Clinical neurology

419 Pages·2009·18.483 MB·English

by  Roger P Simon, David A Greenberg, Michael J Aminoff

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
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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.
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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
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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