EMERGENCY NEUROLOGY

Description

Preface Contents Contributors 1: Headache in the Emergency Department Introduction Epidemiology Pathophysiology Clinical Features History of Trauma Fever or Known Infection Immunocompromised (HIV or Immunosuppression) Concurrent Headache in Close Friends, Family, or Coworkers History of Cancer Pregnancy Visual Loss Headache Induced by Valsalva Maneuver Pupillary Abnormalities Red Flags Approach to Diagnosis Labs and Imaging Serologic Testing ECG Computed Tomography of the Head Lumbar Puncture MRI Vascular Imaging Differential Diagnosis Primary Headaches Migraine Tension-Type Headache Cluster Headache and Other Trigeminal Autonomic Cephalalgias Cluster Headache Paroxysmal Hemicrania Short-Lasting Unilateral Neuralgiform Headache Attacks with Conjunctival Injection and Tearing/Cranial Autonomic Features (SUNCT/SUNA) Hemicrania Continua Benign Cough Headache Benign Sexual or Orgasmic Headache Primary (Benign) Exertional Headache Secondary Headaches Subarachnoid Hemorrhage Other Intracranial Hemorrhage Cerebral Venous Thrombosis Meningitis Cervicocephalic Dissection Ischemic Stroke Reversible Cerebral Vasoconstriction Syndrome Headache Related to Spontaneous Spinal Cerebrospinal Fluid Leak Hypertensive Crisis and PRES Pituitary Apoplexy Idiopathic Intracranial Hypertension Headache Attributed to Traumatic Injury to the Head (Post Traumatic Headache) Third Ventricular Colloid Cyst Trigeminal Neuralgia Glaucoma General Approach to the Management of Primary Headache in the Emergency Department Protocols for Acute Treatment of Migraine in the Emergency Department Migraine-Specific Agents Sumatriptan (5HT 1B/D/F Receptor Agonist) Dihydroergotamine Antidopaminergic Agents Prochlorperazine Chlorpromazine Haloperidol Droperidol Metoclopramide Sodium Valproate Magnesium Sulfate Nonsteroidal Analgesics Corticosteroids Opioids Greater Occipital Nerve Blocks Cluster Headache Treatment Oxygen Sumatriptan Dihydroergotamine Corticosteroids Greater Occipital Nerve Blocks Special Circumstance: Treatment of Headache in the Pregnant Patient References 2: Low Back Pain Emergencies Introduction Epidemiology Clinical Features and Evaluation History Physical Examination General Observation Regional Back Examination Screening Tests for Lumbar Radiculopathy Straight Leg Raising (Lasègue) Test Kernig Sign Seated Straight Leg Raising Reverse Straight Leg Raising Test Patrick or FABER Test Neurological Examination Motor Function Reflexes Sensation Gait Rectal Exam Diagnosis Imaging Studies Plain Radiography Advanced Imaging Studies Computed Tomography Magnetic Resonance Imaging Differential Diagnosis Vertebral Infection Vertebral Osteomyelitis Epidural Abscess Tumors Spinal Cord and Cauda Equina Compression Vascular Disorders: Thoracic Aortic Dissection and Abdominal Aortic Aneurysms Thoracic Aortic Dissection Abdominal Aortic Aneurysm Spondylotic Low Back Pain Emergencies Traumatic Lower Spine Emergencies Conclusions References 3: Dizziness and Vertigo Presentations in the Emergency Department Introduction Evaluation of Emergency Presentations Step 1: Determine if the Dizziness Is the Principal Symptom as Opposed to a Minor Accompanying Symptom Step 2: Define the Characteristics of the Dizziness Symptom Step 3: Perform a General Neurological Examination Step 4: Perform a Neuro-otologic Assessment Step 5: Formulate the Differential Diagnosis Acute Severe Prolonged Vertigo Recurrent Spontaneous Attacks of Vertigo Recurrent Positionally Triggered Attacks of Vertigo Other Dizziness Symptoms and Presentations Management of Emergency Presentations Imaging Studies in Emergency Presentations Conclusion References (Original List) Additional Reference List 4: Syncope Causes Disorders of Vascular Tone or Blood Volume Neurocardiogenic (Vasovagal and Vasodepressor) Syncope Syncope with Normal Heart and ECG and Without Prodrome Postural (Orthostatic) Hypotension Carotid Sinus Hypersensitivity Situational Syncope Glossopharyngeal Neuralgia Cardiovascular Disorders Arrhythmias Structural Disorders Cerebrovascular Disease Differential Diagnosis Anxiety Attacks and the Hyperventilation Syndrome Seizures Hypoglycemia Acute Hemorrhage Hysterical Fainting Approach to the Patient Diagnostic Tests Treatment Further Reading 5: Acute Visual Loss Introduction The Neuro-ophthalmologic Examination in the Emergency Department Visual Acuity Color Vision Visual Fields Examination of the Pupils Eye Movements Ocular Examination and Funduscopic Examination Where Is the Lesion? Ocular Causes of Acute Vision Loss: What the Neurologist Should Know Painful Red Eye with Vision Loss Vision Loss with an Abnormal Retina Optic Neuropathies Inflammatory Optic Neuropathy (Optic Neuritis) Ischemic Optic Neuropathy Traumatic Optic Neuropathy Compressive Optic Neuropathy Acute Bilateral Optic Neuropathies Bilateral Optic Disc Edema Binocular Vision Loss from Chiasmal Lesions Binocular Vision Loss from Retrochiasmal Lesions Transient Visual Loss Monocular Transient Visual Loss Ocular Causes of Monocular Transient Visual Loss Mechanisms of Vascular Transient Monocular Visual Loss Binocular Transient Visual Loss Migrainous Visual Aura Occipital Seizures Occipital Transient Ischemic Attack Posterior Reversible Encephalopathy Syndrome Conclusion References 6: Diplopia, Third Nerve Palsies, and Sixth Nerve Palsies Introduction Epidemiology Third Nerve Sixth Nerve Pathophysiology and Anatomy Third Nerve Sixth Nerve Clinical Features Third Nerve General Clinical Appearance PCom Aneurysm Brainstem Stroke Uncal Herniation Meningitis Pituitary Apoplexy Infectious Orbital and Cavernous Sinus Disease Giant Cell Arteritis Sixth Nerve General Clinical Appearance Brainstem Stroke Wernicke Encephalopathy Meningitis and Alterations in Intracranial Pressure Pituitary Apoplexy Infectious Orbital and Cavernous Sinus Disease Giant Cell Arteritis Diagnosis Third Nerve Microvascular Head Trauma Sixth Nerve Microvascular Head Trauma Treatment and Prognosis Third Nerve Sixth Nerve Conclusion References 7: Facial Nerve Palsy Introduction Epidemiology Facial Nerve Anatomy Pathophysiology and Pathogenesis Clinical Presentation Diagnosis Management and Treatment Conclusion References 8: Evaluation and Management of Acute Ischemic Stroke Introduction Epidemiology Etiology and Classification Pathophysiology Clinical Presentation Large Artery Syndromes Brainstem Stroke Syndromes Midbrain Infarction (Weber Syndrome, Claude Syndrome) Lateral Medullary Infarction (Wallenberg Syndrome) Lacunar Stroke Syndromes Pure Motor, Pure Sensory, and Motor-Sensory Syndromes Dysarthria Clumsy Hand Ataxia Hemiparesis Acute Treatment Prehospital Care Reperfusion Therapy Alteplase Tenecteplase Mechanical Thrombectomy 0–6 Hours 6–24 Hours and Perfusion Imaging Early Supportive Care Blood Pressure Early Dual-Antiplatelet Therapy in Minor Stroke or High-Risk TIA References 9: Intracerebral Hemorrhage Introduction Epidemiology Risk Factors Prognosis Pathophysiology Clinical Presentation and Diagnosis Management of Intracerebral Hemorrhage Blood Pressure Coagulopathy Non-vitamin K Oral Anticoagulants Antiplatelet Agents Intensive Care Management: Intracranial Pressure Intensive Care Management: Fever, Glucose, and Deep Venous Thrombosis Prophylaxis Traditional Open Surgery Minimally Invasive Surgery Conclusion References 10: Seizures and Status Epilepticus Introduction Seizures Diagnostic Testing Therapy Status Epilepticus (SE) Definitions Epidemiology Etiology Pathophysiology Systemic Changes with Status Epilepticus and Complications Clinical Presentation Convulsive Status Epilepticus Nonconvulsive Status Epilepticus New-Onset Refractory Status Epilepticus (NORSE) Investigations in Patients with Status Epilepticus Management Prehospital Management [43] Management in the Emergency Department and Intensive Care Unit Pharmacotherapy of Status Epilepticus Management of Refractory Status Epilepticus Prognosis Summary References 11: Central Nervous System Infections Meningitis Viral Meningitis Bacterial Meningitis Aseptic Meningitis Lyme Disease Tuberculous Meningitis Differential Diagnosis Initial Management Neuroimaging Spinal Fluid Analysis Therapy of Bacterial Meningitis Therapy of Viral Meningitis Therapy of Lyme Disease Meningitis Therapy of Syphilitic Meningitis Encephalitis Herpes Simplex Virus-1 Mosquito-Borne Viruses Varicella Zoster Virus Tick-Borne Bacterial Infections Epstein–Barr Virus Rabies Differential Diagnosis Initial Management Diagnosis Serology Neuroimaging Herpes Simplex Virus-1 Mosquito-Borne Virus Varicella Zoster Virus JC Virus Spinal Fluid Analysis Herpes Simplex Virus-1 Mosquito-Borne Viruses Tick-Borne Bacterial Infections Varicella Zoster Virus Pitfalls Pearl Therapy Parainfectious or Postinfectious Encephalitis Infectious Mass Lesions Spinal Epidural Abscess References 12: Guillain-Barré Syndrome History and Epidemiology Geographic Variability Infections Vaccines Other Triggers Pathogenesis Molecular Mimicry Pathology Anti-ganglioside Antibodies Clinical Features Clinical Variants Acute Inflammatory Demyelinating Polyradiculoneuropathy (AIDP) Acute Motor Axonal Neuropathy (AMAN) and Acute Motor and Sensory Axonal Neuropathy (AMSAN) Miller Fisher Syndrome and Related Disorders Pharyngeal-Cervical-Brachial Variant Guillain-Barré Syndrome in Children Prognosis Localization and Differential Diagnosis Diagnostic Evaluation Cerebrospinal Fluid Electrophysiology Imaging Treatment Plasma Exchange Intravenous Immunoglobulin (IVIG) Nonresponders Treatment-Related Fluctuations Emerging Therapies Supportive Care and Symptomatic Treatment Respiratory Autonomic Dysfunction Pain Mobility and Physical Therapy Conclusion References 13: Spinal Cord Compression and Myelopathies Pathophysiology Differential Diagnosis Structural Vascular Demyelinating Disease Infectious Inflammatory Toxic/Metabolic Iatrogenic Neoplastic and Paraneoplastic Alternate Localizations Epidemiology Demographics and Other Risk Factors Clinical Features Syndromes Brown-Séquard Syndrome Anterior Cord Syndrome Central Cord Syndrome Posterior Cord Syndrome Conus Medullaris Syndrome Complete Cord Syndrome Symptoms Time Course Diagnosis Spine MRI CSF Examination Brain MRI Blood/Serology Blood/Others Other Imaging Studies Treatment Compressive Vascular Approach to Suspected Inflammatory and Other Myelopathies Conclusion References 14: Movement Disorder Emergencies Introduction Acute Parkinsonism Structural Toxic Impaired Levodopa Absorption Iatrogenic Infection Surgery Acute Genetic Parkinsonism Severe or Acute Levodopa-Induced Dyskinesias Acute Behavioral Change in Parkinsonism: Psychosis, Delirium, and Panic Attack Psychosis Panic Delirium Suicide Inspiratory Stridor in Multiple System Atrophy Acute Dystonic Reaction Status Dystonicus Stiff Person Syndrome Hemiballism and Hemichorea References New References 15: Encephalopathy Introduction Epidemiology of Toxic-Metabolic Encephalopathy Pathophysiology of Toxic-Metabolic Encephalopathy Clinical Features of Toxic-Metabolic Encephalopathy Diagnosis of Toxic-Metabolic Encephalopathy Encephalopathic Syndromes Encephalopathy from Basic Metabolic Disorder or Deficiency Oxygen, Glucose, and Electrolytes Thiamine Deficiency (Wernicke’s Encephalopathy) Encephalopathy Due to Severe Systemic Illness or Organ Failure Severe Systemic Illness and Septic Encephalopathy Hepatic Encephalopathy Uremic Encephalopathy Pancreatic Encephalopathy Fat Embolism Medication-Related Encephalopathy Ifosfamide Cefepime Encephalopathies Diagnosed Primarily by Brain Imaging Findings Posterior Reversible Encephalopathy Syndrome Metronidazole Encephalopathy Splenial High-Signal Lesion Treatment of Patients with Encephalopathy Conclusion References 16: Acute Respiratory Failure in Neuromuscular Disorders Overview Epidemiology Pathophysiology Clinical Presentation Diagnosis Differential Diagnosis of Neuromuscular Disorder Treatment Prevention Specific Neuromuscular Conditions Commonly Associated with Respiratory Failure Late-Onset or Adult-Onset Acid Maltase Deficiency Myasthenia Gravis Clinical Features Diagnosis Antibodies EMG (Electrophysiological Testing) Prognosis Treatment Plasma Exchange High-Dose IVIg Corticosteroids Cholinesterase Inhibitors Thymectomy Alternative Immunosuppressive Drug Therapy Complement Inhibitors Rituximab Drugs to Avoid Miscellaneous Myasthenia Issues Lambert-Eaton Syndrome Amyotrophic Lateral Sclerosis Botulism Classic Botulism Clinical Features Diagnosis Management Clinical Course Infant Botulism Wound Botulism Hypokalemic Periodic Paralysis Thyrotoxic Periodic Paralysis (TPP) Tick Paralysis Clinical Features Diagnostic Studies Treatment Subtypes of Tick Paralysis Conclusion References 17: Coma, Disorders of Consciousness, and Brain Death Introduction Mimics of Disorders of Consciousness Anatomy and Pathophysiology of Disorders of Consciousness Arousal Systems Brainstem Arousal Systems Thalamic Arousal Systems Hypothalamic and Basal Forebrain Arousal Systems Approach to Patient Presenting with Acute Coma Etiologies of Acute Coma A Systematic Clinical Approach to the Patient Presenting with Acute Coma Initial Diagnostic Tests Further Testing Management of Cerebral Herniation Complete Neurological Assessment of the Comatose Patient Prognostication in Chronic Disorders of Consciousness Treatment of Chronic Disorders of Consciousness Pharmacological Intervention Non-pharmacological Intervention Brain Death Clinical Determination of Brain Death/Death by Neurological Criteria Proposed Brain Death Protocol Blood Flow Studies Electrophysiologic Studies References 18: Neurotoxicology Emergencies Toxin-Induced Hyperthermic Syndromes General Considerations Serotonin Syndrome Introduction Epidemiology Pathophysiology Clinical Features/Diagnosis Differential Diagnosis Treatment Neuroleptic Malignant Syndrome Introduction Epidemiology Pathophysiology Clinical Features/Diagnosis Differential Diagnosis Treatment Malignant Hyperthermia Introduction Epidemiology Pathophysiology Clinical Features/Diagnosis Differential Diagnosis Treatment Toxin-Induced Cerebrovascular Events General Considerations Cocaine Introduction Epidemiology Pathophysiology Clinical Features/Diagnosis Differential Diagnosis Treatment Amphetamines Introduction Epidemiology Pathophysiology Clinical Features/Diagnosis Treatment Toxin-Induced Seizures Introduction Epidemiology Pathophysiology Clinical Features/Diagnosis Differential Diagnosis Treatment Toxin-Induced Acute Weakness Toxin-Induced Acute Encephalopathy Introduction Pathophysiology Clinical Features/Diagnosis Differential Diagnosis Treatment Conclusion References Index