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Index

Note: entries printed in italics represent information contained in figures, illustrations, andtables.

abdominal aortic aneurysm, 192abdominal pain, and eclampsia, 360abducens nerve

cranial nerve evaluation, 5neuro-ophthalmological emergencies,

201–2absence seizures, 97, 103accessory nerves, and cranial nerve

evaluation, 6accidents. See also driving; electrical

injuries; lightning; SCUBA diving;thermal injuries

acute cervical strain, 290hypothermia, 395–6sleep disorders, 273spinal cord injuries in children, 301

acetazolamide, and intracranial pressure,322

acetylcholinesterase (AChE), andcholinergic syndrome, 373

acid-base disorders, and seizures, 95acid fast bacilli (AFB), 119acidosis, and neurotoxicology, 372, 381–3acoustic nerves, and cranial nerve

evaluation, 5–6acoustic Schwannoma, 27, 86acquired disorders

heart disease in children, 331seizures, 94

activated charcoal, and suspectedpoisoning, 372, 373

activities of daily living, and seizures, 107acute back pain, 263acute bacterial sinusitis, 57

acute cervical strain, 290acute disseminated encephalomyelitis, 27acute dystonic reaction (ADR), 157acute gouty arthritis, 193acute necrotizing myopathy, 178acute neuromuscular respiratory failure, 66acute toxic neuropathies, 388acute transverse myelitis (ATM), 211, 213acyclovir, and viral encephalitis, 127adenosine triphosphate (ATP), and

mitochondrial myopathy, 172adenovirus, 122Adie’s tonic pupil and Adie’s syndrome,

208adjunctive therapy, and myasthenia gravis,

184adrenergic syndrome, 374, 377Adson maneuver, and thoracic outlet

syndrome, 190advanced senescent gait, 109age. See children; elderly; infantsaggressive behavior, and immediate

intervention, 239, 240agitation, and immediate intervention,

239, 240AIDS

fungal meningitis, 119neuropsychiatric symptoms, 239

airway support, and myasthenia gravis, 183akathisia, 157, 387alcohol. See also substance abuse

headache, 390poisoning, 382–3withdrawal and seizures, 101, 106–7, 379

409

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410 Index

altered mental status. See also cognitivedeficits; coma; consciousness;delirium; dementia; mental status

examinationancillary tests, 49central nervous system dysfunction, 43–4differential diagnosis, 46–7, 48evaluation, 44–6management, 49–50neurotoxicology, 371–8prognosis, 50–1traumatic brain injury, 281

alternating hemiplegia, 334alternobaric vertigo, 90Alzheimer’s Association, 225Alzheimer’s disease

dementia, 223–5neuropsychiatric symptoms, 239pharmacologic treatment, 224

American Academy of Neurology, 140–1American College of Obstetrics and

Gynecology, 360American Heart Association, 138American Spinal Cord Injury Association,

287, 288American Stroke Association, 140–1amnesia, and traumatic brain injury, 281amphotericin B, and fungal meningitis,

119ampicillin, and children, 327–8amyotrophic lateral sclerosis (ALS)

motor neuron diseases, 173myasthenia gravis, 182weakness, 62, 65

analgesics. See also aspirin; narcoticanalgesics; nonsteroidalanti-inflammatory drugs; prednisone;opiate

analgesicsdrug-induced seizures, 379headache, 390

anal wink, and spinal cord injuries, 289anatomy, and dizziness, 68–70anion gap metabolic acidosis, 381, 382–3anisocoria, 205–8anklosing spondylitis (AS), 188, 193anoxic brain injury, and EEG findings, 31anoxic encephalopathy, and coma, 48antalgic gait, 112anterior cord syndrome, 264, 292anterior horn cell disorders, 65anterior inferior cerebellar artery (AICA),

70, 86–7

anterior intraosseous syndrome, 190, 306,308

anterior ischemic optic neuropathy, 204–5antiarrythmic medications, and

anticholinergic effects, 375antibiotics

altered mental status, 49bacterial meningitis, 41, 115–16brain abscess, 117infections in children, 328infectious spondylitis, 266Lyme disease, 121sinusitis, 57

anticholinergic drugsdizziness, 88movement disorders, 158

anticholinergic syndrome, 374, 375–6anticoagulation, and stroke, 138–9, 140–1,

142, 336anticonvulsant drugs. See also antiepileptic

drugsaltered mental status, 49coagulopathy in fetus and maternal use

of, 362seizures in children, 339

antidepressants, and movement disorders,158. See also tricyclic antidepressants

antiemetic medications, and dizziness, 88,89

antiepileptic drugs (AEDs). See alsoanticonvulsant drugs; fosphenytoin;phenytoin

movement disorders, 157pregnancy, 362seizures, 103, 340, 346, 347–8, 362

antihistamines. See also diphenhydramineanticholinergic effects, 375dizziness, 88, 89movement disorders, 158

antihypertensive medicines, andpregnancy, 361–2

antinausea drugs, and anticholinergiceffects, 376

anti-Parkinsonian agents, andanticholinergic effects, 376

antiplatelet therapy, and stroke, 138antipsychotic drugs, and anticholinergic

effects, 375. See also neuroleptic drugs;psychopharmacologic medications

antispasmodics, and anticholinergiceffects, 375

antivenins, and toxic envenomations,397–8, 398–9, 401






Index 411

antiviral therapy, for viral encephalitis, 127Anton syndrome, 205anxiety, and dizziness, 89aphasia

dementia, 221mental status examination, 3stroke, 136

apnea, and brain death, 406. See alsoobstructive sleep apnea

apneustic breathing, 44, 45appearance, and mental status

examination, 2arbovirus encephalitis, 122, 124–5, 126Area Agency on Aging, 225arenavirus, 122arrhythmias

altered mental status, 44stroke, 137

arterial blood gases (ABGs)apnea and brain death, 406headache, 54

arterial dissectionheadache, 56neuroradiology, 14

arterial gas embolism (AGE), anddysbarism, 393–5

arterio-venous malformation (AVM), 368arthritis. See osteoarthritis; rheumatoid

arthritisaseptic meningitis, 118aspiration pneumonia, 228aspirin, and stroke, 142, 336asterixis, 156, 387asystole, and electrical injuries, 391, 392ataxic breathing, 44, 45ataxic gait, 111ataxic hemiparesis, 8athetosis, 148, 151atlantoaxial rotary subluxation, 301, 302atlanto-occipital dislocation, 293, 301atlas fractures, 293atonic seizures, 97atropine, and cholinergic syndrome, 373attention deficit hyperactivity disorder

(ADHD), 153auditory canal, and dizziness, 73auditory nerve, and peripheral vestibular

system, 69auditory tests, and acoustic nerve

evaluation, 5. See also hearing lossaura, and seizures, 95–6Australia, and toxic envenomations, 397,

398, 400

automatisms, and seizures, 96automobiles. See drivingaxial skeleton, lesions of, 191axis fractures, 293–4axonopathy, and toxic neuropathies, 388axonotmesis, 304, 306

Babinski response, 163backboard, and spinal cord injuries, 301back pain

infectious spondylitis, 266intraspinal hemorrhage, 270low back and, 192–5neuro-oncological emergencies, 232–4neuroradiography, 265prevalence of, 263spinal epidural abscess, 267spinal cord lesions, 65, 270

bacterial labytinthitis, 84bacterial meningitis. See also meningitis

diagnosis, 114–16lumbar puncture, 41myasthenia gravis, 181neuroradiology, 23presentation of, 113–14

Baker’s cysts, 310ballism, 151“bamboo spine,” 188Bannworth’s syndrome, 121barbiturates

coma and intracranial pressure, 242, 249neurotoxicology and seizures, 378

Becker muscular dystrophy, 172behavior

dementia and disturbances of, 224–5neuropsychiatric symptoms, 236, 238,

240nontraumatic spinal cord emergencies,

271seizures and prolonged bizarre, 98

Bell’s palsycranial nerve lesions, 5peripheral nerve disorders, 170in pregnancy, 365

benign positional vertigo (BPPV), 78, 81–3benign rolandic epilepsy (BRE), 343benzamides, and dizziness, 89benzodiazepines. See also diazepam;

lorazepamadrenergic syndrome, 374agitation and aggression, 240anticholinergic syndrome, 374dizziness, 88, 89






412 Index

benzodiazepines (cont.)eclampsia, 361seizures, 105, 338, 361, 378sleep disorders, 274

biballism, 153bicarbonate therapy, for salicylate toxicity,

382“bicycle sign,” 194bilateral facet dislocation, 296–7bilateral pinpoint pupils, 7binocular diplopia, and

neuro-ophthalmological emergencies,197, 198, 199–200, 201, 202. See alsodiplopia

biopsy studies, and hypotonia in infants,356

bizarre behavior, and seizures, 98blepharospasm, 150blunt trauma, 306blood pressure. See also hypertension

intracranial pressure and maintenance ofadequate, 248

stroke, 138traumatic brain injury, 284

Borrelia burgdorferi, 120–1botanicals. See plants and plant-derived

substancesbotulism

Guillain-Barre syndrome, 178hypotonia in infants, 355myasthenia gravis, 182neuromuscular transmission, 171neuro-ophthalmological emergencies,

203weakness, 65

bowel and bladder dysfunction, andnontraumatic spinal cord emergencies,264

box jellyfish, 400–1brachial plexus, and peripheral nervous

disorders, 167bradyarrhythmias, and altered mental

status, 44brain. See also brain abscesses; brain

death; brain tumors; traumatic braininjury

biopsy and HSV encephalitis, 126herniation and intracranial pressure,

242, 244–5neurological examination, 10

brain abscessesbacterial meningitis, 116–17headache, 55

brain deathcriteria for, 406–7definition of, 405diagnostic features, 50EEG findings, 31, 32evaluation, 405–6

brain imaging. See neuroradiologybrainstem

brain abscess, 117neurological examination, 10reflexes and brain death, 406stroke and myasthenia gravis, 181shunt dysfunctions, 314

Brain Trauma Foundation, 283brain tumors

alteration of mental status, 226–8back pain, 232–4cerebrovascular events, 229–31focal neurological deficits, 231–2headache, 55–6intracranial pressure, 246neuropsychiatric symptoms, 239neuroradiology, 27–8pregnancy, 369seizures and status epilepticus, 228–9

breath holding, in infants and children,100–1

Brief Mental Status Examination, 2bromocriptine, and neuroleptic malignant

syndrome, 383bronchospasm, and cholinergic syndrome,

373Brown-Sequard syndrome, 211, 264, 292bulbocavernous reflex, 289bunyavirus, 122burn patients, 392, 393bursitis, and pain, 192, 193burst fracture, 295, 298, 299butorphanol, and migraine, 60butyrophenones, and dizziness, 89

caffeine, and seizures, 107California encephalitis, 124Campylobacter enteritis, 175, 176cancer. See brain tumors; spinal cord

tumorsCandida albicans

brain abscess, 24fungal meningitis, 119

carbamazepine, and seizures in children,343, 346

carbon monoxide exposure, and headache,54






Index 413

cardiopulmonary bypass, andhypothermia, 395

cardiopulmonary resuscitation, andrecovery, 51

cardiorespiratory arrest, and electricalinjuries, 392

cardiovascular presyncope, and dizziness,79

carotid artery injuries, 290, 333carotid rupture, and brain tumors, 230carotid sinus massage, 77carpal tunnel syndrome

median nerve compression, 307, 308pregnancy, 364upper extremity pain, 190

cataplexy, 273, 275cauda equina syndrome

neuropathic pain, 194sensory deficits, 264spinal cord compression, 233spinal cord injuries, 293

causalgia, 190cavernous angioma, 16cefotaxime, and children, 328cell counts, and lumbar puncture, 39central cord syndrome, 264, 292central facial palsy, 170central midbrain syndrome, 133central nervous system. See also infections

altered mental status and dysfunction of,43

compensatory mechanisms anddizziness, 88

inflammatory disease andneuroradiology, 23–7

neuropsychiatric symptoms andbehavioral change, 236

central transtentorial herniation, 245central vestibular system, 70Centuroides exilicanda (bark scorpion), 398,

399cephalopods, 401cerebellar tremor, 155cerebellopontine angle (CPA) tumors, 86cerebellum, and brain abscess, 117cerebral artery occlusions, 335cerebral contusions, 280cerebral edema, 245–6cerebral embolism, 333cerebral hemispheric lesions, and

weakness, 64cerebral infarction

computed tomography (CT), 13

hemiparetic gait, 111intracranial trauma, 18

cerebral intravascular coagulation, 230cerebral localization, and abnormal

respiratory patterns, 44cerebral palsy, and spastic gait, 111cerebral venoocclusive disease, and

neuroradiology, 14–15cerebral venous thrombosis, 333, 367–8cerebrospinal fluid (CSF). See also shunt

systems; intracranial pressurefungal meningitis, 119Guillain-Barre syndrome, 177headache and abnormalities, 53, 56HSV encephalitis in infants, 326infections in children and contaminated,

329lumbar puncture, 39–40tuberculous meningitis, 118–19viral encephalitis, 126

cerebrovascular disease. See also strokein children, 330–6chorea, 152dizziness, 81headache, 53, 56intracranial pressure, 246leading causes of death and, 131neuro-oncological emergencies,

229–31neuropsychiatric symptoms, 239in pregnancy, 367–8seizures, 101

cervical osteoarthritis, 187cervical radiculopathy, 189–90cervical spine injuries, 293cervical spine joint disorder, 57cervical sprains, 19–20, 21cervical stenosis, 292cervical traction, and spinal cord injuries,

287Cesarean section, and traumatic

neuropathies, 365Charcot-Marie-Tooth syndrome, 352cheiralgia paresthetica, 190, 309chemical restraints, and dementia, 218chemoprophylaxis, and bacterial

meningitis, 116chemotherapeutic agents, and

encephalopathy, 228Cheyne-Stokes respiration, 44, 45chiasmal disease, and

neuro-ophthalmological emergencies,204, 205






414 Index

children. See also infantsbrain tumors, 227breath holding and seizures in, 100–1cerebrovascular disorders, 330–6cholinergic syndrome, 373dextrose and glucose levels, 371hydrocephalus and shunts in, 313–23infections of central nervous system,

325–9intracranial pressure values for, 242scorpion envenomation, 398seizures, 337–48spinal cord injuries, 300–2traumatic brain injury, 284

“chin-chest” maneuver, and herniatednucleus pulposus, 190

Chironex fleckeri (box jellyfish), 400–1chlordiazepoxide, and alcohol withdrawal

seizures, 106chlorpromazine, and migraine, 59, 60cholinergic syndrome, 373–4cholinesterase inhibitors, and Alzheimer’s

disease, 224Chondrichthyes, 399chorea

diagnosis and management of, 151–3drug-induced, 158, 386phenomenology of, 148neurotoxicology, 386

chorea gravidarum (CG), 363choriocarcinomas, 369chromosomal analysis, and hypotonia in

infants, 356chronic inflammatory demyelinating

polyneuropathy (CIDP), 168, 178chronic obstructive pulmonary disease

(COPD), 66, 79chronic pain, 263chronic progressive multiple sclerosis

(CPMS), 210, 213chronic toxic neuropathy, 388cigarette smoking, and cluster headache,

57cingulate herniation, 244–5“clay shoveler’s fracture,” 297Clostridium botulinum, 182, 355Clostridium tetani, 355cluster headache, 57–8CMV encephalitis, 118coagulation disorders, and brain tumors,

230coagulopathies

in children, 332

as contraindication for lumbar puncture,36

maternal use of anticonvulsants andfetal, 362

cobra, 396Coccidioides immitis, 119“Cock-robin” appearance of head, and

spinal cord injuries in children, 301Coelenterates (jellyfish), 400cognitive deficits. See also altered mental

status; memory; mental statusexamination

dementia, 219–21, 223sports-injury related concussion, 282

cold caloric tests, 76coma. See also altered mental status;

consciousnessabnormal respiratory patterns, 44, 371bariturate-induced and intracranial

pressure, 242, 249description of, 43differential diagnosis, 46–7, 48eclampsia, 360neurotoxicology, 378, 381–3prognosis, 51

common peroneal nerve, and compressionneuropathy, 311

Commonwealth Serum Laboratories(Australia), 400/’;

compartment syndrome, 306compensatory mechanisms, and dizziness,

88competency, as medical-legal issue, 225complete blood count (CBC), and

headache, 54complete spinal cord injury, 287complex febrile seizures, 343complex partial seizures

dizziness, 81features of, 96management of, 103

compression fracture, of spinal cord, 295compression neuropathies, 306–11compressive optic neuropathies, 205computerized tomography (CT). See also

neuroradiologyback pain, 265dementia, 221–2intracranial pressure, 243–4magnetic resonance imaging compared

to, 12–13seizures, 102shunt dysfunctions, 319–21






Index 415

stroke, 137, 335traumatic brain injury, 281, 282–3

concussion and concussive syndromesclinical features in sports-related, 282definition of, 280–1

congenital cerebrovascular anomalies, 332congenital heart disease, 331, 334congenital muscular dystrophies, 352–3congenital myasthenia gravis, 180congenital myotonic dystrophy, 355connective tissue disorders, and seizures, 95consciousness. See also altered mental

status; comacomponents of, 43dizziness, 72mental status examination, 3seizures, 98traumatic brain injury, 281

consultation. See also referralsdementia and neurologic, 221–2multiple sclerosis and psychiatric, 217

conus medullaris syndromeneuropathic pain, 194sensory deficits, 264spinal cord injuries, 292–3

convulsive seizures, generalized, 96convulsive status epilepticus, 104–5coordination, and motor function, 8coral snake, 396, 398corneal reflex test, 5, 76cortical infarction, 333corticosteroids. See also steroids

intracranial pressure, 242, 249multiple sclerosis, 215vestibular neuronitis, 84

coughing, and vagus nerves, 6coxalgic gait, 112cranial nerves. See also cranial neuropathies

dizziness, 74–6, 80hypotonia in infants, 351Lyme disease, 121neurological examination, 3–7seizures, 99stroke, 136

cranial neuralgias, 53cranial neuropathies, and

neuro-ophthalmological emergencies,200

cranial weakness, 64craniocervical junction, and

neuroradiology, 20craniospinal trauma, and neuroradiology,

17–19

creatine phosphokinase (CPK)inflammatory myopathy, 171muscular dystrophy in infants, 355

Creutzfeldt-Jakob disease (CJD), 222Cryptococcus neoformans, 119cubital tunnel syndrome, 308Cushing’s phenomenon, 248Cushing’s syndrome, 44Cushing’s triad, 214cutaneous reflexes, 9cyproheptadine, and serotonin syndrome,

384cytomegalovirus (CMV)

Guillain-Barre syndrome, 176HIV-related, 117, 118

cytotoxic edema, 245–6

dantrolene, and neuroleptic malignantsyndrome, 383

deafness, and acoustic nerve evaluation,5–6. See also hearing loss

death. See also brain death; mortalitycause of, 405–6cerebrovascular disease as cause of, 131time of, 406–7traumatic brain injury, 279

decerebrate and decorticate posturing, andaltered mental status, 46

decompression sickness, and diving-relatedinjuries, 393, 394–5

decontamination, and suspectedpoisoning, 372

deep peroneal nerve, 310deep tendon reflexes (DTRs)

altered mental status, 46dizziness, 77hypotonia in infants, 352neurological examination, 8, 9neuromuscular disorders, 163nontraumatic spinal cord emergencies,

264definitive therapy, for spinal cord tumors,

234degenerative disease of the spine, 21, 23degenerative disorders, and seizures, 95Dejerine-Sottas syndrome, 352delirium

altered mental status, 46–7, 48central nervous system dysfunction,

43dementia, 219, 220drug-induced, 372

delirium tremens (Dts), 101






416 Index

dementiadefinition of, 219differential diagnosis, 218–21, 222evaluation, 218laboratory tests, 223management of and disposition of

patients, 221–5normal pressure hydrocephalus, 260–1prevalence in elderly, 218

demyelinating disease, and dizziness, 81dental referral, and facial pain, 186depression

cognitive decline in elderly, 221inpatient evaluation and treatment, 239

de Quervain disease, 189dermatomyositis (DM), 171developmental disorders, and dizziness, 81Devic’s disease, 211dexamethasone

infections in children, 328intracranial pressure, 249migraine, 59, 60spinal cord tumors and back pain, 234

dextrose, and glucose levels, 371diabetes

cerebral edema, 246polyneuropathy, 10

diagnosis. See also differential diagnosis;evaluation; laboratory tests;neurological examination; physical

examinationbacterial meningitis, 114–16brain death, 50, 407Guillain-Barre syndrome, 178headache, 54–5hypotonia in infants, 355–6idiopathic intracranial hypertension

(IIH), 255myasthenia gravis, 182–3neurological history, 1neuropsychiatry, 238–40nontraumatic spinal cord emergencies,

271stroke in children, 335weakness, 63

diazepam. See also benzodiazepinesalcohol withdrawal seizures, 106migraine, 59seizures in children, 339, 340

differential diagnosis. See also diagnosisaltered mental status, 46–7, 48, 226–8back pain, 232–3brain tumors, 226–8, 229–30, 231–2

chorea, 151, 152dementia, 218–21, 222dizziness, 78–87eclampsia, 360epilepsy in children, 337–8Guillain-Barre syndrome, 177, 178headache, 53, 55–60hypotonia in infants, 352–5idiopathic intracranial hypertension

(IIH), 255–6intracranial pressure, 245–6multiple sclerosis, 212–14neuro-ophthalmological emergencies,

199–203nontraumatic spinal cord emergencies,

265–71normal pressure hydrocephalus, 261peripheral nerve disorders, 163–73seizures, 99–102, 229, 337–8, 348shunt systems, 314–21stroke in children, 334viral encephalitis, 123, 125–6weakness, 64–6

diffuse axonal injury (DAI), 280diffuse toxic myopathies, 389dihydroergotamine (DHE-45), and

migraine, 58, 59, 60diphenhydramine, and migraine, 59, 60.

See also antihistaminesdiphenoxylate, and opioid syndrome, 377diplopia. See also binocular diplopia;

monocular diplopia; vertical diplopiaidiopathic intracranial hypertension

(IIH), 252, 253–4oculomotor nerve evaluation, 4

disaster triage protocols, for electrical andlightning injuries, 392

disc herniation, 23, 290. See also vertebraldiscitis

disconjugate eye positions, and alteredmental status, 46

dislocations, and peripheral nerve injuries,305. See also hyperextensiondislocation injuries; thoracic

fracture-dislocation injuriesdisposition, of patients. See also

hospitalizationbrain abscess, 116–17dementia, 221–5eclampsia and preeclampsia, 362hypotonia in infants, 356idiopathic intracranial hypertension

(IIH), 258






Index 417

infections in children and, 327–8multiple sclerosis, 215, 217myasthenia gravis, 184neuropsychiatric symptoms, 237,

238–40seizures, 107stroke, 142

dissociative states, and seizures, 102distal muscle weakness, 64, 352distal shunt malfunction, 321diuretics

intracranial pressure, 248–9pregnancy and pseudotumor cerebri, 368

diverticulitis, 192diving. See SCUBA divingdizziness. See also vertigo

anatomy, 68–70definition of, 68differential diagnosis, 78–87laboratory tests, 87management of, 87–90medical history, 70–3

doll’s eyes, 7, 76dopamine, and parkinsonism, 149dorsal cord syndrome, 264dorsal midbrain syndrome, 133Down’s syndrome, 352, 356driving, of automobiles

dementia, 225seizures, 107–8

drop attacks, 97. See also foot dropsdroperidol, and migraine, 59, 60drug-induced parkinsonism, 157–8Duchenne’s muscular dystrophy (DMD),

172, 356ductions, and neuro-ophthalmological

examination, 198–9DUMBELS (defecation, urination, miosis,

bronchorrhea, emesis, lacrimation,salivation), 373

durable power of attorney, 225dysarthria, 6dysbarism, 393–5dyskinesia

dopamine replacement, 149drugs associated with, 386

dysmetria, an dizziness, 74dystonia, 148, 149–51

early gait apraxia, 109Eastern equine encephalitis (EEE), 122,

124, 126eclampsia, 359–62, 367, 368, 369

edrophonium, and myasthenia gravis,182–3, 184

elapids (snakes), 396elderly

elder abuse, 225medical complications of cognitive

deficits, 223prevalence of dementia, 218

electrical injuries, 306, 391–3electrocardiograms (ECGs)

altered mental status, 49headache, 55tricyclic antidepressants and QRS

interval, 381electroencephalograms (EEGs)

altered mental status, 49appearance of normal, 30headache, 55seizures, 31, 92, 343types of abnormalities, 30–2

electrolyte balancealtered mental status, 44, 48seizures, 95weakness, 66

electronystagmography (ENG), andMeniere’s disease, 85

electrophysiology studies, and hypotoniain infants, 356

emergency medical technicians (EMS), andseizures, 97

emergent imaging, indications for, 13encephalitis. See also viral encephalitis

coma and delirium, 48EEG findings, 31

encephalomyelitis, 211, 214encephalopathy, and chemotherapeutic

agents, 228. See also metabolicencephalopathy; toxic encephalopathy

endocrine disorders, and seizures, 95endolymph

dizziness, 69Meniere’s disease, 85

endotracheal intubation. See alsorapid-sequence intubation

cholinergic syndrome, 373seizures, 104–5

enteroviral encephalitis, 124–5enteroviruses, and infections in children,

327entrapment syndromes, 190, 195envenomation. See toxic envenomationenvironmental causes, of coma and

delirium, 48






418 Index

environmental toxins. See also marinetoxins; organophosphate poisoning;toxic envenomations

accidental hypothermia, 395–6drug-induced seizures, 380dysbarism, 393–5electrical, lightning, and thermal

injuries, 391–3headache, 391

enzyme-linked immunosorbent assay(ELISA), and snake identification kit,297

epicondylitis, 189epidemiology. See pathophysiology;

prevalence; prognosisepidural abscess, 191epidural hematoma (EDH)

craniospinal trauma, 17, 20traumatic brain injury, 280, 281

epidural spinal cord compression (ESCC),232–4

epilepsia partialis continua, 93epilepsy. See also seizures; status epilepticus

in children, 334, 337, 341–8electroencephalograms, 30–1neuropsychiatric symptoms, 239prevalence of, 92types of, 92, 93

epileptic myoclonus, 156Epstein-Barr virus

Guillain-Barre syndrome, 176upper extremity pain, 188

erythema chronicum migrans (ECM), 120erythrocyte sedimentation rate (ESR)

headache, 54infectious spondylitis, 266inflammatory myopathy, 171spinal epidural abscess, 267

Eschericia coli, and infectious spondylitis,266

essential myoclonus, 156essential tremor (ET), 154estropia (ET), 198–9ethanol, and alcohol poisoning, 383ethyl alcohol, and sedative hypnotic

syndrome, 374ethylene glycol, and neurotoxicology, 382,

383evaluation. See also diagnosis

altered mental status, 44back pain, 232–3brain death, 405–6brain tumors, 226–8, 229, 229–30, 231–2

chorea, 151dementia, 218eclampsia, 360epilepsy in children, 338–41, 343–7gait disturbances, 109–12Guillain-Barre syndrome, 177, 178headache, 52–4hemiballism, 153idiopathic intracranial hypertension

(IIH), 252movement disorders, 146–7multiple sclerosis, 211myasthenia gravis, 181neuromuscular disorders, 162neuro-ophthalmological emergencies,

197–9neuropsychiatry, 236–8normal pressure hydrocephalus (NPH),

260–1peripheral nerve injuries, 304–6seizures, 97–9, 229, 338–41, 342, 343–7shunt systems, 314–21spinal cord injuries, 286–9stroke, 135–7, 334–5traumatic brain injury, 281–2viral encephalitis, 125–6

excessive daytime sleepiness (EDS), 273,275

exclusion criteria, for thrombolytictherapy, 141, 143

expressive aphasia, 136extracranial structures, diseases of and

headache, 53extramedullary spinal cord tumors, 233extraocular eye movements (EOM), 4extropia (XT), 198eye. See also neuro-ophthalmological

emergencies; visual acuity; visual field;visual loss

external examination of, 199intracranial pressure, 243

facet disorders, 295–7facial expression test, 5facial mononeuropathy, 169, 170facial muscles, and weakness in infants, 352facial nerves, and cranial nerve evaluation,

5facial pain, 186–7facial weakness, and dizziness, 72falling, and dizziness, 72family history. See also genetic disorders

dizziness, 72






Index 419

hypotonia in infants, 350seizures in children, 341, 343

family members, and medical history, 1,219, 237, 372. See also family history;parent counseling

fasciculations, toxicologic causes of, 397fatigue syndromes, and multiple sclerosis,

213febrile seizures, 341–3femoral mononeuropathy, 169femoral nerve, and compression

neuropathies, 310femoral neuropathy, and pregnancy, 365fetal monitoring, and seizures in

pregnancy, 362fetal position, for lumbar puncture, 37, 38fever

altered mental status, 44–5brain abscess, 116intracranial pressure, 249myasthenia gravis, 183seizures in children, 341–3

firearm wounds. See gun shot woundsFisher’s syndrome, 177fistula test, and dizziness, 78flavivirus, 122floppy infant, causes of, 355flucytosine, and fungal meningitis, 119fluid resuscitation, and intracranial

pressure, 248fluid therapy, and pregnancy-induced

hypertension, 362flumazenil

altered mental status, 49, 371respiratory depression, 378sedative hypnotic syndrome, 376

fluorescent treponemal antibody (FTA) test,85, 120

focal brain lesions, and EEG findings, 31focal dystonia, 150focal neurological deficits

altered mental status, 45–6brain tumors and neuro-oncological

emergencies, 231–2focal toxic neuropathies, 389focused examination, of peripheral nervous

system, 162–3folic acid, and alcohol poisoning, 383foods, and headache, 390. See also marine

toxins; nutritionfoot, and sensory nerves, 310foot drops

gait disturbances, 111–12

pregnancy and traumatic neuropathies,365

forced vital capacity (FVC), 162Formosan krait (Bungarus multicinictus), 396fosphenytoin, and seizures, 105–6, 338,

339, 340. See also antiepileptic drugsfourth cranial nerve palsy, 201fractures, and peripheral nerve injuries,

305. See also axis fractures; sacralfractures; skull fractures; spinalfractures; zone I, II, and III fractures

Frenzel glasses, 74friends, and patient history, 237, 372frogleg position, and hypotonia, 351frontal lobe, and brain abscess, 117frontotemporal dementias, 239Fukuda stepping test, 78fundus, and eye examination, 199funduscopic examination, and spinal

sarcoidosis, 268fungal meningitis. See also meningitis

diagnosis and treatment of, 119lumbar puncture, 41

furosemide, and intracranial pressure,248–9, 321–2

gag reflex test, 6, 76gait disturbances

evaluation and management of, 109–12motor function, 8normal pressure hydrocephalus, 260, 261stroke, 136weakness, 62

gamma-aminobutyric acid (GABA), andneurotoxicological seizures, 378, 381

gastropods, 401gaze-evoked nystagmus, 74–5generalized convulsive SE, in children, 338generalized seizures, 96–7genetic disorders. See also family history

chorea, 151–3dizziness, 81seizures, 94

giant cell arteritis, and headache, 56–7Glasgow Coma Scale, 3, 50, 243, 279glioblastoma multiforme, 27glossopharyngeal nerve, and cranial nerve

evaluation, 6glucose. See also hyperglycemia;

hypoglycemiaaltered mental status and levels of, 371lumbar puncture, 39–40

gout, and lower extremity pain, 192, 193






420 Index

grand mal seizures, 96Grisel’s syndrome, 301guardianship, and patients with dementia,

225Guillain-Barre syndrome

clinical features of typical, 176description of, 175emergency presentation of, 175–6evaluation, 177, 178hypotonia in infants, 355, 356idiopathic intracranial hypertension

(IIH), 253management, 177myasthenia gravis, 181–2variants of, 177weakness, 65, 176

gummatous neurosyphilis, 120gun shot wounds

peripheral nerve injuries, 304vascular injuries and spinal cord, 290

Guyon’s canal syndrome, 309

hair cells, and vestibular sensory organs,69

Hallpike maneuver, 75, 81, 82hallucinations

dementia, 221sleep paralysis and hypnagogic, 275

haloperidol. See also neuroleptic drugsagitation and aggression, 240dementia, 218

“hangman’s fracture,” 294Hapalochlena lunulata (octopus), 401Hashimoto’s disease, and Guillain-Barre

syndrome, 176headaches

after lumbar puncture, 37brain abscess, 116differential diagnosis, 53, 55–60dizziness, 72evaluation, 52–4idiopathic intracranial hypertension

(IIH), 257management, 55–60neurotoxicology, 387, 390–1pregnancy, 362–3, 369

“head-tilt” maneuver, and herniatednucleus pulposus, 190

head trauma. See also traumatic brain injurydefinition of head injury, 279headache, 53seizures, 95

head shaking, and dizziness, 78

hearing loss, and dizziness, 72, 76, 85. Seealso auditory tests; deafness

heavy metalsdrug-induced seizures, 380headache, 391

Heliobacter jejuni, and Guillain-Barresyndrome, 176

HELPP syndrome, 360hematologic disorders, in children, 332hemiballism, 148, 153hemifacial spasm, 101hemiparetic gait, 111hemodialysis

cerebral edema, 246ethanol poisoning, 383

hemoglobinopathy, 192, 193Hemophilus influenzae

bacterial meningitis, 113, 115, 116Guillain-Barre syndrome, 176vaccine for children and, 325

Hemophilus meningitis, 116hemorrhagic infarctions, 330hepatitis

Guillain-Barre syndrome, 176upper extremity pain, 188

herbal medicines. See plants andplant-derived substances

herniated nucleus pulposus (HNP), 189–90herniation, and intracranial pressure

values, 242. See also disc herniationheroin, and neurotoxicology, 384, 387herpes simplex virus (HSV) encephalitis

diagnosis and management of, 123–4,126

frontal and temporal lobes, 122infants, 325–6neuroradiology, 23–4

herpes varicella zoster (HVZ) virusencephalitis, 122, 124, 127

herpetic neuralgia, 187hip girdle weakness, 112HIV (human immunodeficiency virus)

central nervous system infections,117–18

encephalitis, 24Guillain-Barre syndrome, 176neuropsychiatric symptoms, 239weakness, 64

HIV encephalitis, 117HIV leukoencephalopathy, 117“hold-up” maneuver, and thoracic outlet

syndrome, 190Hollenhorst plaque, 4






Index 421

Horner’s syndromeneurological examination, 7sympathetic nervous system, 206–7vascular disease, 87

hospitalization. See also dispositiondementia and behavioral disturbances,

225eclampsia and preeclampsia, 362hypotonia in infants, 356idiopathic intracranial hypertension

(IIH), 258multiple sclerosis, 215myasthenia gravis, 184neuropsychiatric symptoms, 238, 240seizures, 107snake envenomation, 398

household toxins, and drug-inducedseizures, 380

Huntington’s disease (HD), 151–3, 239hydralazine, and hypertension, 361hydrocephalus. See also intracranical

pressure; normal pressurehydrocephalus; shunt systems

headache, 56mental status, 227

hydrostatic edema, 246hydroxyzine, and migraine, 60hyperacusis, 5hyperemesis gravidarum, 362, 369hyperextension, and cervical sprains,

19–20hyperextension dislocation injuries, 297–8hyperglycemia, and dizziness, 79hyperkinetic movement disorders, 149–53hypersomnia, 276hypertension. See also blood pressure;

idiopathic intracranial hypertensionaltered mental status, 44pregnancy-induced, 359, 361–2stroke, 138

hypertensive encephalopathy, 48hyperthermia, and neurotoxicology, 383hypertropia, 199hyperventilation

altered mental status, 44, 45dizziness, 77, 79intracranial pressure, 242, 248seizures, 101

hypnagogic hallucinations, 275hypoglassal nerves, and cranial nerve

evaluation, 6–7hypoglycemia

in children, 334

dizziness, 79hypothermia, 395

hypokalemia, and myasthenia gravis, 182hypothermia

accidental, 395–6altered mental status, 45

hypotonia, in infantsdefinition of, 350differential diagnosis, 352–5evaluation, 350–2management and disposition of patients,

356hypovolemic shock, in children, 284hypoxic coma, 45, 246hypoxic encephalopathy, and coma, 48hypoxic-ischemic encephalopathy, in

infants, 352hysterical gait, 112hysterical paralysis, 271

iatrogenic disorders, in children, 333ice pack test, and myasthenia gravis, 183idopathic brachial plexopathy, 168idiopathic epilepsies

causes of seizures, 94EEG findings, 31

idiopathic intracranial hypertension (IIH)clinical features, 255common symptoms of, 253conditions associated with, 253differential diagnosis, 255–6disposition of patients, 258evaluation, 252management, 257–8

idiopathic torsion dystonia (ITD), 149, 157“imminent death,” 407immunosuppressive agents

multiple sclerosis, 215myasthenia gravis, 184

incidence. See prevalenceinclusion body myositis (IBM), 171inclusion criteria, for thrombolytic therapy,

141, 143increased intracranial pressure. See

intracranial pressureinfants. See also children; pregnancy

breath holding and seizures in, 100–1hypotonia, 350–6infections of central nervous system,

325–7lumbar puncture, 38neonatal myasthenia gravis, 180, 367seizures, 338, 340, 341






422 Index

infants (cont.)traumatic brain injury, 284

infections, of central nervous system. Seealso encephalitis; meningitis

alterations in mental status, 227brain abscess, 116–17in children, 325–9chorea, 152dizziness, 79, 81HIV-related, 117–18intracranial pressure, 246labyrinthitis, 84lumbar puncture, 36Lyme disease, 120–1neurosyphilis, 120nociceptive pain, 188radioculpathy, 167seizures, 94–5shunt systems, 323spinal cord, 265–7

infectious spondylitis, 265–6inflammatory bowel disease, 188inflammatory disorders

headache, 56–7neuroradiology, 23–7nontraumatic spinal cord emergencies,

267–9radioculopathy, 167seizures, 95

inflammatory myopathy, 171influenza, in children, 325insomnia, 273, 276–7inspection, of shunt system, 315, 318intermittent explosive disorders, 101–2initial stabilization, of dizziness, 87–8inner ear disorders, and dizziness, 80insect envenomation. See toxic

envenomationintellectual ability, and dementia, 219intensive care unit (ICU), and myasthenia

gravis, 184intention tremor, 153intermediate syndrome (IMS), and

organophosphorus compounds, 374International Classification of Epileptic

Seizures, 92, 93International Stroke Trial (IST), 138internuclear ophthalmoplegia (INO), 7,

202–3, 211interstitial edema, 246intoxication

coma and delirium, 48staggering gait, 111

intraaxial posterior fossa masses, 27intracerebral hemorrhage (ICH)

in infants, 352neuroradiology, 16–17pregnancy, 367, 368stroke and, 134, 135

intracranial hypotension, and headache, 56intracranial infection

in children, 334headache, 53

intracranial neoplasms, 334. See alsointracranial tumor

intracranial pressure (ICP). See alsohydrocephalus; shunt systems

brain herniation, 242, 244–5differential diagnosis, 245–6evaluation, 243–4idiopathic intracranial hypertension

(IIH), 255lumbar puncture, 35–6management, 247–50, 336mental status, 227pathological processes, 242prehospital care, 243shunt systems, 313–14stroke in children, 336traumatic brain injury, 283, 284values, 242–3

intracranial trauma, and coma or delirium,48. See also traumatic brain injury

intracranial tuberculoma, 118intracranial tumor, and headache, 53,

55–6. See also intracranial neoplasmsintramedullary spinal cord tumors, 233intraocular pressure, and headache, 55intraparenchymal hemorrhage, 280, 330,

333intraspinal hemorrhage, 270intratumoral parenchymal hemorrhage,

230intraventricular catheter placement, and

intracranial pressure, 250iron deficiency anemia, and idiopathic

intracranial hypertension (IIH), 253ischemic infarctions, in children, 333ischemic stroke, 131isoniazid

drug-induced seizures, 381tuberculous meningitis, 119

Jacksonian seizure, 93Jarisch-Herxheimer reaction, 121Jefferson fractures, 293, 294






Index 423

jellyfish, 400–1Joplin’s neuroma, 195jugular vein injuries, 290“jumped facet” syndrome, 295–6, 301

ketorolac, and migraine, 59, 60kinetic tremor, 385Kleine-Levin syndrome, 276krait, 396

labetalol, and hypertension, 361laboratory tests

accidental hypothermia, 395–6altered mental status, 49, 372brain tumors, 228, 230dementia, 223dizziness, 87multiple sclerosis, 214–15neurotoxicology, 372nontraumatic spinal cord emergencies,

264–5normal pressure hydrocephalus, 261seizures, 102stroke, 136–7, 335

labyrinthitis, 84–5lactate dehydrogenase (LDH), and

inflammatory myopathy, 171lacunar infarcts, 132Lambert-Eaton myasthenic syndrome

(LEMS), 170–1lamotrigine, and seizures in children,

347Lance-Adams syndrome, 156Lasegue sign, 194late gait apraxia, 109lateral decubitus position, for lumbar

puncture, 37–8lateral femoral cutaneous neuropathy,

and pregnancy, 365lateral inferior pontine syndrome, 133lateral medullary syndrome, 87, 133lateral superior pontine syndrome, 133legal system. See medical-legal issuesleptomeningeal tumor, 232, 234leukemia, and brain tumors, 230Lhermitt’s sign, 211lidocaine, and migraine, 59lid retraction, and eye examination, 199lightning injuries, 391–2light touch, and sensory examination,

9–10limb ataxia, 8Listeria monocytogenes, 115

lithiumcluster headache, 58drug-induced seizures, 381

local pain, 263location, of weakness, 62, 64“locked-in state,” 43locked-in syndrome, 133lorazepam. See also benzodiazepines

agitated or aggressive behavior, 240seizures in children, 338, 339, 340

Lou Gehrig’s disease. See amyotrophiclateral sclerosis (ALS)

low back and lower extremity pain, 192–5lumbar disc disease, 27lumbar HNP, 194–5lumbar pain, 193lumbar puncture (LP)

altered mental status, 49contraindications for, 36dementia, 221, 222headache, 54idiopathic intracranial hypertension

(IIH), 255indications for, 35–6infections in infants and children, 326,

329meningitis, 35, 36, 41normal pressure hydrocephalus, 261procedure, 37–9results of, 39–40risks and complications of, 36–7seizures, 102shunt infection, 323stroke, 137traumatic tap versus SAH, 40

lumbar spine fracture, 298–9lumbar strain or sprain, 192lumbosacral plexus, 168Lyme disease

diagnosis and management of, 120–1multiple sclerosis, 214

lymphocytic choriomeningitis (LCM) virusencephalitis, 125

lymphoma, 24

maculotoxin, 401magnesium sulfate

eclampsic seizures, 360–1migraine, 59, 60myasthenia gravis in pregnancy, 367

magnetic resonance angiography (MRA)applications of, 13seizures, 102






424 Index

magnetic resonance angiography (cont.)stroke in children, 335subarchanoid hemorrhage, 16

magnetic resonance imaging (MRI). See alsoneuroradiology

computerized tomography compared to,12–13

idiopathic intracranial hypertension(IIH), 255, 257

nontraumatic spinal cord emergencies,265

spinal cord injuries, 302–3malignant invasion, and radioculopathy,

167malingering, and nontraumatic spinal cord

emergencies, 271management. See also medications; surgery

altered mental status, 49–50back pain, 233–4brain abscess, 116–17brain tumors, 228, 229, 230–1, 232cerebrovascular events in pregnancy, 368dementia, 221–5dizziness, 87–90dystonias, 151eclampsia, 360–2epilepsy in children, 338–41, 343, 346,

347gait disturbances, 109–12Guillain-Barre syndrome, 177headache, 55–8hemiballism, 153hypotonia in infants, 356idiopathic intracranial hypertension

(IIH), 257–8infections in children, 327–8intracranial pressure, 247–50migraine, 58–60multiple sclerosis, 211, 215, 216myasthenia gravis, 183–4myoclonus, 156neuropsychiatry, 236–8nontraumatic spinal cord emergencies,

265–71normal pressure hydrocephalus, 261parkinsonism, 149peripheral nerve disorders, 163–73peripheral nerve injuries, 304–6seizures, 97, 102–3, 229, 338–41, 343,

346, 347shunt systems, 321–3sleep disorders, 274spinal cord injuries, 300

spinal cord tumors, 233–4stroke, 137–42, 336traumatic brain injury, 283viral encephalitis, 126–7

manic episodes, 239mannitol, and intracranial pressure, 242,

284manometer, and lumbar puncture, 38–9manual evaluation, of shunt system, 318Marcus-Gunn pupil, 198, 211marine toxins

envenomations, 399–401ingestion of and seizures, 380, 391, 401

masseter muscles, palpation of, 5mass lesions, and dizziness, 81measles, and encephalitis, 125medial longitudinal fasciculus (MLF), 202medial medullary syndrome, 133median inferior pontine syndrome, 133median longitudinal fasciculus (MLE), 70median mononeuropathy, 169median nerve, and compression

neuropathies, 306–7, 308medical complications, of cognitive deficits

in elderly, 223medical history. See also family history;

family members; friendsaltered mental status, 372dementia, 218dizziness, 70–3headache, 52–3movement disorders, 146neuro-ophthalmological emergencies,

197neuropsychiatry, 236, 237seizures, 97–8stroke in children, 334–5weakness, 64

medical-legal issuesdementia, 225seizures, 107–8

medical records, and seizures, 108medications. See also analgesics; antibiotics;

anticholinergic drugs; anticonvulsantdrugs; antiepileptic drugs;antihistamines; barbiturates;benzodiazepines; corticosteroids;diuretics; management; monoamineoxidase inhibitors;psychopharmacologic medications;toxicity

Alzheimer’s disease, 224anisocoria, 208






Index 425

aseptic meningitis, 118chorea, 152delirium, 372dizziness, 72, 79, 80, 88–90idiopathic intracranial hypertension

(IIH), 253, 257movement disorders, 156–8, 364myasthenia gravis and pregnancy, 366patient history, 237pupillary responses, 46status epilepticus, 105–6tremor, 155weakness, 64

memory, and dementia, 219. See alsocognitive deficits

Meniere’s disease, 85–6meningeal syphilis, 120meningiomas, 4, 369meningitis. See also aseptic meningitis;

bacterial meningitis; fungalmeningitis; tuberculosis meningitis;viral meningitis

cerebral edema, 246coma and delirium, 48headache, 55idiopathic intracranial hypertension

(IIH), 257lumbar puncture, 35, 36, 41myasthenia gravis, 181prevalence of in children, 325

meningoencephalitis, 118meningovascular syphilis, 120mental status examination. See also

altered mental status; cognitivedeficits

brain tumors, 226–8dementia, 219dizziness, 74elements of, 2–3hypotonia in infants, 351neuro-oncological emergencies, 226–8neuropsychiatry, 238stroke, 135

meperidinemigraine, 60opioid syndrome, 377

meralgia paresthetica, 365metabolic acidosis, and neurotoxicology,

381–3metabolic disorders

in children, 332chorea, 152dizziness, 81

radioculopathy, 167seizures, 94, 101

metabolic encephalopathyalterations of mental status, 227coma and delirium, 48differential diagnosis, 228EEG findings, 31intracranial pressure, 246

metabolic myopathy, 172metastatic spinal cord tumors, 233, 270,

271methanol, and neurotoxicology, 382,

383methylprednisolone, and spinal cord

injuries, 300metoclopramide, and migraine, 59, 60midazolam, and seizures in children, 338,

339, 340middle ear disorders, and dizziness, 80migraine

in children, 334diagnosis and management, 58–60multiple sclerosis, 213pregnancy, 363prevalence, 52seizures, 101

Miller-Fisher syndrome (MFS), 203Mini-Mental Status Examination (MMSE),

219, 223mitochondrial myopathy, 172mixed nerves, and peripheral nervous

system disorders, 161, 164, 167mollusks. See marine toxinsmonitoring, of intracranial pressure,

249–50. See also fetal monitoringmonoamine oxidase (MAO) inhibitors

movement disorders, 158serotonin syndrome, 384

monoaminergic medications, anddizziness, 88, 89

monocular confrontational testing, 198monocular diplopia, 197, 199. See also

diplopiamononeuritis multiplex, 168mononeuropathy, 168–70, 387mononucleosis, and Guillain-Barre

syndrome, 176mood, and mental status examination, 3mortality, and intracranial pressure values,

242. See also deathMorton’s neuroma, 195motility, and neuro-ophthalmological

examination, 198–9






426 Index

motion sickness agents, andanticholinergic effects, 376

motor functionaltered mental status, 46dizziness, 76–7neurological examination, 7–8nontraumatic spinal cord emergencies,

264peripheral nerve injuries, 305seizures, 99spinal cord injuries, 287, 289stroke, 136

motor neuron disorders, 161, 173movement disorders

common drugs and, 156–8evaluation, 146–7hemiballism, 153hyperkinetic movement disorders,

149–53neurotoxicology, 384, 386parkinsonism, 147–9pregnancy, 363–4seizures, 101tics, 153tremors, 153–5

multifocal myoclonus, 387multi-infarct dementia (MID), 223, 224multiple sclerosis (MS)

description of, 210differential diagnosis, 212–14disposition of patients, 215, 217evaluation, 211laboratory tests, 214–15magnetic resonance imaging (MRI), 25,

26management, 211, 215, 216neurological examination, 211neuropsychiatric symptoms, 239nontraumatic spinal cord emergencies,

267–8pathophysiology, 210–11

mumps, and encephalitis, 125muscles. See also motor function

hypotonia in infants, 351–2neurological examination, 7–8peripheral nervous system disorders, 161

muscle stretch reflexes, and seizures, 99muscular dystrophy. See also Duchenne’s

muscular dystrophy; myotonicmuscular dystrophy

characterization of, 172hypotonia in infants and congenital,

352–3

myasthenia gravisdiagnostic testing, 182–3differential diagnosis, 181–2diplopia, 203disposition of patients, 184evaluation, 181Guillain-Barre syndrome, 178in infants, 352, 353–4management, 183–4neuromuscular transmission, 170in pregnancy, 365–7prevalence of, 180weakness, 62, 65

Mycobacterium tuberculosis, 327mycoplasma, and Guillain-Barre syndrome,

176Mycoplasma pneumoniae, 327myelin disorders, and seizures, 94myelinopathy, and toxic neuropathies,

388myelography, and nontraumatic spinal

cord emergencies, 265myelopathy, and multiple sclerosis, 213myoclonic seizures, 97myoclonus, and movement disorders, 148,

155–6myopathy

neurotoxicology, 387, 389systemic conditions, 172–3weakness, 65–6

myotonic muscular dystrophycongenital form of, 355definition, 172myasthenia gravis, 182

myxedema coma, 182

naloxonedepressed respiratory effort, 49, 371, 378opioid syndrome, 377

narcolepsy, 273, 274, 275narcotic analgesics, and migraine, 60National Acute Spinal Cord Injury

Randomized Controlled Trial(NASCIS), 300

nausea, headaches in pregnancy, 363“near death,” 407near-light dissociation (NLD), 198, 208neck trauma, and headache, 53neck and upper extremity pain, 187–90necrotizing myopathy, 171negative inspiratory force (NIF), 162negative myoclonus, 156Neisseria meningitidis, 113, 115






Index 427

neologisms, 136neonatal myasthenia gravis, 180, 367neonatal seizures, causes of, 340neonatal status epilepticus, 338nerve conduction studies (NCS), and motor

neuron disease, 173nerve root disorders

peripheral nervous system, 161, 163–4spinal cord injuries, 291weakness, 65, 163

nerve sheath tumors, 310nervous system injuries, and spinal cord,

291–3neuroimaging. See neuroradiologyneuroleptic malignant syndrome

dopamine replacement therapy, 149movement disorders, 157neurotoxicology, 383

neuroleptic drugs. See also haloperidol;neuroleptic malignant syndrome

dementia and behavioral disturbances,224

migraine, 60movement disorders, 157

neurological decompression sickness, 393,394

neurological disorders. See also traumabrain tumors, 226–34central nervous system infections,

113–27cerebrovascular disease, 131–43dementia, 218–25dizziness, 79Guillain-Barre syndrome, 175–9idiopathic intracranial hypertension

(IIH), 252–8increased intracranial pressure, 242–50movement disorders, 146–59multiple sclerosis, 210–17musculoskeletal and neurogenic pain,

186–95myasthenia gravis, 180–4neuromuscular disorders, 161–74neuro-ophthalmological emergencies,

197–209normal pressure hydrocephalus (NPH),

260–1seizures, 100sleep disorders, 273–7

neurological emergencies, of pregnancy,359–69

neurological examinationaltered mental status, 47

anatomical basis of, 10–11dizziness, 73–7elements of, 2–10medical history, 1–2movement disorders, 147multiple sclerosis, 211neuropsychiatry, 237–8seizures, 98–9“short form,” 305traumatic brain injury, 281–2

neurological level, of spinal cord injury,287

neurological presentations, commonforms of

altered mental status, 43–51dizziness, 68–90gait disturbances, 109–12headache, 52–60seizures, 92–108weakness, 62–6

neurological trauma. See traumaneuromuscular disorders

evaluation, 162, 166peripheral nervous system, 161

neuromuscular junction disorders, andweakness, 65

neuromuscular transmission, disorders of,170–1

neuromyelitis optica, 211neuronal dysfunction, and altered mental

status, 44neuro-oncological (N-ONC) emergencies

alteration of mental status, 226–8back pain, 232–4cerebrovascular events, 229–31definition of, 226focal neurological deficits, 231–2seizures and status epilepticus, 228–9

neuro-ophthalmological emergenciesanisocoria, 205–8differential diagnosis, 199–203evaluation, 197–9shunt dysfunction, 314visual loss, 203–5

neuropathic paindefinition, 186facial pain, 187low back and lower extremity pain,

193–5neck and upper extremity pain,

189–90thoracic and truncal pain, 191

neuropraxia, 304, 306






428 Index

neuropsychiatry. See also psychiatricdisorders; psychopharmacologicmedications

diagnosis and disposition of patients,238–40

evaluation and management, 236–8scope of discipline, 236

neuroradiology. See also computerizedtomography (CT); magnetic resonanceimaging (MRI)

altered mental status, 49arterial dissection, 14brain tumors, 27–8, 232cerebral venoocclusive disease, 14–15craniospinal trauma, 17–19degenerative disease of the spine, 21, 23dizziness, 87headache, 54inflammatory disease, 23–7intracerebral hemorrhage, 16–17nontraumatic spinal cord emergencies,

265, 266pediatric cervical spine, 301shunt systems, 319–21spinal trauma, 19–20subarachnoid hemmorhage (SAH), 15–16vascular disease, 13–14viral encephalitis, 126

neurosyphilis, 120neurotoxicology. See also toxicity; toxins

altered mental status, 371–8, 383coma and metabolic acidosis, 381–3coma and respiratory depression, 378headaches, 387, 390–1importance of, 371movement disorders, 384neuroleptic malignant disorder, 383peripheral neuropathies, 384, 387seizures, 378–81serotonin syndrome, 384

nifedipine, and hypertension, 361nimodipine, and subarachnoid

hemorrhage, 55nociceptive pain

facial pain, 186–7lower back and lower extremity pain,

192–3neck and upper extremity pain, 187–9thoracic and truncal pain, 191

nocturnal myoclonus, 274nonbacterial septic arthritis, 188nonbacterial thrombotic endocarditis

(NBTE), 229–30

nonconvulsive seizures, generalized, 96–7nonconvulsive status epilepticus

in children, 338EEG findings, 32, 33

nonepileptic paroxysmal events, 99–102nonfebrile seizures, in children, 343–7nonpharmacologic treatment, of migraine,

60nonsteroidal anti-inflammatory drugs

(NSAIDs), and pregnancy, 363. See alsoanalgesics

nontraumatic spinal cord emergencies. Seealso back pain; spinal cord

differential diagnosis and management,265–71

laboratory tests, 264–5presentation of, 263–4special challenges in diagnosis, 271

nonvestibular system dysfunctions, anddizziness, 71, 79

normal pressure hydrocephalus (NPH). Seealso hydrocephalus

differential diagnosis, 261evaluation, 260–1laboratory tests, 261management, 261

normothermia, and brain death, 405nutrition, and differential diagnosis of

coma and delirium, 48. See also foodsNylen-Barany maneuver, 75nystagmus, and dizziness, 74–5, 76, 81

obsessive-compulsive disorder, 153obstructive sleep apnea (OSA), 273–4obturator nerve, and pregnancy, 365occipital nerve blockade, and migraine, 59,

60occupational toxins

drug-induced seizures, 380headache, 391

octopus, and marine toxins, 401ocular motor nuclei, 70ocular motor system, and idiopathic

intracranial hypertension (IIH), 252ocular myopathies, 182ocular reflexes, and altered mental status,

46, 47oculocephalic response, in coma, 46oculomotor nerve palsy, 335oculomotor nerves

cranial nerve evaluation, 4neuro-ophthalmological emergencies,

200–1






Index 429

oculopharyngeal muscular dystrophy, 182odontalgia, 186odontoid fractures, 293–4Ohm’s law, and electricity, 391olfactory nerve, and cranial nerve

evaluation, 3–4opening pressure, and lumbar puncture, 40ophthalmic agents, and anticholinergic

effects, 376ophthalmological disorders, and dizziness,

79opiate analgesics, and traumatic brain

injury, 284opioid syndrome, 377–8optic nerve fenestration (ONSF), and

idiopathic intracranial hypertension(IIH), 257–8

optic nerves, and cranial nerve evaluation,4

optic neuritis, 205, 212optic neuropathy, and idiopathic

intracranial hypertension (IIH), 258oral contraceptives, and movement

disorders, 158organophosphate poisoning, 373–4. See

also pesticidesorgan system dysfunction, and coma or

delirium, 48oromandibular dystonia, 150orthostatic tremor, 154osmotic agents, and shunt systems, 321Osteichthyes, 399osteoarthritis

gait disturbances, 112low back and lower extremity pain, 192nociceptive pain, 187, 189

osteogenesis imperfecta, 352osteomyelitis, and infectious spondylitis,

266otitis media, 327otoscopy and otoscope

dizziness, 73traumatic brain injury, 281

ototoxins, and dizziness, 80outcome. See prognosis

pain. See also back paincluster headache, 57musculoskeletal and neurogenic, 186–95perception of and sensory examination, 9sensory testing and peripheral nervous

system, 162–3palatal elevation, 76

papilledemaidiopathic intracranial hypertension

(IIH), 253–4increased intracranial pressure, 243neuro-ophthalmological emergencies,

199optic nerve evaluation, 4

paralysis. See also periodic paralysisnontraumatic spinal cord emergencies,

264spinal cord injuries, 289

paramyxovirus, 122parasomnias, 276parasympathetic system, and visual loss,

207–8parent counseling, and seizures in children,

341–3parietal lobe, and brain abscess, 117parkinsonism

drug-induced, 384, 157–8movement disorders, 147–9

Parkinson’s diseaseextrapyramidal symptoms, 224gait disturbances, 110neuropsychiatric symptoms, 239pain symptoms, 149

Parkland Hospital (Dallas, Texas), 360–1paroxysmal dyskinesias, 101Parsonage-Turner syndrome, 168partial seizures, 93, 95–6particle repositioning maneuver, 82, 83pathological reflexes, and neurological

examination, 10pathophysiological treatment, of vertigo,

90pathophysiology

of multiple sclerosis, 210–11of traumatic brain injury, 279–81

patient history. See medical historypediatric medicine. See children; infantspelecypods, 401penetrating wounds, and peripheral nerve

injuries, 304penicillin, resistance to, 328pentobarbital, and seizures in children, 339peptic ulcer disease, 192perception

mental status examination, 3of temperature or pain and sensory

examination, 9perched facet syndrome, 297perilymph fistulas, and dizziness, 78, 86Perinaud’s syndrome, 133






430 Index

periodic lateralized epileptiform discharges(PLEDs), 31

periodic limb movement disorder, 274–5periodic paralysis, 172, 178peripheral nerve injuries

compression neuropathies, 306–11evaluation and management, 304–6

peripheral nervous system disorders. Seealso peripheral neuropathies

characterization of, 161differential diagnosis and management,

163–73focused examination, 162–3pregnancy, 364–5

peripheral neuropathies, andneurotoxicology, 384, 387, 388

peripheral vestibular system, and dizziness,68–70

peroneal mononeuropathy, 169pesticides. See also organophosphate

poisoningdrug-induced seizures, 380headache, 391

phakomatoses, and seizures, 94, 98phased array surface coil technology, 28phenobarbital, and seizures, 106, 338, 339,

340, 341, 346phenothiazines, and dizziness, 88, 89phenytoin, and seizures, 105, 106–7, 338,

339, 340, 343, 346, 347, 361, 380. Seealso antiepileptic drugs

phonation test, and vagus nerves, 6physical examination

dementia, 219dizziness, 73headache, 53–4hypotonia in infants, 350–2infections in children, 327neuropsychiatry, 237–8seizures, 98stroke in children, 335

physical restraint, and dementia, 218physical therapy, and dizziness, 90physiological anisocoria, 208physiological myoclonus, 156physiological tremor, 154physostigmine, and anticholinergic

syndrome, 374picornovirus, 122pinhole testing, of visual acuity, 198pinprick sensation, and sensory

examination, 9pituitary adenomas, 369

pituitary apoplexy, 205plants and plant-derived substances

anticholinergic effects, 375drug-induced seizures, 379–80headache, 391

plasmapheresis, and myasthenia gravis,184

plexopathy, 164, 167pneumatic otoscopy, and dizziness, 73, 78poisoning. See neurotoxicology; toxicity;

toxinspoliomyelitis, 65polymyositis (PM), 171polyneuropathy, 168postchiasmal disease, 204, 205posterior cord syndrome, 293posterior fossa masses, 27posterior interosseous syndrome, 190, 309posterior tibial nerve, and compression

neuropathies, 309posthypoxic myoclonus, 156postictal paralysis, 96postpartum foot drop, 365postural tremor, 157, 385povidine-iodine solution, and lumbar

puncture, 38Power’s Ratio, and atlanto-occipital

dislocation, 293Prader-Willi syndrome, 352, 356pralidoxime, and cholinergic syndrome,

373prechiasmal visual loss, 204–5prednisone

cluster headache, 58giant cell arteritis, 57headaches in pregnancy, 363

preeclampsia, 359, 362pregnancy. See also eclampsia; infants

idiopathic intracranial hypertension(IIH), 253

neurological emergencies, 359–69seizures, 95

prehospital care, for seizures, 97premature infants, and hypotonia, 350prescription drugs. See medicationsprevalence

back pain, 263dementia in elderly, 218headache, 52meningitis in children, 325myasthenia gravis, 180seizures and epilepsy in children, 337traumatic brain injury, 279






Index 431

preventive treatment, for headaches inpregnancy, 363

primary brain injury, 279primary brain tumors, 227primary headache syndromes, 57–60primary spinal cord tumors, 233, 270, 271primary tic disorders, 154prochlorperazine, and migraine, 59, 60prodomal symptoms, of seizures, 95–6prognosis

altered mental status, 50–1seizures in children, 343

progressive myoclonic epilepsies, 94progressive supranuclear palsy, 239promethazine, and migraine, 59, 60pronator drift test, 8pronator syndrome, and median nerve,

306, 308pronator teres syndrome, 190propofol, and seizures, 106propoxyphene, and opioid syndrome, 377propranolol, and pregnancy, 363proptosis, 199prostatitis, 192protein, in cerebrospinal fluid (CSF), 40proteinuria, 359provocative tests, and dizziness, 77–8proximal muscle weakness, 62, 352proximal shunt malfunction, 321proximal tibial nerve, 310Pseudomonas auruginosa

infectious spondylitis, 266meningitis, 115

pseudotumor cerebri (PTC), 252, 368–9pseudostatus epilepticus, 31pseudotumor cerebri, and headache, 56psoriatic arthritis, 188psychiatric disorders. See also anxiety;

attention deficit hyperactivitydisorder; depression; neuropsychiatry;obsessive-compulsive disorder;psychosis; schizophrenia

coma and delirium, 48Huntington’s disease, 152–3multiple sclerosis, 211, 217seizures, 100, 101–2

psychic symptoms, of seizures, 95psychogenic pain, 192, 193psychogenic seizures, 101psychogenic tremor, 155psychogenic unresponsiveness, and EEG

findings, 31psychomimetic drugs, and seizures, 101

psychopharmacologic medications. See alsoantipsychotic drugs; lithium;neuroleptic drugs; tricyclicantidepressants

agitation and aggression, 240dizziness, 72, 79, 89–90drug-induced seizures, 379headache, 390

psychosisdementia and delirium, 220, 221inpatient evaluation and treatment, 239

psychosocial factors, in neuropsychiatry,240

ptosiscoma, 46eye lids, 199

pulmonary infection, and myastheniagravis, 183

pupillary asymmetry, 45–6pupillary light reflex

altered mental status, 45–6cranial nerve evaluation, 4, 7

pupils, and neuro-ophthalmologicalemergencies, 197, 198, 207–8

purified protein derivative (PPD) test, 266pursuit movements, and dizziness, 74pyridoxine

alcohol poisoning, 383drug-induced seizures, 381peripheral neuropathies, 388

rabies, 122, 125radial mononeuropathy, 169radial nerve, and compression

neuropathies, 309radial nerve palsy, 190radial sensory nerve entrapment, 309radial tunnel syndrome, 309radiation therapy

encephalopathy, 228spinal cord tumors, 234

radicular pain, 263radiculoneuritis, and Lyme disease, 121radiculopathy, 163–4, 167radionuclide clearance shuntogram, 320rapidly progressive dementia, 222rapid-positioning nystagmus, 75rapid-sequence intubation (RSI). See also

endotracheal intubationintracranial pressure, 247traumatic brain injury, 283

rattlesnake envenomation, 397receptive aphasia, 136






432 Index

recompression chamber, and diving-relatedinjuries, 394

recurrence, of seizures in children, 343,347

recurrent hypersomnia, 276red blood cells (RBCs), and lumbar

puncture, 39referrals, and dementia, 222. See also

consultationreflexes, and peripheral nervous system,

163. See also deep tendon reflexes;pupillary light reflex

reflux sympathetic dystrophy (RSD), 190rehabilitation, dizziness and vestibular, 90.

See also physical therapyReiter’s syndrome, 188relapsing-remitting disease (RRMS), 210,

213, 215REM sleep behavior disorder (RBD), 274,

276Renal failure, and idiopathic intracranial

hypertension (IIH), 253reovirus, 122Reptilia, and sea snakes, 399resisted head turning test, and accessory

nerves, 6respiratory failure and respiratory

abnormalitiesaltered mental status, 44, 45, 371myasthenia gravis, 181neurotoxicology, 378weakness, 66

respiratory fatigue, and spinal cord injuries,287

restless legs syndrome (RLS), 277, 363–4retinal granulomas, 268retrovirus, 122“reverse Lasegue” sign, 194Reye’s syndrome, and cerebral edema, 246rhabdomyolysis, 162rhabdovirus, 122rheumatoid arthritis (RA)

nontraumatic spinal cord emergencies,268–9

upper extremity pain, 188rigidity, and neurotoxicology, 383. See also

neuroleptic malignant syndromeriluzole, and ALS, 173Rinne test, 6, 76Romberg sign, 111roving eye movements, and altered mental

status, 46rubella, 188ruptured neoplastic aneurysm, 230

saccidic eye movements, and dizziness, 74saccule, 69sacral fractures, 299–300sacral sparing, and spinal cord injuries,

289sacroiliitis, 193St. Louis encephalitis, 124, 126salicylate toxicity, 382saline solution, fluid resuscitation and

intracranial pressure, 248Salmonella, and infectious spondylitis, 266saphenous nerve, 310sarcoid granulomas, 268sarcoidosis, and Guillain-Barre syndrome,

176Saturday night palsy, 190schizophrenia, onset of in late life, 221sciatic mononeuropathy, 169scorpion envenomation, 398–9scorpionfish, 399–400SCUBA diving

dybarism and injuries related to, 393–5vertigo, 90

sea snakes, 399, 400“seat belt” injury, 290secondary brain injury, 279–80secondary brain tumors, 227secondary dystonias, 151secondary headache syndromes, 55–7secondary tic disorders, 154sedative-hypnotic agents, 377sedative hypnotic syndrome, 374, 376seizures. See also epilepsy

alcohol withdrawal, 106–7alterations of mental status, 227brain tumors, 228–9coma and delirium, 48differential diagnosis, 99–102disposition of patients after, 107eclampsia, 360–2EEG findings, 31, 92epileptic myoclonus, 156evaluation and management of in

children, 337–48events mimicking in children, 348infections in children, 328intracranial pressure, 249laboratory tests, 102management, 102–3medicolegal issues, 107–8neurotoxicology, 378–81in pregnancy, 362traumatic brain injury, 284types of, 92, 93






Index 433

selective serotonin reuptake inhibitors(SSRIs), and serotonin syndrome, 384

senescent gait, 109sensory disorders, and seizures, 101sensory function

dizziness, 77neurological examination, 7, 9–10nontraumatic spinal cord emergencies,

264peripheral nervous system, 162–3, 165,

305seizures, 99stroke, 136

sensory organs, and peripheral vestibularsystem, 68–9

septic arthritides, 192serum studies, and headache, 54shellfish. See marine toxins“short form” neurological examination,

305shoulder-hand syndrome, 190shunt systems. See also hydrocephalus;

intracranial pressurecomponents and malfunctions of,

313–14evaluation and differential diagnosis,

314–21management, 321–3

shunt tap, 320SIADH (syndrome of inappropriate

secretion of antidiuretic hormone), 246silastic lumboperitoneal shunt, and

idiopathic intracranial hypertension(IIH), 257

simple partial seizuresmanagement of, 103types of seizures, 93, 95, 96

sinusitis, and headache, 57sixth nerve palsies, 201–2skeletal muscle relaxants, and

anticholinergic effects, 376skull fractures

neuroradiology, 20traumatic brain injury, 280, 281

Sjogren’s disease, 215sleep aids, and anticholinergic effects, 376sleep deprivation, and seizures in

pregnancy, 362sleep disorders

parasomnias, 276predisposition to trauma, 273–5types of, 273, 276–7

sleep paralysis, 275sleep-related panic attacks, 273

sleep terrors and sleepwalking, 274,276

slit ventricle syndrome, 322SLUDGE (salivation, lacrimation,

urination, defecation, gastricemptying), 373

slow-wave abnormalities, and EEGs, 32snake envenomations, 396–8, 399Snellen chart, and visual acuity, 211social history, and neurotoxicology, 372sodium bicarbonate

alcohol poisoning, 383sedative hypnotic syndrome, 376

sodium nitroprusside, and hypertension,361

soft tissue injuries, and spinal cord injury,289–93

space-occupying lesions, and lumbarpuncture, 35, 36

spastic gait, 111spectrophotometry, and stroke, 137speech, and glossopharyngeal nerve, 6. See

also aphasiaspinal cord. See also back pain;

nontraumatic spinal cord emergencies;spinal cord compression; spinal cordlesions

infections, 265–7neurological examination, 10–11tumors, 27–8weakness and disorders of, 64–5

spinal cord compression. See also spinalcord; spinal cord injuries; spinal cordlesions; spinal shock

magnetic resonance imaging (MRI), 13,22

neuro-oncological emergencies and backpain, 232–4

sensory deficits, 264weakness, 65

spinal cord infarction, 191, 269–70spinal cord injuries. See also spinal cord;

spinal cord compression; spinal shock;spinal trauma

children, 300–2dislocations and vertebral bony injuries,

293–9evaluation, 286–9incidence of, 286magnetic resonance imaging (MRI),

302–3management, 300soft tissue injuries, 289–93spinal shock, 289






434 Index

spinal cord injury without radiographicabnormality (SCIWORA), 302–3

spinal cord lesions. See also spinal cord;spinal cord compression

Guillain-Barre syndrome, 178neuroimaging, 232neuropathic pain, 189nontraumatic spinal cord emergencies,

270–1primary and metastatic types of, 233

spinal cord syndromes, and nervous systeminjuries, 291–3

spinal epidural abscess, 267spinal fractures, 293“spinal” headache, 56spinal muscular atrophy, 352spinal needle, and lumbar puncture, 39spinal sarcoidosis, 268spinal shock, 271, 289spinal stenosis, 23, 194spinal trauma, and neuroradiology, 19–20spinal tuberculous arachnoiditis, 118spine, degenerative disease of, 21, 23spondylolisthesis, 23spontaneous blinking, and altered mental

status, 46spontaneous nystagmus, 74, 75sports, and clinical findings in concussion,

282stab wounds, and peripheral nerve injuries,

304staggering gait, 111Staphylococcus aureus

infectious spondylitis, 266meningitis, 115, 116

Staphylococcus epidermidis, and shuntinfections, 323

status epilepticus. See also epilepsy;nonconvulsive status epilepticus

brain tumors, 228–9in children, 337–41EEG findings, 31, 32, 33intracranial pressure, 246management of, 103–6

steppage gait, 111–12steroids, and idiopathic intracranial

hypertension (IIH), 257. See alsocorticosteroids

stimulants, and movement disorders, 158stingrays, 399“stocking-glove” pattern, and

polyneuropathy, 10, 77stonefish, 399–400

strength testing, and weakness, 162Streptococcus pneumonia

infectious spondylitis, 266meningitis, 113, 115, 116penicillin-resistant strains, 328

stroke. See also cerebrovascular diseasecerebral edema, 246childhood, 330, 333, 334–5coma and delirium, 48disposition of patients, 142evaluation, 135–7management, 137–42multiple sclerosis, 213, 214pathophysiology of, 131–4pregnancy, 367seizures, 101

stroke prevention and sickle cell disease(STOP) trial, 330

structural anisocoria, 208structural choreas, 152structural disease, and alterations of

mental status in cancer patients, 227Sturge-Weber syndromes, 98subacute meningitis, 181subacute pain, 263subacute toxic neuropathy, 388subarachnoid hemorrhage (SAH)

brain tumors, 230in children, 330headache, 55intracranial pressure, 243lumbar puncture, 35, 40, 41neuroradiology, 15–16, 137in pregnancy, 367–8stroke, 134, 135

subcortical infarction, 333subdural hematoma (SDH)

computerized tomography, 20craniospinal trauma, 17–18traumatic brain injury, 280

subhyaloid hemorrhage, 243substance abuse. See also alcohol

drug-induced seizures, 379headache, 53, 390

suction catheter passes, and intracranialpressure, 249

Sudek’s atrophy, 190sumatriptan

cluster headache, 57–8migraine, 58–9, 60

superficial peroneal nerve, andcompression neuropathy, 311

superior sagittal sinus occlusion, 230






Index 435

supportive treatmentcarpal tunnel syndrome, 364infections in children, 328myasthenia gravis, 183

supranuclear facial palsy, 170surgery. See also management

brain abscess, 116infectious spondylitis, 266spinal cord infarction, 269–70vertigo, 90

swallowing, and glossopharyngeal nerve, 6swinging flashlight test, 198Sydenham’s chorea, 151symmetric eye deviation, and altered

mental status, 46sympathetic system, and visual loss, 206–7symptomatic epilepsies

causes of seizures, 94EEG findings, 31

symptomatic myoclonus, 156syncope

EEG findings, 31seizures, 100–1

syphilis. See neurosyphilis; syphiliticlabyrinthitis

syphilitic labyrinthitis, 84–5systemic disorders

dizziness, 79, 80headache, 53, 54myopathy, 172–3seizures, 100–1

systemic lupus erythematosus (SLE), 176,253

systemic vascular disease, in children, 331

tacrine, and Alzheimer’s disease, 224tardive disorders, and neuroleptics, 157tardive dyskinesia (TD), 158, 386tarsal tunnel syndrome, 309taste test, 5teardrop fracture, 295, 296Technetium shuntogram, 317tegmental syndrome, 133temperature, perception of and sensory

examination, 9. See also hyperthermia;hypothermia; thermoregulation

temperomandibular joint disorder, 57temporal lobe, and brain abscess, 117temporo-mandibular joint dysfunction,

186tendinitis, and pain, 192, 193“tennis elbow,” 189tenosynovitis, and pain, 192, 193

Tensilon test, and myasthenia gravis, 184,203

tension-type headache, 57theophylline, and drug-induced seizures,

380–1thermal injuries, 392, 393thermoregulation, and brain death, 407thiamine

alcohol poisoning, 383altered mental status, 371

thiopental, and seizures in children, 339third nerve palsy, 200, 201, 207–8thoracic burst fracture, 298thoracic compression fracture, 298thoracic fracture-dislocation injuries, 298thoracic outlet syndrome, 190, 308thoracic pain, 191thoracic spine injuries, 298–9thoracolumbar junction fracture, 298–9thought disorders, and mental status

examination, 2thrombocytopenia, 230, 360thrombolytics, and stroke, 139, 141thymectomy, 184thymus, and myasthenia gravis, 180, 184thyroid eye disease, 199thyrotoxicosis, 172tics

evaluation and management of, 153phenomenology of, 148

time course, and symptoms of dizziness, 71Tinel’s sign, 308tinnitus, and dizziness, 72, 85tissue Plasminogen Activator (tPA), and

stroke, 139, 141togavirus, 122tone, of muscles, 7, 8tongue protrusion, and hypoglossal nerves,

6–7tonic seizures, generalized, 96, 97torticollis, 150–1Tourette’s syndrome, 153toxic encephalopathy

alterations in mental status, 227coma and delirium, 48management, 228

toxic envenomationheadache, 391myopathies, 389scorpions, 398–9seizures, 380snake bite, 396–8weakness, 64






436 Index

toxicity, of medications. See alsoneurotoxicology; toxins

antiepileptic drugs and children, 347–8magnesium sulfate and eclampsic

seizures, 361toxic labyrinthitis, 84toxicology screening, and altered mental

status, 49, 372toxins. See also neurotoxicology; toxic

envenomation; toxicitychorea, 152hypotonia in infants, 355seizures, 95, 101tremor, 155weakness, 64

toxoplasma encephalitis, 117toxoplasmosis

HIV-related infections, 117–18neuroradiology, 24, 26

traction injuries, and peripheral nerveinjuries, 306

transarterial angiography, andsubarachnoid hemorrhage, 16

transcatheter angiography, 14transcranical Doppler examination, and

intracranial pressure, 250transient global amnesia, 101, 220transient ischemic attacks (TIAs)

antiplatelet therapy, 138definition of, 131magnetic resonance angiography (MRA),

13–14transmission neuropathy, and toxic

neuropathy, 388transverse myelitis, 65, 267, 384trauma. See also craniospinal trauma; head

trauma; traumatic brain injuryin children, 332–3coma and delirium, 48dizziness, 80, 81peripheral nerve injuries, 304–11radioculopathy, 167sleep disorders and predisposition to,

273–5spinal cord injuries, 286–303

traumatic brain injury (TBI). See also brain;head trauma

in children, 284evaluation, 281–2incidence of, 279intracranial pressure, 246, 249management, 283neuropsychiatric symptoms, 239

neuroradiology, 18, 281, 282–3pathophysiology, 279–81seizures, 94

traumatic neuropathies, and pregnancy,365

traumatic spondylolisthesis, 294traumatic tap, and lumbar puncture, 40trauma-triggered migraine, 334treatment. See adjunctive therapy;

management; medications;nonpharmacologic treatment;pathophysiological treatment;preventive treatment; supportivetreatment; surgery

treatment-related cerebrovasculardisorders, and brain tumors, 230

treatment-related encephalopathy, andalterations in mental status, 227

tremorsevaluation and management of, 153–5phenomenology of, 148

tricyclic antidepressants. See alsoantidepressants

anticholinergic effects, 376dizziness, 89drug-induced seizures, 381movement disorders, 158

trigeminal nerve, and cranial nerveevaluation, 4–5

trigeminal neuralgia, 187triple flexion reflex, and nontraumatic

spinal cord emergencies, 271trochlear nerve, and


truncal ataxia, 8truncal pain, 191tuberculosis, of spine, 266–7tuberculosis meningitis (TBM)

diagnosis and treatment of, 118–19lumbar puncture, 41

tuberous sclerosis, 98Tullio phenomenon, 73tympanic membrane

displacement of and intracranialpressure, 250

dizziness, 73type II decompression sickness, 393

ulnar mononeuropathy, 169ulnar nerve, and compression

neuropathies, 308–9ulnar neuropathy, 190






Index 437

ultrasound imaging, of muscle in infants,356

uncal herniation, 245unilateral facet dislocation, 295–6unresponsiveness, and brain death, 405,

406upper airway resistance syndrome (UARS),

274urinary tract infections, and multiple

sclerosis, 215, 217utricle, 69

vagus nerves, and cranial nerve evaluation,6

valproic acid (VPA), and seizures inchildren, 340, 346, 347–8

valproatemigraine, 59, 60seizures in children, 339

Valsalva maneuvers, and dizziness, 73, 78valves, of shunt system, 315vancomycin, and children, 328vasospastic disorders, in children, 332vascular disease

dizziness, 80, 86–7neuroradiology, 13–14seizures, 95

vascular injuries, and spinal cord injuries,290

vasculitis, in children, 331vasculopathic cranial nerve, and


vasculopathies, in children, 331vasogenic edema, 245, 246, 249“vegetative state,” and coma, 43Venereal Disease Research Laboratory

(VDRL), 120ventilation, controlled, 242ventricular fibrillation, and electrical

injuries, 391ventriculitis, 323vertebral arteries, and vascular injuries,

290, 333vertebral basilar artery occlusion, 335vertebral bony fractures, 295vertebral bony injuries, and spinal cord

injuries, 290vertebral discitis, 27. See also disc

herniationvertebral dissection, and headache, 56vertebral metastases, 27–8vertebral osteomyelitis, 27, 192–3

vertebrobasilar insufficiency (VBI), 86vertical diplopia, 201vertigo. See also dizziness

definition of, 68pathophysiological treatment of, 90vestibular system disorders, 70, 71

vestibular neuronitis, 83–4vestibular nuclei, 70vestibular rehabilitation, 90vestibular schwannomas, 86vestibular suppressants, 88, 89vestibular system disorders, and dizziness,

71, 76, 80vestibular test, 5vestibulo-ocular reflex (VOR), and

dizziness, 70, 76viral encephalitis, diagnosis and

management of, 121–7viral labyrinthitis, 84viral meningitis. See also meningitis

HIV-related, 117lumbar puncture, 41

visual acuity. See also eye; visual field;visual loss

multiple sclerosis, 211neuro-ophthalmological emergencies,

197–8optic nerve evaluation, 4

visual field. See also eye; visual acuity;visual loss

defects and cranial nerve evaluation, 7intracranial pressure, 243neuro-ophthalmological emergencies,

198visual loss. See also eye; visual acuity; visual

fielddefined, 197idiopathic intracranial hypertension

(IIH), 252, 258multiple sclerosis, 212neuro-ophthalmological emergencies,

203–5pseudotumor cerebri in pregnancy, 369

vital signs, and altered mental status, 44vitamin K, and coagulopathy, 362

waddling gait, 112Wallenberg’s syndrome, 87, 133, 207warfarin, and children, 336water intoxication, 246weakness

acute neuromuscular respiratory failure,66






438 Index

weakness (cont.)brachial plexus, 167definition, 62differential diagnosis, 64–6dizziness and facial, 72evaluation, 62–4Guillain-Barre syndrome, 176hypotonia in infants, 351–5myasthenia gravis, 181nontraumatic spinal cord emergencies,

264strength testing, 162

Weber test, 6, 76Wegener’s granulomatosis, and

Guillain-Barre syndrome, 176weight loss, and idiopathic intracranial

hypertension (IIH), 257Werdnig-Hoffmann syndrome, 352, 356

Wernicke’s encephalopathy, 105Western equine encephalitis, 124, 126“whiplash,” and acute cervical strain,

290white blood cells (WBCs), and lumbar

puncture, 39, 329withdrawal

opioid syndrome, 378seizures and alcohol abuse, 101, 106–7,

379Wright maneuver, and thoracic outlet

syndrome, 190

xanthochromia, 40, 54, 137

zone I, II, and III fractures, 299–300zone of partial presentation, and spinal

cord injury, 287






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