Kaufman's Clinical Neurology for Psychiatrists

657 Pages·2016·34.887 MB·English

by  David Myland Kaufman, Howard Geyer and Mark J Milstein (Auth.)

KAUFMAN’S CLINICAL
NEUROLOGY FOR
PSYCHIATRISTS
KAUFMAN’S
CLINICAL
NEUROLOGY FOR
PSYCHIATRISTS
Eighth Edition
David Myland Kaufman, MD
Departments of Neurology and Psychiatry
Montefiore Medical Center
Albert Einstein College of Medicine
Bronx, New York
Howard L. Geyer, MD, PhD
Department of Neurology
Montefiore Medical Center
Albert Einstein College of Medicine
Bronx, New York
Mark J. Milstein, MD
Department of Neurology
Montefiore Medical Center
Albert Einstein College of Medicine
Bronx, New York
© 2017, Elsevier Inc. All rights reserved.
First edition 1981
Second edition 1985
Third edition 1990
Fourth edition 1995
Fifth edition 2001
Sixth edition 2007
Seventh edition 2013
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ISBN: 978-0-323-41559-0;
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D
EDICATION
I dedicate Kaufman’s Clinical Neurology for
Psychiatrists to Rita, my wife of more than 45 years,
whose love has made everything possible, and our
grandchildren – Lila, Owen, Aaron, Penelope, Eliana,
and Benjamin.
David Myland Kaufman
To my parents, my wife, and my daughters, with
gratitude, admiration, and love.
Howard L. Geyer
I dedicate this book to my husband, Chris,
who always makes me laugh, and my parents,
David and Nancy, who will always inspire me to make
the most of my life and career.
Mark J. Milstein
vii
A
CKNOWLEDGMENTS
My wife and best friend, Rita, acted as my muse by origi- framework and encouragement to pursue the writing of
nally suggesting writing this book by expanding the syl- this book and undertake other academic work in the
labus for my course, “Clinical Neurology for Psychiatrists,” midst of our clinical responsibilities. At the same time,
and then giving me numerous ideas for each future they have grown Montefiore into a vibrant, world-
edition. renowned, patient-centered, urban medical center that is
David Myland Kaufman, MD the teaching hospital of the Albert Einstein College of
Medicine.
I am privileged to have worked with and learned from Our housestaff and faculty-colleagues at Montefiore
many wonderful mentors, colleagues, and patients over Medical Center/Albert Einstein College of Medicine and
the years, and am thankful for all they have taught me. I other academic medical centers have reviewed chapters
am especially grateful to my wife Laurence for her love, and in other ways offered invaluable help with this edition:
encouragement, and patience, during my work on this Susan Duberstein, Jelena Pavlović, Gail Solomon, Renee
project and always. Monderer, Jack Farinhas, Jacqueline Bello, Judah Burns,
Howard L. Geyer, MD, PhD Lisa Ferber, and Michael Kaufman. Ms. Meryl Ranzer, Mr.
Barry Morden, and Ms. Ann Mannato captured the sense
I would like to thank Dr. David Kaufman who not only of neurology in wonderful illustrations.
taught me invaluable lessons during my residency train- The library staffs of Montefiore Medical Center Cher-
ing but also brought me into this project and Dr. Steven kasky Library and the D. Samuel Gottesman Library of
Herskovitz (Director of the Neuromuscular Division) the Albert Einstein College of Medicine have graciously
who always pushes me to examine all angles of a problem provided us with modern-day technology information.
and answer medical questions as precisely as possible. Our attorneys, Mr. Jeffrey A. Lowin, of Morris Cohen
Additionally, I owe tremendous gratitude to Dr. Sheryl LLP, and Mr. H. Joseph Mello, of Winston & Strawn
Haut, whose mentorship and support has helped me LLP, provided excellent council.
achieve success in student and resident teaching and per- We also thank our editors at Elsevier, Charlotta Kryhl,
sonal academic endeavors. Ailsa Laing, John Leonard, and Sharon Nash, who have
Mark J. Milstein, MD opened their doors and provided many improvements for
this edition. Finally, our thanks go to the Elsevier pro-
Drs. Steven M. Safyer (President of the Medical Center), duction team for their hard work and dedication includ-
Allen M. Spiegel (Dean of the Albert Einstein College of ing Beula Christopher, Christian Bilbow, and Amy Faith
Medicine), Byram Karasu (Chair of Psychiatry), Herbert Heyden.
Schaumburg (Chair Emeritus of Neurology), Mark David Myland Kaufman, MD
Mehler (Chair of Neurology), and Michael Swerdlow Howard L. Geyer, MD, PhD
(partner at Neurologic Associates) have provided the Mark J. Milstein, MD
viii
N A R
OTES BOUT EFERENCES
Most chapters provide specific references from the neu- Rosenberg, R. N., & Pascual, J. M. (2015). Rosenberg’s Molecular and
rologic and general medical literature. In addition, several Genetic Basis of Neurological and Psychiatric Disease (5th ed.). New York:
Elsevier.
standard, well-written textbooks contain relevant infor-
Schapira, A. H. V. (Ed.), (2007). Neurology and Clinical Neuroscience.
mation about many topics: Philadelphia: Mosby Elsevier.
Scheiber, S. C., Kramer, T. A. M., & Adamowski, S. E. (Eds.), (2003).
Aminoff, M. J., & Faulkner, L. P. (Eds.), (2012). The American Board of Core Competencies for Psychiatric Practice: What Clinicians Need to Know.
Psychiatry and Neurology: Looking Back and Moving Ahead. Washing- A Report of the American Board of Psychiatry and Neurology, Inc. Wash-
ton: American Psychiatric Press. ington, D.C.: American Psychiatric Publishing, Inc.
Biller, J. (2013). Practical Neurology DVD Review (2nd ed.). Philadelphia: Walker, A., Kaufman, D. M., Pfeffer, C., et al. (2008). Child and Ado-
Wolters Kluwer. lescent Neurology for Psychiatrists. Philadelphia: Lippincott Williams &
Blumenfeld, H. (2010). Neuroanatomy Through Clinical Cases (2nd ed.). Wilkins.
Sunderland, MA: Sinauer.
Ellison, D., Love, S., Chimelli, L., et al. (2013). Neuropathology: A Refer- Web Sites That Offer Information About Several Areas
ence Text of CNS Pathology (3rd ed.). Philadelphia: Elsevier. (Sites relevant to single areas are listed in each chapter’s references and
Goetz, C. G. (2011). Textbook of Clinical Neurology (3rd ed.). Philadel- in Appendix 1.)
phia: WB Saunders. American Academy of Neurology’s Practice Guidelines: http://www
Heilman, K. M., & Valenstein, E. (2003). Clinical Neuropsychology (5th .aan.com/professionals/practice/guideline
ed.). New York: Oxford University Press. Gene Clinics: http://geneclinics.org/
Howard, J. (2013). Neurology Video Textbook. New York: DemosMedical. Medlink Neurology (a commercial neurology textbook): http://www
Jones, K. L., Jones, M. C., & del Campo, M. (2013). Recognizable Pat- .medlink.com
terns of Human Malformations (7th ed.). Philadelphia: Elsevier. National Institute of Health: http://health.nih.gov/category/Brainand
Kanner, A. M. (2012). Depression in Neurologic Disorders. Oxford, UK: NervousSystem
Wiley-Blackwell. Online Mendelian Inheritance in Man: http://www.ncbi.nlm.nih.gov/
Lyketos, C. G., Rabins, P. V., Lipsey, J. R., et al. (Eds.), (2008). Psychi- omim
atric Aspects of Neurologic Diseases: Practical Approaches to Patient Care. Pubmed: http://www.ncbi.nlm.nih.gov/pubmed
New York: Oxford University Press. Registry and results database of publicly and privately supported clinical
Posner, J. B., Saper, C. B., Schiff, N., et al. (2007). Plum and Posner’s studies of human participants conducted around the world: http://
Diagnosis of Stupor and Coma (Contemporary Neurology Series) (4th ed.). ClinicalTrials.gov
New York: Oxford University Press.
Ropper, A. H., & Samuels, M. A. (Eds.), (2009). Adams and Victor’s
Principles of Neurology (9th ed.). New York: McGraw Hill, Waltham
Mass., Academic Press, 2014.
ix
P -R , P N
HYSICIAN EADERS LEASE OTE
Kaufman’s Clinical Neurology for Psychiatrists discusses including doing nothing. Some aspects of medical care
medications, testing, procedures, and other aspects of that this book discusses are widely and successfully used
medical care. Despite their purported effectiveness, many for particular purposes not approved by the Food and
are fraught with side effects and other adverse outcomes. Drug Administration (FDA). Regarding these “off-label”
Discussions in this book neither recommend nor offer treatments, as well as conventional ones, this book is
medical advice, and they do not apply to individual reporting – not endorsing – their use by neurologists or
patients. The physician, who should consult the package other physicians. Finally, because medical practices
insert and the medical literature, remains responsible for rapidly evolve, readers should expect that sooner or later
medications’ indications, dosage, contraindications, pre- new diagnostic criteria and treatments will replace those
cautions, side effects, adverse reactions, and alternatives, discussed in this edition.
x
P
REFACE
PURPOSE
Many chapters contain outlines for a bedside examina-
tion; reproductions of standard bedside tests, such as the
We have written Kaufman’s Clinical Neurology for Psychia- Montreal Cognitive Assessment (MoCA) and Abnormal
trists – a collegial straightforward guide – from our per- Involuntary Movement Scale (AIMS), references to
spective as neurologists at a major, urban academic recent medical literature, and pertinent web sites. One
medical center. In a format combining traditional neuro- chapter provides a compilation of computed tomography
anatomic correlations with symptom-oriented discus- (CT), magnetic resonance imaging (MRI), and positron
sions, the book will assist psychiatrists in learning modern emission tomography (PET) images that other chapters
neurology. It emphasizes neurologic conditions that reference. Appendices contain information pertaining
are frequently occurring, common to psychiatry and to most chapters: Patient and Family Support Groups
neurology, illustrative of a scientific principle, or have (Appendix 1); Costs of Various Tests and Treatments
prominent psychiatric manifestations. It also includes (Appendix 2); Diseases Transmitted by Chromosome or
descriptions of numerous neurologic conditions that may Mitochondria Abnormalities (Appendix 3); and Chemical
underlie aberrant behavior, disturbances in mood, or cog- and Biological Neurotoxins (Appendix 4).
nitive impairment – symptoms that prompt patients or In addition, the book reviews neurologic conditions
medical colleagues to solicit psychiatry consultations. that have entered the public arena because, willingly or
Kaufman’s Clinical Neurology for Psychiatrists does not unwillingly, psychiatrists are liable to be drawn into
intend to replace comprehensive neurology textbooks or debates involving their own patients or the medical
convert psychiatrists into semiprofessional neurologists; community. Psychiatrists should be well versed in the
however, this book contains essential information intricacies of the following conditions that this book
required of psychiatrists. describes:
• Amyotrophic lateral sclerosis and multiple sclerosis
as battlegrounds of assisted suicide
ORGANIZATION AND CONTENT • Meningomyelocele with Arnold–Chiari malforma-
tion as an indication for abortion and the value of
The organization and content of Kaufman’s Clinical Neu- spending limited resources on this fatal or severely
rology for Psychiatrists arose from our experience as faculty debilitating condition
at the Albert Einstein College of Medicine, attending • Chronic pain as the fulcrum for legalizing marijuana
physicians at Montefiore Medical Center, and supervisors and heroin
of numerous neurology and psychiatry residents; consul- • Parkinson disease, spinal cord injury, and other dis-
tation with our colleagues, many of whom are world- orders amenable to research and treatment with
renowned physicians; and feedback from many of the stem cells
20,000 psychiatrists who have attended the course, “Clin- • Persistent vegetative state and continuing life-sup-
ical Neurology for Psychiatrists,” and the more than port technology
50,000 individuals who have purchased previous editions • Cost of medical testing and treatment.
of this book. Learning the material in this book should
help readers prepare for examinations, perform effective
ADDITIONS AND OTHER CHANGES
consultations, and improve their practice and teaching.
Section 1 reviews classic anatomic neurology and FOR THE EIGHTH EDITION
describes how to approach patients with a suspected neu-
rologic disorder, identify central or peripheral nervous The first seven editions of Kaufman’s Clinical Neurology for
system disease, and correlate physical signs. Section 2 Psychiatrists have enjoyed considerable success in the
discusses common and otherwise important clinical areas, United States, Canada, and abroad. The book has been
emphasizing aspects a psychiatrist may encounter. Topics translated into Japanese, Italian, Korean, and Spanish. In
include neurologic illnesses, such as multiple sclerosis, the eighth edition, written 3 years after the seventh, we
brain tumors, strokes, and traumatic brain injury; and have clarified the presentations, discussed recent develop-
common symptoms, such as headaches, chronic pain, epi- ments in many areas, and added many clinical, anatomic,
lepsy, and involuntary movement disorders. For each and radiologic illustrations. To give the question-and-
topic, chapters describe the relevant symptoms including answer sections greater power, we have increased the
psychiatric comorbidity, easily performed office and number of questions, refined them, expanded the discus-
bedside examinations, appropriate laboratory tests, dif- sions, and provided more illustrations. We have increased
ferential diagnoses, and some management options. the usage of questions based on clinical vignettes because
xi
xii PREFACE
they mimic the clinical experience and the trend of national In addition, the book reproduces neurologic test results,
specialty examinations. which are also visual records, such as CT, MRI, and
In a major new feature of this edition, Kaufman’s Clini- electroencephalography (EEG).
cal Neurology for Psychiatrists refers to the diagnostic cri- Kaufman’s Clinical Neurology for Psychiatrists comple-
teria for various neurologic disorders in the Diagnostic and ments the text with question-and-answer sections at
Statistical Manual of Mental Disorder, 5th Edition (DSM-5). the end of most chapters and at the conclusion of the
It compares and contrasts DSM-5 diagnostic criteria to book. Sections at the end of chapters generally refer
neurologists’ diagnostic criteria, which admittedly remain to material discussed within that chapter, whereas
for the most part uncodified and variable. With a few those questions at the book’s conclusion tend to require
exceptions, DSM-5 criteria rely entirely on the nature comparison of neurologic disorders that have appeared
and duration of symptoms, but neurologists, depending under different headings. In Chapter 4, before the
on the illness, rely on genetic testing, biopsy results, question-and-answer review of the preceding chapters’
blood tests, various laboratory testing, or physical find- material, the book offers a guide to preparing for stan-
ings, but only sometimes exclusively on the patient’s dardized tests.
symptoms, to make a diagnosis in their field. The Albert Einstein College of Medicine and many
This edition updates and expands most topics and adds other medical schools rely on similar “problem-based
new ones: interactive studying” – case-based question-and-answer
• New nomenclature for seizures and epilepsy problems – as the optimum meaningful and efficient
• Revised diagnostic criteria for multiple sclerosis learning strategy. Not merely quizzing the reader, the
• New treatments for epilepsy, Alzheimer disease, Par- book’s questions-and-answers form an integral part of the
kinson disease, multiple sclerosis, and headaches learning experience. In fact, many readers find that these
• New diagnostic modalities and treatments for sections are the single most informative portion of the
several movement disorders book and term them “high yield.” In keeping with the
• New imaging techniques visual emphasis of the book, many of the questions are
• New organization of sleep–wake disorders based on visual material, including sketches of patients
• Current guidelines for the diagnosis of concussions and reproductions of MRIs, CTs, and EEGs.
and their management
• Psychiatric comorbidity of neurologic illnesses
• New paraneoplastic disorders. ONE CAVEAT
Kaufman’s Clinical Neurology For Psychiatrists expects well-
DIDACTIC DEVICES: THE VISUAL APPROACH
educated and thoughtful readers. It demands attention
AND QUESTION-AND-ANSWER SECTIONS and work, and asks them to follow a rigorous course.
Readers should find the book, like the practice of medi-
Kaufman’s Clinical Neurology for Psychiatrists – like much cine, complex and challenging, but at the same time rich
of the practice of neurology – relies on a visual approach. and fulfilling.
It provides abundant illustrations, including numerous Even with the additions of text, illustrations, and ques-
sketches of “patients” that personify or reinforce clinical tions, the eighth edition of Kaufman’s Clinical Neurology
descriptions, correlate the basic science with clinical find- for Psychiatrists remains manageable in size, depth, and
ings, and serve as the basis for question-and-answer scope, but still succinct enough for psychiatrists to read
learning. The visual approach conforms to neurologists’ and enjoy from cover to cover.
predilection to “diagnose by inspection.” For example, David Myland Kaufman, MD
they rely on their observations for the diagnoses of gait Howard L. Geyer, MD, PhD
abnormalities, psychogenic neurologic deficits, neurocu- Mark J. Milstein, MD
taneous disorders, strokes, and involuntary movements.
C H A P T E R 1
F E W
IRST NCOUNTER ITH A
P : E
ATIENT XAMINATION AND
F
ORMULATION
Despite the ready availability of sophisticated tests, the somewhat of an art and inapplicable in several important
“hands on” examination remains the fundamental aspect neurologic illnesses, such as Alzheimer disease.
of neurology. Beloved by neurologists, the neurologic The examination is not only of historical interest, but
examination provides a vivid portrayal of both function also remains irreplaceable in diagnosis. It consists of a
and illness. When neurologists say they have seen a case functional neuroanatomy demonstration: mental status,
of a particular illness, they mean that they have really seen cranial nerves, motor system, reflexes, sensation, cerebel-
a patient with it. lar system, and gait (Box 1.1). This format should be
When a patient’s history suggests a neurologic illness, followed during most examinations. Trainees still master-
the neurologic examination may unequivocally demon- ing this structure may bring a printed copy to the patient’s
strate it. Even if psychiatrists themselves do not perform bedside to serve both as a reminder and as a place to
the examination, they should be able to appreciate neu- record neurologic findings.
rologic signs and assess a neurologist’s conclusion. The examination usually starts with an assessment
Neurologists systematically examine the nervous sys- of the mental status, because cognition is the most
tem’s major components, paying particular attention to fundamental neurologic function and cognitive impair-
areas of interest in an individual patient in light of his or ments may preclude an accurate assessment of other neu-
her symptoms. Neurologists try to adhere to the routine rologic functions. The examiner should consider specific
while avoiding omissions and duplications. Despite intellectual deficits, such as language impairment (see
obvious dysfunction of one part of the nervous system, Aphasia, Chapter 8), as well as general cognitive impair-
they evaluate all major areas. A neurologist can usually ment (see Dementia, Chapter 7). Tests of cranial nerves
complete an initial or screening examination in 20 may reveal malfunction of nerves either individually or
minutes or less and return to perform detailed or other- in groups, such as the ocular motility nerves (III, IV, and
wise special testing of particular areas, such as the mental VI) or the cerebellopontine angle nerves (V, VII, and VIII)
status. (see Chapter 4).
The examination of the motor system is usually per-
formed more to detect the pattern than the severity of
EXAMINATION weakness. Whether weakness is mild to moderate (paresis)
or complete (plegia), the pattern rather than severity
Neurologists usually begin by noting a patient’s age, sex, offers more clues to localization. On a practical level, of
and handedness, and then review the primary symptom, course, the severity of the paresis determines the patient’s
present illness, medical history, family history, and social functional capacity, e.g., whether a patient walks, requires
history. They explore the primary symptom, associated a wheelchair, or stays bedridden.
symptoms, and possible etiologic factors. If a patient cannot When neurologists detect paresis they attempt to clas-
relate the history, the neurologist might interrupt the sify its pattern. They frequently speak of three patterns.
process to look for language, memory, or other cognitive If the lower face, arm, and leg on one side of the body
deficits. Many chapters in Section 2 contain outlines of the are paretic, they call the pattern hemiparesis. They usually
standard questions that relate to common symptoms. attribute hemiparesis to damage in the contralateral cere-
After obtaining the history, the neurologist should be bral hemisphere or brainstem. They call weakness of
able to anticipate the patient’s deficits and prepare to both legs paraparesis and usually attribute it to spinal cord
look for disease primarily of the central nervous system damage. If the paresis predominantly involves the distal
(CNS) or the peripheral nervous system (PNS). At this portion of all four limbs, distal quadriparesis, they usually
point, without yielding to rigid preconceptions, the phy- ascribe it to PNS rather than CNS damage.
sician should have developed some sense of the problem Eliciting two categories of reflexes assists in determin-
at hand. ing whether paresis – or other neurologic abnormality
Then neurologists should look for the site of involve- – originates in CNS or PNS injury. Deep tendon reflexes
ment (i.e., “localize the lesion”). “Localization,” one of (DTRs) are normally present with uniform reactivity
the initial goals of most neurologic examinations, is valu- (speed and forcefulness) in all limbs, but neurologic
able in the majority of cases. However, it is often injury often alters their activity or symmetry. In general,
3