Netter's Concise Neurology

177 Pages·2016·123.12 MB·English

by  Misulis K.E.

KARL E. MISULIS ANDTHOMAS C. HEAD
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Netter's Neurology
H. Royden Jones, MD
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Netter's Concise Neurology
Karl E. Misulis, MD, PhD
Thomas C. Head, MD
lllustrations by Frank H. Netter, MD
Contributing lllustrators
John A. Craig, MD
Carlos A. G. Machado, MD
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S CONCISE NEUROLOGY ISBN- I 3 : 97 A-1 -929007 -89-9
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Co?fight c 2007 by Saunders, an imprint of Elsevier Inc.
All ridrts reserved. No part of this book may be produced or transmifted in any form or by any means,
::cronic or mechanical, including photocopying, recording or any information storage and retrieval system,
;.-:nout permission in writing from the publishers. Permissions for Netter Art figures may be sought directly from
i.se',ier's Health Science Licensing Department in Philadelphia PA" USA: phone l-800-525-1649, ext.3276 or
215\ 239-3276; or email [email protected].
Notice
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate.
Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the
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and duration of administration, and contraindications. lt is the responsibility of the practitioner, relying on
their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best
treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of
the law neither the Publisher nor the Authors assume any liability for any injury and/or damage to persons
or propefty arising out of or related to any use o{ the material contained in this book.
The Publisher
Library ol Congress Cataloging-in-Publication Data
Misulis, Karl E.
Netter's concise neurology / Karl E. Misulis, Thomas C. Head ; illustrations by Frank H. Netter ; contributing
illustrators, John A. Craig, Carlos A. C- Machado.
p. ; cm.
ISBN-l 3: 978-l -929007-89-9
ISBN- f 0: 1-929OO7-A9-2
l. Nervous system-Diseases-Handbooks, manuals, etc. 2. Nervous system-Diseases-Atlases. l. Head,
Thomas C. (Thomas Channing), 1963- ll. Netter, Frank H. (Frank Henry), 1906-1991. lll. Title.
lV. Title: Concise neurology.
[DNLM: I. Nervous System Diseases-diagnosis-Handbooks. 2. Diagnosis, Differential-Handbooks.
3. Nervous System Diseases-therapy-Handbooks. 4. Neurologic Examination-methods-Handbooks.
WL 39 M678na 20071
RC555.M57 2007
616.8175-dc22
2006050559
Acquisitions Editor: Elyse O' Crady
Developmentol Editor: Marybeth Thiel
Publishing Services Monoger Linda Van Pelt
Ptoject Monoger: Melanie Peirson Johnstone
Design Diredion' Lou Forgione
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Printed in China
Lastdigitistheprintnumber:9 I 7 6 5 4 3 2 I
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To our mentors:
Vivian Abrahams, Russell Durkovic, Gerald Fenichel, Wolf Dettbarn, Shin Oh,
and to the memory of John Whitaker
Prefoce
Netter's Concise Neurology is the product of more than hryo years of
composition. We wrote this book to provide a helpful aid to the evaluation
and management of patients with neurologic conditions.
Neurologic diseases are often complex and there is often a broad
differential diagnosis. Therefore, diagnosis must begin with a systematic
evaluation. First localize the lesion, then narrow the differential diagnosis.
Likewise, management of neurologic disorders can be complex with multiple
options and alternative approaches. Strict protocols will never be employed
in neurology, as the field is too complex and fluid, but guidance on
approaches to management are appropriate.
Netter's Concise Neurology is divided into sections which are in order of
clinical encounter. The first section reviews the neurologic and medical
examination with a discussion of clinical implications of findings. The second
section describes an approach to specific complaints. The third section
describes important neurologic disorders with information on diagnosis,
management and clinical course.
The information is organized as tabular text enhanced by the
accompanying anatomical and clinical arhruork of Frank H. Netter, MD. Dr.
John Craig has contributed excellent new art to this work as well as adapting
some existing art along with Dr. Carlos Machado.
We hope this book will be a help to physicians in all stages of training
and practice.
Korl E. Misulis and Thomos C. Heod
PREFACE vii
Acknowledgments
The authors would like to express their appreciation to everyone who has
been involved in this book. Special thank are offered to Dr. John Craig for
wonderful artwork and to the folks at Elsevier who have done so much for
the editing, production, and promotion of the text.
The authors would also like to acknowledge those who have shaped our
knowledge, practice style, and teaching style: teachers, colleagues, students,
and friends.
ACKNOWLEDCMENTS ix
About the Authors
Karl E. Misulis, MD, PhD is Clinical Professor of Neurology at Vanderbilt
University and Neurologist at the Semmes-Murphey Clinic in Jackson,
Tennessee. He received his BSc from Queen's University (Canada), MD from
Vanderbilt University, and PhD from State University of New York Health
Sciences Center at Syracuse. He is the author of l6 books and has
contributed chapters to many others. Dr. Misulis lectures extensively to
practicing physicians, medical students, residents, fellows, and patient groups.
His lecture style derives, in part, from his experience as a stand-up comedian.
He is the keyboardist for the charity rock band, Heorts & Minds.
Thomas C. Head, MD is Neurologist at the Semmes-Murphey Clinic in
Jackson, Tennessee. A former student and faculty member at University of
Alabama, Birmingham, he has extensive experience in general neurology and
neuromuscular disease. Having taught at all levels of medicine, from medical
students to practicing physicians, Dr. Head is a sought after speaker for his
authoritative information and dynamic style. This is his second collaboration
with Karl Misulis, having co-authored Essentiols of Clinicol Neurophysiology
3rd edition (Elsevier). He performs percussion and vocals for the charity rock
band, Heorts & Minds.
ABOUT THE AUTHORS xi
Fronk H. Netter, MD
Frank H. Netter was born in 1906, in New York City. He studied art at the Art
Student's League and the National Academy of Design before entering
medical school at New York University, where he received his MD degree
in 1931. During his student years, Dr. Netter's notebook sketches attracted
the attention of the medical faculty and other physicians, allowing him to
augment his income by illustrating articles and textbooks. He continued
illustrating as a sideline after establishing a surgical practice in 1933, but he
ultimately opted to give up his practice in favor of a full-time commitment to
art. After service in the United States Army during World War ll, Dr. Netter
began his long collaboration with the CIBA Pharmaceutical Company (now
Novartis Pharmaceuticals). This 45-year partnership resulted in the
production of the extraordinary collection of medical art so familiar to
physicians and other medical professionals worldwide.
lcon Learning Systems acquired the Netter Collection in July 2000 and
continued to update Dr. Netter's original paintings and to add newly
commissioned paintings by artists trained in the style of Dr. Netter. ln 2005,
Elsevier, lnc. purchased the Netter Collection and all publications from lcon
Learning Systems. There are now over 50 publications featuring the art of
Dr. Netter available through Elsevier, lnc.
Dr. Netter's works are among the finest examples of the use of illustration
in the teaching of medical concepts. The l3-book Netter Collection of
Medicol illustrqtions, which includes the greater part of the more than
20,000 paintings created by Dr. Netter, became and remains one of the most
famous medical works ever published. The Netter Atlas of Humon Anotomy,
first published in 1989, presents the anatomical paintings from the Netter
Collection. Now translated into I6 languages, it is the anatomy atlas of
choice among medical and health professions students the world over.
The Netter illustrations are appreciated not only for their aesthetic
qualities, but, more importantly, for their intellectual content. As Dr. Netter
wrote in 1949,"... clarification of a subject is the aim and goal of illustration.
No matter how beautifully painted, how delicately and subtly rendered a
subject may be, it is of little value as a medical illustration if it does not
serve to make clear some medical point." Dr. Netter's planning, conception,
point of view, and approach are what inform his paintings and what make
them so intellectually valuable.
Frank H. Netter, MD, physician and artist, died in 1991.
FRANK H. NETTER, A/D xiii
Toble of Contents
i
I
I
i @ Evqluqtion
I
History 2
Mental Status Examination 5
Language Examination 7
Cranial Nerve Examination 9
It
Cranial Nerve FXll Functions
II
Cranial Nerves FXll Function Testing
Cranial Nerves l-xll Test Findings and lmplications t5
l7
Eye Examination
Motor Examination 2t
Sensory Examination 21
Coordination Examination 26
Cait Examination 28
Reflex Examination 50
Reflex Examination-Tendon t2
Reflex Examination-Pathologic t4
Medical Examination 55
&
Diognosis 39
Approach to Diagnosis 40
Neurodiagnostic Tests Used for Evaluation 42
Brain and Spine lmaging 44
Vascular lmaging 46
Clinical Neurophysiology 50
Lumbar Puncture 34
Mental Status Change: Approach 56
Mental Status: Delirium 60
Mental Status: Dementia 65
Mental Status: Coma 70
Mental Status: Brain Death 7li
Cranial Nerve Dysfunction 78
Ataxia: Approach 8l
Ataxia: cait and Limb 8I
Episodic Disorders: Approach 85
Episodic Disorders: Syncope 88
Episodic Disorders: Seizures 90
Headache 92
Weakness 97
Sensation: Cutaneous Sensory Deficit l02
Sensation: Vision t07
Tremor r09
lll
Rigidity and Stiffness
ItI
Hyperkinetic Disorders
+3 Disorders 1L5
DISORDERS_MENTAL SIATUS
tt6
Dementia Overview
rt8
Alzheimer's Disease
Mild Cognitive lmpairment t20
XY