. Nutritional deficiency can cause pellagra and Wernicke-Korsakoff disorder.

Seizures, illicit drugs, and ethanol.

Recreational substance users are at risk for seizures by indirect mechanisms, including cerebral trauma, central nervous system infection, ischemic and hemorrhagic stroke, and metabolic derangements such as hypoglycemia, hypocalcemia, and renal failure. Drugs and ethanol can also cause seizures more directly, either as a feature of intoxication (eg, psychostimulants) or of withdrawal (eg, sedatives, including ethanol). In any patient with a seizure, clinicians should consider illicit drug or ethanol use.

The association of race and sex with the underuse of stroke prevention measures.

Background: Underuse of effective stroke prevention measures has been demonstrated in the general population. Blacks and Hispanics are at increased risk of recurrent stroke relative to white non-Hispanics. More profound underuse of prevention measures may contribute to this disparity.

A 74-year-old man with memory loss and neuropathy who enjoys alcoholic beverages.

Adverse effects of alcohol on the peripheral and central nervous system can be direct (ie, neurotoxicity) or indirect (eg, nutritional deficiency). Using the case of Mr E, an older, moderate to heavy drinker experiencing memory difficulty, the diagnostic considerations, which include mild cognitive impairment, early Alzheimer dementia, Wernicke-Korsakoff syndrome, and "alcoholic dementia," are discussed. These disorders are not mutually exclusive, and in a patient with either mild cognitive impairment or dementia, the contributory role of alcohol can be difficult to determine.

Seizures and substance abuse: treatment considerations.

Seizures often occur in substance abusers. The mechanism may be indirect (CNS infection, cerebral trauma, stroke, metabolic derangement) or direct (intoxication or withdrawal). These mechanisms are not mutually exclusive.

Hypertensive Encephalopathy.

The term hypertensive encephalopathy should be reserved for patients with diffuse cerebral effects of precipitous and sustained rises in blood pressure that reverse when blood pressure is lowered and are not due to infarction or hemorrhage. The definitive diagnosis of this syndrome depends on accurate exclusion of other causes that may be associated with elevated blood pressure and neurologic deficits. Treatment is aimed at preventing or limiting target organ (brain) damage.