NeurologicDifferentialDiagnosisassets.cambridge.org/.../14558/frontmatter/9781107014558_frontma… · 978-1-107-01455-8 - Neurologic Differential Diagnosis: A Case-Based Approach

Neurologic Differential DiagnosisA Case-Based Approach

www.cambridge.org© in this web service Cambridge University Press

Cambridge University Press978-1-107-01455-8 - Neurologic Differential Diagnosis: A Case-Based ApproachEdited by Alan B. Ettinger and Deborah M.WeisbrotFrontmatterMore information

http://www.cambridge.org/9781107014558

http://www.cambridge.org







Neurologic DifferentialDiagnosisA Case-Based ApproachEdited byAlan B. Ettinger, MD, MBAEpilepsy Director, Neurological Surgery P.C., Rockville Center, New York;Director of the Epilepsy Wellness Program, Winthrop University Hospital, Mineola, New York;Director of EEG and Epilepsy, Huntington Hospital, Huntington, New York; andProfessor of Clinical Neurology, Albert Einstein College of Medicine, Bronx, New York, USA

Deborah M. Weisbrot, MDAssociate Professor of Clinical Psychiatry and Director, Child & Adolescent Psychiatry, Outpatient Clinic,Department of Psychiatry and Behavioral Sciences, Stony Brook University Medical Center, New York, USA






University Printing House, Cambridge CB2 8BS, United Kingdom

Cambridge University Press is part of the University of Cambridge.

It furthers the University’s mission by disseminating knowledge inthe pursuit of education, learning and research at the highestinternational levels of excellence.

www.cambridge.orgInformation on this title: www.cambridge.org/9781107014558

c© Cambridge University Press 2014

This publication is in copyright. Subject to statutory exceptionand to the provisions of relevant collective licensing agreements,no reproduction of any part may take place without the writtenpermission of Cambridge University Press.

First published 2014

Printed in the United Kingdom by TJ International Ltd, Cornwall.

A catalogue record for this publication is available from the BritishLibrary

ISBN 978-1-107-01455-8 Hardback

Cambridge University Press has no responsibility for the persistenceor accuracy of URLs for external or third-party internet websitesreferred to in this publication, and does not guarantee that anycontent on such websites is, or will remain, accurate or appropriate.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Every effort has been made in preparing this book to provideaccurate and up-to-date information which is in accord with acceptedstandards and practice at the time of publication. Although casehistories are drawn from actual cases, every effort has been made todisguise the identities of the individuals involved. Nevertheless, theauthors, editors and publishers can make no warranties that theinformation contained herein is totally free from error, not leastbecause clinical standards are constantly changing through researchand regulation. The authors, editors and publishers therefore disclaimall liability for direct or consequential damages resulting from the useof material contained in this book. Readers are strongly advised topay careful attention to information provided by the manufacturer ofany drugs or equipment that they plan to use.

3rd printing 2015






This book is dedicated to our sons, Joshua and Jonathan Ettinger, withlove. They have been our greatest teachers along the journey of life.











Contents

List of contributors page xiForeword xxiPreface xxiiiAcknowledgments xxiv

Section 1 – Differential Diagnosisof Abnormal Symptoms and Signs

1 Introduction: localization anddifferential diagnosis in neurology 1Alan B. Ettinger and Deborah M. Weisbrot

2 Agitation 12Angela Scicutella and Durga Roy

3 Agnosias 18Marlene Behrmann and Maxim D. Hammer

4 Anxiety and panic 22Kenneth R. Kaufman

5 Aphasia 34Gad E. Klein and Dragana Micic

6 Apraxia 41Jasvindar Chawla and Noam Epstein

7 Ataxia, acute or subacute 45Jay Elliot Yasen

8 Ataxia, subacute or chronic 55Amanda J. Thompson and S. H. Subramony

9 Attentional problems 61Lenard A. Adler, Thomas M. Boes, David M.Shaw, and Samuel Alperin

10 Autonomic failure or syndromes 70Rajpaul Singh and Joe Colombo

11 Bulbar and pseudobulbar palsy 82Eric R. Eggenberger and David Clark

12 Catatonic-like states 84Edward Firouztale

13 Chorea 89Ruth H. Walker

14 Coma 96Galen V. Henderson and Alan B. Ettinger

15 Dementia 106Howard Crystal and Diana Rojas-Soto

16 Depression 119Yelizaveta Sher and John J. Barry

17 Diplopia 129Deborah I. Friedman

18 Dissociative disorder 135Danielle G. Koby and W. Curt LaFrance, Jr.

19 Dizziness 139Martin Gizzi and Manpreet Multani

20 Drop attacks 145Lourdes Bello-Espinosa

21 Dysarthria 149David B. Rosenfield

22 Dysphagia 152Jessica A. Shields and Anne L. Foundas

23 Dystonia 158Ritesh A. Ramdhani and Steven J. Frucht

24 Eating disorders 164Nina Kirz and Vandana Aspen

25 Eyemovements, abnormal 167Heather E. Moss

26 Falls 170Christyn M. Edmundson and Steven A. Sparr

vii






Contents

27 Foot drop 178Pinky Agarwal and Ryan J. Zehnder

28 Gait abnormalities 182Michael A. Williams and Scott E. Brown

29 Hallucinations, visual 188Victoria S. Pelak

30 Headache 191Ira M. Turner and Richard B. Lipton

31 Hearing deficit 197David A. Gudis and Michael J. Ruckenstein

32 Hypersomnolence 202Jeffrey S. Durmer and Heidi D. Riney

33 Incontinence 208Cara Tannenbaum and Nelly Faghani

34 Mania and bipolar symptoms 214Christopher P. Kogut and James L. Levenson

35 Medically unexplained symptoms 218Eve G. Spratt and Ryan R. Byrne

36 Memory loss and cognitive decline –acute and subacute amnesia 223Max C. Rudansky, Jacques Winter, AlanMazurek, Fawaz Al-Mufti, and Alan B. Ettinger

37 Mental status change, acute[and delirium] 236G. Bryan Young, Teneille G. Gofton, andAlan B. Ettinger

38 Movement disorders in psychiatricdisorders 242Gregory M. Pontone

39 Movements, facial 247Kevin M. Biglan and Annie Killoran

40 Movements, focal, clonic 250Daniel J. Luciano and Siddhartha Nadkarni

41 Movements, complexmotor activity 253Siddhartha Nadkarni and Daniel J. Luciano

42 Movements during sleep 258Michael J. Thorpy

43 Movements, tonic-clonic type 262Daniel J. Luciano and Siddhartha Nadkarni

44 Mutism 266Gaia Donata Oggioni and Alberto J. Espay

45 Myalgia, cramps 270Gary P. Kaplan and Rina Caprarella

46 Myoclonus 274Venkat Ramani, David Elliott Friedman, andMehri Songhorian

47 Myotonia 282Beth Stein and Steven Herskovitz

48 Nystagmus 287Sarita B. Dave and Patrick J. M. Lavin

49 Ophthalmoparesis, gaze conjugatelateral deficit and conjugate verticaldeficit 299Matthew J. Thurtell

50 Pain, arm 304Robert Duarte

51 Pain, back 308Michael Ronthal

52 Pain, eye 312Mark Beyer and Deepak Grover

53 Pain, face 316Egilius L. H. Spierings

54 Pain, neck 325Louis J. Goodrich and Ajay Berdia

55 Papilledema 332Don C. Bienfang

56 Paresthesias 337George D. Baquis and Anant M. Shenoy

57 Parkinson’s disease and relatedextrapyramidal syndromes 340Oded Gerber, Fawaz Al-Mufti, and Alan B.Ettinger

58 Proptosis [exophthalmos] 346Luis J. Mejico and Laryssa A. Huryn

59 Psychosis, thought disorder 349Ramses Ribot and Andres M. Kanner

60 Ptosis 355Andrew R. Harrison, Ali Mokhtarzadeh, andJuwan Park

viii






Contents

61 Pupil constriction and Horner’ssyndrome 359Robert C. Sergott and Scott Uretsky

62 Pupil dilation 365Jade S. Schiffman, Rosa Ana Tang, Anastas F.Pass, and L. Anne Hayman

63 Respiratory difficulties, neurologiccauses 375Wan-Tsu W. Chang and Paul A. Nyquist

64 Retardation, mental 380Tal Gilboa, Varda Gross-Tsur, Rolla Nuoman,and Alan B. Ettinger

65 Seizure 387David J. Anschel

66 Sensory deficits and abnormalsensations 395Paul W. Brazis

67 Sensory deficits in the face 405Jeffrey A. Brown and Alan B. Ettinger

68 Smell deficit 408Richard L. Doty and Hakan Tekeli

69 Spasm, hemifacial 412Jagga Rao Alluri

70 Stroke and hemorrhage syndromes 414George C. Newman and Aparna M. Prabhu

71 Stroke in adults, etiologies 432Susan W. Law and Daniel M. Rosenbaum

72 Stroke in the young, etiologies 444Walter J. Molofsky

73 Syncope 450Todd J. Cohen

74 Tinnitus 454Eric E. Smouha and Grace M. Charles

75 Tremor 458Odi Oguh, Esther Baldinger, and Tanya Simuni

76 Vertigo 465Maroun T. Semaan

77 Visual field deficits 477Scott Uretsky

78 Visual loss, acute bilateral 487Robert M. Mallery and Misha L. Pless

79 Visual loss, monocular 494Jeffrey Peterson, Rehan Ahmed, andRod Foroozan

80 Weakness, generalized acute 497Denis Ostrovskiy

81 Weakness, hemiparesis 502Amit M. Shelat, Shicong Ye,and Malcolm H. Gottesman

82 Weakness in the intensive care unit 514John J. Halperin

83 Weakness, monomelic 519Casey A. Chamberlain and Michael Andary

84 Weakness, neck 525Sindhu Ramchandren and Aashit K. Shah

85 Weakness, paraparesis 528Friedhelm Sandbrink

86 Weakness, proximal 537Georgios Manousakis and Glenn Lopate

Section 2 – Differential Diagnosiswithin Specific Localizations

87 Cavernous sinus syndrome 547Vladimir Dadashev, Jonathan L. Brisman,and John Pile-Spellman

88 Facial nerve palsy 549Philip Ragone

89 Fourth nerve palsy 552Kristina Y. Pao and Mark L. Moster

90 Myelopathy 557Amanda R. Bedford and Randall J. Wright

91 Nerve, cranial: multiple deficit 563David Solomon and Jee Bang

92 Neuropathy, axonal versusdemyelinating 573Michael T. Pulley and Alan R. Berger

93 Neuropathy, femoral 580Eva Sahay

ix






Contents

94 Neuropathy, median and carpal tunnel 583Huiying Yu

95 Neuropathy, radial 587Padmaja Aradhya

96 Neuropathy, sciatic 589Julius Bazan and Pedro J. Torrico

97 Neuropathy, tibial 596Reema Maindiratta

98 Neuropathy, ulnar 601Steven Ender

99 Plexopathy, brachial 612Michael Amoashiy, Prajwal Rajappa, andCaitlin Hoffman

100 Plexopathy, lumbar 623Jean Robert Desrouleaux and Alan B. Ettinger

101 Radiculopathy 631Amtul Farheen and Bashar Katirji

102 Sixth nerve palsy 635Scott Uretsky

103 Third nerve palsy 642Claire A. Sheldon and Jason J. S. Barton

Index 648

x






Contributors

Lenard A. Adler, MDProfessor of Psychiatry and Child and AdolescentPsychiatry, NYU School of Medicine, New York, NY,USA

Pinky Agarwal, MDAttending Neurologist, Booth Gardner Parkinson’sCenter at Evergreen Hospital, Kirkland, WA, USA

Rehan Ahmed, MDCullen Eye Institute, Baylor College of Medicine,Houston, TX, USA

Jagga Rao Alluri, MDClinical Neurophysiologist, ABK NeurologicalAssociates, Forest Hills, NY, USA

Fawaz Al-Mufti, MDChief Resident, Department of Neurology, StateUniversity of New York at Stony Brook, Stony BrookUniversity Medical Center, Stony Brook, NY, USA

Samuel Alperin, BSDepartment of Psychiatry, NYU School of Medicine,and Mental Health Research Service, VA NY HarborHealthcare System, New York, NY, USA

Michael Amoashiy, MD, PhDAssistant Professor of Clinical Neurology, WeillCornell Medical College, Brooklyn, NY, USA

Michael Andary, MDProfessor and Residency Program Director, MichiganState University College of Osteopathic MedicineDepartment of Physical Medicine and Rehabilitation,East Lansing, MI, USA

David J. Anschel, MDDirector, Comprehensive Epilepsy of Long Island,St Charles Hospital, Port Jefferson, NY, USA

Padmaja Aradhya, MDNeurologist, Bethpage, NY, USA

Vandana Aspen, PhDPostdoctoral Scholar, Stanford University, Stanford,CA, USA

Esther Baldinger, MDClinical Assistant Professor of Neurology, SUNYDownstate Medical Center, Brooklyn, NY, USA

Jee Bang, MDChief Resident, Department of Neurology, JohnsHopkins Hospital, Baltimore, MD, USA

George D. Baquis, MDHead – Neuromuscular Section, Baystate MedicalCenter and Associate Clinical Professor of Neurology,Tufts University School of Medicine, Springfield,MA, USA

John J. Barry, MDProfessor of NeuroPsychiatry and Behavioral Science,Stanford University Medical Center, Stanford, CA,USA

Jason J. S. Barton, MD, PhD, FRCPCProfessor, Departments of Ophthalmology and VisualSciences, Medicine (Neurology), and Psychology,University of British Columbia, Vancouver, Canada

Julius Bazan, MDNeurologist, Rockville Centre, NY, USA

Amanda R. Bedford, MAUniversity of Houston-Clear Lake, AmericanWashington University College of Law, Houston, TX,USA

Marlene Behrmann, PhDProfessor, Department of Psychology and Center forthe Neural Basis of Cognition, Carnegie MellonUniversity, Pittsburgh, PA, USA

xi






List of contributors

Lourdes Bello-Espinosa, MDAssistant Professor of Neurology and Pediatrics,Stony Brook University, Stony Brook, NY, USA

Ajay Berdia, MDNeurologist, Rochester, NY, USA

Alan R. Berger, MDProfessor and Chairman, Department of Neurology,Interim Chairman, Department of Neurosurgery,Associate Dean for Research, University of FloridaCollege of Medicine – Jacksonville, and Director,Neuroscience Institute, Shands Jacksonville, FL, USA

Mark Beyer, DOResident in Ophthalmology, Philadelphia College ofOsteopathic Medicine, Philadelphia, PA

Don C. Bienfang, MDDirector of Neuro-ophthalmology, Brigham andWomen’s Hospital Assistant Professor, HarvardMedical School, Boston, MA, USA

Kevin M. Biglan, MD, MPHAssociate Chair for Clinical Research, AssociateProfessor of Neurology, Director, National ParkinsonFoundation Center of Excellence, Director,Huntington Disease Society of America Center ofExcellence, University of Rochester School ofMedicine and Dentistry, Rochester, NY, USA

Thomas M. Boes, MDDepartment of Psychiatry, NYU School of Medicine,New York, NY, USA

Paul W. Brazis MDProfessor of Neurology and Consultant in Neuro-Ophthalmology and Neurology, Departments ofNeurology and Ophthalmology, Mayo Clinic,Jacksonville, FL, USA

Jonathan L. Brisman, MDNeurological Surgery PC, Rockville Center, NY, USA

Jeffrey A. Brown, MDNeurological Surgery, PC, Great Neck, NY, USARegional Director, TNA-Facial Pain Organization,Neurosurgery Director of the Winthrop-UniversityHospital CyberKnife R© Program and Chief ofNeurosurgery at Mercy Medical Center, RockvilleCentre, New York, NY, USA

Scott E. Brown, MDChief, Department of Physical Medicine andRehabilitation, Sinai Hospital of Baltimore,Baltimore, MD, USA

Ryan R. Byrne, MDAssistant Professor of Psychiatry and BehavioralMedicine, Medical College of Wisconsin (MCW),Milwaukee, WI, USA

Rina Caprarella, MDChief of Neurology, ProHealth, Lake Success,NY, USA

Casey A. Chamberlain, DOPhysiatrist, Michigan State University College ofOsteopathic Medicine, Department of PhysicalMedicine and Rehabilitation, East Lansing, MI, USA

Wan-TsuW. Chang, MDClinical Fellow, Neurosciences Critical Care Division,Department of Anesthesiology and Critical CareMedicine, Johns Hopkins University School ofMedicine, Baltimore, MD, USA

Grace M. Charles, BAMount Sinai School of Medicine, New York, NY, USA

Jasvinder Chawla, MD, MBA, FAANChief, Neurology Service, Edward Hines, Jr. VAHospital, Hines, IL, USA

David Clark, DONeuro-ophthalmology Fellow, Michigan StateUniversity, East Lansing, MI, USA

Todd J. Cohen MD FACC FHRSDirector of ElectrophysiologyDirector of the Pacemaker Arrhythmia Center,Winthrop University Hospital, Mineola, NY, USA

Joe Colombo, PhDMedical Director, Ansar Medical Technologies,Philadelphia, PA, USA

Howard Crystal, MDProfessor of Neurology, Pathology, and Psychiatry,SUNY Downstate Medical Center, Brooklyn, NY,USA

Vladimir Dadashev, MDNeurosurgeon, Neurological Surgery PC, RockvilleCenter, NY, USA

xii







Sarita B. Dave, MDSenior Resident, Ophthalmology, Vanderbilt EyeInstitute, Nashville, TN, USA

Jean Robert Desrouleaux, MDNeurologist, Hempstead NY, USA

Richard L. Doty, PhDProfessor and Director, Smell and Taste Center,University of Pennsylvania Perelman School ofMedicine, Philadelphia, PA, USA

Robert Duarte, MDDirector, Pain CenterAssistant Professor of Neurology, Hofstra NorthShore-LIJ School of Medicine, Manhasset, NY, USA

Jeffrey S. Durmer, MD, PhDChief Medical Officer, Fusion Health and FusionSleep, Atlanta, GA, USA

Christyn M. EdmundsonMedical Student, Albert Einstein College of Medicine,Bronx, NY, USA

Eric R. Eggenberger, DO, MSEpiProfessor and Vice-Chairman, Michigan StateUniversity Department of Neurology &Ophthalmology, East Lansing, MI, USA

Steven Ender, DOAssistant Clinical Professor of Neurology, AlbertEinstein College of Medicine, Bronx, NY, USA

Noam Epstein, MD, MSStaff Neurologist and Researcher, Edward Hines, Jr.VA Hospital, Hines, IL, USA

Alberto J. Espay, MD, MSc, FAANAssociate Professor of Neurology and Director ofClinical Research, UC Neuroscience Institute,Department of Neurology, Gardner Family Center forParkinson’s Disease and Movement Disorders,University of Cincinnati, Cincinnati, OH, USA

Alan B. Ettinger, MD, MBAEpilepsy Director, Neurological Surgery P.C.,Rockville Center; Director of the Epilepsy WellnessProgram, Winthrop University Hospital, Mineola;Director of EEG and Epilepsy, Huntington Hospital,Huntington; and Professor of Clinical Neurology,Albert Einstein College of Medicine, Bronx, NY, USA

Niloofar (Nelly) Faghani, PTPhysiotherapist/Clinical Director/Owner, AuroraPrime Physiotherapy and Sports RehabilitationCentre, Richmond Hill, ON, Canada

Amtul Farheen, MDNeuromuscular Center, Neurological Institute,University Hospitals Case Medical Center, CaseWestern Reserve University, School of Medicine,Cleveland, OH, USA

Edward Firouztale, DEngSc, DOSouth Shore Neurologic Associates, Patchogue, NY,USA

Rod Foroozan, MDAssociate Professor of Ophthalmology, Cullen EyeInstitute, Baylor College of Medicine, Houston, TX,USA

Anne L. Foundas, MDProfessor and Chair, Department of Neurology andCognitive Neuroscience, University ofMissouri-Kansas City School of Medicine, KansasCity, MO, USA

David Elliot Friedman, MDMedical Director, Winthrop Comprehensive EpilepsyCenter, Mineola, NY, USA

Deborah I. Friedman, MD, MPHProfessor, Departments of Neurology andOphthalmology, University of Texas SouthwesternMedical Center, Dallas, TX, USA

Steven J. Frucht, MDProfessor of Neurology and Director, MovementDisorders Division, Mount Sinai School of Medicine,New York, NY, USA

Oded Gerber, MDAssociate Professor, Department of Neurology atStony Brook University Hospital, Stony Brook,NY, USA

Tal Gilboa, MDPediatric Epilepsy Clinic Director, Shaare-ZedekMedical Center, Jerusalem, Israel

Martin Gizzi, MD, PhDProfessor and Chairman, NJ Neuroscience Institute,Seton Hall University JFK Medical Center, Edison,NJ, USA

xiii







Teneille G. Gofton, MD, MSc, FRCPCDepartment of Clinical Neurological Sciences,London Health Sciences Centre – UniversityHospital, The University of Western Ontario, London,ON, Canada

Louis J. GoodrichMedical Student, Nova Southwestern University,Davie, FL, USA

Malcolm H. Gottesman, MD, FACP, FAANProfessor of Clinical Neurology, Stony BrookUniversity School of MedicineChief, Division of Neurology, Winthrop-UniversityHospital, Mineola, NY, USA

Varda Gross-Tsur, MDAssociate Professor, Pediatrics (Neurology), Facultyof Medicine, Hebrew UniversityDirector, Neurodevelopment Unit, Shaare ZedekMedical Center, Jerusalem, Israel

Deepak Grover, DOOphthalmologist, Philadelphia, PA, USA

David A. Gudis, MDResident Physician, Department ofOtorhinolaryngology: Head and Neck Surgery,University of Pennsylvania Health System,Philadelphia, PA, USA

John J. Halperin, MD, FAAN, FACP, FRCP(E)Professor of Neurology & Medicine, Mount SinaiSchool of Medicine Chair; Department ofNeurosciences, Overlook Medical Center, Summit,NJ, USA

Maxim D. Hammer, MDAssistant Professor of Neurology, University ofPittsburgh Medical Center, Pittsburgh, PA, USA

Andrew R. Harrison, MDDepartments of Ophthalmology & VisualNeurosciences and OtolaryngologyDirector, Ophthalmic Plastic and ReconstructiveSurgery Service Co-Director, Center for Thyroid EyeDisease, Associate Professor, University ofMinnesota, Minneapolis, MN, USA

L. Anne Hayman, MDClinical Director Neuro-Radiology, Anatom-eInformation Systems, Ltd., Houston, TX, USA

Galen V. Henderson, MDDirector of Neuro ICU, Brigham andWomen’sHospital, Boston, MA, USA

Steven Herskovitz, MDProfessor of Clinical Neurology and Director of theNeuromuscular Division and EMG Lab, MontefioreMedical Center, Albert Einstein College of Medicine,Bronx, NY, USA

Caitlin Hoffman, MDDepartment of Neurological Surgery, Weill CornellMedical College, New York Presbyterian Hospital,New York, NY, USA

Laryssa A. Huryn, MDResident in Ophthalmology, Department ofOphthalmology, Syracuse, NY, USA

Andres M. Kanner, MDProfessor of Clinical Neurology, Director,Comprehensive Epilepsy Center and Chief, EpilepsySection, University of Miami Miller School ofMedicine, Miami, FL, USA

Gary P. Kaplan, MD, PhDClinical Associate Professor of Neurology, HofstraNorth Shore-LIJ School of Medicine, Hempstead,NY, USA

Bashar Katirji, MDDirector, Neuromuscular Center and EMGLaboratory, University Hospitals Case Medical CenterProgram Director, Neuromuscular Medicine,University Hospitals Case Medical CenterProfessor, Neurology, Case Western ReserveUniversity School of Medicine, Cleveland, OH, USA

Kenneth R. Kaufman, MD, MRCPsychProfessor of Psychiatry, Neurology, andAnesthesiology, Departments of Psychiatry,Neurology, and Anesthesiology, Rutgers – RobertWood Johnson Medical School, New Brunswick, NJ,USA

Annie Killoran, MDMScAssistant Professor of Neurology, Director of theWVUMovement Disorders Clinic, Robert C. ByrdHealth Sciences Center, West Virginia University,Morgantown, WV, USA

Nina Kirz, MDClinical Instructor, Child and Adolescent Psychiatry,Stanford University, Stanford, CA, USA

xiv







Gad E. Klein, PhDNeurological Surgery PC, Lake Success, New York,USA

Danielle G. Koby, PhDStaff Psychologist, Division of Health Psychology,The Institute of Living, Departments of Neurologyand Neurosurgery, Comprehensive Epilepsy Center,Hartford Hospital, Hartford, CT, USA

Christopher P. Kogut, MDAssistant Professor, Department of Psychiatry,Virginia Commonwealth University, Richmond, VA,USA

W. Curt LaFrance Jr, MD, MPHAssistant Professor of Psychiatry and Neurology(Research), Alpert Medical School, Brown University,Director of Neuropsychiatry and BehavioralNeurology, Rhode Island Hospital, Providence,RI, USA

Patrick J.M. Lavin, MDProfessor of Neurology and Ophthalmology,Vanderbilt University Medical Center, Nashville, TN,USA

SusanW. Law, DONeurology Resident, SUNY Downstate MedicalCenter Long Island College Hospital, Brooklyn, NY,USA

James L. Levenson, MDVice Chair, Department of Psychiatry, Chair, Divisionof Consultation-Liason Psychiatry and Professor ofPsychiatry, Medicine and Surgery, VirginiaCommonwealth University School of Medicine,Richmond, VA, USA

Richard B. Lipton, MDEdwin S. Lowe Professor and Vice Chair ofNeurology, Professor of Epidemiology andPopulation Health and Professor of Psychiatry andBehavioral Sciences, Albert Einstein College ofMedicine, Bronx, NY, USA

Glenn Lopate, MDAssociate Professor, Department of Neurology,Division of Neuromuscular Diseases, WashingtonUniversity School of Medicine; Consulting Staff,Department of Neurology, Barnes-Jewish Hospital,St. Louis, MO, USA

Daniel J. Luciano, MDDirector of the Clinical Epilepsy Program at the NYUComprehensive Epilepsy Center and Director of theOut Patient EEG Epilepsy Service, NYU School ofMedicine, NY, USA

ReemaMaindiratta, MDNeurologist, Babylon, NY, USA

Robert M. Mallery, MDResident in Neurology, Harvard Medical School,Massachusetts General Hospital, and Brigham andWomen’s Hospital, Boston, MA, USA

Georgios Manousakis, MDAssistant Professor, University of Minnesota,Minneapolis, MN, USA

Alan Mazurek, MDAssistant Clinical Professor of Neurology at Mt. SinaiMedical Center and Director of Rockville CenterNeurology, Rockville Centre, NY, USA

Luis J. Mejico, MDAssociate Professor of Neurology andOphthalmology, SUNY Upstate Medical University,Syracuse, NY, USA

Dragana Micic, MA, PhDDepartment of Psychology, Queens College, The CityUniversity of New York, NY, USA

Ali Mokhtarzadeh, MDFellow, Oculoplastic and Orbital SurgeryUniversity of Minnesota Minneapolis, MN, USA

Walter J. Molofsky, MDAssociate Professor of Neurology, Albert EinsteinCollege of Medicine, Chief, Pediatric Neurology, BethIsrael Medical Center, New York, NY, USA

Heather E. Moss, MD, PhDAssistant Professor in Ophthalmology, Department ofOphthalmology & Visual Sciences, University ofIllinois at Chicago, Chicago, IL, USA

Mark L. Moster, MDProfessor of Neurology and Ophthalmology,Neuro-Ophthalmology Service, Wills Eye Institute,Thomas Jefferson University School of Medicine,Philadelphia, PA, USA

Manpreet Multani, MDNJ Neuroscience Institute, Seton Hall University,Edison, NJ, USA

xv







Siddhartha Nadkarni, MDAssistant Professor of Neurology, Director of theEpilepsy HOS Clinic and Epilepsy FellowshipProgram, NYU School of Medicine, New York,NY, USA

George C. Newman, MD, PhDProfessor and Chairman, Neurosurgery Sciences,Director, Stroke Program, Albert Einstein MedicalCenter, Philadelphia, PA, USA

Rolla Nuoman, MDPediatric Resident, Woodhull Medical Center, NewYork University, Brooklyn, NY, USA

Paul A. Nyquist, MD, MPHAssociate Professor, Department of Neurology,Anesthesiology and Critical Care Medicine,Neurosurgery, Johns Hopkins University School ofMedicine, Baltimore, MD, USA

Gaia Donata Oggioni, MDUC Neuroscience Institute, Department ofNeurology, Gardner Family Center for Parkinson’sDisease and Movement Disorders, University ofCincinnati, Cincinnati, OH, USADepartment of Neurology, Universita del PiemonteOrientale A. Avogadro, Novara, Italy

Odi Oguh, MDUniversity of Florida Jacksonville Assistant Professor,Department of Neurology Jacksonville FL, USA

Denis Ostrovskiy, MDAssistant Clinical Professor of Neurology, HofstraNorth Shore-LIJ School of Medicine, HempsteadAssistant Clinical Professor of Neurology, MountSinai School of Medicine, New York, NY, USA

Kristina Y. Pao, MDOphthalmology Resident, Wills Eye Institute atThomas Jefferson University, Philadelphia, PA, USA

Juwen ParkOculoplastic Surgeon, Republic of Korea

Anastas F. Pass, OD, MS, JDUniversity of Houston – University Eye Institute,Co-Director: Neuro-Ophthlamology Service, OcularDiagnostic and Medical Eye Service, University ofHouston – University Eye Institute, Houston, TX,USA

Victoria S. Pelak, MDAssociate Professor of Neurology andOphthalmology, University of Colorado School ofMedicine, Aurora, CO, USA

Jeffrey Peterson, MD, PhDCullen Eye Institute, Baylor College of Medicine,Houston, TX, USA

John Pile-Spellman, MDNeurological Surgery PC, Rockville Center, NY, USA

Misha L. Pless, MDChief, Divisions of General Neurology andNeuro-ophthalmology Neurology Department,Massachusetts General Hospital Associate Professor,Harvard Medical School, Neuro-ophthalmology,Multiple Sclerosis and General Neurology, Boston,MA, USA

Gregory M. Pontone, MDAssistant Professor and Director, MovementDisorders Psychiatry Clinic, John Hopkins UniversitySchool of Medicine, Baltimore, MD, USA

Aparna M. Prabhu, MDAttending Neurologist, Albert Einstein MedicalCenter, Philadelphia, PA, USA

Michael T. Pulley, MD, PhDClinical Associate Professor of Neurology, DirectorEM6 Laboratory, University of Florida, Jacksonville,FL, USA

Philip Ragone, MDNeurologist, Great Neck, NY, USA

Prajwal Rajappa, MDFellow, Department of Neurological Surgery, WeillCornell Medical College, New York PresbyterianHospital, New York, NY, USA

Venkat Ramani, MDProfessor of Neurology at New York Medical CollegeChief of Section of Epilepsy and ClinicalNeurophysiology Laboratory at Westchester MedicalCenter, Valhalla, NY, USA

Sindhu Ramchandren, MD, MSAssistant Professor of Neurology, Director of thePediatric and Adult CMT and MDA Clinic,University of Michigan, Ann Arbor, MI, USA

xvi







Ritesh A. Ramdhani, MDFellow, Movement Disorders Division, Department ofNeurology, Mount Sinai School of Medicine, NewYork, NY, USA

Ramses Ribot, MDFellow in Clinical Neurophysiology, Department ofNeurological Sciences, Rush Medical College at RushUniversity and Rush University Medical Center,Chicago, IL, USA

Heidi D. Riney, MD, D. ABPNSleep Medicine Medical Director, Fusion Sleep,Atlanta, GA, USA

Diana Rojas-Soto, MDStroke Fellow, Department of Neurology SUNYDownstate Medical Center, Brooklyn, NY, USA

Michael Ronthal, MDProfessor of Neurology, Harvard Medical School,Boston, MA, USA

Daniel M. Rosenbaum, MDProfessor and Chairman, Department of Neurology,SUNY Downstate Medical Center, SUNY DownstateStroke Center, Brooklyn, NY, USA

David B. Rosenfield, MDDirector, Speech and Language Center,Director, EMG and Motor Control Laboratory,Neurological Institute, The Methodist HospitalProfessor, Weill Medical College of CornellUniversity, Houston, TX, USA

Durga Roy, MDAssistant Professor Department of Psychiatry andBehavioral Sciences, Johns Hopkins UniversitySchool of Medicine Baltimore, MD, USA

Michael J. Ruckenstein, MDProfessor and Vice Chairman, Department ofOtorhinolaryngology: Head and Neck Surgery,University of Pennsylvania Health System,Philadelphia, PA, USA

Max C. Rudansky, MD, FACPClinical Assistant Professor of Neurology, HofstraNorth Shore-LIJ School of MedicineEmeritus Chief and Director of Stroke Unit,Huntington Hospital, Huntington, NY, USA

Eva Sahay, MDConsultant Neurology and Neurophysiology, SahayMedical Group PC, Garden City, NY, USA

Friedhelm Sandbrink, MDAssistant Clinical Professor of Neurology,Georgetown University, Washington, DC;Director EMG Laboratory and Chief Pain Clinic,Department of Neurology, Washington VAMedicalCenter, Washington, DC, USA

Jade S. Schiffman, MD, FAAO, FAANProfessor of Ophthalmology and Neuro-Oncology,Director of Neuro-Ophthalmology, Head & NeckSurgery, Section of Ophthalmology, and Co-Directorof MS EyeCARE, The University of Texas MDAnderson Cancer Center, Houston, TX, USA

Angela Scicutella, MD, PhDAttending Neuropsychiatrist, Clinical AssociateProfessor in Psychiatry, Hofstra North Shore – LongIsland Jewish School of Medicine at HofstraUniversity, Hempstead, NY, USA

Maroun T. Semaan, MDClinical Assistant Professor of Otolaryngology atUniversity Hospitals Case Medical Center and theLouis Stokes Cleveland Department of VeteranAffairs Medical Center, Case Western ReserveUniversity, Cleveland, OH, USA

Robert C. Sergott, MDDirector, Neuro-Ophthalmology Wills Eye Hospital;Professor of Ophthalmology, Neurology, andNeurosurgery, Thomas Jefferson University,Philadelphia, PA, USA

Aashit K. Shah, MD, FAAN, FANAProfessor and Associate Chair Wayne State UniversityDepartment of Neurology; Director, ComprehensiveEpilepsy Program Director, Clinical NeurophysiologyFellowship, Wayne State University Detroit; MedicalCenter Chief of Neurology, Harper UniversityHospital

David M. Shaw, BADepartment of Psychiatry, NYU School of Medicine,New York, NY Department of Psychology, FordhamUniversity, Bronx, NY, USA

Amit M. Shelat, DO, MPA, FACPAssistant Professor of Clinical Neurology, StonyBrook University School of Medicine and AttendingNeurologist, Winthrop-University Hospital, Mineola,NY, USA

xvii







Claire A. Sheldon, MD, PhD, FRCSCDepartment of Ophthalmology and Visual Sciences,University of British Columbia, VC, Canada

Anant M. Shenoy, MDNeurology Attending, Baystate Medical Center andAssistant Professor of Neurology, Tufts UniversitySchool of Medicine, Springfield, MA, USA

Yelizaveta Sher, MDInstructor, Psychosomatic Medicine, StanfordUniversity Medical Center Stanford, CA, USA

Jessica A. Shields, PhDBrain & Behavior Program, Department ofNeurology, Cell Biology & Anatomy, Louisiana StateUniversity Health Sciences Center, New Orleans, LA,USA

Tanya Simuni, MDArthur C. Nielson Professor of Neurology, Director,Parkinson’s Disease and Movement Disorders Center,Northwestern University Feinberg School ofMedicine, Chicago, IL, USA

Rajpaul Singh, MDNeurology, Hollis, NY, USA

Eric E. Smouha, MDAssociate Professor and Director of Otology-Neurotology, Department of Otolaryngology,Mount Sinai School of Medicine, New York,NY, USA

David Solomon, MD, PhDAssistant Professor of Neurology and OtolaryngologyHead and Neck Surgery, CSF Disorders Program,Johns Hopkins Hospital, Baltimore, MD, USA

Mehri Songhorian, MDNeurologist, Great Neck, NY, USA

Steven A. Sparr, MD, FAANProfessor of Clinical Neurology and AssistantProfessor of Rehabilitation Medicine, Albert EinsteinCollege of Medicine, Bronx, NY, USA

Egilius L. H. Spierings, MD, PhDAssociate Clinical Professor of Neurology, BrighamandWomen’s Hospital, Harvard Medical School;Associate Clinical Professor of Craniofacial Pain,Tufts University School of Dental Medicine; Director,Headache and Face Pain Program, Tufts MedicalCenter, Boston, MA, USA

Eve G. Spratt, MDProfessor of Psychiatry, Medical University of SouthCarolina, Mount Pleasant, SC, USA

Beth Stein, MDAssistant Professor of Neurology, Montefiore MedicalCenter, Albert Einstein College of Medicine, Bronx,NY, USA

S.H. Subramony, MDProfessor, Department of Neurology, University ofFlorida College of Medicine, Gainesville, FL, USA

Rosa Ana Tang, MD, MPH, MBADirector, Neuro-Ophthalmology Service andCo-Director, MS EyeCARE, University of Houston –University Eye Institute, Houston, TX, USA

Cara Tannenbaum, MD, MScAssociate Professor of Medicine, Institut universitairede geriatrie, Universite de Montreal, QC, Canada

Hakan Tekeli, MDNeurology Department, Kasimpasa Military Hospital,Istanbul, Turkey

Amanda J. Thompson, MDAdjunct Clinical Post-Doctoral Fellow, University ofFlorida Center for Movement Disorders andNeurorestoration, Gainesville, FL, USA

Michael J. Thorpy, MDDirector, Sleep-Wake Disorders Center, MontefioreMedical Center, Albert Einstein College of Medicine,Bronx, NY, USA

Matthew J. Thurtell, BSc(Med), MBBS,MSc(Med), FRACPAssistant Professor of Ophthalmology and Neurology,Department of Ophthalmology and Visual Sciences,University of Iowa, Iowa City, IA, USA

Pedro J. Torrico, MDDepartment of Neurology, North Shore MedicalGroup of the Mount Sinai School of Medicine,Huntington, NY, USA

Ira M. Turner, MDThe Center for Headache Care and Research, IslandNeurological Associates PC, Plainview, NY, USA

Scott Uretsky, MDDirector, Neuro-Ophthalmology Division,Neurological Surgery PC, Lake Success, NY, USA

xviii







Ruth H. Walker, MB, ChB, ASS, PhDDepartment of Neurology, James J. Peters VeteransAffairs Medical Center, Bronx, NY and Mount SinaiSchool of Medicine, New York City, NY, USA

Deborah M. Weisbrot, MDAssociate Professor of Clinical Psychiatry andDirector, Child & Adolescent Psychiatry OutpatientClinic, Department of Psychiatry and BehavioralSciences, Stony Brook University Medical Center,New York, USA

Michael A. Williams, MD, FAANMedical Director, The Sandra and Malcolm BermanBrain & Spine InstituteDirector, Adult Hydrocephalus Center, Sinai Hospitalof Baltimore, Baltimore, MD, USA

Jacques Winter, MDNeurologist Huntington, New York, NY, USA

Randall J. Wright, MDClinical Assistant Professor, UT Health, Departmentof Neurosurgery, Mischer Neuroscience Associates,Houston, TX, USA

Jay Elliot Yasen, MDDirector Stroke Service, Associate Professor ofClinical Neurology, School of Medicine, StateUniversity of New York at Stony Brook, NY, USA

Shicong Ye, MDAssistant Professor of Clinical Neurology, StonyBrook University School of Medicine, and AttendingNeurologist, Winthrop-University Hospital, Mineola,NY, USA

G. Bryan Young, MD, FRCPCDepartment of Clinical Neurological Sciences,London Health Sciences Centre – UniversityHospital, The University of Western Ontario, London,ON, Canada

Huiying Yu, MDDirector of Neurodiagnostic Laboratory, WinthropUniversity Hospital, Mineola, NY, USA

Ryan J. Zehnder, MDPhysical Medicine and Rehabilitation, EvergreenRehabilitation, Kirkland, WA, USA

xix











Foreword

There is an apocryphal story of an eminent neurol-ogy professor who was asked to provide a differen-tial diagnosis. He allegedly quipped: “I can’t give youa differential diagnosis. If you wish I will give you alist of wrong diagnoses followed by the right diagno-sis.” Sadly, this sort of arrogance pervaded our field,particularly in the era before there were accurate diag-nostic methods and effective treatments of neurologi-cal diseases. Fortunately, this sort of pomposity is nowrelegated to the past and remains only as an antiquereminder of a type of hubris that precluded discoveryand progress in diseases of the nervous system.

Fortunately, the era of therapeutic nihilism in neu-rology is over, but now we are faced with a differ-ent problem. There is simply too much informationfor any one person to accommodate. In the twenti-eth century, internalmedicine responded to this explo-sion of knowledge by differentiating itself into an arrayof subspecialties, such as cardiology, endocrinology,nephrology, hematology, oncology, gastroenterology,infectious diseases, pulmonology, andmanymore.Theinternist of the 1950s took care of patients with car-diological and hematological problems. In the year2000, no one can imagine a hematologist performinga cardiac catheterization or a nephrologist managinghepatitis C. Similarly, in the twenty-first century neu-rology now is a group of fields, such as stroke, move-ment disorders, epilepsy, cancer neurology, neuromus-cular disease, headache, multiple sclerosis, cognitiveand behavioral neurology, neuroophthalmology andmany more. Just as, in internal medicine, the Parkin-son’s disease expert cannot be expected to undertakethe treatment of brain tumors or complex epilepsy.

But because of the changes in the way medical careis delivered, neurology, as internal medicine, has expe-rienced a renaissance of the generalist in the formof divisions of general and hospital neurology. Afterall, someone must decode the non-specific neurologi-cal complaint, such as dizziness, headache, and confu-sion, and determine the nature of the problem so the

evaluation and treatment can be undertaken in aneffective and efficientmanner.Obtaining an unfocusedarray of neurodiagnostic tests is not only inordinatelyexpensive, but it is potentially dangerous, as it maydisclose an incidentaloma, the irrelevant finding on ablood test or image that can lead to unnecessary andeven life-threatening interventions. Also the availabil-ity of an enormous amount of medical informationto the lay public, some of which is useful but mostof which is misleading and often terrifying for thepatient, greatly complicates the care of patients whomay come to the doctor with a strongly held theory oftheir own problem.

It was in this context that Alan Ettinger andDeborah Weisbrot conceived of the idea of a practi-cal, easily accessible source for the clinician to gen-erate a rapid differential diagnosis when faced withthe most common neurological complaints. This is abold and ambitious endeavor as the number of suchcomplaints is enormous. Entire textbooks have beenwritten about virtually all of the major subjects anda huge literature lurks in the background for everyproblem. Rather than try to create simply another text-book, Drs Ettinger andWeisbrot have disciplined theirlarge array of authors to follow a strict format. Foreach chapter, there is a brief description of the symp-tom, sign, or condition, followed by a summary ofthe relevant anatomy, physiology, and pathophysiol-ogy. The heart of each chapter is a differential diag-nosis table, which is consistent throughout the book.For each item, the differential diagnosis is dividedby the basic nature of the problem, followed by spe-cific types, etiologies, and clinical features. For exam-ple, for the dilated pupil, the several major categoriesof the table are toxic, pressure, degenerative, vascu-lar, traumatic, inflammatory, ictal, and congenital. Fortoxic types, anticholinergic and adrenergic are listedas the subtypes. For anticholinergic, scopolamine, cos-metics, glaucoma treatments are listed as etiologiesand for scopolamine, special clinical features such as

xxi






Foreword

accidental instillation into the eye of an agent beingused for the prevention of motion sickness. Followingthe table, there is an illustrative clinical vignette. Forthe dilated pupil, a case of amalewhowas using scopo-lamine to prevent sea sickness is recounted.

Using this stereotyped method the reader canknow exactly how to look up a particular symp-tom (e.g. dizziness) or sign (e.g. the dilated pupil)and quickly obtain a reasonable differential diagnosiswhich will aid in ordering studies, starting treatment,and referring to the appropriate specialist. The bookwill be valuable to multiple different types of readersdepending on their specific needs and level of sophisti-cation.The studentwill use the book to begin to under-stand the assessment of the patient with a neurolog-ical complaint. The non-neurologist, including otherspecialists and physician extenders, will be aided in

approaching such patients and referring those whoneed it to the appropriate specialist. The general neu-rologist will use it to refresh memory of the many dif-ferent subspecialties of the field and the subspecialistwill find it invaluable to deal with problems outsidetheir area of special competence. Those taking certi-fying examinations can use it as a study guide for themajor neurological problems faced in the practice ofmedicine, whether it be in the office, the hospital, orthe emergency department.

Ettinger and Weisbrot’s Neurologic DifferentialDiagnosis: ACase-BasedApproach is likely to become amust-have for any doctor or other healthcare providerwho must assess neurologic symptoms and signs, andthat is just about everyone.

Martin A. Samuels, M.D.

xxii






Preface

There is certainly no paucity of general and specialtyneurology textbooks, so why produce yet anotherone? This book was inspired by our experiences asneurology and psychiatry residents many years ago,and has been reinforced decades later as senior clin-icians. Nowadays, in the era of managed care, clin-icians are expected to see increasing numbers ofpatients in shorter amounts of time; how can theclinician ensure that important diagnoses are notmissed?

It seems to us that it is unlikely that the busy neu-rologist or neurology resident will have the time orinclination to pore through voluminous textbooks inthe office or emergency room, looking for clarificationof differential diagnosis. A smaller collection of text-books specifically devoted to differential diagnosis isavailable; however, many of these are essentially bare-bone lists of diagnoses while others seem too basic orsuperficial.

What we seek to provide in Neurologic Differen-tial Diagnosis: A Case-Based Approach, is a highlyaccessible and pragmatic guide to the vast array ofpotential etiologies for neurologic and psychiatricsymptoms. Clinicians can readily find, in the alphabet-ized arrangement of topics, immediate references thatremind the clinician of items to check for when facedwith complaints of “dizziness,” “mental status change,”“diplopia,” or “psychosis.” Instead of simple lists ofpotentially responsible causes for symptoms, eachdiagnostic possibility is linked to reminders of key ele-ments that will help the clinician decide whether the

specific patient’s presentation fits with each possibleetiology. In addition, each chapter includes case stud-ies that exemplify a systematic approach to differentialdiagnosis of each symptom.

Who will find the book useful? Both experiencedand junior neurologists should find the content writ-ten by the expert authors to be invaluable. The non-neurologist such as the internist or general or fam-ily practitioner, emergency room physician, physicianassistant, and nurse practitioner who finds the subjectof neurology to be esoteric and difficult to conceptu-alize, will find the organized tables in each chapter tobe readily comprehensible. Many chapters are devotedto psychiatric symptoms and will find good use in thehands of the psychiatrist performing the essential taskof ruling out compelling medical diagnoses present-ing as psychiatric conditions. Neurologists and psychi-atrists preparing for their board examinations will alsofind Neurologic Differential Diagnosis to be invaluable,particularly because of the inclusion of case examplesand the discussion of the organized approach to diag-nosing each symptom.

As academic clinicians teaching residents in neu-rology and psychiatry, we have had the opportunity topilot the use of numerous chapters as teaching guidesfor physicians-in-training. We have been very grati-fied by the enthusiastic and positive feedback that wehave received from our student physicians as well asour colleagues. We sincerely hope that this book willfind an important place on the shelves of clinicianseverywhere.

xxiii






Acknowledgments

This ambitious project would not have been possiblewithout the kind and dedicated efforts of numerousindividuals. We would like to acknowledge the manyauthors who, in spite of daily clinical and academicdemands, contributed invaluable chapters to this book.We extend our special thanks toDr. Bashar Katirji whoprovided additional assistance in reviewing the chap-ters related to peripheral nerve disease. We also thankDr. Richard Libman for his helpful comments.

We would also like to thank the many colleagueswho provided administrative assistance or helped pro-cure medical articles utilized in formulating this book.These include Rosemary Valdez, Chaomei Wu, GildaDavis, Kathy Grzymala, Anna Dushenkov, Erica Jalal,Susan Simpson, Debra Rand, Shifra Atik, BarbaraSacks, and Rita Feigenberg.

We would also like to acknowledge individualswho have played special roles in our lives. First, DaveJones, LCSW, for sharing his extraordinary wisdom

and insight. Second, our friend John Mangione, forproviding musical diversion during the long processof preparing this book and for his generous spirit rais-ing funds to help children with devastating neurolog-ical disorders. Finally, Omri Adut, for bringing thegreat joy of horseback riding into Deborah’s life andenabling her to fulfill her most treasured childhooddream.

We extend our special thanks to Nicholas Dunton,Jane Seakins, Sarah Payne, Lesley Bennun, andArindam Bose at Cambridge University Press, whowere very helpful throughout the publication process.

Finally, we thank our patients, who shared theirlives and struggles with us and taught us the true valueof patiently taking a thorough history when generatingthe differential diagnosis.

Alan B. Ettinger, MD, MBADeborah M. Weisbrot, MD

xxiv






Documents

NeurologicDifferentialDiagnosisassets.cambridge.org/.../14558/frontmatter/9781107014558_frontma… · 978-1-107-01455-8 - Neurologic Differential Diagnosis: A Case-Based Approach