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Note: entries printed in italics represent information contained in figures, illustrations, andtables.
abdominal aortic aneurysm, 192abdominal pain, and eclampsia, 360abducens nerve
cranial nerve evaluation, 5neuro-ophthalmological emergencies,
201–2absence seizures, 97, 103accessory nerves, and cranial nerve
evaluation, 6accidents. See also driving; electrical
injuries; lightning; SCUBA diving;thermal injuries
acute cervical strain, 290hypothermia, 395–6sleep disorders, 273spinal cord injuries in children, 301
acetazolamide, and intracranial pressure,322
acetylcholinesterase (AChE), andcholinergic syndrome, 373
acid-base disorders, and seizures, 95acid fast bacilli (AFB), 119acidosis, and neurotoxicology, 372, 381–3acoustic nerves, and cranial nerve
evaluation, 5–6acoustic Schwannoma, 27, 86acquired disorders
heart disease in children, 331seizures, 94
activated charcoal, and suspectedpoisoning, 372, 373
activities of daily living, and seizures, 107acute back pain, 263acute bacterial sinusitis, 57
acute cervical strain, 290acute disseminated encephalomyelitis, 27acute dystonic reaction (ADR), 157acute gouty arthritis, 193acute necrotizing myopathy, 178acute neuromuscular respiratory failure, 66acute toxic neuropathies, 388acute transverse myelitis (ATM), 211, 213acyclovir, and viral encephalitis, 127adenosine triphosphate (ATP), and
mitochondrial myopathy, 172adenovirus, 122Adie’s tonic pupil and Adie’s syndrome,
208adjunctive therapy, and myasthenia gravis,
184adrenergic syndrome, 374, 377Adson maneuver, and thoracic outlet
syndrome, 190advanced senescent gait, 109age. See children; elderly; infantsaggressive behavior, and immediate
intervention, 239, 240agitation, and immediate intervention,
239, 240AIDS
fungal meningitis, 119neuropsychiatric symptoms, 239
airway support, and myasthenia gravis, 183akathisia, 157, 387alcohol. See also substance abuse
headache, 390poisoning, 382–3withdrawal and seizures, 101, 106–7, 379
409
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410 Index
altered mental status. See also cognitivedeficits; coma; consciousness;delirium; dementia; mental status
examinationancillary tests, 49central nervous system dysfunction, 43–4differential diagnosis, 46–7, 48evaluation, 44–6management, 49–50neurotoxicology, 371–8prognosis, 50–1traumatic brain injury, 281
alternating hemiplegia, 334alternobaric vertigo, 90Alzheimer’s Association, 225Alzheimer’s disease
dementia, 223–5neuropsychiatric symptoms, 239pharmacologic treatment, 224
American Academy of Neurology, 140–1American College of Obstetrics and
Gynecology, 360American Heart Association, 138American Spinal Cord Injury Association,
287, 288American Stroke Association, 140–1amnesia, and traumatic brain injury, 281amphotericin B, and fungal meningitis,
119ampicillin, and children, 327–8amyotrophic lateral sclerosis (ALS)
motor neuron diseases, 173myasthenia gravis, 182weakness, 62, 65
analgesics. See also aspirin; narcoticanalgesics; nonsteroidalanti-inflammatory drugs; prednisone;opiate
analgesicsdrug-induced seizures, 379headache, 390
anal wink, and spinal cord injuries, 289anatomy, and dizziness, 68–70anion gap metabolic acidosis, 381, 382–3anisocoria, 205–8anklosing spondylitis (AS), 188, 193anoxic brain injury, and EEG findings, 31anoxic encephalopathy, and coma, 48antalgic gait, 112anterior cord syndrome, 264, 292anterior horn cell disorders, 65anterior inferior cerebellar artery (AICA),
70, 86–7
anterior intraosseous syndrome, 190, 306,308
anterior ischemic optic neuropathy, 204–5antiarrythmic medications, and
anticholinergic effects, 375antibiotics
altered mental status, 49bacterial meningitis, 41, 115–16brain abscess, 117infections in children, 328infectious spondylitis, 266Lyme disease, 121sinusitis, 57
anticholinergic drugsdizziness, 88movement disorders, 158
anticholinergic syndrome, 374, 375–6anticoagulation, and stroke, 138–9, 140–1,
142, 336anticonvulsant drugs. See also antiepileptic
drugsaltered mental status, 49coagulopathy in fetus and maternal use
of, 362seizures in children, 339
antidepressants, and movement disorders,158. See also tricyclic antidepressants
antiemetic medications, and dizziness, 88,89
antiepileptic drugs (AEDs). See alsoanticonvulsant drugs; fosphenytoin;phenytoin
movement disorders, 157pregnancy, 362seizures, 103, 340, 346, 347–8, 362
antihistamines. See also diphenhydramineanticholinergic effects, 375dizziness, 88, 89movement disorders, 158
antihypertensive medicines, andpregnancy, 361–2
antinausea drugs, and anticholinergiceffects, 376
anti-Parkinsonian agents, andanticholinergic effects, 376
antiplatelet therapy, and stroke, 138antipsychotic drugs, and anticholinergic
effects, 375. See also neuroleptic drugs;psychopharmacologic medications
antispasmodics, and anticholinergiceffects, 375
antivenins, and toxic envenomations,397–8, 398–9, 401
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Index 411
antiviral therapy, for viral encephalitis, 127Anton syndrome, 205anxiety, and dizziness, 89aphasia
dementia, 221mental status examination, 3stroke, 136
apnea, and brain death, 406. See alsoobstructive sleep apnea
apneustic breathing, 44, 45appearance, and mental status
examination, 2arbovirus encephalitis, 122, 124–5, 126Area Agency on Aging, 225arenavirus, 122arrhythmias
altered mental status, 44stroke, 137
arterial blood gases (ABGs)apnea and brain death, 406headache, 54
arterial dissectionheadache, 56neuroradiology, 14
arterial gas embolism (AGE), anddysbarism, 393–5
arterio-venous malformation (AVM), 368arthritis. See osteoarthritis; rheumatoid
arthritisaseptic meningitis, 118aspiration pneumonia, 228aspirin, and stroke, 142, 336asterixis, 156, 387asystole, and electrical injuries, 391, 392ataxic breathing, 44, 45ataxic gait, 111ataxic hemiparesis, 8athetosis, 148, 151atlantoaxial rotary subluxation, 301, 302atlanto-occipital dislocation, 293, 301atlas fractures, 293atonic seizures, 97atropine, and cholinergic syndrome, 373attention deficit hyperactivity disorder
(ADHD), 153auditory canal, and dizziness, 73auditory nerve, and peripheral vestibular
system, 69auditory tests, and acoustic nerve
evaluation, 5. See also hearing lossaura, and seizures, 95–6Australia, and toxic envenomations, 397,
398, 400
automatisms, and seizures, 96automobiles. See drivingaxial skeleton, lesions of, 191axis fractures, 293–4axonopathy, and toxic neuropathies, 388axonotmesis, 304, 306
Babinski response, 163backboard, and spinal cord injuries, 301back pain
infectious spondylitis, 266intraspinal hemorrhage, 270low back and, 192–5neuro-oncological emergencies, 232–4neuroradiography, 265prevalence of, 263spinal epidural abscess, 267spinal cord lesions, 65, 270
bacterial labytinthitis, 84bacterial meningitis. See also meningitis
diagnosis, 114–16lumbar puncture, 41myasthenia gravis, 181neuroradiology, 23presentation of, 113–14
Baker’s cysts, 310ballism, 151“bamboo spine,” 188Bannworth’s syndrome, 121barbiturates
coma and intracranial pressure, 242, 249neurotoxicology and seizures, 378
Becker muscular dystrophy, 172behavior
dementia and disturbances of, 224–5neuropsychiatric symptoms, 236, 238,
240nontraumatic spinal cord emergencies,
271seizures and prolonged bizarre, 98
Bell’s palsycranial nerve lesions, 5peripheral nerve disorders, 170in pregnancy, 365
benign positional vertigo (BPPV), 78, 81–3benign rolandic epilepsy (BRE), 343benzamides, and dizziness, 89benzodiazepines. See also diazepam;
lorazepamadrenergic syndrome, 374agitation and aggression, 240anticholinergic syndrome, 374dizziness, 88, 89
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412 Index
benzodiazepines (cont.)eclampsia, 361seizures, 105, 338, 361, 378sleep disorders, 274
biballism, 153bicarbonate therapy, for salicylate toxicity,
382“bicycle sign,” 194bilateral facet dislocation, 296–7bilateral pinpoint pupils, 7binocular diplopia, and
neuro-ophthalmological emergencies,197, 198, 199–200, 201, 202. See alsodiplopia
biopsy studies, and hypotonia in infants,356
bizarre behavior, and seizures, 98blepharospasm, 150blunt trauma, 306blood pressure. See also hypertension
intracranial pressure and maintenance ofadequate, 248
stroke, 138traumatic brain injury, 284
Borrelia burgdorferi, 120–1botanicals. See plants and plant-derived
substancesbotulism
Guillain-Barre syndrome, 178hypotonia in infants, 355myasthenia gravis, 182neuromuscular transmission, 171neuro-ophthalmological emergencies,
203weakness, 65
bowel and bladder dysfunction, andnontraumatic spinal cord emergencies,264
box jellyfish, 400–1brachial plexus, and peripheral nervous
disorders, 167bradyarrhythmias, and altered mental
status, 44brain. See also brain abscesses; brain
death; brain tumors; traumatic braininjury
biopsy and HSV encephalitis, 126herniation and intracranial pressure,
242, 244–5neurological examination, 10
brain abscessesbacterial meningitis, 116–17headache, 55
brain deathcriteria for, 406–7definition of, 405diagnostic features, 50EEG findings, 31, 32evaluation, 405–6
brain imaging. See neuroradiologybrainstem
brain abscess, 117neurological examination, 10reflexes and brain death, 406stroke and myasthenia gravis, 181shunt dysfunctions, 314
Brain Trauma Foundation, 283brain tumors
alteration of mental status, 226–8back pain, 232–4cerebrovascular events, 229–31focal neurological deficits, 231–2headache, 55–6intracranial pressure, 246neuropsychiatric symptoms, 239neuroradiology, 27–8pregnancy, 369seizures and status epilepticus, 228–9
breath holding, in infants and children,100–1
Brief Mental Status Examination, 2bromocriptine, and neuroleptic malignant
syndrome, 383bronchospasm, and cholinergic syndrome,
373Brown-Sequard syndrome, 211, 264, 292bulbocavernous reflex, 289bunyavirus, 122burn patients, 392, 393bursitis, and pain, 192, 193burst fracture, 295, 298, 299butorphanol, and migraine, 60butyrophenones, and dizziness, 89
caffeine, and seizures, 107California encephalitis, 124Campylobacter enteritis, 175, 176cancer. See brain tumors; spinal cord
tumorsCandida albicans
brain abscess, 24fungal meningitis, 119
carbamazepine, and seizures in children,343, 346
carbon monoxide exposure, and headache,54
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Index 413
cardiopulmonary bypass, andhypothermia, 395
cardiopulmonary resuscitation, andrecovery, 51
cardiorespiratory arrest, and electricalinjuries, 392
cardiovascular presyncope, and dizziness,79
carotid artery injuries, 290, 333carotid rupture, and brain tumors, 230carotid sinus massage, 77carpal tunnel syndrome
median nerve compression, 307, 308pregnancy, 364upper extremity pain, 190
cataplexy, 273, 275cauda equina syndrome
neuropathic pain, 194sensory deficits, 264spinal cord compression, 233spinal cord injuries, 293
causalgia, 190cavernous angioma, 16cefotaxime, and children, 328cell counts, and lumbar puncture, 39central cord syndrome, 264, 292central facial palsy, 170central midbrain syndrome, 133central nervous system. See also infections
altered mental status and dysfunction of,43
compensatory mechanisms anddizziness, 88
inflammatory disease andneuroradiology, 23–7
neuropsychiatric symptoms andbehavioral change, 236
central transtentorial herniation, 245central vestibular system, 70Centuroides exilicanda (bark scorpion), 398,
399cephalopods, 401cerebellar tremor, 155cerebellopontine angle (CPA) tumors, 86cerebellum, and brain abscess, 117cerebral artery occlusions, 335cerebral contusions, 280cerebral edema, 245–6cerebral embolism, 333cerebral hemispheric lesions, and
weakness, 64cerebral infarction
computed tomography (CT), 13
hemiparetic gait, 111intracranial trauma, 18
cerebral intravascular coagulation, 230cerebral localization, and abnormal
respiratory patterns, 44cerebral palsy, and spastic gait, 111cerebral venoocclusive disease, and
neuroradiology, 14–15cerebral venous thrombosis, 333, 367–8cerebrospinal fluid (CSF). See also shunt
systems; intracranial pressurefungal meningitis, 119Guillain-Barre syndrome, 177headache and abnormalities, 53, 56HSV encephalitis in infants, 326infections in children and contaminated,
329lumbar puncture, 39–40tuberculous meningitis, 118–19viral encephalitis, 126
cerebrovascular disease. See also strokein children, 330–6chorea, 152dizziness, 81headache, 53, 56intracranial pressure, 246leading causes of death and, 131neuro-oncological emergencies,
229–31neuropsychiatric symptoms, 239in pregnancy, 367–8seizures, 101
cervical osteoarthritis, 187cervical radiculopathy, 189–90cervical spine injuries, 293cervical spine joint disorder, 57cervical sprains, 19–20, 21cervical stenosis, 292cervical traction, and spinal cord injuries,
287Cesarean section, and traumatic
neuropathies, 365Charcot-Marie-Tooth syndrome, 352cheiralgia paresthetica, 190, 309chemical restraints, and dementia, 218chemoprophylaxis, and bacterial
meningitis, 116chemotherapeutic agents, and
encephalopathy, 228Cheyne-Stokes respiration, 44, 45chiasmal disease, and
neuro-ophthalmological emergencies,204, 205
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414 Index
children. See also infantsbrain tumors, 227breath holding and seizures in, 100–1cerebrovascular disorders, 330–6cholinergic syndrome, 373dextrose and glucose levels, 371hydrocephalus and shunts in, 313–23infections of central nervous system,
325–9intracranial pressure values for, 242scorpion envenomation, 398seizures, 337–48spinal cord injuries, 300–2traumatic brain injury, 284
“chin-chest” maneuver, and herniatednucleus pulposus, 190
Chironex fleckeri (box jellyfish), 400–1chlordiazepoxide, and alcohol withdrawal
seizures, 106chlorpromazine, and migraine, 59, 60cholinergic syndrome, 373–4cholinesterase inhibitors, and Alzheimer’s
disease, 224Chondrichthyes, 399chorea
diagnosis and management of, 151–3drug-induced, 158, 386phenomenology of, 148neurotoxicology, 386
chorea gravidarum (CG), 363choriocarcinomas, 369chromosomal analysis, and hypotonia in
infants, 356chronic inflammatory demyelinating
polyneuropathy (CIDP), 168, 178chronic obstructive pulmonary disease
(COPD), 66, 79chronic pain, 263chronic progressive multiple sclerosis
(CPMS), 210, 213chronic toxic neuropathy, 388cigarette smoking, and cluster headache,
57cingulate herniation, 244–5“clay shoveler’s fracture,” 297Clostridium botulinum, 182, 355Clostridium tetani, 355cluster headache, 57–8CMV encephalitis, 118coagulation disorders, and brain tumors,
230coagulopathies
in children, 332
as contraindication for lumbar puncture,36
maternal use of anticonvulsants andfetal, 362
cobra, 396Coccidioides immitis, 119“Cock-robin” appearance of head, and
spinal cord injuries in children, 301Coelenterates (jellyfish), 400cognitive deficits. See also altered mental
status; memory; mental statusexamination
dementia, 219–21, 223sports-injury related concussion, 282
cold caloric tests, 76coma. See also altered mental status;
consciousnessabnormal respiratory patterns, 44, 371bariturate-induced and intracranial
pressure, 242, 249description of, 43differential diagnosis, 46–7, 48eclampsia, 360neurotoxicology, 378, 381–3prognosis, 51
common peroneal nerve, and compressionneuropathy, 311
Commonwealth Serum Laboratories(Australia), 400/’;
compartment syndrome, 306compensatory mechanisms, and dizziness,
88competency, as medical-legal issue, 225complete blood count (CBC), and
headache, 54complete spinal cord injury, 287complex febrile seizures, 343complex partial seizures
dizziness, 81features of, 96management of, 103
compression fracture, of spinal cord, 295compression neuropathies, 306–11compressive optic neuropathies, 205computerized tomography (CT). See also
neuroradiologyback pain, 265dementia, 221–2intracranial pressure, 243–4magnetic resonance imaging compared
to, 12–13seizures, 102shunt dysfunctions, 319–21
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Index 415
stroke, 137, 335traumatic brain injury, 281, 282–3
concussion and concussive syndromesclinical features in sports-related, 282definition of, 280–1
congenital cerebrovascular anomalies, 332congenital heart disease, 331, 334congenital muscular dystrophies, 352–3congenital myasthenia gravis, 180congenital myotonic dystrophy, 355connective tissue disorders, and seizures, 95consciousness. See also altered mental
status; comacomponents of, 43dizziness, 72mental status examination, 3seizures, 98traumatic brain injury, 281
consultation. See also referralsdementia and neurologic, 221–2multiple sclerosis and psychiatric, 217
conus medullaris syndromeneuropathic pain, 194sensory deficits, 264spinal cord injuries, 292–3
convulsive seizures, generalized, 96convulsive status epilepticus, 104–5coordination, and motor function, 8coral snake, 396, 398corneal reflex test, 5, 76cortical infarction, 333corticosteroids. See also steroids
intracranial pressure, 242, 249multiple sclerosis, 215vestibular neuronitis, 84
coughing, and vagus nerves, 6coxalgic gait, 112cranial nerves. See also cranial neuropathies
dizziness, 74–6, 80hypotonia in infants, 351Lyme disease, 121neurological examination, 3–7seizures, 99stroke, 136
cranial neuralgias, 53cranial neuropathies, and
neuro-ophthalmological emergencies,200
cranial weakness, 64craniocervical junction, and
neuroradiology, 20craniospinal trauma, and neuroradiology,
17–19
creatine phosphokinase (CPK)inflammatory myopathy, 171muscular dystrophy in infants, 355
Creutzfeldt-Jakob disease (CJD), 222Cryptococcus neoformans, 119cubital tunnel syndrome, 308Cushing’s phenomenon, 248Cushing’s syndrome, 44Cushing’s triad, 214cutaneous reflexes, 9cyproheptadine, and serotonin syndrome,
384cytomegalovirus (CMV)
Guillain-Barre syndrome, 176HIV-related, 117, 118
cytotoxic edema, 245–6
dantrolene, and neuroleptic malignantsyndrome, 383
deafness, and acoustic nerve evaluation,5–6. See also hearing loss
death. See also brain death; mortalitycause of, 405–6cerebrovascular disease as cause of, 131time of, 406–7traumatic brain injury, 279
decerebrate and decorticate posturing, andaltered mental status, 46
decompression sickness, and diving-relatedinjuries, 393, 394–5
decontamination, and suspectedpoisoning, 372
deep peroneal nerve, 310deep tendon reflexes (DTRs)
altered mental status, 46dizziness, 77hypotonia in infants, 352neurological examination, 8, 9neuromuscular disorders, 163nontraumatic spinal cord emergencies,
264definitive therapy, for spinal cord tumors,
234degenerative disease of the spine, 21, 23degenerative disorders, and seizures, 95Dejerine-Sottas syndrome, 352delirium
altered mental status, 46–7, 48central nervous system dysfunction,
43dementia, 219, 220drug-induced, 372
delirium tremens (Dts), 101
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416 Index
dementiadefinition of, 219differential diagnosis, 218–21, 222evaluation, 218laboratory tests, 223management of and disposition of
patients, 221–5normal pressure hydrocephalus, 260–1prevalence in elderly, 218
demyelinating disease, and dizziness, 81dental referral, and facial pain, 186depression
cognitive decline in elderly, 221inpatient evaluation and treatment, 239
de Quervain disease, 189dermatomyositis (DM), 171developmental disorders, and dizziness, 81Devic’s disease, 211dexamethasone
infections in children, 328intracranial pressure, 249migraine, 59, 60spinal cord tumors and back pain, 234
dextrose, and glucose levels, 371diabetes
cerebral edema, 246polyneuropathy, 10
diagnosis. See also differential diagnosis;evaluation; laboratory tests;neurological examination; physical
examinationbacterial meningitis, 114–16brain death, 50, 407Guillain-Barre syndrome, 178headache, 54–5hypotonia in infants, 355–6idiopathic intracranial hypertension
(IIH), 255myasthenia gravis, 182–3neurological history, 1neuropsychiatry, 238–40nontraumatic spinal cord emergencies,
271stroke in children, 335weakness, 63
diazepam. See also benzodiazepinesalcohol withdrawal seizures, 106migraine, 59seizures in children, 339, 340
differential diagnosis. See also diagnosisaltered mental status, 46–7, 48, 226–8back pain, 232–3brain tumors, 226–8, 229–30, 231–2
chorea, 151, 152dementia, 218–21, 222dizziness, 78–87eclampsia, 360epilepsy in children, 337–8Guillain-Barre syndrome, 177, 178headache, 53, 55–60hypotonia in infants, 352–5idiopathic intracranial hypertension
(IIH), 255–6intracranial pressure, 245–6multiple sclerosis, 212–14neuro-ophthalmological emergencies,
199–203nontraumatic spinal cord emergencies,
265–71normal pressure hydrocephalus, 261peripheral nerve disorders, 163–73seizures, 99–102, 229, 337–8, 348shunt systems, 314–21stroke in children, 334viral encephalitis, 123, 125–6weakness, 64–6
diffuse axonal injury (DAI), 280diffuse toxic myopathies, 389dihydroergotamine (DHE-45), and
migraine, 58, 59, 60diphenhydramine, and migraine, 59, 60.
See also antihistaminesdiphenoxylate, and opioid syndrome, 377diplopia. See also binocular diplopia;
monocular diplopia; vertical diplopiaidiopathic intracranial hypertension
(IIH), 252, 253–4oculomotor nerve evaluation, 4
disaster triage protocols, for electrical andlightning injuries, 392
disc herniation, 23, 290. See also vertebraldiscitis
disconjugate eye positions, and alteredmental status, 46
dislocations, and peripheral nerve injuries,305. See also hyperextensiondislocation injuries; thoracic
fracture-dislocation injuriesdisposition, of patients. See also
hospitalizationbrain abscess, 116–17dementia, 221–5eclampsia and preeclampsia, 362hypotonia in infants, 356idiopathic intracranial hypertension
(IIH), 258
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infections in children and, 327–8multiple sclerosis, 215, 217myasthenia gravis, 184neuropsychiatric symptoms, 237,
238–40seizures, 107stroke, 142
dissociative states, and seizures, 102distal muscle weakness, 64, 352distal shunt malfunction, 321diuretics
intracranial pressure, 248–9pregnancy and pseudotumor cerebri, 368
diverticulitis, 192diving. See SCUBA divingdizziness. See also vertigo
anatomy, 68–70definition of, 68differential diagnosis, 78–87laboratory tests, 87management of, 87–90medical history, 70–3
doll’s eyes, 7, 76dopamine, and parkinsonism, 149dorsal cord syndrome, 264dorsal midbrain syndrome, 133Down’s syndrome, 352, 356driving, of automobiles
dementia, 225seizures, 107–8
drop attacks, 97. See also foot dropsdroperidol, and migraine, 59, 60drug-induced parkinsonism, 157–8Duchenne’s muscular dystrophy (DMD),
172, 356ductions, and neuro-ophthalmological
examination, 198–9DUMBELS (defecation, urination, miosis,
bronchorrhea, emesis, lacrimation,salivation), 373
durable power of attorney, 225dysarthria, 6dysbarism, 393–5dyskinesia
dopamine replacement, 149drugs associated with, 386
dysmetria, an dizziness, 74dystonia, 148, 149–51
early gait apraxia, 109Eastern equine encephalitis (EEE), 122,
124, 126eclampsia, 359–62, 367, 368, 369
edrophonium, and myasthenia gravis,182–3, 184
elapids (snakes), 396elderly
elder abuse, 225medical complications of cognitive
deficits, 223prevalence of dementia, 218
electrical injuries, 306, 391–3electrocardiograms (ECGs)
altered mental status, 49headache, 55tricyclic antidepressants and QRS
interval, 381electroencephalograms (EEGs)
altered mental status, 49appearance of normal, 30headache, 55seizures, 31, 92, 343types of abnormalities, 30–2
electrolyte balancealtered mental status, 44, 48seizures, 95weakness, 66
electronystagmography (ENG), andMeniere’s disease, 85
electrophysiology studies, and hypotoniain infants, 356
emergency medical technicians (EMS), andseizures, 97
emergent imaging, indications for, 13encephalitis. See also viral encephalitis
coma and delirium, 48EEG findings, 31
encephalomyelitis, 211, 214encephalopathy, and chemotherapeutic
agents, 228. See also metabolicencephalopathy; toxic encephalopathy
endocrine disorders, and seizures, 95endolymph
dizziness, 69Meniere’s disease, 85
endotracheal intubation. See alsorapid-sequence intubation
cholinergic syndrome, 373seizures, 104–5
enteroviral encephalitis, 124–5enteroviruses, and infections in children,
327entrapment syndromes, 190, 195envenomation. See toxic envenomationenvironmental causes, of coma and
delirium, 48
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418 Index
environmental toxins. See also marinetoxins; organophosphate poisoning;toxic envenomations
accidental hypothermia, 395–6drug-induced seizures, 380dysbarism, 393–5electrical, lightning, and thermal
injuries, 391–3headache, 391
enzyme-linked immunosorbent assay(ELISA), and snake identification kit,297
epicondylitis, 189epidemiology. See pathophysiology;
prevalence; prognosisepidural abscess, 191epidural hematoma (EDH)
craniospinal trauma, 17, 20traumatic brain injury, 280, 281
epidural spinal cord compression (ESCC),232–4
epilepsia partialis continua, 93epilepsy. See also seizures; status epilepticus
in children, 334, 337, 341–8electroencephalograms, 30–1neuropsychiatric symptoms, 239prevalence of, 92types of, 92, 93
epileptic myoclonus, 156Epstein-Barr virus
Guillain-Barre syndrome, 176upper extremity pain, 188
erythema chronicum migrans (ECM), 120erythrocyte sedimentation rate (ESR)
headache, 54infectious spondylitis, 266inflammatory myopathy, 171spinal epidural abscess, 267
Eschericia coli, and infectious spondylitis,266
essential myoclonus, 156essential tremor (ET), 154estropia (ET), 198–9ethanol, and alcohol poisoning, 383ethyl alcohol, and sedative hypnotic
syndrome, 374ethylene glycol, and neurotoxicology, 382,
383evaluation. See also diagnosis
altered mental status, 44back pain, 232–3brain death, 405–6brain tumors, 226–8, 229, 229–30, 231–2
chorea, 151dementia, 218eclampsia, 360epilepsy in children, 338–41, 343–7gait disturbances, 109–12Guillain-Barre syndrome, 177, 178headache, 52–4hemiballism, 153idiopathic intracranial hypertension
(IIH), 252movement disorders, 146–7multiple sclerosis, 211myasthenia gravis, 181neuromuscular disorders, 162neuro-ophthalmological emergencies,
197–9neuropsychiatry, 236–8normal pressure hydrocephalus (NPH),
260–1peripheral nerve injuries, 304–6seizures, 97–9, 229, 338–41, 342, 343–7shunt systems, 314–21spinal cord injuries, 286–9stroke, 135–7, 334–5traumatic brain injury, 281–2viral encephalitis, 125–6
excessive daytime sleepiness (EDS), 273,275
exclusion criteria, for thrombolytictherapy, 141, 143
expressive aphasia, 136extracranial structures, diseases of and
headache, 53extramedullary spinal cord tumors, 233extraocular eye movements (EOM), 4extropia (XT), 198eye. See also neuro-ophthalmological
emergencies; visual acuity; visual field;visual loss
external examination of, 199intracranial pressure, 243
facet disorders, 295–7facial expression test, 5facial mononeuropathy, 169, 170facial muscles, and weakness in infants, 352facial nerves, and cranial nerve evaluation,
5facial pain, 186–7facial weakness, and dizziness, 72falling, and dizziness, 72family history. See also genetic disorders
dizziness, 72
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Index 419
hypotonia in infants, 350seizures in children, 341, 343
family members, and medical history, 1,219, 237, 372. See also family history;parent counseling
fasciculations, toxicologic causes of, 397fatigue syndromes, and multiple sclerosis,
213febrile seizures, 341–3femoral mononeuropathy, 169femoral nerve, and compression
neuropathies, 310femoral neuropathy, and pregnancy, 365fetal monitoring, and seizures in
pregnancy, 362fetal position, for lumbar puncture, 37, 38fever
altered mental status, 44–5brain abscess, 116intracranial pressure, 249myasthenia gravis, 183seizures in children, 341–3
firearm wounds. See gun shot woundsFisher’s syndrome, 177fistula test, and dizziness, 78flavivirus, 122floppy infant, causes of, 355flucytosine, and fungal meningitis, 119fluid resuscitation, and intracranial
pressure, 248fluid therapy, and pregnancy-induced
hypertension, 362flumazenil
altered mental status, 49, 371respiratory depression, 378sedative hypnotic syndrome, 376
fluorescent treponemal antibody (FTA) test,85, 120
focal brain lesions, and EEG findings, 31focal dystonia, 150focal neurological deficits
altered mental status, 45–6brain tumors and neuro-oncological
emergencies, 231–2focal toxic neuropathies, 389focused examination, of peripheral nervous
system, 162–3folic acid, and alcohol poisoning, 383foods, and headache, 390. See also marine
toxins; nutritionfoot, and sensory nerves, 310foot drops
gait disturbances, 111–12
pregnancy and traumatic neuropathies,365
forced vital capacity (FVC), 162Formosan krait (Bungarus multicinictus), 396fosphenytoin, and seizures, 105–6, 338,
339, 340. See also antiepileptic drugsfourth cranial nerve palsy, 201fractures, and peripheral nerve injuries,
305. See also axis fractures; sacralfractures; skull fractures; spinalfractures; zone I, II, and III fractures
Frenzel glasses, 74friends, and patient history, 237, 372frogleg position, and hypotonia, 351frontal lobe, and brain abscess, 117frontotemporal dementias, 239Fukuda stepping test, 78fundus, and eye examination, 199funduscopic examination, and spinal
sarcoidosis, 268fungal meningitis. See also meningitis
diagnosis and treatment of, 119lumbar puncture, 41
furosemide, and intracranial pressure,248–9, 321–2
gag reflex test, 6, 76gait disturbances
evaluation and management of, 109–12motor function, 8normal pressure hydrocephalus, 260, 261stroke, 136weakness, 62
gamma-aminobutyric acid (GABA), andneurotoxicological seizures, 378, 381
gastropods, 401gaze-evoked nystagmus, 74–5generalized convulsive SE, in children, 338generalized seizures, 96–7genetic disorders. See also family history
chorea, 151–3dizziness, 81seizures, 94
giant cell arteritis, and headache, 56–7Glasgow Coma Scale, 3, 50, 243, 279glioblastoma multiforme, 27glossopharyngeal nerve, and cranial nerve
evaluation, 6glucose. See also hyperglycemia;
hypoglycemiaaltered mental status and levels of, 371lumbar puncture, 39–40
gout, and lower extremity pain, 192, 193
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420 Index
grand mal seizures, 96Grisel’s syndrome, 301guardianship, and patients with dementia,
225Guillain-Barre syndrome
clinical features of typical, 176description of, 175emergency presentation of, 175–6evaluation, 177, 178hypotonia in infants, 355, 356idiopathic intracranial hypertension
(IIH), 253management, 177myasthenia gravis, 181–2variants of, 177weakness, 65, 176
gummatous neurosyphilis, 120gun shot wounds
peripheral nerve injuries, 304vascular injuries and spinal cord, 290
Guyon’s canal syndrome, 309
hair cells, and vestibular sensory organs,69
Hallpike maneuver, 75, 81, 82hallucinations
dementia, 221sleep paralysis and hypnagogic, 275
haloperidol. See also neuroleptic drugsagitation and aggression, 240dementia, 218
“hangman’s fracture,” 294Hapalochlena lunulata (octopus), 401Hashimoto’s disease, and Guillain-Barre
syndrome, 176headaches
after lumbar puncture, 37brain abscess, 116differential diagnosis, 53, 55–60dizziness, 72evaluation, 52–4idiopathic intracranial hypertension
(IIH), 257management, 55–60neurotoxicology, 387, 390–1pregnancy, 362–3, 369
“head-tilt” maneuver, and herniatednucleus pulposus, 190
head trauma. See also traumatic brain injurydefinition of head injury, 279headache, 53seizures, 95
head shaking, and dizziness, 78
hearing loss, and dizziness, 72, 76, 85. Seealso auditory tests; deafness
heavy metalsdrug-induced seizures, 380headache, 391
Heliobacter jejuni, and Guillain-Barresyndrome, 176
HELPP syndrome, 360hematologic disorders, in children, 332hemiballism, 148, 153hemifacial spasm, 101hemiparetic gait, 111hemodialysis
cerebral edema, 246ethanol poisoning, 383
hemoglobinopathy, 192, 193Hemophilus influenzae
bacterial meningitis, 113, 115, 116Guillain-Barre syndrome, 176vaccine for children and, 325
Hemophilus meningitis, 116hemorrhagic infarctions, 330hepatitis
Guillain-Barre syndrome, 176upper extremity pain, 188
herbal medicines. See plants andplant-derived substances
herniated nucleus pulposus (HNP), 189–90herniation, and intracranial pressure
values, 242. See also disc herniationheroin, and neurotoxicology, 384, 387herpes simplex virus (HSV) encephalitis
diagnosis and management of, 123–4,126
frontal and temporal lobes, 122infants, 325–6neuroradiology, 23–4
herpes varicella zoster (HVZ) virusencephalitis, 122, 124, 127
herpetic neuralgia, 187hip girdle weakness, 112HIV (human immunodeficiency virus)
central nervous system infections,117–18
encephalitis, 24Guillain-Barre syndrome, 176neuropsychiatric symptoms, 239weakness, 64
HIV encephalitis, 117HIV leukoencephalopathy, 117“hold-up” maneuver, and thoracic outlet
syndrome, 190Hollenhorst plaque, 4
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Horner’s syndromeneurological examination, 7sympathetic nervous system, 206–7vascular disease, 87
hospitalization. See also dispositiondementia and behavioral disturbances,
225eclampsia and preeclampsia, 362hypotonia in infants, 356idiopathic intracranial hypertension
(IIH), 258multiple sclerosis, 215myasthenia gravis, 184neuropsychiatric symptoms, 238, 240seizures, 107snake envenomation, 398
household toxins, and drug-inducedseizures, 380
Huntington’s disease (HD), 151–3, 239hydralazine, and hypertension, 361hydrocephalus. See also intracranical
pressure; normal pressurehydrocephalus; shunt systems
headache, 56mental status, 227
hydrostatic edema, 246hydroxyzine, and migraine, 60hyperacusis, 5hyperemesis gravidarum, 362, 369hyperextension, and cervical sprains,
19–20hyperextension dislocation injuries, 297–8hyperglycemia, and dizziness, 79hyperkinetic movement disorders, 149–53hypersomnia, 276hypertension. See also blood pressure;
idiopathic intracranial hypertensionaltered mental status, 44pregnancy-induced, 359, 361–2stroke, 138
hypertensive encephalopathy, 48hyperthermia, and neurotoxicology, 383hypertropia, 199hyperventilation
altered mental status, 44, 45dizziness, 77, 79intracranial pressure, 242, 248seizures, 101
hypnagogic hallucinations, 275hypoglassal nerves, and cranial nerve
evaluation, 6–7hypoglycemia
in children, 334
dizziness, 79hypothermia, 395
hypokalemia, and myasthenia gravis, 182hypothermia
accidental, 395–6altered mental status, 45
hypotonia, in infantsdefinition of, 350differential diagnosis, 352–5evaluation, 350–2management and disposition of patients,
356hypovolemic shock, in children, 284hypoxic coma, 45, 246hypoxic encephalopathy, and coma, 48hypoxic-ischemic encephalopathy, in
infants, 352hysterical gait, 112hysterical paralysis, 271
iatrogenic disorders, in children, 333ice pack test, and myasthenia gravis, 183idopathic brachial plexopathy, 168idiopathic epilepsies
causes of seizures, 94EEG findings, 31
idiopathic intracranial hypertension (IIH)clinical features, 255common symptoms of, 253conditions associated with, 253differential diagnosis, 255–6disposition of patients, 258evaluation, 252management, 257–8
idiopathic torsion dystonia (ITD), 149, 157“imminent death,” 407immunosuppressive agents
multiple sclerosis, 215myasthenia gravis, 184
incidence. See prevalenceinclusion body myositis (IBM), 171inclusion criteria, for thrombolytic therapy,
141, 143increased intracranial pressure. See
intracranial pressureinfants. See also children; pregnancy
breath holding and seizures in, 100–1hypotonia, 350–6infections of central nervous system,
325–7lumbar puncture, 38neonatal myasthenia gravis, 180, 367seizures, 338, 340, 341
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422 Index
infants (cont.)traumatic brain injury, 284
infections, of central nervous system. Seealso encephalitis; meningitis
alterations in mental status, 227brain abscess, 116–17in children, 325–9chorea, 152dizziness, 79, 81HIV-related, 117–18intracranial pressure, 246labyrinthitis, 84lumbar puncture, 36Lyme disease, 120–1neurosyphilis, 120nociceptive pain, 188radioculpathy, 167seizures, 94–5shunt systems, 323spinal cord, 265–7
infectious spondylitis, 265–6inflammatory bowel disease, 188inflammatory disorders
headache, 56–7neuroradiology, 23–7nontraumatic spinal cord emergencies,
267–9radioculopathy, 167seizures, 95
inflammatory myopathy, 171influenza, in children, 325insomnia, 273, 276–7inspection, of shunt system, 315, 318intermittent explosive disorders, 101–2initial stabilization, of dizziness, 87–8inner ear disorders, and dizziness, 80insect envenomation. See toxic
envenomationintellectual ability, and dementia, 219intensive care unit (ICU), and myasthenia
gravis, 184intention tremor, 153intermediate syndrome (IMS), and
organophosphorus compounds, 374International Classification of Epileptic
Seizures, 92, 93International Stroke Trial (IST), 138internuclear ophthalmoplegia (INO), 7,
202–3, 211interstitial edema, 246intoxication
coma and delirium, 48staggering gait, 111
intraaxial posterior fossa masses, 27intracerebral hemorrhage (ICH)
in infants, 352neuroradiology, 16–17pregnancy, 367, 368stroke and, 134, 135
intracranial hypotension, and headache, 56intracranial infection
in children, 334headache, 53
intracranial neoplasms, 334. See alsointracranial tumor
intracranial pressure (ICP). See alsohydrocephalus; shunt systems
brain herniation, 242, 244–5differential diagnosis, 245–6evaluation, 243–4idiopathic intracranial hypertension
(IIH), 255lumbar puncture, 35–6management, 247–50, 336mental status, 227pathological processes, 242prehospital care, 243shunt systems, 313–14stroke in children, 336traumatic brain injury, 283, 284values, 242–3
intracranial trauma, and coma or delirium,48. See also traumatic brain injury
intracranial tuberculoma, 118intracranial tumor, and headache, 53,
55–6. See also intracranial neoplasmsintramedullary spinal cord tumors, 233intraocular pressure, and headache, 55intraparenchymal hemorrhage, 280, 330,
333intraspinal hemorrhage, 270intratumoral parenchymal hemorrhage,
230intraventricular catheter placement, and
intracranial pressure, 250iron deficiency anemia, and idiopathic
intracranial hypertension (IIH), 253ischemic infarctions, in children, 333ischemic stroke, 131isoniazid
drug-induced seizures, 381tuberculous meningitis, 119
Jacksonian seizure, 93Jarisch-Herxheimer reaction, 121Jefferson fractures, 293, 294
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jellyfish, 400–1Joplin’s neuroma, 195jugular vein injuries, 290“jumped facet” syndrome, 295–6, 301
ketorolac, and migraine, 59, 60kinetic tremor, 385Kleine-Levin syndrome, 276krait, 396
labetalol, and hypertension, 361laboratory tests
accidental hypothermia, 395–6altered mental status, 49, 372brain tumors, 228, 230dementia, 223dizziness, 87multiple sclerosis, 214–15neurotoxicology, 372nontraumatic spinal cord emergencies,
264–5normal pressure hydrocephalus, 261seizures, 102stroke, 136–7, 335
labyrinthitis, 84–5lactate dehydrogenase (LDH), and
inflammatory myopathy, 171lacunar infarcts, 132Lambert-Eaton myasthenic syndrome
(LEMS), 170–1lamotrigine, and seizures in children,
347Lance-Adams syndrome, 156Lasegue sign, 194late gait apraxia, 109lateral decubitus position, for lumbar
puncture, 37–8lateral femoral cutaneous neuropathy,
and pregnancy, 365lateral inferior pontine syndrome, 133lateral medullary syndrome, 87, 133lateral superior pontine syndrome, 133legal system. See medical-legal issuesleptomeningeal tumor, 232, 234leukemia, and brain tumors, 230Lhermitt’s sign, 211lidocaine, and migraine, 59lid retraction, and eye examination, 199lightning injuries, 391–2light touch, and sensory examination,
9–10limb ataxia, 8Listeria monocytogenes, 115
lithiumcluster headache, 58drug-induced seizures, 381
local pain, 263location, of weakness, 62, 64“locked-in state,” 43locked-in syndrome, 133lorazepam. See also benzodiazepines
agitated or aggressive behavior, 240seizures in children, 338, 339, 340
Lou Gehrig’s disease. See amyotrophiclateral sclerosis (ALS)
low back and lower extremity pain, 192–5lumbar disc disease, 27lumbar HNP, 194–5lumbar pain, 193lumbar puncture (LP)
altered mental status, 49contraindications for, 36dementia, 221, 222headache, 54idiopathic intracranial hypertension
(IIH), 255indications for, 35–6infections in infants and children, 326,
329meningitis, 35, 36, 41normal pressure hydrocephalus, 261procedure, 37–9results of, 39–40risks and complications of, 36–7seizures, 102shunt infection, 323stroke, 137traumatic tap versus SAH, 40
lumbar spine fracture, 298–9lumbar strain or sprain, 192lumbosacral plexus, 168Lyme disease
diagnosis and management of, 120–1multiple sclerosis, 214
lymphocytic choriomeningitis (LCM) virusencephalitis, 125
lymphoma, 24
maculotoxin, 401magnesium sulfate
eclampsic seizures, 360–1migraine, 59, 60myasthenia gravis in pregnancy, 367
magnetic resonance angiography (MRA)applications of, 13seizures, 102
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424 Index
magnetic resonance angiography (cont.)stroke in children, 335subarchanoid hemorrhage, 16
magnetic resonance imaging (MRI). See alsoneuroradiology
computerized tomography compared to,12–13
idiopathic intracranial hypertension(IIH), 255, 257
nontraumatic spinal cord emergencies,265
spinal cord injuries, 302–3malignant invasion, and radioculopathy,
167malingering, and nontraumatic spinal cord
emergencies, 271management. See also medications; surgery
altered mental status, 49–50back pain, 233–4brain abscess, 116–17brain tumors, 228, 229, 230–1, 232cerebrovascular events in pregnancy, 368dementia, 221–5dizziness, 87–90dystonias, 151eclampsia, 360–2epilepsy in children, 338–41, 343, 346,
347gait disturbances, 109–12Guillain-Barre syndrome, 177headache, 55–8hemiballism, 153hypotonia in infants, 356idiopathic intracranial hypertension
(IIH), 257–8infections in children, 327–8intracranial pressure, 247–50migraine, 58–60multiple sclerosis, 211, 215, 216myasthenia gravis, 183–4myoclonus, 156neuropsychiatry, 236–8nontraumatic spinal cord emergencies,
265–71normal pressure hydrocephalus, 261parkinsonism, 149peripheral nerve disorders, 163–73peripheral nerve injuries, 304–6seizures, 97, 102–3, 229, 338–41, 343,
346, 347shunt systems, 321–3sleep disorders, 274spinal cord injuries, 300
spinal cord tumors, 233–4stroke, 137–42, 336traumatic brain injury, 283viral encephalitis, 126–7
manic episodes, 239mannitol, and intracranial pressure, 242,
284manometer, and lumbar puncture, 38–9manual evaluation, of shunt system, 318Marcus-Gunn pupil, 198, 211marine toxins
envenomations, 399–401ingestion of and seizures, 380, 391, 401
masseter muscles, palpation of, 5mass lesions, and dizziness, 81measles, and encephalitis, 125medial longitudinal fasciculus (MLF), 202medial medullary syndrome, 133median inferior pontine syndrome, 133median longitudinal fasciculus (MLE), 70median mononeuropathy, 169median nerve, and compression
neuropathies, 306–7, 308medical complications, of cognitive deficits
in elderly, 223medical history. See also family history;
family members; friendsaltered mental status, 372dementia, 218dizziness, 70–3headache, 52–3movement disorders, 146neuro-ophthalmological emergencies,
197neuropsychiatry, 236, 237seizures, 97–8stroke in children, 334–5weakness, 64
medical-legal issuesdementia, 225seizures, 107–8
medical records, and seizures, 108medications. See also analgesics; antibiotics;
anticholinergic drugs; anticonvulsantdrugs; antiepileptic drugs;antihistamines; barbiturates;benzodiazepines; corticosteroids;diuretics; management; monoamineoxidase inhibitors;psychopharmacologic medications;toxicity
Alzheimer’s disease, 224anisocoria, 208
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aseptic meningitis, 118chorea, 152delirium, 372dizziness, 72, 79, 80, 88–90idiopathic intracranial hypertension
(IIH), 253, 257movement disorders, 156–8, 364myasthenia gravis and pregnancy, 366patient history, 237pupillary responses, 46status epilepticus, 105–6tremor, 155weakness, 64
memory, and dementia, 219. See alsocognitive deficits
Meniere’s disease, 85–6meningeal syphilis, 120meningiomas, 4, 369meningitis. See also aseptic meningitis;
bacterial meningitis; fungalmeningitis; tuberculosis meningitis;viral meningitis
cerebral edema, 246coma and delirium, 48headache, 55idiopathic intracranial hypertension
(IIH), 257lumbar puncture, 35, 36, 41myasthenia gravis, 181prevalence of in children, 325
meningoencephalitis, 118meningovascular syphilis, 120mental status examination. See also
altered mental status; cognitivedeficits
brain tumors, 226–8dementia, 219dizziness, 74elements of, 2–3hypotonia in infants, 351neuro-oncological emergencies, 226–8neuropsychiatry, 238stroke, 135
meperidinemigraine, 60opioid syndrome, 377
meralgia paresthetica, 365metabolic acidosis, and neurotoxicology,
381–3metabolic disorders
in children, 332chorea, 152dizziness, 81
radioculopathy, 167seizures, 94, 101
metabolic encephalopathyalterations of mental status, 227coma and delirium, 48differential diagnosis, 228EEG findings, 31intracranial pressure, 246
metabolic myopathy, 172metastatic spinal cord tumors, 233, 270,
271methanol, and neurotoxicology, 382,
383methylprednisolone, and spinal cord
injuries, 300metoclopramide, and migraine, 59, 60midazolam, and seizures in children, 338,
339, 340middle ear disorders, and dizziness, 80migraine
in children, 334diagnosis and management, 58–60multiple sclerosis, 213pregnancy, 363prevalence, 52seizures, 101
Miller-Fisher syndrome (MFS), 203Mini-Mental Status Examination (MMSE),
219, 223mitochondrial myopathy, 172mixed nerves, and peripheral nervous
system disorders, 161, 164, 167mollusks. See marine toxinsmonitoring, of intracranial pressure,
249–50. See also fetal monitoringmonoamine oxidase (MAO) inhibitors
movement disorders, 158serotonin syndrome, 384
monoaminergic medications, anddizziness, 88, 89
monocular confrontational testing, 198monocular diplopia, 197, 199. See also
diplopiamononeuritis multiplex, 168mononeuropathy, 168–70, 387mononucleosis, and Guillain-Barre
syndrome, 176mood, and mental status examination, 3mortality, and intracranial pressure values,
242. See also deathMorton’s neuroma, 195motility, and neuro-ophthalmological
examination, 198–9
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426 Index
motion sickness agents, andanticholinergic effects, 376
motor functionaltered mental status, 46dizziness, 76–7neurological examination, 7–8nontraumatic spinal cord emergencies,
264peripheral nerve injuries, 305seizures, 99spinal cord injuries, 287, 289stroke, 136
motor neuron disorders, 161, 173movement disorders
common drugs and, 156–8evaluation, 146–7hemiballism, 153hyperkinetic movement disorders,
149–53neurotoxicology, 384, 386parkinsonism, 147–9pregnancy, 363–4seizures, 101tics, 153tremors, 153–5
multifocal myoclonus, 387multi-infarct dementia (MID), 223, 224multiple sclerosis (MS)
description of, 210differential diagnosis, 212–14disposition of patients, 215, 217evaluation, 211laboratory tests, 214–15magnetic resonance imaging (MRI), 25,
26management, 211, 215, 216neurological examination, 211neuropsychiatric symptoms, 239nontraumatic spinal cord emergencies,
267–8pathophysiology, 210–11
mumps, and encephalitis, 125muscles. See also motor function
hypotonia in infants, 351–2neurological examination, 7–8peripheral nervous system disorders, 161
muscle stretch reflexes, and seizures, 99muscular dystrophy. See also Duchenne’s
muscular dystrophy; myotonicmuscular dystrophy
characterization of, 172hypotonia in infants and congenital,
352–3
myasthenia gravisdiagnostic testing, 182–3differential diagnosis, 181–2diplopia, 203disposition of patients, 184evaluation, 181Guillain-Barre syndrome, 178in infants, 352, 353–4management, 183–4neuromuscular transmission, 170in pregnancy, 365–7prevalence of, 180weakness, 62, 65
Mycobacterium tuberculosis, 327mycoplasma, and Guillain-Barre syndrome,
176Mycoplasma pneumoniae, 327myelin disorders, and seizures, 94myelinopathy, and toxic neuropathies,
388myelography, and nontraumatic spinal
cord emergencies, 265myelopathy, and multiple sclerosis, 213myoclonic seizures, 97myoclonus, and movement disorders, 148,
155–6myopathy
neurotoxicology, 387, 389systemic conditions, 172–3weakness, 65–6
myotonic muscular dystrophycongenital form of, 355definition, 172myasthenia gravis, 182
myxedema coma, 182
naloxonedepressed respiratory effort, 49, 371, 378opioid syndrome, 377
narcolepsy, 273, 274, 275narcotic analgesics, and migraine, 60National Acute Spinal Cord Injury
Randomized Controlled Trial(NASCIS), 300
nausea, headaches in pregnancy, 363“near death,” 407near-light dissociation (NLD), 198, 208neck trauma, and headache, 53neck and upper extremity pain, 187–90necrotizing myopathy, 171negative inspiratory force (NIF), 162negative myoclonus, 156Neisseria meningitidis, 113, 115
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neologisms, 136neonatal myasthenia gravis, 180, 367neonatal seizures, causes of, 340neonatal status epilepticus, 338nerve conduction studies (NCS), and motor
neuron disease, 173nerve root disorders
peripheral nervous system, 161, 163–4spinal cord injuries, 291weakness, 65, 163
nerve sheath tumors, 310nervous system injuries, and spinal cord,
291–3neuroimaging. See neuroradiologyneuroleptic malignant syndrome
dopamine replacement therapy, 149movement disorders, 157neurotoxicology, 383
neuroleptic drugs. See also haloperidol;neuroleptic malignant syndrome
dementia and behavioral disturbances,224
migraine, 60movement disorders, 157
neurological decompression sickness, 393,394
neurological disorders. See also traumabrain tumors, 226–34central nervous system infections,
113–27cerebrovascular disease, 131–43dementia, 218–25dizziness, 79Guillain-Barre syndrome, 175–9idiopathic intracranial hypertension
(IIH), 252–8increased intracranial pressure, 242–50movement disorders, 146–59multiple sclerosis, 210–17musculoskeletal and neurogenic pain,
186–95myasthenia gravis, 180–4neuromuscular disorders, 161–74neuro-ophthalmological emergencies,
197–209normal pressure hydrocephalus (NPH),
260–1seizures, 100sleep disorders, 273–7
neurological emergencies, of pregnancy,359–69
neurological examinationaltered mental status, 47
anatomical basis of, 10–11dizziness, 73–7elements of, 2–10medical history, 1–2movement disorders, 147multiple sclerosis, 211neuropsychiatry, 237–8seizures, 98–9“short form,” 305traumatic brain injury, 281–2
neurological level, of spinal cord injury,287
neurological presentations, commonforms of
altered mental status, 43–51dizziness, 68–90gait disturbances, 109–12headache, 52–60seizures, 92–108weakness, 62–6
neurological trauma. See traumaneuromuscular disorders
evaluation, 162, 166peripheral nervous system, 161
neuromuscular junction disorders, andweakness, 65
neuromuscular transmission, disorders of,170–1
neuromyelitis optica, 211neuronal dysfunction, and altered mental
status, 44neuro-oncological (N-ONC) emergencies
alteration of mental status, 226–8back pain, 232–4cerebrovascular events, 229–31definition of, 226focal neurological deficits, 231–2seizures and status epilepticus, 228–9
neuro-ophthalmological emergenciesanisocoria, 205–8differential diagnosis, 199–203evaluation, 197–9shunt dysfunction, 314visual loss, 203–5
neuropathic paindefinition, 186facial pain, 187low back and lower extremity pain,
193–5neck and upper extremity pain,
189–90thoracic and truncal pain, 191
neuropraxia, 304, 306
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neuropsychiatry. See also psychiatricdisorders; psychopharmacologicmedications
diagnosis and disposition of patients,238–40
evaluation and management, 236–8scope of discipline, 236
neuroradiology. See also computerizedtomography (CT); magnetic resonanceimaging (MRI)
altered mental status, 49arterial dissection, 14brain tumors, 27–8, 232cerebral venoocclusive disease, 14–15craniospinal trauma, 17–19degenerative disease of the spine, 21, 23dizziness, 87headache, 54inflammatory disease, 23–7intracerebral hemorrhage, 16–17nontraumatic spinal cord emergencies,
265, 266pediatric cervical spine, 301shunt systems, 319–21spinal trauma, 19–20subarachnoid hemmorhage (SAH), 15–16vascular disease, 13–14viral encephalitis, 126
neurosyphilis, 120neurotoxicology. See also toxicity; toxins
altered mental status, 371–8, 383coma and metabolic acidosis, 381–3coma and respiratory depression, 378headaches, 387, 390–1importance of, 371movement disorders, 384neuroleptic malignant disorder, 383peripheral neuropathies, 384, 387seizures, 378–81serotonin syndrome, 384
nifedipine, and hypertension, 361nimodipine, and subarachnoid
hemorrhage, 55nociceptive pain
facial pain, 186–7lower back and lower extremity pain,
192–3neck and upper extremity pain, 187–9thoracic and truncal pain, 191
nocturnal myoclonus, 274nonbacterial septic arthritis, 188nonbacterial thrombotic endocarditis
(NBTE), 229–30
nonconvulsive seizures, generalized, 96–7nonconvulsive status epilepticus
in children, 338EEG findings, 32, 33
nonepileptic paroxysmal events, 99–102nonfebrile seizures, in children, 343–7nonpharmacologic treatment, of migraine,
60nonsteroidal anti-inflammatory drugs
(NSAIDs), and pregnancy, 363. See alsoanalgesics
nontraumatic spinal cord emergencies. Seealso back pain; spinal cord
differential diagnosis and management,265–71
laboratory tests, 264–5presentation of, 263–4special challenges in diagnosis, 271
nonvestibular system dysfunctions, anddizziness, 71, 79
normal pressure hydrocephalus (NPH). Seealso hydrocephalus
differential diagnosis, 261evaluation, 260–1laboratory tests, 261management, 261
normothermia, and brain death, 405nutrition, and differential diagnosis of
coma and delirium, 48. See also foodsNylen-Barany maneuver, 75nystagmus, and dizziness, 74–5, 76, 81
obsessive-compulsive disorder, 153obstructive sleep apnea (OSA), 273–4obturator nerve, and pregnancy, 365occipital nerve blockade, and migraine, 59,
60occupational toxins
drug-induced seizures, 380headache, 391
octopus, and marine toxins, 401ocular motor nuclei, 70ocular motor system, and idiopathic
intracranial hypertension (IIH), 252ocular myopathies, 182ocular reflexes, and altered mental status,
46, 47oculocephalic response, in coma, 46oculomotor nerve palsy, 335oculomotor nerves
cranial nerve evaluation, 4neuro-ophthalmological emergencies,
200–1
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oculopharyngeal muscular dystrophy, 182odontalgia, 186odontoid fractures, 293–4Ohm’s law, and electricity, 391olfactory nerve, and cranial nerve
evaluation, 3–4opening pressure, and lumbar puncture, 40ophthalmic agents, and anticholinergic
effects, 376ophthalmological disorders, and dizziness,
79opiate analgesics, and traumatic brain
injury, 284opioid syndrome, 377–8optic nerve fenestration (ONSF), and
idiopathic intracranial hypertension(IIH), 257–8
optic nerves, and cranial nerve evaluation,4
optic neuritis, 205, 212optic neuropathy, and idiopathic
intracranial hypertension (IIH), 258oral contraceptives, and movement
disorders, 158organophosphate poisoning, 373–4. See
also pesticidesorgan system dysfunction, and coma or
delirium, 48oromandibular dystonia, 150orthostatic tremor, 154osmotic agents, and shunt systems, 321Osteichthyes, 399osteoarthritis
gait disturbances, 112low back and lower extremity pain, 192nociceptive pain, 187, 189
osteogenesis imperfecta, 352osteomyelitis, and infectious spondylitis,
266otitis media, 327otoscopy and otoscope
dizziness, 73traumatic brain injury, 281
ototoxins, and dizziness, 80outcome. See prognosis
pain. See also back paincluster headache, 57musculoskeletal and neurogenic, 186–95perception of and sensory examination, 9sensory testing and peripheral nervous
system, 162–3palatal elevation, 76
papilledemaidiopathic intracranial hypertension
(IIH), 253–4increased intracranial pressure, 243neuro-ophthalmological emergencies,
199optic nerve evaluation, 4
paralysis. See also periodic paralysisnontraumatic spinal cord emergencies,
264spinal cord injuries, 289
paramyxovirus, 122parasomnias, 276parasympathetic system, and visual loss,
207–8parent counseling, and seizures in children,
341–3parietal lobe, and brain abscess, 117parkinsonism
drug-induced, 384, 157–8movement disorders, 147–9
Parkinson’s diseaseextrapyramidal symptoms, 224gait disturbances, 110neuropsychiatric symptoms, 239pain symptoms, 149
Parkland Hospital (Dallas, Texas), 360–1paroxysmal dyskinesias, 101Parsonage-Turner syndrome, 168partial seizures, 93, 95–6particle repositioning maneuver, 82, 83pathological reflexes, and neurological
examination, 10pathophysiological treatment, of vertigo,
90pathophysiology
of multiple sclerosis, 210–11of traumatic brain injury, 279–81
patient history. See medical historypediatric medicine. See children; infantspelecypods, 401penetrating wounds, and peripheral nerve
injuries, 304penicillin, resistance to, 328pentobarbital, and seizures in children, 339peptic ulcer disease, 192perception
mental status examination, 3of temperature or pain and sensory
examination, 9perched facet syndrome, 297perilymph fistulas, and dizziness, 78, 86Perinaud’s syndrome, 133
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430 Index
periodic lateralized epileptiform discharges(PLEDs), 31
periodic limb movement disorder, 274–5periodic paralysis, 172, 178peripheral nerve injuries
compression neuropathies, 306–11evaluation and management, 304–6
peripheral nervous system disorders. Seealso peripheral neuropathies
characterization of, 161differential diagnosis and management,
163–73focused examination, 162–3pregnancy, 364–5
peripheral neuropathies, andneurotoxicology, 384, 387, 388
peripheral vestibular system, and dizziness,68–70
peroneal mononeuropathy, 169pesticides. See also organophosphate
poisoningdrug-induced seizures, 380headache, 391
phakomatoses, and seizures, 94, 98phased array surface coil technology, 28phenobarbital, and seizures, 106, 338, 339,
340, 341, 346phenothiazines, and dizziness, 88, 89phenytoin, and seizures, 105, 106–7, 338,
339, 340, 343, 346, 347, 361, 380. Seealso antiepileptic drugs
phonation test, and vagus nerves, 6physical examination
dementia, 219dizziness, 73headache, 53–4hypotonia in infants, 350–2infections in children, 327neuropsychiatry, 237–8seizures, 98stroke in children, 335
physical restraint, and dementia, 218physical therapy, and dizziness, 90physiological anisocoria, 208physiological myoclonus, 156physiological tremor, 154physostigmine, and anticholinergic
syndrome, 374picornovirus, 122pinhole testing, of visual acuity, 198pinprick sensation, and sensory
examination, 9pituitary adenomas, 369
pituitary apoplexy, 205plants and plant-derived substances
anticholinergic effects, 375drug-induced seizures, 379–80headache, 391
plasmapheresis, and myasthenia gravis,184
plexopathy, 164, 167pneumatic otoscopy, and dizziness, 73, 78poisoning. See neurotoxicology; toxicity;
toxinspoliomyelitis, 65polymyositis (PM), 171polyneuropathy, 168postchiasmal disease, 204, 205posterior cord syndrome, 293posterior fossa masses, 27posterior interosseous syndrome, 190, 309posterior tibial nerve, and compression
neuropathies, 309posthypoxic myoclonus, 156postictal paralysis, 96postpartum foot drop, 365postural tremor, 157, 385povidine-iodine solution, and lumbar
puncture, 38Power’s Ratio, and atlanto-occipital
dislocation, 293Prader-Willi syndrome, 352, 356pralidoxime, and cholinergic syndrome,
373prechiasmal visual loss, 204–5prednisone
cluster headache, 58giant cell arteritis, 57headaches in pregnancy, 363
preeclampsia, 359, 362pregnancy. See also eclampsia; infants
idiopathic intracranial hypertension(IIH), 253
neurological emergencies, 359–69seizures, 95
prehospital care, for seizures, 97premature infants, and hypotonia, 350prescription drugs. See medicationsprevalence
back pain, 263dementia in elderly, 218headache, 52meningitis in children, 325myasthenia gravis, 180seizures and epilepsy in children, 337traumatic brain injury, 279
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preventive treatment, for headaches inpregnancy, 363
primary brain injury, 279primary brain tumors, 227primary headache syndromes, 57–60primary spinal cord tumors, 233, 270, 271primary tic disorders, 154prochlorperazine, and migraine, 59, 60prodomal symptoms, of seizures, 95–6prognosis
altered mental status, 50–1seizures in children, 343
progressive myoclonic epilepsies, 94progressive supranuclear palsy, 239promethazine, and migraine, 59, 60pronator drift test, 8pronator syndrome, and median nerve,
306, 308pronator teres syndrome, 190propofol, and seizures, 106propoxyphene, and opioid syndrome, 377propranolol, and pregnancy, 363proptosis, 199prostatitis, 192protein, in cerebrospinal fluid (CSF), 40proteinuria, 359provocative tests, and dizziness, 77–8proximal muscle weakness, 62, 352proximal shunt malfunction, 321proximal tibial nerve, 310Pseudomonas auruginosa
infectious spondylitis, 266meningitis, 115
pseudotumor cerebri (PTC), 252, 368–9pseudostatus epilepticus, 31pseudotumor cerebri, and headache, 56psoriatic arthritis, 188psychiatric disorders. See also anxiety;
attention deficit hyperactivitydisorder; depression; neuropsychiatry;obsessive-compulsive disorder;psychosis; schizophrenia
coma and delirium, 48Huntington’s disease, 152–3multiple sclerosis, 211, 217seizures, 100, 101–2
psychic symptoms, of seizures, 95psychogenic pain, 192, 193psychogenic seizures, 101psychogenic tremor, 155psychogenic unresponsiveness, and EEG
findings, 31psychomimetic drugs, and seizures, 101
psychopharmacologic medications. See alsoantipsychotic drugs; lithium;neuroleptic drugs; tricyclicantidepressants
agitation and aggression, 240dizziness, 72, 79, 89–90drug-induced seizures, 379headache, 390
psychosisdementia and delirium, 220, 221inpatient evaluation and treatment, 239
psychosocial factors, in neuropsychiatry,240
ptosiscoma, 46eye lids, 199
pulmonary infection, and myastheniagravis, 183
pupillary asymmetry, 45–6pupillary light reflex
altered mental status, 45–6cranial nerve evaluation, 4, 7
pupils, and neuro-ophthalmologicalemergencies, 197, 198, 207–8
purified protein derivative (PPD) test, 266pursuit movements, and dizziness, 74pyridoxine
alcohol poisoning, 383drug-induced seizures, 381peripheral neuropathies, 388
rabies, 122, 125radial mononeuropathy, 169radial nerve, and compression
neuropathies, 309radial nerve palsy, 190radial sensory nerve entrapment, 309radial tunnel syndrome, 309radiation therapy
encephalopathy, 228spinal cord tumors, 234
radicular pain, 263radiculoneuritis, and Lyme disease, 121radiculopathy, 163–4, 167radionuclide clearance shuntogram, 320rapidly progressive dementia, 222rapid-positioning nystagmus, 75rapid-sequence intubation (RSI). See also
endotracheal intubationintracranial pressure, 247traumatic brain injury, 283
rattlesnake envenomation, 397receptive aphasia, 136
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432 Index
recompression chamber, and diving-relatedinjuries, 394
recurrence, of seizures in children, 343,347
recurrent hypersomnia, 276red blood cells (RBCs), and lumbar
puncture, 39referrals, and dementia, 222. See also
consultationreflexes, and peripheral nervous system,
163. See also deep tendon reflexes;pupillary light reflex
reflux sympathetic dystrophy (RSD), 190rehabilitation, dizziness and vestibular, 90.
See also physical therapyReiter’s syndrome, 188relapsing-remitting disease (RRMS), 210,
213, 215REM sleep behavior disorder (RBD), 274,
276Renal failure, and idiopathic intracranial
hypertension (IIH), 253reovirus, 122Reptilia, and sea snakes, 399resisted head turning test, and accessory
nerves, 6respiratory failure and respiratory
abnormalitiesaltered mental status, 44, 45, 371myasthenia gravis, 181neurotoxicology, 378weakness, 66
respiratory fatigue, and spinal cord injuries,287
restless legs syndrome (RLS), 277, 363–4retinal granulomas, 268retrovirus, 122“reverse Lasegue” sign, 194Reye’s syndrome, and cerebral edema, 246rhabdomyolysis, 162rhabdovirus, 122rheumatoid arthritis (RA)
nontraumatic spinal cord emergencies,268–9
upper extremity pain, 188rigidity, and neurotoxicology, 383. See also
neuroleptic malignant syndromeriluzole, and ALS, 173Rinne test, 6, 76Romberg sign, 111roving eye movements, and altered mental
status, 46rubella, 188ruptured neoplastic aneurysm, 230
saccidic eye movements, and dizziness, 74saccule, 69sacral fractures, 299–300sacral sparing, and spinal cord injuries,
289sacroiliitis, 193St. Louis encephalitis, 124, 126salicylate toxicity, 382saline solution, fluid resuscitation and
intracranial pressure, 248Salmonella, and infectious spondylitis, 266saphenous nerve, 310sarcoid granulomas, 268sarcoidosis, and Guillain-Barre syndrome,
176Saturday night palsy, 190schizophrenia, onset of in late life, 221sciatic mononeuropathy, 169scorpion envenomation, 398–9scorpionfish, 399–400SCUBA diving
dybarism and injuries related to, 393–5vertigo, 90
sea snakes, 399, 400“seat belt” injury, 290secondary brain injury, 279–80secondary brain tumors, 227secondary dystonias, 151secondary headache syndromes, 55–7secondary tic disorders, 154sedative-hypnotic agents, 377sedative hypnotic syndrome, 374, 376seizures. See also epilepsy
alcohol withdrawal, 106–7alterations of mental status, 227brain tumors, 228–9coma and delirium, 48differential diagnosis, 99–102disposition of patients after, 107eclampsia, 360–2EEG findings, 31, 92epileptic myoclonus, 156evaluation and management of in
children, 337–48events mimicking in children, 348infections in children, 328intracranial pressure, 249laboratory tests, 102management, 102–3medicolegal issues, 107–8neurotoxicology, 378–81in pregnancy, 362traumatic brain injury, 284types of, 92, 93
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selective serotonin reuptake inhibitors(SSRIs), and serotonin syndrome, 384
senescent gait, 109sensory disorders, and seizures, 101sensory function
dizziness, 77neurological examination, 7, 9–10nontraumatic spinal cord emergencies,
264peripheral nervous system, 162–3, 165,
305seizures, 99stroke, 136
sensory organs, and peripheral vestibularsystem, 68–9
septic arthritides, 192serum studies, and headache, 54shellfish. See marine toxins“short form” neurological examination,
305shoulder-hand syndrome, 190shunt systems. See also hydrocephalus;
intracranial pressurecomponents and malfunctions of,
313–14evaluation and differential diagnosis,
314–21management, 321–3
shunt tap, 320SIADH (syndrome of inappropriate
secretion of antidiuretic hormone), 246silastic lumboperitoneal shunt, and
idiopathic intracranial hypertension(IIH), 257
simple partial seizuresmanagement of, 103types of seizures, 93, 95, 96
sinusitis, and headache, 57sixth nerve palsies, 201–2skeletal muscle relaxants, and
anticholinergic effects, 376skull fractures
neuroradiology, 20traumatic brain injury, 280, 281
Sjogren’s disease, 215sleep aids, and anticholinergic effects, 376sleep deprivation, and seizures in
pregnancy, 362sleep disorders
parasomnias, 276predisposition to trauma, 273–5types of, 273, 276–7
sleep paralysis, 275sleep-related panic attacks, 273
sleep terrors and sleepwalking, 274,276
slit ventricle syndrome, 322SLUDGE (salivation, lacrimation,
urination, defecation, gastricemptying), 373
slow-wave abnormalities, and EEGs, 32snake envenomations, 396–8, 399Snellen chart, and visual acuity, 211social history, and neurotoxicology, 372sodium bicarbonate
alcohol poisoning, 383sedative hypnotic syndrome, 376
sodium nitroprusside, and hypertension,361
soft tissue injuries, and spinal cord injury,289–93
space-occupying lesions, and lumbarpuncture, 35, 36
spastic gait, 111spectrophotometry, and stroke, 137speech, and glossopharyngeal nerve, 6. See
also aphasiaspinal cord. See also back pain;
nontraumatic spinal cord emergencies;spinal cord compression; spinal cordlesions
infections, 265–7neurological examination, 10–11tumors, 27–8weakness and disorders of, 64–5
spinal cord compression. See also spinalcord; spinal cord injuries; spinal cordlesions; spinal shock
magnetic resonance imaging (MRI), 13,22
neuro-oncological emergencies and backpain, 232–4
sensory deficits, 264weakness, 65
spinal cord infarction, 191, 269–70spinal cord injuries. See also spinal cord;
spinal cord compression; spinal shock;spinal trauma
children, 300–2dislocations and vertebral bony injuries,
293–9evaluation, 286–9incidence of, 286magnetic resonance imaging (MRI),
302–3management, 300soft tissue injuries, 289–93spinal shock, 289
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spinal cord injury without radiographicabnormality (SCIWORA), 302–3
spinal cord lesions. See also spinal cord;spinal cord compression
Guillain-Barre syndrome, 178neuroimaging, 232neuropathic pain, 189nontraumatic spinal cord emergencies,
270–1primary and metastatic types of, 233
spinal cord syndromes, and nervous systeminjuries, 291–3
spinal epidural abscess, 267spinal fractures, 293“spinal” headache, 56spinal muscular atrophy, 352spinal needle, and lumbar puncture, 39spinal sarcoidosis, 268spinal shock, 271, 289spinal stenosis, 23, 194spinal trauma, and neuroradiology, 19–20spinal tuberculous arachnoiditis, 118spine, degenerative disease of, 21, 23spondylolisthesis, 23spontaneous blinking, and altered mental
status, 46spontaneous nystagmus, 74, 75sports, and clinical findings in concussion,
282stab wounds, and peripheral nerve injuries,
304staggering gait, 111Staphylococcus aureus
infectious spondylitis, 266meningitis, 115, 116
Staphylococcus epidermidis, and shuntinfections, 323
status epilepticus. See also epilepsy;nonconvulsive status epilepticus
brain tumors, 228–9in children, 337–41EEG findings, 31, 32, 33intracranial pressure, 246management of, 103–6
steppage gait, 111–12steroids, and idiopathic intracranial
hypertension (IIH), 257. See alsocorticosteroids
stimulants, and movement disorders, 158stingrays, 399“stocking-glove” pattern, and
polyneuropathy, 10, 77stonefish, 399–400
strength testing, and weakness, 162Streptococcus pneumonia
infectious spondylitis, 266meningitis, 113, 115, 116penicillin-resistant strains, 328
stroke. See also cerebrovascular diseasecerebral edema, 246childhood, 330, 333, 334–5coma and delirium, 48disposition of patients, 142evaluation, 135–7management, 137–42multiple sclerosis, 213, 214pathophysiology of, 131–4pregnancy, 367seizures, 101
stroke prevention and sickle cell disease(STOP) trial, 330
structural anisocoria, 208structural choreas, 152structural disease, and alterations of
mental status in cancer patients, 227Sturge-Weber syndromes, 98subacute meningitis, 181subacute pain, 263subacute toxic neuropathy, 388subarachnoid hemorrhage (SAH)
brain tumors, 230in children, 330headache, 55intracranial pressure, 243lumbar puncture, 35, 40, 41neuroradiology, 15–16, 137in pregnancy, 367–8stroke, 134, 135
subcortical infarction, 333subdural hematoma (SDH)
computerized tomography, 20craniospinal trauma, 17–18traumatic brain injury, 280
subhyaloid hemorrhage, 243substance abuse. See also alcohol
drug-induced seizures, 379headache, 53, 390
suction catheter passes, and intracranialpressure, 249
Sudek’s atrophy, 190sumatriptan
cluster headache, 57–8migraine, 58–9, 60
superficial peroneal nerve, andcompression neuropathy, 311
superior sagittal sinus occlusion, 230
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supportive treatmentcarpal tunnel syndrome, 364infections in children, 328myasthenia gravis, 183
supranuclear facial palsy, 170surgery. See also management
brain abscess, 116infectious spondylitis, 266spinal cord infarction, 269–70vertigo, 90
swallowing, and glossopharyngeal nerve, 6swinging flashlight test, 198Sydenham’s chorea, 151symmetric eye deviation, and altered
mental status, 46sympathetic system, and visual loss, 206–7symptomatic epilepsies
causes of seizures, 94EEG findings, 31
symptomatic myoclonus, 156syncope
EEG findings, 31seizures, 100–1
syphilis. See neurosyphilis; syphiliticlabyrinthitis
syphilitic labyrinthitis, 84–5systemic disorders
dizziness, 79, 80headache, 53, 54myopathy, 172–3seizures, 100–1
systemic lupus erythematosus (SLE), 176,253
systemic vascular disease, in children, 331
tacrine, and Alzheimer’s disease, 224tardive disorders, and neuroleptics, 157tardive dyskinesia (TD), 158, 386tarsal tunnel syndrome, 309taste test, 5teardrop fracture, 295, 296Technetium shuntogram, 317tegmental syndrome, 133temperature, perception of and sensory
examination, 9. See also hyperthermia;hypothermia; thermoregulation
temperomandibular joint disorder, 57temporal lobe, and brain abscess, 117temporo-mandibular joint dysfunction,
186tendinitis, and pain, 192, 193“tennis elbow,” 189tenosynovitis, and pain, 192, 193
Tensilon test, and myasthenia gravis, 184,203
tension-type headache, 57theophylline, and drug-induced seizures,
380–1thermal injuries, 392, 393thermoregulation, and brain death, 407thiamine
alcohol poisoning, 383altered mental status, 371
thiopental, and seizures in children, 339third nerve palsy, 200, 201, 207–8thoracic burst fracture, 298thoracic compression fracture, 298thoracic fracture-dislocation injuries, 298thoracic outlet syndrome, 190, 308thoracic pain, 191thoracic spine injuries, 298–9thoracolumbar junction fracture, 298–9thought disorders, and mental status
examination, 2thrombocytopenia, 230, 360thrombolytics, and stroke, 139, 141thymectomy, 184thymus, and myasthenia gravis, 180, 184thyroid eye disease, 199thyrotoxicosis, 172tics
evaluation and management of, 153phenomenology of, 148
time course, and symptoms of dizziness, 71Tinel’s sign, 308tinnitus, and dizziness, 72, 85tissue Plasminogen Activator (tPA), and
stroke, 139, 141togavirus, 122tone, of muscles, 7, 8tongue protrusion, and hypoglossal nerves,
6–7tonic seizures, generalized, 96, 97torticollis, 150–1Tourette’s syndrome, 153toxic encephalopathy
alterations in mental status, 227coma and delirium, 48management, 228
toxic envenomationheadache, 391myopathies, 389scorpions, 398–9seizures, 380snake bite, 396–8weakness, 64
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toxicity, of medications. See alsoneurotoxicology; toxins
antiepileptic drugs and children, 347–8magnesium sulfate and eclampsic
seizures, 361toxic labyrinthitis, 84toxicology screening, and altered mental
status, 49, 372toxins. See also neurotoxicology; toxic
envenomation; toxicitychorea, 152hypotonia in infants, 355seizures, 95, 101tremor, 155weakness, 64
toxoplasma encephalitis, 117toxoplasmosis
HIV-related infections, 117–18neuroradiology, 24, 26
traction injuries, and peripheral nerveinjuries, 306
transarterial angiography, andsubarachnoid hemorrhage, 16
transcatheter angiography, 14transcranical Doppler examination, and
intracranial pressure, 250transient global amnesia, 101, 220transient ischemic attacks (TIAs)
antiplatelet therapy, 138definition of, 131magnetic resonance angiography (MRA),
13–14transmission neuropathy, and toxic
neuropathy, 388transverse myelitis, 65, 267, 384trauma. See also craniospinal trauma; head
trauma; traumatic brain injuryin children, 332–3coma and delirium, 48dizziness, 80, 81peripheral nerve injuries, 304–11radioculopathy, 167sleep disorders and predisposition to,
273–5spinal cord injuries, 286–303
traumatic brain injury (TBI). See also brain;head trauma
in children, 284evaluation, 281–2incidence of, 279intracranial pressure, 246, 249management, 283neuropsychiatric symptoms, 239
neuroradiology, 18, 281, 282–3pathophysiology, 279–81seizures, 94
traumatic neuropathies, and pregnancy,365
traumatic spondylolisthesis, 294traumatic tap, and lumbar puncture, 40trauma-triggered migraine, 334treatment. See adjunctive therapy;
management; medications;nonpharmacologic treatment;pathophysiological treatment;preventive treatment; supportivetreatment; surgery
treatment-related cerebrovasculardisorders, and brain tumors, 230
treatment-related encephalopathy, andalterations in mental status, 227
tremorsevaluation and management of, 153–5phenomenology of, 148
tricyclic antidepressants. See alsoantidepressants
anticholinergic effects, 376dizziness, 89drug-induced seizures, 381movement disorders, 158
trigeminal nerve, and cranial nerveevaluation, 4–5
trigeminal neuralgia, 187triple flexion reflex, and nontraumatic
spinal cord emergencies, 271trochlear nerve, and
neuro-ophthalmological emergencies,201
truncal ataxia, 8truncal pain, 191tuberculosis, of spine, 266–7tuberculosis meningitis (TBM)
diagnosis and treatment of, 118–19lumbar puncture, 41
tuberous sclerosis, 98Tullio phenomenon, 73tympanic membrane
displacement of and intracranialpressure, 250
dizziness, 73type II decompression sickness, 393
ulnar mononeuropathy, 169ulnar nerve, and compression
neuropathies, 308–9ulnar neuropathy, 190
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ultrasound imaging, of muscle in infants,356
uncal herniation, 245unilateral facet dislocation, 295–6unresponsiveness, and brain death, 405,
406upper airway resistance syndrome (UARS),
274urinary tract infections, and multiple
sclerosis, 215, 217utricle, 69
vagus nerves, and cranial nerve evaluation,6
valproic acid (VPA), and seizures inchildren, 340, 346, 347–8
valproatemigraine, 59, 60seizures in children, 339
Valsalva maneuvers, and dizziness, 73, 78valves, of shunt system, 315vancomycin, and children, 328vasospastic disorders, in children, 332vascular disease
dizziness, 80, 86–7neuroradiology, 13–14seizures, 95
vascular injuries, and spinal cord injuries,290
vasculitis, in children, 331vasculopathic cranial nerve, and
neuro-ophthalmological emergencies,201
vasculopathies, in children, 331vasogenic edema, 245, 246, 249“vegetative state,” and coma, 43Venereal Disease Research Laboratory
(VDRL), 120ventilation, controlled, 242ventricular fibrillation, and electrical
injuries, 391ventriculitis, 323vertebral arteries, and vascular injuries,
290, 333vertebral basilar artery occlusion, 335vertebral bony fractures, 295vertebral bony injuries, and spinal cord
injuries, 290vertebral discitis, 27. See also disc
herniationvertebral dissection, and headache, 56vertebral metastases, 27–8vertebral osteomyelitis, 27, 192–3
vertebrobasilar insufficiency (VBI), 86vertical diplopia, 201vertigo. See also dizziness
definition of, 68pathophysiological treatment of, 90vestibular system disorders, 70, 71
vestibular neuronitis, 83–4vestibular nuclei, 70vestibular rehabilitation, 90vestibular schwannomas, 86vestibular suppressants, 88, 89vestibular system disorders, and dizziness,
71, 76, 80vestibular test, 5vestibulo-ocular reflex (VOR), and
dizziness, 70, 76viral encephalitis, diagnosis and
management of, 121–7viral labyrinthitis, 84viral meningitis. See also meningitis
HIV-related, 117lumbar puncture, 41
visual acuity. See also eye; visual field;visual loss
multiple sclerosis, 211neuro-ophthalmological emergencies,
197–8optic nerve evaluation, 4
visual field. See also eye; visual acuity;visual loss
defects and cranial nerve evaluation, 7intracranial pressure, 243neuro-ophthalmological emergencies,
198visual loss. See also eye; visual acuity; visual
fielddefined, 197idiopathic intracranial hypertension
(IIH), 252, 258multiple sclerosis, 212neuro-ophthalmological emergencies,
203–5pseudotumor cerebri in pregnancy, 369
vital signs, and altered mental status, 44vitamin K, and coagulopathy, 362
waddling gait, 112Wallenberg’s syndrome, 87, 133, 207warfarin, and children, 336water intoxication, 246weakness
acute neuromuscular respiratory failure,66
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weakness (cont.)brachial plexus, 167definition, 62differential diagnosis, 64–6dizziness and facial, 72evaluation, 62–4Guillain-Barre syndrome, 176hypotonia in infants, 351–5myasthenia gravis, 181nontraumatic spinal cord emergencies,
264strength testing, 162
Weber test, 6, 76Wegener’s granulomatosis, and
Guillain-Barre syndrome, 176weight loss, and idiopathic intracranial
hypertension (IIH), 257Werdnig-Hoffmann syndrome, 352, 356
Wernicke’s encephalopathy, 105Western equine encephalitis, 124, 126“whiplash,” and acute cervical strain,
290white blood cells (WBCs), and lumbar
puncture, 39, 329withdrawal
opioid syndrome, 378seizures and alcohol abuse, 101, 106–7,
379Wright maneuver, and thoracic outlet
syndrome, 190
xanthochromia, 40, 54, 137
zone I, II, and III fractures, 299–300zone of partial presentation, and spinal
cord injury, 287
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