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Pediatric Neurology

Normal Neurologic Growth and Development 1. In addition to the routine questions asked during a neurologic interview, what additional questions are important for a complete pediatric neurology history? Antenatal history and risk factors Perinatal history and risk factors Neonatal history and complications History of developmental milestones 2. List important features of the physical examination of infants and young children that may not be included in the…

Pain Processing and Modulation

1. How is pain defined? In 1994, thought leaders in the International Association for the Study of Pain defined pain as follows: “An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms as such.” 2. Can pain occur without tissue injury or impending tissue damage? Yes. While pain most commonly starts with a noxious or injuring stimulus, it may…

Infectious Diseases of the Nervous System

Cerebrospinal Fluid 1. What is the normal composition of cerebrospinal fluid (CSF)? See Table 25-1 . Table 25-1 Normal Composition of Cerebrospinal Fluid (CSF) From Irani DN: Cerebrospinal Fluid in Clinical Practice . Philadelphia, Elsevier, 2009. Opening Pressure WBC RBC Protein Glucose 8-15 mm Hg or 100-180 mm H 2 O 0-5/mm 3 0/mm 3 15-45 mg/dL 45-80 mg/dL WBC, White blood cells; RBC, red blood…

Neurologic Complications of Systemic Disease

Cardiac Disease 1. What is the major neurologic complication of cardiac disease? Stroke is the most common neurologic sequela of cardiac disease. The risks for embolic, thrombotic, and hemorrhagic strokes are elevated in the presence of cardiac disease. Nonvalvular atrial fibrillation, followed by ischemic heart disease and valvular heart disease, is the most common type of cardiac abnormality causing embolic ischemic strokes. Infective endocarditis is frequently…

Sleep Disorders

General Principles 1. What is sleep? Sleep is a dynamic physiologic process that affects physical, emotional, cognitive, and social development; however, the exact mechanisms that occur during sleep are not fully understood. The sleep cycle consists of an alternating pattern of nonrapid eye movement (NREM) sleep and rapid eye movement (REM) sleep at 50- to 60-minute intervals during the first year of age, which gradually increases…

Seizures and Epilepsy

Acknowledgments The authors wish to thank Philip Kurle, MD, and Paul Rutecki, MD, for coauthoring the previous version of this chapter in Neurology Secrets. Description and Classification 1. What is the etymology of epilepsy ? Epilepsy comes from the Greek “epi” meaning “upon,” and lambanein meaning to “take hold of.” 2. What is a seizure and what is epilepsy ? A seizure is a single event…

Headaches

General Principles 1. What is the prevalence of headaches? Having had any type of headache is a near universal experience, with a lifetime prevalence of 90% and a 1-year prevalence of over 50% (migraine 12% and tension type 38%). Migraine is the third most prevalent disorder and seventh highest specific cause of disability worldwide. Approximately 90% of headaches in patients with a normal neurologic examination are…

Neuro-Oncology

Acknowledgment The author would like to acknowledge the contributions of Yvonne Kew, MD, who was the author of this chapter in the previous edition. Primary Brain Tumors 1. How are brain tumors classified? Unlike most other malignant cancers, which are classified by the TNM (tumor size, lymph nodes, and metastasis) system, tumors arising from the central nervous system (CNS) are classified into four grades according to…

Neurocritical Care

Introduction 1. What is neurocritical care? Neurocritical care is a branch of critical care medicine that deals with the intensive care management of patients with life-threatening disorders due to either neurologic and neurosurgical illnesses or other systemic diseases affecting the central nervous system (CNS), the peripheral nervous system, or both. Neurocritical care provides the interface between the brain and other organ systems in the setting of…

Cerebrovascular Disease

Stroke Basics 1. What is a stroke? Stroke is a focal disturbance of blood flow into or out of the brain, either primarily ischemic (87%) or hemorrhagic (13%). Stroke is not a single disease but the end result of many different pathophysiologies leading to cerebrovascular occlusion or rupture. The key clinical feature of a stroke is very rapid symptom onset : “it hit me like a…

Neuropsychiatry and Behavioral Neurology

Acknowledgments The authors would like to acknowledge the contributions of Heike Schmolck, MD, PhD, and Salah Qureshi, MD, who contributed to this chapter in previous editions. Memory and Amnesia 1. What are the different stages of fact-based memory storage, such as recalling a list of words? Clinically, memory can be conceptualized in a three-stage model. Registration (sensory) memory holds large amounts of incoming information briefly in…

Alzheimer’s Disease and Mild Cognitive Impairment

General Considerations 1. How is dementia defined? How do definitions vary? Dementia is generally regarded as an acquired loss of cognitive function due to an abnormal brain condition. The National Institutes of Health criteria (formerly the National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer’s Disease and Related Disorders Association or NINCDS-ADRDA criteria) for the diagnosis of Alzheimer’s disease (AD) stressed that there must be progressive…

Demyelinating and Autoimmune Diseases

Diseases of Myelin 1. What is myelin? Myelin is the proteolipid membrane that ensheathes and surrounds nerve axons to improve their ability to conduct electrical action potentials. Oligodendrocytes make central nervous system myelin and wrap the myelin around axons, leaving gaps called nodes of Ranvier , where membrane ionic channels are heavily concentrated and powerful action potentials can thus be generated. 2. How does demyelination cause…

Movement Disorders

Tremors 1. What is essential tremor (ET)? ET is a neurologic disease characterized by action tremor of the hands in the absence of any identifiable causes, such as drugs or toxins. Other types of tremors, such as isolated head and voice tremors, are also expressions of ET. It is estimated that ET affects at least 5 million Americans. Characterized by action-postural tremor of the hands and…

Brain Stem Disease

Clinical Anatomy of the Brain stem 1. What is the functional importance of the brain stem? The brain stem is a small, narrow region connecting the spinal cord with the diencephalon and cerebrum. It lies ventral to the cerebellum, which it links via the cerebellar peduncles. Its functions are critical to survival. The brain stem is densely packed with many vital structures such as long ascending…