Introduction to Clinical Neurology

Preface
Preface to the First Edition
Contributors
Part I: The Basic Approach
Chapter 1 Where's the Lesion?
I. Sample Localization Problems
II. The Game
III. The Rules
IV. The Play: The Long Version
V. The Play: The Abbreviated Version
VI. Rules for Speed Play
Chapter 2 The Neurologic Examination
I. More Localization Problems
II. General Comments on the Neurologic Examination
III. How to Do the Neurologic Examination
A. Mental Status Examination
B. Cranial Nerve Examination
C. Motor Examination
D. Re?ex Examination
E. Sensory Examination
IV. Additional Comments on Terminology and Examination Technique
A. Mental Status Examination
B. Cranial Nerve Examination
C. Motor Examination
D. Re?ex Examination
E. Sensory Examination
V. Interpretation of the Neurologic Examination
A. Mental Status Examination
B. Cranial Nerve Examination
C. Motor Examination
D. Re?ex Examination
E. Sensory Examination
VI. Modi?cations of the Neurologic Examination
A. Screening Neurologic Examination
B. Examination of Stuporous or Comatose Patients
VII. Discussion of Localization Problems
Chapter 3 What's the Lesion?
James W. Albers and Douglas J. Gelb
I. Case History
II. Beyond Localization
A. Localization
B. Temporal Pro?le
C. Epidemiology
III. Etiology
A. Degenerative Diseases
B. Neoplastic Diseases
C. Vascular Diseases
D. In?ammatory Diseases
E. Toxic and Metabolic Diseases
F. Traumatic Diseases
G. Congenital and Developmental Diseases
IV. Discussion of Case Histories
Chapter 4 Stroke
I. Case Histories
II. Approach to Stroke
III. Background Information
A. De?nitions
B. Classi?cation of Strokes by Etiology
C. Pathophysiology
IV. Diagnosis
A. Clinical Features
B. Imaging
V. Management of Acute Stroke
A. Restoration of Blood Flow in Ischemic Stroke
B. Limitation of De?cits
C. Rehabilitation
VI. Primary Prevention
A. Hypertension
B. Smoking
C. Diabetes
D. Dyslipidemia
E. Mechanical Heart Valves
F. Atrial Fibrillation
G. Carotid Stenosis
H. Sickle Cell Disease
I. Other Factors
VII. Secondary Prevention of Ischemic Stroke
A. Cardioembolic Disease
B. Carotid Stenosis
C. Anti-Platelet Medications
D. Statin Therapy
E. Risk Factor Modi?cation
F. Stroke Mechanisms Other Than Cardioembolism and Carotid Stenosis
G. Determining the Underlying Mechanism of Stroke
VIII. Secondary Prevention of Cerebral Hemorrhage
IX. Discussion of Case Histories
Chapter 5 Seizures
I. Case Histories
II. Approach to Seizures
III. Background Information
A. De?nitions
B. Clinical Characteristics of Seizures
C. Seizures vs. Epilepsy
D. Epilepsy Syndromes
E. Electroencephalography
F. Pathophysiology of Seizures and Epilepsy
IV. Diagnosis
A. Characterizing the Presenting Spell
B. Identifying Prior Spells
C. Recognizing Spells that are Not Seizures
V. Determining the Cause of Seizures
A. Provoked Seizures
B. Epilepsy
C. The Diagnostic Evaluation
VI. Management of Seizures and Epilepsy
A. Patients with Seizures but No Proven Epilepsy
B. Patients with Epilepsy
C. Patient Education (for Patients with Isolated Seizures or Epilepsy)
D. Restrictions (for Patients with Isolated Seizures or Epilepsy)
VII. Special Clinical Problems
A. Status Epilepticus
B. Seizures and Pregnancy
C. Refractory Seizures
VIII. Discussion of Case Histories
Chapter 6 Neuromuscular Disorders
Mark B. Bromberg and Douglas J. Gelb
I. Case Histories
II. Approach to Neuromuscular Diseases
III. Background Information
A. Functional Divisions of the Peripheral Nervous System
B. Proximal-to-Distal Organization of the Peripheral Nervous System
C. Electrodiagnostic and Other Laboratory Studies
IV. Speci?c Neuromuscular Diseases
A. Motor Neuron Diseases
B. Nerve Root Disorders (Radiculopathies)
C. Plexus Disorders (Plexopathies)
D. Peripheral Nerve Disorders (Neuropathies)
E. Neuromuscular Junction Disorders
F. Muscle Disorders (Myopathies)
V. Symptomatic Treatment
A. Emergency Measures
B. Non-Urgent Measures: Motor Symptoms
C. Non-Urgent Measures: Sensory Symptoms
VI. Discussion of Case Histories
Chapter 7 Dementing Illnesses
I. Case Histories
II. Approach to Dementing Illnesses
A. Is It Abnormal?
B. Is It Dementia?
C. Is It Progressive?
D. Is There a Potentially Reversible Cause?
E. Which Diagnosis Is Most Likely?
III. Primary Dementing Illnesses
A. Alzheimer's Disease
B. Dementia with Lewy Bodies (DLB)
C. Frontotemporal Dementia (FTD)
D. Vascular Dementia
E. Normal Pressure Hydrocephalus (NPH)
F. Creutzfeldt-Jakob Disease (CJD)
G. Other Neurologic Diseases That Produce Dementia
IV. Discussion of Case Histories
Chapter 8 Movement Disorders
I. Case Histories
II. Approach to Movement Disorders
III. Background Information
A. Anatomic De?nitions
B. Clinical De?nitions
C. Classi?cation of Movement Disorders
IV. Speci?c Movement Disorders
A. Essential Tremor
B. Parkinson's Disease
C. Other Parkinsonian Syndromes
D. Hereditary Ataxias
E. Huntington's Disease
F. Tardive Dyskinesia
G. Dystonias
H. Wilson's Disease
I. Gilles de la Tourette's Syndrome
V. Discussion of Case Histories
Chapter 9 Sleep Disorders
I. Case Histories
II. Approach to Sleep Disorders
III. Background Information
A. De?nitions
B. Sleep Physiology
C. Diagnostic Tests
D. Classi?cation of Sleep Disorders
IV. Trouble Staying Awake
A. Insuf?cient Sleep
B. Sleep Apnea
C. Narcolepsy
D. Other Causes of Hypersomnolence
V. Trouble Sleeping
A. Sleep-Onset Delay
B. Early Morning Awakening
C. Sleep Fragmentation
D. Sleep State Misperception
VI. Abnormal Behavior During Sleep
A. Nonrapid Eye Movement (NREM) Sleep Parasomnias
B. Rapid Eye Movement (REM) Sleep Parasomnias
VII. Discussion of Case Histories
Chapter 10 Multifocal Central Nervous System Disorders
I. Case Histories
II. Approach to Multifocal Disorders
III. Focal Diseases with Multifocal Propagation
A. Metastatic Cancer
B. Central Nervous System Infections
IV. Inherently Multifocal Diseases
A. Multiple Sclerosis
B. Connective Tissue Diseases
C. Sarcoidosis
D. Coagulation Disorders
V. Discussion of Case Histories
Chapter 11 Acute Mental Status Changes
I. Case Histories
II. Background Information
A. De?nitions
B. Focal Mental Status Changes vs. Altered Level of Consciousness
C. Physiology of Normal and Altered Consciousness
III. Approach to Acute Changes in Level of Consciousness
A. ABCs: Airway, Breathing, Circulation
B. Oxygen, Glucose, Naloxone
C. Pupils, Doll's Eyes, Motor Asymmetry
D. Other Electrolytes, Renal, Hepatic, Temperature Abnormalities
E. Everything Else
IV. Special Circumstances
A. Head Trauma
B. Increased Intracranial Pressure
C. Brain Death
V. Discussion of Case Histories
Chapter 12 Headache
I. Case Histories
II. Approach to Headache
III. Background Information
A. Primary vs. Secondary Headaches
B. Pathophysiology of Migraine
IV. Headache Emergencies: Subarachnoid Hemorrhage and Bacterial Meningitis
V. Other Secondary Headaches
A. Viral Meningitis or Encephalitis
B. Fungal or Tuberculous Meningitis
C. Mass Lesions
D. Giant Cell (Temporal) Arteritis
E. Idiopathic Intracranial Hypertension (IIH; Pseudotumor Cerebri)
F. Spontaneous Intracranial Hypotension
G. Cerebral Venous Thrombosis
H. Arterial Dissection
I. Systemic Conditions
J. Secondary Headache Syndromes with Diagnostic Ambiguity
VI. Primary Headaches
A. Migraine and Tension Headaches
B. Cluster Headaches
C. Trigeminal Neuralgia
D. Glossopharyngeal Neuralgia
E. Chronic Paroxysmal Hemicrania and Related Conditions
F. Atypical Facial Pain
VII. Discussion of Case Histories
Chapter 13 Visual Symptoms
I. Case Histories
II. Background Information
A. De?nitions
B. Overview of the Visual System
III. Approach to Visual Symptoms
IV. Monocular Vision Loss
A. Acute or Subacute Monocular Vision Loss in Young Patients
B. Acute, Subacute, or Chronic Monocular Vision Loss in Older Patients
V. Transient Vision Loss (Monocular or Binocular)
VI. Persistent Binocular Vision Loss
VII. Diplopia
A. Localization
B. Differential Diagnosis and Management
VIII. Discussion of Case Histories
Chapter 14 Dizziness and Disequilibrium
I. Case Histories
II. Approach to Dizziness
III. Localization
IV. Differential Diagnosis
V. Disequilibrium
VI. Discussion of Case Histories
Chapter 15 Back Pain and Neck Pain
I. Case Histories
II. Approach to Back or Neck Pain
A. Emergency Situations
B. Non-urgent Indications for Surgery
III. Speci?c Conditions Causing Back or Neck Pain
A. Musculoskeletal Pain
B. Disc Herniation
C. Spinal Stenosis
IV. Discussion of Case Histories
Chapter 16 Incontinence
I. Case Histories
II. Background Information
III. Approach to Incontinence
A. Neurologic vs. Urologic Causes of Incontinence
B. Central vs. Peripheral Nervous System Causes of Incontinence
IV. Discussion of Case Histories
Chapter 17 Pediatric Neurology
I. Case Histories
II. Developmental Considerations
III. Hypotonic Infants
IV. Developmental Delay and Developmental Regression
V. Paroxysmal Symptoms
A. Headaches
B. Seizures
C. Breath-Holding Spells
D. Benign Paroxysmal Vertigo
VI. Gait Disturbance
A. Spasticity
B. Weakness
C. Ataxia
VII. Discussion of Case Histories
Chapter 18 Geriatric Neurology
I. Case Histories
II. Geriatric Issues
III. The Neurologic Examination in Normal Aging
A. Mental Status
B. Cranial Nerves
C. Motor System
D. Re?exes
E. Sensation
IV. Common Neurologic Symptoms in the Elderly
A. Dizziness
B. Gait Disturbance
C. Incontinence
D. Dementia
E. Pain
V. Discussion of Case Histories
Chapter 19 Practice Cases
I. Case Histories
II. Answers