Harrison Neurology in Clinical Medicine Second Edition

732 Review and Self-Assessment insipidus occurs with dysfunction of the hypothalamus or muscle use, and paradoxical respiration. His arterial blood posterior pituitary. It has been described in patients with gas shows a respiratory alkalosis with an increase in the A–a brain death but is not a component of the diagnosis. gradient to 33 mmHg. His vital capacity is 12.5 mL/kg body weight. Laboratory findings would include normal 48. The answer is B. serum chemistries with an increased cerebrospinal fluid (Chap. 6) Cluster headaches, which can cause excruciating protein without pleocytosis. Electromyography would show hemicranial pain, are notable for their occurrence during evidence of demyelination. Treatment for this individual characteristic episodes. Usually attacks occur during a should include endotracheal intubation with mechanical 4- to 8-week period in which the patient experiences ventilation in addition to IVIg or plasmapheresis. IVIg is one to three severe brief headaches daily. There may then administered as five daily infusions of 2 g/kg body weight. be a prolonged pain-free interval before the next episode. Plasmapheresis is equally effective in treating GBS and is Men between 20 and 50 years are most commonly performed four times over the first week. Mechanical ven- affected. The unilateral pain is usually associated with tilation is indicated in GBS when the vital capacity <20 lacrimation, eye reddening, nasal stuffiness, ptosis, and mL/kg (ND Lawn et al: Arch Neurol 58(6):893, 2001). nausea. During episodes alcohol may provoke the attacks. There is no role for glucocorticoids in the treatment of Even though the pain caused by brain tumors may GBS. Ciprofloxacin is an effective treatment to decrease awaken a patient from sleep, the typical history and nor- symptom duration in C. jejuni infection if given early in the mal neurologic examination do not mandate evaluation course of the illness, but has no effect in treatment of GBS for a neoplasm of the central nervous system. Acute ther- following C. jejuni infection. Botulism also presents as an apy for a cluster headache attack consists of oxygen ascending symmetric paralysis. Cranial nerves are more fre- inhalation, although intranasal lidocaine and subcutaneous quently involved than in GBS. In this patient, there is no sumatriptan may also be effective. Prophylactic therapy associated risk factor for botulism such as home-canned with prednisone, lithium, methysergide, ergotamine, or foods or injection wounds from drug use. verapamil can be administered during an episode to pre- vent further cluster headache attacks. 51. The answer is E. (Chap. 21) Cardioembolism accounts for up to 20% of all 49. The answer is C. ischemic strokes. Stroke caused by heart disease is due to (Chap. 29) Trigeminal neuralgia is a clinical diagnosis based thrombotic material forming on the atrial or ventricular entirely on patient history, and as such should be treated wall or the left heart valves. If the thrombus lyses quickly, once a patient comes with the virtually pathognomonic only a transient ischemic attack may develop. If the arterial complaints of paroxysms of excruciating pain in the lips, occlusion lasts longer, brain tissue may die and a stroke will gums, cheeks, and chin that resolve over seconds to minutes. occur. Emboli from the heart most often lodge in the mid- Carbamazepine is first-line therapy, followed by phenytoin dle cerebral artery (MCA), the posterior cerebral artery for the ~30–50% of patients who do not respond adequately (PCA), or one of their branches. Atrial fibrillation is the to therapy. Surgical approaches, such as radiofrequency ther- most common cause of cerebral embolism overall. Other mal rhizotomy, gamma-knife radiosurgery, and microvascu- significant causes of cardioembolic stroke include myocar- lar decompression, should be considered only when medical dial infarction, prosthetic valves, rheumatic heart disease, options fail. Steroids have no therapeutic role, as trigeminal and dilated cardiomyopathy. Furthermore, paradoxical neuralgia is not an inflammatory condition. Neuroimaging embolization may occur when an atrial septal defect or a is not indicated, unless other clinical features or a focal neu- patent foramen ovale exists. This may be detected by rologic deficit elicited on history or physical examination bubble-contrast echocardiography. Bacterial endocarditis suggest another possible diagnosis such as intracranial mass may cause septic emboli if the vegetation is on the left side or multiple sclerosis. of the heart or if there is a paradoxical source. 50. The answer is C. 52. The answer is B. (Chap. 41) The patient fulfills the diagnostic criteria for (Chap. 7) The crossed straight leg raise is positive when GuillainBarré syndrome (GBS) with progressive weakness flexion of one leg reproduces the pain in the opposite leg of two or more limbs, areflexia, disease course <4 weeks, or buttocks. This sign is more specific for disk herniation and no other identifiable cause. Other characteristic fea- than the straight leg raise. The nerve or nerve root lesion tures include lack of a fever, symmetric weakness, and min- is always on the side of the pain.The straight leg raise test imal sensory symptoms. The diagnosis is further suggested is positive if passive flexion of the leg reproduces the by an antecedent gastrointestinal illness. In the United patient’s usual back pain. The reverse straight leg raise is States, 20–30% of all cases of GBS are associated with a performed by standing the patient next to the examina- preceding infection with Campylobacter jejuni. This patient tion table and passively extending the leg with the knee also has evidence of impending respiratory failure from flexed. This maneuver stretches the L2-L4 nerve roots. neuromuscular weakness manifested by tachypnea, accessory Back pain referred from visceral organs may be palpated

Review and Self-Assessment 733 on abdominal examination but should not be reproduced to threefold increase in mortality for patients with epilepsy by straight leg raise. Passive dorsiflexion of the foot during compared with age-matched controls. Although most of the straight leg raise will add to the stretch but does not the increased mortality results from the underlying etiology add any more diagnostic information. of epilepsy, a significant number of these patients die from accidents, status epilepticus, and a syndrome known as sud- 53. The answer is D. den unexpected death in epileptic patients (SUDEP). The (Chap. 32) This figure illustrates a mass attached to the cause is unknown, but research has centered on brainstem- meninges with a dural tail. Other dural tumors may mediated effects of seizures on cardiopulmonary function. appear this way, but of the options listed, the meningioma is by far the most likely to appear this way. Meningiomas 55. The answer is D. derive from the cells that give rise to the arachnoid gran- (Chap. 21) Nonrheumatic atrial fibrillation is the most ulations.They are usually benign and attached to the dura. common cause of cerebral embolism overall. The pre- They rarely invade the brain. They are more frequent in sumed stroke mechanism is thrombus formation in the women than men and have a peak incidence in middle fibrillating atrium or atrial appendage.The average annual age. Total surgical resection of a meningioma is curative. risk of stroke is around 5%. However, the risk varies with Low-grade astrocytoma and high-grade astrocytoma certain factors: age, hypertension, left ventricular function, (glioblastoma) often infiltrate into adjacent brain and prior embolism, diabetes, and thyroid function. Patients rarely have the clear margins seen in this figure. Oligo- younger than 60 years of age without structural heart dis- dendroma comprise ~15% of all gliomas and show calcifi- ease or without one of these risk factors have a very low cation in roughly 30% of cases. They have a more benign annual risk of cardioembolism: <0.5%.Therefore, it is rec- course and are more responsive than other gliomas to ommended that these patients only take aspirin daily for cytotoxic therapy. For low-grade oligodendromas, the stroke prevention. Older patients with numerous risk fac- median survival is 7–8 years. Brain abscess will have dis- tors may have annual stroke risks of 10–15% and must tinctive ring-enhancing features with a capsule, often have take warfarin indefinitely. Cardioversion is indicated for mass effect, and will have evidence of inflammation on symptomatic patients who want an initial opportunity to MRI scanning. remain in sinus rhythm. However, studies have shown that there is an increased stroke risk for weeks to months after 54. The answer is B. a successful cardioversion, and these patients must remain (Chap. 20) Optimal medical therapy for epilepsy depends on anticoagulation for a long period. Similarly, recent on the underlying cause, type of seizure, and patient factors. studies have shown that patients who do not respond to The goal is to prevent seizures and minimize the side cardioversion and do not want catheter ablation have effects of therapy.The minimal effective dose is determined mortality and morbidity with rate control and anticoagu- by trial and error. In choosing medical therapies, drug lation similar to those of patients who opt for cardiover- interactions are a key consideration. Certain medications, sion. Low-molecular-weight heparin may be used as a such as tricyclic antidepressants, may lower the seizure bridge to warfarin therapy and may facilitate outpatient threshold and should be avoided. Patients who respond well anticoagulation in selected patients. to medical therapy and have completely controlled seizures are good candidates for the discontinuation of therapy, with 56. The answer is D. about 70% of children and 60% of adults being able to dis- (Chap. 43) There are two recognized clinical forms of continue therapy eventually. Patient factors that aid in this myotonic dystrophy, both of which are characterized by include complete medical control of seizures for 1 to 5 years, autosomal dominant inheritance. Myotonic dystrophy 1 a normal neurologic examination, a normal EEG, and sin- (DM1) is the most common form and the most likely dis- gle seizure type. On the other end of the spectrum, about order in this patient. Characteristic clinical features of this 20% of these patients are completely refractory to medical disorder include a “hatchet-faced” appearance, due to therapy and should be considered for surgical therapy. In wasting of the facial muscles, and weakness of the neck the best examples, such as mesial temporal sclerosis, resec- muscles. In contrast to the muscular dystrophies (Becker tion of the temporal lobe may result in about 70% of these and Duchenne), distal limb muscle weakness is more patients becoming seizure free and an additional 15–25% common in DM1. Palatal, pharyngeal, and tongue having a significant reduction in the incidence of seizures. involvement are also common and produce the dysarthric In patients with epilepsy other considerations are critical. voice that is frequently heard. The failure of relaxation Psychosocial sequelae such as depression, anxiety, and after a forced hand grip is characteristic of myotonia. behavior problems may occur. Approximately 20% of Myotonia can also be elicited by percussion of the thenar epileptic patients have depression, with their suicide rate eminence. In most individuals, myotonia is present by age being higher than that of age-matched controls.There is an 5, but clinical symptoms of weakness that lead to diagnosis impact on the ability to drive, perform certain jobs, and may not be present until adulthood. Cardiac conduction function in social situations. Furthermore, there is a twofold abnormalities and heart failure are also common in

734 Review and Self-Assessment myotonic dystrophy. Diagnosis can often be made by clin- must be warned to use standard precautions under these ical features alone in an individual with classic symptoms circumstances. These proteins cannot be measured from and a positive family history. An electromyogram would cerebrospinal fluid (CSF). CSF in CJD is usually normal confirm myotonia. Genetic testing for DM1 would show except for a minimally elevated protein. Many patients with a characteristic trinucleotide repeat on chromosome 19. CJD have elevated CSF stress protein 14-3-3. This test Genetic anticipation occurs with an increasing number of alone is neither sensitive nor specific, as patients with her- repeats and worsening clinical disease over successive gen- pes simplex virus encephalitis, multi-infarct dementia, and erations. Myotonic dystrophy 2 (DM2) causes proximal stroke may have similar elevations. muscle weakness primarily and is also known by the name proximal myotonic myopathy (PROMM). Other 59. The answer is D. features of the disease overlap with DM1. Acid maltase (Chap. 10) The ventral spinal cord includes the corti- deficiency (glucosidase deficiency, or Pompe’s disease) has cospinal tracts, spinothalamic tracts, and descending auto- three recognized forms, only one of which has onset in nomic tracts. Disruption of these tracts causes weakness/ adulthood. In the adult-onset form, respiratory muscle areflexia, loss of pain/temperature sensation, and bladder weakness is prominent and often is the presenting symp- sphincter dysfunction, respectively. The dorsal columns toms. As stated previously, Becker and Duchenne muscu- include vibratory sense and proprioception, which are lar dystrophies present with primarily proximal muscle spared in the ventral cord syndrome. Other causes of the weakness and are X-linked recessive disorders. Becker syndrome include disc herniation, radiation myelitis, and muscular dystrophy presents at a later age than Duchenne human T-lymphocyte virus 1 infection. muscular dystrophy and has a more prolonged course. Otherwise, features are similar to one another. Nemaline 60. The answer is C. myopathy is a heterogeneous disorder marked by the (Chap. 44) This patient’s skin findings are an example of threadlike appearance of muscle fibers on biopsy. Nema- Gottron’s sign of the hands and the heliotrope facial rash line myopathy usually presents in childhood and has a of dermatomyositis. Usually the rash precedes the muscular striking facial appearance similar to myotonic dystrophy weakness. In addition to theV-sign, as described in the sce- with a long, narrow face. This disease is inherited in an nario, one can also see the shawl sign, in which the erythe- autosomal dominant fashion. matous rash is found around the shoulders and posterior neck region. In addition to the skin manifestations, skeletal 57. The answer is D. muscle weakness, particularly the proximal muscles, is part (Chap. 20) Adolescence and early adulthood mark the of the presentation of dermatomyositis. Extra-muscular period where idiopathic or genetic epilepsy syndromes manifestations include constitutional symptoms, joint con- become less common and seizures due to acquired CNS tractures, dysphagia, cardiac disturbances, pulmonary dys- lesions become more common.The most common causes function, and arthralgias. Hepatosplenomegaly is not an of seizures in the young adults are head trauma, central associated clinical finding. Situs inversus is not associated nervous system (CNS) infections, brain tumors, congeni- with dermatomyositis. Hypothyroidism is associated with tal CNS lesions, illicit drug use, or alcohol withdrawal. delayed deep tendon relaxation. In hypothyroidism the Fever rarely causes seizure in patients >12 years. Amyloid skin appears swollen, dry, and coarse with a cool waxy angiopathy and uremia are more common in older adults. appearance. Subcutaneous nodules on the elbows, back of the forearms, and metacarpophalangeal joints of the hands 58. The answer is B. are characteristic of rheumatoid arthritis, particularly in the (Chap. 38) Startle myoclonus is a worrisome sign but is not active phase. specific for CJD, though it is more so if it occurs during sleep. Lewy body dementia,Alzheimer’s disease, central ner- 61. The answer is D. vous system infections, and myoclonic epilepsy can all cause (Chap. 17) This patient has acute angle-closure glaucoma myoclonus. EEG and MRI can both help differentiate CJD resulting from obstruction of the outflow of aqueous humor from these disorders. The MRI finding of cortical ribbon- at the iris. The buildup of intraocular pressure can be con- ing and intensity in the basal ganglia on fluid-attenuated firmed by measurement and requires urgent treatment with inversion recovery sequences are characteristic of CJD. hyperosmotic agents. Permanent treatment requires laser or EEG is useful if stereotypical periodic bursts every 1–2 s are surgical iridotomy. Angle-closure glaucoma is less common present, but this is seen in only 60% of cases, and other than is primary open-angle glaucoma, which is asympto- findings may be less specific. Demonstration of specific matic and is usually detectable only through measurements immunoassays for proteolytic products of disease-causing of intraocular pressure at a routine eye examination. prion proteins (PrPSc) at brain biopsy may be necessary to confirm diagnosis in some cases. However, these proteins 62. The answer is D. are not uniformly distributed throughout the brain and (Chap. 40) CMT disease is a heterogeneous group of false-negative biopsies occur. Both surgeons and pathologists inherited peripheral neuropathies. Transmission is usually

Review and Self-Assessment 735 autosomal dominant but may be recessive or X-linked. this idiopathic condition is carbamazepine or phenytoin if Numerous genetic defects are associated with CMT dis- carbamazepine is not tolerated.When drug treatment is not ease. It is very common, affecting up to 1 in 2500 persons. successful, surgical therapy, including the commonly applied Clinically, patients usually present in the first or second percutaneous retrogasserian rhizotomy, may be effective. A decade of life, but later presentations may occur.The neu- possible complication of this procedure is partial facial ropathy affects both motor and sensory nerves. Symptoms numbness with a risk of corneal anesthesia, which increases may vary, ranging from distal muscle weakness and severe the potential for ulceration. atrophy and disability to only pes cavus and minimal weakness. Although sensory findings and involvement are 66. The answer is C. common, these patients often do not have dominant sen- (Chap. 42) Except for lumbar puncture, all of the options sory complaints. However, if patients have no evidence of listed are indicated at this time. Thymic abnormalities are sensory involvement on detailed neurologic examination present in 75% of patients with myasthenia gravis. A CT or electrodiagnostic studies, an alternative diagnosis or MRI of the mediastinum may show enlargement or should be considered.There is no known effective therapy neoplastic changes in the thymus and is recommended for CMT disease. Orthotics and physical therapy are upon diagnosis. Hyperthyroidism occurs in 3–8% of mainstays for preserving function. patients with myasthenia gravis and may aggravate weak- ness. Testing for rheumatoid factor and antinuclear anti- 63. The answer is D. bodies should also be obtained because of the association (Chap. 35) Listeria has become an increasingly important of myasthenia gravis to other autoimmune diseases. Due cause of bacterial meningitis in neonates (<1 month of age), to side effects of immunosuppressive therapy, a thorough pregnant women, individuals >60 years, and immunocom- evaluation should be undertaken to rule out latent or promised individuals. Infection is acquired by eating conta- chronic infections such as tuberculosis. Measurements of minated foods such as unpasteurized dairy products, cole ventilatory function are valuable as a baseline because of slaw, milk, soft cheeses, delicatessen meats, and uncooked hot the frequency and seriousness of respiratory impairment dogs. Ampicillin is the agent most often added to the initial in myasthenic patients, and they can be used as an objec- empirical regimen to cover L. monocytogenes. tive measure of response to therapy. 64. The answer is E. 67. The answer is D. (Chap. 14) Foraminal herniation, which forces the cere- (Chap. 31) Hemorrhages beneath the dural layer (subdural) bellar tonsils into the foramen magnum, leads to compres- or between the skull and the dura (epidural) are common sion of the medulla and subsequent respiratory arrest. sequelae of head trauma. They can be life-threatening, and Central transtentorial herniation occurs when the medial prompt evaluation and management are imperative. Several thalamus compresses the midbrain as it moves through the clinical features allow these conditions to be distinguished tentorial opening; miotic pupils and drowsiness are the from one another. Acute subdural hematomas typically arise classic clinical signs. A locked-in state is usually caused by from venous sources, often the bridging veins located imme- infarction or hemorrhage of the ventral pons; other causes diately under the dura mater. As the brain volume decreases include Guillain-Barré syndrome and certain neuromus- with age, traction on these venous structures increases and cular blocking agents. Catatonia is a semi-awake state seen even minor head trauma in the elderly can lead to a subdural most frequently as a manifestation of psychotic disorders hematoma. Approximately 33% of patients with an acute such as schizophrenia. Third-nerve palsies arise from an subdural bleed will experience a lucid interval after the uncal transtentorial herniation where the anterior medial event, which is followed by obtundation. Subdural bleeding temporal gyrus herniates into the anterior portion of the is typically slower than epidural bleeding due to their tentorial opening anterior to the adjacent midbrain. different sources. Small subdural bleeds are asymptomatic Coma may occur due to compression of the midbrain. and often do not require evacuation. Epidural hematomas, on the other hand, can arise quickly and typically represent 65. The answer is D. arterial bleeding.They are often caused by a lacerated middle (Chap. 29) Brief paroxysms of severe, sharp pains in the face meningeal artery from an overlying skull fracture. Rapid without demonstrable lesions in the jaw, teeth, or sinuses are increase in intracranial pressure from these bleeds can neces- called tic douloureux, or trigeminal neuralgia.The pain may sitate arterial ligation or emergent craniotomy. Most patients be brought on by stimuli applied to the face, lips, or tongue with epidural bleeding are unconscious when first evaluated; or by certain movements of those structures. Aneurysms, a “lucid interval” can occasionally be seen. neurofibromas, and meningiomas impinging on the fifth cranial nerve at any point during its course typically present 68. The answer is C. with trigeminal neuropathy, which will cause sensory loss (Chap. 29) Pain, loss of function (without clear-cut sensory on the face, weakness of the jaw muscles, or both; neither or motor deficits), and a localized autonomic impairment symptom is demonstrable in this patient. The treatment for are called reflex sympathetic dystrophy (also known as

736 Review and Self-Assessment shoulder-hand syndrome or causalgia). Precipitating events 71. The answer is E. in this unusual syndrome include myocardial infarction, (Chap. 26) Cerebellar ataxia with a strong family history shoulder trauma, and limb paralysis. In addition to the suggests one of the autosomal spinocerebellar ataxias neuropathic-type pain, autonomic dysfunction, possibly (SCA). SCA7 is distinguished from all of the other SCAs resulting from neuroadrenergic and cholinergic hypersen- by the presence of retinal pigmentary degeneration. The sitivity, produces localized sweating, changes in blood flow, visual abnormalities first appear as blue-yellow color and abnormal hair and nail growth as well as edema or blindness and proceed to frank visual loss with macular atrophy of the affected limb. Treatment is difficult; how- degeneration. Proliferative retinopathy would be expected ever, anticonvulsants such as phenytoin and carbamazepine in someone who has poorly controlled diabetes. Lipemia may be effective, as they are in other conditions in which retinalis is often seen in patients with hypertriglyc- neuropathic pain is a major problem. eridemia. Papilledema is seen in increased intracranial pressure, which is not present in SCA. 69. The answer is B. (Chap. 6) The peak prevalence of migraine headaches 72. The answer is E. occurs in the fourth to fifth decades of life. Many women (Chap. 21) Numerous studies have identified key risk fac- experience decreased severity and frequency of headaches tors for ischemic stroke. Old age, family history, diabetes, after menopause, and some individuals cease to have hypertension, tobacco smoking, and cholesterol are all migraines as they age. Migraine has been demonstrated to risk factors for atherosclerosis and therefore stroke. be a risk factor for ischemic stroke in both men and Hypertension is the most significant among these risk women. In addition, women who have migraine with factors. All cases of hypertension must be controlled in aura appear to be at greater risk of ischemic stroke if they the setting of stroke prevention. Antiplatelet therapy has are concurrently taking oral contraceptives.The American been shown to reduce the risk of vascular atherothrom- College of Gynecology has recommended that women botic events. The overall relative risk reduction of nonfa- who are >35 years or have focal neurologic symptoms tal stroke is about 25–30% across most large clinical trials. with their migraine attacks should not take oral contra- The “true” absolute benefit is dependent on the individ- ceptives, but low-dose contraceptive can otherwise be ual patient’s risk; therefore, patients with a low risk for taken safely in women with migraine headaches. Any risk stroke (e.g., younger, with minimal cardiovascular risk factors that are known to increase stroke risk such as factors) may have a relative risk reduction with hypertension or cigarette smoking also contribute to antiplatelet therapy but a meaningless “benefit.” Numer- stroke in individuals with migraine. Interestingly, asymp- ous studies have shown the benefit of statin therapy in tomatic women with migraines have been shown to have the reduction of stroke risk even in the absence of hyper- a greater likelihood of white matter changes on MRI, and cholesterolemia. Although anticoagulation is the treat- those with aura had a significant increased risk of subclin- ment of choice for atrial fibrillation and cardioembolic ical posterior circulation infarcts. causes of stroke, there is no proven benefit in regard to the prevention of atherothrombotic stroke; therefore, warfarin 70. The answer is A. cannot be recommended. (Chap. 9) This patient has classic symptoms and history consistent with Ménière’s disease. Patients have recurrent 73. The answer is C. unilateral labyrinthine dysfunction marked by hearing loss (Chap. 18) Head trauma is the most common etiology of a and tinnitus. The symptoms are very debilitating, and decreased sense of smell in young adults and children. In patients may be incapacitated by the tinnitus and vertigo. most cases this is permanent, with only 10% of these The severity and recurrent nature suggest Ménière’s dis- patients experiencing recovery. In older adults viral infec- ease and argue against a central process. Ménière’s disease tions predominate. Parainfluenza virus type 3 is the most responds to diuretic therapy and/or a low-salt diet. In common associated virus. Patients with HIV also frequently addition, patients should attempt to ambulate in an have a distorted sense of smell, and this is associated with attempt to induce central compensatory mechanisms. HIV wasting syndrome. Although rare, genetic defects such Scopolamine transdermal patches and anticholinergic as Kallmann syndrome and albinism are also causes of anos- medications are useful only for motion sickness. The mia. Influenza virus is not a cause of anosmia. Epley procedure attempts to reposition particulate debris within the semicircular canals such as in benign paroxys- 74. The answer is D. mal positional vertigo. Glucocorticoids are useful for the (Chap. 20) Phenytoin is a commonly used anticonvulsant. acute treatment of vertigo but are used only in the acute Its principal use is in patients with tonic-clonic seizures. It setting and have no role in the long-term treatment of may be given either orally or intravenously.Typical dosing Ménière’s disease. Metoclopramide may be used to treat is about 300 to 400 mg/d in adults.The therapeutic range nausea but has no role in the tinnitus and vertigo of is between 10 and 20 μg/mL. Neurologic side effects Ménière’s disease. include dizziness, ataxia, diplopia, and confusion. Systemic

Review and Self-Assessment 737 side effects include gum hyperplasia, hirsutism, facial brainstem, but not in any other part of the brain, may also coarsening, and osteomalacia. These patients may develop cause episodic generalized weakness. Multiple sclerosis lymphadenopathy and Stevens-Johnson syndrome. Toxic- may cause episodic generalized weakness. Atherosclerotic ity may be enhanced by liver disease and competition occlusive carotid disease may cause focal but not general- with other medications. Phenytoin alters folate metabo- ized weakness. lism and is teratogenic. Leukopenia is not a typical side effect and is seen more often with carbamazepine. 78. The answer is C. (Chap. 1) The patient in this scenario is demonstrating 75. The answer is C. paratonia (fluctuating changes in resistance during testing of (Chap. 43) The muscular dystrophies are hereditary pro- motor tone). Paratonia may be seen in patients who have gressive diseases. Becker’s muscular dystrophy is a less difficulty relaxing during the examination or may be evi- severe form of X-linked recessive muscular dystrophy dence of aberrant frontal lobe pathways, as in some forms than Duchenne’s muscular dystrophy. It occurs 10 times of dementia. The patient has increased tone, making mus- less frequently than DMD.The underlying defect is in the cle injury less likely. Dystonia, as seen in parkinsonism, same protein, dystrophin, which is part of a large complex manifests as cogwheel rigidity and jerky interruptions of of sarcolemmal proteins and glycoproteins. Clinically, resistance without the focality that is seen in this scenario. Becker’s muscular dystrophy (BMD) shows a similar pat- Motor neuron diseases, such as amyotrophic lateral sclero- tern of proximal muscle weakness. Weakness becomes sis, may present with either flaccidity or spasticity. Usually generalized with progression of the disease. Hypertrophy patients with motor neuron disease have abnormalities that of muscles, particularly the calves, is an early feature. Most can be elicited in more than one muscle group (although patients experience the initial symptoms in the first and asymmetry is common). second decades of life, but a later onset may occur. These patients have reduced life expectancy but are significantly 79. The answer is D. more functional than are patients with DMD. Mental (Chap. 36) Ibuprofen, isoniazid, ciprofloxacin, tolmetin, retardation may also occur in patients with BMD, and car- sulfa-containing medicines, and phenazopyridine have diac involvement may result in congestive heart failure. been implicated in drug hypersensitivity leading to menin- Serum creatinine kinase (CK) levels are elevated, and gitis. The cerebrospinal fluid (CSF) will typically show electrodi-agnostic findings are similar to those seen in neutrophils, but mononuclear cells or eosinophils are occa- DMD. The diagnosis is made by demonstrating a reduced sionally present. Most causes of chronic (not recurrent) amount of dystrophin on Western blot analysis. meningitis cause a predominance of mononuclear cells. The differential for chronic meningitis is broad and a diag- 76. The answer is D. nosis is often difficult to make. The treating physician (Chap. 7) There are four indications for surgical repair of needs to consider a diverse array of viral, fungal, bacterial, an intervertebral disk herniation: objective progressive mycobacterial, helminthic, and protozoal pathogens, both motor weakness, signs of spinal cord compression (e.g., common and exotic, and therefore should obtain a bowel or bladder incontinence), incapacitating nerve root detailed social history and consult an expert in the field. pain despite conservative treatment, and recurrent inca- Recurrent meningitis is often due to herpes simplex virus pacitating nerve root pain. Absent deep tendon reflexes, type 2 infection and this should be ruled out, particularly nighttime symptoms, and more than one level of disk her- if active genital ulcers develop concurrently. Malignancy, niation are not uncommon findings in patients with a sarcoidosis, and vasculitis are all potential causes, and his- disk herniation and do not mandate surgery. tory, physical examination, and appropriate further testing should dictate the degree to which these possibilities are 77. The answer is A. explored. Medications are often overlooked as a cause of (Chap. 10) Episodic generalized weakness is caused by dis- chronic meningitis and should always be carefully consid- orders of the central nervous system (CNS) or the motor ered.When CSF neutrophils predominate after 3 weeks of unit. Weakness from CNS disorders is usually associated illness, nocardia, actinomyces, brucella, tuberculosis (<10% with altered consciousness or cognition, increased muscle of cases), fungal, and noninfectious causes of chronic tone and reflexes, and changes in sensation. Motor unit meningitis should be considered. disorders include a variety of electrolyte disturbances (hypokalemia, hyperkalemia, hypercalcemia, hyperna- 80. The answer is E. tremia, hyponatremia, hypophosphatemia, hypermagne- (Chaps. 15 and 23) All the choices given in the question semia), inborn errors of metabolism (carbohydrate or fatty are causes of or may be associated with dementia. Bin- acid metabolism, mitochondrial function), toxins (botu- swanger’s disease, the cause of which is unknown, often lism, curare), neuromuscular junction disorders (myasthe- occurs in patients with long-standing hypertension and/or nia gravis, Lambert-Eaton syndrome), and channelopathies atherosclerosis; it is associated with diffuse subcortical (periodic paralysis). Transient ischemic attacks of the white matter damage and has a subacute insidious course.

738 Review and Self-Assessment Alzheimer’s disease, the most common cause of dementia, bilateral focal neurologic deficits. Brain imaging demon- is also slowly progressive and can be confirmed at autopsy strates multiple areas of stroke. by the presence of amyloid plaques and neurofibrillary tangles. Creutzfeldt-Jakob disease, a prion disease, is associ- 81. The answer is B. ated with a rapidly progressive dementia, myoclonus, (Chap. 40) Carpal tunnel syndrome is caused by entrap- rigidity, a characteristic EEG pattern, and death within ment of the median nerve at the wrist. Symptoms begin 1–2 years of onset.Vitamin B12 deficiency, which often is with paresthesias in the median nerve distribution. With seen in the setting of chronic alcoholism, most commonly worsening, atrophy and weakness may develop.This condi- produces a myelopathy that results in loss of vibration and tion is most commonly caused by excessive use of the joint position sense and brisk deep tendon reflexes (dorsal wrist. Rarely, systemic disease may result in carpal tunnel column and lateral corticospinal tract dysfunction). This syndrome. This may be suspected when bilateral disease is combination of pathologic abnormalities in the setting of apparent. Tenosynovitis with arthritis as in the case of vitamin B12 deficiency is also called subacute combined rheumatoid arthritis and thickening of the connective tis- degeneration. Vitamin B12 deficiency may also lead to a sue as in the case of amyloid or acromegaly are also causes. subcortical type of dementia. Multi-infarct dementia, as in Other systemic diseases, such as hypothyroidism and dia- this case, presents with a history of sudden stepwise betes mellitus, are also possible etiologies. Leukemia is not declines in function associated with the accumulation of typically associated with carpal tunnel syndrome.

INDEX Bold number indicates the start of the main discussion of the topic; numbers with “f ” and “t” refer to figure and table pages. AAA. See Abdominal aortic aneurysm Acute angle-closure glaucoma, 178 AIDS dementia. See HIV infection, dementia in AAN. See Autoimmune autonomic neuropathy tonometry for, 720, 734 AIF. See Apoptosis-inducing factor ABC family. See ATP-binding cassette family AION. See Anterior ischemic optic neuropathy Abdominal aortic aneurysm (AAA), 72, 79 Acute autonomic syndromes, 374 Akathisia, 344, 675 Abdominal reflexes, assessment of, 8 Acute bilateral labyrinthine dysfunction, 98 Akinetic mutism, 130–131 Abducens nerve Acute disseminated encephalomyelitis (ADEM), 449 V-akt murine thymoma viral oncogene homologue diplopia in disorders of, 190 clinical manifestations of, 450 (AKT1), 655, 656t examination of, 6 diagnosis of, 450 AKT1. See V-akt murine thymoma viral oncogene palsy, 533 features of, 449 Abducens palsy, 190 neuroimaging for, 643f homologue Abscess, 127 treatment of, 450 Albendazole, 479 Absence seizures, 224 Acute infectious myelitis, 394 ALBP. See Acute low back pain atypical, 224–225 Acute inflammatory demyelinating polyneuropathy Alcohol. See also Ethanol Abstract thought, 6 Abulia, 131 (AIDP), 551–552, 551t absorption of, 686–687 ACA. See Anterior cerebral artery Acute intoxication, 693 abuse of, 690 Acalculia, 145 Acute low back pain (ALBP), 73–74 behavioral effects of, 687–688 Acamprosate, 694–695 blood level of, 687, 687t Acanthamoeba, 468–469, 487t, 504 back pain treatment for, 80–81, 81f cancer and, 689 Acanthocytes, 341 epidural glucocorticoids for, 80 cardiovascular system and, 689–690 ACAS. See Asymptomatic Carotid Atherosclerosis NSAIDS for, 80 consumption of, 686 Acute motor axonal neuropathy (AMAN), 551 delirium from withdrawal from, 126 Study Acute motor sensory axonal neuropathy (AMSAN), dependence on, 687–688, 690 Accessory nerve examination, 716–717, gastrointestinal system and, 689 551 hematopoietic system and, 689 730–731 Acute MS, 449 insomnia and, 162 ACE. See Angiotensin-converting enzyme Acute otitis media (AOM), 202 metabolism of, 687f Acephalgic migraine, 247 Acute quadriplegic myopathy, 292 nervous system and, 688–689 Acetaminophen, 80 Acute spinal cord disease, 388–394 organ systems, effects of, 688–690 Acute stress disorder, 669 peripheral neuropathy and, 688 adverse effects of, 44 Acute subdural hematoma, 403, 403f sexual dysfunction and, 690 for pain, 44–46, 45t Acute transverse myelitis, 642f sleep impacted by, 688 Acetazolamide, 120, 351t Acute transverse myelopathy (ATM), 392 tolerance and, 687–688, 687t for ataxia, 354 withdrawal syndrome, 692 for headache, 66 evaluation of, 392t Alcohol dehydrogenase (ALDH), 687, 687f for insomnia, 161 Acute unilateral labyrinthine dysfunction, 97 Alcohol Use Disorder Screening Test (AUDIT), for papilledema, 182 Acutely appearing masses, 132 Acetylcholine (ACh) Acyclovir, 470, 541, 652 691, 692t Alzheimer’s disease and, 307 Addison’s disease, 164 Alcoholic myopathy, 690 clinical aspects of, 214t ADEM. See Acute disseminated encephalomyelitis Alcoholic neuropathy, 373 delirium and deficiency of, 124 Adenine nucleotide translocator 1 (ANT1), 588 Alcohol-induced psychotic disorder, 689 MG and, 716, 729–730 Adenoma. See Pituitary tumors Alcoholics Anonymous, 694 role of, 366 ADH. See Antidiuretic hormone Alcoholism, 302, 690 synthesis of, 559, 560f Adie’s syndrome,172–173, 370 Acetylcholine receptors (AChRs) Adjustment insomnia, 161 anxiety and, 694 antibodies to, 561 ADNFLE. See Autosomal dominant nocturnal frontal for benzodiazepine, 693–694 deficiency of, 562, 562t chronic, 161 in MG, 559–560 lobe epilepsy Acetylcholinesterase (AChE), 559 Adolescence, epilepsy in, 229 dementia and, 315–316 deficiency of, 562, 562t ADPEAF. See Autosomal dominant partial epilepsy definitions of, 690 MG, test for, 561 disulfiram for, 695 MG treatment with medications of, 564 with auditory features epidemiology of, 690–691 Acetylsalicylic acid, for pain, 45t Adrenal disorders, 593 genetics of, 691 ACh. See Acetylcholine Adrenocorticotropin hormone (ACTH), 423 identification of, 691, 692t ACHE. See American Council for Headache intervention for, 691–692 efficiency tests for, 427t Education reserve, 426 brief, 692 AChE. See Acetylcholinesterase Adrenomyeloneuropathy, 397 motivational interviewing for, 692 Achilles reflex, 8 Adult Tay-Sach’s disease, 363 natural history of, 691 Achromatopsia, 150 Adults psychiatric disorders from, 688–689 AChRs. See Acetylcholine receptors epilepsy for young, 229 treatment for, 693–695 Acid maltase deficiency, 585–586 seizures in older, 230 Acoustic neuromas, 380 Advanced sleep phase disorder (ASPD), 168–169 acute intoxication in, 693 Aerophobia, 469 rehabilitation in, 694–695 dizziness/vertigo from, 712, 726 Ageusia relapse prevention in, 694 Acoustic reflex, 205 partial, 196 withdrawal in, 693–694 specific, 196 withdrawal and, 692 decay, 205 total, 196 ALDH. See Alcohol dehydrogenase Acquired hypopituitarism, 425 Agitated depression, 676 Alien hand, 313, 336 Acquired vascular lesions, 281 Agnosia, 193 Allergic conjunctivitis, 175 Acromegaly, 428t spatial, 264 Allergic reactions to contrast media, Agoraphobia, 663, 668 familial, 429 diagnostic criteria for, 663t 15, 15t screening test for, 432t Agraphesthesia, 120 Allodynia, 117 Acrylamide, 535 Agraphia, 142 Allopurinol, 566 Acrylamide monomer, 536t pure alexia without, 142t, 144–145 Allyl chloride, 536t ACST. See Asymptomatic Carotid Surgery Trial AIDP. See Acute inflammatory demyelinating Alphaviruses, 466 ACTH. See Adrenocorticotropin hormone Alport syndrome, 201 Actinin, 585 polyneuropathy Alprazolam, 667t, 668 Actinomyces, 486t AIDS, 290, 347. See also HIV infection ALS. See Amyotrophic lateral sclerosis Action dystonia, 338 Alternative splicing, 211 classification of, 493, 494t Altitude insomnia, 161 PML from, 474 primary CNS lymphoma and, 414 739

740 Index Alzheimer’s disease, 146, 305 Anaplasma phagocytophilum, 458 Antiepileptic drugs ACh reduction in, 307 Anaplastic astrocytomas, 411 alternative, 237t age and, 305, 307 Anaplastic oligodendroglioma, 413 discontinuing, 241 apo ε gene and, 308–309 Andersen-Tawil syndrome, 592 dosage/adverse effects of common, Capgras’ syndrome and, 305 Aneurysm, 12t. See also specific types 238t–239t caregiver burnout in, 309, 319 Angiography, 22. See also Computed tomography; epilepsy and, 232 cholinesterase inhibitors treating, 319 epilepsy/seizure treatment for, 236–241 clinical manifestations of, 305–306 Magnetic resonance angiography first-line, 237t clinical presentation of, 302t CNS vasculitis and, 636f monitoring of therapy with, 240–241 depression from, 310 complications with, 23 for partial seizures, 239–240 differential diagnosis of, 306, 306f contrast media and, 23 refractory epilepsy treated with, 241 epidemiology of, 306–307 morbidity and, 22–23 risks of, 237 functional anatomy of, 298–299 spinal, 23 seizures and, 232 genetic considerations for, 307–309, 655 Angiostrongylus, 488t selection of, 237, 237t, 239 genetic mutations in, 219 Angiotensin-converting enzyme (ACE), 393 for generalized seizures, 240 ginkgo biloba for, 309 Ankylosing spondylitis, back pain/neck pain in, 77, 84 for partial seizures, 239–240 MCI leading to, 305 Anomia, 141 therapy initiation with, 237 MMSE for, 303, 303t Anomic aphasia, 142t, 144 molecular basis for, 301t Anosmia, 193, 402 Anti-glycolipid antibodies, GBS and, 553, 553t pathology of, 307 Anosognosia, 148, 247, 305 Antihistamines, 160 presenilins in, 308 ANS. See Autonomic nervous system Anti-Hu paraneoplastic neuropathy, 558 selegiline for, 309 ANS dysfunction Anti-jo-1, 600 smell and, 195 AAN and, 373 Antineuronal antibodies, 516, 518t treatment of, 309–310 acute, 374–375 Antiplatelet agents, 260–262 alcoholic neuropathy and, 373 Antipsychotic agents AMAN. See Acute motor axonal neuropathy amyloidosis and, 372 Amantadine, 322–323, 329, 331, 342, 448 approach to, 369–371 for schizophrenia, 682–684 Amaurosis fugax, 178–180, 179f botulism and, 373 TD from, 683 causalgia and, 375 types of, 682t causes of, 260 classification of, 366–367, 368t Antiretroviral drugs, toxic neuropathy from, 540 Ambient warming, 370 clinical evaluation of, 366–371 Antisense oligonucleotides (ASOs), 363 AmBisome, 473 CRPS and, 375 Antithrombotic treatment American Council for Headache Education (ACHE), diabetes mellitus and, 372 anticoagulation in, 251 gastrointestinal, 369 for ischemic stroke, 250–251 55–56 GBS and, 373 platelet inhibition in, 250–251 Amifostine, 538 inherited, 374 Anton’s syndrome, 268 D-Amino oxidase activator (DAOA), 655, 656t MSA and, 371–372 Anxiety. See also Psychophysiologic insomnia γ-Aminobutyric acid (GABA), 214t neuromuscular junction disorders and, 372 alcoholism and, 694 Aminoglycosides, adverse effects of, 4 PAF and, 373 disorders, 161, 663. See also specific types Amiodarone, 535 peripheral neuropathies and, 372 porphyria and, 373 from Parkinson’s disease, 322 toxicity of, 537t POTS and, 373–374 lorazepam for, 33 Amitriptyline, 60t, 529 primary hyperhidrosis and, 374 syncope v., 91 with spinal cord involvement, 368t, 372 Anxiolytics, 667t autonomic storm from, 374 symptoms of, 367, 369 AOM. See Acute otitis media for depression, 448 syndromes of, 371–375 Aphasia. See also Primary progressive aphasia for pain control, 45t testing for, 370–371, 370t anomic, 142t, 144 Amnesia, 150 Broca’s, 142t, 143 anterograde, 151 heart rate variation with deep breathing in, 370 clinical features of, 142, 142t with concussion, 400–401 pharmacologic, 371 conduction, 142t, 144 hysterical posttraumatic, 401 sudomotor function in, 371 crossed, 141 psychogenic, 318 valsalva response in, 371 diagnosing, 141 retrograde, 151 ANT1. See Adenine nucleotide translocator 1 fluent transcortical, 142t, 144 transient global, 151–152 Anterior cerebral artery (ACA), 252 global, 142t, 143–144 occlusion of, 265 hemorrhage and, 277 characteristics of, 317 stroke in, 265 isolation, 142t, 144 Amnesic state, 150–151 Anterior choroidal artery, 265–266 nonfluent transcortical, 142t, 144 Amoxapine, 665t Anterior cord syndrome, 392 progressive, 146 Anterior ischemic optic neuropathy (AION), 180, 180f pure word deafness and, 142t, 144 risks of, 675 Anterior spinal artery syndrome, 388, 392 subcortical, 146 Amphotericin, 473 Anterior uveitis, 177 Wernicke’s, 142–143, 142t, 154 AMSAN. See Acute motor sensory axonal Anterograde amnesia, 151 Aphemia, 143 Anterolateral system, 117–118 Apnea testing, 138 neuropathy Antiarrhythmic drugs, 48 Apo ε gene, 308–309 Amygdalohippocampectomy, 712, 725–726 Antibiotics, 483. See also specific drugs Apomorphine, subcutaneous injectable, 329 Amyloid angiopathy, 307 for spinal epidural abscess, 391 Aponeurotic ptosis, 188 Anticholinergics, 100t, 331 Apoptosis, 217, 283–284 cerebral, of aging, 310 delirium and, 124 cell death and, 218–219 Amyloid precursor protein (APP), 307, 600 intoxication of, 134 mitochondria controlling pathways of, 219 overdose of, 139 Apoptosis-inducing factor (AIF), 219 cleavage of, 307–308, 308f side effects of, 165 APP. See Amyloid precursor protein Amyloidosis, 372 for sleep, 448 Apraxia, 305 Amyotrophic lateral sclerosis (ALS), 215, 303, 358 Anticoagulation therapy, 262, 278 buccofacial, 145 Anticonvulsant medication, 479 construction, 150 clinical manifestations of, 359–360 discontinuation after EEG, 26 definition of, 102 differential diagnosis for, 362 for migraine treatment, 60t dressing, 150 epidemiology of, 360–361 neuropathic pain and, 48 ideational, 145 familial, 361–362 Antidepressants, 658. See also Tricyclic antidepressants; ideomotor, 145 FTD and, 360 limb, 145 genetic, 361t specific types limb-kinetic, 145 glucose metabolism in, 359 actions of, 660f oculomotor, 149 Guam complex of, 317–318 for panic disorder, 664, 665t optic, 149 MRI of, 360f Aprosodia, 146 mutations in, 219 management of side effects in, 666t Aqueous penicillin, 473 neurodegeneration and, 362 rational selection of, 674 Arachnoid cysts, 430 pathogenesis for, 362 Antidiuretic hormone (ADH), 424 Arbovirus infections, 463 pathology of, 358–359 inappropriate secretion of, 465 treatment for, 362–363 weakness from, 360 Amyotrophic Lateral Sclerosis Association, 364 Amyotrophy, 358 Analgesia definition of, 117 for LP, 33

Index 741 ARCO. See Autosomal recessive cardiomyopathy and Ataxic hemiparesis, 257 Back pain. See also Spine ophthalmoplegia Atherosclerotic disease, 14f AAA and, 72, 79 Atherothrombosis, 270 acute low, 73–74 Aripiprazole, 682t, 683 Atherothrombotic stroke, warfarin for, epidural glucocorticoids for, 80 ARSACS. See Autosomal recessive spastic ataxia NSAIDS for, 80 721, 736 in ankylosing spondylitis, 77, 84 of Charlevoix-Saguenay Athetosis, 338t approach to, 72–74 Arsenic, 535, 536t, 538 Ativan, 667t in arthritis, 77 Arterial TOS, 84 Atlastin, 364 causes of, 74–80, 74t Arteriovenous malformation (AVM) ATM. See Acute transverse myelopathy CES and, 76 Atonic seizures, 225 chronic low, 79 asymptomatic, 280 Atopic conjunctivitis, 176 NSAIDS for, 82 headache and, 280 ATP-binding cassette family (ABC family), risk factors for, 81–82 imaging in, 12t costs of, 70 MRI of, 395f 397 CPGs for, 80, 81f symptoms of, 394–395 Atraumatic needle, 35, 36f CT scanning for, 73 typical presentation of, 394 Atrial fibrillation CT-myelography for, 73–74 vascular anomalies and, 280–281 EMG determining weakness for, 73–74, 73t Artery of Adamkiewicz, 392 cardioembolic stroke and, 253, 254t, 718, in gynecologic disease, 79 Artery-to-artery embolic stroke 732 imaging in, 12t carotid atherosclerosis producing, 254 in inflammatory bowel disease, 79 causes of, 256 stroke risk and, 719, 733 local, 72 formation of, 254 Attention, 152 in lumbar adhesive arachnoiditis, 78 Arthritis, 77 lumbar disk disease and, 75–76 rheumatoid, 84 prefrontal network and, 152–153 metabolic causes of, 78 Arthrogryposis, 579 Audiogram, 204–205 MRI for, 73–74 Ascending paresthesias, 2 Audiometry muscle spasm associated with, 72 Asendin, 665t neoplasms and, 77–78 Aseptic meningitis, 500, 500t pure tone, 204 from neoplastic spinal cord compression, Ashkenazi Jewish families, dystonia and, 338 speech, 205 389 Asimultanagnosia, 268 AUDIT. See Alcohol Use Disorder Screening Test nerve root injury causing, 70–71 ASOs. See Antisense oligonucleotides Aura, 223 in osteoporosis, 78 ASPD. See Advanced sleep phase disorder Autoimmune autonomic neuropathy (AAN), 373 in osteosclerosis, 78 Aspergillus, 178, 487t Automatisms, 224 pain referred to, 72, 78–79 invasive sinonasal, MRI for, 626f–627f Autonomic dysreflexia, 372 postural, 79 MRI for CNS, 625f–626f Autonomic failure, 375 in psychiatric disease, 79 Aspergillus species, 475 treatment of, 375–376 radicular, 72 Aspirin. See also Warfarin-Aspirin Symptomatic SLR for, 718, 732 patient education for, 375–376 spina bifida occulta and, 75 Intracranial Disease symptomatic, 376 in spinal epidural abscess, 78, 390–391 adverse effects of, 44 Autonomic nervous system (ANS), 366. See also ANS spinal stenosis and, 76–77, 77f for pain, 44–46, 45t of spine origin, 72 recommendations for, 253, 254t dysfunction from spondylolysis, 74–75 stroke prevention with, 260–261 BP regulation by, 366 in sprains/strains, 75 Association cortex, 140 functional consequences of normal activation of, statistics of, 70 Astasia-abasia, 112 tethered cord syndrome and, 75 Asterixis, 134 267t traumatic vertebral fractures and, 75 Asthma, 162 inherited disorders of, 374 treatment for, 80–82 Astigmatism, 171 regulation of, 366 ALBP and, 80–81, 81f Astrocytic gliosis, 512 schematic representation of, 367f CLBP and, 81–82 Astrocytomas, 390, 411. See also Intramedullary testing for, 370–371, 370t types of, 72, 72t with unidentified cause, 79–80 astrocytoma heart rate variation with deep breathing in, in urologic disease, 79 anaplastic, 411 370 in vertebral osteomyelitis, 78 grading system for, 411 high-grade, 412–413 pharmacologic, 371 Baclofen, 339, 342, 522 sudomotor function in, 371 Bacterial endocarditis, 254 glucocorticoids managing, 412 valsalva response in, 371 Bacterial meningitis. See Meningitis, bacterial juvenile pilocytic, 411 Autonomic neuropathies, 368t, 546 BAEPs. See Brainstem auditory evoked low-grade, 411–412 Autonomic storm malignant, 411f amitriptyline causing, 374 potentials model for pathogenesis of, 411f from GBS, 375 BAERs. See Brainstem auditory evoked oligodendrogliomas compared to, 413 management of, 375 subependymal giant cell, 411, 417 Autoreactive T lymphocytes, 437 responses Asymptomatic Carotid Atherosclerosis Study (ACAS), Autoregulation, of CBF, 284, 284f BAL. See British anti-Lewisite Autosomal dominant nocturnal frontal lobe epilepsy Balamuthia, 469 255 Balance disorders. See also Falls; Gait disorders Asymptomatic Carotid Surgery Trial (ACST), 255 (ADNFLE), 227t Ataxia. See also Spinocerebellar ataxia; specific ataxia Autosomal dominant partial epilepsy with auditory age and, 109 characteristics of, 113 acetazolamide for, 354 features (ADPEAF), 227t Parkinson’s disease and, 321 autosomal recessive, 354–356 Autosomal recessive ataxia, 354–356 vestibular system and, 113 diagnosing, 347t Autosomal recessive cardiomyopathy and Bálint’s syndrome, 148–150, 191 episodic, 351t, 354 causes of, 268 focal, 347 ophthalmoplegia (ARCO), 588 Balloon angioplasty, 255–256 gait and limb, 510 Autosomal recessive spastic ataxia of Charlevoix- Balo’s concentric sclerosis, 644f–654f Baltic myoclonus, 350t symptoms of, 711, 725 Saguenay (ARSACS), 351t Barbiturates, 64, 535 inherited, 348 AVM. See Arteriovenous malformation for epilepsy, 240 mitochondrial, 356 Avonex, 447 overdoses of, 135 MS and, 438–439, 448 Awake coma, 130 for sleep, 157 symmetric, 346–347 Axonal shearing lesions, 401 Bartonella, 468 symptoms/signs of, 346 Axonotmesis, 548 Basal ganglia treatment for, 356 Axons infarction, 14f with vitamin E deficiency, 355 Parkinson’s disease and, 320 Ataxia telangiectasia, 352t of corticospinal system, 104f Basal meningitis, 484 genetic considerations for, 356 functional categories of, 41f Basic fibroblast growth factor (bFGF), 429 symptoms/signs of, 356 glaucoma destroying, 175 Ataxic disorders nerve conduction in myelinated/demyelinated, approach to, 346–347 diagnosing, 347t 436, 436f treatment for, 356 primary afferent, 40, 41f of pyramidal system, 104f spinothalamic tract, 43, 43f Azathioprine, 447, 556, 607 for MG, 565–566 Azithromycin, 460, 504 Babinski signs, 386 Back, physical examination of, 72–73

742 Index Basilar artery Blood pressure (BP) Brain tumor (Cont.): migraine, 91 ANS regulating, 366 metastatic, 186, 379, 418 occlusion of, 272 OH, recordings of, 371 chemotherapy for, 419 stroke and, 268–272 OH and drop in, 370 from known cancer, 418, 419f syndrome, 269f OH from impaired, 366 without known primary tumor, 418–419 TIA and, 270–271 syncope and, 369 mechanisms of, 418, 418t treatment of, 419 Basilar occlusion, impending, 271 Blood volume disorders, 88–90, 88t neuroimaging for, 409 Baylisascaris procyonis, 469, 488, 488t Blood-brain barrier (BBB), 282 seizures from, 408 BBB. See Blood-brain barrier syndromes of, 408 BDNF. See Brain-derived neurotrophic factor defects in, 13 treatment for, 409–410 Beck Depression Inventory, 47 MS disrupting, 435 Becker muscular dystrophy, 575t, 577, 722, Blood-oxygen-level-dependent (BOLD), 220 Brain-derived neurotrophic factor (BDNF), 215 Bloody tap, LP and, 35 Brainstem 736–737 BOAA. See β-N-oxalylaminoalanine clinical features of, 577–578 BOLD. See Blood-oxygen-level-dependent accessory optic system, 171 laboratory features of, 578 Bone spicules, 185, 186f bilateral signs in, 271 treatment of, 578 Borrelia burgdorferi, 380, 394, 540 coma, examination of, 134, 135f Bedwetting, 166 Bortezomib, 538 encephalomyelitis, 519 Beevor’s sign, 387 Botulinum toxin, 64, 340, 381–382 migraine, pathways in, 53f Behavior, 152 adverse effects of, 373 sensation, 121 prefrontal network and, 152–153 pain from injection of, 374 Brainstem auditory evoked potentials (BAEPs), 27 Behavioral tolerance, 688 placebo trials for, 61 Brainstem auditory evoked responses (BAERs), Behçet’s syndrome, 485, 489t, 490 Botulism, 189 MRI for, 627f ANS dysfunction and, 373 205–206 Bell’s palsy, 380 MG and, 563 Breast-feeding, 245 clinical manifestations of, 380 Bouillon treatment, 376 Brief intervention, for alcoholism, 692 differential diagnosis of, 380–381 Bound morphemes, 143 British anti-Lewisite (BAL), 538 laboratory evaluation of, 381 Bourneville’s disease, 417 Broca’s aphasia, 142t, 143 neuroimaging for, 641f Bovine spongiform encephalopathy (BSE), Broca’s area, 141 pathophysiology of, 380 Bromocriptine, 328t treatment of, 381 508 Brown-Sequard hemicord syndrome, 388 Bell’s phenomenon, 380 vCJD caused by, 512 Brucella, 463, 485, 486t Bell’s reflex, 335 Bowel incontinence, 439 Brudzinski’s sign, 453 Benedikt’s syndrome, 189 BP. See Blood pressure Bruxism, 166 Benign familial neonatal convulsions (BFNC), BPPV. See Benign paroxysmal positional vertigo BSE. See Bovine spongiform encephalopathy Brachial neuritis, neck pain in, 85 Bubble-contrast echocardiography, 254 227t Brachial plexopathy, 546, 547f Buccofacial apraxia, 145 Benign forgetfulness of elderly, 299 lesions of, 547t Bulbospinal upper motor neuron pathways, 104f Benign paroxysmal positional vertigo (BPPV), MRI for, 647f–648f Bunyaviruses, 466 Brachial plexus injury, 523 Buprenorphine, 700 98, 98t neck pain in, 85 Bupropion, 665t Benzodiazepine, 126, 128, 699 Bradyarrhythmia, syncope in, 90 Bradykinesia, 102 side effects of, 675 adverse effects of, 668 Bradykinin, 41 BuSpar, 667t for alcoholism, 693–694 Brain abscess, 475. See also Epidural abscess Buspirone, 345, 667t for GAD, 666, 668 clinical presentation of, 476 for panic disorder, 664, 667t definition of, 475 for GAD, 668 withdrawal from, 668 diagnosis of, 476–477, 477f Butorphanol, 58 Beta blockers differential diagnosis of, 477 for migraine treatment, 60t epidemiology of, 475 for pain control, 45t for phobic disorders, 669 etiology of, 475–476 Betaseron, 447 headache from, 476 Cabergoline, 328t Bextra, adverse effects of, 46 hematogenous, 475–476 CABG. See Coronary artery bypass grafting bFGF. See Basic fibroblast growth factor histopathology of, 476 Cachectic myopathy, 292 BFNC. See Benign familial neonatal convulsions MRI for, 476–477, 477f CADASIL, 259, 311, 318 Biceps weakness, 712, 726 pathogenesis of, 476 Bilateral brainstem signs, 271 prognosis of, 478 MRI for, 634f–635f Bilateral facial palsy, 108 treatment of, 477–478 Coenorhabditis elegans, 308 Bilateral simultaneous stimulation, Brain biopsy Café au lait spots, 417 stereotactic, 713, 726–727 Caffeine, 162 120 in viral encephalitis, 468 Binocular diplopia, 188 Brain death wakefulness from, 168 Binswanger’s disease, 298–299, 310–311, clinical evidence of, 138 Calcinosis, 607 comas and, 138 Calcitonin gene-related peptide (CGRP), 53 311f diagnosis of, 717, 731 Calcium channel disorders of muscle, 589–590, Bipolar disorder, 658f EEG and, 27 Brain edema, 282 591f clinical manifestations of, 676–677 Brain germ-cell tumors, 430 Calcium disturbances, 613–614 differential diagnosis of, 677 Brain hemorrhages Calculation ability, assessment of, 6 etiology/pathophysiology of, 677 causes of, 401 Calf muscle hypertrophy, 576t, 579, 595 lithium and, 658, 677–678 CT scan of, 402f Calpain, 595 treatment of, 677–678 Brain injury. See also Secondary brain insults CAM. See Confusion Assessment Method Bitemporal meningioma, 175 post-cardiac bypass, 611–612 Campral, 694–695 Blackout, 688 post-solid organ transplant, 612 Campylobacter jejuni, 551 Bladder areflexia, 398 Brain tumor. See also Metastatic brain tumors; Primary Bladder dysfunction, 370, 372 GBS and, 552–553, 552f causes of, 398 brain tumor Canal paresis, 100 MS and, 439, 448 approach to, 408–409 Cancer. See also Paraneoplastic neurologic syndromes; Blastomyces dermatitidis, 487t benign, 416–417 Blepharitis, 175 clinical features of, 408–409 specific cancers Blepharoptosis, 187–188 of CNS, 408 alcohol and, 689 Blepharospasm, 277, 382 headache and, 52 depression from, 671 Blepharospasm dystonia, 339 hemorrhage into, 278 metastatic brain tumor from known, 418, 419f Blindness hereditary syndromes associated with, 410t systemic, 421 color, 173 Karnofsky performance scale for, 409t Cancer-associated retinopathy, 524 cortical, 268 laboratory examination for, 409 Candida, 178, 198, 487t defining legal, 172 albicans, 650 form herpes simplex, 177 MRI for newborn, 624f transient monocular, 178–179 Candida species, 475 Blink reflexes, 32 Cannabis, 704 Capgras’ syndrome, 302 Alzheimer’s disease and, 305 Capillary telangiectasias, 280–281

Index 743 CAPRIE, 261 Cellular injury, 282–284 Cerebrospinal fluid (CSF) (Cont.): Capsaicin creams, 529 Cellular tolerance, 688 dementia, levels of, 305 CARASIL, 259 Cellulitis, 127 HIV infection, analysis of, 497 Carbamazepine, 48, 378, 529 Central cord syndrome, 388 LP, leak of, 65–66 Central core disease, 584 LP, normal values of, 36, 36t dosage/adverse effects of, 238t Central fever, 134 LP and collection of, 34–35 for facial pain, 717, 732 Central nervous system (CNS). See also Severe CNS MS and, 442 for glossopharyngeal neuralgia, 94 NPH and absorption of, 315 for mania, 678 dysfunction pathophysiology of, 284, 284f for pain control, 45t aspergillus, MRI for, 625f–626f pleocytosis of, 442, 466 for partial seizures, 239–240 brain tumor of, 408 PMNs in, 36 Carbidopa, 328t, 330 consultations regarding dysfunction of, post-LP headache and pressure drop in, 35 Carbon dioxide inhalation, 664 secondary NDPH with low volume, 65–66 Carbon disulphide, 536t 609–612 secondary NDPH with raised pressure of, 66 Carbon monoxide intoxication, 288 critical care disorders of, 287–291 skull fractures and leakage of, 402 treatment for, 289 detecting abnormalities in, 5 viral encephalitis, culture from, 467 Carcinomatous meningitis, 420f disease, 100 viral encephalitis, examination of, 466 Cardiac cephalgia, 68 illness identified in, 2 viral encephalitis and PCR, 466–467 Cardiac ischemia, 162 infections of, 316. See also Brain abscess; Encephalitis, viral meningitis, examination of, 462 Cardiac syncope, 90–91 WBCs in, 455 Cardioembolic stroke chronic; Encephalitis, viral; Epidural atrial fibrillation and, 253, 254t, 718, 732 abscess; Meningitis, bacterial; Meningitis, suba- Cerebrovascular accidents (CVAs), 142 causes of, 252, 253t cute; Meningitis, viral; Subdural empyema; at thalamus, 712, 726 Cardiovascular disease, 2 Thrombophlebitis, suppurative Cardiovascular system, alcohol and, 689–690 approach to, 452–454, 452f–453f Cerebrovascular disease Caregiver burnout focal supportive, 458 approach to, 247, 247f Alzheimer’s disease and, 309, 319 LP for, 453–454 comas and, 138 FTD and, 313 management of, 451 syncope in, 91 Carmustine, 412 nonbacterial causes of, 478–479 types of, 246 Carney syndrome, 429 isolated vasculitis of, 317 Carnitine palmitoyltransferase deficiency, MTDNA skeletal muscle syndromes of, 588–589 Cervical cord, 386 neoplasms of, 316 Cervical disk disease, neck pain in, 83 586–587 neurologic disorders in critical illness at, 283t Cervical dystonia, 339 Carotid artery PNDs of, 517, 519 Cervical radiculopathy, 83t toxoplasmosis, MRI of, 504, 504f Cervical spine trauma, neck pain in, 82–83, common, 267 tuberculosis, MRI for, 618f–619f internal, 266–267 vasculitis of 83t Carotid atherosclerosis angiography for, 636f Cervical spondylosis, 12t artery-to-artery embolic stroke from, 254 CT/MRI for, 635f risk factors for, 254, 255t Central pontine myelinolysis, 290, 290f neck pain in, 83, 84f treatment for, 254–256 Central serous chorioretinopathy, 185 CES. See Cauda equina syndrome Central sleep apnea, 165 CFS. See Chronic fatigue syndrome EC-IC bypass surgery in, 256 Central transtentorial herniation, 131f, 132 CGRP. See Calcitonin gene-related peptide endovascular therapy in, 255–256 Central vertigo, 98, 98t–99t, 714, 728 Chagas’ disease, 505 surgical therapy in, 254–255 Centronuclear myopathy, 585 Chalazion, 175 Carotid cavernous fistulas, 187 Cephalosporin, 477, 481–482 Channelopathies, 211, 212t, 589, 590t Carotid disease, 262 Cerebellar artery, occlusion of, 271–272 Charcot-Marie-Tooth disease, 528, 541 Carotid sinus hypersensitivity, syncope in, 89, 92 Cerebellar degeneration Carotid stenosis, 179, 263 PND and, 521 autosomal recessive forms of, 544 bilateral, 91 treatment for, 521 classification of, 541–542 imaging in, 12t Cerebellar gait ataxia, 111, 112t clinical features of, 541 treatment for, 255–256 Cerebellar hemorrhage, 277 CMT1, 541–542, 542t Carpal tunnel syndrome, 531t Cerebral abscess, fever and, 18f causes of, 722, 738 Cerebral amyloid angiopathy, 278 CMT1A, 542 CAST. See Chinese Acute Stroke Trial Cerebral amyloid angiopathy of aging, 310 CMT1B, 542–543 Catamenial epilepsy, 244 Cerebral angiography, for stroke, 274–275 CMT1X, 543 Cataract, 184 Cerebral artery. See also Middle cerebral artery CMT2, 541–542, 542t Catatonia, 131 aneurysm of, 13f CMT2A to CMT2D, 543–544 Catechol-O-methyltransferase inhibitors (COMT occlusion of, 14f CMT3. See Déjerine-Roussy syndrome Cerebral blood flow (CBF), 284, 284f CMT4, 543 inhibitors), 331 Cerebral cortex family history and, 4 CATIE study, 683 areas of, 140 forms of, 542t Cauda equina syndrome (CES), 76, 387 hemispheres of, 141f molecular testing for, 544, 544f Cerebral dysfunction, higher, 153–154 rare forms of, 544–546 paraparesis from, 106 Cerebral hemisphere transmission of, 720, 734 Causalgia, 44 coma from damage to, 133 type 1A, 211 coronal section diagram of, 263f X-linked, 542–543, 542t ANS dysfunction and, 375 lateral aspect diagram of, 264f CHARISMA, 261 Cautious gait, 110 medial aspect diagram of, 265f Chemotherapy, 535 Cavernous angiomas, 281 Cerebral herniation for CNS lymphoma, 414 Cavernous sinus syndrome, 384, 384f central transtentorial, 131f, 132 coasting and, 535 CBD. See Cortical basal degeneration coma from, 131–132 for metastatic brain tumor, 419 CBF. See Cerebral blood flow foraminal transtentorial, 131f, 132 toxicities of, 422 CCK-4. See Cholecystokinin tetrapeptide transfalcial, 131f, 132 Cheyne-Stokes respiration, 136 CD4 molecule, 494, 496f transtentorial, 132 Chiari malformation, 52, 67, 347, 396 CDH. See Chronic daily headache types of, 131f syringomyelia and, 713, 727 CDR. See Clinical Dementia Rating uncal transtentorial, 131f, 132 Chiari tonsillar herniation, 396 Cefepime, 460 Cerebral ischemia, 246 Chiasmal tumors, 186 Cefotaxime, 477, 481 major steps in cascade of, 248, 248f Childhood, epilepsy and, 229 Ceftazidime, 460, 477, 482 Cerebral mass lesions, 131–132 Chinese Acute Stroke Trial (CAST), Ceftriaxone, 477, 481 Cerebral perfusion, 284 Celebrex, 46 Cerebral perfusion pressure (CPP), 284 250–251 Celecoxib Cerebritis. See Brain abscess Chlamydia pneumoniae, 436 Cerebrospinal fluid (CSF) Chlorambucil, 230, 523, 557 adverse effects of, 46 bacterial meningitis, analysis of, 455–458, 455t, 457t Chloramphenicol, 536t for pain control, 45t chronic meningitis, analysis of, 490–491 Chlordiazepoxide, 667t, 668, 693 Cell death, 217 Chloride channel disorders, 592 apoptosis and, 218–219 Chloroquine, 535 dopamine, Parkinson’s disease and, 323, 324f Cholecystokinin tetrapeptide (CCK-4), 664 excitotoxicity and, 217–218 Cholesteatoma, 202, 475 mitochondria in, 216f Cholinesterase inhibitors, 319

744 Index Chorea, 340. See also Hemiballismus; Huntington’s Clonazepam, 529, 667t, 668 Comas (Cont.): disease; Levodopa-induced dyskinesia dosage/adverse effects of, 239t LP for, 137 metabolic disorders causing, 132–133 hyperthyroidism and, 342 Clonidine, 372 MRI for, 136 movement characteristics of, 338t Clostridium botulinum, 563 neurologic examination for, 134 Sydenham’s, 341 Clozapine, 331 ocular movements in, 135–136 treatment for, 342 physician examination, general, for, 134 in various disorders, 341–342 for schizophrenia, 657, 682t, 683 physiology of, 131–133 Choriocarcinoma, 278, 430 side effects of, 683 prognosis for, 139 Chorioretinopathy, central serous, 185 Clumsy hand, 257 pupillary reaction assessment for, 135 Chronic alcoholism, 161 Cluster headache respiratory patterns in, 136 dementia and, 315–316 acute attack treatment of, 62, 62t toxic drug-induced, 133 Chronic benign lymphocytic meningitis, 489t clinical features of, 61–62, 61t treatment for, 138–139 Chronic childhood SMA, 363 diagnosis of, 717, 731–732 Chronic daily headache (CDH) neurostimulation therapy for, 62 Common carotid artery, 267 classification of, 64t periodicity of, 61 Comorbid insomnia, 161–162 diagnosis of, 63–64 posterior hypothalamic gray matter in, Complex partial status epilepticus, 316 management of medically disabling, 64 Complex regional pain syndrome (CRPS), 375 preventive treatments for, 64 54, 54f Comprehension, 142 Chronic drug use, 318 preventative treatments of, 62, 62t Comprehensive stroke centers, 275 Chronic fatigue syndrome (CFS), 164, 604, 650 sumatriptan for, 62 Compressive myelopathy diagnosis of, 651t, 652 treatment of, 62 epidemiology of, 650 noncompressive compared to, 388–389 manifestations of, 651–652, 651t sumatriptan for, 709, 723 types of, 389–392 pathogenesis of, 650–651 verapamil for, 62 Computed tomography (CT), 11. See also Single prevalence of, 650 CMD. See Congenital muscular dystrophy symptoms of, 651t CMV. See Cytomegalovirus photon emission computed tomography treatment of, 652 CNS. See Central nervous system axial noncontrast, 14f Chronic hemiparesis, 105 CNS lymphoma for back pain, 73 Chronic inflammatory demyelinating polyneuropathy chemotherapy for, 414 of brain hemorrhages, 402f in HIV infection, 502–503, 503f for brain tumor, 409 (CIDP), 501, 555 MRI of, 415f for CNS vasculitis, 635f clinical manifestations of, 555 primary, 414, 502 for coccidiomycosis meningitis, 623f diagnosis of, 555–556 comas and, 136 GBS compared to, 555 AIDS and, 414 complications of, 13, 15 pathogenesis of, 556 secondary, 414–415 of contusion, 401f treatment for, 556 systemic, 502–503 delirium detected with, 127 Chronic lead poisoning, 362, 536t CNTF. See Ciliary neurotrophic factor guidelines for use of, 12t Chronic low back pain (CLBP), 79 Coasting, 535 helical, 12 back pain treatment for, 81–82 Coats’ disease, 582 for Huntington’s disease, 640f NSAIDS for, 82 Cobalamin, 538–539. See also Vitamin B12 deficiency of hypertensive hemorrhage, 277f risk factors for, 81–82 Cocaine, 699, 702 indications for, 12t, 13 Chronic meningitis. See Meningitis, chronic acute/chronic intoxication of, 703 for lacunar infarction, 633f Chronic metal exposure, 317 crack, 374, 703 MRI compared to, 11, 18, 715, 728 Chronic monoparesis, 107 drug use/abuse of, 702–704 multidetector, 12–13 Chronic myelopathy, 394 prevalence of use of, 702–703 myelography, 21–22 of MS, 396 stroke from, 278 types of, 394–397 treatment for use/abuse of, 703–704 low-dose, 21 Chronic pain, 47 Coccidioides immitis, 487t of oligodendrogliomas, 413f myofascial, 47 Coccidiomycosis meningitis, 623f radiation exposure from, 13 opioids for, 48 Cochlear otosclerosis, 202 for stroke, 273, 274f treatment of, 47–49 Codeine, 696 of superior sagittal sinus thrombosis, 636f Chronic paraparesis, 106 for pain control, 45t techniques in, 11–13 Chronic progressive external ophthalmoplegia pharmacology of, 696–697 for viral encephalitis, 467–468 Coenzyme Q10, 332 xenon, 275 (CPEO), 587 Cognitive dysfunction, 439, 448, 688 Computed tomography angiography (CTA), 11, 13f–14f Chronic quadriparesis, 107 HIV infection and, 498–500 stroke and, 273 Chronic subdural hematoma, 404 Cognitive-behavioral psychotherapy. See also Dialectical COMT. See Catechol-O-methyltransferase inhibitors Concussion, 400 bilateral, 404, 404f behavior therapy amnesia with, 400–401 diagnosis of, 713–714, 728 for depression, 660 mechanics of, 400 Chronic visual loss, 184 for suicide risk, 661 postconcussive syndrome and, 408 Chronic wasting disease (CWD), 508 Cogwheeling sensation, 321 in sports, 405–406, 405t Churg-Strauss syndrome, 528 Colchicine, 536t treatment for, 408 Cidofovir, 394, 471, 474, 505 Collapsing falls, 114 Conduction aphasia, 142t, 144 CIDP. See Chronic inflammatory demyelinating Color blindness, 173 Conduction block, 30 Color vision, 173 Conduction velocity, 30 polyneuropathy Comas Conductive hearing loss, 201–202 Ciliary neurotrophic factor (CNTF), 215 acutely appearing masses and, 132 Cones, 170, 173 Cingulate cortex, 147 anatomy of, 131–133 Confabulation, 151 Circadian rhythm, 167 approach to, 133–136 Confusion arousal level testing for, 134 definition of, 122 medical implications of, 169 awake, 130 right-left, 145 molecular feedback loop in, 157f brain death and, 138 Confusion Assessment Method (CAM), 124, 124t physiology of, 157–158 brainstem examination for, 134, 135f Congenital hypomyelination, 542, 542t sleep disorders, 167–169 cerebral hemisphere damage causing, 133 Déjerine-Roussy syndrome compared to, 543 Circle of Willis, 14f cerebral mass lesions/cerebral herniations causing, Congenital muscular dystrophy (CMD), 575t Cisplatin, 422, 535 clinical features of, 579 composition of, 535, 537 131–132 laboratory features of, 579 peripheral neuropathy and, 537 cerebrovascular disease and, 138 treatment of, 579 Citalopram, 675 CT scans and, 136 types of, 580t CJD. See Creutzfeldt-Jakob disease definition of, 130 Congenital myopathy, 584–585 Claude’s syndrome, 189 differential diagnosis of, 137–138, 137t Conjunctivitis, 175 Claustrophobia, 668 EEG and, 26–27, 136–137 allergic, 175 CLBP. See Chronic low back pain epileptic, 133 atopic, 176 Clindamycin, 479 eyes and, 135–136 Connexins, 213 Clinical Dementia Rating (CDR), 125 history of patient with, 133–134 Conn’s syndrome, 593 Clinical practice guidelines (CPGs), 80, 81f hypotension from, 134 Clomipramine, 670 laboratory studies/imaging for, 136–137 locked-in syndrome and, 131

Index 745 Consciousness, level of, 5 Creutzfeldt-Jakob disease (CJD) (Cont.): Defecation syncope, 89 Constipation, 439, 448 impact of, 507 Deglutition syncope, 89 Construction apraxia, 150 laboratory tests for, 514 Déjerine-Roussy syndrome, 121 Contraception, 245 molecular basis for, 301t Contralateral hemiparesis, 277 MRI for, 514, 514f congenital hypomyelination compared to, 543 Contrast media myoclonus and, 513 forms of, 542t neuropathology of, 512 Delayed postanoxic encephalopathy, 289 adverse effects to, 13, 15, 17 pathogenesis of, 508–511 Delayed sleep phase disorder, 168 allergic reactions to, 15, 15t patient care for, 514 Delirium angiography and, 23 prevention for, 515 ACh deficiency and, 124 gadolinium and, 16–17 rapid progression of, 314 alcohol withdrawal causing, 126 ionic, 13, 15, 15t sporadic, 507 anticholinergics and, 124 MRA, 19–20 variant, 508, 512 approach to, 124–125 MRI, 16–17, 18f BSE causing, 512 CAM for, 124, 124t nonionic, 13, 15, 15t clinical features of, 122–123 in patient with kidney failure, 15t CRH. See Corticotropin-releasing hormone CT for, 127 Contrast nephropathy, 13, 15 Critical care disorders, 287 definition of, 122 Contrecoup lesion, 401 dementia’s relationship with, 123 Contusion approach to, 285–287 diagnosing, 127–128, 128t causes of, 401 of CNS, 287–291 epidemiology of, 123 CT scan of, 401f pathophysiology of, 282–284 etiologies of, 126–127, 126t Conus medullaris, 387 of PNS, 291–292 history with, 125 Convergence-projection hypothesis, of referred pain, in ICU, 122–123 neuropathy of, 291–292 laboratory evaluation for, 127–128 42, 42f Critical illness, sensory neuropathy and, 715, 728 LP for, 127–128 Convulsions, 403 Critical illness myopathy, 292 MMSE for, 125–126 Coordination examination, 9 Critical illness polyneuropathy, 291–292 morbidity form, 129 Corneal abrasions, 175 Crossed aphasia, 141 MRI for, 127 Corneal reflexes, 136 Crossed SLR sign, 73 Parkinson’s disease and, 124 Coronary artery bypass grafting (CABG), 611–612 CRPS. See Complex regional pain syndrome pathogenesis of, 123–124 Cortex, sensation, 121 Cruzi amastigotes, 505 physical examination for, 125–126 Cortical basal degeneration (CBD), 303 Cryptococcal meningitis, 503, 506 prevention of, 129 Cryptococcosis, HIV infection and, 503–504 reversibility of, 122–123 definition of, 336 Cryptococcus, 178, 487t, 488, 490 risks of, 123, 709, 723 features of, 313 CSF. See Cerebrospinal fluid systemic infections causing, 127 Cortical blindness, 268 CSF otorrhea, 402 treatment for, 128 Cortical encephalomyelitis, 519 CSF rhinorrhea, 402 Delirium Detection Score, 124 Cortical necrosis, 288, 288f CT. See Computed tomography Delirium Rating Scale, 124 Cortical sensation CT angiography, for stroke, 273 Delirium tremens (DTs), 692 evaluating, 8–9 CTA. See Computed tomography angiography Delta-9-tetrahydrocannabinol (THC), 704 testing for, 119–120 CT-myelography, back pain and, 73–74 Dementia, 298. See also Alzheimer’s disease; Corticobasal ganglionic degeneration, 145 Cupping, glaucoma causing, 184, 184f Corticospinal system, axons of, 104f Cushing’s disease, 432t Frontotemporal dementia; Huntington’s Corticospinal upper motor neuron pathways, 104f Cutaneous afferent innervation, 117 disease;Vascular dementia Corticotropin-releasing hormone (CRH), 426 Cutaneous nerves, 41f age and risk of, 299 Cortrosyn, 426 Cutaneous reflexes causes of, 299, 300t, 314–318 Cough Assist Device, 363 chronic alcoholism and, 315–316 Cough syncope, 89 abnormalities of, 103 clinical differentiation of types of, 302t Coup lesion, 401 assessment of, 8 CSF levels in, 305 COX inhibitors CVAs. See Cerebrovascular accidents definition of, 146 adverse effects of, 44 CWD. See Chronic wasting disease delirium’s relationship with, 123 classes of, 45–46 Cyanide intoxication, 289 differential diagnosis of, 300t nonselective, 46 Cyclobenzaprine, 80, 448 EEG findings in, 27 opioids combined with, 47 Cyclooxygenase. See COX inhibitors evaluation of, 301t for pain, 44–45 Cyclophosphamide, 447, 532, 556, 607 frontal lobe, 154 COX-1 inhibitors, 45–46 Cycloplegia, 175 functional anatomy of, 298–299 COX-2 inhibitors, 45–46 Cyclosporine, 556, 607 Guam complex of, 317–318 Coxiella, 463 for MG, 566 in HIV infection, 498–500, 499t burnetii, 650 Cyclothymic disorder, 676 MMSE for, 499–500 CPEO. See Chronic progressive external Cymbalta, 665t MRI for, 500, 500f Cysticercosis, 487t imaging in, 12t ophthalmoplegia Cytarabine, 422, 474 with Lewy bodies, 123 CPGs. See Clinical practice guidelines Cytokine family, 217t, 437, 651 major types of, 299, 301t CPP. See Cerebral perfusion pressure Cytologic examination, 36 MMSE for, 303, 303t Cramps, 570–572 Cytomegalovirus (CMV), 393, 462 multi-infarct, 298, 310–311, 722, 737–738 Cranial irradiation, 425 Cytotoxic edema, 282 NSAIDS and, 310 Cranial nerve disorders in Parkinson’s disease, 334 Dacrocystitis, 176 PET images for, 304f imaging in, 12t Dalmane, 667t psychiatric disease compared to, 318 multiple, 383–384 Dandy-Walker syndrome, 347 pugilistica, 317 types of, 382–383, 382t DAOA. See D-Amino oxidase activator schizophrenia compared to, 318 Cranial nerve examination, 6–7 Dapsone, 536t treatment of, 299–305, 318–319 Cranial nerve injuries, 402–403 DATATOP study, 332 cognitive/neuropsychiatric examination for, Cranial neuropathies, 533–534 Dawson’s fingers, 441 303–304 Craniopharyngiomas Daytime sleepiness goals of, 318 features of, 429–430 history in, 300, 302 radiation therapy for, 430 evaluation of, 163–164 laboratory tests for, 304–305, 304f Creatine kinase, 601 excessive, 159, 159t physical/neurological examination for, 302–303 Creutzfeldt-Jakob disease (CJD), 27, 299, 469 DBS. See Deep brain stimulation vitamin B12 deficiency causing, 316 clinical presentation of, 302t, 512–513 DBT. See Dialectical behavior therapy Dementia with Lewy bodies (DLB), 299, 513 decontamination of, 515 Decerebrate rigidity, 134 characteristics of, 313–314 diagnosis of, 513 Decorticate rigidity, 134 clinical presentation of, 302t differential diagnosis of, 314, 513 Deep brain stimulation (DBS) molecular basis for, 301t epidemiology of, 508 controversy surrounding, 333 Parkinson’s disease and, 314, 334 familial, 507, 509t–510t for dystonia, 340 treatment for, 314 iatrogenic, 508, 511 for Parkinson’s disease, 332 Deep tendon reflex, 712, 726 dura mater grafts and, 511–512 Deep vein thrombosis (DVT), 296 hGH preparations for, 512

746 Index Demyelinating myelopathy, 393 Diabetic truncal radiculopathy, 534 Down’s syndrome, 307–308 Dentatorubropallidoluysian atrophy (DRPLA), 354 Diagnostic and Statistical Manual of Mental Disorders genetic considerations for, 655 Deoxypyrimidine, 470 Depression (DSM), 124, 654, 656–657, 688, 698 Doxepin, for pain control, 45t Dialectical behavior therapy (DBT), 680 DRD. See Dopa responsive dystonia agitated, 676 Diarrhea, 369 Dressing apraxia, 150 from Alzheimer’s disease, 310 Diaschisis, 154 Driving amitriptyline for, 448 Diastolic bruit, 280 from cancer, 671 Diazepam, 522, 667t, 668, 693 drowsiness and, 164 cognitive-behavioral psychotherapy for, 660 Dichloralphenazone, 58 epilepsy and, 244 from diabetes mellitus, 671 Diethylenetriaminepentaacetic acid (DTPA), 16 Drop attacks, 114 etiology of, 660–661 Diffuse axonal injury, 401 Drowsiness, 130, 132 gender and, 673 Diffuse Lewy body disease, 314 driving and, 164 from HIV infection, 672 Diffuse white matter disease, 310–311, 311f DRPLA. See Dentatorubropallidoluysian atrophy from hypothyroidism, 672 Diffusion tensor imaging, 220–221 Drug use/abuse insomnia and, 161 Diffusion track imaging (DTI), 11 chronic, 318 major, 672, 672t cocaine and, 702–704 MRI and, 21, 21f HIV infection and, 702 medical management of, 674f Diffusion-weighted imaging (DWI), 20 LSD and, 706 with medical illness, 671–672 Dihydroergotamine (DHE), 58 marijuana and, 704–705 minor, 673 MDMA and, 705–706 MS and, 439, 448 for medication-overuse headache, 65 myopathy and, 595 from neurologic disorders, 671 Dilantin, 48 in neurologic history, 4 from Parkinson’s disease, 322 Dimethylaminopropionitrile (DMAPN), 535 PCP and, 706 PET studies on, 673 polydrug abuse and, 706–707 reactive, 153 toxicity of, 536t seizures from, 230, 230t, 719, 734 seasonal, 673 DIP. See Drug-induced Parkinsonism stroke form, 259 treatment for, 660–661 Diplopia, 189 Drug-induced movement disorders, 344 unipolar disorders of, 673 acute, 344 Depression Inventory and Suicide Intent Scale, 660 in abducens nerve disorders, 190 subacute, 344 Depressive disorders, 672 binocular, 188 tardive syndromes, 344–345 clinical manifestations of, 672–673 in gaze disorders, 190–192, 402 Drug-induced myopathy, 594–596, 594t, 603–604 ECT for, 675–676 in MG, 189 Drug-induced Parkinsonism (DIP), 336 MAOIs for, 675 monocular, 188 Dry beriberi, 538 SSRIs and, 674–675 MS and, 438 Dry eyes, 176 TCAs for, 674–676 in multiple ocular nerve palsies, 190 DSM. See Diagnostic and Statistical Manual of Mental treatment for, 674–676 in oculomotor nerve disorders, 189 Dermatomyositis (DM), 523, 597 restrictive, 188 Disorders autoantibodies and immunogenetics in, 600 in trochlear nerve disorders, 189–190 DSPN. See Diabetic sensorimotor polyneuropathy clinical features of, 597 Dipyridamole, 261 DTI. See Diffusion track imaging clinical findings of, 599–600 DISC1. See Disrupted in schizophrenia DTNBP1. See Dystrobrevin-binding protein 1 diagnosis of, 604–605, 604t Discography, for spine interventions, 22 DTPA. See Diethylenetriaminepentaacetic acid differential diagnosis for, 602–604 Disopyramide, for syncope, 94 DTRN. See Diabetic truncal radiculoneuropathy extramuscular manifestations of, 599 Disputed TOS, 84 DTs. See Delirium tremens immunopathologic mechanisms in, 600, 601f Disrupted in schizophrenia (DISC1), 655, 656t Duchenne muscular dystrophy, 574, 575t malignancies and, 599 Distal myopathies, 582. See also specific types muscle biopsy and, 605, 605f laboratory features of, 584 clinical features of, 574 overlap syndromes and, 599–600 treatment for, 584 diagnosis of, 575 pathogenesis of, 600–601 types of, 583t laboratory features of, 574–575 prognosis of, 608 Distal sensory polyneuropathy, 501 pathogenesis of, 577, 577f specific features of, 598 Distal weakness, 107–108 treatment of, 577 treatment for, 606–607 Distended bladder, 372 Duloxetine, 665t Disulfiram, 536t features of, 675 empirical approach to, 607 for alcoholism, 695 for pain control, 45t viral infections and, 600–601 Diuretic treatment, for tinnitus, 721, 736 Dural arteriovenous fistulas, 281 Dermatomyositis sine myositis, 598 Dizziness, 96 Dural sinus thrombosis, 262–263 Dermoid cysts, 416 acoustic neuromas causing, 712, 726 DVT. See Deep vein thrombosis Desipramine approach to, 99–100 Dysarthria, 257, 277, 355 dosage considerations for, 675 hyperventilation causing, 99 Dysbindin, 655, 656t for pain control, 45t multiple-sensory-defect, 96 Dysesthesias, 710, 724 Desyrel, 665t DLB. See Dementia with Lewy bodies definition of, 116–117 Detrusor dyssynergia, 448 DLSRPN. See Diabetic lumbosacral radiculoplexus process of, 120 Detrusor hyperreflexia, 439, 448 Dysgerminomas, 430 Detrusor sphincter dyssynergia, 439 neuropathy Dysgeusia, 196 Dexamethasone, 389, 460–461, 473, 478 DM. See Dermatomyositis Dysgraphia, 145 for diabetes mellitus, 716, 730 DMAPN. See Dimethylaminopropionitrile Dyskinesias, 329 DHE. See Dihydroergotamine DNA analysis, for muscle disease, 573–574 levodopa-induced, 342 Diabetes insipidus, 138 Donepezil, 309, 332 tardive, 344 Diabetes mellitus, 593 Dopa responsive dystonia (DRD), 338–339 Dysosmia, 193 ANS dysfunction and, 372 Dopamine Dysphagia, 277, 382 depression from, 671 clinical manifestations of, 382–383 dexamethasone for, 716, 730 cell death, Parkinson’s disease and, 323, 324f oculopharyngeal dystrophy and, 582 neuromuscular complications of, 593 clinical aspects of, 214t Dysphonia, 382 Diabetic amyotrophy, 534, 593 migraine and, 54 clinical manifestations of, 382–383 Diabetic lumbosacral radiculoplexus neuropathy migraine treatment with agonists of, 57t, 58 Dysthymic disorder, 673 schizophrenia and, 658, 659f, 681–682 Dystonia, 110–111, 338, 344 (DLSRPN), 532 synthesis/degradation of, 659f action, 338 Diabetic neuropathic cachexia, 534 Dopamine agonists Ashkenazi Jewish families and, 338 Diabetic neuropathy, 532 approval of, 329 blepharospasm, 339 effectiveness of, 329–330 cervical, 339 asymmetric, 533–534 for hemiballismus, 342f clinical features of, 338 symmetric, 532–533 Parkinson’s disease treatment with, 327, 328t, DBS for, 340 treatment for, 533 dopa responsive, 338–339 Diabetic proximal neuropathy, 593 329–330 focal, 339 Diabetic retinopathy, 185 RLS and, 331 idiopathic torsion, 338 Diabetic sensorimotor polyneuropathy (DSPN), side effects of, 330 limb, 339 studies on, 332 movement characteristics of, 338t 532–533 Dorsal root ganglia, 517, 519, 522 Diabetic truncal radiculoneuropathy (DTRN), 532 Dothiepin, 60t Double vision. See Diplopia Downbeat nystagmus, 192

Index 747 Dystonia (Cont.): Electromyogram (EMG) (Cont.): Epidural hematoma, 403–404, 404f, 720–721, 735 oromandibular, 339 for peripheral neuropathy, 530 Epidural spinal hemorrhage, 279 pathophysiology of, 339 quantitative approaches to, 29–30 Epigenetics, 211 primary, 338–339 single-fiber, 31–32 Epilepsia partialis continua, 223 secondary, 339 Epilepsy. See also Status epilepticus; specific types treatment for, 339–340 Electrooculogram (EOG), 155 Electrophysiological studies. See Electromyogram; in adolescence, 229 Dystonic storm, 340 antiepileptic drugs and, 232 Dystrobrevin-binding protein 1 (DTNBP1), 655, 656t Nerve conduction, studies autosomal dominant nocturnal frontal lobe epilepsy, Dystrophia myotonica. See Myotonic dystrophy Electroretinogram (ERG), 524 Dystrophin, 577 Eletriptan, 56, 57t 227t Embolic disease, 611 autosomal dominant partial, with auditory features, EAE. See Experimental allergic encephalomyelitis Embolic stroke. See Artery-to-artery embolic stroke EAN. See Experimental allergic neuritis Embolism of nucleus pulposus, 393 227t Ear. See also Hearing; Hearing loss Embryonal carcinomas, 430 barbiturates for, 240 Emery-Dreifuss muscular dystrophy (EDMD), catamenial, 244 physiology of, 199, 199f causes of, 226, 228, 229t EBV. See Epstein-Barr virus 575t, 578 Echocardiography, bubble-contrast, 254 clinical features of, 578 age and, 228–230 Echo-planar MRI (EPI), 20, 21f laboratory features of, 578, 579f in childhood, 229 Echovirus, 488t treatment of, 579 definition of, 222 EC-IC bypass surgery. See Extracranial-to-intracranial EMG. See Electromyogram diagnosing, 25 Emmetropia, 171 driving and, 244 bypass surgery Employment, epilepsy and, 244 EEG and, 24–26 ECM. See Extracellular matrix Empty sella, 426 employment and, 244 ECST. See European Carotid Surgery Trial Empyema. See Subdural empyema epileptiform activity and, 25 Ecstasy. See Methylenedioxymethamphetamine Emsam, 665t genetic causes of, 231–232 ECT. See Electroconvulsive therapy Encephalitis, 127 head trauma from, 229–230 Ectropion, 176 chronic, 473. See also Progressive multifocal insomnia and, 162 Edinger-Westphal nuclei, 170 interictal behavior and, 243–244 EDMD. See Emery-Dreifuss muscular dystrophy leukoencephalopathy; Progressive rubella juvenile myoclonic, 226 EDSS. See Kurtzke Expanded Disability Status Score panencephalitis; Subacute sclerosing management issues for, 243–244 EDTA. See Ethylenediamine tetraacetic acid panencephalitis mesial temporal lobe, 226 EDx. See Electrodiagnostic studies HIV infection and, 500, 500t EEG. See Electroencephalography identifying, 452–453, 452f–453f characteristics of, 228t Effexor, 665t treatment for, 520–521 EEG of, 228f Ehrlichia chaffeensis, 458 viral, 465 mortality of, 244, 718, 733 Electrocerebral silence, 26 brain biopsy in, 468 phenobarbital for, 240 clinical manifestations of, 465–466 presurgical evaluation for, 241 prognosis of, 26 CSF culture and, 467 progressive myoclonus, 227t Electrocochleography, 205 CSF examination for, 466 psychiatric problems from, 243 Electroconvulsive therapy (ECT), 331 CSF PCR for, 466–467 psychosocial issues with, 244 CT for, 467–468 reflex, 236 for depressive disorders, 675–676 definition of, 465 refractory Electrodiagnostic studies (EDx) diagnostic tests for, 468t antiepileptic drugs treating, 241 differential diagnosis of, 468–470 surgical treatment of, 241–242 limitations of, 530 EEG for, 467–468 syndromes, 222, 226 for MG, 561 etiology of, 466 genes associated with, 227t for peripheral neuropathy, 525 herpes simplex and, 466–467, 469 Lennox-Gastaut, 225, 226 for radiculopathies, 534 laboratory findings in, 466–468 treatment for, 235–242 Electroencephalography (EEG), 24 MRI for, 457f, 467–468 antiepileptic drug therapy in, 236–241 anticonvulsant medication discontinuation after, 26 sequelae of, 471–472 avoidance of precipitating factors in, 236 bipolar derivation for, 24 serologic studies in, 467 of underlying conditions, 236 brain death and, 27 treatment for, 470–471 vestibular, 98 comas and, 26–27, 136–137 WNV and, 471 women and, 244–245 dementia and, 27 Encephalomyelitis. See also specific encephalomyelitis breast-feeding and, 245 epilepsy and, 24–26 brainstem, 519 contraception and, 245 epileptiform activity and, 25–26 definition of, 519 pregnancy issues for, 244–245 eyes open in, 25f MRI for, 520, 521f in young adults, 229 locked-in syndrome and, 27 PND, 519–520 Epileptic coma, 133 of MTLE, 228f treatment for, 520–521 Epileptiform activity recording procedures for, 24 Encephalopathy. See specific types EEG and, 25–26 referential derivation for, 24 Endocarditis, bacterial, 254 epilepsy and, 25 seizures and, 24–26, 26f, 233–234 Endocrine myopathy, 592–593 Epileptiform spikes, 224 sharp waves in, 224 Endogenous factors, 226 Epileptogenesis, 226 for viral encephalitis, 467–468 Endophthalmitis, 178 seizures and mechanisms of, 231 Electrographic seizure activity, 233–234 Endovascular mechanical thrombectomy, 250 Epileptogenic factors, 226 Electrogustometry, 198 Enophthalmos, 186 Epiretinal membrane, 186 Electrolyte disturbances, 612 Entacapone, 331 Episcleritis, 177 calcium, 613–614 Enterobacter species, 459, 475 Episodic ataxia, 351t, 354 common neurologic complications of, 612–614 Enterobacteriaceae, 476 Episodic generalized paresis, 722, 737 hyperkalemia, 613 Enteroviruses, 463 EPs. See Evoked potentials hypernatremia, 612–613 Entrapment neuropathies, 614 Epstein-Barr virus (EBV), 393, 462 hyperosmolality, 612–613 Entropion, 176 infections of, 464 hypokalemia, 613 EOG. See Electrooculogram MS and, 437 hyponatremia, 613 EOMs. See Extraocular muscles ERG. See Electroretinogram magnesium, 614 Eosinophilia-myalgia syndrome, 598 Ergot alkaloids, 328t Electromyogram (EMG), 28, 155 Ependymomas, 413–414 Ergotamine activity recorded by, 29f Ephedrine, 94, 100t ergotism from, 62 for back pain, 73–74, 73t EPI. See Echo-planar MRI for migraine, 56, 57t, 58 blink reflexes and, 32 Epidermoid tumors, 416 Ergotism, 62 F wave studies and, 31 Epidural abscess, 481 ERPs. See Event-related potentials H reflex studies and, 31 anatomy of, 481f Erythrocyte sedimentation rate (ESR), 52 macro, 30 clinical presentation of, 481 TN and elevated, 378 motor unit and, 28–30 etiology/pathophysiology of, 481 Erythromycin, 175 for muscle disease, 573 prognosis of, 482 Erythropoietin, 376 muscle response to repetitive stimulation with, 31 Epidural glucocorticoids, for ALBP, 80 Escherichia coli, 380, 458 for myelopathy, 710–711, 724–725 Escitalopram, 675 nerve conduction studies and, 30–31

748 Index Esmolol, 249, 276, 296 Facioscapulohumeral muscular dystrophy (FSH), Flunarizine, 60t, 64 Esophagus, 689 570f, 575t, 581 Fluoro-2-deoxy-D-glucose (FDG), 21 ESPRIT, 261 Fluorouracil, 422 ESPS. See European Stroke Prevention Study clinical features of, 581–582 Fluoxetine, 670 ESR. See Erythrocyte sedimentation rate laboratory features of, 582 Fluphenazine, 343 Essential tremor (ET), 325, 337 treatment of, 582 Flurazepam, 667t, 668 Factitious illness, 679 Fluvoxamine, 670 clinical features of, 337 Factitious visual loss, 183 fMRI. See Functional magnetic resonance imaging etiology of, 337 Faintness, 96 Focal ataxia, 347 movement characteristics of, 338t Falls, 111 Focal cerebral infarction, 248 pathophysiology of, 337 classifying, 114 Focal dystonia, 339 treatment for, 337–338 collapsing, 114 Focal ischemia, 246 ET. See Essential tremor interventions reducing, 114–115 Focal sensory seizures, 121, 456 Ethambutol, 473 mechanical, 114 Focal stroke, 127 toxicity of, 536t PSP causing, 313 Follicle-stimulating hormone (FSH), 423 Ethanol, 686 recurrent, 113 effects of, 690 risk factors for, 113t efficiency tests for, 427t hypoglycemia from, 687 sensory deficit and, 114 Foramen magnum syndrome, 388 organ systems, effects of, 688–690 toppling, 114 Foraminal transtentorial herniation, 131f, 132 pharmacology and nutritional impact of, FALS. See Familial amyotrophic lateral sclerosis Forced vital capacity (FVC), 370 Famciclovir, 470 Forearm exercise test, 574 686–687 Familial acromegaly, 429 Fortification spectra, 3, 183 Ethionamide neurotoxicity, 538 Familial amyloid neuropathy, 545 Foscarnet, 471 Ethosuximide Familial amyotrophic lateral sclerosis (FALS), 361–362 Fovea, 170 Familial CJD (fCJD), 507, 509t–510t Foveation, 171 dosage/adverse effects of, 238t Familial hemiplegic migraine (FHM), 54 Foville’s syndrome, 190 for generalized seizures, 240 Familial spastic paraplegia (FSP), 358 Fragile X tremor/ataxia syndrome (FXTAS), 352t Ethylene oxide, 536t childhood form of, 364 Ethylenediamine tetraacetic acid (EDTA), 317 clinical characterization of, 364 genetic considerations for, 655 Etilevodopa, 330 symptoms/signs of, 397 Frailty, 114 European Carotid Surgery Trial (ECST), 254–255 Family history Frank sepsis, 127 European Stroke Prevention Study (ESPS), 261 Charcot-Marie-Tooth disease and, 4 Frataxin, 355 Event-related potentials (ERPs), 28 in neurologic history, 4 Freezing gait, 111 Evoked potentials (EPs), 27 Fasciculations, 103 Friedreich’s ataxia, 350t, 354, 539 brainstem auditory, 27 benign, 362 clinical utility of, 27–28 Fatal familial insomnia, 162, 507, 509t–510t forms of, 354–355 cognitive, 28 Fatigability genetic considerations for, 355–356 motor, 28 increased, 102 spine in, 355 MS and, 28, 442 pathologic, 569–570 symptoms/signs of, 355 somatosensory, 27 Fatigue. See also Chronic fatigue syndrome Frontal abulic syndrome, 152 visual, 27 from MG, 559–560 Frontal disinhibition syndrome, 152 Excessive daytime somnolence, 159, 159t MS and, 439, 448 Frontal eye fields, 147, 191 Excitotoxicity, 217, 218f from muscle weakness, 569–570 Frontal gait disorder, 111 cell death and, 217–218 sleepiness compared to, 164 Frontal lobe dementia, 154 Exercise intolerance, 586 fCJD. See Familial CJD Frontal lobe syndrome, 152 Exophthalmos, 186 FCMD. See Fukuyama congenital muscular dystrophy Frontal network syndrome, 153 Experimental allergic encephalomyelitis (EAE), FDG. See Fluoro-2-deoxy-D-glucose (FDG) Frontotemporal dementia (FTD), 299 Fear, pain and, 43 ALS and, 360 218f, 437 Febrile seizures caregiver burnout and, 313 Experimental allergic neuritis (EAN), 552 complex, 229 clinical presentation of, 302t Extinction, 120, 148 simple, 229 differential diagnosis of, 312, 312f Extracellular matrix (ECM), 577 Felbamate, dosage/adverse effects of, 239t gender and, 311 Extracranial-to-intracranial bypass surgery (EC-IC Femoral neuropathy, 531t genetics and, 311 Fenoprofen, for pain control, 45t molecular basis for, 301t bypass surgery), 256 Fentanyl, for pain control, 45t symptoms of, 311–312 Extramedullary syndromes, 388 Ferromagnetic implants, MRI and, 18 tau mutations and, 311 Extraocular muscles (EOMs), 562 Fetal alcohol syndrome, 690 voxel-based morphometry analysis showing, 312f Eyes. See also Gaze; Pupils;Visual function, Fetal cell transplantation, 333 Frontotemporal lobar degenerations (FTLD), 147 Fetal posterior cerebral artery, 267 FSH. See Facioscapulohumeral muscular dystrophy; assessment of Fever comas and, 135–136 central, 134 Follicle-stimulating hormone dry, 176 cerebral abscess and, 18f FSP. See Familial spastic paraplegia melanoma of, 186, 186f ischemia and, 248 FTD. See Frontotemporal dementia ocular alignment of, 173 quadriplegic, 398 FTLD. See Frontotemporal lobar degenerations painful, 175–178 FHM. See Familial hemiplegic migraine Fugue state, 318 red, 175–178 Fibrillation potentials, 103 Fukitin, 577 seizures and, 135 Fibromuscular dysplasia, 258 TIA and, 183 Fibromyalgia, 571–572, 604 protein deficiency and, 580t tumors of, 186 Fibrositis, 604 Fukuyama congenital muscular dystrophy (FCMD), visual function, assessment for movement/alignment Finger anomia, 145 Finger-to-nose testing, 9 579, 580t of, 173 Fisher syndrome, 190 Functional magnetic resonance imaging (fMRI), 11 wrong-way, 135 Fistulas carotid cavernous, 187 features of, 20 F wave studies, 31 dural arteriovenous, 281 for mirror neurons, 220, 220f Facet joint hypertrophy, 77 FLAIR. See Fluid-attenuated inversion recovery Fund of information, assessment of, 6 Facial hemiatrophy, 382 Flaviviruses, 466 FVC. See Forced vital capacity Facial myokymia, 382 Flavor, 193 FXTAS. See Fragile X tremor/ataxia syndrome Fluconazole, 473 MS and, 439 Fludrocortisone, 652 GABA. See γ-Aminobutyric acid Facial nerve Fluent transcortical aphasia, 142t, 144 Gabapentin, 48, 60t, 529, 693 Fluid-attenuated inversion recovery (FLAIR), 16, 17f–19f, anatomy of, 379–380, 379f dosage/adverse effects of, 238t examination of, 6–7 622f, 625f, 627f, 629f, 633f–634f, 644f, 646f GAD. See Generalized anxiety disorder interruption of, 380 for seizures, 234 Gadolinium, 16–17, 65 Facial pain, 377 Gait carbamazepine for, 717, 732 Facial recognition, 150 anatomy/physiology of, 109–110 Facial spasms, 380 apraxia, 111, 112t Facial weakness, 379 cautious, 110 MS and, 439 cerebellar ataxic, 111, 112t muscle weakness compared to, 569 freezing, 111, 114

Index 749 Gait (Cont.): Global aphasia, 142t, 143–144 Haloperidol, 682t, 683, 693 neuromuscular disease and, 112 Global hypoxia-ischemia, 246 Hand-Schüller-Christian disease, 430 Parkinson’s disease and, 111, 321 Glomeruli, 194 Hash oil, 704 postural control of, 109 Glossopharyngeal nerve, examination of, 7 Hashimoto’s encephalopathy, 134, 513 sensory ataxic, 111–112, 112t Glossopharyngeal neuralgia, 382, 439 spastic, 110–111 MRI for, 646f stiff-legged, 110–111 carbamazepine treating, 94 Haw River syndrome, 354 waddling, 569 pain in, 382 Head drop, 597 syncope from, 90 Head injury, 720–721, 735 Gait and limb ataxia, 519 Glucocorticoids, 296, 389, 478, 492, 577, 715, 729 symptoms of, 711, 725 high-grade astrocytomas managed with, 412 clinical syndromes of, 405–407 for inflammatory myopathy, 606–607 considerations for, 400 Gait disorders MG treatment with, 565 cranial nerve injuries associated with, 402–403 age and, 109 myopathy and, 594–595 GCS for, 406, 406t approach to, 112–113 Glucose metabolism, in ALS, 359 seizures and, 403 etiology of, 110t Glutamate, 214t treatment of, 405–407 frontal, 111, 112t Glutathione, 538 metabolic, 112 Glycine, 214t grading/prognosis in, 406, 406t psychogenic, 112 Glycogen storage disease, 585 injury of intermediate severity in, 406 slowly progressive, 112–113 weakness and, 585–586 minor injury in, 405–406 toxic, 112 Glycogenesis severe injury in, 406 types of, 110–113 type II. See Acid maltase deficiency types of, 400–404 type III, 586 Head trauma Gait examination, 9 type IV, 586 from epilepsy, 229–230 Galantamine, 309, 652 type V, 586 intracranial bleeding from, 278 Ganciclovir, 394, 470–471, 501 type VII, 586 Headache, 50. See also Chronic daily headache; Cluster Gangliocytomas, 430 type IX, 586 Ganglion cells, in retina, 170 type X, 586 headache; Hemicrania continua; Migraine; Gastrointestinal system, alcohol and, 689 type XI, 586 New daily persistent headache;Tension-type Gastroparesis, 372 Glycolytic defects, 585 headache;Trigeminal autonomic cephalalgias Gaze exercise intolerance from, 586 acetazolamide for, 66 Gnathostoma spinigerum, 488, 488t acute, 13f diplopia in disorders of, 190–192, 402 GnRH. See Gonadotropin-releasing hormone clinical evaluation of new-onset, 51 horizontal disorders of, 190, 190f Gold, 536t anatomy of, 50–51 supranuclear disorders of, 190–191 Gonadotropin, deficiency of, 426 AVM and, 280 vertical disorders of, 190–191 Gonadotropin-releasing hormone (GnRH), 424f from brain abscess, 476 Gaze-evoked nystagmus, 192 Gottron’s sign, 598 brain tumor and, 52 GBM. See Glioblastoma multiforme Gower’s sign, 569, 571f causes of, 51t GBS. See Guillain-Barré syndrome Gradenigo’s syndrome, 190, 483 glaucoma and, 52 GCS. See Glasgow Coma Scale Grammar, 141 hypnic, 68–69 GCSE. See Generalized convulsive status epilepticus Gram-negative bacillary meningitis, 459t, 460 ICP increase leading to, 409 GDNF. See Glial-derived neurotrophic factor Grand mal, 225 imaging in, 12t Gene transcription, 213 Graphesthesia, 120 intracranial hemorrhage and, 51–52 Generalized anxiety disorder (GAD), 664 Grasp reflex, 8 LP causing, 35–36, 36t benzodiazepine for, 666, 668 Graves’ ophthalmopathy, 187, 592 medication-overuse, 59 buspirone for, 668 Gray matter, posterior hypothalamic, 54, 54f DHE for, 65 clinical manifestations of, 664–666, 667t Growth hormone (GH), 423 inpatient management of, 64–65 diagnostic criteria for, 667t efficiency tests for, 427t outpatient management of, 64 etiology of, 666 human, 512 meningitis and, 51 pathophysiology of, 666 pituitary tumors secreting, 429 menstrual cycle and, 52 treatment for, 666, 668 WBRT and, 715, 729 physiology of, 50–51 Generalized convulsive status epilepticus (GCSE), Growth hormone-releasing hormone (GHRH), 426 post-traumatic, 66 Growth hormone-releasing peptides (GHRP), 426 postural, 22 242–243 GSS. See Gerstmann-Sträussler-Scheinker disease primary, 50, 51t Generalized seizures, 224 Guam,ALS/Parkinson’s disease/dementia complex of, cough, 67 exertional, 67–68 antiepileptic drugs for, 240 317–318 sex, 68 ethosuximide for, 240 Guillain-Barré syndrome (GBS), 30, 76, 291, 380, 523, stabbing, 67 lamotrigine for, 240 thunderclap, 68 tonic-clonic, 225, 236t 528, 550 SDE and, 480 valproic acid for, 240 ANS dysfunction and, 373 secondary, 50, 51t Gentamicin, 460 antecedent events and, 551 from sellar mass, 431 Germinomas, 430 anti-glycolipid antibodies and, 553, 553t temporal arteritis and, 52 Gerstmann’s syndrome, 145 autonomic storm from, 375 treatment for, 716, 730 Gerstmann-Sträussler-Scheinker disease (GSS), 507 CIDP compared to, 555 Hearing, 199 GH. See Growth hormone clinical manifestations of, 550–551, 551t disorders of, 201–203, 202f GHB. See γ-hydroxybutyrate diagnosis of, 554–555, 554t approach to, 202f, 203–204 GHRH. See Growth hormone-releasing hormone Fisher variant of, 383 physiology of, 199, 199f GHRP. See Growth hormone-releasing peptides immunopathogenesis of, 551–554 Hearing aids, 206–207 Giant cell arteritis, 190 Hearing loss, 22, 439 Ginkgo biloba,Alzheimer’s disease and, 309 campylobacter jejuni and, 552–553, 552f approach to, 202f, 203–204 Glasgow Coma Scale (GCS), 139, 285 IVIg for, 555 assessment of for head injury, 406, 406t laboratory features of, 554 audiologic, 204–205 Glatiramer acetate, MS treatment with, 445–447 pain in, 550–551 evoked responses, 205–206 Glaucoma pathophysiology of, 554 imaging studies, 206 acute angle-closure, 178 prognosis/recovery for, 555 conductive, 201–202 axons destroyed by, 175 treatment of, 555 genetic causes of, 199–201, 200t cupping from, 184, 184f Gustatory dysfunction, 197–198, 198t HHI, 199–201, 201t–202t headache and, 52 approach to, 198 Ménière’s disease and, 203 treatment for, 184 treatment for, 198 mixed, 203 Glial-derived neurotrophic factor (GDNF), 215, Gynecologic disease, back pain in, 79 noise-induced, 207 prevention of, 207 333–334 H reflex studies, 31 sensorineural, 203 Glioblastoma, 278 HAART. See Highly active antiviral therapy tinnitus and, 207 Glioblastoma multiforme (GBM) Haemophilus influenzae, 454 trauma and, 203 Halcion, 667t treatment for, 206–207 development of, 410, 410f Hallucinations, 689 vertigo and, 203 genes associated with, 410 treatment of, 412 Glioma, mixed, 413 Gliomatosis cerebri, 413

750 Index Heart failure, 127 HIV (Cont.): Hyperglycemia, 372 Heel-knee-shin testing, 9 morphology of, 494, 496f Hyperhidrosis, primary, 374 Helper T cells, 497 replication cycle of, 494–497, 496f Hyperkalemia, 613 Hemangiopericytoma, 415 reverse transcriptase of, 494, 496f Hyperkalemic periodic paralysis (HyperKPP), Hematologic disorders, 278 Hematoma, 403 HIV infection, 488t 572, 591 AIDS classification for, 493, 494t Hyperkinetic movement disorders, 111, 337 acute subdural, 403, 403f Chagas’ disease in, 505 bleeding in, 403 clinical categories of, 495t drug-induced, 344–345 chronic subdural, 404, 404f CNS lymphoma in, 502–503, 503f types of, 338t cognitive dysfunction associated with, 498–500 HyperKPP. See Hyperkalemic periodic paralysis bilateral, 404, 404f cryptococcosis in, 503–504 Hypernatremia, 612–613 epidural, 403–404, 404f CSF analysis in, 497 Hyperopia, 171 Hematomyelia, 392 dementia in, 498–500, 499t Hyperosmia, 193 Hematopoietic system, alcohol and, 689 MMSE for, 499–500 Hyperosmolality, 612–613 Hemianopia, 148, 175 MRI for, 500, 500f Hyperparathyroidism, 592–593 Hemiballismus depression from, 672 Hyperpathia, 386 definition of, 342 drug use/abuse and, 702 definition of, 117 dopamine agonists for, 342f encephalitis and, 500, 500t Hyperperfusion states, 609 Hemicrania continua encephalopathy in, 498–500, 499t clinical presentation of, 610 features of, 67 meningitis and, 464, 500, 500t diagnosis of, 610 treatment of, 67 myelopathy in, 500–501 etiologies of, 610t Hemifacial spasm, 380, 439 myopathy in, 501 MAP alterations in, 609 causes of, 381–382 neoplasms in, 502–503 treatment for, 611 features of, 381 neurologic disease in, 494t Hyperphagia, 431 Hemineglect, 264 clinical manifestations of, 498–505 Hyperpnea, 277 Hemiparesis, 303 neuropathogenesis of, 497–498 Hyperserotonergic syndrome, 331 acute/episodic, 105 neuropathy in, 501 Hypertension ataxic, 257 opportunistic infections in, 503–504 supine, 369 chronic, 105 pathogenesis of, 497–498 systemic, 179, 179f contralateral, 277 pathophysiology of, 497–498 Hypertensive encephalopathy, 278 subacute, 105 peripheral neuropathies in, 501 Hypertensive hemorrhage weakness in, 105 peripheral neuropathy and, 539–540, 539t CT scan of, 277f Hemispatial neglect, 147–148, 149f PML in, 504–505 at putamen, 277 Hemorrhage. See also specific hemorrhages seizures in, 505–506, 505t Hyperthyroidism aphasia after, 277 smell and, 195 chorea in, 342 into brain tumor, 278 spinal cord disease in, 500–501 clinical features of, 592 cerebellar, 277 stroke in, 505 Hyperventilation, dizziness from, 99 epidural spinal, 279 toxoplasmosis in, 504, 504f Hyperventilation syndrome, 91 ICP in, 279–280 zidovudine and, 595 Hypesthesia, 117 lobar, 278 Hypnic headache, 68–69 pontine, 277 HIV-associated neurocognitive impairment (HNCI), Hypochondriasis, 679 primary intraventricular, 278 498 Hypocupric myelopathy, 397 subconjunctival, 175–176 Hypodipsia, 431 thalamic, 277 HMN. See Hereditary motor neuropathies Hypoesthesia, 117 Heparin, 258, 297, 483 HNCI. See HIV-associated neurocognitive Hypogeusia, 196 Hepatic encephalopathy, 316 partial, 196 Hereditary ataxia, 113 impairment total, 196 Hereditary hearing impairment (HHI), 199–201, HNPP. See Hereditary liability to pressure palsies Hypoglossal nerve, 383 Hodgkin’s disease, 346 examination of, 7 200t–201t Homeless people, mental disorders and, 684 Hypoglycemia Hereditary liability to pressure palsies (HNPP), Hordeolum, 175 ethanol producing, 687 Horner’s syndrome, 172, 272, 370, 383, 386 syncope v., 91 211, 530 HSN. See Hereditary sensory neuropathies Hypokalemia, 613 Hereditary motor neuropathies (HMN), 544 HSP. See Hereditary spastic paraplegia Hypokalemic periodic paralysis (HypoKPP) Hereditary sensory neuropathies (HSN), 544–545 HSV-2 meningitis, 463–464 age and, 589 Hereditary spastic paraplegia (HSP), 110 5-HT. See 5-hydroxytryptamine attacks of, 589–590 Herniation. See Cerebral herniation Human growth hormone (hGH), 512 treatment for, 590 HERNS, 259 Human herpes virus type 6 (HHV-6), 436 HypoKPP. See Hypokalemic periodic paralysis Heroin, 696–697, 699 Humoral autoimmunity, 437 Hypomania, 161, 676 Herpes simplex, 380, 488t Huntington’s disease, 153 Hyponatremia, 133, 613 in SAH, 295 bacterial meningitis compared to, 458 clinical hallmarks of, 314 Hypoparathyroidism, 593 blindness from, 177 CT for, 640f Hypoperfusion, 127 meningitis, 463–464 definition of, 340 Hypopituitarism, 424 viral encephalitis and, 466–467, 469 etiology of, 340–341 acquired, 425 virus infection, 19f experimental models of, 219 cranial irradiation and, 425 Herpes zoster genetic considerations for, 655 diagnosis of, 426 neck pain in, 84 mutations in, 219 empty sella leading to, 426 ophthalmicus, 177 neuroimaging for, 340, 341f etiology of, 425t peripheral neuropathy with, 541 Parkinson’s disease compared to, 325 hormone replacement therapy for, 427t Heterotropia, 173 risperidone for, 341 laboratory investigation of, 426, 427t, 428 Hexacarbone, 536t stem cells for, 217 lymphocytic hypophysitis and, 425–426 hGH. See Human growth hormone treatment for, 314, 341 pituitary apoplexy leading to, 426 HHI. See Hereditary hearing impairment Hydrocephalus, 277, 484 treatment for, 427, 427t HHV-6. See Human herpes virus type 6 Hydrocephalus, in SAH, 294 Hyposmia, 193 Higher cerebral dysfunction, 153–154 Hydrocortisone, 652 Hypotension, 134 Highly active antiviral therapy (HAART), 474, 540 Hydromorphone, for pain control, 45t Hypothalamic gliomas, 430 Hip disease, pain from, 72 Hydrophobia, 469 Hypothalamic hamartomas, 430 Histiocytosis X, 430 γ-hydroxybutyrate (GHB), 126 Hypothalamic infiltration disorders, 425 MRI for, 632f 5-hydroxytryptamine (5-HT) Hypothalamic lesions, 431 Histoplasma capsulatum, 487t for migraine, 53–54 Hypothalamus Histoplasmosis of pons, 622f migraine treatment with agonists of, 56, 57t, 58 hormones of, 423–424 HIV Hyperalgesia, 386 inflammatory lesions and, 425 cellular activation in, 497 definition of, 117 Hypothermia, periodic, 431 as etiologic agent, 493–494 Hypercapnia, 133 HIV-1, 493–494 Hypercoaguable disorders, 258 HIV-2, 493–494 Hyperesthesia, contact, 534

Index 751 Hypothyroidism, 347 INR. See International normalized ratio Intravenous immunoglobulin (IVIg), 447, 465, 517, clinical features of, 592 Insomnia 556, 607, 652 depression from, 672 acetazolamide for, 161 for GBS, 555 Hypoxic-ischemic encephalopathy, 246 adjustment, 161 for MG treatment, 566 clinical manifestations of, 287–288 alcohol-dependent, 162 weakness and, 717–718, 732 diagnosis of, 288 altitude, 161 Intraventricular hemorrhage, primary, 278 pathology of, 288 antihistamines for, 160 Invasive sinonasal aspergillus, 626f–627f treatment for, 288–289 asthma and, 162 Ion channels, 211 chronic, 160 example of, 212t Hysterical fainting, 91 depression and, 161 Ionotropic receptors, 212–213 drug-induced, 162 Iridocyclitis, 177 Iatrogenic CJD (iCJD), 508, 511 epilepsy and, 162 Iritis, 177 dura mater grafts and, 511–512 evaluation of, 159–160 Irritable bowel syndrome, 652 hGH preparations for, 512 fatal familial, 162, 507, 509t–510t Isaacs’ syndrome, 523, 572 long-term, 160 ISAT. See International Subarachnoid Aneurysm Trial IBM. See Inclusion body myositis with mental disorders, 161 Ischemia. See also Transient ischemic attack Ibuprofen, 376, 698 with neurologic disorders, 162 cardiac, 162 primary, 160–161 cerebral, 246 for chronic meningitis, 722, 737 psychophysiologic, 161 Ibuprofen, for pain control, 45t short-term, 160 major steps in cascade of, 248, 248f ICAM. See Intracellular adhesion molecule sleep maintenance, 159 fever and, 248 ICD. See International Classification of Diseases sleep offset, 160 focal, 246 ICDs. See Impulse controlled disorders sleep onset, 159 Ischemic cascade, 282–284 Ichthyosis, 545 sporadic fatal, 510 Ischemic penumbra, 273 iCJD. See Iatrogenic CJD transient, 160 Ischemic stroke, 247. See also Artery-to-artery embolic ICP. See Intracranial pressure trazodone for, 670 Ictal cry, 225 Insulin neuritis, 534 stroke; Cardioembolic stroke ICU. See Intensive care unit Insulin-like growth factor (IGF), 433 causes of, 253t ICU psychosis, 289 Integrase, 497 etiology of, 251–254, 252f Ideational apraxia, 145 Intensive care unit (ICU) migraine and risk of, 721, 735–736 Ideomotor apraxia, 145 delirium in, 122–123 pathophysiology of, 247–248, 252f Idiopathic torsion dystonia (ITD), 338 psychosis, 289 from rheumatic heart disease, 253 IFN-β. See Interferon-β Interferon, 437 treatment of, 248–251 IGF. See Insulin-like growth factor Interferon-β (IFN-β), MS treatment with, ILAE. See International League against Epilepsy antithrombotic, 250–251 Imipramine 445–447 endovascular techniques in, 249–250 Interictal behavior, 243–244 intravenous thrombolysis and, 249 for pain control, 45t Interictal personality, 244 medical support for, 248–249 safety of, 674 Interleukin, 437 neuroprotection in, 251 Immunoglobulin isotopes, MGUS and, 557. See also Internal carotid artery, 266–267 Ishihara plates, 173 International Classification of Diseases (ICD), Isocarboxazid, 665t Intravenous immunoglobulin Isolation aphasia, 142t, 144 Implicit memory, 151 124 Isoniazid, 473 Imprinting, 211 International League against Epilepsy (ILAE), 222, toxicity of, 536t Impulse controlled disorders (ICDs), 323 Isoprinosine, 475 Inadequate sleep hygiene, 160 223t IST. See International Stroke Trial Inclusion body myositis (IBM), 597 International normalized ratio (INR), 33 ITD. See Idiopathic torsion dystonia International Stroke Trial (IST), 250–251 IVIg. See Intravenous immunoglobulin autoantibodies and immunogenetics in, 600 International Subarachnoid Aneurysm Trial (ISAT), clinical features of, 597 Jacksonian march, 223 clinical findings of, 599–600 296 JC virus, 473–474 diagnosis of, 604–605, 604t, 715, 729 Internuclear ophthalmoplegia (INO), 191, 191f Jerk nystagmus, 192 differential diagnosis for, 602–604 Intervention, for alcoholism, 691–692 Jervell and Lange-Nielsen syndrome, 201 immunopathologic mechanisms in, 600 Jet lag, 167 muscle biopsy and, 605, 606f brief, 692 JME. See Juvenile myoclonic epilepsy nonimmune factors in, 600 Interventional neuroradiology, 23 Joint position testing, 8–9 pathogenesis of, 600–601 Intervertebral disk surgery, 76 Joubert syndrome, 352t prognosis of, 608 Intoxication, legal, 687 Jugular foramen syndrome, 382, 382t specific features of, 598–599 Intracellular adhesion molecule (ICAM), 600 Juvenile myoclonic epilepsy (JME), 226 treatment for, 606–607 Intracranial atherosclerosis, 256 Juvenile pilocytic astrocytomas, 411 viral infections and, 600–601 Intracranial bleeding, from head trauma, 278 Juvenile SMA, 363 Increased fatigability, 102 Intracranial hemorrhage, 275. See also Intraparenchymal Indomethacin Kaposi sarcoma, 497 for pain control, 45t hemorrhage Karnofsky performance scale, 409t PH treated with, 63 anticoagulant therapy with, 278 Kearns-Sayre syndrome (KSS), 351t, 587 Infancy, seizures and, 229 causes of, 246, 275t, 278–279 Infantile SMA, 363 diagnosis for, 275–276 causes of, 588 Infarction. See also specific infarctions emergency management of, 276 clinical findings for, 587–588 definition of, 246 headache and, 51–52 Kearns-Sayre variant, 188 focal cerebral, 248 imaging studies for, 279 Kennedy’s disease, 363 lacunar, 256 prevention of, 280 Kennedy’s syndrome, 361 Inferior pontine stroke, 270f treatment for, 279–280 Keratitis, 177 Inflammation, nociceptor-induced, 41, 42f Intracranial pressure (ICP), 282 Keratoconjunctivitis sicca, 176 Inflammatory bowel disease, back pain in, 79 bacterial meningitis and increased, 456, 461 Kernig’s sign, 453 Inflammatory lesions, 425 headache from increase in, 409 LP in, 710, 724 Inflammatory myopathy, 597. See also hemorrhage and, 279–280 Ketamine, 126 interventions to lower, 286 Ketoacidosis, 133 Dermatomyositis; Inclusion body monitoring, 285 Ketorolac myositis; Polymyositis nitroprusside for, 709–710, 724 for pain control, 45t diagnosis of, 604–605, 604t pathophysiology of, 284, 284f potency of, 45 features associated with, 598t treatment of elevated, 285–287, 286f, 286t KIBRA, 220 treatment for, 606–607 Intracranial vasculitides, 513 Kidney failure glucocorticoids in, 606–607 Intramedullary astrocytoma, 709, 723 contrast media in patient with, 15t immunomodulation in, 607 debulking of, 390 NSF and, 17 immunosuppressive drugs in, 607 MRI of, 390f Kinetic tremor, 337 Influenza, 393 Intramedullary syndromes, 388 Klebsiella species, 475 Influenza B infection, decrease in smell and, Intraparenchymal hemorrhage, 276 Klonopin, 667t 721, 736 clinical manifestations of, 277 Inherited ataxia, 348 pathophysiology of, 276–277 INO. See Internuclear ophthalmoplegia

752 Index Korsakoff ’s psychosis, 290 Limb-girdle muscular dystrophy (LGMD), Lyme disease, 346, 394, 486t Korsakoff ’s syndrome, 316, 688 575t, 578 peripheral neuropathy with, 540–541 KSS. See Kearns-Sayre syndrome Kurtzke Expanded Disability Status Score (EDSS), autosomal dominant, 576t, 578 Lymphocytic choriomeningitis virus (LCMV), autosomal recessive, 576t, 578 462, 488t 443, 444t classification of, 578 inherited, 717, 731 infection, 464 LA. See Latex agglutination Limbic encephalitis, 316 Lymphocytic hypophysitis, 425–426 Labetalol, 276, 375 MRI for, 617f–618f Lymphoma. See CNS lymphoma Labyrinthine dysfunction Limbic encephalomyelitis, 519 Lyrica, 48 Limbic network for memory, 150–152 Lysergic acid diethylamide (LSD), 706 acute bilateral, 98 Limbic system, 150 acute unilateral, 97 Limb-kinetic apraxia, 145 Machado-Joseph disease (MJD) recurrent unilateral, 98 Lipid rafts, 497 genetic considerations for, 354 vertigo in, 97–98 Lipid-lowering agents, myopathy from, 594 symptoms/signs of, 353 Labyrinthine ischemia, 97–98 Lipids, as energy source, 586 Lacunar infarction, 256 associated defects of, 586–587 Macro-EMG, 30 CT for, 633f Lipofuscin, 358 Macrophage chemoattractant protein (MCP), 500 MRI for, 633f–634f Lipopolysaccharide (LPS), 456 Macular degeneration, 184–185 Lacunar syndromes, 257–258 Lisch nodules, 417 Lacunes, 257 Listeria monocytogenes, 394, 454, 459t, 460, age-related, 185f Lafora’s disease, 227t Macular hole, 186 Laing distal myopathy, 583, 583t 463, 477, 720, 734–735 MAG. See Myelin-associated glycoprotein Lambert-Eaton myasthenic syndrome (LEMS), Lithium, 62 Magnesium disturbances, 614 Magnetic resonance angiography (MRA), 11, 18 31, 516, 518t, 523 bipolar disorder and, 658, 677–678 MG and, 562–563 for mania, 678 contrast media and, 19–20 Lamotrigine, 529, 540 side effects of, 677–678 for MCA stenosis, 633f dosage/adverse effects of, 238t Liver failure, 162, 331, 586, 612 phase-contrast, 19 for generalized seizures, 240 treatment for, 289 TOF and, 19–20 Language Lobar hemorrhage, 278 Magnetic resonance imaging (MRI), 15 assessment of, 5 Locked-in syndrome for acute transverse myelitis, 642f clinical examination of, 141–142 coma and, 131 of ALS, 360f left perisylvian network for, 140–147 EEG and, 27 of AVM, 395f in PPA, 146–147 Lomustine, 412. See also Procarbazine, lomustine, and for back pain, 73–74 Lardotic posture, 569, 571f for Balo’s concentric sclerosis, 644f–645f Large-scale neural networks, 140 vincristine combination for Behçet’s syndrome, 627f Laryngeal palsy, 383 Long-term memory, 6 for brachial plexopathy, 647f–648f Lateral femoral cutaneous nerve, 615, 615f Loperamide, 699 for brain abscess, 476–477, 477f Lateral medullary syndrome, 268 Lorazepam, 667t for brain tumor, 409 Lateral pontomedullary syndrome, 269f for CADASIL, 634f–635f Lateral sclerosis, 359. See also Primary lateral sclerosis for anxiety, 33 for candida in newborn, 624f Latex agglutination (LA), 458 Low-density lipoprotein (LDL), 260 for chronic meningitis, 490, 491f LCMV. See Lymphocytic choriomeningitis virus Lower body parkinsonism, 111 for CJD, 514, 514f LDL. See Low-density lipoprotein Lower motor neuron weakness, 103, 105f for CNS aspergillus, 625f–626f Lead poisoning, chronic, 362, 536t LP. See Lumbar puncture of CNS lymphoma, 415f Leber’s hereditary optic neuropathy, 181 LPS. See Lipopolysaccharide for CNS toxoplasmosis, 504, 504f Legal blindness, 172 LSD. See Lysergic acid diethylamide CNS tuberculosis, 618f–619f Legal intoxication, 687 Lumbar adhesive arachnoiditis, 78 for CNS vasculitis, 635f Legionella, 346, 356 Lumbar cord, 387 for coccidiomycosis meningitis, 623f LEMS. See Lambert-Eaton myasthenic syndrome Lumbar plexus, 546–548, 548f comas and, 136 Lennox-Gastaut syndrome, 225–226 Lumbar puncture (LP) complications of, 17–18 Lenticulostriate arteries, 263 contraindications to, 17–18, 19t occlusion of, 264 analgesia for, 33 contrast material, 16–17, 18f Leprosy, 380 bloody tap and, 35 CT compared to, 11, 18, 715, 728 Leprous neuritis, peripheral neuropathy with, 541 for CNS infections, 453–454 delirium detected with, 127 Leptomeningeal metastases, 420 comas and, 137 diffusion tensor imaging with, 220–221 clinical features of, 420 CSF collection and, 34–35 diffusion-weighted, 20 laboratory/imaging evaluation for, 420 CSF leak following, 65–66 DTI and, 21, 21f MRI of, 420f CSF normal values in, 36, 36t echo-planar, 20, 21f treatment of, 420–421 for delirium, 127–128 for encephalomyelitis, 520, 521f Leptospira, 463 headache after, 35–36, 36t ferromagnetic implants and, 18 Leukoaraiosis, 259, 310 imaging and laboratory studies prior to, 33 FLAIR images in, 16, 17f–19f Leukopenia, from phenytoin, 722, 736 Kernig’s sign and, 710, 724 gradient echo sequences and, 19 Leukotrienes, 41 lidocaine for preparing, 34 guidelines for use of, 12t Levetiracetam, 232, 241, 343 MG and, 720, 735 for Hashimoto’s encephalopathy, 646f dosage/adverse effects of, 239t needle comparison for, 35, 36f for histiocytosis X, 632f Levodopa, Parkinson’s disease treatment with, 328t, needle insertion for, 34 for histoplasmosis of pons, 622f platelet counts and, 33 for HIV infection dementia, 500, 500f 330 positioning for, 34, 34f of intramedullary astrocytoma, 390f augmentation strategies for, 330–331 SAH from, 35 for invasive sinonasal aspergillus, 626f–627f Levodopa-induced dyskinesia, 342 SAS and, 33 for lacunar infarction, 633f–634f Levorphanol, for pain control, 45t technique for, 34–35 of leptomeningeal metastases, 420f Lewy bodies. See Dementia with Lewy bodies for tonic seizure, 717, 731 for limbic encephalitis, 617f–618f LGMD. See Limb-girdle muscular dystrophy Lumbar spine mean transit time and, 20 LH. See Luteinizing hormone adhesive arachnoiditis of, 78 of meningiomas, 390f, 416f, 718, 732–733 Lhermitte’s symptom, 3, 439 congenital anomalies of, 74–75 for MS, 441–442, 441f Librium, 667t degenerative conditions to, 76–77 for MSA, 639f Lidocaine, 33, 529 disk disease of, 75–76 for neoplastic spinal cord compression, 389, 389f LP preparation using, 34 facet joint hypertrophy and, 77 for neurosarcoid, 628f–632f Lidoderm patches, 49 stenosis, 76–77, 77f neurosyphilis for, 619f–621f Light touch, testing of, 8–9 perfusion, 20–21 Limb apraxia, 145 diagnosis of, 711, 725 for pituitary tumors, 432f Limb dystonia, 339 trauma to, 75 for PML, 474 Limb mononeuropathies, 534 Lumbosacral plexus, 546–547 for PNDs, 519f Limb-girdle, 569 divisions of, 548f safety and, 18 enlargement and, 573 lesions of, 549t for schizophrenia, 657 Lumbosacral radiculoplexus neuropathy, 593 of schwannomas, 416f Luteinizing hormone (LH), 423 efficiency tests for, 427t

Index 753 Magnetic resonance imaging (MRI) (Cont.): Mee’s lines, 317 Meningitis (Cont.): for SDE, 480, 480f MEG. See Magnetoencephalography syphilitic, 473 for sellar mass, 431–432, 432f Melanoma tuberculosis and, 472, 491 for spinal cord infarction, 642f viral, 461 of spinal epidural abscess, 391f of eye, 186, 186f clinical manifestations of, 461 for stroke, 273–274, 275f malignant, 278 CSF examination in, 462 of superior sagittal sinus thrombosis, 636f–639f MELAS. See Mitochondrial myopathy, encephalopathy, differential diagnosis for, 463 of syringomyelia, 396f epidemiology of, 462 T1 and T2 relaxation times in, 16, 16t lactic acidosis and stoke-like episodes etiology of, 461–462, 461f techniques for, 15–17 Melatonin, 158 laboratory diagnosis of, 462–463 TOF and, 19–20 Melkersson-Rosenthal syndrome, 380 PCR amplification in, 462 for viral encephalitis, 467–468, 467f Memantine, 309 pleconaril for, 465 Memory prognosis for, 465 Magnetic resonance neurography, 21 serologic studies in, 462–463 Magnetic resonance spectroscopy (MRS), 11 assessment of, 6 specific viral etiologies for, 463–464 Magnetic source imaging (MSI), 234 benign forgetfulness of elderly and, 299 treatment for, 464–465 Magnetoencephalography (MEG), 234 implicit, 151 viral culture in, 462 Major depression, 672, 672t KIBRA and, 220 VZV and, 464 limbic network for, 150–152 medical management of, 674f long-term, 6 Meningococcal meningitis, 459–460, 459t Major histocompatibility complex (MHC), 494 primary impairments to, 153 Meningoencephalitis, 454 Malignant monoclonal gammopathies, 523 secondary impairments to, 153 Menstrual cycle, 52 Malignant spinal cord compression, 421 short-term, 6 Mental disorders. See also Psychiatric disorders Malingering, 679 MEN. See Multiple endocrine neoplasia Mallory-Weiss lesion, 689 Ménière’s disease, 100–101 classification of, 662 Mania, 161 diagnosis of, 710, 724 homeless people and, 684 hearing loss and, 203 insomnia with, 161 carbamazepine for, 678 Meningeal biopsy, 491 physician considerations for, 662 clinical features of, 676–677 Meningiomas, 379 Mental status examination, 5–6 criteria for episode of, 676t features of, 415 Meperidine, for pain control, 45t differential diagnosis of, 677 location of, 390 Meralgia paresthetica, 531t, 532 etiology/pathophysiology of, 677 MRI of, 390f, 416f, 718, 732–733 Mercury poisoning, 536t lithium for, 678 sellar mass and, 430 Meropenem, 460, 477 mixed, 676 surgical resection of, 415 Merosin deficiency, 580t oxcarbazepine for, 678 Meningitis, 127 MERRF. See Myoclonic epilepsy with ragged red treatment for, 677–678, 678t aseptic, 500, 500t valproic acid for, 678 bacterial fibers MAO-B inhibitors, 330–331 Mesial temporal lobe epilepsy (MTLE), 226 MAOI. See Monoamine oxidase inhibitor acute, 454 MAP. See Mean arterial pressure adjunctive therapy for, 460–461 Amygdalohippocampectomy and, 712, 725–726 Maprotiline, 675 clinical presentation of, 456 characteristics of, 228t MAPT. See Microtubule-associated protein tau CSF analysis in, 455–458, 455t, 457t EEG of, 228f Marburg’s variant, 449 definition of, 454 historic factors associated with, 711–712, 725 Marcus Gunn pupils, 172 diagnosis of, 456–458, 457t Metabolic bone disease, neck pain in, 84 Marfan’s syndrome, 4, 256 differential diagnosis of, 458–459 Metabolic disorders, 132–133 Marijuana, 698, 704 empirical antimicrobial therapy for, 457t, 459, Metabolic encephalopathies, 289 acute/chronic intoxication of, 704 Metabolic myopathy, 592–593 drug use/abuse with, 704–705 459t Metabolic tolerance, 688 physical dependence on, 705 epidemiology of, 454 Metabotropic receptors, 212–213 physical effects of, 704–705 etiology of, 454 Metaiodobenzylguanidine (MIBG), 372 prevalence of use of, 704 herpes simplex compared to, 458 Metastatic adenocarcinoma, 491 therapeutic use of, 705 ICP increase in, 456, 461 Metastatic brain tumors, 186, 379, 418. See also tolerance and, 705 imaging for, 458 Marinesco-Sjogren syndrome, 351t pathophysiology of, 455–456, 455f Leptomeningeal metastases Markesbery-Griggs distal myopathy, 582, 583t prognosis for, 461 from known cancer, 418, 419f Marplan, 665t specific antimicrobial therapy for, 459–461, 459t without known primary tumor, 418–419 Masseter weakness, 378 treatment of, 459–461 mechanisms of, 418, 418t Mastoiditis, 475 basal, 484 treatment of, 419 MBM. See Meat and bone meal carcinomatous, 420f MBP. See Myelin basic protein chronic chemotherapy for, 419 MCA. See Middle cerebral artery approach to, 485–492, 486t–488t Methadone McCune-Albright syndrome, 429 approach to enigmatic case of, 491–492 MCI. See Mild cognitive impairment benign lymphocytic, 489t administration of, 700 McLeod syndrome, 341 clinical pathophysiology of, 484, 484t for pain control, 45t MCP. See Macrophage chemoattractant protein CSF analysis for, 490–491 Methamphetamine, 705 MDCT. See Multidetector CT empirical treatment for, 492 Methotrexate, 447, 556, 607 MDMA. See Methylenedioxymethamphetamine ibuprofen for, 722, 737 Methyl bromide, 536t Mean arterial pressure (MAP), 284, 609 imaging for, 490 Methylenedioxymethamphetamine (MDMA), 126 Meat and bone meal (MBM), prion disease immunosuppressed patient and, 492 drug use/abuse and, 705–706 infectious causes of, 486t–488t Methylphenidate, 165, 344, 448 contaminating, 512 laboratory investigation for, 491 Methylprednisolone, 448 Mechanical falls, 114 meningeal biopsy for, 491 Methysergide, 60t, 64 Mechanical ptosis, 188 MRI for, 490, 491f Metronidazole, 481–482 Mechanic’s hands, 598 noninfectious causes of, 489t–490t toxicity of, 536t Medication-overuse headache, 59 coccidiomycosis, CT/MRI for, 623f Mexiletine, 529, 581 cryptococcal, 503, 506 Mexitil, 48 DHE for, 65 headache and, 51 MFS. See Miller Fisher syndrome inpatient management of, 64–65 herpes simplex, 463–464 MG. See Myasthenia gravis outpatient management of, 64 HIV and, 464 MGUS. See Monoclonal gammopathy of Medicine, task of, 40 HIV infection and, 500, 500t Medulla identifying, 452, 452f–453f undetermined significance axial section of, 269f intracranial, 484–485 MHC. See Major histocompatibility complex intrinsic lesions of, 32 spinal, 485 MIBG. See Metaiodobenzylguanidine Medullary syndrome subacute, 472 Microsomal triglyceride transfer protein (MTP), lateral, 269f clinical manifestations of, 472 medial, 269f etiology of, 472 355 total unilateral, 269f laboratory diagnosis of, 472–473 Microtubule-associated protein tau (MAPT), 210 Medulloblastomas, 414 treatment for, 473 Microvascular decompression, 378–379 Micturition syncope, 89 MIDAS. See Migraine Disability Assessment Score Midazolam, 286 Midbrain stroke, 273f

754 Index Middle cerebral artery (MCA), 249–250 Monoamine oxidase inhibitor (MAOI), 59, 664 Multiple sclerosis (MS) (Cont.): occlusion, 17f depressive disorders and, 675 diagnosis of, 440–441, 440t stenosis, MRA for, 633f differential, 442–443, 442t stroke in, 263–265, 263f–264f Monoclonal anti-CD20, 607 tests for, 441–442, 441f Monoclonal gammopathy of undetermined diplopia and, 438 Midodrine, 376 disease course of, 439–440, 440f Midpontine stroke, 271f significance (MGUS), 556 EBV and, 437 Migraine immunoglobulin isotopes and, 557 EDSS and, 443, 444t therapy for, 557 epidemiology of, 436–437 acephalgic, 247 Monocular diplopia, 188 EPs and, 28, 442 basilar artery, 91 Mononeuritis multiplex, 532, 535 facial myokymia in, 439 brainstem pathways and, 53f Mononeuropathy, 530 facial weakness in, 439 CGRP therapy for, 53 limb, 534 fatigue and, 439, 448 classic, 183 peripheral neuropathy and, 530, 531t gender and, 436 clinical features of, 55 treatment for, 532 genetic considerations for, 437–438, 437t diagnostic criteria for, 55t Mononeuropathy multiplex, 532 heat sensitivity in, 439, 448 dopamine and, 54 treatment for, 532 immunology of, 437 ergotamine for, 56, 57t, 58 Monoparesis lesions of, 435 familial hemiplegic, 54 acute, 107 Lhermitte’s symptom in, 439 5-HT for, 53–54 subacute/chronic, 107 migration studies on, 436 ischemic stroke risk and, 721, 735–736 weakness and, 107 MRI for, 441–442, 441f MIDAS questionnaire for, 55, 55f Mood disorders, 671 neurodegeneration of, 437–438 PET and, 54f Mood stabilizers ON from, 438, 712, 726 symptoms of, 52, 53t clinical pharmacology of, 677t pain from, 448 treatment of, 55–59, 57t treatment with, 677–678 paroxysmal symptoms in, 439, 448 Morphine, 699 pathogenesis of, 435–437 acute attack therapies for, 56, 57t for pain control, 45t physiology of, 436, 436f anticonvulsant medication for, 60t pharmacology of, 696–697 pregnancy and, 442 beta blockers for, 60t Motivational interviewing, for alcoholism, 692 primary progressive, 440, 440f clinical stratification of specific, 58t Motor conduction studies, 30–31, 30f prognosis of, 442 dopamine agonists for, 57t, 58 Motor evoked potentials, 28 progressive/relapsing, 440, 440f drug combinations for, 58–59 Motor examination, 7–8 relapsing/remitting, 439, 440f, 447–448 5-HT agonists for, 56, 57t, 58 Motor neuron disorders. See also Amyotrophic lateral secondary progressive, 439–440, 440f, narcotics for, 58–59 447–448 nonpharmacologic management of, 56 sclerosis sexual dysfunction in, 439 NSAIDs for, 56, 57t etiology and investigation of, 359t spasticity from, 438, 448 preventative, 59, 60t genetic, 361t therapeutic decision-making for, 446f serotonergic drugs for, 60t pathology of, 358–359 treatment for, 443–449, 445t TCAs for, 60t selected types of, 363–364 experimental therapies in, 449 triggers of, 52 sporadic, 360t glatiramer acetate in, 445–447 Migraine Disability Assessment Score (MIDAS), upper, 364 IFN-β for, 445–447 websites with information on, 364–365 initial demyelinating episodes in, 443, 445 55, 55f γ motor neurons, 105f mitoxantrone hydrochloride in, 447 Mild cognitive impairment (MCI), 299 α motor neurons, 105f natalizumab in, 445–447 Motor units off-label options in, 447–448 Alzheimer’s disease from, 305 disorders of, 102 symptomatic, 448–449 Millard-Gubler syndrome, 190 EMG and, 28–30 urinary tract infections and, 448 Miller Fisher syndrome (MFS), 551, 551t function of, 28 weakness from, 438, 448 Minimally conscious state, 130 polyphasic, 29f Mini-mental status examination (MMSE), 5 Moyamoya disease, 259, 278 Multiple sleep latency test (MSLT), 164 MR angiography (MRA), 534 Multiple system atrophy (MSA), 325, 334 for Alzheimer’s disease, 303, 303t MRA. See Magnetic resonance angiography for delirium, 125–126 MRI. See Magnetic resonance imaging age and, 334 for dementia, 303, 303t MRS. See Magnetic resonance spectroscopy in ANS dysfunction, 371–372 for HIV infection dementia, 499–500 MS. See Multiple sclerosis case of, 713, 727 Minor depression, 673 MSA. See Multiple system atrophy clinical phenotypes of, 334–335 Mirror neurons, 220, 220f MSI. See Magnetic source imaging definition of, 371 Mirtazapine, 665t MSLT. See Multiple sleep latency test MRI for, 639f Misonidazole, 536t mtDNA. See Mitochondrial DNA Parkinson’s disease compared to, 335 Mitochondria MTDNA skeletal muscle-CNS syndromes, 588–589 spectrum of disease in, 335 apoptosis and, 219 MTLE. See Mesial temporal lobe epilepsy treatment of, 335 in cell death, 216f MTP. See Microsomal triglyceride transfer protein Multiple-sensory-defect dizziness, 96 DNA of, 587 Multidetector CT (MDCT), 12–13 Mumps, 464, 488t genetic composition of, 587 Multifocal motor neuropathy (MMN), 556 Munchausen’s syndrome, 679 Mitochondrial ataxia, 356 Multifocal motor neuropathy with conduction block Mus musculus, 464 Mitochondrial disorders, 311 Muscle appearance, assessment of, 7 Mitochondrial DNA (mtDNA), 356, 589 (MMCB), 362 Muscle arteriolar vasodilatation, 370 Mitochondrial DNA depletion myopathy, 589 features of, 364 Muscle biopsy, 574 Mitochondrial myopathies, 587–589 Multifocal myoclonus, 134 DM and, 605, 605f Mitochondrial myopathy, encephalopathy, lactic Multi-infarct dementia, 298, 310–311, IBM and, 605, 606f normal, 714–715, 728 acidosis and stoke-like episodes (MELAS), 722, 737–738 PM and, 605, 605f 589 Multiple endocrine neoplasia (MEN), 429 Muscle bulk, 102 Mitoxantrone hydrochloride, for MS treatment, 447 Multiple myeloma, 557 Muscle contracture, 572 Mitral valve prolapse, 253 Multiple ocular nerve palsies, 190 Muscle disease Mixed glioma, 413 Multiple sclerosis (MS), 3, 435 clinical features of, 568–573 Mixed hearing loss, 203 laboratory evaluation in, 573–574 Mixed mania, 676 acute, 449 Mixed sleep apnea, 163f, 165 anatomy of, 435–436 DNA analysis for, 573–574 Mixed-action drugs, 665t ancillary symptoms of, 439 EMG studies for, 573 Miyoshi myopathy, 583, 583t ataxia and, 438–439, 448 forearm exercise test for, 574 MJD. See Machado-Joseph disease BBB disruption in, 435 muscle biopsy for, 574 MMCB. See Multifocal motor neuropathy with bladder dysfunction in, 439, 448 serum enzymes for, 573 conduction block chronic myelopathy of, 396 Muscle disorders MMN. See Multifocal motor neuropathy clinical manifestations of, 438–439, 438t calcium channel, 589–590, 591f MMSE. See Mini-mental status examination clinical variants of, 449–450 chloride channel, 592 Modafinil, 652 constipation and, 439, 448 MOG. See Myelin oligodendrocyte glycoprotein CSF and, 442 Mollaret’s meningitis, 489t depression in, 439, 448 Molluscum contagiosum, 503

Index 755 Muscle disorders (Cont.): Myelin oligodendrocyte glycoprotein (MOG), Myotonia, 572 potassium channel, 592 437 disorders, 573t sodium channel, 591 nondystrophic, 590t Myelin-associated glycoprotein (MAG), 217, 557 potassium-aggravated, 591 Muscle energy metabolism disorders, 585–587 Myelitis potassium-sensitive, 572 Muscle membrane excitability disorders, 589–592 Muscle pain. See Myalgia acute infectious, 394 Myotonia congenita, 572 Muscle pain, weakness from, 604 acute transverse, MRI for, 642f Myotonic discharges, 29 Muscle spasm, back pain associated with, 72 postinfectious, 393–394 Myotonic dystrophy, 29, 188, 579 Muscle stiffness. See Stiffness postvaccinal, 393–394 Muscle strength, assessment of, 7–8 recurrent episodes of, 393 clinical features of, 580–581 Muscle stretch reflexes Myelography, 21 diagnosis of, 581, 719, 733–734 complications of, 22 laboratory features of, 581 assessment of, 8 contraindications to, 22 treatment of, 581 increase in, 103 CT, 21–22 Myotonic muscular dystrophy, 575t Muscle tone, 102 Myotoxicity, 595 assessment of, 7 low-dose, 21 myotubular myopathy, 585 Muscle troponin T, 585 indications for, 21–22 Myxopapillary, 413 Muscle weakness, 719–720, 734 seizure from, 22 acute, 603 techniques for, 21 Naegleria fowleri, 468, 504 examination disclosing, 571t Myelopathy. See also Compressive myelopathy; Nafcillin, 460 facial weakness compared to, 569 Naloxone, 46 fatigue from, 569–570 Noncompressive myelopathy Naltrexone, 694, 700 intermittent, 568, 569f acute transverse, 392 Naproxen, 64 persistent, 569, 570f progressive, 602–603 evaluation of, 392t for pain control, 45t symptoms of, 568–569 chronic, 394 Narcolepsy Muscle-eye-brain disease, 580t Muscle-specific kinase (MuSK), 560 of MS, 396 characteristics of, 164–165 antibodies to, 561 types of, 394–397 diagnosis of, 165 Muscular dystrophy, 574. See also specific types demyelinating, 393 prevalence of symptoms in, 164t Muscular Dystrophy Association, 364 EMG for, 710–711, 724–725 severity of, 165 MuSK. See Muscle-specific kinase in HIV infection, 500–501 treatment of, 165 Myalgia hypocupric, 397 Narcotics, for migraine treatment, 58–59 drugs causing, 571, 572t immune, 393–394 Narcotics Anonymous, 700 fibromyalgia and, 571–572 inflammatory, 393–394 Nardil, 665t identifying, 570–571 retrovirus-associated, 395 NASCET. See North American Symptomatic Carotid types of, 571–572 spondylitic, 394 Myasthenia gravis (MG), 292, 523, 559 vacuolar, 501 Endarterectomy Trial ACh and, 716, 729–730 Myoadenylate deaminase deficiency, 587 Natalizumab, MS treatment with, 445–447 AChE test for, 561 Myoclonic epilepsy with ragged red fibers (MERRF), National Institute of Allergy and Infectious Disease AChRs in, 559–560 botulism and, 563 588–589 (NIAID), 470 clinical features of, 560 Myoclonic jerks, 343 National Institute of Neurological Disorders and congenital, 562t Myoclonic seizures, 225, 305 diagnosis of, 560–564, 561t, 713, 727 Myoclonus, 343 Stroke (NINDS), 249 differential diagnosis for, 562–563 NCVs. See Nerve conduction velocities diplopia in, 189 baltic, 350t nd-NMBAs, 292 disorders associated with, 563–564, 563t CJD and, 513 NDPH. See New daily persistent headache EDx for, 561 movement characteristics of, 338t NE. See Norepinephrine evaluation of, 560–564 reversible, 343 Nebulin gene, 585 fatigue from, 559–560 startle, 719, 734 Neck pain, 82, 712, 726 inherited syndromes of, 561–562, 562t treatment of, 343 LEMS and, 562–563 Myofasciitis, 603 in ankylosing spondylitis, 77, 84 LP and, 720, 735 Myofibrillar myopathies, 583, 583t in brachial neuritis, 85 neurasthenia and, 563 Myogenic ptosis, 188 in brachial plexus injury, 85 ocular, 560 Myoglobinuria, 603 causes of, 74t, 82–84 pathophysiology of, 559–560, 560f Myokymia, 572 in cervical disk disease, 83 patient assessment for, 566–567, 567f Myopathic weakness, 103–105 in cervical spine trauma, 82–83, 83t repetitive stimulation in, 31 Myopathy, 292. See also specific types in cervical spondylosis, 83, 84f treatment for, 564–566, 564f acute necrotizing, 524 in herpes zoster, 84 acute quadriplegic, 292 in metabolic bone disease, 84 AChE medications for, 564 alcoholic, 690 nerve root injury causing, 70–71 azathioprine in, 565–566 cachectic, 292 in Pancoast tumor, 85 cyclosporine in, 566 clinical features of, 568–573 in RA, 84 drugs to avoid in, 566, 567t congenital, 584–585 statistics of, 70 glucocorticoid therapy in, 565 critical illness, 292 stiff, 453 immunosuppression in, 565 disorders of muscle energy metabolism and, in suprascapular neuropathy, 85 IVIg in, 566 in TOS, 84 myasthenic crisis and, 566 585–587 treatment for, 85 mycophenolate mofetil in, 565 disorders of muscle membrane excitability and, Neck weakness, 383 plasmapheresis in, 566 Necrotizing arteritis, 258 tacrolimus in, 566 589–592 Necrotizing myositis, 603 thymectomy in, 564–565 drug-induced, 594–596, 594t, 603–604 Needles weakness from, 105, 560 LP, comparison of, 35, 36f Myasthenic crisis, 566 autoimmune, 595–596 LP, insertion of, 34 Mycobacterium leprae, 541 drug use/abuse and, 595 Nefazodone, 665t Mycophenolate mofetil, 565, 607 endocrine, 592–593 Neglect, hemispatial, 147–148, 149f Mycoplasma, 393, 449, 463, 468, 650 glucocorticoid-related, 594–595 Neisseria meningitidis, 454–455, 458 Mycoplasma pneumoniae, 394, 462, 551 hereditary, 574–584 treatment for, 459–460, 459t Mycotic aneurysms, 293 in HIV infection, 501 Nemaline myopathy, 584–585 Mydriasis, 172 laboratory evaluation for, 573–574 Neonatal period, 229 Myelin, 213 from lipid-lowering agents, 594 Neoplasms clinical aspects of, 215 metabolic, 592–593 back pain and, 77–78 molecular architecture of, 215f mitochondrial, 587–589 of CNS, 316 Myelin basic protein (MBP), 437 of nd-NMBAs, 595 in HIV infection, 502–503 proximal myotonic, 572 Neoplastic spinal cord compression pure syndromes of, 589 back pain from, 389 septic, 292 MRI for, 389, 389f steroid, 607 treatment of, 389–390 in systemic illness, 593–594 Nephrogenic systemic fibrosis (NSF), 17 Myophosphorylase deficiency, 586 Myopia, 171 Myositis, necrotizing, 603

756 Index Nerve biopsy, 535 Neuronopathy, 537 Nonsteroidal anti-inflammatory drugs (NSAIDS) Nerve conduction Neuron-specific enolase (NSE), 287–288 adverse effects of, 44 Neurontin, 48 for ALBP, 80 in myelinated/demyelinated axons, 436, 436f Neuropathic pain for CLBP, 82 studies, 30–31 dementia and, 310 antiarrhythmic drugs for, 48 migraine treatment with, 56, 57t for peripheral neuropathy, 529–530 anticonvulsant medication and, 48 for pain, 44–46, 45t Nerve conduction velocities (NCVs), 541–542 mechanisms contributing to, 44 Nerve growth factor (NGF), 215 TCAs managing, 48 Norepinephrine (NE) Nerve root injury, 70–71 treatment of, 48–49 clinical aspects of, 214t Nerve sensation, 120 Neuropathy. See also specific types role of, 366 Nervous tension, 59 cranial, 533–534 Neural gustatory losses, 197–198, 198t hereditary, with liability to pressure palsies, 542t, 543 Normal-pressure hydrocephalus (NPH), 302 Neurapraxia, 548 in HIV infection, 501 characteristics of, 314–315, 315f Neurasthenia, 563 nutritional, 538 CSF absorption and, 315 Neuregulin 1 (NRG1), 655, 656t Neurosarcoid, 628f–632f Neurilemmomas, 549 Neurosyphilis, MRI for, 619f–621f Normeperidine, 46 Neurinomas. See Schwannomas Neurotmesis, 548 North American Symptomatic Carotid Neuroacanthocytosis, 341 Neurotransmitter receptors, 212 Neurocardiogenic syncope, 88–89 ionotropic, 212–213 Endarterectomy Trial (NASCET), 254–255 Neurocutaneous syndromes, 417 metabotropic, 212–213 Nortriptyline, 60t Neurocysticercosis, 478 Neurotransmitters, 212 peptide, 212 for pain control, 45t clinical presentation of, 478 principal classic, 214t safety of, 674 diagnosis of, 478–479 secreted, 212 Nothnagel’s syndrome, 189 etiology of, 478 Neurotrophic factors, 215, 217t Novantrone, 447 treatment of, 479 brain-derived, 215 NPH. See Normal-pressure hydrocephalus Neurodegeneration, 219 ciliary, 215 NREM sleep, 155–158 ALS and, 362 functions of, 215 NRG1. See Neuregulin 1 Neurodegenerative ataxia, 113 glial-derived, 215 NSE. See Neuron-specific enolase Neurofibrillary tangles (NFTs), 305 vascular endothelial growth, 215 NSF. See Nephrogenic systemic fibrosis tau in form of, 313 Neurotrophin (NT), 215 NT. See Neurotrophin Neurofibromas, 390 New daily persistent headache (NDPH) Nuchal rigidity, 453, 461 Neurofibromatosis (NF), 410 clinical presentation of, 65 Nucleoside analogues, 536t type 1, 417 primary, 66–67 Nucleus pulposus, embolism of, 393 type 2, 417 secondary, 65–66 Numbness, 116, 377 Neurogenetics, 210 of neck, 709, 723 Neurogenic ptosis, 188 low CSF volume, 65–66 in spinal cord, 121 Neuroimaging. See specific imaging methods post-traumatic, 66 Nystagmus Neurokeratitis, 379 raised CSF pressure, 66 downbeat, 192 Neuroleptic malignant syndrome (NMS), 344 NF. See Neurofibromatosis gaze-evoked, 192 definition of, 374 NFTs. See Neurofibrillary tangles jerk, 192 Neurologic disease NGF. See Nerve growth factor vestibular, 192 cost of, 2 Niacin, for ethionamide neurotoxicity, 538 diagnosis of, 9–10 NIAID. See National Institute of Allergy and Infectious OAE. See Otoacoustic emissions in HIV infection, 494t Obesity, 431 Disease Object agnosia, 150 clinical manifestations of, 498–505 Nicotinic acid deficiency, 316 Object recognition, 150 location of lesions for, 2–3 Obsessive-compulsive disorder (OCD), 661f method for, 2 peripheral neuropathy and, 539 pathophysiology defined for, 3 Nightmares, 166 clinical manifestations of, 670 worldwide prevalence of, 2, 3t Night-shift workers, 167 etiology/pathophysiology of, 670 Neurologic disorders. See also specific types NINDS. See National Institute of Neurological TCAs for, 670 depression from, 671 treatment for, 670–671 insomnia with, 162 Disorders and Stroke Obstetric neuropathies, 616 Neurologic examination, 4 Nipah virus, 466 Obstructive sleep apnea, 165 coordination examination for, 9 Nitric oxide synthase, 218 Obturator neuropathy, 531t cranial nerve examination for, 6–7 Nitrofurantoin, 536t OCB. See Oligoclonal banding gait examination for, 9 Nitroprusside, for ICP, 709–710, 724 Occipital lobe stroke, 183 mental status examination for, 5–6 Nitrosoureas, 422 Occipitotemporal network, 150 motor examination for, 7–8 Nitrous oxide, 536t OCD. See Obsessive-compulsive disorder sensory examination for, 8–9 NMDA. See N-methyl-D-aspartate Ocular bobbing, 135 Neurologic history, 3 N-methyl-D-aspartate (NMDA), 217 Ocular dipping, 135 corroboration of history by others in, 4 Ocular flutter, 192 drug use/abuse in, 4 antibodies to, 518f Ocular movements, in comas, 135–136 family history in, 4 NMO. See Neuromyelitis optica Oculomotor apraxia, 149 formulating impression of patient in, 4 NMS. See Neuroleptic malignant syndrome Oculomotor nerve medical illnesses in, 4 Nocardia species, 475, 486t diplopia in disorders of, 189 patients’ descriptions of complaint in, 4 Nociceptin, 696 examination of, 6 temporal course of illness in, 3–4 Nociceptors Oculopharyngeal dystrophy, 188, 582 Neuromas. See Schwannomas clinical features of, 582 Neuromuscular disease, gait and, 112 inflammation induced, 41, 42f dysphagia and, 582 Neuromuscular jitter, 31–32 primary afferent, 40–41, 41f laboratory features of, 582 Neuromuscular junction sensitization and, 41 treatment for, 582 diseases of, 105 silent, 41 Oculopharyngeal muscular dystrophy, 575t weakness in, 710, 724 visceral afferent, 42, 42f Odor Stix, 195 Neuromuscular junction disorders,ANS dysfunction Noise-induce hearing loss, 207 Odorant, 193 Non-24-hour-sleep-wake disorder, 169 Odorant-binding proteins, 194 and, 372 Nonaka distal myopathy, 583, 583t Olanzapine, 682t, 683, 693 Neuromuscular transmission Noncompressive myelopathy, 392 Olfaction, 193–194, 194f compressive compared to, 388–389 Olfactory dysfunction, 194–195, 195f disorders of, 292 types of, 392–394 age and, 196 postactivation facilitation of, 31 Nonconvulsive seizure disorder, 316 approach to, 195–196 Neuromyelitis optica (NMO), 393 Nondepolarizing neuromuscular blocking agents treatment for, 196 features of, 449 Olfactory epithelium, 193 treatment for, 449 (nd-NMBAs), 292 Olfactory nerve, 6 Neuromyotonia, 523, 572 myopathy of, 595 Oligoastrocytoma, 413 Neuronal cell-surface antigens, 516, 518f Non-ergot alkaloids, 328t, 329 Oligoclonal banding (OCB), 442 Neuronal networks, structural changes in, 231 Nonfluent transcortical aphasia, 142t, 144 Oligodendrocyte myelin glycoprotein (OMGP), 217 Non-rapid-eye-movement. See NREM sleep Nonrestorative sleep, 160

Index 757 Oligodendrogliomas, 413, 413f Orthostatic hypotension (OH) (Cont.): Pancreas, 689 anaplastic, 413 transient worsening of, 376 Panic attacks, 663, 663t astrocytomas compared to, 413 treatment of, 94, 375–376, 376t Panic disorder, 663 CT scan of, 413f patient education for, 375–376 symptomatic, 376 antidepressants for, 664, 665t Oligomers, 219 management of side effects in, 666t Olivopontocerebellar atrophy (OPCA), Ossification of posterior longitudinal ligament (OPLL), 83 benzodiazepine for, 664, 667t 334, 348 clinical manifestation of, 663 OMD. See Oromandibular dystonia Osteomalacia, 593 diagnostic criteria for, 663t OMGP. See Oligodendrocyte myelin glycoprotein Osteoporosis, back pain in, 78 differential diagnosis for, 664 ON. See Optic neuritis Osteosclerosis, back pain in, 78 etiology for, 664 Oncogenes, 410 Otitis media, 475 pathophysiology for, 664 One-and-a-half syndrome, 191 Otoacoustic emissions (OAE), 205 treatment for, 664 ONTT. See Optic Neuritis Treatment Trial Otosclerosis, 202 Papaver somniferum, 696 OPCA. See Olivopontocerebellar atrophy Oxaliplatin, 537 Papilledema, 181–182, 182f Ophthalmoplegia β-N-oxalylaminoalanine (BOAA), 397 acetazolamide for, 182 Oxazepam, 667t, 668 Paracoccidioides brasiliensis, 488 chronic progressive external, 188 Oxcarbazepine Paradoxical embolization, 253–254 neuromuscular causes of, 570t Paralysis. See also Weakness; specific types Opioid abuse/dependence, 696 dosage/adverse effects of, 239t acute flaccid, 469 acute/chronic effects of, 697 for mania, 678 definition of, 102 definition of, 698 for pain control, 45t hyperkalemic periodic, 572 epidemiology of, 698 Oxidative phosphorylation, 587 periodic, 590t genetics and, 698 Oxybutynin, 166, 448 tongue, 383 natural history of, 698–699 Oxycodone, for pain control, 45t Paramyotonia congenita, 572, 591, 591f overdose in, treatment for, 697–698 Paraneoplastic neurologic syndromes (PNDs), 516 pharmacology of, 696–697 P1 syndromes, 267 antibody-associated, 516, 518t toxicity and, 697 P2 syndromes, 267–268 Anti-Hu, 558 treatment for, 699–701 PABP2. See Poly-RNA binding protein approach to, 517–518 Paclitaxel, 535 autonomic dysfunction and, 523 drug-free programs in, 700–701 cerebellar degeneration and, 521 maintenance of, 700 peripheral neuropathy and, 537 of CNS, 517, 519 opioid antagonists and, 700 PAF. See Progressive autonomic failure; Pure autonomic dorsal root ganglia and, 517, 519, 522 rehabilitation in, 699–700 encephalomyelitis, 519–520 withdrawal symptoms in, 699 failure MRI for, 519f Opioid antagonists, 700 Pain. See also Back pain; Myalgia; Neck pain; of nerve and muscle, 519 Opioid receptors, 697, 697t opsoclonus-myoclonus syndrome and, 521–522 Opioids Neuropathic pain; Referred pain pathogenesis of, 516–517 addiction to, 48 acetaminophen for, 44–46, 45t peripheral neuropathies and, 523 for chronic pain, 48 acute, 40 PET scan for, 519 commonly used, 45t sensory neuropathy and, 522 COX inhibitors combined with, 47 treatment of, 44–46, 45t specific, 519–524, 520t dosage problems with, 46 ascending pathways for, 42–43 of spinal cord, 522 endogenous, 43 aspirin for, 44–46, 45t stiff-person syndrome and, 522 intravenous administration of, 46 back pain referred from, 72, 78–79 types of, 516t for pain, 43, 46 from botulinum toxin injection, 374 visual loss and, 524 routes of administration for, 46 central mechanisms of, 41–43 Paraparesis spinal cord administration of, 46 chronic, 47 acute, 106 OPLL. See Ossification of posterior longitudinal CES resulting in, 106 treatment of, 47–49 chronic, 106 ligament COX inhibitors for, 44–45 subacute, 106 Opsoclonus-myoclonus syndrome, 521–522 CRPS and, 375 weakness and, 105–107 Optic apraxia, 149 facial, 377 Paraphasia Optic atrophy, 181, 181f fear and, 43 phonemic, 141 Optic disc drusen, 182, 182f GBS and, 550–551 semantic, 141 Optic gliomas, 430 in glossopharyngeal neuralgia, 382 Paraplegin gene, 364 Optic nerve hip disease and, 72 Parasomnias, 166–167 low thoracic, 79 Parathyroid disorders, 592 disease of, 175 modulation of, 43, 43f Paratonia, 102, 722, 737 examination of, 6 from MS, 448 Paresis, 102 Optic neuritis (ON), 180–181, 181f nervous tension and, 59 episodic generalized, 722, 737 MS and, 438, 712, 726 NSAIDS for, 44–46, 45t Paresthesias, 116 Optic Neuritis Treatment Trial (ONTT), opioids for, 43, 46 Parietal lesions, 191 PCA for, 46 Parietofrontal network for spatial orientation, 180–181 peripheral mechanisms of, 40–41 Optic neuropathy from RSD, 721, 735 147–150 sacral, 79 Parinaud’s syndrome, 192 anterior ischemic, 180, 180f sensitization and, 41 Parkinsonism Leber’s hereditary, 181 sensory system, 40 posterior ischemic, 180 shoulder, 82, 85 characteristics of, 320 toxic, 181 spine, structures sensitive to, 71 differential diagnosis of, 321, 326t Orbital cellulitis, 187 sympathetically maintained, 44 disorders of, 334–336 Orbital injury, 402 TCAs for, 48t drug-induced, 336 Orbital pseudotumor, 187 in temporal arteritis, 52 pathophysiologic basis for, 332, 333f Organic Brain Syndrome Scale, 124 testing response to, 8–9 primary, 326t Organophosphorus esters, 536t from TN, 720, 735 secondary, 326t, 336 Orientation, assessment of, 5 transmission of, 43f tauopathies and, 335–336 Oromandibular dystonia (OMD), 339 war and, 43 vascular, 336 Orphanin, 696 Pain control Parkinson’s disease, 153, 190, 320 Orthostatic hypotension (OH), 334 for acute pain, 44–46, 45t anxiety disorders from, 322 approach to, 369–371 for chronic pain, 47–49 balance disorders and, 321 BP drop and, 370 drugs for, 45t basal ganglia and, 320 BP recordings for, 371 Pain receptors. See Nociceptors clinical features of, 320 causes of, 90 Painful eye, 175–178 DBS for, 332 impaired BP causing, 366 Palinopia, 268 delirium and, 124 nonneurogenic causes of, 369t Pallister-Hall syndrome, 430 dementia in, 334 postprandial, 376 Palmomental response, 8 prevalence in different disorders of, 369t PAN. See Polyarteritis nodosa symptoms of, 367, 369t Pan troglodytes, 494 syncope in, 89–90 Pancoast tumor, 85, 421

758 Index Parkinson’s disease (Cont.): Peptide neurotransmitters, 212 Personality disorders, 679 depression from, 322 Percutaneous vertebroplasty (PVP), 78 clinical manifestations of, 679–680 differential diagnosis of, 325, 326t Perfusion magnetic resonance imaging (pMRI), 11 Cluster A, 680 disorders of, 334–336 Perfusion MRI, 20–21 Cluster B, 680 DLB and, 314, 334 Pergolide, 328t, 329 Cluster C, 680 dopamine cell death in, 323, 324f Perhexiline, 535 DBT for, 680 epidemiology of, 320 schizoid, 681 gait and, 111, 321 toxicity of, 537t treatment of, 680 genetic considerations for, 323–325, 655 Perilymphatic fistula, 98 genetic mutations in, 219 Periodic acid-Schiff (PAS), 314 PET. See Positron emission tomography genetically based, 321t Periodic hypothermia syndrome, 431 Petit mal, 224 Guam complex of, 317–318 Periodic lateralized epileptiform discharges (PLEDs), PH. See Paroxysmal hemicrania Huntington’s disease compared to, 325 Phakomatoses, 417 misdiagnosis of, 325, 327t 27 Phantosmia, 193 motor features of, 321 Periodic limb movement disorder (PLMD), 163 Pharmacodynamic tolerance, 688 MSA compared to, 335 Periodic limb movements of sleep (PLMS), Pharmacokinetic tolerance, 688 neuropsychiatric symptoms of, 322–323 phase-contrast MRA, 19 non-motor features of, 322 163, 163f Phencyclidine (PCP), 706 pathogenesis of, 325 Peripheral nerve hyperexcitability, 523 Phenelzine, 64, 665t pathology of, 323 Peripheral nerve injury, 548–549 Phenobarbital, 245, 374, 506 pathophysiologic basis for, 332, 333f Peripheral nerve tumors, 549 postural instability from, 321, 321f Peripheral nervous system (PNS) dosage/adverse effects of, 239t PSP compared to, 313 for epilepsy, 240 psychotic symptoms in, 322–323 consultations regarding dysfunctions of, 614 Phenytoin, 48, 529, 581 rigidity and, 102 critical care disorders of, 291–292 dosage/adverse effects of, 238t rivastigmine for, 331–332 leukopenia from, 722, 736 screening evaluation of, 325 neuropathy of, 291–292 for pain control, 45t sleep disorders from, 322 disease of, 369 Pheochromocytoma, 68 smell and, 195 illness identified in, 2 Phobic disorders, 668 stages of, 323f metastases of, 421 beta blockers for, 669 stem cells for, 217 neurologic disorders in critical illness at, 283t clinical manifestations of, 668 tauopathies and, 335–336 Peripheral neuropathy, 372, 525. See also treatment for, 669 treatment of, 325–334, 714, 728 Phonemic paraphasia, 141 carbidopa/levodopa for, 328t, 330 Charcot-Marie-Tooth disease; Diabetic Physiologic postrotational vertigo, 97 COMT inhibitors for, 331 neuropathy; Mononeuropathy; Physiologic vertigo, 97 dopamine agonists for, 327, 328t, 329–330 Mononeuropathy multiplex;Toxic Physostigmine, 139 general considerations for, 325, 327 neuropathy PICA. See Posterior inferior cerebellar artery initiation of therapy for, 327–329, 327f alcohol and, 688 Pick bodies, 312–313, 313f levodopa augmentation strategies for, 330–331 approach to, 525–529, 526f Pick’s disease, 312–313 MAO-B inhibitors for, 330–331 autonomic pattern of, 527–528, 528t, 546 Pinguecula, 175 motor fluctuations in, 329 bortezomib and, 538 Pituitary apoplexy, 186 motor symptoms and, 329–331 cisplatin and, 537 hypopituitarism after, 426 neuroprotective therapy for, 332 distribution of, 527, 527t Pituitary disorders, 593 neurotransplantation for, 333–334 EDx for, 525 Pituitary gland. See also Hypopituitarism non-motor symptoms and, 331–332 EMG for, 530 anatomy of, 423–424, 424f surgery for, 332–334 etiology of, 528–529 hormones produced by, 423 twins and, 323 evaluation of, 525 inflammatory lesions and, 425 fibers affected by, 527, 527t Pituitary insufficiency, 426 Parnate, 665t form thiamine deficiency, 538 tests of, 427t Paroxetine, 94, 664, 675 with herpes zoster, 541 Pituitary metastases, 430 Paroxysmal hemicrania (PH) histopathological classification of, 528t Pituitary tumor transforming gene (PTTG), 429 HIV infection and, 501, 539–540, 539t Pituitary tumors (adenoma), 428 clinical features of, 61t inherited, 541 bFGF in, 429 indomethacin for treating, 63 laboratory tests for, 715, 729 classification of, 428t Paroxysmal kinesigenic dyskinesia, 341 with leprous neuritis, 541 genetic syndromes associated with, 429 Partial seizures, 223, 223t with lyme disease, 540–541 GH secreting, 429 antiepileptic drugs for, 239–240 with monoclonal gammopathy, 557 hormone-secreting, 429 carbamazepine for, 239–240 mononeuropathy and, 530, 531t monoclonal, 429 complex, 223–224, 223t nerve conduction studies for, 529–530 MRI of, 432f with secondary generalization, 223t, 224 nicotinic acid deficiency and, 539 pathogenesis of, 428–429 simple, 223, 223t oxaliplatin and, 537 screening tests for, 432t valproic acid for, 240 paclitaxel and, 537 treatment of, 433–434 PAS. See Periodic acid-Schiff plexopathy and, 546–547 Pathologic vertigo, 97–98 PNDs and, 523 medical therapy for, 434 Pathologic vestibular vertigo, 100 polyneuropathy, 532 overview of, 433 Patient-controlled analgesia, 46 pure motor, 546 radiation therapy for, 434 Patients’ descriptions of complaint, in neurologic pure sensory, 546 transsphenoidal surgery for, 433–434, 433f from pyridoxine, 538 Pizotifen, 60t history, 4 riboflavin and, 539 Placebo effect, 43 Patrick sign, 72 signs/symptoms of, 526t Plantar reflex, 8 Pavor nocturnus, 166 special presentations of, 546–549 Plaques jaunes, 401 PCA. See Posterior cerebral artery suramin and, 537–538 Plasma exchange, 555 PCNA. See Proliferating cell nuclear antigen TCAs for, 529 Plasmapherisis, for MG treatment, 566 PCP. See Phencyclidine test indications for, 529 Platelet antiaggregation agents, 260 PCR. See Polymerase chain reaction thalidomide and, 538 Platinum compounds, 537t PCV. See Procarbazine, lomustine, and vincristine time course and, 528, 528t Platybasia, 383 treatment appropriate for, 529, 529t Pleconaril, 465 combination vasculitic, 557 Pleconaril, for viral meningitis, 465 Peduncular hallucinosis, 268 vincristine and, 537 PLEDs. See Periodic lateralized epileptiform Pedunculopontine nucleus (PPN), 338 vitamin B12 deficiency and, 538–539 Pellagra, 316 vitamin E deficiency and, 539 discharges Pendred syndrome, 201 Peripheral vertigo, 99t Pleomorphic xanthoastrocytoma, 411 Penicillamine, 538 Perisylvian network, left, 140–147 Plexopathies, 527, 534 Penicillin, aqueous, 473 Periventricular white matter disease, 259 Plexopathy, 546–548, 547f, 547t Pentosan polysulfate, 515 Permeability transition pore, 219 PLMD. See Periodic limb movement disorder Penumbra, 282 Peroneal nerve entrapment, at fibular head, 531t PLMS. See Periodic limb movements of sleep PEO. See Progressive external ophthalmoplegia Peroneal neuropathy, 614, 615f PLS. See Primary lateral sclerosis Perphenazine, 682–683 Persistent vegetative state, 130, 139

Index 759 Plurihormonal tumors, 428–429 Posttraumatic stress disorder (PTSD), 662 Prion disease (Cont.): PM. See Polymyositis diagnostic criteria for, 669, 669t laboratory tests for, 514 PME. See Progressive myoclonus epilepsy etiology/pathophysiology for, 670 MBM contaminated by, 512 PML. See Progressive multifocal propranolol for, 670 pathogenesis of, 508–511 risk factors for, 670 patient care for, 514 leukoencephalopathy treatment for, 670 prevention for, 515 PMNs. See Polymorphonuclear leukocytes species barrier of, 510–511 pMRI. See Perfusion magnetic resonance Postural back pain, 79 spectrum of, 507–511 Postural headache, 22 sporadic, 511 imaging Postural hypotension. See Orthostatic hypotension terminology in, 508t PNDs. See Paraneoplastic neurologic syndromes Postural instability, from Parkinson’s disease, 321, transmission of, 510–511 PNET. See Primitive neuroectodermal tumors types of, 509t Pneumococcal meningitis, 460 321f Pneumocystis carinii, 178 Postural orthostatic tachycardia syndrome (POTS), Prion disorders, 314 Pneumonia, 127 Prion protein (PrP), 507 PNS. See Peripheral nervous system 373 POEMS, 523 ANS dysfunction and, 373–374 isoforms, 509, 509f POLG gene, 588 pathogenesis of, 374 recombinant, 510 Poliomyelitis, 362, 394 Postural syncope, 90 structure of, 507, 508f Polyarteritis nodosa (PAN), 557–558 Postvaccinal myelitis, 393–394 Prions, 507 Polychlorinated biphenyle, 537t Potassium channel disorders, 592 strains of, 509–510, 510t Polydipsia, 431 Potassium-aggravated myotonia, 591 PRL. See Prolactin Polydrug abuse, 706 Potassium-sensitive myotonia, 572 PRMS. See Progressive/relapsing MS POTS. See Postural orthostatic tachycardia syndrome PRNP gene, 508t, 509 drug use/abuse with, 706–707 Potts puffy tumor, 481 human polymorphisms of, 511 treatment for, 707 Powassan virus, 463 PROACT. See Prolyse in Acute Cerebral Polymerase chain reaction (PCR), 35 PPA. See Primary progressive aphasia reverse transcriptase, 463 PPMS. See Primary progressive MS Thromboembolism viral encephalitis, CSF and, 466–467 PPN. See Pedunculopontine nucleus Procainamide, 581 viral meningitis, amplification of, 462 Prader-Willi syndrome, 211 Procarbazine, lomustine, and vincristine combination Polymorphonuclear leukocytes (PMNs), 36 Pramipexole, 328t, 329 Polymyalgia rheumatica, 572, 604 Praziquantel, 479 (PCV), 413 Polymyositis (PM), 523, 597 Precipitating factors, 228 PRoFESS, 262 autoantibodies and immunogenetics in, 600 epilepsy/seizure treatment, avoiding, 236 Progranulin, 311 clinical features of, 597 Prednisone, 381, 532, 606–607 Progressive aphasia, 146. See also Primary progressive clinical findings of, 599–600 Prefrontal cortex, 152 diagnosis of, 604–605, 604t Prefrontal network, 152–153 aphasia differential diagnosis for, 602–604 Pregabalin, 48, 529 Progressive autonomic failure (PAF), 334 extramuscular manifestations of, 599 Pregnancy Progressive external ophthalmoplegia (PEO), 588 immunopathologic mechanisms in, 600 epilepsy in women and, 244–245 muscle biopsy and, 605, 605f MS and, 442 causes of, 588 pathogenesis of, 600–601 Presbycusis, 203 chronic, 188, 587 prognosis of, 608 Presbyopia, 171 Progressive multifocal leukoencephalopathy (PML), specific features of, 598 Presenilins treatment for, 606–607, 709, 723 in Alzheimer’s disease, 308 347, 446 mutations in, 308 from AIDS, 474 empirical approach to, 607 Pressure palsies, hereditary neuropathy with liability clinical features/pathology of, 473–474 viral infections and, 600–601 diagnostic studies of, 474 Polyneuropathy, 532 to, 542t, 543 in HIV infection, 504–505 Polyradiculopathy, 501 Presynaptic rundown, 559 MRI for, 474 Poly-RNA binding protein (PABP2), 582 Presyncopal symptoms, 87 treatment of, 474 Polysomnography, 155 Primary afferent axons, 40, 41f Progressive myoclonus epilepsy (PME), 227t for sleep disorders, 159 Primary brain tumor, 410. See also specific primary Progressive rubella panencephalitis, 475 Pons Progressive supranuclear palsy (PSP), 303, 325 intrinsic lesions of, 32 brain tumors definition of, 335 MRI for histoplasmosis of, 622f etiology of, 410–411 falls from, 313 Pontine hemorrhage, 277 metastatic brain tumors without known, Parkinson’s disease compared to, 313 Porphyria, 373 pathology of, 335–336 Porphyric neuropathy, 545–546 418–419 Progressive/relapsing MS (PRMS), 440, 440f Porphyrin derivatives, 515 Primary cough headache, 67 Prolactin (PRL), 158, 423 Positional vertigo, 98 Primary exertional headache, 67–68 efficiency tests for, 427t Positron emission tomography (PET), 21 Primary headache, 50, 51t Prolactinoma, screening test for, 432t for brain tumor, 409 Primary hyperhidrosis, 374 Proliferating cell nuclear antigen (PCNA), 411 for dementia, 304f Primary insomnia, 160–161 Prolyse in Acute Cerebral Thromboembolism for depression, 673 Primary intraventricular hemorrhage, 278 FDG, 21 Primary lateral sclerosis (PLS), 358 (PROACT), 250 migraine and, 54f PROMM. See Proximal myotonic myopathy for PNDs, 519 definition of, 397 Pronator drift, 7 for stroke, 275 Primary nervous system vasculitis, 258, 259f Propofol, 243f, 286t Post-cardiac bypass brain injury, 611–612 Primary progressive aphasia (PPA), 312 Propranolol, 60t, 68 Postconcussive syndrome, 408 Posterior cerebral artery (PCA), 252. See also clinical presentation/diagnosis of, 146 for PTSD, 670 language in, 146–147 Proptosis, 186 P1 syndromes; P2 syndromes neuropathology for, 147 P2 syndrome, 267 pathophysiology for, 147 causes of, 187 stroke and, 267 Primary progressive MS (PPMS), 440, 440f Prosody, 146 Posterior column-medial lemniscal pathway, Primary sensation, 118–119, 118f–119f, 118t Prosopagnosia, 150 Primary sex headache, 68 Prostaglandins, 41 118 Primary stabbing headache, 67 Protein aggregation, 219 Posterior hypothalamic gray matter, 54, 54f Primary thunderclap headache, 68 Proximal femoral neuropathy, 615, 615f Posterior inferior cerebellar artery (PICA), Primidone, dosage/adverse effects of, 239t Proximal myotonic myopathy (PROMM), Primitive neuroectodermal tumors (PNET), 414 268 Primitive reflexes, assessment of, 8 572 Posterior ischemic optic neuropathy, 180 Prion disease, 507. See also Creutzfeldt-Jakob disease Proximal weakness, 108 Posterior uveitis, 178, 178f clinical features of, 512–513 PrP. See Prion protein Postictal state, 133 decontamination of, 515 Pseudoathetosis, 117 Postinfectious myelitis, 393–394 diagnosis of, 513 Pseudobulbar affect, 360 Post-LP headache, 35–36, 36t differential diagnosis of, 513 Pseudobulbar palsy, 103, 358 Post-solid organ transplant brain injury, 612 epidemiology of, 508 Pseudodementia, 318 Post-traumatic headache, 66 infectious, 511–515 Pseudotumor cerebri, 182 inherited, 511 PSP. See Progressive supranuclear palsy Psychiatric disease dementia compared to, 318 worldwide prevalence of, 2, 3t

760 Index Psychiatric disease, back pain in, 79 Radiation therapy, 419 Reverse transcriptase, 494, 496f Psychiatric disorders for Craniopharyngiomas, 430 Reverse transcriptase PCR (RT-PCR), 463 for pituitary tumors, 434 Reversible posterior leukoencephalopathy (RPLE), alcoholism leading to, 688–689 for sellar mass, 434 anatomy of, 654 side effects of, 434 259, 610 genetic considerations for, 654–657 toxicity of, 421–422 Rf. See Radiofrequency waves neuroimaging for, 657 RGS4. See Regulator of G-protein signaling 4 phenotyping challenges for, 656–657 Radicular back pain, 72 Rhabdomyolysis, 603 treatment for, 657–658, 660–661 Radiculopathies, 534 Rheumatic heart disease, ischemic stroke from, Psychogenic amnesia, 318 Psychogenic disorders, 345 diabetic truncal, 534 253 Psychogenic gait disorders, 112 EDx for, 534 Rheumatoid arthritis (RA), 84 Psychogenic seizures, 235 Radiofrequency thermal rhizotomy, 378 Rhizotomy, 378 Psychogenic vertigo, 98 Radiofrequency waves (Rf), 15 Ribavirin, 471 treatment of, 101 Radionuclide brain scanning, 138 Riboflavin, 539 Psychophysiologic insomnia, 161 Radionuclide cisternography, 315 Rickettsia rickettsii, 458, 463 Pterygium, 175 Radiosurgery, stereotaxic, 412 Rifampin, 460, 473 Ptosis, 187 Ragged red fibers, 587–588 Right-left confusion, 145 aponeurotic, 188 myoclonic epilepsy with, 588–589 Rigidity, Parkinson’s disease and, 102 blepharoptosis, 187–188 Ramsay Hunt syndrome, 380, 541 Riley-Day syndrome, 545 mechanical, 188 Rapid cycling, 677 Risperidone, 310, 331 myogenic, 188 Rapid plasma reagent (RPR), 712, 726 neurogenic, 188 Rapid-eye-movement. See REM sleep for Huntington’s disease, 341 neuromuscular causes of, 570t Rasagiline, 330 for schizophrenia, 682t, 683 PTSD. See Posttraumatic stress disorder Rathke’s cysts, 430 Rituximab, 607 PTTG. See Pituitary tumor transforming gene RBCs. See Red blood cells Rivastigmine, 309 Pull test, 321f RBD. See REM sleep behavior disorder Parkinson’s disease and, 331–332 Punding, 323 Reactivation American trypanosomiasis, 505 Rizatriptan, 56, 57t Pupillary defect, relative afferent, 172, 172f Reactive depression, 153 RLS. See Restless leg syndrome Pupillary reactions, 135 Reading, 142 RMSF. See Rocky Mountain spotted fever Pupils Rebif, 447 Rocky Mountain spotted fever (RMSF), 458 Adie’s syndrome and, 172–173 Recombinant tissue plasminogen activator (rTPA), Rods, 170 assessment of, 135 Rolemmomas. See Schwannomas blown, 533 249, 250t Romberg sign, 346 Marcus Gunn, 172 Recurrent fallers, 113 Root sensation, 120 Shy-Drager syndrome and, 173 Recurrent unilateral labyrinthine dysfunction, 98 Ropinirole, 328t, 329 tonic, 172–173 Red blood cells (RBCs), 36 Rosenbaum card, 171–172, 171f visual function, assessment of, 172–173 Red eye, 175–178 Roth’s spots, 178 Pure alexia, without agraphia, 142t, Referred pain Rotigotine, 328t, 329 Roussy-Lévy syndrome, 542–543 144–145 convergence-projection hypothesis of, 42, 42f RPLE. See Reversible posterior Pure autonomic failure (PAF), 90, 373 spinal cord and, 41–42 Reflex epilepsy, 236 leukoencephalopathy ANS dysfunction and, 373 Reflex hyperactivity, 360 RPR. See Rapid plasma reagent Pure motor hemiparesis, 257 Reflex sympathetic dystrophy (RSD), 44, 375 RRMS. See Relapsing/remitting MS Pure motor neuropathy, 546 pain from, 721, 735 RSD. See Reflex sympathetic dystrophy Pure sensory neuropathy, 546 Reflexes, assessment of, 8. See also specific reflexes rTPA. See Recombinant tissue plasminogen Pure sensory stroke, 257 Refractive state, 171 Pure tone audiometry, 204 Refractory epilepsy activator Pure word deafness, 142t, 144 antiepileptic drugs treating, 241 RT-PCR, 463 Putamen, hypertensive hemorrhage in, 277 surgical treatment of, 241–242 PVP. See Percutaneous vertebroplasty Refsum disease, 545 Saccular aneurysm, 292 Pyramidal neurons, 712, 726 Regulator of G-protein signaling 4 (RGS4), clinical manifestations of, 293–294 Pyramidal system, axons of, 104f delayed neurologic deficits of, 294–295 Pyramidal weakness, 8 655, 656t laboratory findings in, 295 Pyrazinamide, 473 Rehabilitation interventions, 114 pathophysiology of, 293 Pyridoxine, 473, 535 Relapse prevention, alcoholism treatment and, rerupture of, 294 for ethionamide neurotoxicity, 538 694 Sacral cord, 387 high-dose, 537t Relapsing/remitting MS (RRMS), 439, 440f, Sacral pain, 79 peripheral neuropathy from, 538 Sacral plexus, 546–548 toxicity of, 536t 447–448 Sacral sparing, 388 Pyrimethamine, 479 Relative afferent pupillary defect, 172, 172f Sadness, intense, 689 Relaxation rate, 16, 16t SAH. See Subarachnoid hemorrhage QSART. See Quantitative sudomotor axon reflex REM sleep, 155–158, 156f Saint Vitus’ dance, 341 test REM sleep behavior disorder (RBD), 166–167 Sarcoidosis, 383 Remeron, 665t SAS. See Subarachnoid space Quadriparesis Repetition, 142 Saturday night palsy, 614 acute, 107 Respiratory arrest, 720, 735 SCA. See Spinocerebellar ataxia subacute/chronic, 107 Respiratory patterns, in comas, 136 SCA1 weakness and, 107 Restless leg syndrome (RLS), 162–163 genetic considerations for, 348, 353 Quadriplegic fever, 398 dopamine agonists and, 331 symptoms/signs of, 348 Quantitative sensory testing, 119 Restoril, 667t SCA2 Quantitative sudomotor axon reflex test (QSART), Reticular activating system, 131 genetic considerations for, 353 Retina symptoms/signs of, 353 371 SCA3 Quetiapine, 682t, 683 cone classes in, 173 genetic considerations for, 354 Quinacrine, 515, 681 function of, 170 symptoms/signs of, 353 Quinine, 581 ganglion cells in, 170 SCA6, 354 systemic hypertension and, 179, 179f SCA7, 354 RA. See Rheumatoid arthritis Retinal detachment, 183, 183f SCA8, 354 Rabies, 469 Retinal pigmentary degeneration, 721, 736 Scapular winging, 581 Raccoon sign, 402 Retinal vein occlusion, 179, 180f Schistosomiasis, 394 Radial neuropathy, 614, 615f Retinitis pigmentosa, 185–186, 186f Schizoaffective disorder, 680 Retinopathy Schizoid personality disorder, 681 at spiral groove, 531t cancer-associated, 524 Schizophrenia, 161, 680 Radiation injury diabetic, 185 antipsychotic agents for, 682–684 Retrobulbar tumors, 186 catatonic-type, 680 acute, 421 Retrograde amnesia, 151 clinical manifestations of, 680–681 early delayed, 421 Retrovirus-associated myelopathy, 395 late delayed, 421, 422f Reverse SLR sign, 73

Index 761 Schizophrenia (Cont.): Seizures (Cont.): Septic encephalopathy clozapine for, 657, 682t, 683 myoclonic, 225 diagnosis of, 289–290 dementia compared to, 318 nonconvulsive disorder of, 316 pathogenesis of, 289 differential diagnosis of, 681 in older adults, 230 disorganized-type, 680 partial, 223, 223t Septic myopathy, 292 dopamine and, 658, 659f, 681–682 antiepileptic drugs for, 239–240 Septic shock, 127 general population’s rate of, 655 carbamazepine for, 239–240 Serax, 667t genetic considerations for, 654–657, 656t complex, 223–224, 223t Serotonergic drugs, for migraine treatment, 60t MRI for, 657 with secondary generalization, 223t, 224 Serotonin paranoid-type, 680 simple, 223, 223t phenotyping challenges for, 656–657 valproic acid for, 240 clinical aspects of, 214t residual-type, 680 postictal state after, 133 syndrome of, 675 risperidone for, 682t, 683 psychogenic, 235 Serotonin/norepinephrine reuptake inhibitors structural/functional abnormalities with, 681 syncope v., 91, 234–235, 236t treatment for, 657–658, 660–661, 682–684 tonic, 26f (SNRIs), 49 LP for, 717, 731 Serous otitis media (SOM), 202 Schizophreniform disorder, 680 treatment for, 235–242 Sertraline, 94, 448, 670 Schwannomas, 379 antiepileptic drug therapy in, 236–241 Serum anti-AChR antibodies, 717, 731 avoidance of precipitating factors in, 236 Serum enzymes, 573 causes of, 415–416 of underlying conditions, 236 Serzone, 665t MRI of, 416f unclassified, 225 Severe CNS dysfunction, 285 vestibular, 415–416, 416f Sexual dysfunction Sciatic neuropathy, 531t Selective serotonin reuptake inhibitors (SSRIs), sCJD. See Sporadic CJD 331, 665t alcohol and, 690 SCLC. See Small cell lung cancer MS and, 439 Scleritis, 177 depressive disorders and, 674–676 SSRIs and, 675 SCN. See Suprachiasmatic nuclei sexual dysfunction and, 675 sFI. See Sporadic fatal insomnia Scopolamine, 173, 736 side effects of, 675 Sharp waves, 224 side effects of, 94 Selegiline, 330 Shawl sign, 598 Scotoma, 174–175, 175f for Alzheimer’s disease, 309 Sheehan’s syndrome, 426 SDDS-PC. See Symptom-Driven Diagnostic System transdermal, 665t Shift-work disorder (SWD), 167–168 zydis, 330 treatment for, 168 for Primary Care Sella chordomas, 430 Short-lasting unilateral neuralgiform headache attacks SDE. See Subdural empyema Sellar fractures, 402 Seasonal affective disorder, 673 Sellar mass, 429. See also Pituitary tumors with cranial autonomic symptoms. See Second impact syndrome, 405–406 evaluation of, 431–433 SUNCT/SUNA Secondary brain insults, 283 features of, 431t Short-term memory, 6 headaches from, 431 Shoulder pain, 82, 85 approach to, 287 histologic evaluation of, 433 Shy-Drager syndrome, 173, 334–335 Secondary headache, 50, 51t laboratory investigation of, 432–433 case of, 713, 727 Secondary progressive MS (SPMS), 439–440, 440f, local mass effects of, 431 Sickle cell anemia, 258 meningiomas and, 430 Sideroblastic anemia, 352t 447–448 MRI for, 431–432, 432f Signal recognition particle (SRP), 603 Segmental signs, 386 ophthalmologic evaluation of, 432 Signaling pathways, 213 Seizures, 222, 716, 730 treatment of, 433–434 Silent nociceptors, 41 Simian immunodeficiency virus (SIV), 494 absence, 224 medical therapy for, 434 Simultanagnosia, 149–150, 149f atypical, 224–225 overview of, 433 treatment for, 153 radiation therapy for, 434 Simultaneous bilateral stimulation, 148 antiepileptic drugs and, 232 transsphenoidal surgery for, 433–434, 433f Single nucleotide polymorphism arrays, 655 approach to, 232 types of, 429–430 Single photon emission computed tomography atonic, 225 Semantic paraphasia, 141 (SPECT), 234 brain imaging in, 234 Sensation. See also Cortical sensation for stroke, 275 causes of, 226, 228, 229t abnormal, 116 single-fiber EMG, 31–32 localization of, 120–121 Sinuvertebral nerve, 71 age and, 228–230 anatomy of, 117–118, 117f SIRS. See Systemic inflammatory response syndrome classifications of, 222–225, 223t brainstem, 121 Situational syncope, 89 definition of, 222 cortex, 121 SIV. See Simian immunodeficiency virus differential diagnosis of, 234–235, 235t examination of, 118–120 Sjögren’s syndrome, 490 drug use/abuse causing, 230, 230t, 719, 734 nerve, 120 Skew deviation, 192 EEG during, 24–26, 26f, 233–234 positive/negative symptoms of, 116 Skull fractures episodic nature of, 228 primary, 118–119, 118f–119f, 118t CSF leakage in, 402 evaluation of, 233f quantitative sensory testing and, 119 depressed, 402 eyes and, 135 root, 120 features of, 401–402 febrile spinal cord, 120–121 SLE. See Systemic lupus erythematosus temperature, 118 Sleep. See also Circadian rhythm complex, 229 terminology for, 116–117 age’s impact on, 156 simple, 229 thalamus, 121 alcohol’s impact on, 688 FLAIR for, 234 of touch, 118 anticholinergics for, 448 focal sensory, 121, 456 trigeminal nerve’s function for, 377, 378f barbiturates for, 157 form brain tumor, 408 Sensitization, 41 bruxism, 166 generalized, 224 Sensorineural hearing loss, 203 deprivation, 167 antiepileptic drugs for, 240 Sensory ataxia, 111–112, 112t, 350t endocrine function during, 158 ethosuximide for, 240 definition of, 117 enuresis, 166 lamotrigine for, 240 Sensory deficit, falls and, 114 inadequate hygiene in, 160 tonic-clonic, 225, 236t Sensory dissociation, 120 maintenance insomnia, 159 valproic acid for, 240 Sensory examination, 8–9 melatonin secretion and, 158 head injury and, 403 Sensory gustatory losses, 197, 198t neuroanatomy of, 156–157 history in, 232 Sensory level, 386, 386t neurochemistry of, 157 in HIV infection, 505–506, 505t Sensory neuropathy nonrestorative, 160 ictal phase in, 224 critical illness causing, 715, 728 NREM, 155–158 imaging in, 12t PNDs and, 522 offset insomnia, 160 infancy and, 229 treatment for, 522 onset insomnia, 159 interictal behavior with, 243–244 SEPs. See Somatosensory evoked potentials organization of, 156 laboratory findings in, 232–233 Sepsis, 278 parasomnias of, 166–167 management issues for, 243–244 Septic cavernous sinus thrombosis, 483 physiology of, 155–158 mechanism of epileptogenesis in, 231 REM, 155–158, 156f mechanism of initiation and propagation of, respiratory function during, 158 230–231 MEG for, 234 MSI locating, 234 myelography causing, 22

762 Index Sleep (Cont.): Spinal cord Splicing, alternative, 211 stages/states of, 155–156 anatomy of, 385–386, 386t SPMS. See Secondary progressive MS behavioral correlates of, 158 ANS dysfunction with, 368t, 372 Spondylitic myelopathy, 394 physiologic correlates of, 158 lesions of, 30–31 Spondylolisthesis, 74 terrors, 166 malignant compression of, 421 Spondylolysis, back pain from, 74–75 thermoregulatory function during, 158 numbness in, 121 Spondylosis, 77 opioids administered through, 46 Spongiform degeneration, 512 Sleep apnea, 165 PNDs of, 522 Spontaneous speech, 141 central, 165 puncture of, 22 Sporadic CJD (sCJD), 507 mixed, 163f, 165 referred pain and, 41–42 Sporadic fatal insomnia (sFI), 510 obstructive, 165 segments of, 385–386, 386t Sporadic motor neuron disorders, 360t syndromes, 165–166 sensation, 120–121 Sporothrix schenkii, 487t, 488 transverse sections through, 387f Sports, concussion in, 405–406, 405t Sleep disorders, 159. See also Daytime sleepiness; Sprains, back pain and, 75 Insomnia; Narcolepsy Spinal cord disease, 385. See also Compressive Spurling’s sign, 83 myelopathy; Noncompressive myelopathy SRP. See Signal recognition particle approach to, 159 SRT. See Speech reception threshold circadian rhythm, 167–169 acute, 388–394 SSPE. See Subacute sclerosing panencephalitis evaluation for, 159t approach to, 385–388 SSRIs. See Selective serotonin reuptake inhibitors Parkinson’s disease and, 322 cervical cord and, 386 Stalk section phenomena, 431 polysomnography for, 159 devastation from, 385 Stapedectomy, 202 Sleepiness, fatigue compared to, 164. See also Daytime in HIV infection, 500–501 Staphylococcus aureus, 384, 391, 454, 459t, imaging in, 12t sleepiness level of lesion in, 386, 386t 460, 479 Sleep-wake cycle, 157–158 lumbar cord and, 387 Statins, 594 Sleepwalking, 166 neurologic function following, 398t Status epilepticus, 242 Slipping, 114 polyradiculopathy and, 501 Slowly progressive gait disorder, rehabilitation of, 397–398 complex partial, 316 sacral cord and, 387 definition of, 242 112–113 segmental signs in, 386 generalized convulsive, 242–243 SLR. See Straight leg-raising special patterns of, 387–388, 387f pharmacologic treatment of, 243f SMA. See Spinal muscular atrophy subacute, 388–394 Stem cells, 216 Small cell lung cancer (SCLC), 516 syndromes of, 388 for Huntington’s disease, 217 thoracic cord and, 386–387 for Parkinson’s disease, 217 diagnosis of, 558 treatable, 386t transplantation and, 216–217 Small-vessel stroke Spinal cord infarction, 719, 734 Stereognosis, 120 causes of, 392–393 Stereopsis, 173 clinical manifestations of, 257–258 MRI for, 642f Stereotaxic radiosurgery, 412 definition of, 256 Spinal cord ischemia, 392–393 Sterilization, 515 pathophysiology of, 256–257, 257f Spinal epidural abscess Steroid myopathy, 607 Smell, 193 antibiotics for, 391 STICH. See Surgical Trial in Intracerebral Alzheimer’s disease and, 195 back pain in, 78, 390–391 definitions of, 193 MRI of, 391f Hemorrhage disorders of, 194–195, 195f risk factors of, 391 Stiff neck, 453 treatment for, 391 Stiff-legged gait, 110–111 approach to, 195–196 Spinal epidural hematoma, 391 Stiffness, 570–572 treatment for, 196 Spinal meningitis, 485 Stiff-person syndrome, 110–111 HIV infection and, 195 Spinal muscular atrophy (SMA) influenza B infection and, 721, 736 chronic childhood, 363 affect of, 572 Parkinson’s disease and, 195 definition of, 363 PNDs and, 522 physiology of, 193–194, 194f infantile, 363 treatment for, 522 SND. See Striatonigral degeneration juvenile, 363 STN. See Subthalamic nucleus Snellen chart, 171 Spinal shock, 386, 392 Stomach, 689 SNpc. See Substantia nigra pars compacta Spinal stenosis, 76–77, 77f Strachan’s syndrome, 539 SNRIS. See Serotonin/norepinephrine reuptake imaging in, 12t Straight leg-raising (SLR), 73 Spine, 70. See also Lumbar spine back pain and, 718, 732 inhibitors anatomy of, 70–71, 71f Strains, back pain and, 75 Social phobia, 668 anterior, 70, 71f Strength testing, 7–8 back pain originating from, 72 Streptococcus, 391 treatment for, 669 Friedrich’s ataxia in, 355 Streptococcus pneumoniae, 454–456 Sodium channel disorders of muscle, 591 hyperextension of, 72 Stress disorders, 669. See also Posttraumatic stress Sodium valproate, 522 pain-sensitive structures in, 71 Solid organ transplant, 612 posterior, 70 disorder SOM. See Serous otitis media Spine interventions, 22 acute, 669 Somatization disorder, 678–679, 679t discography for, 22 clinical manifestations of, 669–670 Somatoform disorders, 678 selective nerve root and epidural injections in, etiology/pathophysiology for, 670 treatment for, 670 clinical manifestations of, 678–679 22 Striatonigral degeneration (SND), 334 diagnostic criteria for, 679t Spinocerebellar ataxia (SCA) Stroke. See also Artery-to-artery embolic stroke; treatment for, 679 Somatosensory evoked potentials (SEPs), 27 causes of, 348 Ischemic stroke Somatosensory pathways, 117f classification of, 349t–352t in anterior circulation, 263–267 Somatosensory vertigo, 97 SCA1 Somnambulism, 166 ACA and, 265 Space sickness, 97 genetic considerations for, 348, 353 anterior choroidal artery and, 265–266 Spasm, 572 symptoms/signs of, 348 common carotid artery and, 267 Spasmodic dysphonia, 339 SCA2 internal carotid artery and, 266–267 Spastic gait, 110–111 genetic considerations for, 353 MCA and, 263–265, 263f–264f Spastin, 364 symptoms/signs of, 353 atherothrombotic, warfarin for, 721, 736 Spatial agnosia, 264 SCA3 atrial fibrillation and risk of, 719, 733 Spatial orientation, 147–150 genetic considerations for, 354 basilar artery and, 268–272 SPECT. See Single photon emission computed symptoms/signs of, 353 cardioembolic, causes of, 252, 253t SCA6, 354 causes of, 253t, 262–263 tomography SCA7, 354 cerebral angiography in, 274–275 Speech SCA8, 354 from cocaine, 278 Spinothalamic tract, 117, 118 CT scans and, 273, 274f assessment of, 5 axons, 43, 43f CTA for, 273 audiometry, 205 Splanchnic pooling, 370 definition of, 246 spontaneous, 141 diagnosis of, 248 Speech reception threshold (SRT), 205 from drug use/abuse, 259 Speech synthesizers, 363 Speedball, 699 Sphincter dyssynergia, 448 Spina bifida occulta, 75 Spinal accessory nerve, examination of, 7 Spinal angiography, 23

Index 763 Stroke (Cont.): Subthalamic nucleus (STN), 323, 342 Syringomyelia focal, 127 Suck reflex, 8 Chiari malformation and, 713, 727 in HIV infection, 505 Sudden respiratory arrest, 268 classic presentation of, 395 inferior pontine, 270f Sudden unexpected death in epileptic patients definition of, 395 less common causes of, 258–259 MRI of, 396f management of, 247, 247f (SUDEP), 244 treatment for, 396 midbrain, 273f SUDEP. See Sudden unexpected death in epileptic midpontine, 271f Syrinx cavities, 395 MRI for, 273–274, 275f patients Systemic diseases, 316 in occipital lobe, 183 Sudomotor function, 371 Systemic hypertension, 179, 179f P1 syndrome and, 267 Suicide, 439 Systemic illness, myopathy in, 593–594 P2 syndrome and, 267–268 Systemic inflammatory disorders, 393 PCA and, 267 cognitive-behavioral psychotherapy for individuals Systemic inflammatory response syndrome (SIRS), PET for, 275 at risk of, 661 PICA and, 268 289 in posterior circulation, 267–272 risk factor assessment for, 672–673 Systemic lupus erythematosus (SLE), 342, 392, prevention of Sulfadiazine, 479 anticoagulation therapy for, 262 Sulfamethoxazole, 460 459, 489t antiplatelet agents in, 260–262 Sumanirole, 329 Systems neuroscience, 219 aspirin and, 260–261 Sumatriptan, 56, 57t, 58 atherosclerosis risk factors and, 260 Tabes dorsalis, 397 general principles of, 260 for cluster headache, 62 Tachyarrhythmia, 90 pure sensory, 257 cluster headache treatment with, Tachycardia,TCA-induced, 671 rehabilitation for, 251 Tacrine, 309 risk factors for, 254, 255t 709, 723 Tacrolimus, 607 sickle cell anemia and, 258 SUNCT/SUNA small-vessel for MG treatment, 566 clinical manifestations of, 257–258 clinical features of, 61t TACs. See Trigeminal autonomic cephalalgias definition of, 256 diagnosis of, 63 Taenia solium, 475, 490 pathophysiology of, 256–257, 257f secondary, 63 Takayasu’s arteritis, 258 SPECT for, 275 TN confused with, 63 Tangier disease, 545 superior pontine, 272f treatment of, 63 Tardive dyskinesia (TD), 344 syndromes, 263–272 Sundowning, 125 from temporal arteritis, 258 treatment for, 128 antipsychotic agents causing, 683 ultrasound techniques for, 275 Superior pontine stroke, 272f Tardive syndromes, 344–345 vertebral artery and, 268 Superior sagittal sinus thrombosis Tarsal tunnel syndrome, 531t CT for, 636f Tastants, 196–197 Stupor, 130, 132 MRI for, 636f–639f Taste, 196 Sty, 175 Supine hypertension, 369 Subacute combined degeneration. See Vitamin B12 Suprachiasmatic nuclei (SCN), 157 definitions of, 196 Suprascapular neuropathy, 85 disorders of, 197–198, 198t deficiency Supraventricular tachyarrhythmias, 90 Subacute sclerosing panencephalitis (SSPE), 474 Suramin, 535 approach to, 198 peripheral neuropathy and, 537–538 treatment for, 198 diagnostic studies for, 474–475 toxicity of, 536t physiology of, 196–197, 197f treatment for, 475 Surgical Trial in Intracerebral Hemorrhage Taste buds, 196, 197f Subacute spinal cord disease, 388–394 Tau, 307 Subarachnoid hemorrhage (SAH), (STICH), 279 FTD and mutations of, 311 SWD. See Shift-work disorder mutations of, 335–336 247, 285, 292 Sydenham’s chorea, 341 as NFTs, 313 causes of, 292 Symmetric ataxia, 346–347 Tauopathies, 335–336 clinical manifestations of, 293–294 Sympathetically maintained pain, 44 Taxol, 422 delayed neurologic deficits of, 294–295 Symptom-Driven Diagnostic System for Primary toxicity of, 536t grading scales for, 294t Tay-Sach’s disease, adult, 363 hydrocephalus in, 294 Care (SDDS-PC), 662 TCAs. See Tricyclic antidepressants hyponatremia in, 295 Syncope, 87 TD. See Tardive dyskinesia imaging in, 12t Tegretol, 48 laboratory findings in, 295 anxiety v., 91 Temazepam, 667t LP and, 35 approach to, 92–93, 92f Temozolomide, 412–413 pathophysiology of, 293 BP and, 369 Temperature rerupture of, 294 in bradyarrhythmia, 90 sensation, 118 survival with, 293 cardiac, 90–91 testing responses to, 8–9 treatment for, 296–297 in carotid sinus hypersensitivity, 89, 92 Temporal arteritis vasospasm in, 294–295 causes of, 88–90, 88t headache and, 52 Subarachnoid space (SAS), 33 in cerebrovascular disease, 91 pain in, 52 Subclavian steal, 268 cough, 89 stroke from, 258 Subconjunctival hemorrhage, 175–176 defecation, 89 Temporal course of illness, in neurologic history, Subcortical aphasia, 146 definition of, 87 Subcortical arteriosclerotic encephalopathy, 310 deglutition, 89 3–4 Subdural empyema (SDE), 479. See also Epidural diagnostic tests for, 92–93 Tendon jerks, 360 disopyramide for, 94 Tension-type headache (TTH) abscess form glossopharyngeal neuralgia, 90 anatomy of, 479f hyperventilation syndrome v., 91 clinical features of, 59 clinical presentation of, 480 hypoglycemia v., 91 pathophysiology of, 59 diagnosis of, 480 hysterical fainting v., 91 treatment of, 61 differential diagnosis of, 480 micturition, 89 Teratomas, 430 epidemiology of, 479 neurocardiogenic, 88–89 Terazosin, 398, 448 etiology of, 479 in OH, 89–90 Terminal restlessness, 127 headache and, 480 pathophysiology of, 87 Tethered cord syndrome, 75 MRI for, 480, 480f postural, 90 Tetrabenazine, 340, 342, 344 pathophysiology of, 479–480 presyncopal symptoms of, 87 Tetrodotoxin, 535 prognosis of, 481 seizures v., 91, 234–235, 236t TGA. See Transient global amnesia treatment of, 481 situational, 89 Thalamic hemorrhages, 277 Subependymal giant cell astrocytomas, in tachyarrhythmia, 90 Thalamus TIA from, 92 CVA at, 712, 726 411, 417 tilt table testing for, 93, 371 sensation, 121 Substance P, 41–42, 42f treatment for, 93–94 Thalidomide, 536t Substantia nigra pars compacta (SNpc), vasodepressor, 88–89 peripheral neuropathy and, 538 vasovagal, 88–89, 94 Thallium, 535 323 Synkinesis, 380 toxicity of, 536t Syntax, 141 THC. See Delta-9-tetrahydrocannabinol Syphilis, 394, 486t, 488 Thermoregulatory sweat test (TST), 371 Syphilitic meningitis, 473

764 Index Thiamine deficiency Tramadol, for pain control, 45t TST. See Thermoregulatory sweat test peripheral neuropathy and, 538 Transcranial magnetic stimulation (TMS), 675–676 TTH. See Tension-type headache Wernicke’s encephalopathy from, 316 Transdermal fentanyl, 48 TTP. See Thrombocytopenic purpura Transdermal selegiline, 665t Tuberculosis Thoracic cord, 386–387 Transfalcial herniation, 131f, 132 Thoracic outlet syndrome (TOS), 531t Transient global amnesia (TGA), 151–152 CNS, MRI for, 618f–619f meningitis and, 472, 491 arterial, 84 characteristics of, 317 Tuberins, 417 disputed, 84 Transient insomnia, 160 Tuberous sclerosis, 417 neck pain in, 84 Transient ischemic attack (TIA), 3 Tumor necrosis factor (TNF), 437 Thought. See Abstract thought Tumors. See Brain tumor; Pituitary tumors Thrombocytopenic purpura (TTP), 611 basilar artery and, 270–271 Tumor-suppressor genes, 410 Thrombolysis, intravenous, 249 definition of, 246, 259–260 Twins, Parkinson’s disease amongst, 323 Thrombophlebitis, suppurative, 482 eyes and, 183 Two-point discrimination, 120 definition of, 482 management of, 247, 247f Tympanogram, 205 diagnosis of, 483 prevention of Tympanometry, 205 treatment of, 483 Tyramine, 330, 371 Thymectomy, MG treatment with, 564–565 anticoagulation therapy for, 262 Thymidine, 470 antiplatelet agents in, 260–262 Udd distal myopathy, 582, 583t Thyroid disorders, 592 atherosclerosis risk factors and, 260 UFC. See Urinary free cortisol Thyroid-stimulating hormone (TSH), 423 general principles of, 260 Uhthoff ’s symptom, 439 efficiency tests for, 427t risk factors for, 260 Ulnar nerve entrapment at elbow (UNE), 531t Thyrotoxicosis, 362 syncope producing, 92 Ulnar nerve entrapment at wrist, 531t TIA. See Transient ischemic attack vertigo from, 271 Ulnar nerve lesions, 30–31 Tiagabine, 522 Transient monocular blindness, 178–179 Ulnar neuropathy, 614, 615f dosage/adverse effects of, 238t Transient receptor potentials (TRPs), 218 Ultrasound Tibial muscular dystrophy, 583t. See also Udd distal Transport gustatory losses, 197, 198t Transsphenoidal surgery, 433–434, 433f guidelines for use of, 12t myopathy Transtentorial herniation, 132 for stroke, 275 Tic douloureux. See Trigeminal neuralgia Transverse sinus thrombosis, 483 Uncal transtentorial herniation, 131f, 132 Tics, 343 Tranylcypromine, 665t UNE. See Ulnar nerve entrapment at elbow Traumatic needle, 35, 36f Unilateral miosis, 135 definition of, 343 Trazodone, 665t, 675 Unipolar depression disorders, 673 movement characteristics of, 338t for insomnia, 670 Unipolar disease, 658f types of, 343 Tremor, 320. See also Essential tremor University of Pennsylvania Smell Identification Test Tilt table testing, for syncope, 93, 371 kinetic, 337 Time-of-flight imaging (TOF), 19–20 spread of, 321 (UPSIT), 195 Tinel’s sign, 530 Treponema pallidum, 394, 463 Unverricht-Lundborg disease, 227t Tingling, 116 Trial of Organon in Acute Stroke Treatment (TOAST), Upper motor neuron weakness, 103, 104f Tinnitus, 203 UPSIT. See University of Pennsylvania Smell diuretic treatment for, 721, 736 251 hearing loss and, 207 Triazolam, 667t Identification Test therapy for, 207 Trichinella spiralis, 488t Urinary free cortisol (UFC), 433 TMS. See Transcranial magnetic stimulation Trichloroethylene, 537t Urinary tract infections, MS and, 448 TN. See Trigeminal neuralgia Tricyclic antidepressants (TCAs), 331, 664 Urologic disease, back pain in, 79 TNF. See Tumor necrosis factor Uveitis, 438 TOAST. See Trial of Organon in Acute Stroke for depressive disorders, 674–676 for migraine treatment, 60t anterior, 177 Treatment neuropathic pain managed with, 48 posterior, 178, 178f Todd’s paralysis, 223 for OCD, 670 Tolcapone, 331 overdose of, 675 V sign, 598 Tolerance for pain, 48t Vacor, 535 for peripheral neuropathy, 529 Vagus nerve, 7 alcohol and, 687–688, 687t tachycardia from, 671 Vagus nerve stimulation (VNS), 242, 676 marijuana and, 705 Trigeminal autonomic cephalalgias (TACs), 61. See also Valacyclovir, 470 types of, 688 Valdecoxib Tolosa-Hunt syndrome, 384 Cluster headache; Paroxysmal hemicrania; Tone, muscle, 102 SUNCT/SUNA adverse effects of, 46 Tongue paralysis, 383 clinical features of, 61t for pain control, 45t Tonic pupil, 172–173 Trigeminal nerve Valium, 667t Tonic seizures, 26f compression of, 378 Valproate, 60t Tonometry, for acute angle-closure glaucoma, disorders of, 379t Valproic acid examination of, 6 dosage/adverse effects of, 238t 720, 734 sensation function of, 377, 378f for generalized seizures, 240 Topiramate, 60t, 67, 529 Trigeminal neuralgia (TN), 439 for mania, 678 clinical manifestations of, 377 for partial seizures, 240 dosage/adverse effects of, 238t diagnosis of, 715, 728 Valsalva response, 371 Toppling falls, 114 differential diagnosis of, 378 Vancomycin, 460, 477, 481–482 TOS. See Thoracic outlet syndrome ESR elevation and, 378 Variant CJD (vCJD), 508, 512 Toscana virus, 466 laboratory evaluation of, 378 BSE causing, 512 Touch pain from, 720, 735 in Europe, 711, 725 pathophysiology of, 377–378 Varicella-zoster virus (VZV), 462 localization, 120 SUNCT/SUNA confused with, 63 meningitis and, 464 sensation of, 118 treatment of, 378–379 reactivation of, 541 Tourette syndrome (TS), 343 Trigeminal neuropathy, 379 Variegate porphyria, 545 definition of, 343 Trigeminovascular system, 50 Vascular anomalies, 280 etiology and pathophysiology of, 343 Trihexyphenidyl, 339 acquired vascular lesions, 281 treatment of, 343 Trimethaphan, 371 AVMs, 280–281 Toxic drug-induced comas, 133 Trimethoprim, 460 Vascular cell adhesion molecule-1 (VCAM-1), Toxic neuropathy, 534 Tripping, 114 from antiretroviral drugs, 540 Trismus, 379 497, 600 Trochlear nerve Vascular dementia, 299, 300t treatment for, 540 diplopia in disorders of, 189–190 clinical evaluation of, 535 examination of, 6 categories of, 310 treatment for, 538 TRPs. See Transient receptor potentials clinical presentation of, 302t types of, 536t Trypanosoma, 505 psychiatric symptoms of, 304 Toxic optic neuropathy, 181 Trypanosomiasis, 487t recurrence of, 310 Toxoplasma gondii, 475, 478, 487t, 488, 504 TS. See Tourette syndrome treatment of, 311 Toxoplasma solium, 478 TSH. See Thyroid-stimulating hormone Vascular endothelial growth factor (VEGF), Toxoplasmosis, 478, 712–713, 726 CNS, MRI of, 504, 504f 215 HIV infection and, 504, 504f Vascular lesions, acquired, 281 Tracheal intubation, 138

Index 765 Vascular malformation Vibration sense testing, 8–9, 119 WBRT. See Whole-brain radiation therapy of cord and dura, 394–395, 395f Vigabatrin, 522 Weakness. See also Muscle weakness; Paralysis imaging in, 12t Vincristine, 4, 422. See also Procarbazine, lomustine, from ALS, 360 Vascular Parkinsonism, 336 and vincristine combination of biceps, 712, 726 Vascular tone, disorders of, 88–90, 88t peripheral neuropathy and, 537 definition of, 102 Vasculitic neuropathy, 557 toxicity of, 536t distal, 107–108 Vasculitis, 278, 456 Violence, 684 distinguishing signs of origin of, 103t VIP. See Vasoactive intestinal peptide distribution of, 106f CNS, 317 Viral infections. See specific infections facial, 379 angiography for, 636f Viral meningitis. See Meningitis, viral CT/MRI for, 635f Visual acuity, 171–172, 171f MS and, 439 Visual blurring, 438 muscle weakness compared to, 569 of nerve and muscle, 523 Visual evoked potentials (VEPs), 27 frailty and, 114 systemic, 532, 557 Visual fields, 174–175, 174f generalized, 107, 107t Vasoactive intestinal peptide (VIP), 498 Visual function, assessment of, 171 glycogen storage disease and, 585–586 Vasodepressor syncope, 88–89 color vision, 173 in hemiparesis, 105 Vasogenic edema, 282 eye movements and alignment, 173 IVIg for, 717–718, 732 Vasospasm, in SAH, 294–295 pupils, 172–173 lower motor neuron, 103, 105f Vasovagal syncope, 22, 88–89, 94 refractive state, 171 masseter, 378 VCAM-1. See Vascular cell adhesion molecule-1 stereopsis, 173 from MG, 105, 560 vCJD. See Variant CJD visual acuity, 171–172, 171f monoparesis and, 107 VDRL test. See Venereal disease research laboratory visual fields, 174–175, 174f MS and, 438, 448 Visual loss, 174f from muscle pain, 604 test chronic, 184 myopathic, 103–105 Vegetative state, 130 factitious, 183 neck, 383 PNDs and, 524 in neuromuscular junction, 710, 724 persistent, 130, 139 sudden, 178–183 paraparesis and, 105–107 VEGF. See Vascular endothelial growth factor transient, 178–183 progressive, 722, 737 Vein-of-Galen malformations, 23 Visual object agnosia, 150 proximal, 108 Velcade, 538 Visual system, 170 quadriparesis and, 107 VEMP. See Vestibular-evoked myogenic potential Visual target cancellation, 148 in restricted distribution, 108 Venereal disease research laboratory test (VDRL test), Vitamin B1, 538. See also Thiamine deficiency upper motor neuron, 103, 104f Vitamin B6, 538. See also Pyridoxine Weber’s syndrome, 189 316, 490 Vitamin B12 deficiency, 316, 501 Wegener’s granulomatosis, 490t Venlafaxine, 370t, 448, 665t diagnosis of, 396 Welander distal myopathy, 582, 583t peripheral neuropathy and, 538–539 Wellbutrin, 665t features of, 675 treatment for, 396–397 Wernicke’s aphasia, 142–143, 142t, 154, 264 for pain control, 45t Vitamin D deficiency, 436, 593 Wernicke’s area, 140–142 Venous anomalies, 280 Vitamin E Wernicke’s disease Venous sinus thrombosis, 258 benefits of, 309 causes of, 290 Ventral cord syndrome, 719, 734 deficiency of pathogenesis of, 291 Ventral posterolateral nucleus (VPL), 117 pathology of, 290, 291f Ventral tegmental area (VTA), 213 ataxia with, 355 recovery from, 290 Ventrolateral preoptic hypothalamus (VLPO peripheral neuropathy and, 539 treatment of, 291 Vitreous degeneration, 182–183 Wernicke’s encephalopathy, 190, 383 hypothalamus), 156 Vitreous detachment, 182–183 from thiamine deficiency, 316 Ventromedial bulbospinal pathways, 104f VLDL. See Very low density lipoprotein Wernicke’s syndrome, 688 VEPs. See Visual evoked potentials VLPO hypothalamus. See Ventrolateral preoptic West Nile virus (WNV), 462–463 Verapamil, 62 encephalitis and, 471 Vertebral artery, 268 hypothalamus Whipple’s disease, 190, 486t Vertebral basilar insufficiency, 12t VNS. See Vagus nerve stimulation White blood cells (WBCs), in CSF, 455 Vertebral fractures, back pain and traumatic, 75 Vogt-Koyanagi-Harada syndrome, 489t, 490 White matter disorders, 12t Vertebral osteomyelitis, 78 Voltage-gated potassium channels (VGKC), Whole-brain radiation therapy (WBRT), Vertigo, 96, 439 516–517, 518f 414 acoustic neuromas causing, 712, 726 Von Hippel-Lindau syndrome, 350t GH and, 715, 729 approach to, 99–100 WNV. See West Nile virus benign paroxysmal positional, 98, 98t characteristics of, 417–418 Wolff-Parkinson-White syndrome, 90 causes of, 96 mutation of, 418 Women, epilepsy and, 244–245 central, 98, 98t–99t, 714, 728 Von Recklinghausen’s disease, 417 breast-feeding and, 245 global considerations for, 101 VOR. See Vestibulocochlear reflex contraception and, 245 hearing loss and, 203 VPL. See Ventral posterolateral nucleus pregnancy issues for, 244–245 in labyrinthine dysfunction, 97–98 VTA. See Ventral tegmental area World Federation of Neurology, 360 pathologic, 97–98 VZV. See Varicella-zoster virus Wrist drop, 614 pathologic vestibular, 100 Writing, 142 perilymphatic fistula and, 98 Waardenburg syndrome, 201 Wrong-way eyes, 135 peripheral, 99t Wakefulness physiologic, 97 Xanax, 667t physiologic postrotational, 97 caffeine promoting, 168 Xenon-CT, 275 positional, 98 disorders, 159 Xerostomia, 198 psychogenic, 98 physiology of, 155–158 X-linked spinobulbar muscular atrophy, 363 Waldenström’s macroglobulinemia, 523 treatment of, 101 Walker-Warburg syndrome, 580t Zidovudine, HIV infection and, 595 somatosensory, 97 Wallerian degeneration, 530 Zinc supplementation, 185,194 from TIA, 271 War, pain and, 43 Ziprasidone, 682t, 683, 693 treatment of, 100–101, 100t Warfarin Zolmitriptan, 56, 57t of vestibular nerve origin, 98 for atherothrombotic stroke, 721, 736 Zolpidem, 160 Very low density lipoprotein (VLDL), 355 recommendations for, 253, 254t Zomig nasal, 58 Vestibular epilepsy, 98 Warfarin-Aspirin Symptomatic Intracranial Disease Zonisamide, dosage/adverse effects of, 239t Vestibular nerve, 98 Zostavax, 541 Vestibular neuritis, 97 (WASID), 256 Zydis selegiline, 330 Vestibular nystagmus, 192 study on, 262 Vestibular schwannomas, 415–416, 416f WASID. See Warfarin-Aspirin Symptomatic Vestibular system, balance disorders and, 113 Vestibular-evoked myogenic potential (VEMP), 206 Intracranial Disease Vestibulocochlear nerve, 7 WBCs. See White blood cells Vestibulocochlear reflex (VOR), 96–97 VGKC. See Voltage-gated potassium channels