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Recognition of sleep disorders is important because: They are common, affecting approximately 10-15% of the US population.Many medical, neurological, and psychiatric disorders present with sleep problems.Sleep disorders can have a significant affect on a patient's physical, social, and occupational life. [ABSTRACT FROM AUTHOR]

Movement disorders (MDs) typically result from abnormalities of the extrapyramidal system. The core structures of the extrapyramidal system include the caudate nucleus, globus pallidus, substantia nigra, red nucleus, thalamic nucleus, subthalamic nucleus and their connections to the cerebral cortex, brain stem, and cerebellum, with the final output being pyramidal tract. The main transmitter substances are dopamine, acetylcholine, GABA and glutamate. MDs can be hyperkinetic, hypokinetic, or dyskinetic. This chapter highlights the approach to common MDs. [ABSTRACT FROM AUTHOR]

Peripheral neuropathy (PN) is a term applied to any condition affecting peripheral nerve function. The disorder can affect the peripheral nerve soma (motor or sensory neurons), which are referred to as neuronopathies, or peripheral nerve fibers, which are neuropathies. Most peripheral nerves are mixed, having sensory motor and autonomic nerves. The pure form of sensory or motor neuropathy occurs when the soma (dorsal root ganglion or anterior horn cells) are selectively involved. [ABSTRACT FROM AUTHOR]

History: Obtaining a careful and thorough history of the headache is the most important part of the evaluation. You should establish the following as you are taking the history: Age at onset of headache.Onset of headache: whether it is acute, subacute, or chronic.Severity and frequency of the headache.Characteristics of the pain as described by the patient.Location and duration of the headache.Any associated symptoms or signs.What the aggravating or relieving factors are.Have there been any recent changes of headache type?Any relation to menstrual period or season?How often are medications used or how was the response to previous treatment? [ABSTRACT FROM AUTHOR]

Differentiate dizziness from true vertigo (sensation of movement) and other terms that are used by the patient, because the description by the patients can be nonspecific, many times, for example,"lightheadedness," "faint" or "giddiness" is vertigo and vice versa.Sudden onset of vertigo is due to asymmetry of vestibular system dysfunction.Approximately half of patients presenting with dizziness have true vertigo.Establish the onset of problem, and whether it is acute, subacute, or chronic.Vertigo is usually paroxysmal. Constant vertigo suggests psychogenic and not vestibular dysfunction. Chronic conditions such as acoustic neuroma rarely present with vertigo.Aggravating factors can be head or body position.Benign positional vertigo accounts for about half of all cases of vertigo.Associated symptoms: nausea, vomiting, fullness of ears, hearing loss, tinnitus, all of which suggest otological etiologies; headaches, diplopia, blurred vision, ataxia, paresthesia, all suggestive of central nervous system (CNS) etiologies.History of recent ear or upper respiratory infection or head trauma.History of drug regimen or drug overdose.History of depression or other psychiatric problems.Vertigo that is provoked by exertion, loud noise, sneezing, or coughing (Tullio's phenomenon) is suggestive of perilymphatic fistula. [ABSTRACT FROM AUTHOR]

In this chapter, only generalized convulsive status epilepticus (SE), is discussed. [ABSTRACT FROM AUTHOR]

Coma: a state of unconsciousness and unresponsiveness to external stimuli. Coma is caused by dysfunction of either or both the reticular activating system and cerebral cortex. [ABSTRACT FROM AUTHOR]

Back and neck pain are common complaints and are the main reasons for work-related injury and disability claims, with a major economic affect in industrial countries. Many conditions cause back and neck pain (spinal, nonspinal, psychological). Back pain is treated with many specialties: family practice, orthopedic, chiropractic, neurological surgery and neurologists. [ABSTRACT FROM AUTHOR]

The motor unit is the anatomic core of the peripheral nervous system. It consists of motor neurons or anterior horn cells, and muscle fibers that are innervated their peripheral axons. Other parts of motor units are the nerve root, plexus, and neuromuscular junction. Knowing components of the motor unit helps you localize the site of pathology in the peripheral nervous system. [ABSTRACT FROM AUTHOR]

Acquired central nervous system (CNS) demyelinating disorders that are commonly seen in adults include: Multiple sclerosis (MS).Acute disseminated encephalomyelitis (ADEM).Acute/subacute transverse myelitis.Isolated optic neuritis (ON).Clinically isolated syndrome (CIS).Cerebral pontine myelinolysis. [ABSTRACT FROM AUTHOR]

Alteration or changing mental status is a common cause of hospital admission, and neurologists are often asked to evaluate these patients in consultation. [ABSTRACT FROM AUTHOR]

Suspect central nervous system (CNS) infection when the patient presents with fever, headaches, nausea and vomiting, photophobia, alterations of mental state, or focal neurological deficit.The triad of meningitis—fever, headaches, and meningismus—are not always present in all patients, but fever and headaches are the most common occurrence.Jolt-accentuated headache, increased intensity of headache by side-to-side head movement, is another useful sign.Encephalitis can occur when a febrile patient presents with behavior, personality changes, mental dysfunction, and seizure, with or without focal neurological deficit. Meningitis and encephalitis often occur together (meningoencephalitis).All patients with suspected CNS infection should have blood cultures, brain imaging (computed tomography scan/magnetic resonance imaging [MRI]), and cerebrospinal fluid (CSF) examination.Because of a high rate of morbidity and mortality in bacterial meningitis and herpes simplex encephalitis, empiric broad-spectrum combined antibiotic and acyclovir therapy should begin promptly and not be delayed when performing imaging or spinal tap.Consult an infectious disease specialist when you are dealing with CNS infection. [ABSTRACT FROM AUTHOR]

Seizures are transient abnormal neuronal discharges of the cerebral cortex that often result in stereotyped behavior.Seizure is often a manifestation or symptom of many medical conditions. Epilepsy is the occurrence of two or more unprovoked seizures. Epilepsy is a chronic disorder. In other words, a seizure is a sign, and epilepsy is a disorder.It has been estimated that approximately 10% of individuals reaching age 70 will have a seizure, but only 1-2% will be subject to recurrence and become epileptic. After a generalized tonic-clonic seizure, with normal exam, magnetic resonance imaging (MRI), and electroencephalogram (EEG), 15-30% have recurrence.Seizure should be differentiated from syncope, migraine, transient ischemic attack, multiple sclerosis, hypoglycemic attack, sleep disorder (narcolepsy/ cataplexy/night terror, rapid eye movement behavior disorder), anxiety attacks, and pseudoseizure (psychogenic nonepileptic seizure).Routine workup for onset of unprovoked seizure in adults includes blood count, chemistry profile, EEG, and neuroimaging (computed tomography scan, MRI). Further workup depends on individual case (lumbar puncture).Late onset of seizures is usually because of vascular, degenerative, and neoplastic processes. However, more than half of the patients remain idiopathic, which is possibly genetically determined. Family history of seizure, previous history of head trauma, and prior history of seizure including febrile convulsion in childhood are important to establish. [ABSTRACT FROM AUTHOR]

Stabilize the vital signs and monitor the heart and blood pressure (BP).Start intravenous line and administer intravenous fluid (25% normal saline at a rate of 50-75 mL/hour).Draw blood and send to the lab for complete blood count, prothrombin time, partial thromboplastin time, platelet, chemistry profile, cardiac enzymes, and arterial blood gases.Obtain a 12-lead electrocardiogram.Obtain brief, but pertinent, medical and neurological history, and establish the onset and duration of stroke.Do a 5-minute neurological examination focusing on mental status, pupillary function, stiff neck, and focal neurological deficits.Consult the neurologist and stroke team at your hospital.Obtain head computed tomography (CT) scan without contrast to exclude hemorrhagic stroke or mass lesion. [ABSTRACT FROM AUTHOR]

Remember the following general rules when you are ordering a diagnostic test or procedure on your patient: 1.Diagnostic procedures are a supplement or an extension of your history and physical examination, and are ordered to support your clinical impression or exclude other possibilities.2.Diagnostic procedures should be considered on an individual basis and not routinely; not all patients with dementia need to have an electroencephalogram (EEG) or spinal tap. Each patient should be analyzed individually.3.The clinician should be familiar with the test, knowing how it is done (explaining it to the patient), and the risks, limitations, contraindications and indications, sensitivity, and specificity.4.Consider the potential risk(s) (invasiveness) and cost of the test. Explain these facts to the patient when necessary. For practical purposes, consider ordering the test that gives you the most information and is noninvasive. Consider ordering an invasive test when it has a high sensitivity, specificity, and is beneficial to the patient by influencing the treatment and/or outcome.5.At times, it is necessary and justified to repeat a test. Some disease processes require time to establish their full clinical expression; repeating a test will increase its diagnostic yield, for example, repeating an EEG in the evaluation of a seizure disorder.6.When ordering a test, provide adequate and pertinent information regarding the history and physical findings to the consultant. Be as specific as possible regarding what you are looking for. [ABSTRACT FROM AUTHOR]

1.Subcortical (e.g., internal capsule) versus cortical lesion: Motor weakness (paresis) usually affects the face, arm, and leg equally.Primary sensory deficits (paresthesia, numbness) are more prominent because of involvement of the posterior limb of the internal capsule. Cortical lesions affect higher cortical sensory, manifesting as agnosia, agraphesthesia, and impairment of double simultaneous stimulation.Visual field defects are more common because visual tracts travel through the posterior limb of the internal capsule. Occipital lobe lesions produce visual field defect, but usually are not associated with motor or sensory deficit.Speech dysarthria is more common. A dominant cortical lesion produces aphasia and apraxia.2.Gerstmann's syndrome. This syndrome is commonly caused by a stroke affecting the left angular and supramarginal gyrus and clinically characterized by finger agnosia, left-right disorientation, agraphia, and dyscalculia.3.Watershed or border zone infarcts. Watershed areas are end-artery zones between superficial branches of a major cortical blood supply such as between the anterior cerebral artery-middle cerebral artery and middle cerebral artery-posterior cerebral artery. Bilateral watershed infarcts occur in severe hypotension or hypoxia, and unilateral watershed infarcts occur when the affected artery is stenotic, and collateral circulation cannot compensate in a hypotensive episode. [ABSTRACT FROM AUTHOR]

A primary objective of medical students and residents rotating in the neurology service is to learn and to be able to perform a good neurological examination. They often think that the neurological examination is difficult and hard to remember. However, more importantly, I believe that many medical students and junior residents do not know what to look for, how to find neurological signs, and how to interpret their findings. [ABSTRACT FROM AUTHOR]