Pitfalls in the Diagnosis of Neurological Disorders Ambar Chakravarty
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table.
A
Abducens nerve palsy 566
acute isolated 565
causes of 565t
painful 565
pitfalls in diagnosis of 565
Abductor digiti minimi 430, 432f
Abductor pollicis brevis 596
Abetalipoproteinemia 298-300
Abscess 470
spinal epidural 480
Absolute neutrophil count 462
Abulia 35
Aceruloplasminemia 291
Acetylcholine 428f
esterase deficiency 427
receptor 362, 427, 428f, 667
antibody 429
reduced release of 427
Acetylcholinesterase
collagen tail 667
inhibitor 667
Achille's reflexes 46
Acid-fast bacilli 468, 663
Acidosis 464
metabolic 37, 285
Aciduria
glutaric 261
organic 497
Acquired immunodeficiency syndrome 499, 580
Acute confusional state 27
pitfalls in assessment of 27
Acute disseminated encephalomyelitis 9, 35, 175, 314, 322, 326, 330, 331, 339, 589
Acute flaccid paralysis 373, 374, 376, 379, 380fc
causes of 375f, 376
differential diagnosis of 374
pitfalls in diagnosis of 373
Acute stroke 186, 201
episodes, management of 538b
Acute transverse myelitis 339, 378
Addenbrooke's cognitive examination 508
Addison's disease 531
Adductor spasmodic dysphonia 251
Adenoma, pituitary 585, 586
Adenosine
deaminase 109, 478
triphosphate 528
Adie's tonic pupil 559, 560
Adrenal functions 533
Adrenalitis, infectious 528
Adrenocortical dysfunction 534
Adrenoleukodystrophy 323
neonatal 525
Adrenomyeloneuropathy 529, 530, 531f, 532
diagnosis of 530
Adson's test 593
Adventitious movements 38
Airplane headache, pathophysiology of 108
Airway 36
Akathisia 249, 284
Akinetic mutism 35, 65, 486
Alberta stroke program early CT score 182
Albuminocytological dissociation 382
Alcohol 37, 250, 284
Alexander disease 324
juvenile 323
Alkyldihydroxyacetonephosphate synthase deficiency 525
Alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid 355
Alzheimer's disease 16, 485, 512, 513, 519, 521
Amantadine 284
Amaurosis fugax 547
Amebic encephalitis 467
American Academy of Neurology 64, 116
American Clinical Neurophysiology Society 66
American Heart Association 182, 637
American Stroke Association 637
Amikacin 248
Amino acid, degradation of 525
Amiodarone 248, 261
Amitriptyline 248, 376
Amlodipine 233
Ammonia 486
Amoxapine 284
Amphetamine 259, 284, 285
Amphotericin 248, 470
Amplified musculoskeletal pain syndromes 56
Amyloid
polyneuropathy, familial 397
spells 194
Amyloidosis 389
Amyotrophic lateral sclerosis 63, 236, 368, 410, 413, 415, 423, 445, 499, 562, 667
Amyotrophy 403
diabetic 406
neuralgic 412
Anarthria 164
Anasarca 670
Anemia 37, 473
Aneurysm 116, 584
intracerebral 654
Aneurysmal subarachnoid hemorrhage 642
Angiitis, primary 323
Angiographic vasospasm, mild 645f
Angiotensin-converting enzyme 341, 472, 662
Anisocoria 547
Ankle reflexes reduction 406
Anterior ischemic optic neuropathy 548, 549
arteritic 549t
nonarteritic 549t
Anterior spinal artery 207, 339, 340, 375
infarction 377f
Anterior tibial compartment syndrome 58
Antiarrhythmics 248
Antibiotics 248
Antibody 362
disorder 313
myositis specific 444, 447
role of 391
Anticholinergic
overdose 284
syndrome, central 286
Anticholinesterase inhibitors 433
Anticoagulation, oral 636
Anticonvulsants 261
Antidepressants 248, 261, 369
Antiepileptic 248
drugs 359
Antiganglioside antibodies 383b, 413
Antigen 355, 369
prostate-specific 46
Anti-glutamic acid decarboxylase-associated ataxia 298, 299, 303
Anti-Hu encephalitis 261
Anti-musk antibody 438
Antimycotics 248
Antineutrophil cytoplasmic antibody 59, 341, 468, 667
Anti-N-methyl-D-aspartate 30
encephalitis 261, 352
receptor 352
Antinuclear antibody 330, 341, 468
Antiphospholipid syndrome 260, 261, 494
Antipsychotics 261
Antiretroviral therapy 481
Antisense oligonucleotides 304
Antisynthetase syndrome 448
Antituberculous therapy 477
Antivirals 248
therapy 475
Anti-voltage-gated potassium channel 30
Anxiety disorder 194
Aphasia
progressive 230, 485, 515, 515t, 516
syndromes 515
Apico-lordotic chest X-ray 593
Apnea test 66, 70
Apparent diffusion coefficient 487, 488, 657, 661
Aquaporin-4 antibody 330, 341
Arachnoiditis 467
Areflexia 106
Argyll Robertson pupil 497, 560
Aripiprazole 284
Arrhythmia 627
Arterial dissections 90
Arteriopathy, cerebral autosomal dominant 105, 174, 323, 325, 597
Arteriovenous malformation 90, 116, 174
Artery
aneurysm, anterior communicating 654f
midbasilar 207, 623f
proximal basilar 207
Arthralgia, post-viral 379
Arthritis 379
Arthrogryposis multiplex congenita 163
Artificial intelligence 180
Ascending reticular activating system 34, 621, 632
Ascites 670
Ashkenazi jews 414
Aspergillus 470
Astrocytoma 579
desmoplastic infantile 582
pilocytic 579
Asymmetrical painful proximal neuropathy, mimics of 403
Ataxia 218, 236, 261, 469
acquired 299
diagnosis of 298t
episodic 266, 267, 298, 299
evaluation of 297b
frontal 21
hereditary cerebellar 299
spinocerebellar 299, 414, 425
syndromes, hereditary 299
telangiectasia 301
Atherosclerosis 200
Atonic spasms 161
Atrophy 516f
bilateral
frontal 514f
posterior cortical 206
Attack
duration of 84
ischemic 195, 200
Autism spectrum disorders 163
Autoantibody 418, 456
mediated encephalitic syndromes 518
myositis specific 448, 448t, 456
testing 385, 390
Autoimmune 233, 260, 472
adrenalitis 528
autonomic
ganglionopathy 418
neuropathy 369
diseases 50, 261t, 418
disorders 323, 360, 369
encephalitis 323, 353, 354, 355t
diagnosis of 351
pitfalls in therapy of 354
therapy synopsis for 356t
epilepsy 359
myopathy, necrotizing 443
thyroiditis 298, 299, 303, 351
Automatisms 127
Autonomic dysfunction 229, 285, 499
Autonomic nervous system 115
Autonomic neuropathy, painful 402
Autonomic phenomenon 130
Autosomal dominant 236, 299, 408, 439, 487
cerebellar ataxias 304
Autosomal recessive 236, 300, 408, 439
B
Babinski response 300
Back pain
chronic 601
low 48
Baclofen 284
Bacteria 446
Baker's cyst 51
Barbiturate poisoning 37
Barth myopathy 669
Basal ganglia 249f, 513f
Basilar artery 620f, 624f
international cooperation study 625
occlusion endovascular intervention 625
tip of 207
Battered root syndrome 603
Battle's sign 37
B-cell lymphoma, argues against 663
Beat-to-beat heart rate 397
Becker muscular dystrophy 439
Behçet's disease 258, 323, 338
Bell's palsy 6, 19, 263
Belly-tendon montage 431
Benign focal epilepsy, pitfalls in diagnosis of 164, 166
Benítez-Rivero's observations 99
Benson syndrome 520
Benzodiazepines 131, 248, 284
Bevacizumab 673
Bickerstaff brainstem encephalitis 323, 377
Bile acids 525
Bilirubin, serum 464
Biological inflammatory syndrome 261
Biopsy 441
Biotin
responsive basal ganglia disease 323
thiamine-responsive basal ganglia disease 324, 333f
Biotinidase deficiency 323, 324
Bipyramidal syndrome 426
Birth injury 259
Bladder 48
dysfunction 374
involvement 378
Blastomyces 470
Blepharospasm 562
Blindness, transient monocular 20, 547, 548
Blood
brain barrier 631, 654, 657
glucose 463
parameters 440
pressure 132, 175, 207, 650
labile 283
orthostatic 397
products
hyperacute 651f
isointense 651f
tests 373
B-methyl-D-aspartate 367
B-mode 201
Body mass index 357
Bone
flap, replacement of 636f
lesions, sclerotic 671
marrow transplantation 533
Borrelia burgdorferi 325, 338, 343, 446
Botulism 667
Bowel
disease, inflammatory 635
dysfunction 374
Brachial amyotrophic diplegia 411
Bradycardia 37, 430, 627
Bradykinesia 229, 236
abnormality, several structural 160
abscess 35, 284, 467
atrophy, diffuse 518
calcifications, Familial 236
computed tomography scan of 574
damage, preexisting 35
death 34, 64, 67, 68f, 69, 71, 72, 577
determination of 64, 70
pediatric 69
pitfalls in diagnosis of 68
whole 71
injury 355f, 644, 645f
lesions 261
structural 195
magnetic resonance imaging of 489
parenchyma 539f
prominent atrophy of 513
reveal multiple neuroparenchymal lesions 580f
tumors 221, 259
pitfalls in diagnosis of 579, 588
Brainstem
arterial supply of 205
auditory evoked
potentials 19
response 526
death 71
encephalitis 361, 363
paraneoplastic 364
infarctions 208
lower 663f
pathology 259
reflexes 36, 39
stroke 403, 567
syndromes 311, 312
Branch retinal artery occlusion 548
Breast 48
Breath-holding spells 132, 134
Breathing
apneustic 37
ataxic 37
cluster 37
Brisk jaw reflex 413, 415
Broca's aphasia 426
Bromperidol 284
Bronchodilators 248
Brown–Vialetto–Van Laere syndrome 421, 555
Brucella standard agglutination test 468
Brucellosis 467
Brugada syndrome 136
Bruns' nystagmus 208
Bulbar muscle weakness 419
Bulbar nuclear disease 420
Bulbar palsy 420
causes of 420
isolated 423
progressive 411, 421, 423
Bulbar weakness 420, 421
Bulbospinal muscular atrophy, X-linked progressive 422
Burkholderia cepacia complex 459
Burst
fracture 574f
suppression pattern 630f
Buspirone 285
C
Calcium 56
binding protein 395
Caloric testing 38
Calpainopathy 439
Campylobacter jejuni 286, 375
Canadian Subarachnoid Decision Rule 117
Cancer 365f
surveillance 364b
Candida 459, 470
Candidiasis, oral 500
Capillary blood glucose 464
Capsular warning syndrome 195
Carbohydrate metabolism disorders 445
Carbon
dioxide arterial pressure targets 576
monoxide 233
poisoning 37, 259
Carcinoma, nasopharyngeal 116, 562
Carcinomatosis, leptomeningeal 478, 480
Cardiac conduction defects 542
Carotid artery
chronic occlusion of 200
right internal 639
stenosis 200
asymptomatic 201
Carotid bruit 547
absence of 200
Carotid occlusion, chronic extracranial 201
Carpal tunnel syndrome 263
Castleman disease 671
Cataract, bilateral 528
Catatonia 35
Cauda equina syndrome 63
Caudal ventrolateral medulla 627
Cavernous angioma 258
Cavernous sinus thrombophlebitis 641
Ceftriaxone 468
Celiac disease 168, 261, 455
Cell adhesion molecule, immunoglobulin-like 351, 355
Centers for Disease Control and Prevention 493, 501
Central nervous system 9, 34, 64, 65, 107, 133, 175, 221, 251, 284, 311, 322, 323, 337, 361, 467, 470, 471f, 477, 481, 491, 501, 580, 631
areas of 313b
brucellosis 467
demyelination, acute 325, 329t
infections 457
epidemiology of 467
lymphoma, primary 324, 585
tuberculosis, pitfalls in diagnosis of 477
vasculitis 323
Central pontine
myelinolysis 423
tegmental lesions 37
Central retinal artery occlusion 548
Centrotemporal spikes 164
Cephalalgia
diagnosis of unilateral 92
trigeminal autonomic 77, 81, 87, 89, 89t, 101t, 116, 120
Cephalic aura 165
Cerebellar artery
anterior inferior 6, 204, 207, 208, 210f
superior 205, 207, 627
Cerebellar ataxia 106, 297300, 527
acute 379
acquired causes of 302
postinfectious 299
causes of 303
etiology of 302
treatment of 304
Cerebellar degeneration 361
chronic alcoholic 304
paraneoplastic 298, 299, 303, 362, 364, 365, 365b, 365f
subacute 363
Cerebellar fits 38
Cerebellar foliar atrophy 238f
Cerebellar gangliocytoma, dysplastic 583
Cerebellar hemisphere
atrophy 366f
white matter 336f
Cerebellar syndromes 311
Cerebellitis 302
Cerebellum, arterial supply of 205
Cerebral adrenoleukodystrophy 530
Cerebral angiogram 623f, 639f, 653f, 654f
Cerebral artery
anterior 187, 640, 640f
hyperdense middle 182f
posterior 207
Cerebral blood
flow 67, 187190, 639
volume 187190, 324, 579, 639
Cerebral cortex 417
Cerebral edema 467, 634
diffuse 645f
Cerebral hemisphere 190f
Cerebral hemorrhage 12, 634f
Cerebral herniation 639f
external 634f
Cerebral hypoperfusion 190
Cerebral ischemia 651f
delayed 644
Cerebral malaria 37, 221, 284
Cerebral perfusion pressure 576
Cerebral small vessel disease 198
Cerebral vasculitis 35
Cerebral venous sinus thrombosis 90, 177, 221, 557, 633
over diagnosis of 223
pitfalls in diagnosis of 221
treatment of 638
Cerebrospinal fluid 9, 21, 39, 54, 116, 155, 221, 234, 255, 284, 300, 313, 331, 342, 351, 363, 373, 380, 382, 398, 410, 459462, 477, 486, 491, 496, 502, 513, 535, 540, 549, 594, 621, 631, 647, 659, 662, 664
elevated 440
examination 375
leak syndrome 116
lymphocytosis of 104
values 460, 463
Cerebrovascular diseases 513
Cervical injury, missed high 576f
Cervical internal carotid artery, proximal 183
Cervical radiculoplexus neuropathy, diabetic 407
Cervical spinal cord 659f
Cervical spine 599
upper 663f
Cervical spondylosis 598
Cervical spondylotic myelopathy 345, 414, 425, 591, 593, 598
pitfalls in diagnosis of 591, 595t
Cervical spondylotic radiculopathy 591, 592
pitfalls in diagnosis of 591, 593
Cervical vascular disorder 115
Cervico-medullary junctional abnormalities 116
Cervix 48
Cesarean section, lower-segment 125
Chancroid 500
Charcot–Marie–Tooth disease 390, 396
Chemosis 638f
Chest X-ray 592, 593
Chiari malformation 116
Chikungunya 338
Childhood epilepsy, benign 164, 166, 170
Childhood seizure susceptibility syndrome, benign 164, 170
Chloroquine 446
Chlorpromazine 233, 284
Cholesterol
emboli 547
synthesis of 525
Choline acetyltransferase 667
deficiency 427
Chondrodysplasia punctata 527
Chorea 261, 421
gravidarum 258
Choreoathetosis 266
paroxysmal 162
Choroid plexus
carcinoma 582
papilloma 582
Chronic migraine 78, 96
pitfalls in diagnosis of 75, 76
Ciliary dyskinesia, primary 355
Cingulate island sign, posterior 521
Cinnarizine 233
Circle of Willis 204
Circulation 36, 204
Cirrhosis 281
Cisplatin 221
Clinical dementia rating score 508, 512
Clinically isolated syndrome 314, 322
Clock-drawing test 508, 509
Clonic seizures 127
Clopenthixol 284
Clostridium
botulinum 668
toxicity 429
perfringens streptococci 446
Clozapine 284
Cluster headache 79, 87, 89, 89t, 90, 90b, 91, 96, 101, 112
pitfalls in diagnosis of 87
Coat hanger ache 593
Cobalamin disorders 323
Cocaine 259, 284, 285
Cockayne syndrome 528
Coenzyme Q10 541
deficiency 298, 299, 301
Cognitive impairment
mild 16, 509, 512
subacute 312
Colistin 470
Collagen vascular diseases 338
Collapsing response mediated protein 5 345, 362, 367
Colon 48
ColQ syndrome 667
Coma 34, 35, 35t,
causes of 35, 35b
Complete transverse myelopathy 312
Complex regional pain syndrome 52
Complex visual hallucination 166
Compound muscle action potential 49, 58, 383, 404, 430, 444, 593, 667
Compression, neural 609f
Computed tomography 16, 38, 47, 49, 53, 176, 182, 183, 185187, 592, 619, 621, 623, 626, 632, 633, 638, 643, 647, 650, 654, 656, 661
angiography 177, 182, 650
contrast-enhanced 91
perfusion 186
scan 209, 574
Confusion 34, 131, 225
assessment method 29
Congenital cranial dysinnervation disorder 566
Congenital neuromuscular junction disorder, causes of 427t
Connective tissue disorders 444
Consciousness 34
alteration of 312
fluctuating 620
human 16, 34
state of 37
Continuous positive airway pressure 66, 461
Continuous spike-wave 151, 156
Contraceptive pills, oral 221, 258
Conversion disorder 269
Copper metabolism 291
Cord, viral infections of 378
Corneal confocal microscopy 406
Coronavirus disease 2019 (COVID-19) 9, 119, 175, 223, 385, 461
associated neurological disorders 16
encephalopathy, treatment of 11
global outbreak of 9
infection 9, 10, 12, 14, 15, 16, 121, 225, 394, 404
pandemic 119, 510
vaccination 177, 422
neurologic complications of 177
Corpus callosum 526f, 581f
splenium of 532f
Cortical atrophy 513f
Cortical internal carotid artery dissection 174
Cortical spreading depression 104, 178, 547
Cortical venous thrombosis 35
Corticobasal degeneration 230, 233, 236, 517
Corticobasal syndrome 232
Corticospinal tract 531f, 660
Corticosteroids 365
adverse effects of 568
Co-trimoxazole 248
Cotton wool spots 475f, 500
Cranial autonomic
signs 81
symptom 83, 84
Cranial fossa, anterior 584f
Cranial nerve 196, 419, 420, 422
palsy 562
eighth 19
fifth 19
fourth 19
lower 20
seventh 19
sixth 18
third 18
Cranial neuropathy 323, 402, 402f, 407, 499
diabetic 403
Craniopharyngioma 553f, 586
Cranium, disorder of 115
C-reactive protein 11, 49, 56, 283, 297, 456, 480, 548, 592
Creatine kinase 285, 409, 439, 445
Creatine phosphokinase 52, 285, 375, 412, 444, 539
Creutzfeldt–Jakob disease 41, 175, 259, 484486, 491, 517, 546
sporadic 491
Critical cervical stenosis 659f
Crossed pyramidal tract signs 421
Cryptococcal granuloma 258
Cryptococcal infections 467
Cryptococcal meningitis 472f, 477, 481, 495
C-spine injury 66
Cushing's reflex 37
Cushing's syndrome 445
Cyanosis 37
Cyclooxygenase 93, 539
Cyclophosphamide 365
Cysticercal antibodies 471
Cysticercosis 338
Cysts, epidermoid 379f, 584
Cytomegalovirus 325, 384, 473, 479, 495, 499, 528
D
Danon disease 669
Dantrolene 304
De novo seizures 14
Deafness 291
Deep peroneal nerve affection 60
Deep tendon reflexes 298, 374, 387
Dehydration 27
Delirium 16, 30, 32
Dementia 15, 30, 491, 497, 508, 510, 512, 518, 521, 538
causes of 471
diagnosis of 512, 520
mixed 513
pre-existing 16
rapidly progressive 485, 486, 490f, 491, 518
vascular 513
Demyelinating disorders 175, 436
clinical diagnosis of 323t
radiological diagnosis of 323t
Demyelinating syndromes, acute 322
Demyelination 195
antibody-associated 322
Dentatorubral-pallidoluysian atrophy 262f
Deoxyribonucleic acid 302
double-stranded 297, 341
Dermatitis, seborrheic 500
Dermatomyositis 361, 363, 420, 443, 448
Descemet's membrane 288
Desipramine 284
Desminopathy 669
Dexmedetomidine 65
Diabetes insipidus 555
Diabetes mellitus 37, 48, 400, 474, 542, 555
type 1 406
type 2 50, 217, 404, 406, 623
Diabetic autonomic neuropathy 404
signs of 404b
symptoms of 404b
Diabetic neuropathy 400, 402t
cachexia 407
clinical forms of 402f
painful 400
pitfalls in
diagnosis of 400
evaluation of 400
Diaphoresis 283
Diarrhea 500
diseases 379
Diatrizoate 284
Diffuse axonal injury 576
Diffuse infiltrative lymphocytosis syndrome 499
Diffuse leptomeningeal glioneuronal tumor 583
Diffusion-weighted imaging 110, 189, 190, 209, 341, 487, 488, 579, 587, 624f, 661
Digital rectal examination 46
Digital subtraction angiography 341
Dihydroxyacetonephosphate acyltransferase deficiency 525
Diltiazem 233
Dimethylarginine, asymmetric 536
Dipeptidyl aminopeptidase-like protein 355
Diplopia 561, 562
intermittent 560
Disability
mild 78
moderate-to-severe 464
Disease-modifying therapy 311, 342
Disk
anomalies, congenital 554
edema, bilateral centrocecal 557
Distress, respiratory 410
Dixon sequences 448
Dizziness 174, 194, 208, 214, 312
pitfalls in diagnosis of 219
Dizzy spells 130
Doll's eye reflex 38
Domperidone 233, 284
Doose syndrome 153, 162
Dopamine
agonist therapy 284, 285
transporter 233, 242, 293
imaging 245
single-photon emission computerized tomography 233
Doppler sonography 45
Dorsal column hyperintensities 498f
Dorsal nigral hyperintensity 232
Dorsal spinal cord 531f
Dorsolateral pons 37
Dosulepin 284
Doxycycline 470
Dravet syndrome 151, 157, 158, 161, 162
Droperidol 284
Drowsiness, discharges of 138
Drugs 299, 302
intoxication 35, 65, 233, 248
Duane's retraction syndrome 566
Duchenne muscular dystrophy 439
Dural fistulas 221
Dyken's criteria 155
Dysautonomia, acute 363
Dyselectrolytemias 27, 375
Dyskinesia 266
paroxysmal 254, 261, 266
hypnogenic 266
nonkinesigenic 261, 266
Dysphagia 283
Dysphasia 110
Dystonia 236, 247, 254, 258, 261, 265, 266, 421
acute 284
functional 261, 264
gene 247
parkinsonism, rapid-onset 259
peripherally induced 265
primary 259
secondary 259
transient paroxysmal 162
Dystonic storm 259
Dystonic tremor 242, 244, 247
E
Edema 580f
conjunctival 638f
vasogenic 176f, 656f
Edinger–Westphal nucleus 19, 37, 560
Edrophonium test 430, 430t
Electrocardiogram 27, 87, 283
Electroencephalogram 30, 39, 40f, 41f, 66, 125, 128, 130, 138, 143, 148, 149, 151, 152f, 154f, 200, 245, 289, 486, 486f, 489, 559, 628
Electroencephalography 11, 161f, 164, 266, 273, 359, 619
Electrolyte
disturbances 259
serum 468
Electromyogram 369, 596, 606
Electromyographic studies 60
Electromyography 47, 49, 50, 52, 245, 253, 268, 352, 368, 369, 373, 666
single-fiber 434
Electron transport chain 535
Electroneuromyography 266
Electrophysiology 440, 592
pitfalls in 245
Embryonal neoplasms 583
Emery–Dreifuss
muscular dystrophy 439, 668
syndrome 411
Empty delta sign 223
Empyema, subdural 35
Encephalitis 9, 14, 37, 167, 189, 258, 352, 467
focal 35
paraneoplastic 261
progressive 366
rickettsial 469, 469f
viral 469
Encephalomalacia 294f
temporal 636f
Encephalomyelitis 9, 361, 363
anti-Hu-associated paraneoplastic 364b
paraneoplastic 362, 364
progressive 355
Encephalopathy 11, 312, 653
anoxic ischemic 35
contrast-induced 654, 656
developmental 158
hepatic 35, 190, 518
hypertensive 37
hypoxic ischemic 42, 126, 528
infantile epileptic 163
metabolic 35
myoclonic 151
viral 259
Endocarditis 494
bacterial 494
infective 37
Endocrine disorders 414
Endocrinopathy 388, 670
Endoneurial microvascular deficits 400
Endothelial cell marker 640
Entacapone 284
Enteropathy 291
Enterovirus 338, 378, 467
Enzyme
Deficiency
bifunctional 525
single peroxisomal 525
hepatic 401
linked immunosorbent assay 344
Ependymoma 581
Epilepsy 14, 139, 158, 162, 163, 236, 254, 323, 474
atypical benign partial 152
benign 164
focal 146
frontal lobe 157
genetic 162
myoclonic 323
absence 151
astatic 153, 162
occipital 166
syndromes
neonatal 128
self-limited 158
Epileptic disorders, pediatric 123
Epileptic encephalopathy 151, 152f, 157, 158, 163
nonsyndromic 163
pitfalls in diagnosis of 151
Epileptic spasms 127, 153, 159, 161
Epileptiform
abnormalities 138, 138b, 146
discharges, true 140, 140t
Episodes, recurrent 214
Episodic vestibular syndrome 216
Epstein–Barr virus 233, 302, 325, 489
encephalitis 233
Erectile dysfunction 404
Erythrocyte sedimentation rate 6, 56, 59, 217, 283, 290, 297, 339, 401, 456, 468, 480, 496, 548, 592
Escherichia coli 286, 459
Essential tremor 241245, 247
diagnosis of 242
misdiagnosis of 242
pitfalls in diagnosis of 241
prevalence of 243
Esthesioneuroblastoma 584
Eucapnia 66
European Federation of Neurological Societies 116, 299, 300
European Neurological Society 299, 300
Euvolemia 66
Exercise
paroxysmal 266
test 431
Expressed breast milk 461
Extensive transverse myelitis 337
Extensor digitorum
brevis 57, 389
communis 434
longus 57
Extensor hallucis longus 46, 57
Extracorporeal membrane oxygenation 66
use of 70
Extracranial carotid artery, pseudo-occlusion of 201
Extracranial vascular diseases, pitfalls in diagnosis of 200
Extrapontine myelinolysis, evidence of 423
Extrapyramidal disorders 421
Extrapyramidal dysfunction 251t
Extrapyramidal syndromes 420
Eye
deviation, conjugate lateral 37
movement 38, 219
non-rapid 266
pain 77
response 36
skew deviation of 174
Eyelid
edema 82
opening, apraxia of 437
F
Fabry's disease 50, 542
Face arm speech test 209
Facial
diplegia 377
dyskinesias 491
malignancy 90
pain 115
seizure, focal 167
sweating 82
Faciobrachial dystonic seizures 261, 351
Facioscapulohumeral dystrophy 439, 441, 444
Failed back surgery syndrome 601, 605, 608
False-positive anti-acetylcholine receptor antibody test 430b
Fatal insomnia, familial 487
Fatigable ptosis 561
Fatigue
isolated 312
theory 56
Fatty acids, very long-chain 525, 533, 534
Fazio–Londe disease 421
Febrile seizures plus 162
Femoral neuropathy 51, 406
Fentanyl 65
Fever 37, 117, 491, 500
Fiber loss, small 418
Fibrin plaques 547
Fibromuscular dysplasia 200
Fibromyalgia 593
syndrome 52
Fibrosis, idiopathic retroperitoneal 48
Finger extensor weakness 413
Fisher's rules 8
Fistula
carotidocavernous 642
traumatic arteriovenous 575f
Flaccid paralysis, acute 373, 374, 376, 379, 380fc
Flail-arm syndrome 411, 417
Flail-leg syndrome 412, 417
Fluctuations, acute 621t
Fluid-attenuated inversion recovery 40, 175, 189, 225, 282, 335f, 340, 352, 486489, 495, 495f, 496, 513, 516, 539f, 541f, 567, 580f, 581f, 582, 584f, 585f, 589f, 629, 657
hyperintensities 152
sequence 120, 249f
Flunarizine 233
Fluorescent treponemal antibody absorption 502, 503
Fluorodeoxyglucose positron emission tomography imaging 201, 363
Flupenthixol 284
Fluphenazine 284
Focal brain function, sudden loss of 173
Focal supratentorial syndrome 312
Fontanelles, large 525
Foodborne 667
Foot drop 5759, 62
acute bilateral 63
electrophysiological assessment of 57
postpartum 58
spastic 63
Foramen magnum lesions 22
Fosman syndrome 413
Fossa, posterior 35, 116
Four-mountain test 510
Fracture, skull base 37
Frenzel's glasses 211, 219
use of 211
Friedreich's ataxia 298-300
Frontal lobe syndrome 514
Frontotemporal dementia 236, 485, 514
spectrum 410
Frontotemporal disorders 520
Functional neurological symptom disorder 269
Fundoscopy 37, 39
Fungal
brain abscess 467
infection 175, 261, 470
Fungi 446
Funicular paresthesia 403
F-waves 375
G
Gabapentin 259, 376
Gait 276, 278
antalgic 278, 279
ataxic 279
buckling 279
cerebellar ataxic 278
disorders 276, 278, 281, 420
classification of 277, 277t
pitfalls in assessment of 276, 277
psychogenic 277
dyskinetic 278
functional 265
hypokinetic rigid 278, 279
hypotonic 278
paretic 279
pattern 277
sensory ataxia 278
spastic 278, 279
syndrome 278t, 279t
type of 279
Trendelenburg 279
vestibular 278
weak 279
Galactocerebrosidase assay 526
Galactosemia 528
Gamma globulins, abnormal 456
Gamma-aminobutyric acid 351, 355
receptor antibody encephalitis 352
Gammaglobulinemia, polyclonal 500
Gamma-glutamyl transferase 297
Ganglia, autonomic 417
Gangliocytoma 583
Ganglioglioma 579, 582
desmoplastic infantile 582
Ganglionic acetylcholine receptor 418
Ganglionopathy 417
Gangliosidosis 542
Ganser's syndrome 519
Gastroenteritis 167
Gastroesophageal reflux disease 132, 167, 170, 283
Gastrointestinal pseudo-obstruction, chronic 363
Gastrostomy, percutaneous endoscopic 426
Gene therapy 533, 534
Lenti viral-based 533
Genetic disorders 324
Geniculate body, lateral 89
Geniospasm, familial 248
Gentamicin 248
Germ cell tumors 583
Germinoma 583
Gerstmann–Sträussler–Scheinker disease 487
Geste antagoniste 253
Giant cell 664f
arteritis 115, 116, 456, 548
astrocytoma, subependymal 579
Gilles de la Tourette syndrome 260
Glasgow coma scale 36, 36t, 283, 574
Glaucoma 568
normal tension 550, 551
primary open angle 551
uncommonly acute 554
Glial tumors 189
Glioblastoma multiforme 580
Glioma 189
Gliomatosis cerebri 580, 589
Globus
pallidi, bilateral 497f
pallidus 282f
Glossopharyngeal neuralgia 91, 116
Glucocorticoid deficiency, familial 528
Glucose
hypometabolism, diffuse 521
transporter 299
defects 107
deficiency 107, 157, 300
Glutamic acid decarboxylase 298, 299, 303, 345, 353, 355, 366
Gluten ataxia 298, 299, 303
Gluteus medius 452f
Glyceryl trinitrate 89
Glycine receptor 259
Glycogen
branching enzyme 414
storage disorders 445
Glycoprotein 636
anti-myelin-associated 388
myelin-associated 413
Glyoxylate detoxification 525
Gonorrhea 500
Gower's sign 290
Gradient echo
scans 341, 569
sequence 513
Granuloma
formation 470
frontal lobe 471f
inguinale 500
necrotizing 664f
Granulomatous diseases, pathogen-free 665
Grocott methenamine silver 663
Growing pain 52
Growth pains, mimics of 56t
Guillain–Barré syndrome 10, 21, 65, 177, 323, 326, 326t, 373, 375, 375f, 376, 377f, 380, 382, 383, 388, 410, 420, 429, 430, 444, 499, 661, 667, 671
classification of 383b
diagnosis of 377, 390
differential diagnoses of 384b
painful 377
severe 35
variants of 377, 383t
Guillain–Mollaret triangle 247
H
H reflex 375
Haemophilus influenzae 461
Hairy leukoplakia, Oral 500
Hallpike's test 194
Haloperidol 233, 284
Hammer toes 397f
Hansen's disease 6, 602
Hashimoto's encephalopathy 261
Head
impulse test 6, 208, 211, 213, 218, 280
trauma 90, 221
tremor 243
Headache 78, 79t, 103, 108, 114, 115, 117, 119, 173, 174, 174f, 200, 312, 491, 557
acute onset 562
attacks 78
frequency of 76
chronic
cluster 98
daily 76, 96
tension-type 96
cluster 79, 87, 89, 89t, 90, 90b, 91, 96, 101, 112
cough 96
daily persistent 96, 119
disorder 73, 75, 76b, 82, 96b, 114, 216, 546
post-COVID-19 119
episodes, migraine-like 110
exacerbation of 89
exercise 96
hemiplegic cluster 112
medication overuse 75, 78, 79
postdural puncture 652
postural 116
progressive 117, 638
recurrent 563
migrainous 538
secondary 99, 114
sexual 96
short-lasting neuralgiform 82
side-locked 78, 99
sinus 79, 117
suicide 87
tension-type 75, 79
thunderclap 115
transient 104
Valsalva-induced 96
Head-up tilt-table test 133
Hearing loss 6
sensorineural 106, 528, 538
Heart
disease 542
ischemic 42
failure, congestive 65
rate 133, 650
Heat stroke 37, 259, 284
Heavy metal intoxication 394
Heimler syndrome 555
Hemangiopericytoma 584
Hematoma 15, 51
acute subdural 22f, 574f
intracerebral 573f
subdural 116, 190
Hematopoietic stem cell transplantation 533
Hemianopia
bilateral temporal 553f
homonymous 558, 559
Hemicrania
chronic paroxysmal 98
continua 79, 96, 97, 97b, 98101, 101t, 195
classification of 97b
misdiagnosis of 97
pitfalls in diagnosis of 96, 98
subtypes of 97
paroxysmal 89, 92, 96, 101
syndrome 81, 88
Hemicraniectomy 634f
decompressive 633
Hemifacial spasm 19
Hemiparesis 110, 279
Hemiparesthesia 110
Hemiplegia 469
alternating 104
Hemodialysis 653
Hemoglobin 469, 471
glycated 50, 59
Hemogram 592
complete 486
Hemorrhage 35, 650
acute intracerebral 639f
adrenal 528
intracerebral 35, 37, 116, 174, 565, 636f
intra-plaque 202
intraventricular 461
nonaneurysmal subarachnoid 656
nontraumatic subarachnoid 117b
peripapillary streaky 550f
pontine 37
retinal 13f
retroperitoneal 48
spinal subarachnoid 651f
splinter 37
subarachnoid 35, 37, 116, 173, 190, 222, 573, 573f, 642, 643f, 645f, 647, 648f, 650f, 651, 656
subdural 35
subhyaloid 37
symptomatic intracranial 176
Hepatic failure 259, 369
Hepatitis
B surface antigen 468
C virus 468
Hepatocerebral degeneration, acquired 281, 293, 293t
Hereditary neuropathy 389, 396, 398
pitfalls in diagnosis of 396
Herpes
simplex 528
encephalitis 352
virus 40, 375, 467
zoster 286
Hexamethylpropyleneamine oxime 67
High-frequency synchronous discharge, bilateral 248
High-intracranial pressure syndromes 116
High-performance liquid chromatography 297
Hip, transient synovitis of 379
Histocompatibility complex, major 447
Histoplasma 470
Hodgkin's disease 365
Hoffmann's reflexes 593
Hoffmann's signs 412
Holmes tremor 242, 244, 247
Homoeostasis, disorder of 115
Hormone 248
adrenocorticotropic 153, 529
Horn cell, anterior 373, 422, 596
Horner's syndrome 21, 37, 200, 593
painful 21
preganglionic 421
Hounsfield unit 183, 184, 657
H-reflexes, absent 404
Human immunodeficiency virus 175, 233, 258, 286, 297, 298, 315, 323, 339, 343, 375, 401, 403, 414, 444, 468, 491, 493, 496, 499, 503, 580
Human leukocyte antigen 437, 592
Human organs Act, transplantation of 72
Human prion diseases 491
Human T-cell
lymphoma virus 339, 340
lymphotropic virus 315, 596, 597
Humming bird 436
Huntington's disease 256, 267, 289, 514, 521
juvenile 255
Huppke–Brendel syndrome 291
Hutchinson's
angina 25
disease 25
facies 25
freckles 25
Gilford disease 25
mask 25
melanotic disease 25
patch 25
prurigo 25
teeth 25
triad 25
Hydrocephalus 467, 477, 643f
normal-pressure 230, 233, 517
Hydrogen peroxide 525
Hydromyelia, evidence of 663f
Hydrophobia, history of 473
Hygroma, subdural 648
Hypercalcemia 261, 369
Hyperekplexia 132, 259, 261, 265
Hyperemesis gravidarum 567f
Hyperemia 631
Hyperglycemia 190, 261
nonketotic 258
Hyperintense signal representing spinal infarct 659f
Hyperintensities 474f
Hyperkinetic disorders 421
Hyperkinetic movement disorder 252, 257fc, 258, 261t
pitfalls in diagnosis of 252
Hypernatremia 369
Hyperosmolar diabetic coma 35
Hyperparathyroidism 445
Hyperplasia, focal intimal 640f
Hyperpyrexia 37
Hyperreflexia 285
Hypersalivation 164
Hypersynchrony, hypnagogic 138, 141, 145f
Hypertension 37, 199, 474, 623
idiopathic intracranial 9, 19, 90, 116, 557, 588
intracerebral 18, 225
malignant 557
Hyperthermia 34
malignant 37, 284, 285
Hyperthyroidism 258, 261, 445
Hypertrichosis 670
Hyperventilation 37, 138
central neurogenic 37
Hypoesthesia, vibration 406
Hypoglycemia 35, 173, 175, 190, 258, 261, 405, 464
Hypokinetic disorders 421
Hypokinetic rigid syndrome 289
Hyponatremia 233, 491
Hypophysitis, lymphocytic 116
Hypopituitarism 37
Hypoplasia, adrenal 528
Hypotension 627
intracranial 221
postcardiac arrest 37
refractory 670
Hypothalamic dysfunction 323
Hypothalamic lesions 37
Hypothermia 34, 37, 65, 460
Hypothyroidism 445
Hypotonia 464, 528
Hypovolemia 116
Hypoxemia 27
Hypoxia, absence of 66
Hypsarrhythmia 153, 159161
Hysteria, Janet's view of 519
I
Ice pack test 429, 434
Ichthyosis 291
Ictal blindness 166
Ictus emeticus 167
Idiopathic inflammatory myopathy 443, 444, 447, 448t, 449, 455
diagnosis of 444, 454
pitfalls in diagnosis of 443
Idiopathic intracranial hypertension 9, 19, 90, 116, 557, 588
over diagnosis of 558
Immune
disorders 323
inflammatory
diseases 338f, 341
disorders 338
reconstitution inflammatory syndrome 481, 499
sensory polyradiculopathy, chronic 395
Immunodeficiency syndromes 323
Immunoelectrophoresis 401
Immunoglobulin
G 297, 355, 503, 590, 662
intravenous 257, 356, 365, 376, 382, 411
M 388, 662
serum 472
Immunosuppression 365
Immunosuppressive therapy, initiation of 447
Implantable loop recorder 136
Inclusion body myositis 412, 443
diagnosis of 444
Incontinence 283
Incontinentia pigmenti 555
Infantile spasm syndrome 158, 159, 250
Infarction 470
cerebellar 206, 208
venous 35, 190
Infections 27, 35, 56, 90, 115, 116, 221, 323, 338, 491, 495
bacterial 343, 464, 480
opportunistic 495t
rickettsial 469
viral 343
Inferior altitudinal visual field defect 559
Inflammation, post-COVID-19 13
Inflammatory cells, acute 635f
Inflammatory disorders 90
Inflammatory myopathy 9, 369, 441, 445, 452
group of 440
Injury
peripheral 259
physical 58
Insulin neuritis 402
Intensive care unit 10, 27, 29fc, 135, 384, 539, 619, 666
Interictal epileptiform
abnormalities 140
discharges 151
Internal carotid artery 184, 185, 200, 639
diameter 201
Internal elastic lamina 640, 640f
reduplication of 640f
Internuclear ophthalmoplegia 37, 311, 312
Interstitial lung disease 444
Intracranial disorder, nonvascular 115
Intracranial pressure 18, 37, 460, 480, 547, 576
Intraepidermal nerve fiber density 402
Intraocular pressure 90, 117, 551
Ipsilateral afferent pupillary defect 548
Iris sphincter 559
Isaacs syndrome 369
Ischemic stroke 12, 35, 116, 258, 494
pitfalls in diagnosis of 182
Isolated rest tremor 242
Itraconazole 248
J
Japanese B virus 338, 343
Japanese encephalitis virus 233, 473
Jaundice 37, 464
Jaw clonus 425
Jaw jerk reflex 424
physiological functions of 424
Jaw tremor 425
Jitteriness 132, 162, 249
John Cunningham virus 325
K
Kaposi sarcoma 500
Kayser–Fleischer ring 245, 252, 288
Kennedy's disease 410, 422
Keratodermia 291
Kernohan–Woltman notch phenomenon 21, 25
Ketamine infusion 630f
Ketoacidosis 402
Ketones 37
Ketosis 404
Kidney 48
disease, chronic inflammatory 672
muscle-specific 427
Klebsiella pneumoniae 459
Krabbe disease 323, 527, 528, 542
juvenile 323
Kussmaul breathing 37
L
L'hermite's sign 593
Labyrinth, vascular supply of 205f
Labyrinthine
concussion 578
infarct 209
Lacrimation 82
Lactic acidosis 121, 190, 258, 489, 535, 537, 540b
Lacunar syndrome 193, 196, 198
pitfalls in 196
Lacunes syndrome 198
Lafora disease 168
Lambda waves 138, 140
Lambert-Eaton myasthenia
gravis 427, 430
syndrome 355, 361364, 369, 440, 441, 667
Laminopathy 669
Lamotrigine 248
Landau–Kleffner syndrome 135, 151, 156
Langerhans cell histiocytosis 323, 583, 585
Language
disorder, acquired 515
therapy 426
Lateral femoral cutaneous
nerve 46, 51
neuropathy 51, 52
Leber's hereditary optic neuropathy 553
Leg
muscles 452f
pain 56
assessment of 55
chronic inflammatory 601
spasticity 593
Leigh syndrome 236
Lennox–Gastaut syndrome 148, 151, 161, 162
Lenticular nucleus 233
Lentiform nuclei 474f
Leprosy 51, 60
Leptomeninges 664f
Leptomeningitis 470
Lesions
larger 58f
ring-enhancing 340
space-occupying 173
Lethal catatonia 284, 285
Lethargy 34, 464
Leucine rich glioma 355
Leukemia, acute lymphocytic 335f
Leukocytes
peripheral 541
polymorphonuclear 462
Leukocytosis 283
neutrophilic 473
Leukodystrophy 315, 324, 497, 518
metachromatic 323, 527, 528, 542
Leukoencephalopathy 105, 174, 323, 325, 597
hereditary diffuse 236
posterior reversible 546
progressive multifocal 175, 298, 304, 324, 325, 495
Levocarnitine 542
Levodopa 230, 259, 261, 284
Lewy body 229, 245, 512
disease, Diffuse 259, 520, 521
Lhermitte's phenomenon 312
Lhermitte–Duclos disease 583
Limb girdle
muscular dystrophy 439, 447
diagnosis of 439, 441
existence of 441
pitfalls in diagnosis of 439
myasthenia 440
refractory 441
weakness 10, 374, 440f
Limbic encephalitis 355, 361363, 367, 367f, 368b
Line bisection test 510
Lipid disorders 445
Lipid-rich necrotic core 202
Lipohyalinosis 198
Lipomas 445
Lipoprotein
dyscrasias 542
receptor-related protein 4 427
Listeria 175
monocytogenes 467, 459
Lithium 248, 261, 284, 285
overdose 284
Liver 468
biopsy 292
dysfunction 525, 534
enzymes 464
function test 293, 596
abnormal 285
normal 473
Locked-in syndrome 35, 64
Longitudinally extensive
optic neuritis 342
spinal cord lesion 337, 341, 341t, 378f
transverse myelitis 330, 337, 340, 341, 341t, 342, 346
pitfalls in diagnosis of 337
Lorenzo's oil 528, 533
Low molecular weight heparin 636
Lowe syndrome 528
Lower cranial nerves palsy, clinical features of 419
Lower extremity pain 45, 50
causes of 45, 52t
pitfalls in diagnosis of 45
Lower limb, clinical picture of 47t
Lower motor neuron 62, 368, 373, 382, 408, 409
diseases 420
disorders 420, 430
syndromes 410, 411
hereditary 408
Lower uterine cesarean section 221
Low-intracranial pressure syndromes 116
Loxapine 284
L-tryptophan 285
Lubag's disease 245
Luciferase immunoprecipitation systems 418
Lumbar
canal stenosis 403
degenerative disease 62
disk disease 62
paraspinal muscle 60
plexopathy 46
puncture 39, 116, 221, 382, 478
scoliosis, degenerative 615f
segments 46
lesions of 48
spine 45, 47, 49, 50
stenosis, symptomatic 386
Lumbosacral plexopathy 403
inflammatory 403
Lumbosacral plexus, lesions of entire 48
Lyme disease 323325
Lyme polyradiculitis 384
Lymphadenopathy, generalized 500
Lymphocytes 469
Lymphogranuloma venereum 500
Lymphohistiocytosis, hemophagocytic 323, 335f
Lymphoma 48, 491, 494, 585
Lymphoproliferative disorder, post-transplant 585
Lysergic acid diethylamide 285
Lysosomal myopathy 445
M
Machine learning 180
Macroadenoma, pituitary 585
Magnesium supplements 56
Malabsorption syndrome 455
Manganese 233
transport disorder 236
Man-in-the-barrel syndrome 35
Mass lesion 258, 259
Maximum intensity projection 185
McArdle's disease 432, 447, 456
McDonald criteria 311, 312, 317
Medial medullary infarction 208
MEDNIK syndrome 291
Medullary syndrome, lateral 90
Medulloblastoma 335f, 583
Melioidosis 467
Membrane
postsynaptic 428f
protein
synaptobrevin-associated 410
vesicle-associated 410
Ménière's disease 214
Ménière's syndrome 88
Meningeal carcinomatosis 116
Meningeal signs 39, 491
Meningism 35, 37
Meningismus 312
Meningitis 37, 190, 459, 460, 463, 469, 470, 477
acute bacterial 477
bacterial 221, 467
carcinomatous 116, 491
chronic inflammatory 467, 470
neonatal 459, 460, 464
signs of 465
symptoms of 465
syphilitic 502
uncommon 467
viral 479
Meningococcal rash 37
Meningoencephalitis 35, 284, 467, 469, 470
viral 473
Meningomas 584
Meningomyelitis 467
Meningovascular syphilis 502
Menkes disease 291
Mental retardation 291
Meropenem 470
Metabolic disorders 523
Metabolism, inborn errors of 464
Meta-iodobenzylguanidine 231, 418
Metastasis 90, 116
Methanol 233
Methotrexate 221
toxicity 335f
Methyldopa 233
Methylprednisolone, intravenous 339, 357
Metoclopramide 233, 284
Mexiletine 248
Michigan neuropathy screening instrument 401
Microadenoma, pituitary 586
Micturition, urgency of 420
Midazolam 65
Midbrain lesions 37
Middle cerebral artery 183185, 185f, 186, 187, 477, 639, 640f, 642
Middle east respiratory syndrome 15
Migraine 76, 78, 79, 79t, 89, 89t, 167, 168t, 173, 174, 189, 324
allodynia 593
aura 193
childhood 90
chronic 78, 96
clustering of 94
diagnosis of 78
equivalents 132
hemiplegic 103, 104, 163
misdiagnosis of 75
pain, part of 77
pitfalls in diagnosis of 75, 76
side-locked 100, 100t
sporadic hemiplegic 103, 104
synonymous of 77
vestibular 218
with aura 107, 168
Milkmaid's grip 253
Millard–Gubler syndromes 196
Miller Fisher syndrome 302, 377, 383, 402
Mills' syndrome 413
Mini-mental state examination 15, 508
Minimus muscles 452f
Minipolymyoclonus 254
Missed cervical injury, pitfalls of 575
Mitochondrial diseases 323, 429, 538
Mitochondrial disorder 107, 323, 324, 334f, 497, 523, 527, 528, 540, 541
Mitochondrial encephalomyopathy 121, 535, 537
pitfalls in diagnosis of 535
with lactic acidosis and stroke syndrome 535, 536, 538
pathogenesis of 536fc
differential diagnoses of 540
Mitochondrial encephalopathy 190, 258, 489
differential diagnosis of 540b
with lactic acidosis and stroke syndrome, clinical manifestations of 538f
Mitochondrial myopathy 445, 447
Miyoshi myopathy 396
Molluscum contagiosum 500
Monoamine oxidase inhibitors 259, 285
Monoclonal protein 670
Monocular blindness
acute
persistent 548
transient 547
Monomelic amyotrophy 412
Mononeuritis multiplex 402, 499
Mononeuropathy 52t, 195, 402
Mood stabilizers 248
Morphine 65
Morvan syndrome 445
Motion, range of 593
Motor
axonal neuropathy, acute 377, 383
examination 38
function 36
sensory axonal neuropathy, acute 377, 383, 402
signs 48
unit action potential 444, 667
weakness, ascending 499
Motor neuron 375
disease 363, 368, 408, 409, 413, 420, 433, 444, 596
paraneoplastic 368b
pitfalls in diagnosis of 408
spectrum disorders 409t
Motor neuronopathy 499
subacute 364
syndrome 413
Motor neuropathy 60
distal 291
hereditary 396, 401
multifocal 388, 403, 410
Movement disorders 227, 244, 250, 251, 261, 267
childhood 249
functional 263, 264b
organic 266
paroxysmal 261
psychogenic hyperkinetic 260
Moyamoya disease 90, 542
Mucormycosis
rhinocerebral 117
rhino-orbital 117
Mucous membranes 37
Multifocal inflammatory demyelination, pathological abnormalities of 382
Multiple sclerosis 90, 258, 259, 302, 311, 311t, 312t, 314, 322, 326, 327t, 329t, 330, 337, 342, 342t, 414, 549, 554, 568, 588
clinical phenotypes of 314
diagnosis of 311b
misdiagnosis of 311b
pediatric 316, 316b
pitfalls in diagnosis of 311
primary progressive 315, 327, 409
secondary progressive 315
Multiple systemic atrophy 230, 233, 236, 237, 244, 409
Multisystem disorder, maternally inherited 537
Multisystem inflammatory syndrome 434
Muscle 373
biopsy 448
tissue, analysis of 441
diseases 430
inflammatory 403
disorders of 384
enzymes
normal levels of 456
pitfalls in interpretation of 446
hypertrophied 455
ipsilateral intrinsic 419
jaw closing 425
rigidity 285
specific tyrosine kinase 667
tone 36, 38
vasculitis of 361
wrong choice of 431
Muscular atrophy, progressive 396, 410
Musculoskeletal symptoms 445
Mutation 484
Mutism 283
Myasthenia 420
gravis 361363, 369, 409, 411, 421, 428f, 429, 430, 443, 562, 568, 667
diagnosis of 434t
juvenile 434
ocular 562
misdiagnosis of 436
oculobulbar 195
pediatric 434
seronegative 437
Myasthenic syndromes 441
congenital 434, 440, 667
Mycobacteria 446
Mycobacterium tuberculosis 338, 467, 478
Mycoplasma 258
pneumoniae 375
Mydriasis
isolated unilateral 559
painful 559
Myelin oligodendrocyte glycoprotein 13, 313, 314, 322, 330, 341, 359, 549, 596
antibody disease 337, 339, 342, 342t
Myelitis 9, 14, 378, 378
acute
disseminated transverse 342
flaccid 343
necrotizing 479, 480
infectious 343
paraneoplastic 345
partial 311, 337
rickettsial 343
transverse 311, 325, 326, 326t, 342, 378f
tuberculous transverse 479
viral 385
transverse 479
Myelopathic hand 594f
Myelopathy 315, 345, 414, 498
acute 384
compressive 378
extensive 341
hand 593, 594f
necrotizing 361
nutritional 414
partial 312
traumatic 345
Myocardial scintigraphy 418
Myoclonic epilepsy, juvenile 154
Myoclonic syndrome 161
Myoclonus 249, 259, 261, 285, 486
benign 132
functional 265
rhythmic 38
Myofascial pain syndrome 52, 562
development of 604
Myogenic potentials, vestibular-evoked 214
Myoglobin 284
Myokymia 249
Myopathy 59, 538
acute necrotizing 361, 363
antimicrotubular 445
endocrine 445
genetic 444, 455
idiopathic inflammatory 443, 444, 447, 448t, 449, 455
infective 443
metabolic 445, 447, 454, 455
myofibrillar 396
necrotizing 445
painful 52
Myorhythmia 242, 248, 369
Myositis
cancer associated 443
chameleons 449
infective 446
inflammatory 440
orbital 90, 117
overlap 443
Myotilinopathy 669
Myxedema coma 37
N
N-acetyl aspartate 496, 529
Nasal
congestion 82
intonation 420
regurgitation 420
Nasogastric tube 461
Nausea 626
absence of 79
Neck pain 77, 200, 592f
Necrotizing myopathy, immune-mediated 443, 448
Needle track marks 37
Neonatal intensive care unit 25, 125
Neonatal meningitis 459, 460, 464
diagnosis of 459, 465
treatment of 461
Neonatal seizures 125127, 128fc, 129
diagnosis of 127
etiology of 126f
Neonatal sepsis 461
prevention of 459
Neonatal sleep myoclonus, benign 126, 249
Neoplasias, extracerebral 221
Neoplasm 563
Neoplastic lesions 90
Neostigmine test 430t
Nephrotic syndrome 221
Nerve
biopsy 390, 391
conduction study 49, 52, 254, 368, 369, 374, 382, 394, 401, 409, 410, 444, 666
velocity 373, 397, 409
growth factor 400
muscle junction 427
roots 373, 663f
sheath tumors 584
ultrasound 398
vasculitis of 361
Nervous system 493
sexually transmitted diseases of 493
Neural origin, lower extremity pain of 45
Neuralgia
classical trigeminal 83
postherpes zoster 593
secondary 116
trigeminal 81, 84t, 116, 311, 312
Neuritis
brachial 263
traumatic 379
vestibular 208, 218
Neurocognitive disorder 496
diagnosis of 510
type of 507
Neurocognitive dysfunction
diagnosis of 508
major 508, 509
Neurocytoma, central 583
Neurodegeneration, beta-propeller protein-associated 236
Neurodegenerative diseases, rapidly progressive 518
Neurofascin 155 386
Neuroferritinopathy 236
Neurofibromatosis 323
Neurogenic disorders 437, 445, 455, 518
Neuroimmunological disorders 309
Neuroinfections 175, 324
Neurointensive care unit 656
Neuroleptic malignant syndrome 283, 284, 284t, 285t
mimic of 284t
pitfalls in diagnosis of 283
Neuroleptics 233, 261, 284
induced syndromes 284
Neurologic dysfunction, antibody-associated 353
Neurological deficits 104, 335f, 336f
Neurological disorder 493, 500
diagnosis of 9
Neurological syndrome, post-COVID-19 119
Neuroma, acoustic 116
Neurometabolic disorders 323, 324
Neuromuscular disorders 371
clinical manifestations of 427
Neuromuscular junction 361, 373, 420, 428f, 430, 666
disease 423
disorder 420, 422, 427, 429, 436
acquired 427b
diagnosis of 427
Neuromuscular paraneoplastic disorders 368
Neuromuscular weakness 9
Neuromyelitis optica 14, 329t, 330, 337, 468, 549, 589, 596
spectrum disorder 312, 317, 322, 331, 337, 338f, 339, 342, 342t
Neuromyopathy 10, 446
Neuromyotonia, acquired 363
Neuron
autonomic 417
diseases 416
Neuronal ceroid lipofuscinosis 528
Neuro-ophthalmologic disorders, pitfalls in diagnosis of 545
Neuro-ophthalmology, radiological pitfalls in 569
Neuropathy 291, 397, 400, 407, 417
acquired inflammatory 391
acute inflammatory demyelinating 377
alcoholic 403
autonomic 361, 407
cardiac autonomic 404
distal acquired symmetric 395
dysfunction score 401
entrapment 402, 402f
focal 407
hereditary 389, 396, 398
sensory autonomic 397, 399, 401
immune-mediated 410
multifocal 407
nonarteritic anterior ischemic 548
nondiabetic 407
obturator 51
paraproteinemic demyelinating 388
peripheral 323, 384, 401t, 420, 538
segmental 402f
sensorimotor 363, 402, 402f
spectrum of 499f
symptom score 401
symptomatic peripheral 400
vasculitic 389
Neurophysiology, interpretation of 398
Neuropsychological tests 509, 510
Neuroregressive syndrome 528
Neurosarcoidosis 116, 313, 323
Neurosyphilis 175, 261, 497, 501, 502, 503t
stages of 502t
Neutropenia 470
Next-generation sequencing 479
Niemann–Pick disease 236, 255, 298300
Nitric oxide 536, 542
synthase 536
N-methyl-D-aspartate receptor 355, 491
Nodule, subependymal 579
Nonastrocytic glial neoplasms 580
Nonconsensus transient ischemic attack 193
Nondeconvolution methods 186, 187
Nonepileptic disease 163
Noninflammatory muscular diseases 449
Noninvasive cerebellar stimulation 304
Non-neuroleptic drug-induced syndromes 284
Nonsteroidal anti-inflammatory drugs 54
Normothermia 66
Nuclear genes 540
Nucleic acid amplification tests 479
Numb chin syndrome 19
Nystagmus 174, 211, 568
convergence-retraction 38
downbeat 38, 413
gaze-evoked 205, 218
head-shaking 208
periodic alternating 38, 208
rebound 38
spontaneous 218
upbeat 38
O
O'Sullivan–McLeod syndrome 413
Obstructive sleep apnea 116, 351
Occipital horn syndrome 291
Occupational therapy 533
Ocular disorders 194
Ocular motility disorders 37, 416, 560
Ocular motor palsy 20
Oculomotor abnormality 236
Oculomotor nerve 37
Olanzapine 233, 284
Oligoclonal band 327, 590
Oligodendroglioma 580
Onconeural antibody 363b
Opercular syndrome 425
Ophthalmoparesis, acute 377
Ophthalmoplegia 374, 563, 641f
chronic progressive external 563
complete 312
progressive external 429
Opiates 285, 369
Opsoclonus 38
myoclonus syndrome 259, 299, 302, 363
Optic atrophy 106, 548, 555
Optic disk, swelling of 549f
Optic nerve 13f
sheath meningioma 554, 556
Optic neuritis 117, 311, 322, 325, 342, 361, 363, 370, 549, 549t, 554, 568, 596
bilateral 312
unilateral 312
Optic neuropathy 551
glaucomatous 551t
nonglaucomatous 551t
Optic perineuritis 551
Optical coherence tomography 550
Orbital roof, perforating injury of 575f
Orbits 13f
Organ
donation 72
failures 27
transplantation 470
Organomegaly 388, 670
Orofacial dyskinesia 261
Oropharyngolaryngeal symptoms 164
Orthostatic hypotension, symptoms of 404
Orthostatic tachycardia syndrome 116
Osmotic demyelination syndrome 233
Owl eye appearance 344
Oxygen deprivation 259
P
Pachymeningitis
chronic 473f
idiopathic hypertrophic 116
PAID syndrome 260
Pain 47
localization of 84
ocular 90, 90f
pelvic 48
radicular 48
Pallid syncopal attacks 134
Pallor 549f
Panayiotopoulos syndrome 164, 165, 167, 169
Pancoast tumor 593
Pan-sacral plexopathy, clinical features of 48
Pantothenate kinase 236
Papilledema 37, 116, 557
localizing value of 20
Parainfectious syndromes 261
Paralysis 130, 373
familial periodic 445
hypokalemic 379
Paramedian pontine reticular formation 211
Paraneoplastic antineuronal antibodies 362t
Paraneoplastic cerebellar degeneration 298, 299, 303, 362, 364, 365, 365b, 365f
prognosis in 365
treatment in 365
Paraneoplastic encephalomyelitis 362, 364
prognosis in 364
treatment in 364
Paraneoplastic motor neuron
disease 368b
syndrome 364, 368, 368b
Paraneoplastic neurological syndrome 361, 361t, 362b, 363, 363b, 363t, 364, 365
diagnosis of 361, 363
Paraneoplastic peripheral nervous system disorder 369b
Paraneoplastic syndrome 361b, 362b, 456
clinical 369fc
immune-mediated 361
Paraparesis, hereditary spastic 315, 414, 415
Paraproteinemia 401
Parasites 446
Parasomnias 132
Paraspinous tissue, posterior 651f
Paratonia 659
Parenteral nutrition, total 461, 671
Parieto-occipital atrophy, bilateral 517f
Parkinson's disease 55, 229, 231, 233, 233t, 234, 240, 242, 425, 512
diagnosis of 229, 230
idiopathic 229
spasticity, X-linked 236
Parkinsonian pyramidal syndromes 236
Parkinsonism
atypical 232, 233t, 236
hyperpyrexia syndrome 284, 285
Paroxysmal positional vertigo, benign 213, 218, 599
Paroxysmal torticollis 162
benign 132
Paroxysmal vertigo, benign 132
Paroxysmia, vestibular 219
Parsonage–Turner syndrome 398, 412, 449, 593
Patent foramen ovale 627
Patrikios' variant 412
Pediatric head injuries, pitfalls of 576
Pelizaeus–Merzbacher disease, diagnosis of 260
Pelvic muscles 452f
Penicillamine treatment 430
Pentamidine 248
Percheron artery 204
Perimesencephalic cistern 648f
Periodic acid–Schiff 640
Periodic paralysis spectrum disorders 411
Peripheral nerve 373
damage 400
hyperexcitability 361
Peripheral nervous system 398, 525
disorder of 43
paraneoplastic disorders of 369t
Perisylvian atrophy 516f
Peroneal nerve 51, 59
Peroneal neuropathy 51, 58
Peroxisomal disorders 525, 527, 528b
pitfalls in diagnosis of 525
Peroxisome biogenesis disorder 525, 526f
Perphenazine 284
Perthes' disease 379
Pes cavus 106, 397f
Peutz–Jeghers syndrome 555
PEX genes, dysfunctions of 534
Phantoms spikes 138
Pharyngeal-cervical-brachial syndrome 377
Phenelzine 284
Phenobarbitone 131
Phenomenology 252
Phenylalanine hydroxylase 160
Phenytoin 65
Pheochromocytoma 116, 284
Phonophobia 78
absence of 79
Photophobia 78
absence of 79
Picture naming test 507
Pineoblastoma 583
Pineocytoma 583
Pinpoint pupils 37
Plantar
reflex 48
responses 36
Plasma
cell
proliferative disorder 388
rich inflammatory infiltrate 664f
exchange 356, 365
glucose 565
Plasmacytoid dendritic cells 447
Plasmacytoma 90
Platelet emboli 547
Plexopathy
acute painless ischemic lumbosacral 48
postpartum lumbosacral 48
radiation-induced 48
Plexus neuropathy, hereditary brachial 398
Pneumocephalus 574f
Pneumonia 518
POEMS syndrome 50, 389
Polioclastic viruses 479
Poliomyelitis 378
acute anterior 384
vaccine-associated paralytic 375
Polyarteritis nodosa 499
Polycystic ovarian syndrome 623
Polyglucosan body disease, adult 414
Polymerase chain reaction 40, 109, 339, 356, 378, 460, 664
reverse transcription 9
Polymyalgia rheumatica 6, 456
Polymyositis 443
Polyneuritis cranialis 377
Polyneuropathy 50, 236, 388, 402, 670
acute inflammatory demyelinating 6, 401, 402, 409, 412
chronic inflammatory demyelinating 394, 395, 401403, 407, 409, 410, 499, 661, 670
demyelinating 499
distal symmetrical 406, 407
painful 50
Polyradiculoneuropathy
acute 361
inflammatory demyelinating 325, 382, 499
chronic
idiopathic demyelinating 444
inflammatory demyelinating 382, 386, 387t, 390t, 440, 445
disease, chronic inflammatory demyelinating 395
lumbosacral 499
therapy, chronic inflammatory demyelinating 388
Polyradiculopathy, acute inflammatory demyelinating 394
Polyunsaturated fatty acids 525
Pompe disease 439, 447, 455
Pontine
lesions 37
paramedian penetrators 207
warning syndrome 207
Porphyria, acute intermittent 384
Positron emission tomography 486, 487
Post-coronary artery bypass graft 42
Posterior circulation stroke 204, 206, 209, 562
pitfalls in diagnosis of 204
syndromes 206t
Posterior cortical atrophy 517f, 518
syndrome 520
Posterior inferior cerebellar artery 207, 208, 627
infarction 186f
Posterior reversible encephalopathy syndrome 35, 39, 116, 173, 189, 190, 324, 628, 629, 631b, 634
Post-polio syndrome 411
Poststroke recrudescence 176, 195
Postsynaptic muscle membrane 427
Prader–Willi syndrome 528
Pregabalin 376
Pregnancy 258
Pressure palsy 389
Presynaptic disorder 430
Presyncope 139
Primary progressive aphasia 485, 515, 515t, 516
semantic variant of 516
Primary progressive multiple sclerosis 315, 327, 409
diagnosis of 315b
Prion diseases 484, 485
diagnosis of 484
Procainamide 248
Prochlorperazine 284
Progressive disease 513
Promazine 284
Promethazine 284
Prophylaxis, postexposure 473
Propofol 65
Prostigmine test 430
Prostrate 48
Prothrombin time 526
Proximal muscle weakness, causes of 444t
Pseudoaneurysm 639f
Pseudoarthrosis 604, 613, 614f
Pseudo-bitemporal defect 559
Pseudo-coma 35
Pseudodementia 510, 519
depressive 519
Pseudodepression 520
Pseudodystonia 254
Pseudomeningocele 603
Pseudomonas 459
Pseudopapilledema 557
Pseudoparalysis, causes of 379
Pseudopolyneuritic variant 412
Pseudo-pseudodementia 520
Pseudo-subarachnoid hemorrhage pattern, causes of 649b
Pseudotumor, orbital 561, 566
Psoas abscess 48
Psychiatric
disorder 115, 264
illnesses 538
medications 533
symptoms 323
Psychogenic movement disorder 263, 273, 273t
pitfalls in diagnosis of 263
Psychosis, functional 30
Psychostimulants 261
Ptosis 561f, 641f
evaluation 560
painful 561
painless 562
Puerperium 221
Pulse oximetry 650
Pupil size
and reactivity 37
asymmetry of 37
Pupillary defect, relative afferent 551, 554
Pupillary disorders 559
Purine metabolism disorders 445
Purkinje cell 251
dysfunction 251
Pyramidal signs 486
Pyramidal tract involvement 411, 527
Pyruvate dehydrogenase deficiency 107
Q
Quadrigeminal cistern 22f, 238f, 634f
Quadriparesis 200
Quetiapine 284
R
Rabbit syndrome 248
Rabies 284, 338, 467
encephalitis, diagnosis of 473
meningoencephalitis 473
paralytic 373
Raccoon eye 37
Radermecker complexes 155
Radial pulses 200
Radiation 200
plexopathy 593
Radical mastectomy, modified 365
Radiculomyelopathy 378
Radiculopathy 47t
compressive 46
lumbosacral 449
multiple 21
Radiculoplexoneuropathy 402
lumbosacral 389
Radiculoplexopathy, lumbosacral 48
Radiculoplexus neuropathy
diabetic 407
lumbosacral 49, 50t
Radiologically isolated syndrome 315
Radionuclide scanning 67
Raeder's paratrigeminal syndrome 21
Rankin scale, modified 637
Rapid eye movement 229, 355
behavior disorder 243
sleep 87
Rapid plasma reagin test 502
Rectum 48
Recurrent laryngeal nerve
lesion of 419
supplies 419
Reflex 48
anoxic seizures 132, 134
oculocephalic 38
spinal 67
Refsum's disease 298, 299, 301
adult 525
classical 528
infantile 525
Renal disease, end-stage 657
Renal failure 259, 284
Renal function tests 468
Repetitive nerve stimulation 369, 374, 666
test 411, 429, 430, 434, 562
Reserpine 233, 284
Respiratory patterns 36, 37
Restless legs syndrome 55, 261, 403
Resuscitation, cardiopulmonary 42
Retina 500
Retinal ganglion cells 90
Retinal nerve fiber layer 550
Retinitis pigmentosa 525, 528
Retinopathy 37, 361, 445
paraneoplastic 370
venous stasis 547
Rett syndrome 163
Reversible cerebral vasoconstriction syndrome 116, 117, 174, 190, 634
Rhabdomyolysis, recurrent 456
Rheumatoid
atlantoaxial dislocation 592f
factor 59
Rhinorrhea 82
Rhizomelic chondrodysplasia punctata 525, 528
Rhombencephalitis 364
Rhythmic electrical discharge, subclinical 146
Rhythmic temporal theta discharges 146
Riboflavin 541
Ribonucleic acid 304
Richmond agitation sedation scale 28, 29fc
Rifampicin 479
Risperidone 233, 284
Rituximab 365, 438
Rolandic epilepsy 164, 165, 167, 169
Rosette-forming glioneuronal tumor 583
Rostral ventrolateral medulla 627
Rotator cuff injury 593
Rubella 528
S
Sacral plexus, lesions of 48
Salbutamol 248
Salicylate poisoning 284
Salivatory nucleus, superior 90
Salmeterol 248
Salmonella typhi 446
Sandhoff disease 555
Sandifer syndrome 132, 162
Sarcoglycanopathy 669
Sarcoidosis 258, 259, 323, 338, 468
Sarcoma 48
Scalp hematoma 574, 574f, 575f
Schistosoma 343
Schistosomiasis 338
Schwannoma, vestibular 584
Sciatic nerve, anatomy of 57f
Sciatic neuropathy 50
Scleritis, posterior 117
Scleroderma 258
Sclerosing panencephalitis, subacute 155, 259, 323325
Sclerosis, primary lateral 63, 315, 414, 415
Scotoma, bilateral centrocecal 558
Scrub typhus 338, 467
Sedative hypnotic drugs 284
Seesaw nystagmus 38
Seizure 9, 14, 125, 166, 173, 249, 464
acute symptomatic 14, 126
anoxic epileptic 135
disorder 131
epileptic 130
generalized tonic-clonic 135
focal 131, 158, 162, 194
generalized tonic-clonic 289
intraictal 189
myoclonic 127
neonatal 125127, 128fc, 129
nonconvulsive 30
occipital 168, 168t
partial 151, 152, 162
postictal 189
psychogenic nonepileptic 130, 132, 273, 273t
remote secondary 126
tonic 127
type 127
unprovoked 126
Selective serotonin
receptor inhibitors 6, 133, 244, 290
uptake inhibitors 285
Sellar neoplasms 585
Semicircular canal 217, 578
Sensorimotor
chronic symmetrical 403
neuropathy, acute 363
Sensorium, altered 285
Sensory
abnormality 378
area 47
examinations 59
impairments 27
level 374, 380
lower limb 374
motor peripheral neuropathy, subacute 361
nerve action potential 49, 383, 405
neuronopathy 361
subacute 363, 364
neuropathy 396, 401, 407
nucleus 424
phenomenon 130
polyneuropathy 401t
signs 48
Sepsis 35, 173, 284, 464
neonatal 461
Septum pellucidum 636f
Serologic tests 503
Serotonin
norepinephrine reuptake inhibitors 259, 285
syndrome 259, 284, 285b, 285t
Serum glutamic
oxaloacetic transaminase 526
pyruvic transaminase 526
Serum neurofilament light chain 234
Severe acute respiratory syndrome-related coronavirus
diagnosis of 14
infection 434
Sexually transmitted
disease 493, 500
infection 493
Shock
electric 259
hypovolemic 469
Short segment transverse myelitis 337, 342
Short tau inversion recovery 49, 659
Short toe, extensor of 59
Short-lasting neuralgiform headache 82
attacks 83, 84t, 85, 92, 96
Short-lasting trigeminal autonomic cephalalgias, pitfalls in diagnosis of 81
Shoulder capsulitis 593
Shunt, ventriculoperitoneal 643
Sickle cell disease 542
Siderosis, superficial 298, 299, 304
Sigmoid sinus 222f
Single fiber electromyography 429
Sinonasal neuroendocrine carcinoma 584
Sinus, superior sagittal 223
Sinusitis 90
Sixth nerve palsy, bilateral 564
Sjögren's syndrome 338, 362
Skew deviation 38
Skin 37, 670
Sleep
behavior disorder 229, 516
benign epileptiform transients of 136
electroencephalogram 156f
myoclonus, neonatal 132
Slimmer's palsy 58
Slow channel syndrome 667
Small cell lung cancer 355, 362, 364, 365
Smooth muscle
actin 640
layer 640f
Snake-eye signs 413
Somatic symptom disorder 274
Somatoform conversion disorder 519
Sparling maneuver 592
Spasmus nutans 250
Spastic quadriparesis, mild 592f
Spectrum disorder 468
Speech 133
apraxia of 420
arrest 164, 167
telegraphic 515
therapy 426
Sphenoid sinusitis 116
Sphenopalatine ganglion 90
Spheroid 236
Spider
envenomation 284
nevi 37
Spina bifida 379f
Spinal arteriovenous malformations 344
Spinal artery, posterior 339
Spinal cord 348, 477, 479, 651f
bacterial infections of 479
infarct 344f
injury 660
lesion 22, 337
signs of 23
Spinal meningitis 479
Spinal muscular atrophy 408, 439, 441
Spinal nerves 46
Spinal subarachnoid space 349f
Spinal tenderness 374
Spine 374, 377f, 651f
disease, degenerative 339, 345
lumbosacral 651f
surgery syndrome 605
Spinobulbar muscular atrophy 410
Spinocerebellar degeneration 414
Splenial lesion 532f
Splenic injury 574f
Spondylodiscitis 608f
Spondylolisthesis 615f
degenerative 609f
Spondylotic myelopathy 345
Spontaneous episodic vestibular syndrome 174, 216
Sporadic sleep spikes, benign 138, 146
Staphylococcus aureus 446, 480
Startle disease 259
Static encephalopathy 236
Status dystonicus 259
Status epilepticus 30, 628, 630
electrical 151, 152
nonconvulsive 39, 284, 628, 629
refractory 359
Stenosis
measurement of 201
midbasilar 620f
overestimation of 201
severe 183
Steroid 221, 473
induced myopathy 447
pulse therapy 418
responsive encephalopathy 298, 299, 303, 351
role of 461
Stiff–Person disorders 261
Stiff–Person syndrome 355, 361, 363, 366, 366b
prognosis of 367
treatment of 367
Strabismus 568
Straight leg raising test 374
Streptococcus pneumonia 175, 467
Striatopathy, diabetic 258
Stridor 261
Stroke 9, 11, 34, 173, 174f, 201, 258, 259, 323, 540b
acute 186, 201
ischemic 189
arterial ischemic 624
cerebellar 218, 219
chameleon 173, 178, 179
clinical features of 494
diagnosis of 12, 180
etiology of 183
hemorrhagic 258
ischemic 12, 35, 116, 258, 494
lacunar 196, 198
like episodes 121, 323
mimics 173, 174, 176, 177, 179
ocular 548
ischemic 200
pitfalls in diagnosis of 173
risk of 208
Strychnine poisoning 284
Sturge–Weber syndrome 105
Subarachnoid space 651, 656f
opacification of 649f
Subcortical infarcts 105, 174, 325, 326
Subependymoma 581
Substantia nigra 229, 233
SUNCT syndrome 82, 89
Supranuclear palsy, progressive 230, 233, 236, 237, 259, 437, 514, 563
Surgery 48
neurological 221
Susac's syndrome 548
Swelling
hyperemic 553
orbital 638f
Swollen disks, pitfalls in diagnosis of 57
Sydenham chorea 258, 261
Synaptic antibody-mediated autoimmune encephalitis 355f
Syncope 132, 139, 167, 173, 194
cardiogenic 135
neurally mediated 132
neurocardiogenic 132
Syndrome of inappropriate secretion of antidiuretic hormone 351
Syphilis 486, 491, 494, 500
Syringobulbia 411
Syringomyelia 414
multisegmental 411
Systemic inflammatory disorders 338, 342
Systemic lupus erythematosus 116, 258, 323, 324, 336f, 339, 401
neuropsychiatric 255, 261
T
Tabes dorsalis 497, 502
Tachycardia 283
postural orthostatic 177
Takayasu's arteritis 200
Takayasu's disease 202
Tangier's disease 23
Tardive dyskinesia 284
Tarsal tunnel syndrome 51
Telangiectasia, circumpapillary 553
Tendon reflexes 36, 280
Testes 48
Tetanus 261, 284
Tetrabenazine 233, 284
Tetrahydrobiopterin 250
Thalamic lesions 37
Therapeutic paradox 292
Thigh muscles 452f, 454f
Thioridazine 284
Thiothixene 284
Third nerve palsy, painful progressive 562
Thoracic radiculopathy, diabetic 407
Thrombectomy
endovascular 637
mechanical 201
Thrombolysis
intravenous 176
safety of 176
Thrombotic thrombocytopenic purpura 37
Thyroglobulin 261, 297
Thyroid
autoantibodies 518
disorder 429
functions 486
hormones 261
ophthalmopathy 566
peroxidase antibody 486, 487
stimulating hormone 401
Thyroperoxidase 261, 297
Thyrotoxicosis 284
Tic 132
disorders 260
Tinel's sign 51, 62, 593
Tolcapone 284
Tolosa–Hunt syndrome 563
Tongue 419
muscle, tone of 421
Tonic pupil, chronic tension-type 560
Toxic acute vestibular syndrome 216
Toxic encephalopathy 259
Toxic myelopathy 344
Toxic myopathy 373, 445
Toxic neuropathy 373
Toxins 299, 302
Toxoplasma 474
gondii 446
Toxoplasmosis 233, 258, 495, 528
Transcranial Doppler 66, 67, 642, 651
Transcranial magnetic stimulation 411
Transient global amnesia 179, 194
Transient ischemic attack 108, 193, 196, 247, 621
chameleons 195
mimics 193
pitfalls in diagnosis of 193
Trauma 48
Traumatic brain injury 573
minor 578
pitfalls in assessment of 573
Tremor 241, 242, 261, 283
action 241
cerebellar 247
classification 241
essential 241245, 247
evaluation of 248
functional 242, 244, 248, 264
intention 242
isometric 241
kinetic 241
metabolic 250
neuropathic 244, 247
orthostatic 241, 247
palatal 247
Parkinson's disease 243
parkinsonian 247
paroxysmal 248
post-traumatic 250
postural 284
psychogenic 250, 562
rest 241
syndromes 242, 244
isolated 242, 244
synopsis of 247
task-specific 247
unusual drug-induced 248
voice 243, 248
withdrawal 248
Trendelenburg gait 279
Treponema pallidum 338, 493, 501
hemagglutination assay 498
particle agglutination assay 498
Trichinella spiralis 446
Tricyclic antidepressant 244, 259, 285
Trifluoperazine 284
Triggered episodic vestibular syndrome 174
Trimipramine 284
Triphasic waves 41
Triptans 285
Tuberculoma 258, 477, 480
Tuberculosis 109, 233, 261, 324, 339, 373, 474, 477
spinal meningitis 478
Tuberculous bacilli 471
Tuberculous meningitis 472, 477, 494
pitfalls in diagnosis of 478
Tuberous sclerosis complex 583
Tumefactive demyelination 316, 325, 336f
Tumor 51, 56, 369, 355
association and immune response 365, 367, 370
dysembryoplastic neuroepithelial 579, 582, 583
glioneuronal 582
histiocytic 585
intraocular 117
multinodular 583
neuronal 582
pineal parenchymal 583
pineal region 583
pituitary 90, 116
primitive neuroectodermal 339
recurrence 48
rhabdoid 581
solid 324
solitary fibrous 584
Twilight hysteria 519
U
Uhthoff's phenomenon 312
Ulcerative colitis 633
Uniform Determination of Death Act 64
Unterberger test 281
Upper motor neuron 59, 368, 373, 408, 409, 479
diseases 420
disorders 420
facial palsy 109
Uremia 50
Urinary catheters 27
Urinary tract infection 518
Usher syndrome 528
Uveitis 117, 361
V
Vaginalitis, destructive 198
Valproate 233
Valproic acid 248, 261
Valsalva heart rate 397
Varicella zoster 467, 494
virus 84, 175, 233, 375, 473
Vascular cognitive
disorder 521
impairment 520
Vascular diseases 105
Vascular endothelial growth factor 670
Vascular lower extremity pain 54
Vascular parkinsonism 233, 517
Vascular vis-à-vis neurogenic claudication 45
Vasculitis 190, 323, 362, 491
necrotizing 499
systemic 221
Vasovagal syncope
diagnosis of 133
infantile 134
Vecuronium 65
Venereal disease research laboratory 297, 502, 503
Ventricular drain, external 642, 656
Verapamil 233
Verbal learning test 508, 509
Verbatim test 510
Vertebral artery 204, 207, 620f
Vertebral diseases 542
Vertebrobasilar arterial system 205f
Vertebrobasilar transient ischemic attack 207
Vertigo 173, 174, 200, 214, 599
acute prolonged 208
central paroxysmal positional 216
cluster 88
peripheral originating 215t
pitfalls in diagnosis of 219
transient 194
isolated 213fc
Vestibular syndrome, acute 6, 174, 178, 205, 208
Vestibulo-ocular
reflex 212f
response 280
Vestibulopathy, bilateral 280
Vidarabine 248
Virchow–Robin spaces 198
Vision, impairment of 546b
Visual analog scale 98
Visual aura 168t
Visual difficulty, progressive 559
Visual disturbances 469, 486
Visual evoked potential 312, 526, 549, 596
Visual field defect 568
unusual 558
Visual hallucination 20, 166, 168, 517
Visual loss 545
acute 547, 568
pitfalls in diagnosis of 557
progression of 551
sequential 552
sudden transient bilateral 168
unexplained 545, 558
Visual obscuration 312
Visuo-constructional functions 508
Visuospatial functions 508
Vitamin
B complex 542
deficiency 315, 324
levels 486
C 56, 542
D 56, 518
deficiency 445, 455
D3 therapy 454
E 542
deficiency 298300
Vocal cord paralysis 410
Voice
change, symptoms of 376
fatigability of 421
Voltage-gated
calcium channel 362, 427, 428f
potassium channel 351, 355, 367
complex 445
sodium channels 162
Vomiting 626
Vulpian–Bernhardt syndrome 411
W
Waardenburg syndrome 528
Wartenberg's reflexes 593
Wasted leg syndrome 412
Weakness
acute onset 373
jaw closing 423
progressive 662, 666
Wegener's granulomatosis 90, 663, 665
Weil–Felix test 286
Wernicke's encephalopathy 39, 298, 299, 302, 518, 567
West Nile virus 233, 338, 343, 378, 384
West syndrome 151, 160, 162
Westphal variant 289
Whipple's disease 260, 261, 369, 491
White blood cell 49, 314, 377, 461, 462
raised 285
White matter
hyperintensities 513
lesions 116
predominant cerebral edema 629
Wild polio virus 378
Willis–Ekbom disease 55
Wilson's disease 245, 261, 288, 293t, 298, 323, 518
pitfalls in diagnosis of 288
seizures in 289
Wolfram syndrome 555
X
Xanthoastrocytoma, pleomorphic 579
Xanthomatosis, cerebrotendinous 236, 298, 299, 301
X-linked adrenoleukodystrophy 414, 525, 528, 529f, 532f, 533t, 542
differential diagnosis of 533
X-linked disorder 530
Z
Zellweger spectrum disorder 525, 526f
Zellweger syndrome 525, 534
Ziehl–Neelsen stain 478
Ziprasidone 284
Zygomycetes 470
×
Chapter Notes

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Pitfalls in The Diagnosis of Neurological Disorders
Pitfalls in The Diagnosis of Neurological Disorders
Editor Ambar Chakravarty Honorary Professor and Emeritus Consultant Department of Neurology Vivekananda Institute of Medical Science Kolkata, West Bengal, India Past President Indian Academy of Neurology (2005–2006) Foreword Robert C Griggs
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Pitfalls in the Diagnosis of Neurological Disorders/ Ambar Chakravarty
First Edition: 2022
9789354656668
Printed at:
The Surviving members and Departed souls of the
Batch of 1965
MEDICAL COLLEGE BENGAL
Estd. 1835
Tribute to My Revered Teacher on his Birth Centenary
Professor Shyamal Kumar Sen MD FRCP
(1922–2011)
Contributors
EDITOR
CO-EDITOR
SECTION EDITORS: CRITICAL CARE NEUROLOGY
CONTRIBUTING AUTHORS
FOREWORD
All physicians make mistakes. During their early training, mistakes are, thankfully, prevented by more senior trainees or by an experienced supervisor. But when one has become senior oneself, who will let her/him know that she/he is making an error? Thankfully, most of my errors were either unimportant or soon became obvious to me. But not all. The skilled clinician should learn humility from the errors she/he makes. And errors should become “the teachable moment” that enables you to let others learn how to avoid not just the same error but other similar errors. Many experienced clinical neurologists develop their own “rules for avoiding an incorrect diagnosis.” Some of these neurologists share these rules with their students, but only a few remarkable teachers share their experience with a wider audience. Professor Chakravarty is one of the few. I first met Professor Chakravarty in Calcutta, India, in 1997 when I participated in a Teaching Program organized by him and Bangalore, India, in 2006, when I was his guest during his Presidency of the Indian Academy of Neurology. We were able to spend sufficient time together for me to learn that he was a charismatic leader and a highly experienced clinician. I was recently privileged to read his 2021 Neurology & Internal Medicine—A Case Based Study . That volume as well as this new text on “Pitfalls in Diagnosis” reflects his stellar ability to present and discuss interesting cases that illustrate crucial diagnostic insights.
This compendium of challenging diseases and errors to be wary of will help the careful reader to identify diagnostic “traps” where either physical findings or a coincidental (and incidental, irrelevant) condition can mislead the less experienced clinician. Read and pay attention to this book carefully! The errors you will learn about may help you save your peace of mind and your reputation. More importantly, it may keep you from harming one of your patients.
The topics covered by this book include challenging problems in the diagnosis of common diseases such as headache, multiple sclerosis, stroke, and equally challenging problems in recognizing rare disorders. One of the most illuminating discussions is that of the other diagnosis to consider when one has the results of cervical spine imaging suggesting that there could be spinal cord compression and that there is most certainly evidence that the neural foramina are comprised I have had over 50+ years’ experience seeing patients who had cervical spine operations for spinal cord and spinal root compression, but who then did not improve or stabilize with surgery. They subsequently proved to have ALS, MS, or another disease. This experience trained me to be suspicious of allowing imaging findings to dictate treatment. One rule I developed that served me well was “Never order a neuro-diagnostic test until you have decided what you are looking for…and if you find something unexpected consider the possibility that it's an incidental finding”—“an incidentaloma.” The discussion of the many disorders that can misled the unwary is a valuable resource for the clinician who should be hoping to avoid an unnecessary operation. This topic is just one of many “pitfalls” this useful resource will help avoid. Give it your serious attention!
Robert C Griggs MD FAAN (Honorary)
Professor of Neurology, Medicine, Pathology and Laboratory
Medicine, and Pediatrics and the Center for Health + Technology
Chair of Neurology (1986–2008) Emeritus
University of Rochester Medical Center, New York, USA
PREFACE
Like all human beings, doctors too are not immune from making mistakes—mistakes not only in making a diagnosis or missing a diagnosis but also in providing appropriate therapeutic care to his/her patients. Although making the correct diagnosis is the most fundamental step in providing appropriate medical care, the overall rate of diagnostic errors in medical practice all over the world may be as high as 15–20% or may be higher in countries with limited recourses. Advances in medical technology have not solved the problem of diagnostic error in medicine, as seen by autopsy studies. Diagnostic error continues to be a widespread problem and may affect hundreds of people across the globe. Diagnostic error is more difficult to define than other types of medical errors. The majority of diagnostic errors is due to cognitive errors by physicians, particularly in synthesizing the available information to identify the correct diagnosis. And this is particularly evident in neurological practice even in the current days of sophisticated technological support. It is indeed true that all these facilities are not universally available and even if available, would prove to be very expensive to common people. The problem arises when such modern supportive measures are not appropriately used to solve a clinical problem or the results provided are misinterpreted. A recent US National Academy of Medicine report defines a diagnostic error as the failure to establish an accurate and timely explanation of the patient's health problem(s) or communicate that explanation to the patients. It emphasizes that improving diagnosis is not only possible but also represents a moral, professional, and public health imperative. Therefore, it is crucial to identify causes of diagnostic error and define strategies to improve diagnostic accuracy to achieve a better clinical outcome. And this is exactly what had been attempted in this volume. An all-round attempt had been made to discuss the diagnostic strategies to a host of common and uncommon problems encountered in neurological practice, both in a clinic setting and in the setting of an intensive care unit. Such diagnostic processes would be critically evaluated to find lacunae or areas where an average clinician would be apt to make a mistake and means to avoid making such mistakes would be highlighted, on many occasions with the help of illustrative case studies. A total of over 50 such clinical problems have been identified which would be discussed in the light of the issues raised above, by several renowned clinicians both from India and abroad. In the process, over 100 authentic clinical cases have been discussed highlighting issues pertaining to arriving at the correct diagnosis and avoiding pitfalls. Many chapters would be followed by Editorial notes and Appendices on some key issues relating to diagnostic pathways, again at times with the help of illustrative case studies. This volume, most certainly, is much different from the standard neurological differential diagnosis texts available in the market.
Since 2018, with the help from some of my colleagues and friends both in India and abroad, I have been able to write, edit, and publish as many as five books, three of which happened to be entirely case-based studies (headache disorders, vertigo and dizziness, and the most recent one dealing with problems lying in the interface of neurology and internal medicine) and the other two (clinical neuro-ophthalmology and mimics of epileptic seizures) also contained several illustrative cases. Having received some educational grants, it was possible to distribute all these five books free of any cost to every member of the Indian Academy of Neurology and to all trainees in neurology in every teaching institute of the country. The feedbacks received had really been very encouraging.
My deepest gratitude goes to Professor Robert C Griggs of University of Rochester, New York, USA, for kindly writing the Foreword of the book and reviewing a few sections. I am privileged to have a fairly long association with him spanning several years.
I also would like to thank profusely the contributing authors, some of whom are world-renowned authorities, for kindly writing for this volume in the midst of their numerous commitments. Special mention needs to be made of Drs Sarosh M Katrak, Satish V Khadilkar, Sanjib Sinha, Subhash Kaul, Sangeeta Ravat, Joy D Desai, Sulalyan Purkayastha, and Sandip Chatterjee for their contributions. Drs Venkatesh Aiyagari and Bappaditya Ray of the University of Texas South Western Medical Center, Dallas, Texas, USA, deserve very special thanks for their hard work in compiling the section on Critical Care Neurology comprising 15 very interesting cases, all being discussed in an interactive manner. My longtime younger colleagues Drs Angshuman Mukherjee, Debasish Roy, and Amit Halder had always remained by my side, helping me whenever needed.
I am indebted to the publishers for their cooperation in bringing out the book in time even in the midst of the pandemic. I would like to especially thank Mr Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director) and Mr MS Mani (Group President) from Jaypee Brothers Medical Publishers (P) Ltd . I would also like to extend my thanks to Dr Richa Saxena (Associate Director-Professional Publishing), Ms Pooja Bhandari (Production Head), Mr Sabyasachi Hazra (Senior Business Manager, Publishing), and Ms Ritu Kumari (Development Editor).
Last, I wish and pray that the book becomes really useful to all those for whom it had been written !
Ambar Chakravarty
May 2022