Differential Diagnosis in Neurology and Neurosurgery

I Differential Diagnosis in Neurology and Neurosurgery A Clinician’s Pocket Guide Sotirios A. Tsementzis, M.D., Ph.D. Professor and Chairman of Neurosurgery Director of the Neurosurgical Institute University of Ioannina Medical School Ioannina, Greece 16 Illustrations Thieme Stuttgart · New York 2000 Tsementzis, Differential Diagnosis in Neurology and Neurosurgery © 2000 Thieme All rights reserved. Usage subject to terms and conditions of license. II Library of Congress Cataloging-in-Publication Data Tsementzis, S. A. Differential diagnosis in neurosurgery / Sotirios A. Tsementzis. p. cm. Includes bibliographical references and index. ISBN 3-13-116151-5. – ISBN 0-86577-830-2 1. Nervous system–Surgery–Diagnosis Handbooks, manuals, etc. 2. Diagnosis, Differential Handbooks, manuals, etc. I. Title. [DNLM: 1. Nervous System Diseases–diagnosis. 2. Diagnosis, Differential. 3. Neurologic Examination. 4. Signs and Symptoms. WL 141 T881d 1999] RC348.T84 1999 616.8’0475–dc21 DNLM/DLC for Library of Congress 99-23138 CIP Cover drawing by Cyclus, Stuttgart Any reference to or mention of manufacturers or specific brand names should not be Important Note: Medicine is an ever- interpreted as an endorsement or advertise- changing science undergoing continual ment for any company or product. development. Research and clinical ex- Some of the product names, patents, and reg- perience are continually expanding our istered designs referred to in this book are in knowledge, in particular our knowledge fact registered trademarks or proprietary of proper treatment and drug therapy. names even though specific reference to this Insofar as this book mentions any dosage fact is not always made in the text. 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Every dosage Typesetting by Druckhaus Götz GmbH, schedule or every form of application D-71636 Ludwigsburg used is entirely at the user’s own risk and Printed in Germany by Offizin Andersen responsibility. The authors and publish- Nexö, Leipzig ers request every user to report to the publishers any discrepancies or inac- ISBN 3-13-116151-5 (GTV) curacies noticed. ISBN 0-86577-830-2 (TNY) 1 2 3 4 5 6 Tsementzis, Differential Diagnosis in Neurology and Neurosurgery © 2000 Thieme All rights reserved. Usage subject to terms and conditions of license. III This book is dedicated to the Greek national benefactress Mrs Theoula Carouta for generously supporting to the department of neurosurgery, to my university professors N. Matsaniotis, S. Moulopoulos, Gr. Skalkeas, K. Stefanis and to my neurosurgical instructors F. J. Gillingham, E. R. Hitchcock, M. Salcman, G. Sloughter, H. J. Hoffman, C. Tator, and J. T. Hoff who have greatly influenced my professional career Tsementzis, Differential Diagnosis in Neurology and Neurosurgery © 2000 Thieme All rights reserved. Usage subject to terms and conditions of license. IV Preface A wealth of neurological textbooks, journals, and papers are available today. The student of clinical neuroscience is therefore faced with a large number of unrelated facts that can be very difficult to remember and apply. In neurology, one of the most difficult tasks is knowing how to reach the correct diagnosis by differentiating it from the other possibili- ties, so that the patient can receive the appropriate treatment for the disease concerned. Physicians frequently encounter clinical symptoms and signs, as well as other data, that require interpretation. Establishing a differential diagnosis list is essential to allow correct interpretation of clinical and laboratory data, and it provides the basis for appropriate therapy. But it is difficult for the physician, who is unable to remember everything on the spot, to compile a complete differential diagnosis list. Despite a firm intention to “check it,” the physician does not always do so, because the information is located in multiple reference sources at the library or at home, but not at the bedside or prior to taking final examinations. Lists of differential diagnoses of neurological signs provide information that can be used logically when analyzing a neurological problem. But time-consuming searches in massive textbooks, trying to memorize lists, or—even worse—trying to construct them oneself, all involve time and effort that could be put to better use elsewhere. I felt that if this information could be brought together in a single source and made available in paperback format, it would be a valuable aid to medical students, house staff, emergency room physicians, and specialist clinicians. This book of differential diagnosis provides a guide to the differentia- tion of over 230 symptoms, physical and radiological signs, and other ab- normal findings. The lists of differential diagnoses for the major disease categories are organized into a familiar pattern, so that completely different clinical problems can be approached using a common algo- rithm. The template is arranged under 15 major headings in neurology and neurosurgery, typically beginning with the most general and preva- lent, to allow the physician to proceed, in as much detail as may be re- quired, to the most rarely encountered disorders. The aim of this book is to provide assistance with differential diagnosis in neurological and neurosurgical disease. It is not intended for use on its own, as it is not a complete textbook of neurology and neurosurgery. Tsementzis, Differential Diagnosis in Neurology and Neurosurgery © 2000 Thieme All rights reserved. Usage subject to terms and conditions of license. Preface V I should like to express my thanks to the colleagues, trainees, and students who encouraged me to write this book. In particular, I am grateful to my patients who taught me how to look and how to differentiate. I am indebted to Dr. P. Toulas for providing several personal X-ray cases for the book. I am also grateful to Dr. Clifford Bergman, medical editor at Thieme, for excellent advice and collaboration in preparing this book. Sotirios A. Tsementzis Tsementzis, Differential Diagnosis in Neurology and Neurosurgery © 2000 Thieme All rights reserved. Usage subject to terms and conditions of license. VI Contents Epidemiological Characteristics of Neurological Diseases . 1 Prevalence of Neurological Diseases . 1 Incidence of Common Neurological Diseases . 2 Disorders and Incidence of First Seizure, Based on Age Distribution . 2 Incidence of Brain Tumors . 3 Epidemiology of Spinal Cord Injury . 4 Incidence . 4 Prevalence . 5 Age at Injury . 5 Ethnic Groups and Spinal Cord Injury . 5 Etiology . 6 Associated Injuries . 6 Neurological Level of Injury (at Discharge) . 6 Neuroradiology . 7 Solitary Radiolucent Skull Lesion without Sclerotic Margins in Adults . 7 Solitary Radiolucent Skull Lesion without Sclerotic Margins in Children . 8 Solitary Radiolucent Skull Lesion with Sclerotic Margins . 9 Multiple Radiolucent Skull Lesions . 10 Localized Increased Density or Hyperostosis of the Skull Vault . 11 Diseases Affecting the Temporal Bone . 12 Destructive (Lucencies with Irregular Margins) . 12 Erosive (Lucencies with Well-Defined Margins, with or without Sclerosis) . 14 Abnormalities of the Craniovertebral Junction . 18 Congenital Anomalies and Malformations . 18 Developmental and Acquired Abnormalities . 19 Craniosynostosis . 21 Types . 21 Associated Craniofacial Syndromes . 21 Associated Congenital Syndromes . 22 Associated Disorders . 23 Macrocephaly or Macrocrania . 23 Tsementzis, Differential Diagnosis in Neurology and Neurosurgery © 2000 Thieme All rights reserved. Usage subject to terms and conditions of license. Contents VII Microcephaly or Microcrania . 24 Pneumocephalus . 25 Small Pituitary Fossa . 25 Enlarged Pituitary Fossa . 26 Suprasellar and Parasellar Lesions . 27 Neoplastic Lesions . 27 Nonneoplastic Lesions . 32 Intracranial Calcifications . 35 Calcifications of the Basal Ganglia . 37 Parasellar Calcification . 38 Posterior Fossa Tumors . 39 Postoperative Brain Scar Versus Residual Brain Tumor . 41 Stages and Estimation of Age of Hemorrhage on MRI . 43 Normal Pressure Hydrocephalus Versus Brain Atrophy . 44 Meningeal Enhancement . 45 Gyriform Enhancement . 46 Corpus Callosum Lesions . 46 Ring Enhancing Lesions . 47 Developmental and Acquired Anomalies and Pediatric Disorders . .50. Movements Resembling Neonatal Seizures . 50 Neonatal Seizures by Time of Onset . 51 First Nonfebrile Tonic–Clonic Seizure after Two Years of Age . 53 Causes of Confusion and Restlessness . 54 Causes of Coma . 55 Papilledema . 56 Hypotonic Infant . 56 Precocious Puberty . 59 Arthrogryposis . 59 Progressive Proximal Weakness . 59 Progressive Distal Weakness . 61 Acute Generalized Weakness . ..

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