Neurology at the Bedside

Foreword
Foreword
Abbreviations
1: What to Expect from This Book (and What Not to)
2: Clinical History and Neuroanatomy: “Where Is the Lesion?”
	2.1	 Muscle
	2.2	 Neuromuscular Junction
	2.3	 Peripheral Nerves, the Plexus, and Spinal Nerve Roots
		2.3.1	 Peripheral Nerves
			2.3.1.1	 Mononeuropathies of the Upper Extremities
			2.3.1.2	 Mononeuropathies of the Lower Extremities
		2.3.2	 Brachial Plexus and Lumbosacral Plexus
		2.3.3	 Spinal Nerve Roots
	2.4	 Spinal Cord
		2.4.1	 Complete or Near-Complete Transection of the Spinal Cord
		2.4.2	 Brown-Séquard Syndrome
		2.4.3	 Anterior Cord Syndrome
		2.4.4	 Dorsal Cord Syndrome
		2.4.5	 Syringomyelia
		2.4.6	 Central Cord Syndrome
		2.4.7	 Conus Medullaris Syndrome
	2.5	 Brainstem
	2.6	 Cranial Nerves
		2.6.1	 Olfactory Nerve
		2.6.2	 Optic Nerve
		2.6.3	 Oculomotor Nerve, Trochlear Nerve, Abducens Nerve
			2.6.3.1	 Supranuclear, Infranuclear, and Nuclear Dysfunction of Eye Movements
			2.6.3.2	 Oculomotor Nerve
			2.6.3.3	 Trochlear Nerve
			2.6.3.4	 Abducens Nerve
			2.6.3.5	 Horner’s Syndrome
		2.6.4	 Trigeminal Nerve
		2.6.5	 Facial Nerve
		2.6.6	 Vestibulocochlear Nerve
		2.6.7	 Glossopharyngeal Nerve
		2.6.8	 Vagus Nerve
		2.6.9	 Spinal Accessory Nerve
		2.6.10	 Hypoglossal Nerve
	2.7	 Cerebellum
	2.8	 Subcortical Gray Matter
		2.8.1	 Basal Ganglia
		2.8.2	 Diencephalon
			2.8.2.1	 Hypothalamus
			2.8.2.2	 Thalamus
	2.9	 Subcortical White Matter
	2.10	 Cortex
		2.10.1	 Frontal Lobes
		2.10.2	 Temporal Lobes
		2.10.3	 Parietal Lobes
		2.10.4	 Occipital Lobes
	2.11	 Cerebrovascular System
		2.11.1	 Anterior Circulation
		2.11.2	 Posterior Circulation
	2.12	 The Healthy Brain
	References and Suggested Reading
3: Neurological Bedside Examination: “Can I Confirm My Anatomical Hypothesis?”
	3.1	 Cognitive and Mental Functions
		3.1.1	 The History as Part of the Cognitive Examination
			3.1.1.1	 Cognitive Symptoms
			3.1.1.2	 Mental Functions
			3.1.1.3	 Onset and Progression
			3.1.1.4	 Past Medical History
			3.1.1.5	 Family History
			3.1.1.6	 Activities of Daily Living, Social Consequences, and Driving
		3.1.2	 Bedside Examination of Mental and Cognitive Functions
		3.1.3	 General Neurological Examination in the Cognitively Impaired Patient
	3.2	 Cranial Nerves
	3.3	 Motor Function
	3.4	 Sensory Function
	3.5	 Cerebellar Function
	3.6	 Gait
	3.7	 System Overview
	3.8	 Examination of the Comatose Patient
		3.8.1	 Verification and Quantification of Unconsciousness
		3.8.2	 Assessment of Neurological Deficits, in Particular Signs of Brainstem Injury
		3.8.3	 Neurological Causes for Coma
		3.8.4	 Coma, Vegetative, and Minimal Conscious States
		3.8.5	 Prognostication of Neurological Outcome Following Cardiac Arrest
		3.8.6	 Diagnosis of Brain Death
	3.9	 Examination of the Patient with an Acute Ischemic Stroke
	3.10	 Examination of the Patient with an Epileptic Seizure
		3.10.1	 Taking the History of a Patient with a Seizure
		3.10.2	 The Examination and Management of a Patient with a Seizure
	3.11	 Examination of the Patient with Functional/Nonorganic Deficits
	References and Suggested Reading
4: Differential Diagnosis: “What Is the Lesion?”
	4.1	 Introduction to Heuristic Neurological Reasoning
	4.2	 The Differential Diagnosis of Coma
		4.2.1	 Structural Causes of Coma
		4.2.2	 Nonstructural Causes of Coma
	4.3	 The Differential Diagnosis of Traumatic Brain Injury
		4.3.1	 Assessing the Need for Observation and Imaging in Closed Head Injury
	4.4	 The Differential Diagnosis of Headache
		4.4.1	 Primary Headache Syndromes
		4.4.2	 Symptomatic Headaches
	4.5	 The Differential Diagnosis of Cognitive Impairment and Dementia
		4.5.1	 Potentially Reversible Conditions
		4.5.2	 The Amnestic Syndrome
			4.5.2.1	 Transient
			4.5.2.2	 Chronic
		4.5.3	 Chronic Dementia Disorders
		4.5.4	 Rapidly Progressive Dementias
	4.6	 The Differential Diagnosis of Encephalopathy
	4.7	 The Differential Diagnosis of Epilepsy
		4.7.1	 Practical Clinical Definition of Epilepsy
		4.7.2	 Epileptic Seizures
		4.7.3	 Epileptic Syndromes
		4.7.4	 Status Epilepticus
	4.8	 The Differential Diagnosis of Nonepileptic Seizures, Blackouts, and Drop Attacks
	4.9	 The Differential Diagnosis of Vertigo and Dizziness
		4.9.1	 Vertigo of Central Origin
		4.9.2	 Vertigo of Peripheral Origin
		4.9.3	 Dizziness and Light-Headedness
	4.10	 The Differential Diagnosis of Sleep Disorders
	4.11	 The Differential Diagnosis of TIA and Stroke
		4.11.1	 Ischemic Stroke: Clinical Presentation and Classification
		4.11.2	 Space-Occupying Ischemic Stroke
		4.11.3	 Transitory Ischemic Attacks: Definitions and Risk Assessment
		4.11.4	 Rare Causes of Ischemic Stroke and Transitory Ischemic Attacks
		4.11.5	 Ischemic Stroke Mimics
		4.11.6	 Hemorrhagic Stroke
		4.11.7	 Subarachnoid Hemorrhage
	4.12	 The Differential Diagnosis of Demyelinating Disorders
		4.12.1	 Multiple Sclerosis
		4.12.2	 Other Forms of Demyelinating Disease and Related Conditions
	4.13	 The Differential Diagnosis of Infectious Diseases
		4.13.1	 Viral Infections
		4.13.2	 Bacterial Infections
		4.13.3	 Infections Due to Parasites, Fungi, and Prions
	4.14	 The Differential Diagnosis of Malignancy, Including Paraneoplastic Conditions
		4.14.1	 Primary Tumors of the CNS and PNS and Secondary Malignancies
		4.14.2	 Paraneoplastic Conditions
	4.15	 The Differential Diagnosis of Movement Disorders
		4.15.1	 Hypokinetic Movement Disorders (Parkinsonism)
		4.15.2	 Hyperkinetic Movement Disorders
	4.16	 The Differential Diagnosis of Ataxia
	4.17	 The Differential Diagnosis of Gait Disorders
	4.18	 The Differential Diagnosis of Cranial Nerve Deficits
	4.19	 The Differential Diagnosis of Myelopathy
	4.20	 The Differential Diagnosis of Motor Neuron Disease
		4.20.1	 Amyotrophic Lateral Sclerosis
		4.20.2	 Other Motor Neuron Diseases
	4.21	 The Differential Diagnosis of Peripheral Nerve Disorders
		4.21.1	 Algorithm for Evaluation of Polyneuropathies
	4.22	 The Differential Diagnosis of Neuromuscular Junction Disorders
		4.22.1	 Myasthenia Gravis
		4.22.2	 Other Neuromuscular Junction Disorders
	4.23	 The Differential Diagnosis of Myopathy
		4.23.1	 Acquired Myopathies
		4.23.2	 Genetic Myopathies
	References and Suggested Reading
5: Ancillary Investigations
	5.1	 Neuroimaging
		5.1.1	 Computer Tomography (CT)
		5.1.2	 Positron Emission Tomography (PET)
		5.1.3	 Single Photon Emission Computed Tomography (SPECT)
		5.1.4	 Magnetic Resonance Imaging (MRI)
	5.2	 Electroencephalography (EEG)
	5.3	 Electromyography (EMG) and Nerve Conduction Studies (NCS)
		5.3.1	 EMG
		5.3.2	 NCS
		5.3.3	 Electrodiagnostic Findings in Selected Neuromuscular Disorders
			5.3.3.1	 Spinal Radiculopathy
			5.3.3.2	 Plexus Lesions
			5.3.3.3	 Axonal Polyneuropathy
			5.3.3.4	 Demyelinating Polyneuropathy
			5.3.3.5	 GBS (Acute Inflammatory Demyelinating Polyradiculoneuropathy, AIDP)
			5.3.3.6	 CIDP
			5.3.3.7	 Multifocal Motor Neuropathy with Conduction Block (MMNCB)
			5.3.3.8	 Polyneuropathy Associated with Anti-MAG IgM Antibodies
			5.3.3.9	 MND (ALS)
			5.3.3.10	 MG
			5.3.3.11	 Lambert-Eaton Myasthenic Syndrome (LEMS)
			5.3.3.12	 Inflammatory Myositis (Polymyositis, IBM)
			5.3.3.13	 Noninflammatory Myopathies
	5.4	 Other Neuroelectrophysiological Investigations
		5.4.1	 Evoked Potentials
		5.4.2	 Evaluation of the Autonomic Nervous System
		5.4.3	 Polysomnography and Other Studies of Sleep
	5.5	 Ultrasound of the Cerebral Vessels and the Heart
	5.6	 Lumbar Puncture
	5.7	 Neurogenetics
		5.7.1	 Basic Neurogenetics
		5.7.2	 Genetic Testing
	5.8	 Other Tests
		5.8.1	 Blood and Urine Chemistry
		5.8.2	 Tissue Biopsies
		5.8.3	 Formal Neuropsychological Examination
	References and Suggested Reading
6: Treatment of Neurological Disorders
	6.1	 Coma and Acute Encephalopathies
	6.2	 Headache
	6.3	 Cognitive Impairment and Dementia
	6.4	 Epilepsy
		6.4.1	 General Aspects
		6.4.2	 Status Epilepticus
		6.4.3	 Antiepileptic Drugs (AED)
		6.4.4	 Epilepsy and Mood Disorders
		6.4.5	 Options for Patients with Medically Refractory Seizures
			6.4.5.1	 Epilepsy Surgery
			6.4.5.2	 Vagus Nerve Stimulation
			6.4.5.3	 Ketogenic Diet
			6.4.5.4	 Deep Brain Stimulation (DBS)
	6.5	 Sleep Disorders
	6.6	 Cerebrovascular Disorders
		6.6.1	 Intravenous Thrombolysis (IVT)
		6.6.2	 Endovascular Therapy (EVT) for Acute Ischemic Stroke
		6.6.3	 Surgical Decompression for Space-Occupying Ischemic Stroke
		6.6.4	 Arterial Dissection
		6.6.5	 Symptomatic Treatment of Ischemic Stroke
		6.6.6	 Secondary Prevention of Ischemic Stroke
		6.6.7	 Cerebral Venous Sinus Thrombosis
		6.6.8	 Spontaneous Intracranial Hemorrhage and Bleedings Associated with Vascular Malformations
		6.6.9	 Unruptured Intracranial Aneurysms
	6.7	 Multiple Sclerosis and Other Neuroinflammatory Disorders
	6.8	 Infectious Diseases
	6.9	 Parkinson’s Disease
	6.10	 Non-parkinsonian Movement Disorders
	6.11	 Cranial Neuropathies and Related Conditions
	6.12	 Autonomic Dysreflexia with Spinal Cord Injury
	6.13	 Neuromuscular Disorders
		6.13.1	 Motor Neuron Diseases and Peripheral Neuropathies
			6.13.1.1	 Amyotrophic Lateral Sclerosis
			6.13.1.2	 Peripheral Nerve Disorders
			6.13.1.3	 Peripheral Neuropathic Pain
			6.13.1.4	 Central Neuropathic Pain
		6.13.2	 Neuromuscular Junction Disorders and Myopathies
			6.13.2.1	 Myasthenia Gravis (MG)
			6.13.2.2	 Lambert-Eaton Myasthenic Syndrome (LEMS)
			6.13.2.3	 Neuromyotonia (Isaacs Syndrome)
			6.13.2.4	 Muscle Cramps
			6.13.2.5	 Myopathies
	References and Suggested Reading
Index