Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:57

1198 Portal Hypertensive Bleeding Postconcussion Syndrome

follow-up

■patients at risk for recurrent bleeding and should be treated with

endoscopic therapy to obliteration of varices and chronic beta

blocker with or without nitroglycerin therapy

■endoscopy typically performed every 2–4 weeks until varices are

obliterated, and beta blockers+/– nitroglycerin continued long-

term

■routine monitoring of hepatic function with CBC, INR and LFTs every

2–4 months

complications and prognosis

■uncontrollable or recurrent variceal bleeding, which may be treat-

able in selected patients with reasonable hepatic function by TIPS,

portosystemic shunt or esophageal transaction

Prognosis

■portal hypertensive bleeding indicates decompensation of chronic

liver disease and reduced short-term and long-term survival man-

dating consideration of liver transplantation

POSTCONCUSSION SYNDROME OR

POSTCONCUSSIVE SYNDROME

CHAD CHRISTINE, MD

history & physical

■Impairment of neurologic function persisting days to weeks after

mild to severe traumatic brain injury

■Headache, fatigue, dizziness most common symptoms

■Symptoms worsened by mental & physical effort

■Cognitive symptoms

■Neurologic signs typically unremarkable

tests

■Serum tests are unremarkable

■Brain CT or MRI usually normal; may show small subcortical hem-

orrhages

■Neuropsychological testing usually abnormal in severe cases

differential diagnosis

■Intracranial hemorrhage, epidural or subdural hematoma excluded

by brain imaging