Table Of Content

12887_FM.qxd 10/9/08 9:51 PM Page i BLUEPRINTS NEUROLOGY Third Edition 12887_FM.qxd 10/9/08 9:51 PM Page ii 12887_FM.qxd 10/9/08 9:51 PM Page iii BLUEPRINTS NEUROLOGY Third Edition Frank W. Drislane, MD Juan Acosta, MD Associate Professor of Neurology Neurologist, Clinical Harvard Medical School Neurophysiologist Comprehensive Epilepsy Center European Medical Doctor Beth Israel Deaconess Medical Center Best Doctors Boston, Massachusetts Madrid, Spain Michael Benatar, MBChB, DPhil Andrew Tarulli, MD Associate Professor of Neurology and Instructor in Neurology Epidemiology Harvard Medical School Director, Electromyography Laboratory Division of Neuromuscular Disease Emory University Beth Israel Deaconess Medical Center Atlanta, Georgia Boston, Massachusetts Bernard S. Chang, MD Louis R. Caplan, MD Assistant Professor of Neurology Professor of Neurology Harvard Medical School Harvard Medical School Comprehensive Epilepsy Center Cerebrovascular Service Beth Israel Deaconess Medical Center Beth Israel Deaconess Medical Center Boston, Massachusetts Boston, Massachusetts 12887_FM.qxd 10/9/08 8:01 PM Page iv Acquisitions Editor: Charley Mitchell Managing Editor: Stacey Sebring and Jessica Heise Associate Production Manager: Kevin Johnson Creative Director: Doug Smock Compositor: Maryland Composition/ASI Printer: RR Donnelly Copyright © 2009 Frank W. Drislane, MD; Michael Benatar, MBChB, DPhil; and Bernard S. Chang, MD 351 West Camden Street Baltimore, MD 21201 530 Walnut Street Philadelphia, PA 19106 All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner. The publisher is not responsible (as a matter of product liability, negligence, or oth- erwise) for any injury resulting from any material contained herein. This publication contains information relating to general principles of medical care that should not be construed as specific instructions for individual patients. Manufacturers’ product information and package inserts should be reviewed for current information, includ- ing contraindications, dosages, and precautions. Printed in China Library of Congress Cataloging-in-Publication Data Blueprints neurology / Frank W. Drislane ... [et al.]. — 3rd ed. p. ; cm. Includes bibliographical references and index. ISBN 978-0-7817-9685-9 1. Neurology—Examinations, questions, etc. 2. Physicians—Licenses—United States—Examinations—Study guides. I. Drislane, Frank. II. Title: Neurology. [DNLM: 1. Nervous System Diseases. 2. Neurology. WL 140 B658 2009] RC336.B575 2009 616.80076—dc22 2008025255 The publishers have made every effort to trace the copyright holders for borrowed mate- rial. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 824-7390. International customers should call (301) 714-2324. Visit Lippincott Williams & Wilkins on the Internet: http://www.LWW.com.Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. 12887_FM.qxd 10/9/08 9:51 PM Page v Contents Reviewers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .x Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xii PART ONE: Basics of Neurology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 1 The Neurologic Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 2 Neurologic Investigations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 PART TWO: Common Neurologic Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 3 The Approach to Coma and Altered Consciousness . . . . . . . . . . . . . . . . . . . .21 4 Neuro-Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 5 The Approach to Weakness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40 6 The Sensory System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48 7 Dizziness, Vertigo, and Syncope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54 8 Ataxia and Gait Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58 9 Urinary and Sexual Dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63 10 Headache and Facial Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69 PART THREE: Neurologic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75 11 Aphasia and Other Disorders of Higher Cortical Function . . . . . . . . . . . . . .77 12 Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84 13 Sleep Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92 14 Vascular Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96 15 Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103 16 Movement Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111 17 Head Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119 18 Systemic and Metabolic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .124 19 Central Nervous System Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131 20 Demyelinating Diseases of the Central Nervous System . . . . . . . . . . . . . . .139 12887_FM.qxd 10/9/08 9:51 PM Page vi vi • Contents 21 Infections of the Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145 22 Disorders of the Spinal Cord . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .152 23 The Peripheral Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159 24 Disorders of the Neuromuscular Junction and Skeletal Muscle . . . . . . . .169 25 Pediatric Neurology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .178 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .186 Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .199 Appendix: Evidence-Based Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .209 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .212 12887_FM.qxd 10/9/08 9:51 PM Page vii Reviewers Catarina Castaneda, MD Class of 2004 Drexel University College of Medicine Philadelphia, Pennsylvania Maureen Chase, MD Resident, Emergency Medicine Hospital of University of Pennsylvania Jefferson Medical College Thomas Jefferson University Hospital Philadelphia, Pennsylvania Suzanne Crandall Class of 2005 Kansas City University of Medicine and Biosciences Kansas City, Missouri Alexis Dang, MD Class of 2004 University of California—San Francisco San Francisco, California Lee S. Engel, MD, PhD Fellow, Department of Infectious Diseases Louisiana State University Health Sciences Center New Orleans, Louisiana Merritt Fajt, MD Class of 2004 Temple University School of Medicine Philadelphia, Pennsylvania R1- Internal Medicine, Penn State University Milton S. Hershey Hershey Medical Center Hershey, Pennsylvania Baback Gabbay, MD Class of 2005 David Geffen School of Medicine at UCLA Los Angeles, California 12887_FM.qxd 10/9/08 9:51 PM Page viii viii • Reviewers Amir A. Ghaferi Class of 2005 Johns Hopkins School of Medicine Baltimore, Maryland Hoda Ghanem, MD Intern UC Irvine—Internal Medicine Irvine, California Sarah Harper Class of 2005 University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Gloria Hsu Class of 2005 Stanford University School of Medicine Stanford, California Mark Lassoff, MD Class of 2004 UMDNJ—New Jersey Medical School Newark, New Jersey Urology Resident LAC(cid:2)USC Medical Center Los Angeles, California Ryan Ley Class of 2005 University of Nevada School of Medicine Reno, Nevada Meredith M. LeQuear, DO Class of 2004 New York College of Osteopathic Medicine Old Westbury, New York Mark Naftanel Class of 2005 Duke University School of Medicine Durham, North Carolina David J. Nusz, MD Class of 2004 SUNY Downstate College of Medicine Brooklyn, New York

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12887_FM.qxd 10/9/08 9:51 PM Page i BLUEPRINTS NEUROLOGY Third Edition 12887_FM.qxd 10/9/08 9:51 PM Page ii 12887_FM.qxd 10/9/08 9:51 PM Page iii BLUEPRINTS NEUROLOGY Third Edition Frank W. Drislane, MD Juan Acosta, MD Associate Professor of Neurology Neurologist, Clinical Harvard Medical School Neurophysiologist Comprehensive Epilepsy Center European Medical Doctor Beth Israel Deaconess Medical Center Best Doctors Boston, Massachusetts Madrid, Spain Michael Benatar, MBChB, DPhil Andrew Tarulli, MD Associate Professor of Neurology and Instructor in Neurology Epidemiology Harvard Medical School Director, Electromyography Laboratory Division of Neuromuscular Disease Emory University Beth Israel Deaconess Medical Center Atlanta, Georgia Boston, Massachusetts Bernard S. Chang, MD Louis R. Caplan, MD Assistant Professor of Neurology Professor of Neurology Harvard Medical School Harvard Medical School Comprehensive Epilepsy Center Cerebrovascular Service Beth Israel Deaconess Medical Center Beth Israel Deaconess Medical Center Boston, Massachusetts Boston, Massachusetts 12887_FM.qxd 10/9/08 8:01 PM Page iv Acquisitions Editor: Charley Mitchell Managing Editor: Stacey Sebring and Jessica Heise Associate Production Manager: Kevin Johnson Creative Director: Doug Smock Compositor: Maryland Composition/ASI Printer: RR Donnelly Copyright © 2009 Frank W. Drislane, MD; Michael Benatar, MBChB, DPhil; and Bernard S. Chang, MD 351 West Camden Street Baltimore, MD 21201 530 Walnut Street Philadelphia, PA 19106 All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner. The publisher is not responsible (as a matter of product liability, negligence, or oth- erwise) for any injury resulting from any material contained herein. This publication contains information relating to general principles of medical care that should not be construed as specific instructions for individual patients. Manufacturers’ product information and package inserts should be reviewed for current information, includ- ing contraindications, dosages, and precautions. Printed in China Library of Congress Cataloging-in-Publication Data Blueprints neurology / Frank W. Drislane ... [et al.]. — 3rd ed. p. ; cm. Includes bibliographical references and index. ISBN 978-0-7817-9685-9 1. Neurology—Examinations, questions, etc. 2. Physicians—Licenses—United States—Examinations—Study guides. I. Drislane, Frank. II. Title: Neurology. [DNLM: 1. Nervous System Diseases. 2. Neurology. WL 140 B658 2009] RC336.B575 2009 616.80076—dc22 2008025255 The publishers have made every effort to trace the copyright holders for borrowed mate- rial. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 824-7390. International customers should call (301) 714-2324. Visit Lippincott Williams & Wilkins on the Internet: http://www.LWW.com.Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. 12887_FM.qxd 10/9/08 9:51 PM Page v Contents Reviewers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .x Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xii PART ONE: Basics of Neurology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 1 The Neurologic Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 2 Neurologic Investigations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 PART TWO: Common Neurologic Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 3 The Approach to Coma and Altered Consciousness . . . . . . . . . . . . . . . . . . . .21 4 Neuro-Ophthalmology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 5 The Approach to Weakness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .40 6 The Sensory System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .48 7 Dizziness, Vertigo, and Syncope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .54 8 Ataxia and Gait Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58 9 Urinary and Sexual Dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63 10 Headache and Facial Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69 PART THREE: Neurologic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75 11 Aphasia and Other Disorders of Higher Cortical Function . . . . . . . . . . . . . .77 12 Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .84 13 Sleep Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92 14 Vascular Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .96 15 Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103 16 Movement Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111 17 Head Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .119 18 Systemic and Metabolic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .124 19 Central Nervous System Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131 20 Demyelinating Diseases of the Central Nervous System . . . . . . . . . . . . . . .139 12887_FM.qxd 10/9/08 9:51 PM Page vi vi • Contents 21 Infections of the Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .145 22 Disorders of the Spinal Cord . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .152 23 The Peripheral Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .159 24 Disorders of the Neuromuscular Junction and Skeletal Muscle . . . . . . . .169 25 Pediatric Neurology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .178 Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .186 Answers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .199 Appendix: Evidence-Based Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .209 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .212 12887_FM.qxd 10/9/08 9:51 PM Page vii Reviewers Catarina Castaneda, MD Class of 2004 Drexel University College of Medicine Philadelphia, Pennsylvania Maureen Chase, MD Resident, Emergency Medicine Hospital of University of Pennsylvania Jefferson Medical College Thomas Jefferson University Hospital Philadelphia, Pennsylvania Suzanne Crandall Class of 2005 Kansas City University of Medicine and Biosciences Kansas City, Missouri Alexis Dang, MD Class of 2004 University of California—San Francisco San Francisco, California Lee S. Engel, MD, PhD Fellow, Department of Infectious Diseases Louisiana State University Health Sciences Center New Orleans, Louisiana Merritt Fajt, MD Class of 2004 Temple University School of Medicine Philadelphia, Pennsylvania R1- Internal Medicine, Penn State University Milton S. Hershey Hershey Medical Center Hershey, Pennsylvania Baback Gabbay, MD Class of 2005 David Geffen School of Medicine at UCLA Los Angeles, California 12887_FM.qxd 10/9/08 9:51 PM Page viii viii • Reviewers Amir A. Ghaferi Class of 2005 Johns Hopkins School of Medicine Baltimore, Maryland Hoda Ghanem, MD Intern UC Irvine—Internal Medicine Irvine, California Sarah Harper Class of 2005 University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania Gloria Hsu Class of 2005 Stanford University School of Medicine Stanford, California Mark Lassoff, MD Class of 2004 UMDNJ—New Jersey Medical School Newark, New Jersey Urology Resident LAC(cid:2)USC Medical Center Los Angeles, California Ryan Ley Class of 2005 University of Nevada School of Medicine Reno, Nevada Meredith M. LeQuear, DO Class of 2004 New York College of Osteopathic Medicine Old Westbury, New York Mark Naftanel Class of 2005 Duke University School of Medicine Durham, North Carolina David J. Nusz, MD Class of 2004 SUNY Downstate College of Medicine Brooklyn, New York

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