Neurology for the Non-Neurologist, 6th Edition

Cover......Page 1
Title Page......Page 3
Copyright......Page 4
Dedication......Page 5
Contents......Page 6
Contributors......Page 8
Preface......Page 11
Acknowledgments......Page 13
MENTAL STATUS AND COGNITION......Page 15
Speech and Language......Page 16
Executive Function......Page 17
Mini-Mental Status Examination (MMSE)......Page 18
CRANIAL NERVES......Page 19
CN II. The Optic Nerve......Page 20
CN V. The Trigeminal Nerve......Page 21
CN VIII. The Vestibulocochlear Nerve......Page 22
CN XII. Hypoglossal Nerve......Page 23
MOTOR EXAMINATION......Page 24
DEEP TENDON REFLEXES (DTRs)......Page 25
SENSORY TESTING......Page 26
COORDINATION AND GAIT......Page 28
Mental Status......Page 29
Coordination......Page 30
QUESTIONS AND DISCUSSION......Page 31
SUGGESTED READING......Page 32
COMMON NEUROLOGIC TERMS......Page 34
MENTAL STATUS CHANGES......Page 35
WEAKNESS......Page 36
Upper Motor Neuron Lesions......Page 37
Lower Motor Neuron Lesions......Page 38
PAIN AND SENSORY SYNDROMES......Page 39
GAIT DISORDERS......Page 41
ROLE OF THE TEMPORAL COURSE OF NEUROLOGIC ILLNESS IN NEUROLOGIC DIAGNOSIS......Page 42
QUESTIONS AND DISCUSSION......Page 43
SUGGESTED READING......Page 46
INTRODUCTION......Page 47
Computed Tomography (CT)......Page 48
Myelography......Page 49
Catheter Angiography......Page 50
Electromyography (EMG)......Page 51
Lumbar Puncture......Page 52
Tissue Biopsy......Page 53
QUESTIONS AND DISCUSSION......Page 55
SUGGESTED READING......Page 56
CHAPTER 4: Fundamentals of Neuroradiology......Page 57
COMPUTED TOMOGRAPHY VERSUS MAGNETIC RESONANCE IMAGING......Page 58
CONTRAST VERSUS NONCONTRAST......Page 60
HERNIATION AND MASS EFFECT......Page 61
HYDROCEPHALUS VERSUS VOLUME LOSS......Page 63
CYTOTOXIC VERSUS VASOGENIC EDEMA......Page 64
INTRA-AXIAL VERSUS EXTRA-AXIAL......Page 65
INTRACRANIAL HEMORRHAGE......Page 67
INFARCT EVALUATION AND VASCULAR IMAGING......Page 70
CONCLUSION......Page 74
QUESTIONS AND DISCUSSION......Page 75
SUGGESTED READING......Page 76
Status Epilepticus......Page 77
Treatment of SE......Page 79
ACUTE ALTERATION OF MENTAL STATUS......Page 83
Treatment of Delirium......Page 87
ACUTE INTRACRANIAL HYPERTENSION......Page 88
Treatment of Acute Intracranial Hypertension......Page 90
ACUTE SPINAL CORD COMPRESSION......Page 91
Treatment of Acute Spinal Cord Compression......Page 92
Myasthenic Crisis......Page 93
Treatment of Myasthenic Crisis......Page 94
GUILLAIN–BARRÉ SYNDROME......Page 95
Treatment of Guillain–Barré Syndrome......Page 96
NEUROLEPTIC MALIGNANT SYNDROME......Page 97
Treatment of Neuroleptic Malignant Syndrome......Page 98
QUESTIONS AND DISCUSSION......Page 100
SUGGESTED READING......Page 101
CHAPTER 6: Examination of the Comatose Patient......Page 103
DEFINITIONS AND CLINICAL SYNDROMES......Page 104
ETIOLOGY......Page 105
HISTORY AND EXAMINATION......Page 107
LABORATORY EVALUATION AND TREATMENT......Page 113
WHEN TO REFER THE PATIENT TO A NEUROLOGIST......Page 116
QUESTIONS AND DISCUSSION......Page 117
SUGGESTED READING......Page 118
CHAPTER 7: Cerebrovascular Disease......Page 119
IDENTIFICATION OF THE STROKE-PRONE INDIVIDUAL......Page 120
CLINICAL EVALUATION......Page 122
DIAGNOSTIC EVALUATION......Page 124
Presentation and Localization......Page 127
OPTIMIZATION OF ISCHEMIC STROKE PREVENTION......Page 128
ACUTE ISCHEMIC STROKE INTERVENTION......Page 129
Clinical Approach......Page 131
Treatment......Page 132
Intracranial Aneurysm......Page 134
Arteriovenous Malformation......Page 135
SPECIAL CHALLENGES FOR HOSPITALIZED PATIENTS......Page 136
QUESTIONS AND DISCUSSION......Page 137
SUGGESTED READING......Page 139
INTRODUCTION......Page 141
MIGRAINE......Page 142
TENSION-TYPE HEADACHE......Page 143
MEDICATION OVERUSE HEADACHE (FORMERLY CALLED REBOUND HEADACHE)......Page 144
CLUSTER HEADACHE AND ITS VARIANTS......Page 145
Nonpharmacologic Treatments for Primary Headaches......Page 146
Treatment of MOH......Page 147
Acute Treatment of Migraine......Page 148
Preventive Treatment of Migraine......Page 149
Treatment of Cluster Headache......Page 150
DIAGNOSTIC TESTING AND SECONDARY HEADACHE DISORDERS......Page 151
Hospitalization......Page 152
When and When Not to Administer Opioids......Page 153
QUESTIONS AND DISCUSSION......Page 154
SUGGESTED READING......Page 155
TYPES OF SEIZURES......Page 157
EPILEPSY SYNDROMES......Page 158
DIAGNOSING EPILEPSY......Page 161
MANAGEMENT OF EPILEPSY......Page 162
SERUM ANTIEPILEPTIC DRUG LEVELS......Page 164
SOME INDIVIDUAL ANTIEPILEPTIC DRUGS......Page 165
SURGICAL THERAPIES......Page 166
SPECIAL CHALLENGES FOR MANAGING HOSPITALIZED PATIENTS......Page 167
QUESTIONS AND DISCUSSION......Page 168
SUGGESTED READING......Page 169
CHAPTER 10: Sleep Disorders......Page 170
SLEEP ARCHITECTURE......Page 171
SLEEP DISORDERS ASSOCIATED WITH INSOMNIA......Page 173
SLEEP-ONSET DELAY......Page 174
Treatment......Page 175
Precautions......Page 179
Alternative Therapies......Page 180
RESTLESS LEGS SYNDROME......Page 181
Alternative Treatments......Page 182
EARLY MORNING AWAKENING......Page 184
SPECIAL CHALLENGES FOR HOSPITALIZED PATIENTS......Page 185
SLEEP APNEA......Page 186
EVALUATION OF SUSPECTED SLEEP APNEA......Page 189
Treatment of Sleep Apnea......Page 190
NARCOLEPSY......Page 193
Treatment of Narcolepsy......Page 194
INSUFFICIENT SLEEP......Page 197
PARASOMNIAS......Page 198
When to Refer the Patient with Parasomnia to the Sleep Specialist......Page 200
QUESTIONS AND DISCUSSION......Page 201
SUGGESTED READING......Page 204
HISTORY......Page 206
PATHOLOGY OF MULTIPLE SCLEROSIS......Page 207
Pathologic Correlations with Magnetic Resonance Imaging......Page 209
Immunology of Multiple Sclerosis......Page 210
Relapsing–Remitting Multiple Sclerosis......Page 211
Progressive-Relapsing Multiple Sclerosis......Page 212
Neuromyelitis Optica......Page 213
Optic Neuritis......Page 214
Cerebellar Signs......Page 216
Bladder, Bowel, and Sexual Dysfunction......Page 217
Important Radiologic and Laboratory Features......Page 218
CSF Analysis......Page 220
Errors in Diagnosing Multiple Sclerosis......Page 222
Disease-Modifying Therapies......Page 223
Initiation of Early Therapy......Page 226
Symptomatic Therapy......Page 227
Remyelination and Neuroprotection......Page 232
QUESTIONS AND DISCUSSION......Page 233
SUGGESTED READING......Page 234
CLINICAL FEATURES......Page 236
MECHANISMS OF DISEASE......Page 240
TREATMENT......Page 242
COMPLICATIONS......Page 244
DRUG-INDUCED PARKINSONISM......Page 247
FURTHER CONSIDERATIONS......Page 248
COMPLEMENTARY THERAPIES......Page 249
SPECIAL CHALLENGES FOR HOSPITALIZED PATIENTS......Page 250
QUESTIONS AND DISCUSSION......Page 251
SUGGESTED READING......Page 254
CHAPTER 13: Hyperkinetic Movement Disorders......Page 255
DYSTONIA......Page 256
Classification......Page 258
Pathology and Neurochemistry......Page 265
Treatment......Page 266
Clinical Features......Page 268
Differential Diagnosis......Page 270
Treatment......Page 271
When to Refer to a Neurologist......Page 273
Clinical Features......Page 274
Genetics......Page 275
Pathology, Neurochemistry, and Pathogenesis......Page 277
Treatment......Page 279
Clinical Manifestations......Page 280
Pathogenesis and Genetics......Page 282
Diagnosis......Page 283
Treatment......Page 284
GILLES DE LA TOURETTE SYNDROME......Page 287
Associated Behavioral Disturbances......Page 288
Genetics and Pathophysiology......Page 289
Treatment......Page 290
Clinical Features......Page 293
Pathophysiology......Page 294
Prevention......Page 295
Treatment......Page 296
QUESTIONS AND DISCUSSION......Page 298
SUGGESTED READING......Page 299
OVERVIEW......Page 301
DEMENTIA......Page 302
Differential Diagnosis for Conditions Presenting with Cognitive Impairment......Page 303
Differential Diagnosis of Primary Neurodegenerative Dementias......Page 305
Prion Diseases......Page 311
Pharmacotherapy......Page 312
Other Interventions......Page 315
Special Considerations for Hospitalized Patients......Page 316
QUESTIONS AND DISCUSSION......Page 317
SUGGESTED READING......Page 318
CHAPTER 15: Behavioral Neurology......Page 321
ANATOMIC BASIS—PAPEZ CIRCUIT......Page 322
TEMPORAL LOBE EPILEPSY......Page 323
ANATOMY AND CLINICAL FINDINGS......Page 325
When to Refer Patients to a Neurologist......Page 326
FLUENT APHASIA......Page 327
ETIOLOGY......Page 328
WERNICKE–KORSAKOFF SYNDROME (WERNICKE ENCEPHALOPATHY)......Page 329
ANATOMIC BASIS......Page 330
TRANSIENT GLOBAL AMNESIA......Page 331
Treatment......Page 332
HERPES SIMPLEX ENCEPHALITIS......Page 333
Future Perspectives......Page 334
QUESTIONS AND DISCUSSION......Page 335
SUGGESTED READING......Page 336
EPIDEMIOLOGY AND OVERVIEW......Page 338
PATHOPHYSIOLOGY AND OPERATIONAL TERMS......Page 339
ACUTE HOSPITALIZATION......Page 344
POSTACUTE HOSPITALIZATION......Page 345
Sleep–Wake Cycle Disturbance (SWCD)......Page 346
Late-Onset Hydrocephalus......Page 349
Agitation......Page 350
Mild TBI......Page 352
Neuropsychologic Testing......Page 354
QUESTIONS AND DISCUSSION......Page 355
SUGGESTED READING......Page 357
Weakness......Page 358
Atrophy and Hypertrophy......Page 366
Muscle Twitching......Page 367
Enzyme Elevation......Page 368
Electrodiagnostic Studies......Page 369
SPECIFIC NEUROMUSCULAR DISORDERS......Page 371
Motor Neuron Diseases......Page 372
Disorders of the Neuromuscular Junction......Page 373
Myopathies......Page 375
Special Considerations in Children......Page 381
Special Outpatient Problems in Adults......Page 382
Specific Issues in Other Neuromuscular Disorders......Page 383
Rhabdomyolysis and Myoglobinuria......Page 384
WHEN TO REFER TO A NEUROLOGIST......Page 385
QUESTIONS AND DISCUSSION......Page 386
SUGGESTED READING......Page 388
CLINICAL FEATURES AND SCIENTIFIC BACKGROUND......Page 389
ANATOMY......Page 390
ANATOMIC DISTRIBUTION......Page 391
PATTERNS OF ABNORMALITY......Page 394
PATHOLOGY......Page 395
DIAGNOSIS......Page 396
Management......Page 401
GUILLAIN–BARRÉ SYNDROME......Page 403
NEUROPATHIES ASSOCIATED WITH DIABETES MELLITUS......Page 404
Ulnar Neuropathy......Page 406
FUTURE PERSPECTIVES......Page 407
QUESTIONS AND DISCUSSION......Page 408
SUGGESTED READING......Page 410
ANATOMY......Page 412
Disc Herniation......Page 414
Neurogenic Pain......Page 415
Referred Pain from Abdominal or Pelvic Structures......Page 416
Neurologic Exam......Page 417
WORKUP......Page 418
MRI Spine with Gadolinium......Page 419
Treatment of Acute Low Back Pain (<4 to 6 weeks)......Page 420
Conservative Treatment in Acute Low Back Pain......Page 421
QUESTIONS AND DISCUSSION......Page 422
SUGGESTED READING......Page 425
Presyncope......Page 426
Hyperventilation Syndrome......Page 427
Vasovagal/Vasodepressor Presyncope......Page 428
VERTIGO......Page 429
Central or Peripheral Vertigo?......Page 430
Benign Paroxysmal Positional Vertigo......Page 432
Acute Peripheral Vestibulopathy......Page 433
Ménière’s Disease......Page 434
CENTRAL CAUSES OF VERTIGO......Page 435
Basilar Migraine......Page 436
Vestibular Dysfunction......Page 437
QUESTIONS AND DISCUSSION......Page 438
SUGGESTED READING......Page 440
DEFINITION......Page 441
SCOPE OF THE PROBLEM......Page 442
DIAGNOSING THE CAUSE OF FALLS......Page 443
BALANCE PROBLEMS LEAD TO FALLS IN NEUROLOGIC PATIENTS......Page 448
FALLS ARE MULTIFACTORIAL......Page 451
Medical Treatment of Neurologic Causes of Falls......Page 452
Rehabilitation to Prevent Falls in Neurologic Patients......Page 453
QUESTIONS AND DISCUSSION......Page 456
SUGGESTED READING......Page 458
CHAPTER 22: Neurotoxic Effects of Drugs Prescribed by Non-neurologists......Page 460
Antituberculous Drugs......Page 461
OTHER COMMONLY PRESCRIBED ANTIBIOTICS......Page 462
Cyclosporine......Page 463
Glycosides......Page 464
Antiarrhythmics......Page 465
Diuretics......Page 466
Vasodilators......Page 467
GASTROINTESTINAL AGENTS......Page 468
Antidiarrheals......Page 469
Xanthine Bronchodilators......Page 470
Neuroleptic Agents......Page 471
Antidepressant Agents......Page 473
Salicylate Compounds......Page 475
Steroids......Page 476
Hormones......Page 477
Vitamins and Additives......Page 478
QUESTIONS AND DISCUSSION......Page 480
SUGGESTED READING......Page 483
CHAPTER 23: Neurologic Complications of Alcoholism......Page 484
WERNICKE ENCEPHALOPATHY......Page 485
PELLAGRA ENCEPHALOPATHY......Page 486
Hepatic Encephalopathy......Page 488
Acquired Hepatocerebral Degeneration......Page 489
Pancreatic Encephalopathy......Page 490
MARCHIAFAVA–BIGNAMI DISEASE......Page 491
ALCOHOLIC DEMENTIA......Page 492
Alcoholic Neuropathy......Page 493
Alcoholic Myopathy......Page 494
WHEN TO REFER PATIENTS TO A NEUROLOGIST......Page 496
QUESTIONS AND DISCUSSION......Page 497
SUGGESTED READING......Page 499
CHAPTER 24: Central Nervous System Infections......Page 500
Common Laboratory Findings......Page 501
Viral Meningitis......Page 502
Acute Bacterial Meningitis......Page 503
Tuberculous and Fungal Meningitis......Page 505
ENCEPHALITIS......Page 506
Management and Prognosis......Page 507
Laboratory Findings......Page 508
PRION DISEASES (CREUTZFELDT–JAKOB DISEASE)......Page 509
QUESTIONS AND DISCUSSION......Page 510
SUGGESTED READING......Page 511
CHAPTER 25: Neurologic Aspects of Cancer......Page 513
Astrocytoma......Page 514
Ependymoma......Page 516
Meningioma......Page 517
Intracranial Metastases......Page 518
Leptomeningeal Metastases......Page 521
Spinal Metastases......Page 523
Cerebrovascular Complications......Page 524
Paraneoplastic Syndromes......Page 525
COMPLICATIONS FROM RADIATION THERAPY......Page 526
SPECIAL CHALLENGES FOR HOSPITALIZED PATIENTS......Page 527
QUESTIONS AND DISCUSSION......Page 528
SUGGESTED READING......Page 529
CHAPTER 26: Eye Signs in Neurologic Diagnosis......Page 530
Evaluation of Vision Loss......Page 531
Optic Disc Appearance......Page 532
Visual Pathway and Visual Field Defects......Page 534
Optic Neuropathy......Page 541
Diplopia......Page 542
Disorders of Object Recognition......Page 543
Pupil Anatomy and Function......Page 544
Relative Afferent Pupillary Defect......Page 545
Anisocoria......Page 546
Bilateral Light-Near Dissociation......Page 551
ABNORMAL EYE MOVEMENTS......Page 552
Conjugate Gaze Abnormalities......Page 553
Vertical Double Vision......Page 556
Horizontal Double Vision......Page 558
Pendular Nystagmus......Page 561
QUESTIONS AND DISCUSSION......Page 562
SUGGESTED READING......Page 563
CHAPTER 27: Principles of Neurorehabilitation......Page 565
ROLE OF ASSESSMENT IN NEUROREHABILITATION......Page 567
Maintenance of Homeostasis......Page 569
Prevention of Joint Contractures......Page 570
Prevention of Falls, Fractures, and Dislocations......Page 571
Early Mobilization and Return to Self-Care......Page 572
Rehabilitation Program Criteria......Page 573
REHABILITATION MANAGEMENT PLAN......Page 574
Management of Impaired Mobility......Page 575
Management of Impaired Cognition......Page 576
Management of Chronic Pain......Page 577
Discharge Planning......Page 578
When to Refer a Patient to a Neurorehabilitation Specialist......Page 580
Special Challenges for Hospitalized Patients......Page 581
QUESTIONS AND DISCUSSION......Page 582
SUGGESTED READING......Page 585
CHAPTER 28: Medicolegal Issues in the Care of Patients with Neurologic Illness......Page 586
INFORMED CONSENT......Page 588
DECLARING DEATH BY USING NEUROLOGIC CRITERIA (BRAIN DEATH)......Page 592
LICENSING OF DRIVERS......Page 595
QUESTIONS AND DISCUSSION......Page 599
SUGGESTED READING......Page 600
Index......Page 602