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Metastatic Disease and the Nervous System

The entire nervous system is potentially vulnerable to metastatic disease, typically occurring in the setting of a known disseminated systemic malignancy. Approximately 45 percent of patients with systemic cancer and neurologic deficits are found to have metastatic involvement of the nervous system. The most common cancer-related neurologic diagnosis is brain metastasis (16%), followed by bone metastasis (10%) and epidural metastasis (9%). The incidence of metastatic involvement…

Neurologic Manifestations of Hematologic Disorders

Anemia Iron-Deficiency Anemia Nonspecific neurologic symptoms of tiredness, fatigue, weakness, poor concentration, irritability, faintness, dizziness, tinnitus, and headache are commonly associated with anemia. Occasionally, more concrete neurologic syndromes arise, such as the association of both idiopathic intracranial hypertension and cerebral venous sinus thrombosis with iron-deficiency anemia. The intracranial hypertension may resolve and recur with resolution and recurrence of the iron-deficiency anemia. In some patients with iron-deficiency…

Neuro-Ophthalmology in Medicine

Perhaps more than any other realm of neurology, neuro-ophthalmologic disorders require a systematic approach that emphasizes precise localization guided by the patient’s history followed by confirmation with specific examination maneuvers. To this end, the neurologist should be familiar with specialized techniques concerning fundus examination, eye movements and alignment, and pupillary assessment in order to examine patients properly and guide their evaluation. Afferent Visual Disturbances Afferent neuro-ophthalmologic…

Otoneurologic Manifestations of Otologic and Systemic Disease

Neurologic Manifestations of Otologic Disease Complications of Middle Ear Pathology Intracranial complications occur in 0.25 to 0.5 percent of all cases of otitis media. The mortality rate of intracranial complications has decreased dramatically over the last century, from approximately 90 percent in the preantibiotic era to 10 percent now. However, significant morbidity still exists despite this improvement in survival. Diagnosis of an intracranial complication of otitis…

The Skin and Neurologic Disease

This chapter provides an overview of disorders that have both neurologic and cutaneous manifestations, the latter often reducing what would have been a broad differential diagnosis into a single entity. Because the emphasis is on diagnosis by a neurologist, the presentation is organized around familiar neurologic syndromes rather than pathologic or dermatologic entities. This approach is complementary to those based on traditional pathophysiologic categories, such as…

Sex Hormone, Pituitary, Parathyroid, and Adrenal Disorders and the Nervous System

The most common endocrine disorders causing neurologic disease are thyroid disease and diabetes mellitus, which are addressed in Chapter 18, Chapter 19 . Nevertheless, sex hormone, pituitary, parathyroid, and adrenal disorders may have important neurologic implications or consequences and are therefore reviewed here, with emphasis on features relevant to neurologic practice. Sex Hormones and the Nervous System The effects of sex steroids on neurologic function in…

Diabetes and the Nervous System

Both type 1 and type 2 diabetes mellitus commonly target the nervous system. In the peripheral nervous system, complications include polyneuropathies and focal neuropathies. In the central nervous system (CNS), diabetes may be associated with cognitive decline, leukoencephalopathy, and heightened risk of both stroke and dementia. Acute changes in blood glucose levels are also associated with neurologic signs and symptoms. This chapter summarizes the acute and…

Thyroid Disease and the Nervous System

Disorders of the thyroid gland are common and arefrequently accompanied by neurologic complications. Prevalence estimations have suggested that 1 to 2 percent of general medical, geriatric, and psychiatric inpatients have some form of thyroid disease. Neurologists should be aware of the common and the more unusual neurologic complications of thyroid disease, since they may be the presenting feature of the thyroid disorder and because they are…

Neurologic Complications of Electrolyte Disturbances

Electrolyte disturbances are frequent and associated with a variety of central and peripheral neurologic manifestations. Electrolyte disturbances are usually secondary processes related to a primary metabolic or endocrine disorder. Effective management requires prompt identification and treatment of the underlying primary disorder, and correction of the electrolyte abnormality. Neurologic consequences of electrolyte disorders are usually functional rather than structural. Consequently, the neurologic manifestations of electrolyte disturbances are…

Neurologic Dysfunction and Kidney Disease

The neurologic aspects of renal disease and the neurologic complications of dialysis and renal transplantation are discussed in this chapter. The neurologic complications of renal carcinoma are not considered, but paraneoplastic complications of malignancy are considered in Chapter 27 , and the neurologic consequences of radiation and chemotherapy in Chapter 28 . The subject itself is complicated because many of the causes of renal failure lead…

Neurologic Manifestations of Nutritional Disorders

Maintenance of medical and neurologic health requires adequate ingestion, absorption, and storage of vitamins and minerals. Nutritional deficiencies may result from inadequate intake or malabsorption of critical vitamins and micronutrients. Individuals at risk for deficient nutrient intake include the impoverished in developed and underdeveloped countries (where certain nutritional disorders may be endemic), individuals with eating disorders or engaging in fad or restrictive diets, those suffering from…

Disturbances of Gastrointestinal Motility and the Nervous System

Interactions Between the Extrinsic Nervous System and the Gut The major functions of the gastrointestinal tract (motor, fluid and electrolyte transport, secretory, storage, and excretory functions) result from an intricately balanced series of control mechanisms ( Fig. 14-1 ): the electrical and contractile properties of the smooth muscle cell that result from transmembrane fluxes of ions. Control is by the enteric nervous system through chemical transmitters…

Other Neurologic Disorders Associated with Gastrointestinal Disease

The presence of gastrointestinal (GI) dysfunction in the setting of neurologic disease has received increasing attention in recent years, particularly in disorders such as Parkinson disease. Much less attention has been devoted to the occurrence of neurologic dysfunction in primary GI disease processes. The enteric nervous system (ENS), which lines virtually the entire GI tract, contains approximately the same number of neurons as the spinal cord…

Hepatic and Pancreatic Encephalopathy

Hepatic Encephalopathy Definition The term hepatic encephalopathy (HE) refers to any type of cerebral dysfunction that is due to liver insufficiency and/or portosystemic shunting and is detectable by clinical, neuropsychologic, or neurophysiologic means. Three types of HE are differentiated based on the underlying cause: type A occurs in patients with acute liver failure (ALF), type B in patients with portosystemic shunting in the absence of liver…

Stroke as a Complication of General Medical Disorders

Stroke broadly describes the sudden onset of neurologic dysfunction due to an abnormality of blood supply to the brain, retina, or spinal cord. Ischemic stroke makes up the majority of all strokes and is often considered synonymous with stroke although the definition extends to intracerebral hemorrhage, cerebral venous sinus thrombosis, subarachnoid hemorrhage, and retinal and spinal ischemia. In a 2013 update from the American Heart Association…

Cardiac Manifestations of Acute Neurologic Lesions

Cardiac abnormalities are common after acute neurologic injury. Disturbances can range in severity from transient electrocardiographic (ECG) abnormalities to profound myocardial injury and dysfunction. Evidence from animal models and clinical observations indicate that the central nervous system (CNS) is involved in the generation of cardiac arrhythmias and dysfunction even in an otherwise normal myocardium. Neurologic lesions may influence cardiovascular function and affect cardiac prognosis, and—in addition—the…

Neurologic Complications of Cardiac Arrest

Despite advances in the management of cardiac arrest, patients continue to have high mortality, exceeding 90 percent. Following the return of spontaneous circulation, dysfunction of multiple organ systems along with a systemic inflammatory response, collectively termed the “post-arrest syndrome,” can lead to substantial morbidity. The diagnosis of primary hypoxic-ischemic brain injury and the prevention of secondary neurologic injury are the primary goals of early management. Persistence…