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The care of a patient with a spinal cord injury is part of healthcare systems. It causes a substantial physical and emotional drain on the caretakers who often are in short supply and thus may lack adequate training, preparation, and support. Long hours of assisting a chronically handicapped patient with activities of daily living and exercises decrease the rehabilitator's quality of life and take a psychological toll that increases a risk of burnout syndrome. The present study found a significant caregiving burden among care providers of chronically dependent patients with spinal cord injuries. Additionally, financial drain escalates the issue in this rather neglected health and quality of life aspect concerning caregivers. For the situation to improve, there must be a paradigm shift in care taking toward the motivative patient's participation in the rehabilitative process. Provisions for social support and educational programs focusing on the patients and their families need to be reappraised.

Cisternostomy is defined as opening the basal cisterns to atmospheric pressure. This technique helps to reduce the intracranial pressure in severe head trauma as well as other conditions when the so-called sudden “brain swelling” troubles the surgeon. We elaborated the surgical anatomy of this procedure as well as the proposed physiology of how cisternostomy works. This novel technique may change the current trends in neurosurgery.

Atlas has unique anatomy in that it sits just inferior to the occiput and, through the articulations with C2 and condyles of the occipital bone, joins the skull with the cervical spine. C1 is devoid of a vertebral body. It contains the anterior and posterior arches, which encircle the spinal cord (posteriorly) and the odontoid process (anteriorly). The arches are joined by lateral masses on either side, whose superior and inferior articular surfaces take part in the occipito-cervical and atlantoaxial joints, respectively. The atlantoaxial joint is highly mobile and is stabilized by the anterior atlantoaxial ligament (between the anterior ring of atlas and C2), transverse ligament (posterior to odontoid process), and posterior atlantoaxial ligament (between the posterior ring of atlas and C2). The transverse ligament contributes the most to the C1-C2 articulation among these ligaments. The atlas characteristically lacks a spinous process or vertebral body. It behaves as an intercalated segment cradling the base of the occiput at the atlanto-occipital articulation allowing almost fifty percent of flexion-extension to occur at the neck. The craniocervical junction is comprised of the occiput, C1 (atlas), and C2 (axis). The occipito-atlantal and atlantoaxial articulations provide 50% of the flexion and rotation in the cervical spine, respectively. Due to their high degree of motion, these bony segments are also the most often injured in adults. C1 fractures should be promptly identified and treated in all patients, although they rarely require surgery. Any bony fracture of the atlas merits a thorough examination of the ligamentous structures between O-C1 and C1-C2., (Copyright © 2022, StatPearls Publishing LLC.)

Elderly patients have greater morbidity and mortality associated with falls versus their younger peers. Estimates are that greater than 30% of individuals over the age of 65 and approximately 50% of individuals over the age of 85 will fall each year. Approximately 12 to 42% of those who fall will have an injury. Further, once individuals fall, they are 50% more likely to have a second fall. In this population, a fall is associated with restricted mobility, a decline in activities of daily living (ADLs), hip fracture and other musculoskeletal injuries, dehydration, pneumonia, and long-term hospitalization. Moreover, a fear of falling compromises the patient’s independence and mobility, affecting overall physical and mental health. Fortunately, many falls are preventable using appropriate screening modalities and prevention interventions. Falls are often multi-factorial, considering there is usually a disturbance in gait and balance. Some causes include sarcopenia, muscle atrophy and imbalance, improper bio-mechanics, poor-blood pressure control, home environment, and polypharmacy. The pathologies on this list can be identified through screening modalities. One screening modality that can be used in many different settings such as outpatient primary care, inpatient hospital ward, or physical therapy office is the Tinetti gait and balance assessment, also known as the performance-oriented mobility assessment (POMA). This test is useful because it can be applied to different patient populations, including the elderly, patients with Parkinson disease or multiple sclerosis, traumatic brain injury (TBI), and stroke patients. The test assesses a patient’s balance and gait using a standardized scoring system., (Copyright © 2022, StatPearls Publishing LLC.)

Basilar Invagination (BI) was first described by Ackermann in cretins. Schuller gave the first radioimaging diagnosis which Chamberlain and other radiologists later refined. BI is an abnormality at the craniovertebral junction, either congenital or degenerative, resulting in the odontoid prolapsing into the already limited space of the foramen magnum. It is commonly associated with conditions such as Chiari malformation, syringomyelia, and Klippel-Feil syndrome. Clinical presentations can range from chronic headaches, limited neck motion, and acute neurologic deterioration. CT and MRI are critical to diagnosing and managing this condition, including operative planning when needed. Determining the need for operative intervention is controversial in asymptomatic patients, but those at risk of neurologic compromise could require preoperative cervical traction and algorithmic surgical strategies., (Copyright © 2022, StatPearls Publishing LLC.)

The ulnar nerve has several potential compression sites along its course. Although the elbow is the most common site of compression, the ulnar nerve is also susceptible to injury at the wrist, forearm, and upper arm. Prevention of compression and early diagnosis/treatment is important for its prognosis because the treatment outcome is usually disappointing once the nerve has axonal damage. The C8 and T1 nerve roots merge to form the lower trunk of the brachial plexus which continues as the medial cord to give rise to the ulnar nerve. The ulnar nerve then courses along the upper arm medial to the brachial artery, in proximity to the median nerve. Just above the elbow, the ulnar nerve courses posteriorly to pass through the retroepicondylar groove between the medial epicondyle and olecranon process. It then passes underneath the humeroulnar aponeurotic arcade (HUA), which is a dense aponeurosis between the tendon attachments of the flexor carpi ulnaris (FCU). The area beneath the HUA is also called the cubital tunnel. The nerve then passes through the belly of the FCU muscle and out through the deep flexor-pronator aponeurosis.  At the forearm, it innervates the FCU and the flexor digitorum profundus (FDP). At the mid to distal forearm, the palmar ulnar cutaneous branch (PUC) splits from the ulnar nerve and enters the hand ventral to the Guyon canal and gives sensory innervation to the skin at the hypothenar area. Distal to the bifurcation of the PUC, the dorsal ulnar cutaneous (DUC) branch separates from the main trunk, curves around the ulna, and provides sensory innervation to the dorsum of the skin of the medial hand, medial half of the fourth digit, and fifth digit. The main trunk of the ulnar nerve enters through the Guyon’s canal at the level of the distal wrist crease. The proximal wall of Guyon’s canal is formed by the pisiform bone and the distal wall by the hook of the hamate. The roof is formed by the palmaris brevis muscle, and the floor is formed by the combination of the transverse carpal ligament, the hamate, and the triquetrum bone. A thick band is formed at the outlet  (pisohamate hiatus) connecting the hook of the hamate to the pisiform bone. In the canal, the nerve separates into the superficial sensory branch and the deep palmar motor branch. The superficial sensory branch provides sensory innervation to the palmar aspects of the medial half of the fourth digit and the fifth digit. Before the nerve exits through the pisohamate hiatus, the motor fibers branch off from the deep palmar motor branch to innervate the hypothenar muscles (abductor digiti minimi, flexor digiti minimi, opponens digiti minimi, and palmaris brevis).  The deep palmar branch gives motor innervation to the adductor pollicis, the deep head of the flexor pollicis brevis, the third and fourth lumbricals, and the three palmar and four dorsal interossei muscles., (Copyright © 2022, StatPearls Publishing LLC.)

Blood is mandatory to maintain adequate circulation, provide nutrients, and remove waste from the brain, vital organs, and tissues. A hemorrhage is the loss of blood components from the cardiovascular system. Hemorrhagic shock occurs when this blood loss leads to inadequate tissue oxygenation. Hemorrhage secondary to traumatic injury is the leading cause of death of Americans from one to 46 years of age. The stop the bleed campaign was first launched in 2013. This educational program aims to reduce the morbidity and mortality associated with hemorrhage secondary to traumatic injury. Significant improvements in clinical outcomes can be made by transferring knowledge from the military to civilian medicine. This article reviews some of the latest science and lessons learned to improve the care of a hemorrhaging patient., (Copyright © 2022, StatPearls Publishing LLC.)

The odontoid process, or dens, is a superior projecting bony element from the second cervical vertebrae (C2, or the axis). The first cervical vertebrae (atlas) rotates around the odontoid process to provide the largest single component of lateral rotation of the cervical spine. Fracture of the odontoid process is classified into one of three types: type I, type II, or type III fractures, depending on the location and morphology of the fracture., (Copyright © 2022, StatPearls Publishing LLC.)

Mycobacterium tuberculosis is responsible for 5.9% of community-acquired CNS infections worldwide. Neurological tuberculosis (TB) or central nervous system tuberculosis (CNS-TB) may take three clinic-pathological forms: a diffuse form of tubercular meningitis (TBM), a focal form as tuberculoma, and spinal arachnoiditis also referred to as TB radiculomyelitis [TBRM]. Of these, TBM predominates, causing 70 to 80% of the infections. It presents as a subacute to chronic meningitis with disease severity commensurate with the duration of illness.  The diagnosis is fraught with challenges and is often delayed due to the varied and non-specific presentation. Besides the clinical clues, diagnostic indicators in cerebrospinal fluid (CSF) include mononuclear pleocytosis, low sugar values, and high protein concentrations. Identifying Mycobacterium tuberculosis in CSF by staining, culture methods, and molecular analysis is confirmatory but may be challenging.  Advanced radiological imaging techniques are usually of great assistance in making presumptive diagnoses. CNS-TB is frequently complicated by vasculitic infarcts, cranial nerve palsies, multiple neurological deficits, and hydrocephalus. A strong clinical suspicion is enough to start prompt anti-tubercular therapy. A 4-drug regimen of isoniazid, rifampin, pyrazinamide, and ethambutol with adjunctive corticosteroid reduces morbidity and mortality. The diagnosis and management of CNS-TB may be complicated by drug resistance, immune reconstitution inflammatory syndrome, and human immunodeficiency virus (HIV) coinfection.  Treatment efficacy depends upon how early it is instituted. Multiple factors determine the prognosis, the most important being the clinical stage of TBM at initial presentation. Untreated or unrecognized TBM may cause death within 5 to 8 weeks of the onset of the disease., (Copyright © 2022, StatPearls Publishing LLC.)

Approximately 90% of the population will present with low back pain at some point in their lifetime.  Spinal stenosis is a condition that is caused by the narrowing of the central canal, the lateral recess, or neural foramen. This condition can cause significant discomfort, interfere with activities of daily living, and may result in progressive disability. With increasing longevity of humankind, degenerative diseases of the spine and its sequelae are bound to have an immense negative impact on the global front. It is important to appreciate that spinal stenosis is part of the aging process, and predicting who will develop symptoms is not always easy. There is no clear cut association between spinal stenosis and the presence of symptoms. While the degenerative process is not 100% preventable, it can be slowed down with exercise diet or changes in lifestyle. Overall, spinal stenosis is most common in the lumbar and cervical regions., (Copyright © 2022, StatPearls Publishing LLC.)

Migraine is a primary neurologic headache, often accompanied by nausea, vomiting, photophobia, phonophobia, or vertigo, and may present with or without aura. It is prevalent in 11.7% of Americans with 17.1% in women, and 5.6% in men. Migraine can be acute or chronic. Treatment of this condition includes beta-blockers, anticonvulsants, calcium channel blockers, tricyclic antidepressants, non-steroidal anti-inflammatory drugs, among others. Migraine surgery is indicated when the condition is refractory to medical management. Chronic migraine is defined by the International Headache Society classification of headache disorders (ICHD-3). It is described as: Headache occurring on ≥15 days/month. Duration > 3 months. Having features of migraine on ≥8 days/month., (Copyright © 2022, StatPearls Publishing LLC.)

Neuropraxia is the mildest form of traumatic peripheral nerve injury. It is characterized by focal segmental demyelination at the site of injury without disruption of axon continuity and its surrounding connective tissues. This condition results in blockage of nerve conduction and transient weakness or paresthesia. Complete recovery is the expectation upon spontaneous remyelination—peripheral nerve injury (PNI) organizes into five categories that clinicians use today. Sunderland stratified and expanded Seddon's (1943) classification into Grade I, refers focal segmental demyelination; Grade II refers to damaged axon with intact endoneurium; Grade III refers to damaged axon and endoneurium with intact perineurium; Grade IV refers to the damaged axon, endoneurium, and perineurium with intact epineurium; and Grade V refers to complete transection (Table 1).[1][2][3][4][5][6][7][8] Some authors also describe a sixth-degree peripheral nerve injury, which refers to the mixed pathology of injury.[5][3] Neuropraxia, and PNI in general, can be secondary to trauma from sports, accidents, or improper positioning.[6][7][5] Injury to nerves results in motor or sensory loss, pain, or a combination of these, leading to significant morbidity or functional impairment.[9][3][7] , (Copyright © 2022, StatPearls Publishing LLC.)

While there may be a tendency to associate anesthetic intervention with neurological pathology in the practice of obstetrics, the events surrounding pregnancy and labor are most commonly responsible for such neuropathies. Obstetric palsies are estimated to be more common than neurological injuries caused by regional anesthesia. Thus, understanding the spatial relationship between nerves and surrounding anatomical structures is paramount to properly identify the site of obstetrical palsy, its presentation relative to neurological dysfunction, and subsequent treatment options. Foot drop is one type of obstetrical palsy. First described in 1838, a foot drop can have pronounced adverse effects on quality of life if not recognized, diagnosed, and treated appropriately. It can be caused by three separate but similar etiologies: lumbar radiculopathy, lumbosacral (LS) plexopathy, or common fibular (CF) neuropathy. The location of the neural injury should be assessed by a combination of careful neurological examination, MRI imaging, and electrophysiological studies.   Foot drop manifests primarily as a loss of dorsiflexion and eversion of the foot at the ankle. This can produce a slapping sound when the foot hits the ground. To avoid scraping the foot on the ground, the patient learns to elevate it higher than normal, leading to the classic steppage gait. Patients suffering from foot drop can also present symptoms including but not limited to paresthesia, hypoesthesia, numbness, weakness, atrophy, and diminished or absent deep tendon reflexes. The presentation of foot drop is most commonly described as unilateral, except for the case of common fibular neuropathy, which may be bilateral. This paper aims to elucidate the individual mechanisms underlying each etiology of obstetric foot drop and to use relevant clinical anatomy to guide clinicians in the appropriate diagnosis and management of such nerve palsies. Anatomy of the Roots of the Lumbosacral Plexus The lumbosacral (LS) plexus is located in the psoas muscles and is formed by the L1-S4 nerve roots, which provide motor and sensory innervation to the pelvis, thigh, leg, and foot. Its dorsal (sensory) and ventral (motor) roots emerge from the spinal cord and stream down in the cauda equina to exit the intervertebral foramina to join to form the mixed spinal nerves. Each mixed spinal nerve then divides into a ventral primary ramus and a dorsal primary ramus. The muscles of the pelvis and lower limbs are innervated by the ventral primary rami of the lumbosacral plexus. Damage to one or more of the dorsal nerve roots before the fibers join causes a loss of sensation in a dermatomal distribution. Meanwhile, damage to the ventral roots will result in paresis of all muscles innervated by that root level. Regarding obstetrical neural lesions, the L5 and S1 ventral rami of the plexus are the most important. Anatomy of the Lumbosacral Trunk Component of the Lumbosacral Plexus The nerve roots of L1-L4 form the upper portion of the plexus, while the roots of the L4-S4 constitute the lower portion of the lumbosacral plexus. Between these two portions of the lumbosacral plexus, the L4 and L5 rami unite to form the lumbosacral trunk. The lumbosacral trunk must pass inferiorly on the anterior surface of the sacral ala, where it is liable to injury by the head of the descending fetus. The lumbosacral trunk is part of the lumbosacral plexus but is considered separately in this paper, as its exposed position renders it especially liable to injury. Damage to the L5 component of the lumbosacral trunk is sufficient to cause foot drop.  Anatomy of the Peripheral Nerves formed from the Lumbosacral Plexus Branches of each portion of the lumbosacral plexus divide to form the distinct peripheral nerves associated with the lower limbs. The upper portion of the plexus gives rise to the iliohypogastric nerve (T12-L1), the ilioinguinal nerve (L1), genitofemoral nerve (L1-L2), lateral femoral cutaneous nerve (L2-L3), the femoral nerve (L2-L4), and obturator nerve (L2-L4). The lower part of the plexus gives rise to the superior gluteal nerve (L4-S1), inferior gluteal nerve (L5-S2), posterior femoral cutaneous nerve (S1-S3), the pudendal nerve (S1-S4), and the large sciatic nerve (L4-S3).   Anatomy of the Common Fibular Nerve   The common fibular nerve arises from the sciatic nerve above the popliteal fossa. It passes over the head of the fibula to curve around the posterior aspect of the fibula. It divides into the superficial fibular nerve and the deep fibular nerve. The superficial fibular nerve supplies the fibularis longus and brevis and the skin over the lateral side of the leg and dorsum of the foot. The fibularis longus and brevis are the evertors of the foot at the ankle. The deep fibular nerve then enters the anterior compartment of the leg, where it innervates the tibialis anterior, extensor hallucis longus, and extensor digitorum longus muscles. These muscles are extensors of the foot at the ankle (the dorsiflexors in clinical terminology). Lesion of the common fibular nerve or the deep fibular nerve will produce foot drop., (Copyright © 2022, StatPearls Publishing LLC.)

Brain herniation can be labeled as “brain code” to connate the emergent need to timely counteract such disastrous brain processes.[1] The brain is encased within the skull, any rise in intracranial pressure is limited to some extent by the compensatory displacement of cerebrospinal fluid (CSF) and changes in cerebral blood volume as evident by the Monro-Kellie doctrine.[2] When it overrides these compensatory mechanisms, certain parts of the brain start herniating through specific foramina formed by the falx and the tentorial incisura within the skull, thereby propagating progressive herniation syndromes. Brain herniation is a life-threatening event and needs urgent attention. The five types of brain herniations include: Subfalcine involves the cingulate gyrus, which is pushed against the falx cerebri. Transtenorial (uncal) involves the medial temporal lobe, which is often squeezed by a mass under and across the tentorium. Central involves herniation of both temporal lobes through the tentorial notch. A tonsillar herniation is caused by an infratentorial mass, forcing the cerebellar tonsils through the foramen magnum. Upward herniation occurs when an infratentorial mass compressed the brainstem., (Copyright © 2022, StatPearls Publishing LLC.)

Decorticate posturing is a specific pattern of response shown in neurological and neurosurgical patients in whom the pathological processes have led to intracranial hypertension and already initiated the herniation syndrome. There will be flexor posturing along with internal rotation of the upper limbs with extensor posturing of the lower limbs. The painful stimulation should be given over supra eye-brow region or on other dermatomal distribution of cranial nerves only, to prevent the confounding bias from response seen from the spinal reflexes. The internal rotation posturing helps to differentiate it from normal flexor response to pain., (Copyright © 2022, StatPearls Publishing LLC.)

Posterior cortical atrophy (PCA) is a rare heterogeneous, progressive neurodegenerative condition that primarily affects the occipital and parietal cortex, leading to visuoperceptual, visuospatial, praxis skills, and literacy impairment. Typically, the age of onset is between 50 to 65 years. Benson and colleagues originally introduced the term  posterior cortical atrophy  in 1988 while describing the deficits in higher-order visual processing that are similar to Gerstmann and Balint syndromes with relatively preserved episodic memory.  Though considered a visual variant of Alzheimer disease, PCA is a distinct clinical syndrome. Patients with posterior cortical atrophy have a good memory, language, insight, and a greater degree of posterior atrophy on Brain MRI than Alzheimer's disease controls., (Copyright © 2022, StatPearls Publishing LLC.)

The control of muscular movements in the human brain is a very complex, yet delicate process. Multiple areas of the brain are involved, each of which is responsible for specific areas and functions. This control is conveyed mainly through the pyramidal tract, which arises from the pyramidal cell in the cortex, primarily the primary motor cortex. It divides into the corticospinal tract, which synapses with the lower motor neurons innervating the muscles in the limbs and trunk, and the corticobulbar tract, which synapses with the cranial nerves to control muscular movements of the face, head, and neck., (Copyright © 2022, StatPearls Publishing LLC.)

There are approximately 300,000 individuals living with spinal cord injury (SCI) in the United States, with approximately 18,000 new cases annually. Central cord syndrome, first described in 1954, is the most common form of incomplete spinal cord injury (SCI) and has an annual incidence of approximately 11,000 cases in the United States. It leads to motor deficits that are more pronounced in the upper extremities compared to the lower extremities, as well as bladder dysfunction (retention) with sacral sparing. Because of its unique clinical presentation, central cord syndrome is also described in the differential diagnosis of "man in a barrel" syndrome. The degree of clinical presentation is quite variable and corresponds to the extent of the injury to the nerve root., (Copyright © 2022, StatPearls Publishing LLC.)

In humans, the perception and ability to distinguish different colors is mediated by a variety of mechanisms in the retina as well as the brain. Understanding the physiologic basis of color vision is essential to detecting abnormalities and devising treatments. In this article, we will review the cellular and genetic mechanisms that underlie color perception and apply these mechanisms to characterizing defects in color vision and avenues for treatment., (Copyright © 2022, StatPearls Publishing LLC.)

The vertebrobasilar (VB) system,  comprised of the vertebral and basilar arteries,  serves as a critical arterial supply to the cervical spinal cord brainstem, cerebellum, thalamus, and occipital lobes. Disruptions of VB circulation can have devastating neurologic consequences; thus, a thorough understanding of the anatomy and clinical significance of the VB system is critical for assessing neurologic syndromes and preoperative neurosurgical planning., (Copyright © 2022, StatPearls Publishing LLC.)

A spinal epidural abscess(SEA) is a suppurative central nervous system infection involving the space between the spinal dura and vertebral periosteum. Giovanni Morgagni first described SEA in 1761. Although classically, patients with spinal epidural abscesses present with midline back pain, fever, and neurologic deficits, presentations of this disease process can be highly variable. A spinal epidural abscess is difficult to diagnose if clinical suspicion is not high. When left untreated spinal epidural abscess can cause significant morbidity and mortality. Thus any clinical concern for this diagnosis requires prompt evaluation and treatment. Diagnosing and managing spinal epidural abscesses are greatly aided by the advent of modern radiological techniques, including computerized tomography and magnetic resonance imaging (MRI)., (Copyright © 2022, StatPearls Publishing LLC.)

First described by Hart in 1830, in the present era an intramedullary spinal cord abscess (ISCA) is a very rare form of spinal cord abscess. Their rarity may be accountable to the following factors: 1. A relatively smaller volume and total surface area of the cord.    . 2. An acute angle of origin of the corresponding spinal arteries.       . 3. The protection is provided by the osseous vertebral canal and the meningeal layers, notably the pia mater. Though rare, prompt diagnosis and treatment of this condition are of paramount importance to preventing damage to the spinal cord that can lead to disabling neurological deficits and possibly death. , (Copyright © 2022, StatPearls Publishing LLC.)

Neurofibromatosis type 1 (NF-1) or Von Recklinghausen disease is one of the inheritable neurocutaneous disorders that also harbinger the risk for bone abnormalities, vasculopathy, and cognitive impairment. It is an autosomal dominant disorder. Moreover, it is the most common hamartoma neoplastic syndrome, such as tuberous sclerosis, Gardner, and Cowden syndromes. Other types of neurofibromatosis are Neurofibromatosis type 2 (NF2) and schwannomatosis. Cafe-au-lait macules and neurofibromas are the distinguishing features of NF1. NF2 can have similar cutaneous manifestations as that of NF1. But the hallmark manifestations of NF2 include schwannoma, meningioma, and ependymoma., (Copyright © 2022, StatPearls Publishing LLC.)

Mollart and Goulon first coined the term 'coma depasse,' meaning a state beyond coma, for brain death.[1] The Conference of Royal Medical Colleges in 1976  came to the consensus that brainstem death constitutes brain death. The revised memorandum in 1979 correlated brainstem death with death itself.[1] The American Academy of Neurology (AAN) has postulated brain death as a “coma, absence of brainstem reflexes, and apnea.”[2] Academy of Medical Royal Colleges Working Party has defined brainstem death as 'the irreversible loss of the capacity for gaining consciousness, and the capacity to spontaneously breathe.' Persistent vegetative state  - loss of only cortical functions with intact brain stem functions Brain-stem death  - absent brain stem reflexes but the presence of few cortical as well as hypothalamic integrity such as osmoregulation Whole Brain death  - biological death with absent cortical and brainstem functions Death  - Whole-brain death along with the cardiopulmonary arrest, (Copyright © 2022, StatPearls Publishing LLC.)

The use of point-of-care ultrasound (POCUS) has expanded considerably over the past two decades allowing for enhanced and swift evaluations, rapid triage, improved diagnostic capabilities in austere situations, and real-time assessment of focused clinical questions in critically ill patients in the intensive care unit (ICU). Emergency medicine physicians have led the way in establishing and educating bedside use of ultrasound. In 2001, the American College of Emergency Physicians (ACEP) published the first Emergency Ultrasound Guidelines to clarify the primary indications, the scope of practice, training, and continuing education regarding the use of emergency ultrasound. These guidelines have continued to expand alongside the ever-growing use of ultrasound. They have been adopted by several other specialties, especially in applying “procedural ultrasound” to assist in real-time guidance of vascular access, peripheral nerve blockade, and pre-surgical evaluations. The main difference between POCUS and dedicated ultrasound exams is the ability to rapidly answer a focused clinical question, facilitate serial examinations in clinical deterioration, or guide a bedside procedure rather than provide a detailed report with the grading of pathology. With small, portable ultrasound models becoming available, advanced diagnostics are becoming more accessible in remote environments and on the battlefield. Physicians and advanced paramedical providers in these settings are becoming trained to perform extended focused assessment with sonography in trauma (eFAST), optic nerve sheath ultrasound (ONSUS) for the evaluation of intracranial hypertension, inferior vena cava collapsibility assessments for the evaluation of volume status, and countless other examples of image-guided procedures. This article will focus on optic nerve sheath ultrasound for the diagnosis, monitoring, and management of elevated intracranial pressure (ICP)., (Copyright © 2022, StatPearls Publishing LLC.)

Confidentiality plays a critical role in patient care; however, there may be special circumstances where confidentiality must be breached in order to not only ensure the safety of the patient but also to protect third parties. This concept of ‘duty to warn’ stems from California Supreme Court case of Tarasoff v. Regents of the University of California that took place in the 1970s and comprised of two rulings known as the Tarasoff I (1974) and Tarasoff II (1976)., (Copyright © 2022, StatPearls Publishing LLC.)

The Romberg's sign or Romberg's test is named after a European neurologist, Mortiz Romberg, historically, this was described by Marshall Hall, Moritz Romberg, and Bernardus Brach. Initially, this sign was tethered specifically with tertiary syphilis patients who exhibited neurologic signs of late-stage disease referred to as locomotor ataxia, or tabes dorsalis. When examining a patient's neurological effects from sequelae involving late-stage syphilis, the Romberg sign became a precise test to determine the integrity of the dorsal column pathway of the brain and spinal cord, which controls proprioception. Proprioception is the sense of awareness of the position and movement of the body. Romberg described this sign as a severe postural impairment in a darkroom setting or with eyes closed of patients who had severe damage to the posterior dorsal columns of the spinal cord. Used as a precise clinical tool, the Romberg test is positive if a patient cannot maintain an upright stance with vision eliminated or in the darkness.  Often the Romberg test can be confused as a sign of cerebellar disease, but instead, this test demonstrates the effects of posterior column disease. Normal stance in a person is governed by the integrity of vision, proprioception, and vestibular function. The ability to gauge actual proprioception status can be confounded by the vestibular and vision somatosensory system, which may compensate for vestibular function and vision. The Romberg sign removes the visual and vestibular components that contribute to maintaining balance, and can thus identify a proprioception-related neurologic disease.  The Romberg sign is said to be positive in a patient who is able to stand with his feet placed together and eyes open, but paradoxically sways or falls while closing his eyes thereby eliminating his visual cues., (Copyright © 2022, StatPearls Publishing LLC.)

Spinal cord injury (SCI) accounts for multispectral neurological deficits and severely affects the dichotomous utilization of health resources, especially in low and middle-income nations. Nearly 80% of the victims are males, with almost 60% of them falling within the age group of 16 to 30 years. Moreover, as high as 60% of them are left unemployed following the incidents. Subluxation is an important entity of traumatic subaxial cervical spinal injuries. There is a varying degree of slippage of the body of one vertebra relative to the adjacent vertebra, owing to ligamentous injury and the jumped facets, with therefore a high predisposition for injury to the spinal cord., (Copyright © 2022, StatPearls Publishing LLC.)

The posterior auricular nerve is an extracranial branch of the facial nerve, cranial nerve VII, that supplies relatively small muscles of the head and neck.  It sometimes receives consideration during head and neck surgery as a potential source of iatrogenic injury, and it has been proposed to be a possible candidate for utilization as a nerve graft donor., (Copyright © 2022, StatPearls Publishing LLC.)

Fahr disease is named after Karl Theodor Fahr, a German neurologist who first reported the disorder in 1930. It is a rare neurological condition characterized by abnormal idiopathic calcification of basal ganglia and commonly has an autosomal dominant inheritance. Abnormal calcified deposits (composed of calcium carbonate and phosphate) are not just limited to basal ganglia but also occur in some other locations, such as thalamus, hippocampus, dentate nucleus, cerebral cortex, and cerebellar subcortical white matter. Usually, in the literature, the term Fahr disease and syndrome are used interchangeably, but it has been argued that: For primary basal ganglia calcifications, with no known etiology, the term Fahr disease should be used. For secondary causes of basal ganglia calcifications, with known underlying causes, the term Fahr syndrome should be used. Fahr disease is also termed bilateral strio-pallido-dentate calcinosis or primary familial brain calcification (PFBC) or calcinosis nucleorum., (Copyright © 2022, StatPearls Publishing LLC.)

Adverse events (AE) frequently occur in any medical system, and at least one in ten patients are affected.[1] An AE is a harmful and negative outcome that happens when a patient has been provided with medical care.[2] Medical treatment may include a procedure, surgery, or medication. Any patient who undergoes treatment may experience a negative outcome as a result of that treatment. Adverse events that occur with medical treatment can include medication side effects, injury, psychological harm or trauma, or death. Adverse events can be either preventable or unpreventable and are often associated with medication errors.[3] Adverse events can occur with any provision of care or treatment have a wide range of severity., (Copyright © 2022, StatPearls Publishing LLC.)