Neurology: A Clinician’s Approach

Preface
Contents
1: Confusion
	History
		Agitated Delirium
		Somnolence
		Incoherence
	Examination
		Inattention
			Months of the Year Backwards
			Reverse Digit Span
			Serial Sevens
			Spelling “World” Backwards
		Other Changes in Mental Status
		Asterixis
	Differential Diagnosis
		Aphasia
		Neglect and the Right Hemispheric Syndrome
			Visual Neglect
			Somatosensory Neglect
			Other Elements of the Right Hemispheric Syndrome
		Transient Global Amnesia (TGA)
		Psychosis
		Charles Bonnet Syndrome
	Diagnostic Testing
	Etiologies
		Toxic and Metabolic Encephalopathies
			Ethanol and Confusion
				Ethanol Intoxication
				Ethanol Withdrawal
				Wernicke Encephalopathy
			Hepatic Encephalopathy
		Spinal Fluid Pleocytosis
			Bacterial Meningitis
			Viral Meningitis and Encephalitis
			Neoplastic Meningitis/Leptomeningeal Metastasis
			Lyme Meningitis
			Tuberculous Meningitis
			Fungal Meningitis
			Limbic Encephalitis
			Drug-Induced Meningitis
		Nonconvulsive Status Epilepticus (NCSE)
		Structural Lesions Responsible for Confusion
		Posterior Reversible Encephalopathy Syndrome (PRES)
		Neuroleptic Malignant Syndrome (NMS)
	General Approach to Treatment
	References
2: Coma and Related Disorders
	History
	Examination
		Mental Status Examination
		Pupillary Reactions
		Blink Reflexes
		Eye Position
			Horizontal Eye Position
			Vertical Eye Position
		Spontaneous Eye Movements
		Vestibulo-Ocular Reflex
		Motor Examination
			Spontaneous and Purposeful
			Spontaneous but Nonpurposeful
			Reflexive
			Absent
		Respiratory Patterns
	Investigation of Impaired Consciousness and Coma
		Phase 1: History, Examination, and Basic Studies
		Phase 2: MRI, EEG, and Lumbar Puncture
		Phase 3: Uncommon Etiologies and Coma Mimics
	Prognostication in Coma
	The Persistent Vegetative State
	The Minimally Conscious State
	Brain Death
	Increased Intracranial Pressure
		Uncal Herniation
		Transtentorial Herniation
		Other Herniation Syndromes
		Management of Increased Intracranial Pressure
	References
3: Aphasia
	Introduction
	Bedside Examination of the Aphasic Patient
		Spontaneous Speech
		Comprehension
		Repetition
		Confrontation Naming
		Reading
		Writing
	Aphasia Syndromes
		Broca Aphasia
		Wernicke Aphasia
		Global Aphasia
		Transcortical Motor Aphasia (TCMA)
		Conduction Aphasia
		Transcortical Sensory Aphasia and Mixed Transcortical Aphasia
		Subcortical Aphasias
		Anomic Aphasia
	Mimics of Aphasia
		Dysarthria
		Confusion
		Aphemia
	Determining the Cause and Treatment of Aphasia
	Recovery and Rehabilitation of Acute Aphasia
	References
4: Dementia
	History
		Memory
		Language
		Praxis
		Visuospatial Function
		Behavioral Abnormalities
		Gait Difficulties
		Relevant Medical History
		Age of Onset and Tempo
	Examination
		Mental Status Examination
			Attention
			Language
				Semantic Fluency
				Phonemic Fluency
			Memory
			Praxis
			Construction
			Mental Flexibility, Set-Shifting, and Response Inhibition
				Luria Test
				Stroop Test
				Antisaccade Test
			Processing Speed
			Frontal Release Signs
		The General Neurologic Examination
			Cranial Nerve Examination
			Motor Examination
			Sensory Examination
			Gait
	Diagnostic Testing
		Bloodwork
		Structural Neuroimaging
		Functional Neuroimaging
		Lumbar Puncture
		Genetic Testing
	Causes of Dementia
		Alzheimer Disease (AD)
		Dementia with Lewy Bodies (DLB)
		Behavioral Variant Frontotemporal Dementia (FTD)
		Vascular Dementia
			Multi-infarct Dementia
			Subcortical White Matter Disease
			Strategic Infarct Dementia
		Normal Pressure Hydrocephalus (NPH)
		Primary Progressive Aphasia (PPA)
		Posterior Cortical Atrophy
		Alcohol and Dementia
		HIV Dementia
		Neurosyphilis
		Dementia and Movement Disorders
		Chronic Traumatic Encephalopathy
	Mild Cognitive Impairment (MCI) and Subjective Memory Impairment (SMI)
	Pseudodementia
		Depression
		Obstructive Sleep Apnea (OSA) and Other Sleep Disorders
		Pain
		Adult Attention Deficit Hyperactivity Disorder (ADHD)
		Medication Side Effects
		Conversion Disorders and Malingering
	Postconcussion Syndrome
	Subacute and Rapidly Progressive Dementias
		Creutzfeldt-Jakob Disease (CJD)
		Hashimoto Encephalopathy
		Leptomeningeal Metastasis and Limbic Encephalitis
		Evaluation of Undiagnosed Rapidly Progressive Dementia
	References
5: Visual Loss and Other Visual Disturbances
	Neuroanatomy
	History
	Examination of the Visual System
		Visual Acuity
		Pupillary Reactions
		Relative Afferent Pupillary Defect (RAPD)
		Color Discrimination
		Visual Field Examination
			Central Visual Fields
			Peripheral Visual Fields
		Funduscopic Examination
	Monocular Visual Loss
		Optic Neuritis
			Idiopathic Optic Neuritis
			Atypical Optic Neuritis
		Ischemic Optic Neuropathies
			Temporal Arteritis
			Nonarteritic Ischemic Optic Neuropathy (NAION)
		Less Common Optic Neuropathies
			Structural Optic Neuropathies
			Toxic and Nutritional Optic Neuropathies
			Inherited Optic Neuropathies
		Retinal Ischemia and Infarction
		Migraine Aura Without Headache
		Angle Closure Glaucoma
	Bitemporal Hemianopsia and Junctional Scotoma
	Homonymous Upper Quadrantanopsia
	Homonymous Hemianopsia
		Posterior Cerebral Artery Infarction
		Alexia Without Agraphia
	Cortical Blindness
		Bilateral Occipital Lobe Infarction
		Posterior Reversible Encephalopathy Syndrome (PRES)
	Functional Visual Loss
	Other Cortical Visual Syndromes
		Balint Syndrome
		Visual Object Agnosia
			Visual Apperceptive Agnosia
			Visual Associative Agnosia
		Prosopagnosia
		Cerebral Achromatopsia
	References
6: Diplopia
	Establishing Binocularity and Direction of Diplopia
	Inspecting Ocular Misalignment
	Localizing the Dysfunctional Eye Movement
	Localizations of Horizontal Diplopia
		Abducens Nerve Palsy
			Nuclear Lesions
			Fascicular Lesions
			Prepontine Segment Lesions
			Cavernous Sinus and Orbit Lesions
		Partial Oculomotor (Cranial Nerve III) Palsy
		Internuclear Ophthalmoplegia (INO)
		Duane Retraction Syndrome
	Localizations of Vertical Diplopia
		Trochlear Nerve Palsy
			Nuclear, Fascicular, and Cisternal Segment Lesions
			Cavernous Sinus and Orbit Lesions
		Skew Deviation
		Partial Third Nerve Palsy
	Localization of Multidirectional Diplopia
		Oculomotor Nerve Palsy
			Nuclear Lesions
			Fascicular Lesions
			Cisternal Segment Lesions
			Cavernous Sinus Lesions
			Ischemic Third Nerve Lesions
		Wernicke Encephalopathy
		Cavernous Sinus Lesions
		Tolosa-Hunt Syndrome
		Orbital Lesions
		Miller-Fisher Syndrome and Brainstem Encephalitis
		Cranial Polyneuropathy
		Restrictive Disorders
		Convergence Insufficiency
		Spasm of the Near Reflex
	Fluctuating Diplopia-Ocular Myasthenia Gravis
	Diagnostic Testing
	Treatment
	References
7: Disorders of the Eyelids and Pupils
	Ptosis and Lid Retraction
		Supranuclear Lesions
		Nerve Lesions
			Oculomotor Nerve
			Oculosympathetic Nerves
			Facial Nerve
		Neuromuscular Junction Lesions
		Muscle Lesions
		Soft Tissue Lesions
		Lid Retraction
		Treatment of Ptosis and Lid Retraction
	Other Disorders of the Eyelids
		Blepharospasm
		Eyelid-Opening Apraxia
	Anisocoria
		Anisocoria Worse in Light (Parasympathetic Dysfunction)
			Nuclear Lesions
			Fascicular and Subarachnoid Lesions
			Cavernous Sinus Lesions
			Ciliary Ganglion Lesions
			Iris Lesions
			Unlocalized Lesions
			Clinical Approach
		Anisocoria Worse in Dark (Sympathetic Dysfunction)
			First-Order Neuron
			Second-Order Neuron
			Third-Order Neuron
			Clinical Approach
		Physiologic Anisocoria
	References
8: Facial Weakness, Dysarthria, and Dysphagia
	Lower Brainstem Symptoms
	Facial Weakness
		Anatomy
		Examination of Facial Movement
		Differentiating Between Central and Peripheral Facial Weakness
		Causes of Facial Weakness
			Supranuclear Lesions
			Pontine Lesions
			Bell’s Palsy and Facial Nerve Lesions
			Incidental Facial Weakness
	Dysarthria
		Spastic (Upper Motor Neuron) Dysarthria
		Flaccid (Lower Motor Neuron) Dysarthria
		Extrapyramidal Dysarthrias
		Scanning Dysarthria
		“Slurred” Speech
	Dysphagia
		Oral Phase Dysphagia
			Trigeminal Nerve Lesions
			Hypoglossal Nucleus and Nerve Lesions
		Pharyngeal Phase Dysphagia
			Supranuclear Lesions (the Pseudobulbar State)
			Nuclear Lesions
			Glossopharyngeal and Vagus Nerve Lesions
			Neuromuscular Junction Lesions
			Myopathic Lesions
			Extrapyramidal Lesions
	References
9: Dizziness and Vertigo
	“What Do You Mean by Dizziness?”
	Lightheadedness
		Cardiogenic Syncope
		Orthostatic Hypotension
		Neurally Mediated Syncope
		Postural Orthostatic Tachycardia Syndrome (POTS)
	Imbalance
	Evaluation of Vertigo
		History
		Neurologic Examination
			“Cerebellar” Signs
				Finger-to-Nose Test
				Overshoot
				Rebound
				Heel-Knee Shin Test
				Truncal Ataxia
			Nystagmus
			Head-Thrust Test
			Dix-Hallpike Maneuver
			Imaging of the Patient with Vertigo
		Causes of Vertigo
			Vertebrobasilar Ischemia and Infarction
			Vestibular Neuritis
			Benign Paroxysmal Positional Vertigo (BPPV)
			Meniere Disease
			Migraine
			Medication Toxicity
			Perilymph Fistula
			Epileptic Dizziness
			Cerebellopontine Angle (CPA) Tumors
			Cervicogenic Dizziness and Vertigo
			Chronic Undifferentiated Dizziness
			Postconcussion Syndrome and Posttraumatic Dizziness
			Multiple Sclerosis
			Paraneoplastic Cerebellar Degeneration
			Episodic Ataxia
			Dizziness of Psychological Origin
	References
10: Proximal and Generalized Weakness
	Weakness and Its Mimics
	The Evaluation of Weakness
		History
		Muscle Bulk
		Power
	Proximal Weakness: History
		Associated Features
	Proximal Weakness: Examination
		Muscle Bulk
		Muscle Strength
		Exercise Testing
		Reflexes
		Sensation
		Gait
		Other Signs and Symptoms
	Laboratory Testing in the Patient with Proximal Weakness
		Creatine Kinase (CK)
		Aldolase
		Nerve Conduction Studies (NCS) and Electromyography (EMG)
		Muscle Biopsy
		Myositis-Associated Antibodies
		HMGCR Antibodies
		Forearm Exercise Testing
		Other Laboratory Tests
	Causes of Proximal and Generalized Weakness
		Inflammatory Myopathies
			Polymyositis
			Dermatomyositis
			Inclusion Body Myositis (IBM)
			Overlap Myopathies
		Muscular Dystrophies
			Dystrophinopathies
			Limb-Girdle Muscular Dystrophies
		Thyroid Myopathies
		Toxic and Iatrogenic Myopathies
			Statin-Induced Myopathy
			Alcohol-Related Myopathies
			Steroid Myopathy
		Other Myopathies
		Generalized Myasthenia Gravis
			Lambert-Eaton Myasthenic Syndrome (LEMS)
		Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP)
	Amyotrophic Lateral Sclerosis (ALS)
	Central Nervous System Dysfunction
	References
11: Focal Limb Weakness
	Anatomy
	Shoulder Weakness
		C5–C6 Radiculopathy
		Brachial Plexopathy
	Periscapular Weakness (Scapular Winging)
		Long Thoracic Neuropathy
		Spinal Accessory Neuropathy
	Hand and Finger Weakness
		Ulnar Neuropathy
		Motor Neuron Disease
		C8–T1 Radiculopathy
		Cerebral Causes of Hand Weakness
	Wrist and Finger Drop
		Stroke
		Radial Neuropathy
		Differentiating Between Stroke and Radial Neuropathy
	Hip and Proximal Leg Weakness
		L2–L3 Radiculopathy
		Lumbosacral Plexopathy
	Foot Drop
		Peroneal Neuropathy
		Sciatic Neuropathy
		L5 Radiculopathy
		Motor Neuron Disease
		Central Nervous System Localizations
		Treating Foot Drop
	Postpartum Leg Weakness
	Hemiparesis and Hemiplegia
	Multifocal Weakness
		Vasculitic Mononeuropathy Multiplex
		Multifocal Motor Neuropathy with Conduction Block (MMNCB)
		Hereditary Neuropathy with Liability to Pressure Palsies (HNPP)
	References
12: Rapidly Progressive Weakness
	Neuromuscular Respiratory Failure
	The Initial Pattern of Weakness
	Neurologic Examination
	Diagnostic Studies
		Neuroimaging Studies
		Electromyography (EMG) and Nerve Conduction Studies (NCS)
			Demyelinating Neuropathy
			Axonal Neuropathy
			Presynaptic Neuromuscular Junction Dysfunction
			Postsynaptic Neuromuscular Junction Dysfunction
			Myopathy
		Cerebrospinal Fluid (CSF) Analysis
		Blood, Urine, and Stool Examination
	Common Causes of Acute Paralysis
		Guillain-Barre Syndrome (GBS)
		Myasthenic Crisis
		Brainstem Catastrophe
		Less Common Causes of Acute Paralysis
			Botulism
			Uncommon Polyneuropathies
		Poliomyelitis
		Spinal Cord Insults
	Difficulty Weaning from the Ventilator
		Critical Illness Polyneuropathy
		Critical Illness Myopathy
		Prolonged Neuromuscular Junction Blockade
	References
13: Parkinsonism
	History
		Age of Onset
		Pace of Onset
		Presence of Tremor
		Gait Dysfunction and Falls
		Left-Right Symmetry
		Autonomic Symptoms
		Ataxia
		Medications and Toxins
		Family History
		Dementia
		Activities of Daily Living
	Examination
		Rigidity
		Bradykinesia
		Tremor
		Gait
		Speech
		Mental Status Examination
		Eye Movements
		Orthostatic Hypotension
	Laboratory and Neuroimaging Studies
		Brain MRI
		Other Studies
	Parkinson Disease
		Treatment of Early-Stage PD
		Treatment of Intermediate-Stage PD
		Treatment of Advanced PD
		Treatment of Nonmotor Symptoms
			Depression
			Dementia
			Hallucinations and Psychosis
			Dysphagia
			Dysarthria
			Constipation
	Atypical Parkinsonism
		Progressive Supranuclear Palsy (PSP)
		Multisystem Atrophy (MSA)
		Corticobasal Ganglionic Degeneration (CBD)
	Other Causes of Parkinsonism
		Drug-Induced Parkinsonism
		Vascular Parkinsonism
	Other Extrapyramidal Disorders
	References
14: Hyperkinetic Movement Disorders
	Introduction
	Tremor
		Action Tremor
			Essential Tremor
			Wilson Disease
			Enhanced Physiologic Tremor
			Secondary Tremor
		Resting Tremor
			Parkinsonian Tremor
		Intention Tremor
			Cerebellar Outflow Tremor
		Other Tremors
			Palatal Tremor
			Dystonic Tremor
			Neuropathic Tremor
			Task-Specific Tremor
			Orthostatic Tremor
			Psychogenic Tremor
	Jerking Movements
		Myoclonus
			Toxic and Metabolic Myoclonus
			Anoxic Myoclonus
				Acute Post-anoxic Myoclonus
				Chronic Post-anoxic Myoclonus (Lance-Adams Myoclonus)
			Myoclonus Associated with Dementia
			Myoclonic Epilepsy
			Opsoclonus-Myoclonus
			Segmental Myoclonus
			Physiologic Myoclonus
			Essential Myoclonus
		Ballismus
		Tics
		Limb-Shaking Transient Ischemic Attacks
	Twitching
		Fasciculations
	Twisting and Repetitive Movements
		Chorea and Athetosis
			Huntington Disease (HD)
			Chorea Gravidarum
			Other Causes of Chorea
		Dystonia
			Cervical Dystonia (CD)
			Task-Specific (Occupational) Dystonias
	Stiffness and Cramping
		Cramps
		Stiff-Person Syndrome
		Myotonia
			Myotonic Dystrophy
			Myotonia Congenita and Paramyotonia Congenita
	Abnormal Facial Movements
		Myokymia
		Oromandibular Dystonia
		Hemifacial Spasm
	Tardive Dyskinesia (TD)
	References
15: Distal and Generalized Sensory Symptoms
	Overview of Sensory Symptoms
	Sensory System Anatomy
	Sensory Examination
		Pinprick and Temperature Sensation
		Vibratory and Joint Position Perception
		Cortical Sensory Modalities
	Polyneuropathy: Length-Dependent
	Polyneuropathy: Non-length-Dependent
	Evaluation of Polyneuropathy
		Laboratory Screening
		Electromyography (EMG) and Nerve Conduction Studies (NCS)
		Nerve Biopsy
	Etiologies of Polyneuropathy
		Diabetes Mellitus
		B12 Deficiency
		Monoclonal Gammopathy
		Vasculitis
		Ethanol
		Charcot-Marie-Tooth Disease
		HIV
		Thyroid Dysfunction
		Medication-Induced Neuropathies
		Idiopathic Polyneuropathy
	Treatment of Neuropathic Symptoms
	Other Causes of Distal Sensory Symptoms
		Spine Disease
		Plantar Fasciitis
		Tarsal Tunnel Syndrome
		Morton Neuroma
		Cramps
		Restless Legs Syndrome (RLS)
		Raynaud Phenomenon
	Generalized Pain Disorders
		Fibromyalgia
	References
16: Focal Pain Syndromes of the Extremities
	Introduction
	Shoulder and Proximal Arm Pain
		C5 Radiculopathy
		Brachial Plexopathy
			Trauma
			Cancer
			Idiopathic Brachial Neuritis
		Rotator Cuff Tendonitis
	Lateral Arm Pain
		C6 Radiculopathy
		Lateral Epicondylitis
	Medial Hand and Arm Pain
		Ulnar Neuropathy
		C8 Radiculopathy
		Lower Trunk Brachial Plexopathy
		Medial Epicondylitis
	Lateral Hand Pain
		Carpal Tunnel Syndrome (CTS)
		De Quervain’s Tenosynovitis
		Carpometacarpal (CMC) Joint Arthritis
	Thigh and Hip Pain
		L2 and L3 Radiculopathy
		Meralgia Paresthetica
		Lumbosacral Plexopathy
			Trauma
			Retroperitoneal Hematoma
			Cancer
			Diabetic Amyotrophy (Diabetic Lumbosacral Radiculoplexus Neuropathy)
			Idiopathic Lumbosacral Plexitis
		Trochanteric Bursitis
		Osteoarthritis of the Hip and Occult Hip Fracture
	Knee Pain
	General Principles of Nociceptive Pain Treatment
	Controversial Localized Pain Syndromes
		Complex Regional Pain Syndrome (CRPS)
		Myofascial Pain Syndrome
	References
17: Back Pain, Myelopathy, and Radiculopathy
	Definitions, History, and Examination
		Radiculopathy
		Myelopathy
			Cauda Equina Syndrome
	Compressive Myelopathies and Radiculopathies
		Red Flags
		Herniated Nucleus Pulposus
		Spinal Stenosis
		Neoplasm
		Epidural Abscess
	Non-compressive Myelopathies and Radiculopathies
		Transverse Myelitis and Multiple Sclerosis
		Vitamin B12 Deficiency
		Spinal Cord Infarction
		Adrenoleukodystrophy (ALD)
		Tropical Spastic Paraparesis
		Dural Arteriovenous Fistula (AVF)
		Copper Deficiency Myelopathy
		Hereditary Spastic Paraplegia (HSP)
		Inflammatory Radiculopathies (Radiculitis)
	Musculoskeletal Back Pain
		Strains and Sprains
		Vertebral Fractures
		Sacroiliac Joint Dysfunction
		Coccygodynia
	References
18: Gait Disorders
	Introduction
	Natural Gait
	Provocative Maneuvers
		Trendelenburg Sign and Gowers’ Sign
		Heel and Toe Walking
		Tandem Gait
		Stress Gait
		Pull Test
		Romberg Sign
	General Neurologic Examination
	Abnormal Gait Patterns
		Frontal Gait
		Spastic Gait
		Parkinsonian Gait
		Progressive Supranuclear Palsy (PSP) Gait
		Ataxic Gait
		Waddling Gait
		Steppage Gait
		Antalgic Gait
		Psychogenic Gait
		Multifactorial Gait Disorder
	General Recommendations for Patients with Frequent Falls
19: Headache and Facial Pain
	History
		Epidemiology
		Location
		Character
		Rapidity of Onset
		Duration
		Diurnal Variation
		Associated Symptoms
			Aura
			Other Neurologic Symptoms
			Systemic Symptoms
		Exacerbating Factors
		Alleviating Factors
		Frequency
		Severity and Disability Level
		Prior Evaluation and Treatment
	Dangerous Headaches
		Sudden-Onset Dangerous Headache Syndromes
			Subarachnoid Hemorrhage (SAH)
			Carotid Artery Dissection
			Pituitary Apoplexy
			Reversible Cerebral Vasoconstriction Syndrome (RCVS)
			Migraine
		Subacute and Chronic Dangerous Headache Syndromes
			Temporal Arteritis
			Cerebral Venous Sinus Thrombosis (CVST)
			Meningitis
			Headache Secondary to Mass Lesions
			Pseudotumor Cerebri (Idiopathic Intracranial Hypertension)
			Hypertensive Encephalopathy
	“Benign” Headaches
		Migraine Headaches
		Tension Headaches
		Trigeminal Autonomic Cephalalgias (TACs)
			Cluster Headache
			Paroxysmal Hemicrania
			Short-Lasting Unilateral Neuralgiform Headaches with Conjunctival Injection and Tearing (SUNCT)
		Visual Strain Headaches
		Medication-Related Headache
		Post-lumbar Puncture Headaches
		Spontaneous Intracranial Hypotension (SIH)
		Occipital Neuralgia
	Status Migrainosus
	Chronic Daily Headache (CDH)
	Headache in Pregnancy
	Facial Pain
		Trigeminal Neuralgia
		Glossopharyngeal Neuralgia
		Intermedius Neuralgia
		Sinus Headache
		Temporomandibular Joint (TMJ) Disease
		Herpes Zoster and Post-herpetic Neuralgia
		Atypical Facial Pain Syndrome
		Primary Headache Disorders Presenting with Facial Pain
	References
20: Seizures and Epilepsy
	The First-Time Seizure
		Ictal Semiology
			Generalized Tonic-Clonic Seizures
			Focal Seizures
			Focal Seizures with Preserved Awareness
				Motor Seizures
				Sensory Seizures
				Cognitive and Emotional Seizures
			Focal Seizures with Impaired Awareness
			Absence Seizures
			Myoclonic Seizures
			Atonic Seizures
		The Differential Diagnosis of Seizures
			Syncope
			Migraine and Transient Ischemic Attack
			Movement Disorders
			Sensory Symptoms
			Psychiatric Disorders
			Narcolepsy
		Was This Really the First Seizure?
		Determining Seizure Etiology
			Laboratory Testing
			Neuroimaging
			Electroencephalography (EEG)
		Specific Seizure and Epilepsy Etiologies
			Electrolyte Abnormalities
			Uremia and Dialysis Disequilibrium
			Glucose Imbalance
			Hepatic Encephalopathy
			Posttraumatic Seizures
			Alcohol Withdrawal
			Other Medications and Toxins
			Meningitis and Encephalitis
			Neurocysticercosis
			Neoplasms
			Stroke
			Anoxic Brain Injury
			Arteriovenous Malformations
			Neurodegenerative Diseases
			Juvenile Myoclonic Epilepsy (JME)
			Eclampsia
			Catamenial Epilepsy
			Autoimmune and Paraneoplastic Epilepsy
			Seizures of Unknown Origin
		Treatment of the First-Time Seizure
			Provoked Seizures
			The Chance of Seizure Recurrence
			Choosing an AED
				AEDs in Patients with Renal Dysfunction
			Counseling After the First Seizure
	Treatment of Epilepsy and Refractory Epilepsy
		Epilepsy Surgery
		Vagus Nerve Stimulation
	Status Epilepticus
		Step 1: Life Support
		Step 2: Abort Seizures
			Phase 1: Benzodiazepines
			Phase 2: Intravenous AEDs
			Phase 3: AEDs That Require Intubation
			Phase 4: Pentobarbital Coma
			Phase 5: Superrefractory Status Epilepticus
		Step 3: Determine the Underlying Etiology of Status Epilepticus
		Step 4: Prevent Further Episodes
	Sudden Unexpected Death in Epilepsy (SUDEP)
	Withdrawing AEDs
	References
21: Stroke
	Stroke and Transient Ischemic Attack
	Common Stroke Syndromes
		Anterior Circulation Ischemic Strokes
			Middle Cerebral Artery (MCA) Syndromes
			Anterior Cerebral Artery (ACA) Syndrome
			Internal Carotid Artery (ICA)
		Posterior Circulation Ischemic Strokes
			Wallenberg Syndrome
			Mid-basilar Artery Occlusion
			Mid-basilar Penetrating Branch Occlusion
			Rostral Basilar (“Top of the Basilar”) Occlusion
			Posterior Cerebral Artery (PCA) Infarction
			Thalamic Strokes
			Cerebellar Strokes
		Lacunar Strokes
		Intracranial Hemorrhage (ICH)
		Cerebral Venous Thrombosis
		Spinal Cord Strokes
	Stroke Mimics
		Acute Confusional State
		Focal Neuropathies
		Metabolic Insult Causing Re-expression of Old Stroke (MICROS)
		Migraine Aura
		Todd Paralysis
		Transient Global Amnesia (TGA)
		Subdural Hematoma (SDH)
		Convexal Subarachnoid Hemorrhage
		Hypoglycemia and Hyperglycemia
		Psychogenic Disorders
		Peripheral Vestibulopathy
		Bell’s Palsy
	Physical Examination
	Laboratory Studies
	Neuroimaging
		Non-contrast Head CT
		Diffusion-Weighted MRI (DWI)
		Susceptibility Images
		Vascular Imaging Studies
		CT Perfusion (CTP)
		Selecting Imaging Studies
	Hyperacute Ischemic Stroke Treatment
		Intravenous Recombinant Tissue Plasminogen Activator (rt-PA)
			Mechanical Thrombectomy
			Acute Antiplatelet Therapy
			Acute Anticoagulation
			Blood Pressure Management
		Surgical Treatment of Ischemic Stroke
			Malignant MCA Syndrome
			Cerebellar Infarction
	Inpatient Evaluation
		Cardiac Evaluation
		Vascular Evaluation
		Blood Tests
	Uncommon Causes of Stroke
	Secondary Prevention
		Antiplatelet Agents
		Anticoagulation
		Blood Pressure Control
		Hyperlipidemia
		Diabetes Mellitus
		General Lifestyle Recommendations
		Carotid Endarterectomy and Stenting
			Symptomatic Carotid Artery Stenosis
			Asymptomatic Carotid Artery Stenosis
		Other Interventions
		Supportive Care
		Treating Hyperthermia and Infection
		Correcting Hyperglycemia
		Maintaining Adequate Nutrition
		Assessing Aspiration Risk and Preventing Aspiration
		Deep Venous Thrombosis (DVT) Prophylaxis
		Preventing Falls
		Initiating a Rehabilitation Program
	Evaluation and Treatment of Intracranial Hemorrhage
		Acute Life Support
		Reversing Anticoagulation
			Warfarin
			Heparin
			Direct Oral Anticoagulants
		Blood Pressure Treatment
		Managing Increased Intracranial Pressure
		Surgical Intervention
		Defining ICH Etiology
		Prognosis of Intracranial Hemorrhage
		Restarting Anticoagulation After Intracerebral Hemorrhage
	References
22: Multiple Sclerosis
	Clinically Isolated Syndromes (CIS) Suggestive of Multiple Sclerosis
		Visual Loss
		Myelopathy
		Sensory Syndromes
		Motor Syndromes
		Diplopia
		Incoordination
		Multifocal and Progressive Presentations
		The Radiologically Isolated Syndrome
		Atypical Symptoms
	Making the Diagnosis
		Past History
		Physical Examination
		Magnetic Resonance Imaging
			T2 and FLAIR Imaging
			Contrast-Enhanced T1-Weighted Imaging
			T1 Black Holes
			Spine MRI
		Lumbar Puncture
			Basic Studies
			Oligoclonal Bands
			Visual Evoked Potentials (VEPs)
		Patience
	Differential Diagnosis
		Other Primary Demyelinating Disorders
			Neuromyelitis Optica (NMO)
			Acute Disseminated Encephalomyelitis (ADEM)
			Progressive Multifocal Leukoencephalopathy (PML)
		Secondary Demyelinating Disorders: Reasonable Exclusion of Multiple Sclerosis Mimics
	Treatment of Clinically Isolated Syndromes
		Treatment of Optic Neuritis
		Treatment of Other Clinically Isolated Syndrome Suggestive of Multiple Sclerosis
		Disease-Modifying Treatment for Patients with CIS
	Treatment of Relapsing-Remitting MS
		Treatment of MS Flares
		Interferon-β
		Glatiramer Acetate
		Natalizumab
		Fingolimod
		Dimethyl Fumarate
		Teriflunomide
		Alemtuzumab
		Ocrelizumab
		Choosing a First Disease-Modifying Therapy
		Switching Disease-Modifying Therapy
	Progressive MS and Symptomatic Treatment
		Disease-Modifying Therapy
		Symptomatic Treatment
			Spasticity
			Urinary Dysfunction
			Fatigue
			Depression and Anxiety
			Cognitive Dysfunction
			Pain and Paresthesias
			Motor Impairments
			Tonic Spasms
	Fulminant MS
	References
23: Intracranial Mass Lesions
	Introduction
	Supratentorial Masses
		Metastatic Tumors
		Gliomas
			Deterioration in Patients with Gliomas
				Glioma Recurrence and Progression
				Radiation-Induced Pseudoprogression
				Radiation Necrosis
		Meningiomas
		Primary Central Nervous System Lymphomas (PCNSL)
		Arteriovenous Malformations
		Abscesses
		Tumefactive Multiple Sclerosis
	Sellar Region Masses
	Cerebellopontine Angle (CPA) Masses
	Masses in Immunocompromised Patients
		Toxoplasmosis and Primary Central Nervous System Lymphoma
		Fungal Abscesses
	Masses in Patients from the Tropics and Developing World
		Neurocysticercosis
		Tuberculoma
	References
Index