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Clinical neurology PDF

419 Pages·2009·18.483 MB·English
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FREQUENTLY USED NEUROLOGIC DRUGS Drug Brand Use Sizes (mg) Usual dose1 Acetaminophen Tylenol Headache 325 650 po or pr at onset, then q4h Almotriptan Axert Headache 6.25,12.25 6.25 or 12.5 mg po* Alteplase (rt-PA) Activase Stroke — 0.9 mg/kg IV Amantadine Symmetrel Parkinsonism 100 100 mg bid Amitriptyline Elavil Headache,pain 10,25,50,75,100,150 10–150 mg qd Aspirin Ecotrin TIA/stroke,headache 81,325,500,650,975 81 mg qd–650 mg q 4–6h Atenolol Tenormin Headache 50,100 80 mg once/d Baclofen Lioresal Spasticity 10,20 5 mg tid–20 mg qid Benztropine Cogentin Movement disorders 0.5,1,2 1–2 mg qd-bid Bromocriptine Parlodel Parkinsonism 2.5,5 1.5–20 mg bid Carbamazepine Tegretol Seizures,pain 100,200,400 200–600 mg bid Carbidopa/levodopa Sinemet Parkinsonism 10/100,25/100,25/250, 25/250 mg tid-qid 50/200 Carbidopa/levodopa/ entacapone Stalevo Parkinsonism 12.5/50/200,25/100/200, up to 5 times daily 37.5/150/200 Chlorpromazine Largactil, Headache 1mg/kg im (max 100 mg) Thorazine Clonazepam Klonopin Seizures,myoclonus 0.125,0.25,0.5,1,2 0.5–6.5 tid Clopidogrel Plavix TIA/stroke 75 75 qd Cyclobenzaprine Flexeril Pain 10 10–20 mg tid Desipramine Norpramin Pain 10,25,50,75,100 100–200 mg/d in sigle or and Pertofrane divided doses Dihydroergotamine Migranal Headache 4 4 mg IN Donepezil Aricept Alzheimer’s disease 5,10 5–10 mg qhs Eletriptan Relpax Headache 20,40 20 or 40 mg* Entacapone Comtan Parkinsonism 200 200 mg Ethosuximide Zarontin Seizures 250 250–500 mg qd Fosphenytoin Cerebyx Seizures 150,750 22.5–30 mg/kg IV Flunarizine Sibeliums,Apo- Headache 5,10 3 mg/d Flunarizine Frovatriptan Frova Headache 2.5 2.5 mg po* Gabapentin Neurontin Seizures,pain 100,300,400 300–1200 mg tid Galantamine Reminyl Alzheimer’s disease 4,8,12 4–12 mg bid Glatiramer Copaxone Multiple sclerosis 20 20 mg SC qd Haloperidol Haldol Movement disorders 0.5,1,2,5,10,20 1–5 mg tid Heparin — TIA/stroke — 1000 U/hr2 Ibuprofen Motrin Headache,pain 200,300,400,600,800 200–800 mg qid Indomethacin Indocin Headache,pain 25,50,75 25–50 mg tid Interferon beta-1A Avonex Multiple sclerosis 0.003 0.003 mg IM q week Interferon beta-1b Betaseron Multiple sclerosis 0.25 0.25 mg Ketoprofen Orudis and Headache 25,50,75,100 25 or 50 mg po Oruvail 150,200 Lamotrigine Lamictal Seizures 25,100,150,200 150–250 mg bid Levetiracetam Keppra Seizures 250,500,750 500–1500 mg bid Meclizine Antivert Vertigo 12.5,25,50 25 mg q6h Memantine Namenda Alzheimer’s disease 5,10 5 mg qd–10 mg bid Metoclopramide Reglan Headache 5,10 10–30 qid Metoprolol Lopressor Headache 50,100 200 mg once/d Nadolol Corgard Headache 40,80,120,160 40 mg once/d Naproxen Naprosyn Headache,pain 200,250,375,500 250–500 mg bid Naratriptan Amerge Headache 1,2.5 2.5 mg q4h x 1–2 Nimodipine Nimotop Subarachnoid 30 60 mg q4h hemorrhage FREQUENTLY USED NEUROLOGIC DRUGS (continued) Drug Brand Use Sizes (mg) Usual dose1 Nortriptyline Pamelor Headache,pain 10,25,50,75 10–150 mg qhs Pergolide Permax Parkinsonism 0.05,0.25,1 1–5 mg tid Phenobarbital Luminal Seizures 15,30,60,100 60 mg bid-tid Phenytoin Dilantin Seizures,pain 30,50,100 300–400 mg qd Pramipexole Mirapex Parkinsonism 0.125,0.25,1,1.5 0.5–1.5 mg tid Pregabalin Lyrica Seizures,pain 25,50,75,100,150 50–100 mg tid 200,225,300 Primidone Mysoline Seizures,tremor 50,250 250 mg tid-qid Prochlorperazine Compazine Headache 5,10,25 5–10 tid-qid Promethazine Phenergan Headache,nausa Tablets:12.5,25,and 25 mg im or iv 50 mg;Suppositories: 12.5,25,and 50 mg; injection:25 and 50 mg/ml Propranolol Inderal Headache,tremor 10,20,40,80,90,120,160 20–120 bid Pyridostigmine Mestinon Myasthenia gravis 60,180 6–120 mg tid Riluzole Rilutek ALS 50 50 mg q12h Rivastigmine Exelon Alzheimer’s disease 1.5,3,4.5,6 1.5–6 mg bid Rizatriptan Maxalt Headache 5,10 5 or 10 mg po* Ropinirole Requip Parkinsonism 0.25,0.5,1 0.25–8 mg tid Selegiline Eldepryl Parkinsonism 5 5 mg bid Sumatriptan Imitrex Headache 25,50,100 PO;6 SC;5,20 25–100 mg x 1–3;6 mg SC x nasal spray 1–2;20 mg IN x 1–2 Tacrine Cognex Alzheimer’s disease 10,20,30,40 10–20 mg qid Tiagabine Gabitril Seizures 4,12,16,20 8–28 mg bid Ticlopidine Ticlid TIA/stroke 250 250 mg bid Timolol Biocadren Headache 10,20 10 mg bid Tolcapone Tasmar Parkinsonism 100,200 100–200 mg tid Topiramate Topamax Seizures 25,100,200 200 mg bid Trihexyphenidyl Artane Movement disorders 2,5 1 mg qd–5 mg tid Valproic acid Depakote Seizures,headache 125,250,500 250–650 mg tid Verapamil Calan Headache 40,80,120,180,240 80 mg tid Vigabatrin Sabril Seizures 500 1–4 g/d Warfarin Coumadin TIA/stroke 1,2,2.5,3,4,5,6,7.5,10 5 mg qd3 Zolmitriptan Zomig Headache 2.5,5 2.5 mg q2h x 1–4 Zonisamide Zonegran Seizures 100 300–600 (cid:2)g in 2 divided dose 1Typical maintenance doses in adults,given orally unless stated otherwise (SC (cid:3)subcutaneous,IM (cid:3)intramuscular;IN (cid:3) intranasal). Consult prescribing information for indications and contraindications,drug interactions,adverse drug effects, safety in pregnancy and breastfeeding,doses in hepatic or renal failure,and recommended initial doses. 2Adjusted according to partial thromboplastin time (PTT) or international normalized ratio (INR). 3Adjusted according to prothrombin time (PT) or international normalized ratio (INR). a LANGE medical book Clinical Neurology seventh edition ROGER P.SIMON,MD Robert Stone Dow Chair of Neurology Director of Neurobiology Research Legacy Health Systems Portland,Oregon DAVID A.GREENBERG,MD,PHD Professor and Vice-President for Special Research Programs Buck Institute for Age Research Novato,California MICHAEL J.AMINOFF,MD,DSC,FRCP Professor and Executive Vice-Chair Department of Neurology School of Medicine University of California,San Francisco Lange Medical Books/McGraw-Hill Medical Publishing Division New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2009, 2005, 2002 by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. ISBN: 978-0-07-166433-2 MHID: 0-07-166433-5 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-154644-7, MHID: 0-07-154644-8. All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps. McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. To contact a representative please e-mail us at [email protected]. Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The editors and the publisher of this work have checked with sources believed to be reliable in their efforts to pro- vide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the editors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of such information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licensors reserve all rights in and to the work. Use of this work is subject to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms. THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. Since the last edition of Clinical Neurology, Lydia Bayne, our colleague, fellow neurologist and Roger’s beloved wife, has died of motor neuron disease. This seventh edition is dedicated to her memory. Lydia wrote The Neurologic Examination section (Appendix A) as her handout to UCSF medical students rotating on her service at the Laguna Honda Hospital in San Francisco where she was chief. She was a remarkably skilled neurologist. Her clinical experience and scholarship had impact on many editions of this book. Personally and professionally, she is sorely missed. This page intentionally left blank Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii Chapter 1: Disorders of Cognitive Function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Chapter 2: Headache & Facial Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69 Chapter 3: Disorders of Equilibrium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .94 Chapter 4: Disturbances of Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125 Chapter 5: Motor Deficits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .152 Chapter 6: Disorders of Somatic Sensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .203 Chapter 7: Movement Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .238 Chapter 8: Seizures & Syncope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .270 Chapter 9: Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .292 Chapter 10: Coma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .328 Chapter 11: Neurologic Investigations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .348 Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .366 A: The Neurologic Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .366 B: A Brief Examination of the Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .377 C: Clinical Examination of Common Isolated Peripheral Nerve Disorders . . . . . . . . . . . . . . . . . .379 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .387 v This page intentionally left blank Preface This seventh edition of Clinical Neurology retains its In preparing this new edition, especially in the areas primary focus, arising from the authors’ experience of therapeutics and genetics, we have again consulted teaching in the clinics and wards of the University of our expert colleagues, who have been of great help. In California, San Francisco hospitals: an approach to this regard, we particularly thank Hubert Leonard, neurology based on the patients’ presenting symptoms Norman So, Alisa Gean, Allitia Dibernardo, Michael or signs. Thus the chapters are organized according to Moskowitz, Dennis Bourdette, Thomas Koch, John problems such as headaches, seizures, stroke, and coma, Nutt, Joe Quinn, Robert Egan, Randolph Evans, and rather than as a catalog of specific diseases. We believe Karen Furie. The present and past staff at McGraw- this method continues to be a useful teaching tool and Hill have, as always, been enormously helpful in mov- accordingly it is retained in the current volume. ing this book through editing and production. We trust This new edition encompasses the rapidly expand- the final product will serve as a tool to demystify clini- ing knowledge of therapy for neurologic disease and of cal neurology for students and practitioners, providing molecular, and especially genetic, disease mechanisms. patients better and more focused diagnosis, which can A host of new and effective treatments for multiple increasingly be translated into therapy. We are delight- sclerosis, Parkinson’s disease, headache, epilepsy, and ed that Clinical Neurology now appears in eight lan- stroke has been incorporated into the therapy section of guages. the text. Sections devoted to neurobiology have been extensively updated and expanded. Because neuroimag- Roger P. Simon ing continues to evolve and improve, attention has Micahel J. Aminoff been paid to new magnetic resonance (MR) and com- David A. Greenberg puted tomography (CT) images in the text. We have retained the appendix containing extensive, step-by- Portland and San Francisco step descriptions of the neurologic examintaion. December 2008 vii

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