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The following organizations provide patients and their families with educational, legal, medical, and personal assistance. Some of them also provide educational materials for physicians. General Resources American Academy of Neurology Neurology: Official Journal of the American Academy of Neurology www.neurology.org National Institutes of Health www.nih.gov National Institutes of Health Clinical Trials: www.ClinicalTrials.gov Acquired Immune Deficiency Syndrome Gay Men's Health Crisis www.gmhc.org Alzheimer Disease Alzheimer's Association…

Following the classification of the American Academy of Neurology, one of many neurologists distinguish mild traumatic brain injury (TBI ) from severe TBI . They define mild TBI as “a trauma-induced alteration in mental status that may or may not involve loss of consciousness.” They expect the altered mental status to consist of confusion and amnesia lasting seconds to minutes. Often substituting the everyday word concussion…

Neurologists have traditionally attributed neurologic symptoms and signs to lesions in particular areas of the central nervous system (CNS) or peripheral nervous system (PNS), and have used imaging studies, such as computed tomography (CT) and magnetic resonance imaging (MRI), to confirm their clinical localization. Another way to envision neurologic illnesses is in terms of disruption of neurotransmitters. This chapter reviews the synthesis, metabolism, and anatomic pathways…

Lumbar Puncture Neurologists often obtain cerebrospinal fluid (CSF) by performing a lumbar puncture (LP), one of the oldest neurologic tests still in use. Analysis of CSF can be very helpful, if not diagnostic, in many situations. When patients have at least two elements of the relatively common triad of headache, fever, and nuchal rigidity, neurologists usually perform an LP to check for meningitis, subarachnoid hemorrhage, or…

With their unpredictable onset and frequently tragic course, brain tumors command unique attention. Moreover, they seem to arise in children and adults in the prime of their life. Because brain tumors may produce neuropsychological changes without any accompanying physical symptoms, they occasionally mimic psychiatric disturbances. Types of Brain Tumors Primary Brain Tumors Tumors may arise from the tissues of the brain or spinal cord ( parenchyma…

Involuntary movement disorders occur frequently and typically cause serious disabilities. Moreover, some of these disorders produce dementia and various psychiatric symptoms that routinely precede or overshadow the movements, but others produce neither psychiatric nor cognitive impairment despite profound physical disability. Abnormalities of the basal ganglia underlie the classic movement disorders: Parkinson disease, athetosis, chorea, hemiballismus, Huntington disease, and generalized dystonia. In contrast, for several other disorders—including…

Neurologists describe sleep and its components, variations, abnormalities, and response to treatment through the lens of the polysomnogram (PSG) . Although the clinical manifestations of sleep disorders remain paramount, the PSG provides a unique physiologic correlate for most of those defined in the Diagnostic and Statistical Manual of Mental Disorder, 5th Edition (DSM-5) . In sleeping individuals, the full PSG simultaneously records: Cerebral activity through several…

Whatever its underlying psychology, sexual function depends on two complex and delicate neurologic pathways: (1) a connection between the brain and the genitals and (2) a reflex loop between the genitals and spinal cord. Both involve the central nervous system (CNS), peripheral nervous system (PNS), and autonomic nervous system (ANS). In the pathway between the brain and the genitals, the brain converts various stimuli, including sleep-related…

Multiple sclerosis (MS) is the most common disabling neurologic illness of North American and European young and middle-aged adults. It is also the primary example of a central nervous system (CNS) autoimmune demyelinating illness. Neurologists base their diagnosis on the McDonald criteria , which were first published in 2011 and modified most recently in 2017 and named for the senior member of an international panel, Dr.…

Chronic pain is a complex, endless disturbance with unique qualities and psychiatric comorbidities. Traditional medical approaches to chronic pain emphasized diagnosis, distinguished between its psychologic and physiologic components, and sought its eradication. Currently, multidisciplinary pain teams focus on symptomatic management, reducing pain’s affective component (suffering), and restoring function. These teams see their role as pain management without holding out the expectation that they will eliminate pain.…

Many perinatal cerebral injuries, brain malformations, and genetic mutations create distinctive and life-long neurologic, neuropsychologic, and physical impairments. Although usually apparent in infancy, some of these disorders do not become evident until childhood or adolescence. One explanation for the delay is that the time course of cerebral myelination, which begins in the third trimester of gestation and spreads from the brainstem to the cortex, is incomplete…

This chapter describes several common visual disturbances that frequently occur in psychiatric patients, including decreased visual acuity, glaucoma, visual field loss, and visual hallucinations ( Box 12.1 ). In addition, it reviews the causes of visual impairments that may have psychiatric effects in individuals older than 65 years ( Box 12.2 ). Box 12.1 Common Neurologic Causes of Visual Hallucinations Blindness/sensory deprivation—Charles Bonnet syndrome Palinopsia Dementia-producing…

Transient ischemic attacks ( TIAs ) and strokes cause readily recognizable constellations of transient or permanent neurologic deficits. Psychiatrists should recognize their physical and neuropsychologic manifestations, including amnesia, depression, and altered level of consciousness. Psychiatrists should also distinguish TIAs and strokes from conditions that produce similar clinical manifestations, including seizures and brain tumors. Finally, like all physicians, psychiatrists must recognize the signs of acute stroke so…

Neurologists define a seizure as a transient occurrence of signs and/or symptoms—commonly abnormal movements and/or changes in behavior—due to abnormal excessive or synchronous neuronal activity in the brain. They define epilepsy as the tendency to have recurrent unprovoked seizures. They typically diagnose epilepsy after two unprovoked seizures more than 24 hours apart; however, they occasionally diagnose epilepsy after a single unprovoked seizure in patients who are…

Neurologists generally follow the International Headache Society’s (IHS) classification that recognizes three major headache categories. Primary Headaches include tension-type , migraine , and cluster headaches . Although not life-threatening, they may create excruciating pain, incapacitate patients, and reduce a patient’s quality of life. Neurologists diagnose them not by physical findings or laboratory tests, which are characteristically normal, but by their distinctive symptoms. Secondary Headaches , in…

Since the inception of the discipline of neurology in the 19th century, neurologists have studied language, language impairment ( aphasia ), and related disorders to deduce how the normal brain functions and to advance the study of neurolinguistics. In practice, they test for language-related disorders, often striking in their presentation, to help localize and diagnose neurologic disease. Aphasia appears prominently in many neurologic and psychiatric disorders…

Physicians have long used the term dementia to define a progressive decline in cognitive function that impairs daily activities. Criteria for this diagnosis include memory impairment plus one or more of the following: aphasia, apraxia, agnosia, or disturbance in executive function (see Chapter 8 ). Because this definition requires deficits in at least two domains, it excludes both isolated amnesia (Greek, forgetfulness) and aphasia (Greek, speechlessness)…