Netter's Concise Neurology PDF
Preview Netter's Concise Neurology
KARL E. MISULIS ANDTHOMAS C. HEAD 4{tr Ntr Netter's Neurology H. Royden Jones, MD r ISBN: 1-929007-06-X ISBN-1 3: 978-1 -929007-06-6 Whether your interest is medical education, clinical reference, or simply the expansion of your medical knowledge, these titles, The Granial Nerves featuring the aftwork of Dominique Doyon, MD, master medical illustrator Kathlyn MarsolDupuch, MD, and Jean-Paul Francke, MD Frank H. Nettet MD, equip r ISBN: 1-929007-54-X you with the authoritative, ISBN-1 3: 978-'l -929007-54-7 exquisitely illustrated, and easy-to-use guidance you needl Netter's Concise Neuroanatorny Michael Rubin, MD, FRCP(C) J; aISnBdN J:o 1se-9ph3 3E2. 4S7a-fd2ie2h-3, .MD Hf i '-'- ISB N -1 3: 97 8-1 -933247 -22-9 Netter's Atlas of Human Neuroscience David Felten, MD, PhD, and Netter's Neuroscience Ralph F. Jozefowicz, MD Flash Cards ISBN:1-929007-16-7 o ISBN-1 3: 97 8 -1 -929007 -1 6 -5 David L. Felten, MD, Ph.D ISBN:1-929007-64-7 ISBN-1 3: 978-1 -929007-64-6 To order any of these titles visit www.elsevierhealth.com... contact you r local Elsevier Sales Representative... cal I 1 -800-5 45-2522... or visit your local medical bookstore. Netter's Concise Neurology Karl E. Misulis, MD, PhD Thomas C. Head, MD lllustrations by Frank H. Netter, MD Contributing lllustrators John A. Craig, MD Carlos A. G. Machado, MD F-S'. ,ER !1.'-!:R.S . .:-:-=d!, Blvd. : ,i 19103-2899 .:_:: S CONCISE NEUROLOGY ISBN- I 3 : 97 A-1 -929007 -89-9 ISBN- 1 O: | -929OO7 -A9-2 Co?fight c 2007 by Saunders, an imprint of Elsevier Inc. All ridrts reserved. No part of this book may be produced or transmifted in any form or by any means, ::cronic or mechanical, including photocopying, recording or any information storage and retrieval system, ;.-:nout permission in writing from the publishers. Permissions for Netter Art figures may be sought directly from i.se',ier's Health Science Licensing Department in Philadelphia PA" USA: phone l-800-525-1649, ext.3276 or 215\ 239-3276; or email [email protected]. Notice Knowledge and best practice in this field are constantly changing. As new research and experience broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. lt is the responsibility of the practitioner, relying on their own experience and knowledge of the patient, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law neither the Publisher nor the Authors assume any liability for any injury and/or damage to persons or propefty arising out of or related to any use o{ the material contained in this book. The Publisher Library ol Congress Cataloging-in-Publication Data Misulis, Karl E. Netter's concise neurology / Karl E. Misulis, Thomas C. Head ; illustrations by Frank H. Netter ; contributing illustrators, John A. Craig, Carlos A. C- Machado. p. ; cm. ISBN-l 3: 978-l -929007-89-9 ISBN- f 0: 1-929OO7-A9-2 l. Nervous system-Diseases-Handbooks, manuals, etc. 2. Nervous system-Diseases-Atlases. l. Head, Thomas C. (Thomas Channing), 1963- ll. Netter, Frank H. (Frank Henry), 1906-1991. lll. Title. lV. Title: Concise neurology. [DNLM: I. Nervous System Diseases-diagnosis-Handbooks. 2. Diagnosis, Differential-Handbooks. 3. Nervous System Diseases-therapy-Handbooks. 4. Neurologic Examination-methods-Handbooks. WL 39 M678na 20071 RC555.M57 2007 616.8175-dc22 2006050559 Acquisitions Editor: Elyse O' Crady Developmentol Editor: Marybeth Thiel Publishing Services Monoger Linda Van Pelt Ptoject Monoger: Melanie Peirson Johnstone Design Diredion' Lou Forgione \Torking together to grow libraries in developing countries w.elseviercom I mw.bookaid.org I w.sabre.org Printed in China Lastdigitistheprintnumber:9 I 7 6 5 4 3 2 I Th$,$S, fltuVw,rf,,,{ .l;t*iIr PIID - Nstqi rK To our mentors: Vivian Abrahams, Russell Durkovic, Gerald Fenichel, Wolf Dettbarn, Shin Oh, and to the memory of John Whitaker Prefoce Netter's Concise Neurology is the product of more than hryo years of composition. We wrote this book to provide a helpful aid to the evaluation and management of patients with neurologic conditions. Neurologic diseases are often complex and there is often a broad differential diagnosis. Therefore, diagnosis must begin with a systematic evaluation. First localize the lesion, then narrow the differential diagnosis. Likewise, management of neurologic disorders can be complex with multiple options and alternative approaches. Strict protocols will never be employed in neurology, as the field is too complex and fluid, but guidance on approaches to management are appropriate. Netter's Concise Neurology is divided into sections which are in order of clinical encounter. The first section reviews the neurologic and medical examination with a discussion of clinical implications of findings. The second section describes an approach to specific complaints. The third section describes important neurologic disorders with information on diagnosis, management and clinical course. The information is organized as tabular text enhanced by the accompanying anatomical and clinical arhruork of Frank H. Netter, MD. Dr. John Craig has contributed excellent new art to this work as well as adapting some existing art along with Dr. Carlos Machado. We hope this book will be a help to physicians in all stages of training and practice. Korl E. Misulis and Thomos C. Heod PREFACE vii Acknowledgments The authors would like to express their appreciation to everyone who has been involved in this book. Special thank are offered to Dr. John Craig for wonderful artwork and to the folks at Elsevier who have done so much for the editing, production, and promotion of the text. The authors would also like to acknowledge those who have shaped our knowledge, practice style, and teaching style: teachers, colleagues, students, and friends. ACKNOWLEDCMENTS ix About the Authors Karl E. Misulis, MD, PhD is Clinical Professor of Neurology at Vanderbilt University and Neurologist at the Semmes-Murphey Clinic in Jackson, Tennessee. He received his BSc from Queen's University (Canada), MD from Vanderbilt University, and PhD from State University of New York Health Sciences Center at Syracuse. He is the author of l6 books and has contributed chapters to many others. Dr. Misulis lectures extensively to practicing physicians, medical students, residents, fellows, and patient groups. His lecture style derives, in part, from his experience as a stand-up comedian. He is the keyboardist for the charity rock band, Heorts & Minds. Thomas C. Head, MD is Neurologist at the Semmes-Murphey Clinic in Jackson, Tennessee. A former student and faculty member at University of Alabama, Birmingham, he has extensive experience in general neurology and neuromuscular disease. Having taught at all levels of medicine, from medical students to practicing physicians, Dr. Head is a sought after speaker for his authoritative information and dynamic style. This is his second collaboration with Karl Misulis, having co-authored Essentiols of Clinicol Neurophysiology 3rd edition (Elsevier). He performs percussion and vocals for the charity rock band, Heorts & Minds. ABOUT THE AUTHORS xi Fronk H. Netter, MD Frank H. Netter was born in 1906, in New York City. He studied art at the Art Student's League and the National Academy of Design before entering medical school at New York University, where he received his MD degree in 1931. During his student years, Dr. Netter's notebook sketches attracted the attention of the medical faculty and other physicians, allowing him to augment his income by illustrating articles and textbooks. He continued illustrating as a sideline after establishing a surgical practice in 1933, but he ultimately opted to give up his practice in favor of a full-time commitment to art. After service in the United States Army during World War ll, Dr. Netter began his long collaboration with the CIBA Pharmaceutical Company (now Novartis Pharmaceuticals). This 45-year partnership resulted in the production of the extraordinary collection of medical art so familiar to physicians and other medical professionals worldwide. lcon Learning Systems acquired the Netter Collection in July 2000 and continued to update Dr. Netter's original paintings and to add newly commissioned paintings by artists trained in the style of Dr. Netter. ln 2005, Elsevier, lnc. purchased the Netter Collection and all publications from lcon Learning Systems. There are now over 50 publications featuring the art of Dr. Netter available through Elsevier, lnc. Dr. Netter's works are among the finest examples of the use of illustration in the teaching of medical concepts. The l3-book Netter Collection of Medicol illustrqtions, which includes the greater part of the more than 20,000 paintings created by Dr. Netter, became and remains one of the most famous medical works ever published. The Netter Atlas of Humon Anotomy, first published in 1989, presents the anatomical paintings from the Netter Collection. Now translated into I6 languages, it is the anatomy atlas of choice among medical and health professions students the world over. The Netter illustrations are appreciated not only for their aesthetic qualities, but, more importantly, for their intellectual content. As Dr. Netter wrote in 1949,"... clarification of a subject is the aim and goal of illustration. No matter how beautifully painted, how delicately and subtly rendered a subject may be, it is of little value as a medical illustration if it does not serve to make clear some medical point." Dr. Netter's planning, conception, point of view, and approach are what inform his paintings and what make them so intellectually valuable. Frank H. Netter, MD, physician and artist, died in 1991. FRANK H. NETTER, A/D xiii Toble of Contents i I I i @ Evqluqtion I History 2 Mental Status Examination 5 Language Examination 7 Cranial Nerve Examination 9 It Cranial Nerve FXll Functions II Cranial Nerves FXll Function Testing Cranial Nerves l-xll Test Findings and lmplications t5 l7 Eye Examination Motor Examination 2t Sensory Examination 21 Coordination Examination 26 Cait Examination 28 Reflex Examination 50 Reflex Examination-Tendon t2 Reflex Examination-Pathologic t4 Medical Examination 55 & Diognosis 39 Approach to Diagnosis 40 Neurodiagnostic Tests Used for Evaluation 42 Brain and Spine lmaging 44 Vascular lmaging 46 Clinical Neurophysiology 50 Lumbar Puncture 34 Mental Status Change: Approach 56 Mental Status: Delirium 60 Mental Status: Dementia 65 Mental Status: Coma 70 Mental Status: Brain Death 7li Cranial Nerve Dysfunction 78 Ataxia: Approach 8l Ataxia: cait and Limb 8I Episodic Disorders: Approach 85 Episodic Disorders: Syncope 88 Episodic Disorders: Seizures 90 Headache 92 Weakness 97 Sensation: Cutaneous Sensory Deficit l02 Sensation: Vision t07 Tremor r09 lll Rigidity and Stiffness ItI Hyperkinetic Disorders +3 Disorders 1L5 DISORDERS_MENTAL SIATUS tt6 Dementia Overview rt8 Alzheimer's Disease Mild Cognitive lmpairment t20 XY
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