Clinical Adult Neurology-xh

495 Pages·2008·8.57 MB·English

by  Jody Corey-Bloom

D C T H IrD eD I T IoN
CliniCal adult
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Neurolo gy B C l i n iC a l a du lt
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T H IrD eD I T IoN
N e u ro l o g y
A Highly Illustrated and Concise Approach to Adult Neurology
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Clinical Adult Neurology provides clinicians and residents with an accessible and concise guide to
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the diagnosis and treatment of the most commonly seen neurologic disorders.
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Organized by disease, this easy-to-use and extensively illustrated reference includes hundreds
of diagnostic tools that guide physicians through clinical decision making and optimal patient
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management.
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All aspects of the neurologic evaluation are covered in the first section, followed by a catalog of a
common clinical problems and strategies for evaluating, managing, and treating them. The final
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section illustrates the spectrum of specific neurologic diseases and disorders. The new edition of
Clinical Adult Neurology is state-of-the-art and current with a focus in adult neurology and clinical
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tools and guidelines that today’s busy practitioners need.
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OUTSTANDING DIAGNOSTIC TOOLS u
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Get on-the-spot answers to clinical questions
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• Features Tables—provide diagnostic help in recognizing the hallmarks of particular neurologic

diseases n
• Pearls and Perils boxes – offer short distillations of clinical wisdom from leading experts
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• Key Clinical Questions boxes—help clinicians frame patient diagnosis and management u
• Consider Consultation When boxes—supply guidelines for referral
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• Annotated Bibliographies—highlight the most important references for further study o
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The new third edition of Clinical Adult Neurology is a great desk reference and an excellent clinical
companion for bedside and office decision-making.
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y
ISBN-13: 978-1-933864-35-8
ISBN-10: 1-933864-35-4
90000
eDITeD B y JoDy Corey-Bloom WITH roNAlD B. DAVID
386 Park Avenue South, Suite 301
New York, NY 10016
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Neurology 00:Layout 1 3/5/09 11:18 AM Page i
Clinical Adult Neurology
Third Edition
Editedby
JodyCorey-Bloom,MD,PhD
ProfessorofNeurosciences
DepartmentofNeurosciences
UniversityofCalifornia,SanDiego
LaJolla,California
with
RonaldB.David,MD
AttendingPhysician
DepartmentofPediatrics
St.Mary’sHospital
AssociateClinicalProfessor
DepartmentofPediatrics
VirginiaCommonwealthUniversitySchoolofMedicine
Richmond,Virginia
NewYork
Neurology 00:Layout 1 3/5/09 11:18 AM Page ii
AcquisitionsEditor:R.CraigPercy
CoverDesign:AmyNordin
Copyeditor:JoannWoy
Compositor:PatriciaWallenburg
Printer:BangPrinting
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LibraryofCongressCataloging-in-PublicationData
Clinicaladultneurology/editedbyJodyCorey-Bloom,withRonaldB.David.—3rded.
p.;cm.
Rev.ed.of:Adultneurology/editedbyJodyCorey-Bloom.2nded.2005.
Includesbibliographicalreferencesandindex.
ISBN-13:978-1-933864-35-8(hardcover:alk.paper)
ISBN-10:1-933864-35-4(hardcover:alk.paper)
1. Neurology.2. Nervoussystem—Diseases. I.Corey-Bloom,Jody.II.David,RonaldB.III.Adultneurology.
[DNLM:1. NervousSystemDiseases—diagnosis.2. NervousSystemDiseases—therapy.3. NeurologicManifestations.
WL140C63952009]
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Contents
Foreword v
Preface vii
Contributors ix
(cid:2) I AdultNeurologicExamination
1. TheNeurologicHistoryandExaminationoftheAdult 3
DouglasGalasko
2. ElectroencephalographyandEvokedPotentialStudies 15
JosephDrazkowskiandEliS.Neiman
3. ElectrodiagnosisofNeuromuscularDisease 37
J.RobinsonSingleton,JamesW.Russell,andEvaL.Feldman
4. Neuroradiology:DiagnosticImagingStudies 53
StevenG.Imbesi
(cid:2) II CommonProblemsinAdultNeurology
5. SyncopeandSeizures 81
AndrewD.Massey
6. VertigoandOtherFormsofDizziness 93
DouglasJ.Lanska
7. DisordersofGait 113
StephenJ.Ryan
8. Headaches 123
JohnT.SlevinandMelodyRyan
9. Pain 149
ThomasC.Chelimsky
10. SleepDisorders 167
RuzicaKovacevic-RistanovicandTomaszJ.Kuzniar
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iv Contents
11. AcuteConfusionalStates 185
DouglasJ.Lanska
12. Dementia 201
DouglasJ.Lanska
13. Coma 213
JosephR.Berger
14. TheEpilepsies 229
EvelynS.TecomaandJodyCorey-Bloom
(cid:2) III NeurologicDiseasesandDisorders
15. VascularDisease 259
RichardM.ZweiflerandJohnF.Rothrock
16. TraumaticInjuriesoftheCentralNervousSystem 271
LawrenceF.Marshall
17. MovementDisorders 285
SithSathornsumeteeandMarkA.Stacy
18. NeuromuscularDiseases 307
NayanP.DesaiandRichardK.Olney
19. InfectionsoftheNervousSystem 335
AnitaKoshyandCherylA.Jay
20. DemyelinatingDiseases 363
EdwardKim,Michelek.Mass,RuthH.Whitham,andDennisN.Bourdette
21. NeoplasticDiseases 377
MarcC.Chamberlain
22. DementingandDegenerativeDisorders 395
MichaelS.Rafii,RonaldJ.Ellis,andJodyCorey-Bloom
23. SystemicDiseases 419
StephanieLessigandJodyCorey-Bloom
Bibliography 443
Index 465
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Foreword
Traditionaltextbooksconveyknowledge.Itisthegoalof Areviewofthemostenduringhierarchicalclassification
thistexttoconveynotonlyessentialknowledge,butalso systems,particularlythatofLinnaeus(thatis,phyla,gen-
the collected wisdom of its many highly regarded con- era,species),makesclearthevalueofgroupingaccording
tributors.Thisvolumeisdividedintothreesections: todiscriminatingfeatures,aswellasthevalueofsimplic-
ity,expandability,anddynamism.
AdultNeurologicExamination The goal, whatever the classification system, is to
(cid:2)
CommonProblemsinAdultNeurology seek the most powerful discriminating features that will
(cid:2)
NeurologicDiseasesandDisorders producethegreatestdiagnosticclarity.Discriminatingfea-
(cid:2)
turesshouldavoidcrossingdomains.Muchoftheconfu-
Also included to facilitate a physician’s use of this sion that arises in diagnosis may be the result of the
bookare: clinicianwhounwittinglycrossestheanatomic,pathologic,
pathophysiologic, phenomenologic, and etiologic classifi-
Nosologicdiagnosistables cation domains used in medicine (for example, the inclu-
(cid:2)
“PearlsandPerils”boxes sionofanatomically-oriented“temporallobeseizures”in
(cid:2)
“ConsiderConsultationWhen...”boxes a phenomenologically based classification system that in-
(cid:2)
“KeyClinicalQuestions”boxes cludescomplexpartialseizures).Someconditions,suchas
(cid:2)
Selectedannotatedbibliographies braintumors,areclassifiedaccordingtotheirhistopathol-
(cid:2)
Acompletebibliography ogyandlendthemselveswelltothisclassificationsystem.
(cid:2)
Others, such as headaches and movement disorders, are
The nosologic diagnosis tables are based on a dis- classifiedphenomenologicallyandarethereforemuchless
criminator model to promote clearer understanding and easily classified. In other cases, discriminators must en-
are superior to a criterion-based model and others that compassinclusionaryaswellasexclusionaryfeatures.At
lacksimilarspecificity. times, we can only use a criterion-based system or con-
structtablestocomparefeatures.
Whoeverhavingundertakentospeakorwrite Arbitrarily, we label as consistent features those
hath first laid for themselves some [basis] to whichoccurmorethan75%ofthetime;featuresarecon-
theirargumentsuchashotorcoldormoistor sidered variable when they occur less than 75% of the
dryorwhateverelsetheychoose,thusreduc- time. The diagnostic tables should be viewed, therefore,
ingtheirsubjectwithinanarrowcompass. only as a beginning in the extremely difficult effort to
—Hippocrates makediagnosismorepreciseandbiologicallybased.How
well this book accomplishes the goals of identifying the
AsHippocrateshassuggested,structureisthekeyto most powerful discrimination features for maximum di-
learning. Unless there is a structure onto which knowl- agnostic clarity is limited by the current state of the art.
edge can be built, confusion and disorganization are the In some areas, several features, when clustered together,
inevitableconsequences. servetodiscriminate.
Classification systems induce orderliness in think- Thistextisdesignedtobepithy,notexhaustive,as
ing and enhance our ability to communicate effectively. therearealreadymanyavailableofthisilk.
v
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vi Foreword
This text is therefore in no way a singular effort est wish that this text reside on your desk, rather than
and reflects the expertise of all who contributed in so yourbookshelf.
many different ways and it is my hope that this is re-
flectedinthequalityoftheeffort.Itisthereforemyfond- RonaldB.David,MD
Neurology 00:Layout 1 3/5/09 11:18 AM Page vii
Preface
Manyofthecontributorstothisbookarerecognizedau- ofmedicalproblems.Someinstrumentstoaidinthisen-
thorities in their fields but were asked to participate be- deavorwerefirstpioneeredbyDr.RonaldDavid,theSe-
cause of their ability to meld their knowledge of a ries Editor, in his volume on Pediatric Neurology. They
discipline with practical clinical experience. I would be include the “Features Table” which attempts to capture
highlyremissifIdidnotacknowledgetheirextraordinary the discriminating, consistent and variable features of a
contributionstothiseffort. disease.Likewise,the“PearlsandPerils”boxemphasizes
SectionIofthisbookoffersanorganizeddiscussion essences of a diagnosis in addition to some of the possi-
oftheadultneurologicalevaluationincludingthehistory ble covert traps. “Consider Consultation When” should
andexamination,electrophysiologicalstudiesandneuro- provide physicians with helpful guidelines for referral;
radiology.SectionIIcoverscommonclinicalproblemsin “KeyClinicalQuestions”steerstheclinicianinhisthink-
neurology and ways of evaluating, managing, and treat- ingandhistorytaking.
ing them. Section III illustrates the spectrum of specific Itismyhopethatyoufindthechaptersinthisbook
neurologicdiseasesanddisorders. bothcomprehensiveandpracticalandthatClinicalAdult
One of my motivations for editing this book was Neurology quickly becomes indispensable reference in
theopportunitytoprovidephysiciansinvolvedinthepri- yourbedsideandofficedecision-making.
marycareofpatientswithamethodicalyetsuccinctguide
toneurologicdisease.Clearly,thesearetimesthatrequire JodyCorey-Bloom
a well-rationed, yet efficient, approach to the diagnosis
vii
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Contributors
JosephR.Berger,MD JosephDrazkowski,MD
RuthL.WorksProfessorandChairman Director,EEGLab
DepartmentofNeurology DepartmentofNeurology
UniversityofKentucky MayoClinicArizona
Lexington,Kentucky Phoenix,Arizona
DennisN.Bourdette,MD RonaldJ.Ellis,MD,PhD
ChairandRoyandEulaliaSwankFamilyResearch AssociateProfessor
Professor DepartmentofNeurosciences
DepartmentofNeurology UniversityofCalifornia,SanDiego
OregonHealthandScienceUniversity SanDiego,California
Portland,Oregon
EvaL.Feldman,MD,PhD
MarcC.Chamberlain,MD RussellN.DeJongProfessor
DirectorandProfessor Director,JDRFCenterfortheStudyofComplications
DepartmentsofNeuro-OncologyandNeurology inDiabetes
SeattleCancerCareAlliance Director,ALSClinic
Seattle,Washington DepartmentofNeurology
UniversityofMichigan
ThomasC.Chelimsky,MD AnnArbor,Michigan
ProfessorofNeurology,AnesthesiaandPediatrics
DepartmentofNeurology DouglasGalasko,MB,BCh
CaseWesternReserveUniversityandMedicalCenter Professor
Cleveland,Ohio DepartmentofNeurosciences
UniversityofCalifornia,SanDiego
JodyCorey-Bloom,MD,PhD SanDiego,California
ProfessorofNeurosciences
DepartmentofNeurosciences StevenG.Imbesi,MD
UniversityofCalifornia,SanDiego Professor
LaJolla,California RadiologyandNeurosurgery
DepartmentofRadiology
NayanP.Desai,MD UniversityofCalifornia,SanDiego
Neurologist SanDiego,California
DepartmentofNeurology
PaloAltoMedicalFoundation
Fremont,California
ix
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x Contributors
CherylA.Jay,MD MicheleK.Mass,MD
ClinicalProfessor AssociateProfessor
DepartmentofNeurology DepartmentofNeurology
UniversityofCalifornia,SanFrancisco OregonHealthandScienceUniversity
SanFrancisco,California Portland,Oregon
EdwardKim,MD AndrewD.Massey,MD
Instructor AssociateProfessor
DepartmentofNeurology DepartmentofInternalMedicine
OregonHealthandScienceUniversity KansasUniversitySchoolofMedicine,Wichita
Portland,Oregon Wichita,Kansas
AnitaA.Koshy,MD EliS.Neiman,DO
PostdoctoralFellow DepartmentofNeurology
DepartmentsofMicrobiologyandImmunology,and NewJerseyNeurologicalInstitute
Medicine Edison,NewJersey
StanfordUniversitySchoolofMedicine
Stanford,California RichardK.Olney,MD
Professor
RuzicaKovacevic-Ristanovic,MD DepartmentofNeurology
AssociateProfessor UniversityofCalifornia,SanFrancisco
NorthwesternUniversityFeinbergSchoolofMedicine SanFrancisco,California
DepartmentofNeurology
EvanstonNorthwesternHealthcare MichaelS.Rafii,MD,PhD
Evanston,Illinois AssistantProfessor
DepartmentofNeurosciences
TomaszJ.Kuzniar,MD,PhD UniversityofCalifornia,SanDiego
AssistantProfessor LaJolla,California
NorthwesternUniversityFeinbergSchoolofMedicine
DivisionofPulmonaryandCriticalCareMedicine JohnF.Rothrock,MD
EvanstonNorthwesternHealthcare ProfessorandViceChair
Evanston,Illinois DepartmentofNeurology
UniversityofAlabamaatBirmingham
DouglasJ.Lanska,MD,MS,MSPH Birmingham,Alabama
Neurologist
DepartmentofMedicineService JamesW.Russell,MD,MS,FRCP
VeteransAdministrationMedicalCenter AssociateProfessor
Tomah,Wisconsin DepartmentofNeurology
ProfessorofNeurology UniversityofMarylandSchoolofMedicine
DepartmentofNeurology Baltimore,Maryland
UniversityofWisconsinSchoolofMedicineandPublic
Health MelodyRyan,PharmD,MPH
Madison,Wisconsin AssociateProfessor
DepartmentsofPharmacyPracticeandScience,and
StephanieLessig,MD Neurology
AssistantClinicalProfessor UniversityofKentucky
DepartmentofNeurosciences Lexington,Kentucky
UniversityofCalifornia,SanDiego
SanDiego,California StephenJ.Ryan,MD,MA
AssociateProfessor
LawrenceF.Marshall,MD DepartmentofNeurology
ProfessorandChiefofNeurosurgicalServices UniversityofKentucky
UniversityofCalifornia,SanDiego Lexington,Kentucky
SanDiego,California