BOOK
Bradley's Neurology in Clinical Practice E-Book
Robert B. Daroff | Joseph Jankovic | John C Mazziotta | Scott L Pomeroy
(2015)
Additional Information
Book Details
Abstract
Comprehensive, easy to read, and clinically relevant, Bradley’s Neurology in Clinical Practice provides the most up-to-date information presented by a veritable "Who's Who" of clinical neuroscience. Its unique organization allows users to access content both by presenting symptom/sign and by specific disease entities—mirroring the way neurologists practice. A practical, straightforward style; templated organization; evidence-based references; and robust interactive content combine to make this an ideal, dynamic resource for both practicing neurologists and trainees.
- Authoritative, up-to-date guidance from Drs. Daroff, Jankovic, Mazziotta, and Pomeroy along with more than 150 expert contributors equips you to effectively diagnose and manage the full range of neurological disorders.
- Easy searches through an intuitive organization by both symptom and grouping of diseases mirrors the way you practice.
- The latest advances in clinical neurogenetics, brain perfusion techniques for cerebrovascular disease, the relationship between neurotrauma and neurodegenerative disease, management strategies for levodopa-related complications in movement disorders, progressive neuropsychiatric disorders arising from autoimmune encephalitis, and more keep you at the forefront of your field.
- Reorganized table of contents which includes new chapters on: Brain Death, Vegetative, and Minimally Conscious States; Deep Brain Stimulation; Sexual Dysfunction in Degenerative and Spinal Cord Disorders; Sports and Performance Concussion; Effects of Drug Abuse on the Nervous System; and Mechanisms of Neurodegenerative Disorders.
Table of Contents
Section Title | Page | Action | Price |
---|---|---|---|
9780323339162v1_WEB | 1 | ||
Front Cover | 1 | ||
Half title page | 2 | ||
Dedication | 3 | ||
Bradley’s Neurology in Clinical Practice | 4 | ||
Copyright Page | 5 | ||
Table Of Contents | 6 | ||
Foreword | 10 | ||
Preface | 11 | ||
List of Contributors | 12 | ||
Video Table of Contents | 19 | ||
I Common Neurological Problems | 24 | ||
1 Diagnosis of Neurological Disease | 24 | ||
Chapter Outline | 24 | ||
Neurological Interview | 24 | ||
Chief Complaint | 25 | ||
History of Present Illness | 25 | ||
Review of Patient-Specific Information | 26 | ||
Review of Systems | 26 | ||
History of Previous Illnesses | 26 | ||
Family History | 27 | ||
Social History | 27 | ||
Examination | 27 | ||
Neurological Examination | 27 | ||
General Physical Examination | 28 | ||
Assessment of the Cause of the Patient’s Symptoms | 28 | ||
Anatomical Localization | 28 | ||
Differential Diagnosis | 29 | ||
Laboratory Investigations | 29 | ||
Management of Neurological Disorders | 30 | ||
Experienced Neurologist’s Approach to the Diagnosis of Common Neurological Problems | 30 | ||
2 Episodic Impairment of Consciousness | 31 | ||
Chapter Outline | 31 | ||
Syncope | 31 | ||
History and Physical Examination | 31 | ||
Causes of Syncope | 33 | ||
Cardiac Arrhythmias | 33 | ||
Atrioventricular Block | 33 | ||
Sinoatrial Block | 33 | ||
Paroxysmal Tachycardia | 33 | ||
Reflex Cardiac Arrhythmias | 34 | ||
Decreased Cardiac Output | 34 | ||
Hypovolemia | 34 | ||
Hypotension | 34 | ||
Cerebrovascular Ischemia | 35 | ||
Metabolic Disorders | 35 | ||
Miscellaneous Causes of Syncope | 35 | ||
Investigations of Patients with Syncope | 36 | ||
Seizures | 36 | ||
History and Physical Examination | 36 | ||
Absence Seizures | 37 | ||
Tonic-Clonic Seizures | 37 | ||
Complex Partial Seizures | 37 | ||
Investigations of Seizures | 37 | ||
Psychogenic (Nonepileptic) Seizures | 38 | ||
Miscellaneous Causes of Altered Consciousness | 38 | ||
References | 39 | ||
References | 40 | ||
3 Falls and Drop Attacks | 41 | ||
Chapter Outline | 41 | ||
Drop Attacks with Loss of Consciousness | 41 | ||
Syncope | 41 | ||
Seizures | 42 | ||
Drop Attacks without Loss of Consciousness | 42 | ||
Transient Ischemic Attacks | 42 | ||
Vertebrobasilar Insufficiency | 42 | ||
Anterior Cerebral Artery Ischemia | 42 | ||
Third Ventricular and Posterior Fossa Abnormalities | 42 | ||
Otolith Crisis | 43 | ||
Falls | 43 | ||
Neuromuscular Disorders and Myelopathy | 43 | ||
Stroke | 43 | ||
Other Cerebral or Cerebellar Disorders | 43 | ||
Cryptogenic Falls in the Middle-Aged | 43 | ||
Aging, Neurodegeneration, and the Neural Substrate of Gait and Balance | 44 | ||
Basal Ganglia Disorders | 44 | ||
Parkinson Disease. | 44 | ||
Progressive Supranuclear Palsy and other Parkinsonian Syndromes. | 44 | ||
Aged State | 44 | ||
Summary | 46 | ||
References | 46 | ||
References | 47 | ||
4 Delirium | 49 | ||
Chapter Outline | 49 | ||
Clinical Characteristics | 49 | ||
Acute Onset with Fluctuating Course | 49 | ||
Cognitive and Related Abnormalities | 50 | ||
Attentional Deficits | 50 | ||
Confusion or Disorganized Thinking | 51 | ||
Altered Level of Consciousness | 51 | ||
Perceptual Disturbances | 51 | ||
Disturbed Sleep/Wake Cycle | 51 | ||
Altered Psychomotor Activity | 51 | ||
Disorientation and Memory Impairment | 52 | ||
Other Cognitive Deficits | 52 | ||
Behavioral and Emotional Abnormalities | 52 | ||
Pathophysiology | 52 | ||
Diagnosis | 53 | ||
Predisposing and Precipitating Factors | 53 | ||
Mental Status Examination | 54 | ||
Diagnostic Scales and Criteria | 54 | ||
Physical Examination | 55 | ||
Laboratory Tests | 55 | ||
Differential Diagnosis | 55 | ||
Common Causes of Delirium | 55 | ||
Metabolic Disturbances | 55 | ||
Drugs | 56 | ||
Infections | 56 | ||
Strokes | 56 | ||
Epilepsy | 57 | ||
Postoperative Causes | 57 | ||
Other Neurological Causes | 57 | ||
Miscellaneous Causes | 57 | ||
Special Problems in Differential Diagnosis | 57 | ||
Prevention and Management | 58 | ||
Prognosis | 59 | ||
References | 59 | ||
References | 60 | ||
5 Stupor and Coma | 62 | ||
Chapter Outline | 62 | ||
Definitions | 62 | ||
Conditions That May Mimic Coma | 62 | ||
Approach to the Patient in Coma | 63 | ||
Rapid Initial Examination and Emergency Therapy | 63 | ||
Common Presentations | 65 | ||
History | 65 | ||
General Examination | 66 | ||
Blood Pressure Evaluation | 66 | ||
Hypotension. | 66 | ||
Hypertension. | 66 | ||
Heart Rate | 66 | ||
Respiration | 66 | ||
Temperature | 66 | ||
General Appearance | 66 | ||
Head and Neck Examination | 67 | ||
Eye Examination | 67 | ||
Otoscopic Examination | 67 | ||
Oral Examination | 67 | ||
Integument Examination | 67 | ||
Examination of Lymph Nodes | 67 | ||
Cardiac Examination | 67 | ||
Abdominal Examination | 67 | ||
Miscellaneous Examinations | 67 | ||
Neurological Examination | 68 | ||
State of Consciousness | 68 | ||
Respiration | 69 | ||
Pupil Size and Reactivity | 70 | ||
Ocular Motility | 71 | ||
Abnormalities in Resting Position. | 72 | ||
Eye Deviation. | 72 | ||
Spontaneous Eye Movements. | 72 | ||
Reflex Ocular Movements. | 72 | ||
Motor System | 73 | ||
Coma and Brain Herniation | 74 | ||
Differential Diagnosis | 75 | ||
Differentiating Toxic-Metabolic Coma from Structural Coma | 75 | ||
Differentiating Psychiatric Coma and Pseudocoma from Metabolic or Structural Coma | 75 | ||
Helpful Laboratory Studies | 76 | ||
Other Useful Studies | 76 | ||
Electrocardiography | 76 | ||
Neuroradiological Imaging | 76 | ||
Electroencephalography | 76 | ||
Evoked Potentials | 77 | ||
Intracranial Pressure Monitoring | 77 | ||
Prognosis | 78 | ||
Nontraumatic Coma | 78 | ||
Traumatic Coma | 78 | ||
Persistent Vegetative State | 78 | ||
Brain Death | 78 | ||
References | 78 | ||
References | 79 | ||
6 Brain Death, Vegetative State, and Minimally Conscious States | 80 | ||
Chapter Outline | 80 | ||
Brain Death | 80 | ||
Prolonged Disorders of Consciousness | 83 | ||
Vegetative State | 83 | ||
Minimally Conscious State | 83 | ||
Imaging in Disorders of Consciousness | 84 | ||
Decision-making and bioethics | 85 | ||
References | 85 | ||
References | 86 | ||
7 Intellectual and Memory Impairments | 87 | ||
Chapter Outline | 87 | ||
Neural Basis of Cognition | 87 | ||
Cerebral Cortex | 87 | ||
Consciousness | 88 | ||
Memory | 90 | ||
Forms and Stages of Declarative Memory | 90 | ||
Formation and Retrieval of Episodic Memories | 91 | ||
Amnestic Syndrome | 91 | ||
Syndromes of Partial Memory Loss | 93 | ||
Transient Amnesia | 93 | ||
Other Types of Memory (Nondeclarative or Implicit Memory) | 93 | ||
Bedside Tests of Memory and Cognitive Function | 94 | ||
References | 95 | ||
References | 96 | ||
8 Global Developmental Delay and Regression | 98 | ||
Chapter Outline | 98 | ||
Typical and Atypical Development | 98 | ||
Child Development Concepts | 98 | ||
Global Developmental Delay | 98 | ||
Developmental History | 98 | ||
Neurological and Other Medical History | 98 | ||
Physical Examination | 99 | ||
Diagnostic Testing | 99 | ||
Genetic Testing | 100 | ||
Neuroimaging | 101 | ||
Other Tests | 101 | ||
Management | 103 | ||
Prognosis | 103 | ||
Recurrence Risk | 103 | ||
Regression | 104 | ||
References | 104 | ||
References | 105 | ||
9 Behavior and Personality Disturbances | 106 | ||
Chapter Outline | 106 | ||
Frontosubcortical Circuitry | 106 | ||
Assessing Behavior and Personality Disturbances in Patients with Cerebral Dysfunction | 108 | ||
Classification of Neurobehavioral Symptoms and Disorders | 109 | ||
Assessment of Depression | 109 | ||
Assessment of Other Behavioral and Personality Disturbances | 109 | ||
Behavior and Personality Disturbances Associated with Cerebral Dysfunction | 110 | ||
Alzheimer Disease | 110 | ||
Depression | 111 | ||
Apathy | 111 | ||
Aggression | 111 | ||
Psychosis | 111 | ||
Frontotemporal Dementia | 112 | ||
Behavioral Disruption | 112 | ||
Anosognosia | 112 | ||
Relationship to Anatomy | 113 | ||
Vascular Dementia | 113 | ||
Depression | 113 | ||
Additional Behavioral and Psychiatric Disorders | 113 | ||
Parkinson Disease | 113 | ||
Depression | 114 | ||
Psychosis | 114 | ||
Apathy | 114 | ||
Impulse Control Disorders | 114 | ||
Neuropsychiatric Effects of Deep Brain Stimulation | 114 | ||
Dementia with Lewy Bodies | 115 | ||
Psychosis | 115 | ||
Huntington Disease | 115 | ||
Depression | 115 | ||
Suicide | 120 | ||
Psychosis | 120 | ||
Obsessive-Compulsive Traits | 120 | ||
Aggression | 120 | ||
Apathy | 120 | ||
Tourette Syndrome | 120 | ||
Multiple Sclerosis | 120 | ||
Depression | 120 | ||
Anxiety | 121 | ||
Euphoria | 121 | ||
Pseudobulbar Affect | 121 | ||
Amyotrophic Lateral Sclerosis | 122 | ||
Depression | 122 | ||
Pseudobulbar Affect | 122 | ||
Personality Change | 122 | ||
Epilepsy | 123 | ||
Depression | 125 | ||
Anxiety | 125 | ||
Psychosis | 125 | ||
Aggression | 126 | ||
Stroke | 126 | ||
Depression | 126 | ||
Pseudobulbar Affect | 127 | ||
Aggression | 127 | ||
Psychosis | 127 | ||
Traumatic Brain Injury | 127 | ||
Anosognosia | 127 | ||
Depression | 127 | ||
Anxiety | 128 | ||
Apathy | 128 | ||
Personality Change | 128 | ||
References | 128 | ||
References | 129 | ||
10 Depression and Psychosis in Neurological Practice | 133 | ||
Chapter Outline | 133 | ||
Principles of Differential Diagnosis | 133 | ||
Principles of Neuropsychiatric Evaluation | 135 | ||
Cognitive-Affective-Behavioral Brain Behavior Relationships | 136 | ||
Cortical Networks | 136 | ||
Frontosubcortical Networks | 138 | ||
Cerebrocerebellar Networks | 139 | ||
Biology of Psychosis | 139 | ||
Biology of Depression | 140 | ||
Clinical Symptoms and Signs Suggesting Neurological Disease | 141 | ||
Psychiatric Manifestations of Neurological Disease | 141 | ||
Stroke and Cerebral Vascular Disease | 141 | ||
Infectious | 145 | ||
Human Immunodeficiency Virus | 145 | ||
Creutzfeldt–Jakob Disease | 145 | ||
Neurosyphilis | 146 | ||
Metabolic and Toxic | 146 | ||
Thyroid Disease | 146 | ||
Wilson Disease | 148 | ||
Vitamin B12 and Folic Acid Deficiency | 148 | ||
Porphyrias | 148 | ||
Drug Abuse | 149 | ||
Systemic Lupus Erythematosus | 149 | ||
Multiple Sclerosis | 149 | ||
Neoplastic | 151 | ||
Degenerative | 151 | ||
Alzheimer Disease and Mild Cognitive Impairment | 152 | ||
Frontotemporal Dementia | 152 | ||
Idiopathic Parkinson Disease | 153 | ||
Dementia with Lewy Bodies | 153 | ||
Huntington Disease | 153 | ||
Epilepsy | 153 | ||
Traumatic Brain Injury | 155 | ||
Depression-Related Cognitive Impairment | 156 | ||
Delirium | 156 | ||
Catatonia | 157 | ||
Treatment Modalities | 157 | ||
Electroconvulsive Therapy | 160 | ||
Vagus Nerve Stimulation | 160 | ||
Repetitive Transcranial Magnetic Stimulation | 160 | ||
Psychiatric Neurosurgery or Psychosurgery | 160 | ||
Treatment Principles | 161 | ||
References | 161 | ||
References | 162 | ||
11 Limb Apraxias and Related Disorders | 166 | ||
Chapter Outline | 166 | ||
Historical Perspective | 166 | ||
A Model for Praxis | 167 | ||
Classification of Limb Apraxias | 167 | ||
Ideomotor Apraxia, Parietal Variant | 168 | ||
Ideomotor Apraxia, Disconnection Variant | 168 | ||
Dissociation Apraxia | 168 | ||
Ideational Apraxia | 168 | ||
Conceptual Apraxia | 168 | ||
Limb-Kinetic Apraxia | 168 | ||
Callosal Apraxia | 169 | ||
Testing for Limb Apraxias | 169 | ||
Testing for Ideomotor Apraxia, Parietal and Disconnection Variants | 170 | ||
Testing for Dissociation Apraxia | 170 | ||
Testing for Ideational Apraxia | 171 | ||
Testing for Conceptual Apraxia | 171 | ||
Testing for Limb-Kinetic Apraxia | 171 | ||
Testing for Callosal Apraxia | 171 | ||
Pathophysiology of Limb Apraxias | 171 | ||
Rehabilitation for Limb Apraxias | 171 | ||
Related Disorders | 172 | ||
Summary | 172 | ||
References | 172 | ||
References | 173 | ||
12 Agnosias | 174 | ||
Chapter Outline | 174 | ||
Visual Agnosias | 174 | ||
Cortical Visual Disturbances | 174 | ||
Cortical Visual Distortions | 175 | ||
Balint Syndrome and Simultanagnosia | 175 | ||
Visual Object Agnosia | 175 | ||
Apperceptive Visual Agnosia | 175 | ||
Associative Visual Agnosia | 176 | ||
Optic Aphasia | 176 | ||
Prosopagnosia | 177 | ||
Klüver–Bucy Syndrome | 177 | ||
Auditory Agnosias | 177 | ||
Cortical Deafness | 177 | ||
Pure Word Deafness | 178 | ||
Auditory Nonverbal Agnosia | 178 | ||
Phonagnosia | 178 | ||
Amusia | 178 | ||
Tactile Agnosias | 179 | ||
Tactile Aphasia | 179 | ||
Summary | 179 | ||
Acknowledgment | 179 | ||
References | 179 | ||
References | 180 | ||
13 Aphasia and Aphasic Syndromes | 181 | ||
Chapter Outline | 181 | ||
Symptoms and Differential Diagnosis of Disordered Language | 183 | ||
Bedside Language Examination | 183 | ||
Differential Diagnosis of Aphasic Syndromes | 184 | ||
Broca Aphasia | 184 | ||
Aphemia | 185 | ||
Wernicke Aphasia | 185 | ||
Pure Word Deafness | 186 | ||
Global Aphasia | 186 | ||
Conduction Aphasia | 186 | ||
Anomic Aphasia | 187 | ||
Transcortical Aphasias | 188 | ||
Subcortical Aphasias | 189 | ||
Pure Alexia without Agraphia | 190 | ||
Alexia with Agraphia | 191 | ||
Aphasic Alexia | 191 | ||
Agraphia | 192 | ||
Language in Right Hemisphere Disorders | 192 | ||
Language in Dementing Diseases | 193 | ||
Investigation of the Aphasic Patient | 194 | ||
Clinical Tests | 194 | ||
Differential Diagnosis | 194 | ||
Recovery and Rehabilitation of Aphasia | 196 | ||
References | 197 | ||
References | 198 | ||
14 Dysarthria and Apraxia of Speech | 200 | ||
Chapter Outline | 200 | ||
Motor Speech Disorders | 200 | ||
Dysarthrias | 200 | ||
Apraxia of Speech | 201 | ||
Oral or Buccolingual Apraxia | 202 | ||
Aphemia | 202 | ||
The “Foreign Accent Syndrome” | 202 | ||
Acquired Stuttering | 202 | ||
Opercular Syndrome | 202 | ||
References | 202 | ||
References | 203 | ||
15 Neurogenic Dysphagia | 204 | ||
Chapter Outline | 204 | ||
Normal Swallowing | 204 | ||
Neurophysiology of Swallowing | 204 | ||
Mechanical Dysphagia | 205 | ||
Neuromuscular Dysphagia | 205 | ||
Oculopharyngeal Muscular Dystrophy | 206 | ||
Myotonic Dystrophy | 206 | ||
Other Muscular Dystrophies | 206 | ||
Inflammatory Myopathies | 206 | ||
Mitochondrial Disorders | 207 | ||
Myasthenia Gravis | 207 | ||
Neurogenic Dysphagia | 207 | ||
Stroke | 208 | ||
Multiple Sclerosis | 209 | ||
Parkinson Disease | 210 | ||
Other Basal Ganglia Disorders | 210 | ||
Amyotrophic Lateral Sclerosis | 211 | ||
Cranial Neuropathies | 211 | ||
Brainstem Processes | 211 | ||
Cervical Spinal Cord Injury | 211 | ||
Other Processes | 212 | ||
Evaluation of Dysphagia | 212 | ||
References | 213 | ||
References | 214 | ||
16 Visual Loss | 216 | ||
Chapter Outline | 216 | ||
Pattern of Visual Loss | 216 | ||
Central Visual Loss | 216 | ||
Peripheral Visual Loss | 216 | ||
Temporal Profile of Visual Loss | 216 | ||
Sudden-Onset Visual Loss | 216 | ||
Transient Monocular Visual Loss | 216 | ||
Amaurosis Fugax. | 216 | ||
Retinal Artery Vasospasm. | 216 | ||
Angle-Closure Glaucoma. | 216 | ||
Visual Loss in Bright Light. | 217 | ||
Uhthoff Phenomenon. | 217 | ||
Transient Visual Obscurations. | 217 | ||
Other Causes of Transient Visual Loss. | 217 | ||
Transient Binocular Visual Loss | 217 | ||
Sudden Monocular Visual Loss without Progression | 217 | ||
Sudden Binocular Visual Loss without Progression | 219 | ||
Sudden Visual Loss with Progression | 219 | ||
Progressive Visual Loss | 219 | ||
References | 220 | ||
References | 221 | ||
17 Abnormalities of the Optic Nerve and Retina | 222 | ||
Chapter Outline | 222 | ||
Optic Nerve Anatomy and Physiology | 222 | ||
The Swollen Optic Disc | 222 | ||
Unilateral Optic Disc Swelling | 222 | ||
Optic Neuritis | 224 | ||
Ischemic Optic Neuropathy | 225 | ||
Other Causes | 226 | ||
Bilateral Optic Disc Swelling | 229 | ||
Papilledema | 229 | ||
Malignant Hypertension | 231 | ||
Diabetic Papillopathy | 231 | ||
Other Causes | 231 | ||
Pseudopapilledema | 232 | ||
Optic Disc Drusen | 232 | ||
Optic Neuropathies with Normal-Appearing Optic Discs | 233 | ||
Unilateral Presentations | 233 | ||
Bilateral Presentations | 233 | ||
Optic Neuropathies with Optic Atrophy | 233 | ||
Congenital Optic Disc Anomalies | 234 | ||
Tilted Optic Disc | 234 | ||
Optic Nerve Dysplasia | 234 | ||
Retinal Disorders | 235 | ||
Retinal Arterial Disease | 235 | ||
Branch Retinal Artery Occlusions and Encephalopathy (Susac Syndrome) | 236 | ||
Ocular Ischemic Syndrome | 236 | ||
Retinal Vein Occlusion | 236 | ||
Retinal Degenerations | 236 | ||
Phakomatoses | 237 | ||
References | 237 | ||
References | 238 | ||
18 Pupillary and Eyelid Abnormalities | 239 | ||
Chapter Outline | 239 | ||
Pupillary Abnormalities | 239 | ||
Pupil Anatomy and Neural Control | 239 | ||
Normal Pupil Phenomena | 239 | ||
Afferent Pathological Conditions of the Pupils | 239 | ||
Efferent Pathological Conditions of the Pupils | 240 | ||
Clinical Presentation and Examination | 240 | ||
Anisocoria Greater in the Light | 240 | ||
Postganglionic Parasympathetic Dysfunction—Tonic Pupil. | 240 | ||
Preganglionic Parasympathetic Dysfunction—Oculomotor Palsy. | 242 | ||
Iris Sphincter Injury and Ischemia. | 243 | ||
Pharmacological Mydriasis. | 243 | ||
Anisocoria Greater in the Dark | 244 | ||
Horner Syndrome. | 244 | ||
Anterior Uveitis (Iris Inflammation). | 245 | ||
Episodic Anisocoria | 246 | ||
Pupillary Light-Near Dissociation | 246 | ||
Eyelid Abnormalities | 246 | ||
Eyelid Anatomy and Neural Control | 246 | ||
Pathological Conditions of the Eyelids | 246 | ||
Clinical Presentation and Examination | 246 | ||
Pathologically Widened Palpebral Fissures | 247 | ||
Pathologically Narrowed Palpebral Fissures | 248 | ||
Dynamic Eyelid Abnormalities | 248 | ||
References | 249 | ||
References | 250 | ||
19 Disturbances of Smell and Taste | 251 | ||
Chapter Outline | 251 | ||
Anatomy and Physiology | 251 | ||
Olfaction | 251 | ||
Gustation | 252 | ||
Chemosensory Testing | 253 | ||
Disorders of Olfaction | 254 | ||
Disorders of Taste | 255 | ||
Clinical Evaluation of Taste and Smell | 256 | ||
Treatment and Management | 256 | ||
References | 257 | ||
References | 258 | ||
20 Cranial and Facial Pain | 259 | ||
Chapter Outline | 259 | ||
History | 259 | ||
Types of Headaches | 259 | ||
Onset of Headaches | 259 | ||
Frequency and Periodicity of Episodic Headaches | 260 | ||
Temporal Profile | 260 | ||
Time of Day and Precipitating Factors | 261 | ||
Location | 261 | ||
Quality and Severity | 261 | ||
Premonitory Symptoms, Aura, and Accompanying Symptoms | 261 | ||
Aggravating and Mitigating Factors | 262 | ||
Family History of Headaches | 262 | ||
Prior Evaluation | 262 | ||
Prior Treatment | 262 | ||
Disability | 262 | ||
Patient Concerns and Reasons for Seeking Help | 262 | ||
Other Medical or Neurological Problems | 262 | ||
Examination | 262 | ||
Diagnostic Testing | 263 | ||
Neuroimaging and Other Imaging Studies | 263 | ||
Computed Tomography and Magnetic Resonance Imaging | 263 | ||
Plain Radiographs and Other Imaging of the Skull, Sinuses, and Cervical Spine | 264 | ||
Temporomandibular Joint/Dental Imaging Studies | 264 | ||
Cerebral Angiography | 264 | ||
Myelography with Computed Tomography and Radioisotope Studies for Detection of Cerebrospinal Fluid Leaks | 264 | ||
Cerebrospinal Fluid Tests | 264 | ||
Electrophysiological Testing | 264 | ||
General Medical Tests | 264 | ||
Special Examinations and Consultations | 265 | ||
Further Observation | 266 | ||
References | 266 | ||
References | 267 | ||
21 Brainstem Syndromes | 268 | ||
Chapter Outline | 268 | ||
Ocular Motor Syndromes | 268 | ||
Combined Vertical Gaze Ophthalmoplegia | 268 | ||
Upgaze Paresis (Dorsal Midbrain or Parinaud Syndrome) | 269 | ||
Downgaze Paresis | 269 | ||
Internuclear Ophthalmoplegia | 270 | ||
Horizontal Gaze Paresis | 270 | ||
Global Paralysis of Gaze | 270 | ||
One-and-a-Half Syndrome | 271 | ||
Syndromes Involving Ocular Motor Nuclei | 271 | ||
Third Cranial Nerve Nucleus | 271 | ||
Sixth Cranial Nerve Nucleus | 271 | ||
Other Brainstem and Associated Syndromes | 271 | ||
Diencephalic Syndrome (Russell Syndrome) | 271 | ||
Thalamic Syndrome | 272 | ||
Tectal Deafness | 272 | ||
Foramen Magnum Syndrome | 272 | ||
Syringobulbia | 272 | ||
Brainstem Ischemic Stroke Syndromes | 273 | ||
Thalamic Stroke Syndromes | 273 | ||
Midbrain Stroke Syndromes | 274 | ||
Pontine Stroke Syndromes | 275 | ||
Medullary Stroke Syndromes | 275 | ||
References | 279 | ||
References | 280 | ||
22 Ataxic and Cerebellar Disorders | 281 | ||
Chapter Outline | 281 | ||
Symptoms and Signs of Ataxic Disorders | 281 | ||
Symptoms in Patients with Ataxia | 281 | ||
Gait Disturbances | 281 | ||
Limb Ataxia | 281 | ||
Truncal Ataxia | 281 | ||
Dysarthria and Bulbar Symptoms | 281 | ||
Visual Symptoms | 281 | ||
Symptoms in Sensory Ataxia | 281 | ||
Neurological Signs in Patients with Cerebellar Ataxia | 281 | ||
Stance and Gait | 282 | ||
Limb Incoordination | 282 | ||
Dysmetria. | 282 | ||
Kinetic (Intention) Tremor. | 282 | ||
Action Tremor. | 282 | ||
Other Types of Tremor. | 282 | ||
Dysdiadochokinesia. | 282 | ||
Abnormalities of Muscle Tone and Strength | 282 | ||
Oculomotor Disturbances | 282 | ||
Disorders of Pursuit. | 283 | ||
Disorders of Saccades. | 283 | ||
Other Saccadic Intrusions. | 283 | ||
Nystagmus. | 283 | ||
Vestibulo-Ocular Reflex. | 283 | ||
Speech and Bulbar Function | 283 | ||
Cognitive-Affective Features | 283 | ||
Neurological Signs in Patients with Sensory Ataxia | 283 | ||
Diagnostic Approach to Ataxia | 283 | ||
References | 286 | ||
References | 287 | ||
23 Diagnosis and Assessment of Parkinson Disease and Other Movement Disorders | 288 | ||
Chapter Outline | 288 | ||
Parkinsonism | 289 | ||
Motor Abnormalities | 290 | ||
Cognitive, Autonomic, and Sensory Abnormalities | 291 | ||
Onset and Course | 292 | ||
Examination and Clinical Signs | 292 | ||
Differential Diagnosis | 293 | ||
Tremor | 295 | ||
Common Symptoms | 295 | ||
Rest Tremor | 295 | ||
Postural Tremor | 296 | ||
Other Types of Tremor | 296 | ||
Other Clues in the History | 297 | ||
Examination | 297 | ||
Dystonia | 300 | ||
Common Symptoms | 300 | ||
Examination | 302 | ||
Chorea | 302 | ||
Common Symptoms | 302 | ||
Other Clues in the History | 303 | ||
Examination | 304 | ||
Tardive Dyskinesia | 304 | ||
Ballism | 305 | ||
Tics | 305 | ||
Common Symptoms | 306 | ||
Examination | 307 | ||
Myoclonus | 307 | ||
Common Symptoms | 307 | ||
Examination | 308 | ||
Miscellaneous Movement Disorders | 309 | ||
Investigation of Movement Disorders | 310 | ||
References | 314 | ||
References | 315 | ||
24 Gait Disorders | 317 | ||
Chapter Outline | 317 | ||
Physiological and Biomechanical Aspects of Gait | 317 | ||
Anatomical Aspects of Gait | 317 | ||
History: Common Symptoms and Associations | 318 | ||
Weakness | 318 | ||
Slowness and Stiffness | 318 | ||
Imbalance | 318 | ||
Falls | 319 | ||
Sensory Symptoms and Pain | 319 | ||
Urinary Incontinence | 319 | ||
Cognitive Changes | 319 | ||
Examination of Posture and Walking | 319 | ||
Arising from Sitting | 319 | ||
Stance | 319 | ||
Trunk Posture | 320 | ||
Postural Responses | 321 | ||
Walking | 321 | ||
Initiation of Gait | 321 | ||
Stepping | 321 | ||
Turning | 321 | ||
More Challenging Tests of Walking | 321 | ||
Associated and Synergistic Limb Movements While Walking | 321 | ||
Motor and Sensory Examination | 321 | ||
Discrepancies on Examination of Gait | 322 | ||
Classification of Gait Patterns | 322 | ||
Lower Level Gait Disorders | 322 | ||
Myopathic Weakness and Gait | 322 | ||
Neurogenic Weakness and Gait | 322 | ||
Sensory Ataxia | 322 | ||
Vestibular Imbalance, Vertigo, and Gait | 322 | ||
Middle-Level Gait Disorders | 323 | ||
Spastic Gait | 323 | ||
Cerebellar Ataxia | 323 | ||
Spastic Ataxia | 323 | ||
Hypokinetic (Parkinsonian) Gait | 324 | ||
Choreic Gait | 324 | ||
Dystonic Gait | 324 | ||
Mixed Movement Disorders and Gait | 324 | ||
Tremor of the Trunk and Legs | 325 | ||
Action Myoclonus | 325 | ||
Higher Level Gait Disorders | 325 | ||
Hypokinetic Higher Level and Freezing Gait Patterns | 325 | ||
Elderly Gait Patterns, Cautious Gaits, and Fear of Falling | 327 | ||
Perceptions of Instability and Illusions of Movement | 327 | ||
Reckless Gait Patterns | 327 | ||
Hysterical and Psychogenic Gait Disorders | 327 | ||
Musculoskeletal Disorders and Antalgic Gait | 328 | ||
Skeletal Deformity and Joint Disease | 328 | ||
Painful (Antalgic) Gaits | 328 | ||
References | 328 | ||
References | 329 | ||
25 Hemiplegia and Monoplegia | 330 | ||
Chapter Outline | 330 | ||
Anatomy and Physiology | 330 | ||
Motor System Anatomy | 330 | ||
Pyramidal Tract | 330 | ||
Basal Ganglia | 330 | ||
Cerebellum | 330 | ||
Localization of Motor Deficits | 331 | ||
Hemiplegia | 331 | ||
Cerebral Lesions | 331 | ||
Cortical Lesions | 331 | ||
Infarction. | 331 | ||
Middle Cerebral Artery. | 331 | ||
Anterior Cerebral Artery. | 332 | ||
Posterior Cerebral Artery. | 332 | ||
Mass Lesion. | 332 | ||
Subcortical Lesions | 332 | ||
Infarction. | 332 | ||
Lenticulostriate Arteries. | 332 | ||
Thalamoperforate Arteries. | 332 | ||
Demyelinating Disease. | 332 | ||
Multiple Sclerosis. | 332 | ||
Acute Disseminated Encephalomyelitis. | 332 | ||
Progressive Multifocal Leukoencephalopathy. | 332 | ||
Migraine. | 333 | ||
Seizures. | 333 | ||
Tumors. | 333 | ||
Infections. | 333 | ||
Alternating Hemiplegia of Childhood. | 333 | ||
Hemiconvulsion–Hemiplegia–Epilepsy Syndrome. | 333 | ||
Brainstem Lesions | 333 | ||
Brainstem Motor Organization | 333 | ||
Common Lesions | 334 | ||
Spinal Lesions | 334 | ||
Spinal Hemisection (Brown–Séquard Syndrome) | 334 | ||
Transverse Myelitis | 334 | ||
Spinal Cord Compression | 334 | ||
Spinal Cord Infarction | 334 | ||
Peripheral Lesions | 335 | ||
Psychogenic Hemiplegia | 335 | ||
Monoplegia | 336 | ||
Cerebral Lesions | 336 | ||
Infarction | 336 | ||
Transient Ischemic Attack | 336 | ||
Migraine | 336 | ||
Seizure | 336 | ||
Multiple Sclerosis | 336 | ||
Tumors | 336 | ||
Infections | 336 | ||
Brainstem Lesions | 336 | ||
Spinal Lesions | 336 | ||
Peripheral Lesions | 336 | ||
Pressure Palsies | 336 | ||
Hereditary Neuropathy with Predisposition to Pressure Palsies. | 337 | ||
Pressure Palsies in Polyneuropathy. | 337 | ||
Mononeuropathies | 337 | ||
Median Nerve. | 337 | ||
Carpal Tunnel Syndrome. | 337 | ||
Anterior Interosseus Syndrome. | 338 | ||
Pronator Teres Syndrome. | 338 | ||
Ulnar Nerve. | 338 | ||
Radial Nerve Palsy. | 338 | ||
Femoral Neuropathy. | 338 | ||
Sciatic Neuropathy. | 338 | ||
Peroneal (Fibular) Neuropathy. | 338 | ||
Radiculopathies | 338 | ||
Plexopathies | 339 | ||
Brachial and Lumbar Plexitis (or Plexopathy). | 339 | ||
Neoplastic Plexus Infiltration. | 339 | ||
Radiation Plexopathy. | 339 | ||
Plexopathy from Hematomas. | 339 | ||
Plexus Trauma. | 339 | ||
Thoracic Outlet Syndrome. | 339 | ||
Diabetic Amyotrophy. | 340 | ||
Neuronopathies | 340 | ||
Monomelic Amyotrophy. | 340 | ||
Poliomyelitis. | 340 | ||
Multifocal Motor Neuropathy. | 340 | ||
Pitfalls in the Differential Diagnosis of Hemiplegia and Monoplegia | 340 | ||
Pitfalls in the Differential Diagnosis of Hemiplegia and Monoplegia | 341 | ||
Focal Weakness of Apparently Central Origin | 341 | ||
Focal Weakness That Appears to Be Central: Cerebral Cortex, Internal Capsule, Brainstem, or Spinal Cord? | 341 | ||
Focal Weakness That Appears to Be Central: Migraine, TIA, or Seizure? | 341 | ||
Weakness of the Hand and Wrist | 342 | ||
Weakness in Intrinsic Muscles of the Hand: Median Nerve, Ulnar Nerve, Brachial Plexus, or Small Cerebral Cortical Lesion? | 342 | ||
Weakness of the Wrist: Radial Neuropathy or Small Cerebral Cortical Infarcts? | 342 | ||
Leg Weakness | 342 | ||
Peroneal Nerve Palsy or Paramedian Cerebral Cortical Lesion? | 342 | ||
Cauda Equina Lesion, Myelopathy, or Paramedian Cerebral Cortical Lesion? | 342 | ||
References | 340 | ||
References | 343 | ||
26 Paraplegia and Spinal Cord Syndromes | 344 | ||
Chapter Outline | 344 | ||
Common Spinal Cord Syndromes | 344 | ||
Spinal Shock | 344 | ||
Incomplete Lesions of the Spinal Cord | 344 | ||
Unilateral Transverse Lesion | 344 | ||
Central Cord Syndrome | 345 | ||
Anterior Spinal Artery Syndrome | 345 | ||
Anterior Horn and Pyramidal Tract Syndromes | 345 | ||
Combined Posterior and Lateral Column Disease | 346 | ||
Characteristic Clinical Features of Lesions at Different Levels | 346 | ||
Foramen Magnum and Upper Cervical Spine | 346 | ||
Lower Cervical and Upper Thoracic Spine | 347 | ||
Thoracic Levels | 347 | ||
Conus Medullaris and Cauda Equina | 347 | ||
Pain and Autonomic Dysfunction | 348 | ||
Pain Syndromes | 348 | ||
Local Pain | 348 | ||
Projected Pain | 348 | ||
Central Neurogenic Pain | 348 | ||
Autonomic Dysreflexia | 349 | ||
Bowel and Bladder Dysfunction | 349 | ||
References | 349 | ||
References | 350 | ||
27 Proximal, Distal, and Generalized Weakness | 351 | ||
Chapter Outline | 351 | ||
Clinical Presentation by Affected Region | 351 | ||
General Considerations | 351 | ||
Ocular Muscles | 352 | ||
Facial and Bulbar Muscles | 352 | ||
Neck, Diaphragm, and Axial Muscles | 352 | ||
Proximal Upper Extremity | 352 | ||
Distal Upper Extremity | 353 | ||
Proximal Lower Extremity | 353 | ||
Distal Lower Extremity | 353 | ||
Bedside Examination of the Weak Patient | 353 | ||
Observation | 353 | ||
Muscle Bulk and Deformities | 354 | ||
Muscle Palpation, Percussion, and Range of Motion | 355 | ||
Muscle Tone | 355 | ||
Strength | 355 | ||
Fatigue | 356 | ||
Reflexes | 356 | ||
Sensory Disturbances | 356 | ||
Peripheral Nerve Enlargement | 356 | ||
Fasciculations, Cramps, and Other Abnormal Muscle Movements | 357 | ||
Functional Evaluation of the Weak Patient | 357 | ||
Walking | 357 | ||
Arising from the Floor | 357 | ||
Stepping onto a Stool | 357 | ||
Psychogenic Weakness | 358 | ||
Clinical Investigations in Muscular Weakness | 358 | ||
Serum Creatine Kinase | 358 | ||
Electromyography | 358 | ||
Muscle Biopsy | 359 | ||
Genetic Testing | 359 | ||
Exercise Testing | 359 | ||
Differential Diagnosis by Affected Region and Other Manifestations of Weakness | 360 | ||
Disorders with Prominent Ocular Weakness | 360 | ||
Disorders with Distinctive Facial or Bulbar Weakness | 361 | ||
Disorders with Prominent Respiratory Weakness | 362 | ||
Disorders with Distinctive Shoulder-Girdle or Arm Weakness | 362 | ||
Disorders with Prominent Hip-Girdle or Leg Weakness | 362 | ||
Disorders with Fluctuating Weakness | 363 | ||
Disorders Exacerbated by Exercise | 364 | ||
Disorders with Constant Weakness | 364 | ||
Acquired Disorders Causing Weakness | 365 | ||
Lifelong Disorders | 366 | ||
Lifelong Nonprogressive Disorders | 366 | ||
Lifelong Disorders Characterized by Progressive Weakness | 366 | ||
Other Conditions | 367 | ||
References | 367 | ||
References | 368 | ||
28 Muscle Pain and Cramps | 369 | ||
Chapter Outline | 369 | ||
General Features of Pain | 369 | ||
Muscle Pain: Basic Concepts | 369 | ||
Nociceptor Terminal Stimulation and Sensitization | 369 | ||
Nociceptive Axons | 370 | ||
Clinical Features of Muscle Pain | 372 | ||
General Features of Muscle Pain | 372 | ||
Evaluation of Muscle Discomfort | 372 | ||
Muscle Discomfort: Specific Causes | 373 | ||
Myopathies with Muscle Pain | 373 | ||
Muscle Cramps | 376 | ||
Other Involuntary Muscle Contraction Syndromes | 376 | ||
Myalgia Syndromes without Chronic Myopathy | 376 | ||
References | 377 | ||
References | 378 | ||
29 Hypotonic (Floppy) Infant | 379 | ||
Chapter Outline | 379 | ||
Approach to Diagnosis | 379 | ||
History | 379 | ||
Physical Examination | 379 | ||
General Features of Hypotonia | 379 | ||
Localization | 380 | ||
Diagnostic Studies | 381 | ||
Neuroimaging | 381 | ||
Electroencephalography | 381 | ||
Creatine Kinase | 381 | ||
Metabolic Studies | 382 | ||
Nerve Conduction Studies and Electromyography | 382 | ||
Muscle Biopsy | 382 | ||
Nerve Biopsy | 382 | ||
Genetic Testing | 382 | ||
Serology | 382 | ||
Specific Disorders Associated with Hypotonia in Infancy | 383 | ||
Cerebral Disorders | 383 | ||
Chromosomal Disorders | 383 | ||
Chronic Nonprogressive Encephalopathy | 383 | ||
Chronic Progressive Encephalopathy | 383 | ||
Benign Congenital Hypotonia | 383 | ||
Combined Cerebral and Motor Unit Disorders | 383 | ||
Acid Maltase Deficiency | 384 | ||
Congenital Myotonic Dystrophy | 384 | ||
Infantile Facioscapulohumeral Dystrophy | 384 | ||
Syndromic Congenital Muscular Dystrophies | 384 | ||
Congenital Disorders of Glycosylation | 384 | ||
Lysosomal Disorders | 384 | ||
Infantile Neuroaxonal Dystrophy | 384 | ||
Spinal Cord Disorders | 384 | ||
Acquired Spinal Cord Lesions | 384 | ||
Spinal Muscular Atrophy | 385 | ||
Infantile Spinal Muscular Atrophy with Respiratory Distress Type 1 | 385 | ||
X-linked Spinal Muscular Atrophy | 385 | ||
Peripheral Nerve Disorders | 385 | ||
Neuromuscular Junction Disorders | 386 | ||
Juvenile Myasthenia Gravis | 386 | ||
Neonatal Myasthenia | 386 | ||
Congenital Myasthenic Syndromes | 386 | ||
Infant Botulism | 386 | ||
Muscle Disorders | 386 | ||
Congenital Myopathies | 387 | ||
Centronuclear Myopathy. | 387 | ||
Nemaline Myopathy. | 387 | ||
Central Core Disease. | 387 | ||
Nonsyndromic Congenital Muscular Dystrophies | 387 | ||
Merosin-Deficient Congenital Muscular Dystrophy. | 387 | ||
Ullrich Congenital Muscular Dystrophy. | 387 | ||
Summary | 387 | ||
References | 387 | ||
References | 388 | ||
30 Sensory Abnormalities of the Limbs, Trunk, and Face | 390 | ||
Chapter Outline | 390 | ||
Anatomy and Physiology | 390 | ||
Peripheral Pathways | 390 | ||
Spinal Cord Pathways | 390 | ||
Brain Pathways | 390 | ||
Brainstem | 390 | ||
Thalamus | 390 | ||
Cerebral Cortex | 390 | ||
Sensory Input Processing | 390 | ||
Approach to Localization and Diagnosis | 392 | ||
Sensory Abnormalities | 392 | ||
Localization of Sensory Abnormalities | 392 | ||
Peripheral Sensory Lesions | 393 | ||
Spinal Sensory Lesions | 394 | ||
Sensory Level. | 394 | ||
Dissociated Sensory Loss. | 395 | ||
Suspended Sensory Loss. | 395 | ||
Sacral Sparing. | 395 | ||
Brainstem Sensory Lesions | 395 | ||
Cerebral Sensory Lesions | 396 | ||
Thalamic Lesions. | 396 | ||
Cortical Lesions. | 396 | ||
Common Sensory Syndromes | 396 | ||
Peripheral Syndromes | 396 | ||
Sensory Polyneuropathy | 396 | ||
Diabetic Neuropathies | 397 | ||
Small Fiber Neuropathy | 397 | ||
Acquired Immunodeficiency Syndrome-Associated Neuropathies | 397 | ||
Toxic Neuropathies | 397 | ||
Amyloid Neuropathy | 397 | ||
Proximal Sensory Loss | 397 | ||
Temperature-Dependent Sensory Loss | 397 | ||
Acute Inflammatory Demyelinating Polyradiculoneuropathy | 397 | ||
Mononeuropathy | 398 | ||
Carpal Tunnel Syndrome. | 398 | ||
Ulnar Neuropathy. | 398 | ||
Radial Neuropathy. | 398 | ||
Radiculopathy | 398 | ||
Spinal Syndromes | 398 | ||
Myelopathy | 398 | ||
Syringomyelia | 399 | ||
Spinal Hemisection | 399 | ||
Tabes Dorsalis and Related Disorders | 399 | ||
Brain Syndromes | 399 | ||
Thalamic Infarction and Hemorrhage | 399 | ||
Thalamic Pain Syndrome (Central Post-Stroke Pain) | 399 | ||
Trigeminal Neuralgia | 399 | ||
Mental Neuropathy (Numb Chin Syndrome) | 399 | ||
Cortical Infarction | 399 | ||
Deficits of Higher Sensory Perception | 399 | ||
Functional (or Psychogenic) Sensory Loss | 400 | ||
Pitfalls | 400 | ||
Pitfalls | 401 | ||
Acute Inflammatory Demyelinating Polyneuropathy in a Patient with Known Peripheral Neuropathy | 401 | ||
Myelopathy vs Midline Cerebral Lesion | 401 | ||
References | 400 | ||
References | 402 | ||
31 Arm and Neck Pain | 403 | ||
Chapter Outline | 403 | ||
Clinical Assessment | 403 | ||
History | 403 | ||
Neurological Causes of Pain: Sites That Can Trigger Pain | 403 | ||
Muscle Spasm. | 403 | ||
Central Pain. | 403 | ||
Nerve Root Pain. | 403 | ||
Ulnar Nerve Pain. | 403 | ||
Median Nerve Pain. | 403 | ||
Plexus Pain. | 403 | ||
Non-Neurological Causes of Neck Pain and Brachialgia | 404 | ||
Examination | 405 | ||
Motor Signs—Atrophy and Weakness | 405 | ||
Sensory Signs | 405 | ||
Tendon Reflexes | 406 | ||
Pathology and Clinical Syndromes | 406 | ||
Spinal Cord Syndromes | 406 | ||
Intramedullary Lesions | 406 | ||
Extramedullary Lesions | 406 | ||
Other Cord Compression Syndromes | 406 | ||
Radiculitis | 407 | ||
Brachial Plexopathy | 407 | ||
Brachial Neuritis (Neuralgic Amyotrophy, Parsonage-Turner Syndrome) | 407 | ||
Brachial Plexopathy in Cancer Patients | 407 | ||
Thoracic Outlet Syndrome | 407 | ||
Suprascapular Nerve Entrapment | 407 | ||
Carpal Tunnel Syndrome | 407 | ||
Ulnar Entrapment at the Elbow | 408 | ||
Radial Nerve–Posterior Interosseus Nerve Syndrome | 408 | ||
Complex Regional Pain Syndrome | 408 | ||
“In-Between” Neurogenic and Non-Neurogenic Pain Syndrome—Whiplash Injury | 409 | ||
Rheumatoid Arthritis of the Spine | 409 | ||
Non-Neurological Neck/Arm Pain Syndromes | 409 | ||
Fibromyalgia and Myofascial Syndrome | 410 | ||
Polymyalgia Rheumatica | 410 | ||
Tendonitis, Bursitis, and Arthritis | 410 | ||
Shoulder. | 410 | ||
Elbow | 410 | ||
Epicondylitis. | 410 | ||
Olecranon Bursitis. | 410 | ||
Wrist | 410 | ||
Tendonitis. | 410 | ||
Hands. | 410 | ||
References | 410 | ||
Further Reading | 411 | ||
32 Lower Back and Lower Limb Pain | 412 | ||
Chapter Outline | 412 | ||
Anatomy and Physiology | 412 | ||
Approach to Diagnosis of Low Back and Leg Pain | 412 | ||
History and Examination | 412 | ||
Differential Diagnosis of Lower Back and Leg Pain | 414 | ||
Evaluation | 414 | ||
Magnetic Resonance Imaging | 415 | ||
Myelography and Postmyelographic Computed Tomography | 415 | ||
Nerve Conduction Studies and Electromyography | 415 | ||
Radiography | 417 | ||
Bone Scan | 417 | ||
Clinical Syndromes | 417 | ||
Lower Back and Leg Pain | 417 | ||
Lumbar Spine Stenosis | 417 | ||
Cauda Equina Syndrome and Conus Medullaris Syndrome | 417 | ||
Lumbosacral Radiculopathy | 417 | ||
Arachnoiditis | 418 | ||
Plexopathy | 418 | ||
Neoplastic Lumbosacral Plexopathy. | 418 | ||
Plexus Injury from Retroperitoneal Abscess. | 418 | ||
Plexus Injury from Retroperitoneal Hematoma. | 418 | ||
Leg Pain without Lower Back Pain | 418 | ||
Peripheral Nerve Syndromes | 418 | ||
Femoral Neuropathy. | 419 | ||
Meralgia Paresthetica. | 419 | ||
Sciatic Neuropathy. | 419 | ||
Piriformis Syndrome. | 419 | ||
Peroneal (Fibular) Neuropathy. | 419 | ||
Polyneuropathy. | 419 | ||
Plexopathy | 420 | ||
Lumbosacral Plexitis. | 420 | ||
Diabetic Amyotrophy. | 420 | ||
Herpes Zoster | 420 | ||
Claudication of Leg Arteries | 420 | ||
Lower Back Pain without Leg Pain | 420 | ||
Mechanical Lower Back Pain | 420 | ||
Sacroiliac Joint Inflammation (Sacroilitis) | 420 | ||
Facet Joint Pain Syndrome | 420 | ||
Lumbar Spine Osteomyelitis | 421 | ||
Lumbar Spine Compression | 421 | ||
Lumbar Diskitis | 421 | ||
Spinal epidural abscess | 421 | ||
Pitfalls | 421 | ||
Pitfalls | 422 | ||
Low Back Pain: Disc, Tumor, Diskitis, or Epidural Abscess | 422 | ||
Lower Back Pain from Intra-abdominal and Pelvic Causes | 422 | ||
Lower Back and Leg Pain from Arterial Insufficiency | 422 | ||
References | 421 | ||
References | 423 | ||
II Neurological Investigations and Related Clinical Neurosciences | 425 | ||
A General Principles | 425 | ||
33 Laboratory Investigations in Diagnosis and Management of Neurological Disease | 425 | ||
Chapter Outline | 425 | ||
Diagnostic Yield of Laboratory Tests | 426 | ||
Interpretation of Results of Laboratory Investigations | 426 | ||
Risk and Cost of Investigations | 427 | ||
Risk-to-Benefit Analysis | 427 | ||
Lumbar Puncture | 427 | ||
Cerebral Arteriography | 427 | ||
Brain Biopsy | 427 | ||
Cost-to-Benefit Analysis | 428 | ||
Prioritization of Tests | 428 | ||
Reliability of Laboratory Investigations | 429 | ||
Decision Analysis | 429 | ||
Research Investigations and Teaching Hospitals | 429 | ||
Patient Confidentiality | 429 | ||
Role of Laboratory Investigations in Neurological Disease Management | 429 | ||
B Clinical Neurophysiology | 430 | ||
34 Electroencephalography and Evoked Potentials | 430 | ||
Chapter Outline | 430 | ||
Electroencephalography | 430 | ||
Physiological Principles of Electroencephalography | 430 | ||
Normal Electroencephalographic Activities | 432 | ||
Common Types of Electroencephalographic Abnormalities | 433 | ||
Focal Polymorphic Slow Activity | 433 | ||
Generalized Polymorphic Slow Activity | 433 | ||
Intermittent Monomorphic Slow Activity | 433 | ||
Voltage Attenuation | 433 | ||
Epileptiform Discharges | 433 | ||
Recording Techniques | 433 | ||
Clinical Uses of Electroencephalography | 434 | ||
Epilepsy | 435 | ||
Focal Cerebral Lesions | 438 | ||
Altered States of Consciousness | 439 | ||
Metabolic Encephalopathies | 440 | ||
Hypoxia | 440 | ||
Infectious Diseases | 440 | ||
Brain Death | 442 | ||
Aging and Dementia | 442 | ||
Continuous EEG Monitoring in the Intensive Care Unit | 442 | ||
cEEG Monitoring for Nonconvulsive Seizures | 443 | ||
Electrographic Identification of Nonconvulsive Seizures | 444 | ||
The “Ictal-Interictal Continuum” | 444 | ||
Periodic Discharges | 445 | ||
Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges | 445 | ||
Quantitative EEG | 445 | ||
Magnetoencephalography | 448 | ||
Magnetoencephalography | 449 | ||
Evoked Potentials | 448 | ||
Evoked Potentials | 449 | ||
Visual Evoked Potentials | 449 | ||
Normal Visual Evoked Potentials | 449 | ||
Visual Evoked Potentials in Neurological Disease | 450 | ||
Brainstem Auditory Evoked Potentials | 451 | ||
Normal Brainstem Auditory Evoked Potentials | 451 | ||
Brainstem Auditory Evoked Potentials in Neurological Disease | 451 | ||
Somatosensory Evoked Potentials | 452 | ||
Median Nerve Somatosensory Evoked Potentials | 453 | ||
Posterior Tibial Nerve Somatosensory Evoked Potentials | 454 | ||
Somatosensory Evoked Potentials in Neurological Disease | 455 | ||
Motor Evoked Potentials and Magnetic Coil Stimulation | 455 | ||
Intraoperative Monitoring | 448 | ||
Intraoperative Monitoring | 457 | ||
References | 448 | ||
References | 460 | ||
35 Clinical Electromyography | 461 | ||
Chapter Outline | 461 | ||
Nerve Conduction Studies | 461 | ||
Principles | 461 | ||
Stimulators | 461 | ||
Recording Electrodes | 462 | ||
Recording Procedure | 462 | ||
Motor Nerve Conduction Studies | 462 | ||
Sensory Nerve Conduction Studies | 463 | ||
Mixed Nerve Conduction Studies | 464 | ||
Segmental Stimulation in Short Increments | 464 | ||
Physiological Variability and Common Sources of Error | 464 | ||
Temperature | 465 | ||
Age | 465 | ||
Height and Nerve Segment Lengths | 465 | ||
Anomalies | 465 | ||
Martin–Gruber Anastomosis. | 465 | ||
Accessory Deep Peroneal Nerve. | 466 | ||
Pre- and Post-Fixed Brachial Plexus. | 466 | ||
Riche–Cannieu Anastomosis. | 466 | ||
Temporal Dispersion and Phase Cancellation | 466 | ||
Intertrial Variability | 466 | ||
Electrodiagnosis by Nerve Conduction Studies | 466 | ||
Focal Nerve Lesions | 466 | ||
Demyelinative Mononeuropathy. | 468 | ||
Axon-Loss Mononeuropathy. | 469 | ||
Preganglionic (Intraspinal Canal) Lesions. | 469 | ||
Generalized Polyneuropathies | 470 | ||
Axonal Polyneuropathies. | 470 | ||
Demyelinating Polyneuropathies. | 470 | ||
Needle Electromyographic Examination | 471 | ||
Principles and Techniques | 471 | ||
Insertional and Spontaneous Activity | 471 | ||
Normal Insertional and Spontaneous Activity | 471 | ||
End-Plate Noise (see Video 35.1, available at http://www.experconsult.com). | 471 | ||
End-Plate Spikes (see Video 35.2, available at http://www.experconsult.com). | 471 | ||
Abnormal Insertional and Spontaneous Activity | 471 | ||
Prolonged Versus Decreased Insertional Activity. | 471 | ||
Fibrillation Potentials (see Video 35.3, available at http://www.experconsult.com). | 472 | ||
Fasciculation Potentials (see Video 35.4, available at http://www.experconsult.com). | 474 | ||
Myotonic Discharges (see Video 35.5, available at http://www.experconsult.com). | 474 | ||
Myokymic Discharges (see Video 35.6, available at http://www.experconsult.com). | 474 | ||
Complex Repetitive Discharges (see Video 35.7, available at http://www.experconsult.com). | 474 | ||
Neuromyotonic Discharges (see Video 35.8, available at http://www.experconsult.com). | 474 | ||
Cramp Discharges (see Video 35.9, available at http://www.experconsult.com). | 475 | ||
Voluntary Motor Unit Action Potentials | 475 | ||
MUAP Morphology (see Videos 35.10, 35.11, 35.12, 35.13, available at http://www.experconsult.com) | 475 | ||
Amplitude. | 475 | ||
Duration. | 475 | ||
Phases. | 475 | ||
MUAP Stability (see Video 35.14, available at http://www.experconsult.com) | 476 | ||
MUAP Firing Patterns (see Videos 35.10, 35.13, 35.15, 35.16, available at http://www.experconsult.com) | 476 | ||
Electrodiagnosis by Needle Electromyography | 476 | ||
Lower Motor Neuron Disorders | 476 | ||
Radiculopathies. | 477 | ||
Plexopathies. | 477 | ||
Mononeuropathies. | 477 | ||
Peripheral Polyneuropathies. | 478 | ||
Anterior Horn Cell Disorders. | 478 | ||
Upper Motor Neuron Lesions | 479 | ||
Myopathic Disorders | 479 | ||
Specialized Electrodiagnostic Studies | 480 | ||
F Wave | 480 | ||
A Wave | 480 | ||
H Reflex | 480 | ||
Blink Reflex | 481 | ||
Repetitive Nerve Stimulation | 481 | ||
Principles | 481 | ||
Slow Repetitive Nerve Stimulation | 482 | ||
Rapid Repetitive Nerve Stimulation | 483 | ||
Single-Fiber Electromyography | 483 | ||
Fiber Density | 484 | ||
Jitter | 484 | ||
References | 485 | ||
References | 486 | ||
36 Neuromodulation and Transcranial Magnetic Stimulation | 487 | ||
Chapter Outline | 487 | ||
Methods and Their Neurophysiological Background | 487 | ||
Stimulation Parameters for Diagnostic Use of TMS | 487 | ||
Central Motor Conduction Measurements | 487 | ||
Motor Excitability Measurements | 488 | ||
Motor Thresholds | 488 | ||
MEP Recruitment Curve (Stimulus Response Curve; Input–Output Curve) | 488 | ||
Silent Period and Long-Interval Intracortical Inhibition (LICI) | 488 | ||
Short-Interval Intracortical Inhibition (SICI) and Intracortical Facilitation (ICF) | 489 | ||
Short-Interval Intracortical Facilitation (SICF) | 489 | ||
Short-Latency and Long-Latency Afferent Inhibition (SAI and LAI) | 489 | ||
Surround Inhibition (SI) | 489 | ||
Other Inhibitory Phenomena of the Motor Cortex | 489 | ||
Motor Cortical Plasticity Measurements—Paired Associative Stimulation | 490 | ||
Clinical Applications for Diagnostic Use of TMS | 490 | ||
Movement Disorders | 490 | ||
Parkinson Disease and Parkinson Plus Syndromes | 490 | ||
Dystonia | 491 | ||
Huntington Disease | 492 | ||
Other Neurodegenerative Disorders | 492 | ||
Dementia and Mild Cognitive Impairment | 492 | ||
Amyotrophic Lateral Sclerosis | 492 | ||
Cerebellar Disorders | 492 | ||
Epilepsy and Antiepileptic Drugs | 492 | ||
Stroke | 492 | ||
Multiple Sclerosis (MS) | 493 | ||
Migraine | 493 | ||
Cervical Myelopathy and Other Spinal Cord Lesions | 493 | ||
Therapeutic Applications | 493 | ||
Rationale for rTMS | 493 | ||
Basic Principles of rTMS | 493 | ||
Current Concepts of Therapeutic Application of rTMS | 494 | ||
Depression | 494 | ||
Auditory Hallucinations and Negative Symptoms in Schizophrenia | 494 | ||
Parkinson Disease | 494 | ||
Dystonia | 495 | ||
Pain and Migraine | 495 | ||
Tinnitus | 495 | ||
Stroke with Motor Deficits, Aphasia, and Hemispatial Neglect | 495 | ||
Amyotrophic Lateral Sclerosis | 495 | ||
Epilepsy | 496 | ||
Conclusion and Outlook | 496 | ||
References | 496 | ||
References | 497 | ||
37 Deep Brain Stimulation | 500 | ||
Chapter Outline | 500 | ||
Parkinson Disease | 501 | ||
Clinical Evidence: Randomized Controlled Trials | 501 | ||
Dystonia | 503 | ||
Tremor | 503 | ||
Neuropsychiatric Disorders | 503 | ||
Tourette Syndrome | 503 | ||
Depression | 504 | ||
Obsessive-Compulsive Disorder | 504 | ||
Drug Addiction | 504 | ||
Pain | 505 | ||
Epilepsy | 505 | ||
Closed Loop Stimulation—The Epilepsy Experience | 505 | ||
Conclusions and the Future of DBS | 505 | ||
References | 505 | ||
References | 506 | ||
38 Intraoperative Monitoring | 509 | ||
Chapter Outline | 509 | ||
Introduction | 509 | ||
Techniques | 509 | ||
Spinal Cord Monitoring Techniques | 509 | ||
Interpretation | 511 | ||
Monitoring | 511 | ||
Testing | 511 | ||
Response to Change | 511 | ||
Prediction of Deficits | 511 | ||
Anesthesia | 512 | ||
Clinical Settings | 512 | ||
References | 512 | ||
References | 513 | ||
C Neuroimaging | 514 | ||
39 Structural Imaging using Magnetic Resonance Imaging and Computed Tomography | 514 | ||
Chapter Outline | 514 | ||
Computed Tomography | 514 | ||
Magnetic Resonance Imaging | 515 | ||
Basic Principles | 515 | ||
T1 and T2 Relaxation Times | 516 | ||
Repetition Time and Time to Echo | 517 | ||
Tissue Contrast (T1, T2, and Proton Density Weighting) | 518 | ||
Magnetic Resonance Image Reconstruction | 519 | ||
Spin Echo and Fast (Turbo) Spin Echo Techniques | 521 | ||
Gradient-Recalled Echo Sequences, Partial Flip Angle | 521 | ||
Inversion Recovery Sequences (FLAIR, STIR) | 522 | ||
Fat Saturation | 522 | ||
Echoplanar Imaging | 522 | ||
Diffusion-Weighted Magnetic Resonance Imaging | 523 | ||
Perfusion-Weighted Magnetic Resonance Imaging | 523 | ||
Susceptibility-Weighted Imaging | 523 | ||
Diffusion Tensor Imaging | 524 | ||
Magnetization Transfer Contrast Imaging | 524 | ||
Structural Neuroimaging in the Clinical Practice of Neurology | 520 | ||
Brain Diseases | 520 | ||
Brain Tumors | 520 | ||
Intra-axial Primary Brain Tumors | 520 | ||
Ganglioglioma and Gangliocytoma. | 520 | ||
Pilocytic Astrocytomas. | 527 | ||
Pleomorphic Xanthoastrocytoma. | 528 | ||
Low-Grade Astrocytomas. | 527 | ||
Anaplastic Astrocytoma. | 529 | ||
Oligodendroglioma. | 530 | ||
Oligoastrocytoma. | 531 | ||
Gliomatosis Cerebri. | 532 | ||
Glioblastoma Multiforme. | 532 | ||
Ependymoma. | 533 | ||
Lymphoma. | 533 | ||
Hemangioblastoma. | 534 | ||
Extra-axial Primary Brain Tumors | 533 | ||
Meningiomas. | 533 | ||
Schwannoma. | 536 | ||
Primitive Neuroectodermal Tumor. | 535 | ||
Medulloblastoma. | 535 | ||
Esthesioneuroblastoma. | 536 | ||
Pineoblastoma. | 535 | ||
Other Pineal Region Tumors. | 537 | ||
Pineocytoma. | 537 | ||
Germ Cell Tumors (Germinoma). | 538 | ||
Central Neurocytoma. | 539 | ||
Subependymal Giant Cell Astrocytoma. | 538 | ||
Choroid Plexus Papilloma. | 538 | ||
Subependymoma. | 539 | ||
Tumors in the Sellar and Parasellar Region | 538 | ||
Pituitary Adenomas. | 538 | ||
Craniopharyngioma. | 540 | ||
Metastatic Tumors | 542 | ||
Advanced Structural Neuroimaging for Planning of Brain Tumor Surgery. | 543 | ||
Ischemic Stroke | 542 | ||
Acute Ischemic Stroke. | 542 | ||
Temporal Evolution of Ischemic Stroke on Magnetic Resonance Imaging | 544 | ||
Acute Stroke. | 544 | ||
Subacute Ischemic Stroke (1 Day to 1 Week after Onset). | 547 | ||
Late Subacute Ischemic Stroke (1 to 3 Weeks after Onset). | 548 | ||
Chronic Ischemic Stroke (3 Weeks and Older). | 548 | ||
Stroke Etiology | 548 | ||
Watershed Ischemic Stroke. | 549 | ||
Ischemic Stroke of Thromboembolic Origin. | 549 | ||
Lacunar Ischemic Stroke. | 550 | ||
Other Cerebrovascular Occlusive Disease | 548 | ||
Microvascular Ischemic White Matter Lesions, “White Matter Disease,” Binswanger Disease. | 548 | ||
CADASIL. | 553 | ||
Hippocampal Sclerosis. | 552 | ||
Venous Stroke. | 554 | ||
Cerebral Venous Sinus Thrombosis. | 552 | ||
Hemorrhagic Cerebrovascular Disease | 557 | ||
Hyperacute Hemorrhage (0 to 24 Hours). | 558 | ||
Acute Hemorrhage (1 to 3 Days). | 558 | ||
Early Subacute Hemorrhage (3 Days to 1 Week). | 558 | ||
Late Subacute Hemorrhage (1 to 4 Weeks). | 558 | ||
Chronic Hemorrhage (>4 Weeks). | 558 | ||
Superficial Siderosis | 559 | ||
Cerebral Amyloid Angiopathy | 559 | ||
Infection | 558 | ||
Bacterial Meningitis. | 559 | ||
Cerebritis, Abscess. | 559 | ||
CNS Tuberculosis. | 560 | ||
Lyme Disease. | 560 | ||
Cysticercosis. | 560 | ||
Herpes Simplex Encephalitis. | 561 | ||
Human Immunodeficiency Virus Encephalitis. | 562 | ||
Cerebral Toxoplasmosis. | 563 | ||
Progressive Multifocal Leukoencephalopathy. | 563 | ||
Cytomegalovirus. | 563 | ||
Creutzfeldt-Jakob Disease. | 563 | ||
Noninfectious Encephalitis | 558 | ||
Limbic Encephalitis. | 563 | ||
Multiple Sclerosis and Other White Matter Diseases | 558 | ||
Multiple Sclerosis. | 565 | ||
Inflammatory and Noninflammatory Lesions of the Corpus Callosum. | 569 | ||
Acute Disseminated Encephalomyelitis. | 568 | ||
Neurosarcoidosis. | 568 | ||
Leukodystrophy. | 569 | ||
Krabbe Disease. | 569 | ||
Metachromatic Leukodystrophy. | 569 | ||
Adrenoleukodystrophy. | 569 | ||
Radiation Leukoencephalopathy. | 569 | ||
Posterior Reversible Encephalopathy Syndrome. | 569 | ||
Central Pontine Myelinolysis. | 570 | ||
Trauma | 568 | ||
Traumatic Subarachnoid Hemorrhage. | 568 | ||
Subdural Hemorrhage. | 571 | ||
Epidural Hemorrhage. | 572 | ||
Cortical Contusion. | 573 | ||
Diffuse Axonal Injury. | 574 | ||
Cerebral Parenchymal Hematoma. | 574 | ||
Metabolic and Toxic Disorders | 574 | ||
Disorders due to Ethanol. | 575 | ||
Carbon Monoxide Poisoning. | 575 | ||
Methanol Poisoning. | 575 | ||
Wilson Disease. | 575 | ||
Mitochondrial Disease. | 576 | ||
Genetic and Degenerative Disorders Primarily Causing Ataxia (Cerebellar Disorders) | 574 | ||
Multiple System Atrophy, Cerebellar Subtype. | 576 | ||
Spinocerebellar Ataxias. | 576 | ||
Friedreich Ataxia. | 577 | ||
Ataxia-Telangiectasia. | 577 | ||
Fragile X Premutation Syndrome. | 577 | ||
Genetic and Degenerative Disorders Primarily Causing Parkinsonism or Other Movement Disorders | 578 | ||
Idiopathic Parkinson Disease. | 579 | ||
Progressive Supranuclear Palsy. | 579 | ||
Multiple System Atrophy, Parkinsonian Variant (Striatonigral Degeneration). | 580 | ||
Huntington Disease. | 580 | ||
Degenerative Disorders Primarily Causing Dementia | 578 | ||
Age-Related Involutional Changes. | 578 | ||
Alzheimer Disease. | 581 | ||
Frontotemporal Lobar Degeneration, Including Pick Disease. | 581 | ||
Neurocutaneous Syndromes | 581 | ||
Neurofibromatosis. | 583 | ||
Hamartoma. | 583 | ||
Neurofibroma. | 583 | ||
Tuberous Sclerosis (Bourneville Disease). | 583 | ||
Cortical Tubers. | 583 | ||
Subependymal Nodules. | 583 | ||
White Matter Lesions. | 583 | ||
Von Hippel-Lindau Disease. | 583 | ||
Sturge-Weber Syndrome. | 583 | ||
Congenital Anomalies of the Brain | 581 | ||
Holoprosencephaly. | 586 | ||
Septo-Optic Dysplasia. | 586 | ||
Dandy-Walker Malformation. | 586 | ||
Agenesis of the Corpus Callosum. | 586 | ||
Gray Matter Heterotopia. | 586 | ||
Pachygyria, Polymicrogyria, Lissencephaly. | 586 | ||
Schizencephaly. | 586 | ||
Porencephaly. | 586 | ||
Hydranencephaly. | 586 | ||
Lipomas. | 587 | ||
Non-neoplastic Congenital Cystic Lesions | 581 | ||
Epidermoid. | 588 | ||
Dermoid. | 589 | ||
Colloid Cyst. | 589 | ||
Arachnoid Cyst. | 589 | ||
Dilated Virchow-Robin Spaces. | 589 | ||
Choroid Fissure Cyst. | 590 | ||
Choroid Plexus Cyst. | 590 | ||
Ependymal Cyst. | 590 | ||
Neuroglial Cyst. | 590 | ||
Vascular Malformations | 594 | ||
Arteriovenous Malformations. | 595 | ||
Cavernous Malformation. | 595 | ||
Developmental Venous Anomaly. | 595 | ||
Capillary Telangiectasia. | 595 | ||
Cerebrospinal Fluid Circulation Disorders | 594 | ||
Obstructive, Noncommunicating Hydrocephalus. | 594 | ||
Normal-Pressure Hydrocephalus. | 594 | ||
Chiari Malformation. | 596 | ||
Idiopathic Intracranial Hypertension (Pseudotumor Cerebri). | 598 | ||
Intracranial Hypotension. | 598 | ||
Orbital Lesions | 597 | ||
Ocular Tumors. | 598 | ||
Optic Nerve Tumors. | 598 | ||
Thyroid Ophthalmopathy. | 598 | ||
Optic Neuritis. | 598 | ||
Orbital Pseudotumor. | 600 | ||
Spinal Diseases | 597 | ||
Spinal Tumors | 597 | ||
Vertebral Metastases, Extradural Tumors. | 597 | ||
Extramedullary Intradural Spinal Tumors. | 601 | ||
Leptomeningeal Metastases. | 601 | ||
Spinal Meningiomas. | 601 | ||
Nerve Sheath Tumors. | 602 | ||
Embryonal Tumors. | 602 | ||
Intramedullary Tumors. | 601 | ||
Ependymoma. | 601 | ||
Astrocytoma. | 601 | ||
Intramedullary Metastases. | 603 | ||
Vascular Disease | 603 | ||
Spinal Cord Infarction. | 604 | ||
Arteriovenous Malformation. | 604 | ||
Dural Arteriovenous Fistula. | 604 | ||
Cavernous Malformation. | 604 | ||
Infection | 605 | ||
Discitis and Osteomyelitis. | 605 | ||
Epidural Abscess, Paravertebral Phlegmon. | 605 | ||
Noninfectious Inflammatory Disorders | 605 | ||
Multiple Sclerosis. | 605 | ||
Acute Disseminated Encephalomyelitis. | 605 | ||
Transverse Myelitis. | 605 | ||
Sarcoidosis. | 608 | ||
Vacuolar Myelopathy. | 608 | ||
Trauma | 607 | ||
Hangman’s Fracture. | 608 | ||
Odontoid Fracture. | 608 | ||
Burst Fracture. | 608 | ||
Jefferson Fracture. | 608 | ||
Facet Joint Disruption, Traumatic Spondylolisthesis. | 609 | ||
Spinal Epidural Hematoma. | 609 | ||
Spinal Subdural Hematoma. | 609 | ||
Spinal Subarachnoid Hemorrhage. | 610 | ||
Spinal Cord Trauma. | 610 | ||
Spinal Cord Injury without Radiologic Abnormality. | 611 | ||
9780323339162v2_WEB | 1078 | ||
Front Cover | 1078 | ||
Half title page | 1079 | ||
Dedication | 1080 | ||
Bradley’s Neurology in Clinical Practice | 1081 | ||
Copyright Page | 1082 | ||
Table Of Contents | 1083 | ||
Foreword | 1087 | ||
Preface | 1088 | ||
List of Contributors | 1089 | ||
Video Table of Contents | 1096 | ||
III Neurological Diseases and Their Treatment | 1101 | ||
A Principles of Management | 1101 | ||
53 Management of Neurological Disease | 1101 | ||
Chapter Outline | 1101 | ||
Principles of Neurological Management | 1101 | ||
Evidence-Based Medicine in Neurology | 1101 | ||
Goals of Treatment | 1102 | ||
Arresting an Attack | 1102 | ||
Slowing Disease Progression | 1102 | ||
Relieving Symptoms | 1102 | ||
Circumventing Functional Disability | 1103 | ||
Principles of Symptom Management | 1103 | ||
Treatment of Common Neurological Symptoms | 1103 | ||
Pain | 1103 | ||
Sensory Loss, Paresthesias, and Burning Pain | 1103 | ||
Weakness | 1103 | ||
Ataxia | 1104 | ||
Slowness of Movement or Abnormal Involuntary Movements | 1104 | ||
Aphasia and Dysarthria | 1104 | ||
Respiratory Failure | 1104 | ||
Ethical Considerations in the Treatment of Respiratory Failure. | 1104 | ||
Managing Terminal Respiratory Failure. | 1105 | ||
Memory Impairment and Dementia | 1105 | ||
Treatment of Secondary Effects of Neurological Disease | 1105 | ||
Explaining the Prognosis | 1105 | ||
Palliation and Care of the Terminally Ill Patient | 1106 | ||
Genetic Counseling | 1106 | ||
Legal Issues | 1106 | ||
Implications for Clinical Practice | 1107 | ||
References | 1107 | ||
References | 1108 | ||
54 Principles of Pain Management | 1109 | ||
Chapter Outline | 1109 | ||
Definition and Challenge | 1109 | ||
Anatomy and Physiology of the Pain Pathways | 1109 | ||
Central Modulation of Nociception | 1110 | ||
Opioid Receptors | 1110 | ||
Neuronal Plasticity and Chronic Pain | 1111 | ||
Multidisciplinary Approach to Pain Management | 1111 | ||
Pharmacological Management of Chronic Pain | 1112 | ||
Nonsteroidal Anti-inflammatory Drugs | 1112 | ||
Antidepressants | 1112 | ||
Anticonvulsants | 1114 | ||
Systemic Local Anesthetic Therapies | 1115 | ||
Topical Analgesics | 1115 | ||
Muscle Relaxants | 1115 | ||
N-Methyl-d-Aspartate Receptor Blockers | 1115 | ||
Opioid Analgesics | 1116 | ||
Interventional Pain Management | 1118 | ||
Greater Occipital Nerve Block | 1118 | ||
Sphenopalatine Ganglion Block for Headache and Facial Pain | 1118 | ||
Gasserian Ganglion Lesions for Trigeminal Neuralgia | 1119 | ||
Stellate Ganglion Block | 1120 | ||
Epidural Corticosteroid Injection | 1120 | ||
Lumbar Facet Joint Block | 1121 | ||
Percutaneous Disk Decompression | 1121 | ||
Spinal Cord Stimulation | 1122 | ||
Intrathecal Drug Delivery Systems | 1123 | ||
Motor Cortex Stimulation | 1123 | ||
Psychological Therapy in Chronic Pain Management | 1123 | ||
Rehabilitation in Chronic Pain Management | 1124 | ||
Common Pain Syndromes | 1124 | ||
Trigeminal Neuralgia | 1124 | ||
Low Back Pain | 1125 | ||
Cervicogenic Headache | 1126 | ||
Complex Regional Pain Syndrome | 1126 | ||
Post-Stroke Pain Syndrome | 1128 | ||
Spinal Cord Injury and Pain | 1128 | ||
Pain in Multiple Sclerosis | 1129 | ||
Phantom-Limb Pain and Stump Pain | 1129 | ||
Summary | 1130 | ||
References | 1130 | ||
References | 1131 | ||
55 Principles of Neurointensive Care | 1133 | ||
Chapter Outline | 1133 | ||
Clinical Assessment of Critically Ill Neurological Patients | 1133 | ||
Monitoring in the Neurointensive Care Unit | 1134 | ||
Systemic Monitoring | 1134 | ||
Brain Monitoring | 1135 | ||
Global Brain Monitoring Techniques | 1136 | ||
Intracranial Pressure Monitoring | 1136 | ||
Jugular Bulb Oximetry | 1137 | ||
Electroencephalography | 1138 | ||
Regional/Focal Brain Monitoring Techniques | 1138 | ||
Regional Cerebral Blood Flow Monitoring | 1138 | ||
Transcranial Doppler Ultrasonography | 1139 | ||
Evoked Potentials | 1139 | ||
Local Cerebral Oxygenation Monitoring Techniques | 1139 | ||
Microdialysis | 1139 | ||
Principles of Managing Critically Ill Neurological Patients | 1140 | ||
Analgesia and Sedation | 1140 | ||
Airway and Ventilatory Assistance | 1141 | ||
Pulmonary Complications | 1143 | ||
Cardiovascular Care and Blood Pressure Management | 1143 | ||
Acute Coronary Syndrome | 1143 | ||
Cardiac Arrhythmias | 1144 | ||
Congestive Heart Failure | 1144 | ||
Blood Pressure Management | 1144 | ||
Acute Ischemic Stroke. | 1145 | ||
Intracerebral Hemorrhage. | 1145 | ||
Subarachnoid Hemorrhage. | 1145 | ||
Traumatic Brain Injury. | 1145 | ||
Fluid and Electrolytes | 1145 | ||
Nutrition and Metabolic Derangements | 1146 | ||
Fever and Infections | 1147 | ||
Hematological Complications | 1148 | ||
References | 1148 | ||
References | 1149 | ||
56 Principles of Neurointerventional Therapy | 1152 | ||
Chapter Outline | 1152 | ||
Ischemic Stroke | 1152 | ||
Acute Stroke Treatment | 1152 | ||
Sonothrombolysis | 1152 | ||
Endovascular Revascularization Therapy | 1152 | ||
Intra-arterial Thrombolysis | 1153 | ||
Mechanical Recanalization | 1153 | ||
MR CLEAN, ESCAPE, EXTEND-IA, and SWIFT-PRIME Trials | 1155 | ||
Angioplasty and Stenting | 1156 | ||
Carotid Artery Disease | 1157 | ||
Carotid Artery Angioplasty and Stenting | 1157 | ||
Angioplasty and Stenting Procedure. | 1157 | ||
Clinical Trials. | 1157 | ||
Intracranial Atherosclerotic Disease | 1159 | ||
Intracranial Angioplasty | 1159 | ||
Intracranial Angioplasty and Stenting | 1159 | ||
Angioplasty/Stenting Procedure. | 1160 | ||
Clinical Trials. | 1160 | ||
Vertebral Artery Disease | 1161 | ||
Hemorrhagic Stroke | 1162 | ||
Cerebral Aneurysms | 1162 | ||
Ruptured Aneurysms | 1162 | ||
Unruptured Aneurysms | 1163 | ||
Endovascular Treatment Modalities | 1163 | ||
Coil Embolization. | 1163 | ||
Balloon Remodeling. | 1164 | ||
Stent-Assisted Coil Embolization. | 1164 | ||
Alternative Treatments | 1167 | ||
Management of Cerebral Vasospasm | 1168 | ||
Balloon Angioplasty | 1168 | ||
Intra-arterial Vasodilators | 1168 | ||
Cerebral Arteriovenous Malformations | 1169 | ||
Embolization Procedure | 1169 | ||
Polyvinyl Alcohol | 1169 | ||
n-Butyl Cyanoacrylate | 1170 | ||
Ethylene Vinyl Alcohol Copolymer | 1170 | ||
Stereotactic Radiotherapy | 1171 | ||
Cerebral Arteriovenous Fistulas | 1171 | ||
Cranial Dural Arteriovenous Fistulas | 1171 | ||
Carotid-Cavernous Fistulas | 1172 | ||
Spinal Vascular Malformations | 1173 | ||
Spinal Dural Arteriovenous Fistula (Type I) | 1174 | ||
Glomus Arteriovenous Malformation (Type II) | 1174 | ||
Juvenile/Metameric Arteriovenous Malformation (Type III) | 1174 | ||
Perimedullary Arteriovenous Malformation (Type IV) | 1174 | ||
Tumor Embolization | 1174 | ||
Embolization Procedure | 1175 | ||
Embolization Materials | 1175 | ||
Vessel Selection | 1176 | ||
Clinical Evidence | 1176 | ||
Idiopathic Intracranial Hypertension | 1176 | ||
References | 1177 | ||
References | 1178 | ||
57 Neurological Rehabilitation | 1184 | ||
Chapter Outline | 1184 | ||
Goals and Structure of Rehabilitation | 1184 | ||
Aims | 1184 | ||
Personnel and Strategies | 1185 | ||
Physicians | 1185 | ||
Rehabilitation Nursing | 1185 | ||
Physical Therapists | 1186 | ||
Exercise and Compensatory Functional Training. | 1186 | ||
Conditioning and Strengthening. | 1186 | ||
Neurophysiological Schools. | 1186 | ||
Motor Learning Approaches. | 1187 | ||
Task-Oriented Practice. | 1187 | ||
Assistive Equipment. | 1187 | ||
Occupational Therapists | 1187 | ||
Speech and Cognitive Therapists | 1188 | ||
Recreational Therapists | 1189 | ||
Psychologists | 1189 | ||
Social Workers | 1189 | ||
Orthotists and Bracing | 1189 | ||
Measurement Tools | 1190 | ||
Organization of Services | 1191 | ||
Service Provision | 1191 | ||
Inpatient Rehabilitation Unit. | 1191 | ||
Community-Based Services. | 1192 | ||
Biological Bases for Rehabilitative Interventions | 1192 | ||
Neuromedical Problems during Rehabilitation | 1193 | ||
Frequency of Complications | 1193 | ||
Complications in Patients with Stroke | 1193 | ||
Complications in Patients with Spinal Cord Injury | 1193 | ||
Complications in Patients with Traumatic Brain Injury | 1194 | ||
Management of Neuromedical Problems | 1194 | ||
Dysphagia | 1194 | ||
Skin Ulcers | 1195 | ||
Contractures | 1195 | ||
Heterotopic ossification | 1195 | ||
Dysautonomia | 1195 | ||
Bowel and Bladder Dysfunction | 1196 | ||
Fatigue | 1197 | ||
Central Pain | 1197 | ||
Sleep Disorders | 1197 | ||
Spasticity and Upper Motor Neuron Syndrome | 1197 | ||
Mechanisms. | 1197 | ||
Assessments. | 1197 | ||
Treatment. | 1198 | ||
Physical Modalities. | 1198 | ||
Pharmacotherapy. | 1198 | ||
Chemical Injections. | 1199 | ||
Surgical Interventions. | 1199 | ||
Therapies for Impairments and Disabilities | 1199 | ||
Gait Training | 1199 | ||
Constraint-Induced Upper Extremity Therapy | 1201 | ||
Bimanual Upper Extremity Therapy | 1201 | ||
Virtual Reality Training | 1201 | ||
Mirror Therapy and Imagery | 1202 | ||
Instrumented Biofeedback | 1202 | ||
Acupuncture | 1202 | ||
Visual Field Deficits | 1202 | ||
Mechanical and Robotic-Assistive Devices | 1202 | ||
Upper Extremities | 1202 | ||
Mobility | 1202 | ||
Functional Neuromuscular Stimulation | 1203 | ||
Brain Stimulation | 1203 | ||
Neural Prostheses and Brain–Computer Interfaces | 1204 | ||
Pharmacological Adjuncts | 1204 | ||
Mobile Health and Wireless Sensing Devices | 1204 | ||
Therapies for Cognitive and Behavioral Disabilities | 1204 | ||
Overview of Cognitive Therapy | 1204 | ||
Aphasia | 1205 | ||
Treatments | 1205 | ||
Pharmacological Adjuncts | 1206 | ||
Outcomes | 1206 | ||
Apraxia | 1206 | ||
Attentional Disorders | 1206 | ||
Memory Disturbances | 1207 | ||
Frequency of Memory Disturbance across Diseases | 1207 | ||
Treatments | 1207 | ||
Pharmacological Adjuncts | 1207 | ||
Outcomes | 1208 | ||
Hemineglect | 1208 | ||
Frequency | 1208 | ||
Treatments | 1209 | ||
Behavioral Disorders | 1209 | ||
Affective Disorders | 1210 | ||
Incidence | 1210 | ||
Treatment | 1210 | ||
Functional Outcomes with Rehabilitation | 1210 | ||
Stroke | 1210 | ||
Ambulation | 1211 | ||
Self-Care Skills | 1211 | ||
Spinal Cord Injury | 1211 | ||
Traumatic Brain Injury | 1212 | ||
Parkinson Disease | 1212 | ||
Multiple Sclerosis | 1212 | ||
Other Diseases | 1213 | ||
Aging with Neurological Disabilities | 1213 | ||
Future Directions | 1213 | ||
References | 1213 | ||
References | 1214 | ||
B Neurological Complications of Systemic Disease | 1216 | ||
58 Neurological Complications of Systemic Disease | 1216 | ||
Chapter Outline | 1216 | ||
Cardiac Disorders and the Nervous System | 1217 | ||
Cardiogenic Embolism | 1217 | ||
Syncope | 1217 | ||
Cardiac Arrest | 1218 | ||
Complications of Cardiac Catheterization and Surgery | 1218 | ||
Neurological Complications of Medication | 1219 | ||
Infective Endocarditis | 1219 | ||
Diseases of the Aorta | 1220 | ||
Aortic Aneurysms | 1220 | ||
Aortitis | 1220 | ||
Coarctation of the Aorta | 1221 | ||
Subclavian Steal Syndrome | 1221 | ||
Complications of Aortic Surgery | 1221 | ||
Connective Tissue Diseases and Vasculitides | 1221 | ||
Polyarteritis Nodosa, Churg-Strauss Syndrome, and Overlap Syndrome | 1221 | ||
Giant Cell Arteritis | 1222 | ||
Granulomatosis with Polyangiitis | 1222 | ||
Isolated Angiitis of the Nervous System | 1223 | ||
Rheumatoid Arthritis | 1223 | ||
Systemic Lupus Erythematosus | 1223 | ||
Sjögren Syndrome | 1223 | ||
Progressive Systemic Sclerosis | 1224 | ||
Behçet Disease | 1224 | ||
Relapsing Polychondritis | 1224 | ||
Respiratory Diseases | 1224 | ||
Hypoxia | 1224 | ||
Hypercapnia | 1224 | ||
Hypocapnia | 1224 | ||
Systemic Inflammatory Response Syndrome | 1224 | ||
Sarcoidosis | 1225 | ||
Hematological Disorders with Anemia | 1226 | ||
Megaloblastic Anemia | 1226 | ||
Sickle Cell Disease | 1226 | ||
Thalassemias | 1226 | ||
Acanthocytic Syndromes | 1226 | ||
Proliferative Hematological Disorders | 1226 | ||
Leukemias | 1226 | ||
Plasma Cell Dyscrasias | 1226 | ||
Myelomatosis | 1226 | ||
Waldenström Macroglobulinemia | 1227 | ||
Monoclonal Gammopathy of Undetermined Significance | 1227 | ||
Amyloidosis | 1227 | ||
Cryoglobulinemia | 1227 | ||
Lymphoma | 1228 | ||
Polycythemia | 1228 | ||
Hemorrhagic Diseases | 1228 | ||
Hemophilia | 1228 | ||
Other Hemorrhagic Disorders | 1228 | ||
Disseminated Intravascular Coagulation | 1228 | ||
Thrombocytopenia | 1228 | ||
Thrombotic Thrombocytopenic Purpura | 1228 | ||
Iatrogenic Hemorrhagic Disorders | 1228 | ||
Antiphospholipid Antibody Syndromes | 1229 | ||
Liver Disease | 1229 | ||
Portal-Systemic Encephalopathy | 1229 | ||
Chronic NonWilsonian Hepatocerebral Degeneration | 1229 | ||
Liver Transplantation | 1230 | ||
Pancreatic Encephalopathy | 1230 | ||
Gastrointestinal Diseases | 1230 | ||
Gastric Surgery | 1230 | ||
Small-Bowel Disease | 1230 | ||
Celiac Disease | 1230 | ||
Whipple Disease | 1230 | ||
Renal Failure | 1231 | ||
Overview of Related Neurological Complications | 1231 | ||
Neurological Complications of Dialysis | 1231 | ||
Neurological Complications of Renal Transplantation | 1232 | ||
Electrolyte Disturbances | 1232 | ||
Sodium | 1232 | ||
Potassium | 1232 | ||
Calcium | 1232 | ||
Magnesium | 1233 | ||
Pituitary Disease | 1233 | ||
Pituitary Adenomas | 1233 | ||
Cushing Disease and Syndrome | 1233 | ||
Hypopituitarism | 1234 | ||
Diabetes Insipidus | 1234 | ||
Thyroid Disease | 1234 | ||
Hyperthyroidism | 1234 | ||
Hypothyroidism | 1234 | ||
Hashimoto Thyroiditis | 1234 | ||
Parathyroid Disease | 1235 | ||
Hyperparathyroidism | 1235 | ||
Hypoparathyroidism | 1235 | ||
Adrenal Glands | 1235 | ||
Pheochromocytoma | 1235 | ||
Addison Disease | 1235 | ||
Diabetes Mellitus | 1235 | ||
Peripheral Nervous System | 1235 | ||
Central Nervous System | 1235 | ||
Hypoglycemia | 1236 | ||
References | 1236 | ||
References | 1237 | ||
59 Neurological Complications of Systemic Disease: | 1238 | ||
Chapter Outline | 1238 | ||
Cardiac Disorders and the Nervous System | 1238 | ||
Congenital Heart Disease | 1238 | ||
Cerebral Dysgenesis and Malformations | 1238 | ||
Chromosomal and Genetic Disorders | 1238 | ||
Neurological Complications Unrelated to Intervention and Cardiac Surgery | 1239 | ||
Cerebrovascular Accidents in Uncorrected Congenital Heart Disease | 1239 | ||
Brain Abscess | 1239 | ||
Infective Endocarditis | 1239 | ||
Cognitive Impairment | 1239 | ||
Neurological Complications of Intervention and Cardiac Surgery | 1240 | ||
Cardiac Transplantation | 1240 | ||
Acquired Heart Disease | 1241 | ||
Connective Tissue Diseases and Vasculitides | 1241 | ||
Polyarteritis Nodosa | 1241 | ||
Kawasaki Disease | 1241 | ||
Henoch-Schönlein Purpura | 1242 | ||
Takayasu Arteritis | 1242 | ||
Churg-Strauss Syndrome | 1242 | ||
Juvenile Rheumatoid Arthritis | 1242 | ||
Systemic Lupus Erythematosus | 1242 | ||
Granulomatosis with Polyangiitis (Wegener) | 1243 | ||
Behçet Disease | 1244 | ||
Sjögren Syndrome | 1244 | ||
Primary Angiitis of the Central Nervous System | 1244 | ||
Respiratory Disorders | 1244 | ||
Periodic Breathing and Apnea | 1244 | ||
Bronchopulmonary Dysplasia | 1244 | ||
Cystic Fibrosis | 1245 | ||
Sarcoidosis | 1245 | ||
Hypertension | 1245 | ||
Hematological Disorders | 1246 | ||
Hemolytic Disease of the Newborn and Kernicterus | 1246 | ||
Hemorrhagic Disease of the Newborn | 1246 | ||
Neonatal Polycythemia | 1246 | ||
Sickle Cell Disease | 1246 | ||
Hemophilia | 1247 | ||
Thrombotic Thrombocytopenic Purpura | 1247 | ||
Hemolytic-Uremic Syndrome | 1248 | ||
Gastrointestinal Disorders | 1248 | ||
Hepatic Encephalopathy | 1248 | ||
Liver Transplantation | 1248 | ||
Endocrine Disorders | 1249 | ||
Thyroid Disorders | 1249 | ||
Hypothyroidism | 1249 | ||
Hyperthyroidism | 1249 | ||
Parathyroid Disorders | 1249 | ||
Adrenal Gland Dysfunction | 1250 | ||
Addison Disease | 1250 | ||
Cushing Syndrome | 1250 | ||
Excess Mineralocorticoid Secretion | 1250 | ||
Pituitary Disorders | 1250 | ||
Diabetes Mellitus | 1250 | ||
Renal Disorders | 1251 | ||
Renal Failure | 1251 | ||
Complications of Dialysis | 1251 | ||
Headaches | 1251 | ||
Dialysis Disequilibrium Syndrome | 1251 | ||
Progressive Dialysis Dementia | 1251 | ||
Renal Transplantation | 1251 | ||
References | 1252 | ||
References | 1253 | ||
C Trauma of the Nervous System | 1255 | ||
60 Basic Neuroscience of Neurotrauma | 1255 | ||
Chapter Outline | 1255 | ||
Experimental Models of Traumatic Brain Injury | 1255 | ||
Percussion Concussion | 1255 | ||
Acceleration Concussion | 1256 | ||
Military Models | 1256 | ||
In Vitro Models | 1256 | ||
Neuronal Damage after Traumatic Brain Injury | 1256 | ||
Temporal Patterns of Neuronal Death | 1256 | ||
Selective Neuronal Vulnerability | 1257 | ||
Progressive Damage | 1257 | ||
Secondary and Repetitive Damage | 1258 | ||
Axonal and Dendritic Injury | 1258 | ||
Importance of Gender | 1259 | ||
Basic Mechanisms of Injury | 1260 | ||
Primary Injury Mechanisms | 1260 | ||
Secondary Injury Mechanisms | 1260 | ||
Therapeutic Interventions Directed Against Pathophysiological Processes | 1261 | ||
Glutamate Antagonists | 1261 | ||
Free Radical Scavengers | 1261 | ||
Neurotrophic Factors | 1261 | ||
Protection by Nitric Oxide-Related Species | 1261 | ||
Inflammation | 1262 | ||
Antiapoptotic Agents | 1262 | ||
Therapeutic Hypothermia | 1262 | ||
Recovery of Function | 1263 | ||
Environmental Enrichment | 1263 | ||
Reparative and Transplantation Strategies | 1263 | ||
Summary and Future Directions | 1264 | ||
References | 1264 | ||
References | 1265 | ||
61 Sports and Performance Concussion | 1266 | ||
Chapter Outline | 1266 | ||
Epidemiology | 1266 | ||
Definition | 1266 | ||
Pathophysiology | 1266 | ||
Neurometabolic Cascade | 1266 | ||
Cerebral Blood Flow | 1267 | ||
Axonal Dysfunction | 1267 | ||
Synaptic Plasticity and Neural Activation | 1267 | ||
Diagnosis | 1267 | ||
In-Office/Outpatient Evaluation | 1268 | ||
Neuropsychological Testing | 1268 | ||
Neuroimaging | 1268 | ||
Acute and Subacute Management | 1268 | ||
Return to School, Work, or Cognitive Activity | 1269 | ||
Return to Physical Activity | 1269 | ||
Risk Involved with Premature Return to Participation | 1270 | ||
Long-Term Effects | 1270 | ||
Post-Concussion Syndrome (PCS) | 1270 | ||
Chronic Traumatic Encephalopathy | 1271 | ||
When to Retire an Athlete | 1271 | ||
Prevention | 1272 | ||
References | 1272 | ||
References | 1273 | ||
62 Craniocerebral Trauma | 1275 | ||
Chapter Outline | 1275 | ||
Epidemiology | 1275 | ||
Classification | 1275 | ||
Mechanism | 1275 | ||
Injury Severity | 1276 | ||
Morphology | 1277 | ||
Skull Fractures | 1277 | ||
Intracranial Injuries | 1277 | ||
Pathophysiolgy | 1280 | ||
Treatment | 1281 | ||
Evaluation | 1281 | ||
Management of Diffuse Injuries | 1281 | ||
Management of Focal Injuries | 1286 | ||
Late Complications | 1287 | ||
Outcome | 1287 | ||
Future of TBI | 1288 | ||
References | 1288 | ||
References | 1289 | ||
63 Spinal Cord Trauma | 1291 | ||
Chapter Outline | 1291 | ||
Epidemiology | 1291 | ||
Pathophysiology | 1291 | ||
Clinical Presentation | 1293 | ||
Spinal Cord Injury Syndromes | 1293 | ||
Central Cord Syndrome | 1293 | ||
Anterior Cord Syndrome | 1294 | ||
Posterior Column Syndrome | 1294 | ||
Brown–Séquard Syndrome | 1294 | ||
Cervicomedullary Syndrome | 1295 | ||
Conus Medullaris Syndrome | 1295 | ||
Cauda Equina Syndrome | 1296 | ||
Transient Spinal Cord Syndromes | 1296 | ||
Spinal Shock | 1296 | ||
Mechanisms and Types of Injuries | 1297 | ||
Cervical Spine Fractures | 1297 | ||
Atlanto-occipital Dissociation | 1297 | ||
Occipital Condyle Fractures | 1297 | ||
Atlantoaxial Injuries | 1297 | ||
Subaxial Cervical Spine Injuries | 1298 | ||
Thoracolumbar Injuries | 1299 | ||
Penetrating Spinal Cord Injuries | 1299 | ||
Management of Acute Spinal Cord Injuries | 1299 | ||
Management in the Field | 1299 | ||
Initial Hospital Assessment | 1300 | ||
Radiographic Evaluation | 1300 | ||
Current Guidelines | 1300 | ||
Plain Radiography | 1300 | ||
Computed Tomography | 1301 | ||
Magnetic Resonance Imaging | 1301 | ||
SCIWORA | 1301 | ||
Treatment of Spinal Cord Injuries in the Acute Setting | 1301 | ||
Cardiovascular Management in the Intensive Care Unit Setting | 1301 | ||
Respiratory Management in the Intensive Care Unit Setting | 1302 | ||
Medical Management | 1303 | ||
Nutritional Support | 1304 | ||
Stabilization and Support | 1304 | ||
Nonsurgical Management | 1304 | ||
Surgical Management | 1305 | ||
Long-Term Management of Spinal Cord Injuries | 1306 | ||
Spinal Cord Injury and Bladder Function | 1306 | ||
Spinal Cord Injury and Bowel Function | 1308 | ||
Delayed Post-traumatic Spinal Cord Syndromes | 1309 | ||
Post-traumatic Syringomyelia | 1309 | ||
Neuropathic Pain | 1309 | ||
Spasticity | 1310 | ||
Autonomic Dysreflexia | 1311 | ||
Deep Vein Thrombosis and Thromboembolism in Spinal Cord Injury | 1312 | ||
Future Directions | 1312 | ||
References | 1313 | ||
References | 1314 | ||
64 Trauma of the Nervous System: Peripheral Nerve Trauma | 1317 | ||
Chapter Outline | 1317 | ||
Anatomy of the Spinal Nerves of the Peripheral Nervous System | 1317 | ||
Axon | 1317 | ||
Peripheral Nerve Trunks | 1318 | ||
Classification of Nerve Trauma | 1319 | ||
Peripheral Nerve Degeneration and Regeneration | 1319 | ||
Segmental Demyelination | 1319 | ||
Wallerian Degeneration | 1320 | ||
Distal Segment Changes | 1320 | ||
Proximal Segment | 1320 | ||
Nerve Regeneration | 1320 | ||
Mechanisms of Traumatic Nerve Injury | 1321 | ||
Compression | 1321 | ||
Stretch and Traction | 1321 | ||
Laceration | 1322 | ||
Crush | 1322 | ||
Gunshot | 1322 | ||
Radiation | 1322 | ||
Cold Injury | 1322 | ||
Electrical | 1323 | ||
Injection | 1323 | ||
Evaluation of Nerve Trauma | 1323 | ||
Clinical and Electrodiagnostic Examination | 1323 | ||
Imaging Studies | 1324 | ||
Surgical Repair of Nerve Trauma | 1325 | ||
Indications for and Timing of Surgical Repair | 1325 | ||
Intraoperative Nerve Monitoring | 1327 | ||
Surgical Techniques | 1328 | ||
Neurolysis (External and Internal) | 1328 | ||
Primary Neurorrhaphy | 1328 | ||
Nerve Grafting | 1329 | ||
Nerve Transfer | 1330 | ||
Management of Neuropathic Pain Associated with Nerve Trauma | 1331 | ||
Pharmacological Options | 1331 | ||
Interventional Strategies | 1331 | ||
Movement Disorders after Nerve Trauma | 1331 | ||
Future Directions in Treatment of Nerve Trauma | 1333 | ||
References | 1333 | ||
References | 1334 | ||
D Vascular Diseases of the Nervous System | 1336 | ||
65 Ischemic Cerebrovascular Disease | 1336 | ||
Chapter Outline | 1336 | ||
Epidemiology and Risk Factors | 1336 | ||
Risk Factors for Stroke | 1337 | ||
Heredity and Risk of Stroke | 1337 | ||
Common Modifiable Risk Factors | 1337 | ||
Other Risk Factors for Stroke | 1340 | ||
Pathophysiology of Cerebral Ischemia | 1340 | ||
Pathology of Ischemic Stroke | 1341 | ||
Clinical Syndromes of Cerebral Ischemia | 1341 | ||
Transient Ischemic Attacks | 1341 | ||
Carotid Artery System Syndromes | 1343 | ||
Carotid Artery Syndromes | 1343 | ||
Middle Cerebral Artery Syndromes | 1343 | ||
Syndromes of the Anterior Cerebral Artery and Related Blood Vessels | 1344 | ||
Lacunar Syndromes | 1344 | ||
Vertebrobasilar System Syndromes | 1345 | ||
Posterior Cerebral Artery Syndromes | 1346 | ||
Syndromes of Thalamic Infarction | 1348 | ||
Watershed Ischemic Syndromes | 1348 | ||
Diagnosis and Treatment of Threatened Ischemic Stroke | 1348 | ||
Large-Artery Atherothrombotic Infarctions | 1350 | ||
Small-Vessel or Penetrating Artery Disease | 1351 | ||
Cardiogenic Embolism | 1351 | ||
Nonatherosclerotic Vasculopathies | 1354 | ||
Dissections | 1354 | ||
Trauma | 1356 | ||
Radiation Vasculopathy | 1356 | ||
Moyamoya | 1356 | ||
Fibromuscular Dysplasia | 1358 | ||
Inflammatory Vasculitides | 1358 | ||
Infections and Stroke | 1359 | ||
Drug Abuse and Stroke | 1359 | ||
Stroke and Systemic Vasculitides | 1360 | ||
Migraine and Stroke | 1362 | ||
Inherited and Miscellaneous Disorders | 1363 | ||
Hypercoagulable Disorders | 1365 | ||
Primary Hypercoagulable States | 1365 | ||
Secondary Hypercoagulable States | 1367 | ||
Sickle Cell Disease | 1370 | ||
Thrombotic Thrombocytopenic Purpura | 1370 | ||
Infarcts of Undetermined Cause | 1370 | ||
Essential Investigations for Patients with Threatened Strokes | 1370 | ||
Neuroimaging | 1371 | ||
Cardiac Evaluation of the Stroke Patient | 1372 | ||
Cerebral Angiography | 1373 | ||
Preventing Stroke Recurrence: Medical Therapy | 1374 | ||
Platelet Antiaggregants | 1374 | ||
Oral Anticoagulants | 1375 | ||
Treatment of Acute Ischemic Stroke | 1377 | ||
Heparins and Heparinoids | 1377 | ||
Thrombolytic Therapy | 1377 | ||
Defibrinogenating and Hemorheological Agents | 1382 | ||
Neuroprotective Agents | 1382 | ||
Hypothermia | 1383 | ||
Surgical Therapy | 1382 | ||
Symptomatic Carotid Artery Stenosis | 1382 | ||
Asymptomatic Carotid Artery Stenosis | 1384 | ||
Stenting of the Carotid Artery and Other Cervicocerebral Vessels | 1385 | ||
General Management of Acute Ischemic Stroke | 1386 | ||
Cerebral Venous Thrombosis | 1388 | ||
References | 1393 | ||
References | 1394 | ||
66 Intracerebral Hemorrhage | 1399 | ||
Chapter Outline | 1399 | ||
Mechanisms of Intracerebral Hemorrhage | 1399 | ||
Hypertension | 1399 | ||
Vascular Malformations | 1399 | ||
Intracranial Tumors | 1400 | ||
Bleeding Disorders, Anticoagulants, and Fibrinolytic Treatment | 1400 | ||
Cerebral Amyloid Angiopathy | 1402 | ||
Granulomatous Angiitis of the Central Nervous System and Other Vasculitides | 1403 | ||
Sympathomimetic Agents | 1405 | ||
Hemorrhagic Infarction | 1406 | ||
Head Trauma | 1406 | ||
Clinical Features of Intracerebral Hemorrhage | 1406 | ||
Putaminal Hemorrhage | 1407 | ||
Caudate Hemorrhage | 1409 | ||
Thalamic Hemorrhage | 1409 | ||
Lobar Hemorrhage | 1409 | ||
Cerebellar Hemorrhage | 1412 | ||
Pontine Hemorrhage | 1412 | ||
Mesencephalic Hemorrhage | 1412 | ||
Medullary Hemorrhage | 1414 | ||
Intraventricular Hemorrhage | 1414 | ||
Treatment of Intracerebral Hemorrhage | 1414 | ||
General Management of Intracerebral Hemorrhage | 1414 | ||
Initial Evaluation | 1414 | ||
General Measures for Prevention of Further Elevation of Intracranial Pressure | 1416 | ||
Specific Treatment of Increased Intracranial Pressure | 1416 | ||
Choice between Medical and Surgical Therapy in Intracerebral Hemorrhage | 1416 | ||
Hemostatic Therapy of Intracerebral Hemorrhage | 1417 | ||
References | 1417 | ||
References | 1419 | ||
67 Intracranial Aneurysms and Subarachnoid Hemorrhage | 1421 | ||
Chapter Outline | 1421 | ||
Epidemiology | 1421 | ||
Associated Conditions | 1421 | ||
Pathophysiology | 1422 | ||
Saccular Aneurysm | 1422 | ||
Fusiform Aneurysm | 1423 | ||
Dissecting Aneurysm | 1423 | ||
Natural History of Intracranial Aneurysms | 1423 | ||
Imaging Modalities and Diagnosis | 1425 | ||
Subarachnoid Hemorrhage | 1425 | ||
Symptoms | 1428 | ||
Treatment of Incidental Intracranial Aneurysms | 1428 | ||
Open Surgical Treatment | 1429 | ||
Endovascular Treatment | 1429 | ||
Management of Subarachnoid Hemorrhage | 1431 | ||
Endovascular and Surgical Treatment of Ruptured Aneurysms | 1431 | ||
Vasospasm and Delayed Cerebral Ischemia | 1432 | ||
References | 1433 | ||
References | 1434 | ||
68 Stroke in Children | 1436 | ||
Chapter Outline | 1436 | ||
Stroke and the Developing Cerebrovascular System | 1436 | ||
Epidemiology | 1436 | ||
Full-Term and Near-Term Neonates | 1436 | ||
The General Population of Children | 1436 | ||
High-Risk Subgroups | 1436 | ||
Presentations | 1438 | ||
Etiology | 1439 | ||
Cardiac | 1439 | ||
Hematological | 1439 | ||
Trauma and Vascular Compression | 1439 | ||
Infection | 1440 | ||
Vascular Malformations/Vasculopathy/Migraine | 1440 | ||
Drugs/Toxins | 1440 | ||
Metabolic | 1441 | ||
Gender and Ethnicity | 1441 | ||
Genetic | 1441 | ||
Differential Diagnosis | 1442 | ||
Evaluation | 1442 | ||
History and Physical | 1442 | ||
Imaging Studies | 1444 | ||
Coagulation Workup | 1444 | ||
Cardiac Evaluation | 1444 | ||
Other Studies | 1445 | ||
Treatment | 1445 | ||
The Acute Period and Initiating Chronic Therapy | 1445 | ||
Additional Issues in Chronic Therapy | 1445 | ||
Other Issues | 1446 | ||
Summary | 1446 | ||
References | 1446 | ||
References | 1447 | ||
69 Spinal Cord Vascular Disease | 1450 | ||
Chapter Outline | 1450 | ||
Vascular Anatomy of the Spinal Cord | 1450 | ||
Vascular Anatomy of the Spinal Cord | 1451 | ||
Intrinsic Spinal Cord Arterial Supply | 1451 | ||
Venous Drainage | 1451 | ||
Spinal Cord Infarction | 1450 | ||
Presentation and Initial Course | 1450 | ||
Examination Findings | 1450 | ||
Investigations | 1450 | ||
Course and Prognosis | 1453 | ||
Causes of Spinal Cord Infarction | 1454 | ||
Treatment | 1455 | ||
Spinal Vascular Malformations | 1455 | ||
Distribution and Prevalence | 1455 | ||
Clinical Presentation and Course | 1455 | ||
Investigations | 1456 | ||
Treatment | 1457 | ||
Spinal Cavernous Malformation | 1458 | ||
Spinal Hemorrhage | 1458 | ||
Subarachnoid Hemorrhage | 1458 | ||
Hematomyelia | 1458 | ||
Spinal Epidural and Subdural Hemorrhage | 1458 | ||
References | 1459 | ||
References | 1460 | ||
70 Central Nervous System Vasculitis | 1461 | ||
Chapter Outline | 1461 | ||
Types of Central Nervous System Vasculitis | 1461 | ||
Isolated Central Nervous System Vasculitis | 1461 | ||
Clinical Findings | 1461 | ||
Pathology | 1461 | ||
Laboratory Findings | 1462 | ||
Approach to Diagnosis | 1462 | ||
Therapy | 1462 | ||
Central Nervous System Vasculitis Associated with Other Disorders | 1463 | ||
Cutaneous Herpes Zoster Infection | 1463 | ||
Drug Abuse | 1463 | ||
Lymphoma | 1463 | ||
Amyloid | 1463 | ||
References | 1463 | ||
References | 1464 | ||
E Cancer and the Nervous System | 1465 | ||
71 Epidemiology of Brain Tumors | 1465 | ||
Chapter Outline | 1465 | ||
Classification | 1465 | ||
Descriptive Epidemiology | 1465 | ||
Incidence | 1465 | ||
Mortality and Prognostic Factors | 1466 | ||
Gender and Race | 1466 | ||
Temporal Trends | 1467 | ||
Geographical Trends and Migrant Studies | 1467 | ||
Primary Central Nervous System Lymphoma | 1467 | ||
Analytical Epidemiology | 1467 | ||
Study Designs | 1467 | ||
Methodological Challenges | 1468 | ||
Radiation | 1468 | ||
Ionizing Radiation | 1468 | ||
Electromagnetic Field Radiation | 1468 | ||
Radiofrequency and Cellular Telephone | 1468 | ||
Occupational Studies | 1469 | ||
Head Trauma | 1469 | ||
N-Nitroso Compounds | 1469 | ||
Vitamins | 1470 | ||
Tobacco and Alcohol | 1470 | ||
Tea and Coffee | 1470 | ||
Infections, Allergies and Immunity | 1470 | ||
Genetic Syndromes | 1471 | ||
Genetic Susceptibility | 1472 | ||
Summary | 1472 | ||
References | 1472 | ||
References | 1473 | ||
72 Pathology and Molecular Genetics | 1475 | ||
Chapter Outline | 1475 | ||
General Principles of Nervous System Tumor Biology | 1475 | ||
History of Nervous System Tumor Classification Schemes | 1475 | ||
General Histopathological Features and Techniques | 1476 | ||
General Histopathological Features | 1476 | ||
Anaplasia | 1477 | ||
Tumor Grading | 1477 | ||
Palisading | 1477 | ||
Rosettes | 1477 | ||
Desmoplasia | 1477 | ||
Microvascular Proliferation | 1477 | ||
Frozen Sections and Touch Imprints/Smears | 1477 | ||
Electron Microscopy (Ultrastructural Pathology) | 1478 | ||
Immunohistochemistry | 1478 | ||
Glial Markers | 1478 | ||
Neuronal Markers | 1478 | ||
Epithelial Markers | 1479 | ||
S100 Protein | 1479 | ||
Other Useful Immunomarkers | 1479 | ||
Methods of Assessing Cell Proliferation | 1479 | ||
Molecular Diagnostics | 1479 | ||
Primary Neuroepithelial Tumors | 1479 | ||
Diffuse Astrocytoma (WHO Grade II–III) | 1480 | ||
Oligodendroglioma (WHO Grade II–III) | 1480 | ||
Oligoastrocytoma (WHO Grade II–III) | 1481 | ||
Glioblastoma (WHO Grade IV) | 1481 | ||
Molecular Characteristics of Diffuse Gliomas | 1481 | ||
Circumscribed (“Favorable Prognosis”) Neuroepithelial Tumors | 1482 | ||
Pilocytic Astrocytoma (WHO Grade I) | 1483 | ||
Pleomorphic Xanthoastrocytoma (WHO Grade II or III) | 1483 | ||
Subependymal Giant Cell Astrocytoma (WHO Grade I) | 1483 | ||
Ganglioglioma/Gangliocytoma (WHO Grade I or II) | 1484 | ||
Dysembryoplastic Neuroepithelial Tumor (WHO Grade I) | 1484 | ||
Other Glioneuronal Tumors | 1484 | ||
Central Neurocytoma (WHO Grade II) | 1485 | ||
Ependymoma (WHO Grade II or III) | 1485 | ||
Myxopapillary Ependymoma (WHO Grade I) | 1485 | ||
Subependymoma (WHO Grade I) | 1486 | ||
Choroid Plexus Tumors | 1486 | ||
Choroid Plexus Papilloma (WHO Grade I) | 1486 | ||
Choroid Plexus Carcinoma (WHO Grade III) | 1486 | ||
Embryonal Tumors/Primitive Neuroectodermal Tumors | 1487 | ||
Medulloblastoma (WHO Grade IV) | 1487 | ||
Atypical Teratoid/Rhabdoid Tumor (WHO Grade IV) | 1488 | ||
Meningeal/Extra-axial Tumors | 1488 | ||
Meningioma (WHO Grade I) | 1488 | ||
Atypical Meningioma (WHO Grade II) | 1488 | ||
Anaplastic Meningioma (WHO Grade III) | 1489 | ||
Molecular Features of Meningioma | 1489 | ||
Hemangiopericytoma and Solitary Fibrous Tumor (WHO Grade II or III) | 1489 | ||
Nerve Sheath Tumors | 1490 | ||
Schwannoma (Neurilemoma) (WHO Grade I) | 1490 | ||
Neurofibroma (WHO Grade I) | 1490 | ||
Miscellaneous Tumors | 1490 | ||
Central Nervous System Lymphoma | 1490 | ||
Germ Cell Tumors | 1491 | ||
Hemangioblastoma (WHO Grade I) | 1492 | ||
Craniopharyngioma (WHO Grade I) | 1492 | ||
Epidermoid and Dermoid Cysts | 1492 | ||
Neuroenteric, Colloid, and Rathke Cleft Cysts | 1492 | ||
Lipomas | 1493 | ||
Metastatic Tumors | 1493 | ||
Acknowledgments | 1493 | ||
References | 1493 | ||
References | 1494 | ||
73 Clinical Features of Brain Tumors and Complications of Their Treatment | 1496 | ||
Chapter Outline | 1496 | ||
Clinical Features of Brain Tumors | 1496 | ||
Overview of Symptoms | 1496 | ||
Specific Symptoms and Signs | 1496 | ||
Focal Symptoms | 1496 | ||
Focal Motor Symptoms. | 1496 | ||
Ataxia. | 1496 | ||
Aphasia. | 1497 | ||
Visual Problems. | 1497 | ||
Seizures. | 1497 | ||
Generalized Symptoms | 1497 | ||
Headaches. | 1497 | ||
Nausea and Vomiting. | 1498 | ||
Syncope. | 1498 | ||
Mental Status and Behavioral Changes. | 1498 | ||
Complications of Brain Tumor Treatment | 1498 | ||
Surgery | 1498 | ||
Radiation | 1499 | ||
Chemotherapy and Biologic Therapy | 1499 | ||
References | 1499 | ||
References | 1500 | ||
74 Primary Nervous System Tumors in Adults | 1501 | ||
Chapter Outline | 1501 | ||
General Aspects | 1501 | ||
Established Treatment Strategies | 1501 | ||
Surgery | 1501 | ||
Radiation Therapy | 1502 | ||
Conventional Fractionated Radiotherapy. | 1502 | ||
Brachytherapy. | 1502 | ||
Sensitization of Tumor Cells to Ionizing Radiation. | 1502 | ||
Stereotactic Radiosurgery Techniques. | 1502 | ||
Chemotherapy | 1503 | ||
Standard Cytotoxic Chemotherapy. | 1503 | ||
Delivery Strategies. | 1503 | ||
New Treatment Strategies | 1503 | ||
Management of Specific Brain Tumors | 1507 | ||
Neuroepithelial Tumors | 1507 | ||
Astrocytic Tumors | 1507 | ||
Noninfiltrative Tumors | 1507 | ||
Pilocytic Astrocytoma. | 1507 | ||
Pleomorphic Xanthoastrocytoma. | 1507 | ||
Subependymal Giant Cell Astrocytoma. | 1508 | ||
Neuroepithelial Tumors of Unknown Origin: Chordoid Glioma of the Third Ventricle. | 1508 | ||
Infiltrative Low-Grade Astrocytomas. | 1508 | ||
High-Grade Astrocytomas | 1509 | ||
Anaplastic Astrocytoma. | 1509 | ||
Glioblastoma Multiforme. | 1509 | ||
Others | 1510 | ||
Gliomatosis Cerebri. | 1510 | ||
Oligodendroglial Tumors | 1510 | ||
Oligodendroglioma and Oligoastrocytoma. | 1510 | ||
Anaplastic Oligodendroglioma and Anaplastic Oligoastrocytoma. | 1510 | ||
Ependymal Tumors | 1510 | ||
Ependymoma and Anaplastic Ependymoma. | 1510 | ||
Subependymoma. | 1510 | ||
Choroid Plexus Tumors | 1510 | ||
Choroid Plexus Papilloma and Carcinoma. | 1510 | ||
Neuronal and Mixed Neuronal-Glial Tumors | 1511 | ||
Ganglioglioma and Gangliocytoma. | 1511 | ||
Central Neurocytoma. | 1511 | ||
Pineal Parenchymal Tumors | 1511 | ||
Peripheral Neuroblastic Tumors | 1511 | ||
Esthesioneuroblastoma. | 1511 | ||
Embryonal Tumors | 1511 | ||
Medulloblastoma. | 1511 | ||
Supratentorial Primitive Neuroectodermal Tumors. | 1512 | ||
Tumors of Cranial and Peripheral Nerves | 1512 | ||
Schwannoma and Neurofibroma | 1512 | ||
Malignant Peripheral Nerve Sheath Tumor | 1513 | ||
Meningeal Tumors | 1513 | ||
Meningioma | 1513 | ||
Hemangiopericytoma | 1514 | ||
Neuraxis Tumors Derived from the Hematopoietic System | 1514 | ||
Primary Central Nervous System Lymphoma | 1514 | ||
NonAIDS Related Disease. | 1514 | ||
AIDS-Related PCNSL. | 1515 | ||
Germ Cell Tumors | 1515 | ||
Germinoma | 1515 | ||
Nongerminomatous Germ Cell Tumors | 1515 | ||
Tumors of the Sellar Region | 1515 | ||
Craniopharyngioma | 1515 | ||
Pituitary Adenoma | 1516 | ||
References | 1516 | ||
References | 1517 | ||
75 Primary Nervous System Tumors in Infants and Children | 1520 | ||
Chapter Outline | 1520 | ||
Pediatric Primary Nervous System Tumors | 1520 | ||
Embryonal Tumors | 1520 | ||
Medulloblastoma and Central Nervous System Primitive Neuroectodermal Tumor | 1520 | ||
Background | 1520 | ||
Etiology | 1520 | ||
Clinical Presentation | 1522 | ||
Diagnosis | 1522 | ||
Management | 1522 | ||
Prognosis | 1524 | ||
Atypical Teratoid/Rhabdoid Tumor | 1524 | ||
Background | 1524 | ||
Clinical Presentation | 1524 | ||
Diagnosis | 1524 | ||
Management and Prognosis | 1524 | ||
Astrocytic Tumors | 1525 | ||
Pilocytic Astrocytoma | 1525 | ||
Background | 1525 | ||
Clinical Presentation | 1525 | ||
Diagnosis | 1525 | ||
Management | 1526 | ||
Prognosis | 1526 | ||
Optic Pathway Glioma | 1526 | ||
Background | 1526 | ||
Clinical Presentation | 1526 | ||
Diagnosis and Management | 1527 | ||
Prognosis | 1527 | ||
Subependymal Giant Cell Astrocytoma | 1527 | ||
Background | 1527 | ||
Clinical Presentation | 1527 |