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