Sections
Index
Symptoms
Cardiovascular Disorders
Clinical Pharmacology
Critical Care Medicine
Dental Disorders
Dermatologic Disorders
Ear, Nose, and Throat Disorders
Endocrine and Metabolic Disorders
Eye Disorders
Gastrointestinal Disorders
Genitourinary Disorders
Geriatrics
Gynecology and Obstetrics
Hematology and Oncology
Hepatic and Biliary Disorders
Immunology; Allergic Disorders
Infectious Diseases
Injuries; Poisoning
Musculoskeletal and Connective Tissue Disorders
Neurologic Disorders
Nutritional Disorders
Pediatrics
Psychiatric Disorders
Pulmonary Disorders
Special Subjects
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
Abdominal Pain, Acute
Abdominal pain, Chronic
Alopecia
Amenorrhea
Amnesia
Anosmia
Bleeding, Excessive
Breast Lumps
Chest Pain
Constipation in Adults
Constipation in Children
Cough in Adults
Cough in Children
Crying
Diarrhea in Adults
Diarrhea in Children
Diplopia
Dizziness
Dry Mouth
Dysmenorrhea
Dyspepsia
Dysphagia
Dyspnea
Dysuria
Earache
Ear Discharge
Edema
Edema During Late Pregnancy
Epistaxis
Erectile dysfunction
Eyelid Swelling
Eye Pain
Fever
Fever, Acute, in Adults
Fever, Chronic (FUO)
Fever in Infants and Children
Floaters
Gas
Gastrointestinal Bleeding
Halitosis
Headache
Hearing Loss
Hearing Loss: Sudden Deafness
Hematospermia
Hematuria
Hemoptysis
Hiccups
Hirsutism
Insomnia and Excessive Daytime Sleepiness
Itching
Itching, Anal
Jaundice in Adults
Jaundice in Neonates
Joint Pain, Monarticular
Joint Pain, Polyarticular
Knee pain
Lump in Throat
Nasal Congestion and Rhinorrhea
Nausea and Vomiting During Early pPregnancy
Nausea and Vomiting in Adults
Nausea and Vomiting in Infants and Children
Neck and Back Pain
Neck Mass
Nipple Discharge
Orthostatis Hypotension
Pain
Pain, Chronic
Palpitations
Pelvic Pain
Pelvic Pain During Early Pregnancy
Polyuria
Priapism
Red Eye
Scrotal Pain
Sore Throat
Stomatitis
Stridor
Syncope
Tearing
Tinnitus
Toothache
Tremor
Urinary Frequency
Urinary Incontinence in Adults
Urinary Incontinence in Children
Urinary Retention
Urticaria
Vaginal Bleeding
Vaginal Bleeding During Early Pregnancy
Vaginal Bleeding During Late Pregnancy
Vaginal Itching and Discharge
Vision, Blurred
Vision Loss, Acute
Weakness, Generalized
Wheezing
Resources
About
The Merck Manual
Ready Reference Guides
Trade Names of Some Commonly Used Drugs
Normal Laboratory Values
Clinical Calculators
Multimedia
Selected Links
Manuals
available online
'/home/index.html' + bookPageLink
'/professional/index.html'
These and other Manuals available
in print, online, and as mobile applications.
See more at
MerckManuals.com
Sections
in
Health Care Professionals
Cardiovascular Disorders
Clinical Pharmacology
Critical Care Medicine
Dental Disorders
Dermatologic Disorders
Ear, Nose, and Throat Disorders
Endocrine and Metabolic Disorders
Eye Disorders
Gastrointestinal Disorders
Genitourinary Disorders
Geriatrics
Gynecology and Obstetrics
Hematology and Oncology
Hepatic and Biliary Disorders
Immunology; Allergic Disorders
Infectious Diseases
Injuries; Poisoning
Musculoskeletal and Connective Tissue Disorders
Neurologic Disorders
Nutritional Disorders
Pediatrics
Psychiatric Disorders
Pulmonary Disorders
Special Subjects
Merck Manual
>
Health Care Professionals
>
Neurologic Disorders
Neurologic Disorders
Approach to the Neurologic Patient
Evaluation of the Neurologic Patient
History
Neurologic Examination
Mental status
Cranial nerves
Motor system
Muscle strength
Gait, stance, and coordination
Sensation
Reflexes
Autonomic nervous system
Cerebrovascular examination
Neurologic Diagnostic Procedures
Lumbar puncture (spinal tap)
CT
MRI
Echoencephalography
Cerebral catheter angiography
Duplex Doppler ultrasonography
Myelography
EEG
Measurement of evoked responses (potentials)
Electromyography and nerve conduction studies
Biopsy
Memory Loss
Etiology
Evaluation
History
Physical examination
Red flags
Interpretation of findings
Testing
Treatment
Patient safety
Environmental measures
Drugs
Geriatric Essentials
Key Points
Muscle Cramps
Causes
Evaluation
Treatment
Prevention
Key Points
Numbness
Pathophysiology
Anatomy
Mechanisms
Etiology
Evaluation
History
Physical examination
Red flags
Interpretation of findings
Testing
Treatment
Key Points
Weakness
Pathophysiology
Etiology
Fatigue
Evaluation
History
Physical examination
General examination
Red flags
Interpretation of findings
Determination of a specific causative disorder
Testing
Treatment
Geriatrics Essentials
Key Points
Neurotransmission
Neurotransmission
Propagation
Transmission
Receptors
Major Neurotransmitters and Receptors
Glutamate and aspartate
GABA
Serotonin
Acetylcholine
Dopamine
Norepinephrine
Endorphins and enkephalins
Other neurotransmitters
Disorders Associated With Defects in Neurotransmission
Autonomic Nervous System
Overview of the Autonomic Nervous System
Anatomy
Sympathetic
Parasympathetic
Physiology
Etiology
Evaluation
History
Physical examination
Laboratory testing
Autonomic Neuropathies
Diagnosis
Treatment
Horner Syndrome
Etiology
Symptoms and Signs
Diagnosis
Treatment
Multiple System Atrophy
Etiology
Symptoms and Signs
Parkinsonian symptoms
Cerebellar abnormalities
Autonomic symptoms
Diagnosis
Treatment
Key Points
Pure Autonomic Failure
Symptoms
Diagnosis
Treatment
Pain
Overview of Pain
Pathophysiology
Pain transmission and modulation
Geriatrics Essentials
Evaluation of Pain
Pain severity
Demented and aphasic patients
Patients receiving neuromuscular blockade
Treatment of Pain
Nonopioid Analgesics
Opioid Analgesics
Route of administration
Dosing and titration
Adverse effects
Opioid antagonists
Adjuvant Analgesic Drugs
Neural Blockade
Neuromodulation
Chronic Pain
Symptoms and Signs
Diagnosis
Treatment
Drugs
Physical methods
Psychologic treatments
Neuropathic Pain
Etiology
Symptoms and Signs
Diagnosis
Treatment
Complex Regional Pain Syndrome
Etiology
Pathophysiology
Symptoms and Signs
Diagnosis
Prognosis
Treatment
Function and Dysfunction of the Cerebral Lobes
Overview of Cerebral Function
Frontal lobes
Parietal lobes
Temporal lobes
Occipital lobes
Insula
Pathophysiology
Recovery
Cerebral dysfunction syndromes
Diagnosis
Agnosia
Diagnosis
Prognosis
Treatment
Amnesias
Etiology
Diagnosis
Treatment
Transient Global Amnesia
Symptoms and Signs
Diagnosis
Prognosis
Treatment
Aphasia
Symptoms and Signs
Diagnosis
Prognosis
Treatment
Apraxia
Symptoms and Signs
Diagnosis
Prognosis
Treatment
Stroke (CVA)
Overview of Stroke
Symptoms and Signs
Complications
Evaluation
Treatment
Ischemic Stroke
Etiology
Thrombosis
Embolism
Lacunar infarcts
Other causes
Pathophysiology
Symptoms and Signs
Diagnosis
Prognosis
Treatment
Acute
Long term
Transient Ischemic Attack
Etiology
Symptoms and Signs
Diagnosis
Treatment
Intracerebral Hemorrhage
Etiology
Pathophysiology
Symptoms and Signs
Diagnosis
Treatment
Subarachnoid Hemorrhage (SAH)
Etiology
Pathophysiology
Symptoms and Signs
Diagnosis
Prognosis
Treatment
Coma and Impaired Consciousness
Overview of Coma and Impaired Consciousness
Pathophysiology
Etiology
Symptoms and Signs
Diagnosis
History
General physical examination
Neurologic examination
Eye examination
Respiratory patterns
Testing
Prognosis
Treatment
Endotracheal intubation
ICP control
Long-term care
Key Points
Vegetative State and Minimally Conscious State
Symptoms and Signs
Vegetative state
Minimally conscious state
Diagnosis
Prognosis
Vegetative state
Minimally conscious state
Treatment
Key Points
Locked-in Syndrome
Diagnosis
Prognosis
Treatment
Brain Death
Diagnosis
Prognosis
Delirium and Dementia
Overview of Delirium and Dementia
Delirium
Etiology
Pathophysiology
Symptoms and Signs
Diagnosis
Mental status examination
History
Physical examination
Testing
Prognosis
Treatment
General measures
Drugs
Prevention
Key Points
Dementia
Etiology
Symptoms and Signs
Early
Intermediate
Late (severe)
Diagnosis
Clinical criteria
Assessment of cognitive function
Laboratory testing
Neuroimaging
Prognosis
Treatment
Patient safety
Environmental measures
Drugs
Caregiver assistance
End-of-life issues
Key Points
Alzheimer Disease
Etiology
Pathophysiology
Symptoms and Signs
Diagnosis
Differential diagnosis
Prognosis
Treatment
Prevention
Key Points
Vascular Dementia
Symptoms and Signs
Diagnosis
Prognosis
Treatment
Key Points
Lewy Body Dementia and Parkinson Disease Dementia
Symptoms and Signs
Lewy body dementia
Parkinson disease dementia
Diagnosis
Treatment
Key Points
HIV-Associated Dementia
Symptoms and Signs
Diagnosis
Prognosis
Treatment
Frontotemporal Dementia
Symptoms and Signs
Frontal variant FTD
Primary progressive aphasia
Diagnosis
Prognosis
Treatment
Normal–Pressure Hydrocephalus
Symptoms and Signs
Diagnosis
Treatment
Behavioral and Psychologic Symptoms of Dementia
Etiology
Evaluation
Treatment
Environmental measures
Caregiver support
Drugs
Key Points
Seizure Disorders
Seizure Disorders
Definitions
Etiology
Classification
Generalized
Partial seizures
Symptoms and Signs
Partial seizures
Generalized seizures
Status epilepticus
Diagnosis
History
Physical examination
Testing
Prognosis
Treatment
Acute seizures and status epilepticus
Posttraumatic seizures
Long-term drug therapy
Surgery
Vagus nerve stimulation
Key Points
Drug Treatment of Seizures
Principles of Long-Term Treatment
Drug Choice for Long-Term Treatment
Adverse effects
Specific Anticonvulsants
Acetazolamide
Carbamazepine
Clobazam
Clonazepam
Divalproex
Ethosuximide
Ezogabine
Felbamate
Fosphenytoin
Gabapentin
Lacosamide
Lamotrigine
Levetiracetam
Oxcarbazepine
Phenobarbital
Phenytoin
Pregabalin
Primidone
Tiagabine
Topiramate
Valproate
Vigabatrin
Zonisamide
Sleep and Wakefulness Disorders
Introduction to Sleep and Wakefulness Disorders
Approach to the Patient With a Sleep or Wakefulness Disorder
Pathophysiology
Etiology
Evaluation
History
Physical examination
Red flags
Interpretation of findings
Testing
Treatment
Hypnotics
Other sedatives
Key Points
Snoring
Pathophysiology
Etiology
Sleep-disordered breathing
Complications
Risk factors
Evaluation
History
Physical examination
Red flags
Interpretation of findings
Testing
Treatment
General measures
Oral appliances
Continuous positive airway pressure (CPAP)
Surgery
Key Points
Circadian Rhythm Sleep Disorders
Circadian rhythm sleep disorder, jet lag type (jet lag disorder)
Circadian rhythm sleep disorder, shift work type (shift work disorder)
Circadian rhythm sleep disorder, altered sleep phase types
Insomnia and Excessive Daytime Sleepiness (EDS)
Inadequate sleep hygiene
Adjustment insomnia
Psychophysiologic insomnia
Physical sleep disorders
Mental sleep disorders
Insufficient sleep syndrome (sleep deprivation)
Drug-related sleep disorders
Narcolepsy
Symptoms and Signs
Diagnosis
Treatment
Key Points
Idiopathic Hypersomnia
Parasomnias
Somnambulism
Sleep (night) terrors
Nightmares
REM sleep behavior disorder
Sleep-related leg cramps
Periodic Limb Movement Disorder and Restless Legs Syndrome
Symptoms and Signs
Diagnosis
Treatment
Key Points
Headache
Approach to the Patient With Headache
Pathophysiology
Etiology
Evaluation
History
Physical examination
Red flags
Interpretation of findings
Testing
Treatment
Geriatrics Essentials
Key Points
Cluster Headache
Symptoms and Signs
Diagnosis
Treatment
Key Points
short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT)
Diagnosis
Treatment
Idiopathic Intracranial Hypertension
Symptoms and Signs
Diagnosis
Treatment
Migraine
Epidemiology
Pathophysiology
Symptoms and Signs
Chronic migraines
Other symptoms
Diagnosis
Prognosis
Treatment
Mild to moderate attacks
Severe attacks
Chronic migraines
Prevention
Key Points
Post–Lumbar Puncture and Other Low–Pressure Headaches
Diagnosis
Treatment
Tension-Type Headache
Symptoms and Signs
Diagnosis
Treatment
Brain Infections
Introduction to Brain Infections
Brain Abscess
Etiology
Symptoms and Signs
Diagnosis
Treatment
Key Points
Encephalitis
Etiology
Primary viral infection
Immunologic reaction
Pathophysiology
Symptoms and Signs
Diagnosis
MRI
CSF testing
Brain biopsy
Prognosis
Treatment
Key Points
Rabies
Symptoms and Signs
Diagnosis
Treatment
Prevention
Preexposure
Postexposure
Key Points
Helminthic Brain Infections
Neurocysticercosis
Other infections
Progressive Multifocal Leukoencephalopathy (PML)
Etiology
Symptoms and Signs
Diagnosis
Treatment
Key Points
Subdural Empyema
Etiology
Complications
Symptoms and Signs
Diagnosis
Treatment
Prion Diseases
Overview of Prion Diseases
Creutzfeldt-Jakob Disease (CJD)
Symptoms and Signs
Diagnosis
Prognosis
Prevention
Variably Protease-Sensitive Prionopathy (VPSPr)
Gerstmann-Sträussler-Scheinker Disease
Fatal Insomnia
Kuru
Meningitis
Overview of Meningitis
Symptoms and Signs
Diagnosis
Treatment
Acute Bacterial Meningitis
Pathophysiology
Etiology
Age
Route
Immune status
Symptoms and Signs
Atypical presentations in adults
Diagnosis
Lumbar puncture
Prognosis
Treatment
Antibiotics
Corticosteroids
Other measures
Prevention
Physical measures
Vaccination
Chemoprophylaxis
Key Points
Viral Meningitis
Causes
Symptoms and Signs
Diagnosis
Treatment
Key Points
Noninfectious Meningitis
Recurrent Meningitis
Subacute and Chronic Meningitis
Tuberculous meningitis
Meningitis due to spirochetes
Cryptococcal meningitis
Fungal meningitis that develops after epidural methylprednisolone injection
Other fungal meningitides
Other causes of chronic meningitis
Chronic idiopathic meningitis
Chronic meningitis in patients with HIV infection
Diagnosis
Treatment
Key Points
Neuro-ophthalmologic and Cranial Nerve Disorders
Overview of Neuro-ophthalmologic and Cranial Nerve Disorders
Diagnosis
Treatment
Conjugate Gaze Palsies
Horizontal gaze palsies
Vertical gaze palsies
Downward gaze palsies
Internuclear Ophthalmoplegia
One-and-a-half syndrome
Third Cranial Nerve Disorders
Etiology
Symptoms and Signs
Diagnosis
Treatment
Fourth Cranial Nerve Palsy
Sixth Cranial Nerve Palsy
Etiology
Symptoms and Signs
Diagnosis
Treatment
Trigeminal Neuralgia
Etiology
Symptoms and Signs
Diagnosis
Treatment
Hemifacial Spasm
Facial Nerve Palsy
Etiology
Pathophysiology
Symptoms and Signs
Diagnosis
Prognosis
Treatment
Key Points
Glossopharyngeal Neuralgia
Symptoms and Signs
Diagnosis
Treatment
Craniocervical Junction Abnormalities
Craniocervical Junction Abnormalities
Etiology
Congenital
Acquired
Symptoms and Signs
Diagnosis
Neuroimaging
Treatment
Bone disease
Movement and Cerebellar Disorders
Overview of Movement and Cerebellar Disorders
Classification
Hyperkinetic disorders
Chorea, Athetosis, and Hemiballismus
Dystonias
Primary generalized dystonia (
DYT1
dystonia)
Dopa-responsive dystonia
Focal dystonias
Segmental dystonias
Diagnosis
Treatment
Key Points
Cervical Dystonia
Symptoms and Signs
Diagnosis
Treatment
Key Points
Fragile X–Associated Tremor/Ataxia Syndrome (FXTAS)
Symptoms and Signs
Diagnosis
Treatment
Huntington Disease
Symptoms and Signs
Diagnosis
Treatment
Key Points
Myoclonus
Symptoms and Signs
Diagnosis
Treatment
Key Points
Parkinson Disease
Pathophysiology
Etiology
Symptoms and Signs
Diagnosis
Treatment
Levodopa
Amantadine
Dopamine agonists
Selective MAO-B inhibitors
Anticholinergic drugs
Catechol
O
-methyltransferase (COMT) inhibitors
Surgery
Physical measures
Key Points
Secondary and Atypical Parkinsonism
Symptoms and Signs
Diagnosis
Treatment
Key Points
Progressive Supranuclear Palsy
Symptoms and Signs
Diagnosis
Treatment
Tremor
Pathophysiology
Classification
Etiology
Physiologic tremor
Pathologic (nonphysiologic) tremor
Evaluation
History
Physical examination
Red flags
Interpretation of findings
Testing
Treatment
Physiologic tremors
Essential tremors
Cerebellar tremors
Parkinsonian tremors
Disabling tremor
Geriatrics Essentials
Key Points
Cerebellar Disorders
Etiology
Congenital malformations
Hereditary ataxias
Acquired conditions
Diagnosis
Treatment
Demyelinating Disorders
Overview of Demyelinating Disorders
Multiple Sclerosis (MS)
Pathophysiology
Symptoms and Signs
Cranial nerves
Motor
Cerebellar
Sensory
Spinal cord
Diagnosis
Prognosis
Treatment
Disease-modifying drugs
Symptom control
Supportive care
Neuromyelitis Optica
Diagnosis
Treatment
Peripheral Nervous System and Motor Unit Disorders
Overview of Peripheral Nervous System Disorders
Anatomy
Physiology
Etiology
Pathophysiology
Damage
Recovery
Evaluation
Clinical evaluation
Testing
Treatment
Key Points
Disorders of Neuromuscular Transmission
Eaton-Lambert syndrome
Botulism
Drugs or toxic chemicals
Disorders With Neuromuscular Manifestations
Stiff-person syndrome
Isaacs' syndrome
Guillain-Barré Syndrome (GBS)
Symptoms and Signs
Diagnosis
Prognosis
Treatment
Key Points
Chronic Inflammatory Demyelinating Polyneuropathy
Diagnosis
Treatment
Hereditary Neuropathies
Motor and sensory neuropathies
Sensory and autonomic neuropathies
Diagnosis
Treatment
Hereditary Motor Neuropathy With Liability to Pressure Palsies (HNPP)
Diagnosis
Treatment
Amyotrophic Lateral Sclerosis and Other Motor Neuron Diseases
Symptoms and Signs
Amyotrophic lateral sclerosis (ALS)
Progressive bulbar palsy
Progressive muscular atrophy
Primary lateral sclerosis and progressive pseudobulbar palsy
Diagnosis
Treatment
Key Points
Myasthenia Gravis
Uncommon forms
Symptoms and Signs
Diagnosis
Treatment
Symptomatic treatment
Immunomodulating treatment
Key Points
Nerve Root Disorders
Symptoms and Signs
Diagnosis
Treatment
Key Points
Herniated Nucleus Pulposus
Symptoms and Signs
Diagnosis
Treatment
Key Points
Peripheral Neuropathy
Mononeuropathies
Symptoms and Signs
Diagnosis
Treatment
Key Points
Multiple Mononeuropathy
Polyneuropathy
Symptoms and Signs
Myelin dysfunction
Vasa nervorum compromise
Axonopathy
Diagnosis
Electrodiagnostic tests
Laboratory tests
Treatment
Key Points
Brachial Plexus and Lumbosacral Plexus Disorders
Symptoms and Signs
Diagnosis
Treatment
Key Points
Spinal Muscular Atrophies
Diagnosis
Treatment
Key Points
Thoracic Outlet Compression Syndromes
Symptoms and Signs
Diagnosis
Treatment
Key Points
Spinal Cord Disorders
Overview of Spinal Cord Disorders
Anatomy
Symptoms and Signs
Diagnosis
Acute Transverse Myelitis
Symptoms and Signs
Diagnosis
Prognosis
Treatment
Key Points
Spinal Cord Arteriovenous Malformations
Symptoms and Signs
Diagnosis
Treatment
Cervical Spondylosis and Spondylotic Cervical Myelopathy
Symptoms and Signs
Diagnosis
Treatment
Hereditary Spastic Paraparesis
Symptoms and Signs
Diagnosis
Treatment
Spinal Cord Infarction
Symptoms and Signs
Diagnosis
Treatment
Spinal Cord Compression
Symptoms and Signs
Diagnosis
Treatment
Key Points
Spinal Epidural Abscess
Symptoms and Signs
Diagnosis
Treatment
Spinal Subdural or Epidural Hematoma
Symptoms and Signs
Diagnosis
Treatment
Syrinx
Symptoms and Signs
Diagnosis
Treatment
Tropical Spastic Paraparesis/HTLV-1–Associated Myelopathy (TSP/HAM)
Symptoms and Signs
Diagnosis
Treatment
Intracranial and Spinal Tumors
Overview of Intracranial Tumors
Classification
Pathophysiology
Symptoms and Signs
Diagnosis
Treatment
End-of-life issues
Cranial Radiation Therapy and Neurotoxicity
Acute radiation neurotoxicity
Early-delayed neurotoxicity
Late-delayed neurotoxicity
Gliomas
Treatment
Anaplastic astrocytomas and glioblastomas
Low-grade astrocytomas
Oligodendrogliomas
Medulloblastomas
Ependymomas
Key Points
Meningiomas
Symptoms and Signs
Diagnosis
Treatment
Key Points
Pineal Region Tumors
Pituitary Tumors
Symptoms and Signs
Diagnosis
Treatment
Key Points
Primary Brain Lymphomas
Diagnosis
Treatment
Spinal Cord Tumors
Intramedullary tumors
Extramedullary tumors
Symptoms and Signs
Diagnosis
Treatment
Key Points
Audio
Figures
Photographs
Sidebars
Tables
Videos
Copyright
© 2010-2013 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Whitehouse Station, N.J., U.S.A.
Privacy
Terms of Use