Clinical Vignette A 22-year-old previously healthy woman developed slurred speech, difficulty walking, and hand tremors over the course of 1 month after a severe psychologic trauma. She had mild neck pain and took cyclobenzaprine without benefit. She denied any history…
Clinical Vignette A 31-year-old woman had the spontaneous onset of a relatively mild horizontal (“no-no”) head tremor. She had no family history of neurologic disorders. This tremor was initially inconsequential but it gradually increased in severity. Turning her head to…
Atypical parkinsonian syndromes, previously called Parkinson-plus syndromes, are chronic, progressive neurodegenerative disorders characterized by rapidly evolving parkinsonism in association with other signs of neurologic dysfunction beyond the spectrum of idiopathic Parkinson disease (PD). These include early dementia, postural instability, supranuclear…
Clinical Vignette This 64-year-old auto mechanic noticed intermittent tremor in his right hand while working. His wife reported he was not swinging his right arm when walking, and she was also observing tremor in his right hand when they were…
The diagnosis and management of dementia in older adults presents major challenges to the clinician and to society at large. The age-related increase in prevalence of dementia combined with increasing life expectancy is expected to result in a worldwide epidemic…
Clinical Vignette A 19-year-old woman is brought to the emergency room after she experiences her first ever generalized seizure. An unenhanced brain computed tomography (CT) and basic blood work are normal. She is initially drowsy and disoriented but gradually awakens,…
This chapter is an overview of the examination of higher cortical function as it relates to cortical anatomy and associated functions. Detailed anatomic drawings of the cerebral cortex are provided for one's review while reading this chapter. By the end…
Primary sleep disorders, such as sleep apnea syndrome, narcolepsy, periodic limb movements (PLMs), and rapid eye movement (REM) behavior disorder, are common and often underdiagnosed. These conditions result in excessive daytime sleepiness (EDS) and/or disrupted sleep, may have a profound…
Epilepsy is generally defined as an illness of recurrent seizures. The prevalence of epilepsy is estimated at 1 in 200 persons. It affects all ages and is generally a chronic problem with significant personal, social, and economic impact, often affecting…
Clinical Vignette Tracy, a 65-year-old right-hand–dominant receptionist is referred to orthopedic surgery for right carpal tunnel release following progressively worsening pain and paresthesia in her right hand. Surgery is performed under conscious sedation without complications, and the patient is discharged…