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H
O
OUSE FFICER
S E R I E S
Weiner & Levitt’s
Pediatric Neurology
FOURTH EDITION
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The House Officer Series is based on Weiner and Levitt’s Neurology for the
House Officer, first published in 1973.
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H
O
OUSE FFICER
S E R I E S
Weiner & Levitt’s
Pediatric Neurology
FOURTH EDITION
Michael E. Cohen, M.D.
Professor of Neurology and Pediatrics
The Children’s Hospital of Buffalo
State University of New York at Buffalo
Buffalo, New York
Patricia K. Duffner, M.D.
Professor of Neurology and Pediatrics
The Children’s Hospital of Buffalo
State University of New York at Buffalo
Buffalo, New York
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Acquisitions Editor:Charles W. Mitchell
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Production Editor:Christiana Sahl
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©2003 by LIPPINCOTT WILLIAMS & WILKINS
530 Walnut Street
Philadelphia, PA 19106 USA
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All rights reserved. This book is protected by copyright. No part of this book may be repro-
duced in any form or by any means, including photocopying, or utilized by any information stor-
age and retrieval system without written permission from the copyright owner, except for brief
quotations embodied in critical articles and reviews. Materials appearing in this book prepared by
individuals as part of their official duties as U.S. government employees are not covered by the
above-mentioned copyright.
Printed in the USA
Library of Congress Cataloging-in-Publication Data
Weiner & Levitt’s pediatric neurology / Michael E. Cohen . . . [et al.].—4th ed.
p. cm. — (House officer series)
Includes bibliographical references and index.
ISBN 0-7817-2931-9
1. Pediatric neurology.I. Cohen, Michael E., 1937- II. Series.
RJ486.W35 2003
618.92'8—dc21
2002043458
Care has been taken to confirm the accuracy of the information presented and to describe
generally accepted practices. However, the authors and publisher are not responsible for errors
or omissions or for any consequences from application of the information in this book and make
no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the
contents of the publication. Application of this information in a particular situation remains the pro-
fessional responsibility of the practitioner.
The authors and publisher have exerted every effort to ensure that drug selection and dosage
set forth in this text are in accordance with current recommendations and practice at the time of
publication. However, in view of ongoing research, changes in government regulations, and the
constant flow of information relating to drug therapy and drug reactions, the reader is urged to
check the package insert for each drug for any change in indications and dosage and for added
warnings and precautions. This is particularly important when the recommended agent is a new
or infrequently employed drug.
Some drugs and medical devices presented in this publication have Food and Drug Admin-
istration (FDA) clearance for limited use in restricted research settings. It is the responsibility of
the health care provider to ascertain the FDA status of each drug or device planned for use in
their clinical practice.
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Dedication
To our spouses and all the students and residents
we have been privileged to train and to interact with over the years
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Foreword
Pediatric Neurologywas an outgrowth of the companion adult man-
ual Neurology.The latter, first published in 1973, has gone through
six editions and has been translated into eight foreign languages.
Its “child,” the pediatric manual, was inspired by the late Randolph
K. Byers, a giant in the field of pediatric neurology in his genera-
tion. The pediatric manual was first published in 1977 with the in-
valuable assistance of Michael J. Bresnan, who likewise was key in
the second edition. Michael Bresnan was a superb clinician and
teacher. He died prematurely, and his absence is keenly felt by his
family and his colleagues at both the Children’s Hospital in
Boston and elsewhere. The third edition was published with the
aid of David K. Urion at the Children’s Hospital in Boston and was
dedicated to Dr. Michael Bresnan. For the fourth edition, we are
indebted to Michael E. Cohen and Patricia K. Duffner, of the Chil-
dren’s Hospital of Buffalo. They have taken responsibility for this
and future editions, and they completely reorganized the book and
updated the content and references to make it even more reader
friendly than the previous editions were. We hope that Pediatric
Neurologycontinues to meet the need for a readable, pocket-sized,
practical reference for pediatric neurologic illness.
Howard L. Weiner, M.D.
Lawrence P. Levitt, M.D.
vi
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About the Authors
Michael E. Cohen,M.D., Professor of Neurology and Pediatrics at
the State University of New York at Buffalo, was formerly the Chair-
man of the Department of Neurology at the University at Buffalo.
He is now an attending neurologist at the Children’s Hospital of
Buffalo and the Clinical Director of Neurology Services for the
Kaleida Health System. He attended the University at Buffalo
Schoolof Medicine & Biological Sciences. He received his neuro-
logic training at the University Hospitals of Cleveland in Cleveland,
Ohio and his child neurology training at Boston Children’s
Hospital. His main interests are in the areas of clinical pediatric
neurology and central nervous system tumors of childhood.
Patricia K. Duffner,M.D., Professor of Neurology and Pediatrics at
the State University of New York at Buffalo, is presently an attend-
ingphysician at the Children’s Hospital of Buffalo. A graduate of
the University of Rochester, she then received her medical train-
ing at the State University of New York at Buffalo. She is a frequent
lecturer for the American Academy of Pediatrics and the former
President of the Section of Neurology of the American Academy
of Pediatrics. Her main interests are clinical child neurology and
central nervous system neoplasms of childhood, as well as their
long-term treatment effects.
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About the Series Creators
Howard L. Weiner,M.D., Physician in Medicine (Neurology) at the
Brigham and Women’s Hospital, is the Robert L. Kroc Professor of
Neurology at Harvard Medical School. He graduated from Dart-
mouth College and then attended the University of Colorado Med-
ical School; he interned at Chaim Sheba Hospital, Tel Hashomer,
Israel, and served as a medical resident at the Beth Israel Hospi-
tal, Boston. He received his neurology training at the Harvard
teaching hospitals of the Longwood Area Neurology Program.
Dr. Weiner is the Director of the Partners Multiple Sclerosis
program at the Brigham and Women’s and Massachusetts General
Hospitals and Codirector of the Center for Neurologic Diseases at
the Brigham and Women’s Hospital.
Lawrence P. Levitt, M.D., Senior Consultant in Neurology at
Lehigh Valley Hospital in Allentown, Pennsylvania, is a Professor
of Clinical Neurology at Pennsylvania State University College of
Medicine. A graduate of Queens College, he attended Cornell
Medical College as a Jonas Salk Scholar. Dr. Levitt completed his
internship and his first year of residency at Bellevue Hospital, and
he then spent 2 years in the Public Health Service at the En-
cephalitis Research Center in Tampa, Florida. He did his neurol-
ogy training at the Harvard teaching hospitals of the Longwood
Area Neurology Program.
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Preface
This manual is designed to guide house officers in recognizing
and treating pediatric neurologic disease. It is not intended to be
encyclopedic, but it should instead serve as a point of departure
for many of the problems encountered by residents in child neu-
rology, pediatrics, adult neurology, and child psychiatry; students;
and others interested in child neurology. This manual is the out-
growth of a similar adult manual written for the House Officer Se-
ries. The favorable response to the adult manual and the demand
of our colleagues for a comparable title covering pediatric neu-
rology have been the impetus behind this book. In keeping with
the adult manual, we tried to retain a problem-oriented approach
wherever possible, and we hope that the manual fills the need for
a readable, pocket-sized, practical reference to the neurologic
problems of pediatric patients.
Our desire with regard to this manual is that it will not only
excite the intellect of those interested in the nervous system in
children but will also provide a point of departure for further in-
quiry. Interested readers are directed to review articles and major
textbooks of child neurology. Resources can be found in the Sug-
gested Reading at the end of each chapter.
Michael E. Cohen, M.D.
Patricia K. Duffner, M.D.
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