Neurologic Disorders: Merck Manual Professional

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Neurologic Disorders

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 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 Stroke (CVA) Coma and Impaired Consciousness 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 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

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