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Glossary of Common Neurologic Terms

ABCs Term referring to airway, breathing, and with agraphia) or without writing deficits circulation management of a patient with (alexia without agraphia). impaired consciousness or breathing. Steps Allodynia Nonpainful cutaneous stimuli caus- include ensuring airway access, delivering ing . oxygen either nasally or via intubation if Amnesia Partial or complete loss of the ability needed, and establishing intravenous access to learn new information or to retrieve previ- plus others. ously acquired knowledge. Absence or petit mal seizure Typically Amaurosis fugax Transient monocular blind- begins with arrest of speech and the abrupt ness. This usually comes from an internal onset of loss of awareness without loss of carotid embolus temporarily occluding muscle tone or falling followed by seconds of the ophthalmic artery. staring without being able to communicate. Amyotrophic lateral sclerosis Progressive The individual then becomes alert but does neurodegenerative fatal disorder affecting not the episode. primarily upper and lower motor in Accommodation Sensory having the and motor cortex. dynamic firing rates that decline with time Amyotrophy Wasting of muscles usually from even though the is maintained. denervation. Acute disseminated Anal Reflexive contraction of anal (ADEM) Complex monophasic illness, sphincter upon perianal sensory stimulation. particularly in children, that often follows a Aneurysm Abnormal dilatation or bulging of recent infection or occasionally vaccination an intracranial artery wall, usually at bifurca- characterized by an abrupt tions of the circle of Willis. often with obtundation, hemiparesis, , Anisocoria Unequal pupil size. cranial palsies, visual impairment, and jerk Deep reflex (Achilles reflex) . elicited by striking the Achilles tendon at the Afferent pathway leading to the ankle resulting in plantar flexion. or spinal cord. Anterior horn Gray matter in the ventral spinal Agnosia Implies lack of knowledge and is cord that contains neurons including anterior synonymous with an impairment of recogni- horn cells (lower motor neurons). tion. An example is visual agnosia in which Anterior root Motor nerves from anterior horn patient cannot arrive at the meaning of previ- neurons from ventral spinal cord exit to point ously known nonverbal visual stimuli despite of joining mixed peripheral nerve at the dor- normal visual and alertness. sal root . Agraphia Inability to recognize numbers/letters Anton’s syndrome Lesions involving the written on the palm or fingertips. occipital and parietal lobes that produce Alexia Acquired reading impairment that may blindness or a homonymous hemianopia that be accompanied with writing deficits (alexia is denied by the patient.

L. E. Davis, S. Pirio Richardson, Fundamentals of Neurologic Disease, 2nd Edition 277 DOI 10.1007/978-1-4939-2359-5, © Springer Science+Business Media, LLC 2015 278 Glossary of Common Neurologic Terms

Aphasia Disorder of expression or comprehen- Bellʼs palsy Abrupt idiopathic peripheral sion of spoken due to dysfunction seventh cranial nerve facial palsy of ipsilat- of language centers in dominant cerebral eral facial muscle plus variable cortex or thalamus. The most common forms unilateral loss of tearing, taste appreciation, are Broca’s aphasia, Wernicke’s aphasia, and and ability to dampen loud noises. Recovery global aphasia. is usually good. Apoptosis Genetically programmed neuronal Benign paroxysmal positional vertigo Brief cell death that may be normal or abnormal. vertigo when rotating ones head upward or Apraxia Inability to perform a learned act downward without accompanying nausea or despite demonstrated ability to perform hearing loss that develops from abnormal components of the act usually due to dys- endolymphatic fluid movement in a posterior function of a . The most common semicircular canal usually due to the presence forms are , constructional, and of otoconia that broke loose from the macula apraxia. of the utricle. Arteriovenous malformation (AVM) Abnor- Deep elicited by mal blood vessel complex consisting of arter- hitting the biceps tendon resulting in brief ies, , and capillaries located in the brain contraction of the biceps muscle. or spinal cord that often hemorrhage. Blood-brain barrier Separation of circulating Arteritis Inflammation of walls of . blood from brain extracellular fluid due to Astereognosis The inability to distinguish and tight junctions around all brain capillaries recognize small objects based on size, shape, that do not exist in normal circulation. and texture when placed in the that has Botulinum toxin Potent produced normal primary tactile sensory input. by Clostridium botulinum causing botu- Ataxia Incoordination of limb or body move- lism with prolonged muscle . The ments, particularly gait, often due to impair- enzymatic toxin inactivates proteins in the ment of cerebellar function. posterior synaptic side of the neuromuscu- Involuntary movements characterized lar junction preventing normal release of by slow, sinuous, twisting changes of , . legs or body. Brachioradialis reflex Deep tendon reflex Atrophy Wasting of muscle/s from disuse or elicited by hitting the distal resulting denervation. in brief contraction of the triceps muscle. Aura prodrome that usually is visual Bradykinesia or akinesia Difficulty in mov- with blurred visual and colored flashing ing despite intact motor nerves and normal lights seen with open or closed that lasts muscles as seen in Parkinson’s disease. 5–15 min. Localized intracerebral infection Autism Childhood illness affecting language that begins as a focal area of cerebritis, devel- and interpersonal relationships. oping into a collection of pus surrounded by Babinski sign Extensor response of the great a capsule, that is usually due to a but with fanning of the other in response occasionally from a fungus or protozoa. to stimulus on of foot. The extensor Broca’s aphasia Motor speech disorder plantar response is normal in infants to about (expressive aphasia, nonfluent or anterior 9 months, thereafter reflects damage to the aphasia) due to dysfunction located in the corticospinal tract (upper motor sign). dominant frontal lobe and characterized by Deep gray matter nuclei of effortful, sparse, agrammatic, halting, trun- the cerebral hemispheres comprising puta- cated speech with loss of normal language men, caudate, globus pallidus, subthalamic melody. , substantial nigra, and ? thalamus. Glossary of Common Neurologic Terms 279

Bruit Sound due to turbulence of blood passing ing a physician to turn off a ventilator and a narrow artery segment, often heard from individuals to donate organs. the internal carotid artery in the . An excess accumulation Bulbar Refers to the medulla and of the of fluid in the intracellular or extracellular lower . spaces of the brain. Vasogenic edema is due Calcarine cortex Primary visual cortex located to breakdown of the tight endothelial junc- in the medial occipital lobe. tions which make up the blood–brain barrier Caloric test Placement of warm or cool water (BBB) allowing intravascular proteins and in the external canal to evaluate move- fluid to penetrate into the brain extracel- ments from stimulation of the vestibulo- lular space. Cytotoxic edema has an intact ocular reflex. BBB and is due to disruption of cellular Compression mono- metabolism leading to glial cell swelling neuropathy of the at the carpal from impairment of the sodium and potas- canal of the characterized by pain, sium pump. Interstitial edema in obstructive tingling, and numbness involving mainly the is due to disruption of the palmar aspect of the , index , CSF-brain barrier resulting in trans-epen- and middle finger plus variable weakness dymal flow of CSF into the brain into the of median nerve innervated thenar hand extracellular spaces and the . muscles. Cerebral Palsy Refers to a group of disorders Charcot-Marie-Tooth disease or Hereditary that affect motor, cognitive, communica- Motor and Sensory Neuropathy 1 Domi- tion, and behavioral . It is the most nant autosomal genetic disease affecting common cause of disability in childhood and distal myelinated axons of limbs, espe- is due to a permanent, non-progressive brain cially legs producing distally symmetrical injury. polyneuropathy. Channelopathies Group of diseases with Cauda equina Lumbosacral nerve roots in the abnormal ion channels (pores) in cell mem- lumbar and sacral vertebral canal before the branes resulting from genetic disorders most exit via neural foramina. often affecting muscle or brain. Caudal Lower in the neural axis as in brain- Cheyne-Stokes respirations Regular cyclic stem is caudal to the basal ganglia. oscillations of breathing between hyperpnea Central pontine myelinolysis Demyelinating or over breathing and apnea. condition affecting the pons or outside of the Abnormal involuntary movements pons (known as extrapontine myelinolysis) characterized by rapid flicks or jerks of limb, occurring at times of severe osmotic disrup- or trunk muscles. tion, such as during rapid correction of serum Chromatolysis Dissolution of Nissl bodies in hyponatremia. a neuron cell body usually triggered by axot- Cerebral amyloid angiopathy Intracranial omy, ischemia, cell , cell exhaustion, hemorrhage occurring in older adults from or virus infection. deposition of β-amyloid protein into the Circadian rhythms Physiological and behav- tunica media and adventitia of cortical arte- ioral processes controlled by circadian clocks rioles causing the vessel walls to spontane- that have photoreceptors and visual pathways ously rupture. that transduce photic entraining information, Cerebral death State of coma in which recov- pacemakers that generate a circadian signal, ery of consciousness is no longer possible. and output pathways that couple the pace- Cerebral death implies death of all critical maker to effector systems. brainstem neurons for which normal CNS Central nervous depends. It is often embedded in law allow- Cogwheel rigidity Ratchet-like increased resistance to passive movement (hypertonia) 280 Glossary of Common Neurologic Terms

usually found at the of patients with monly found in muscle (especially skeletal Parkinson’s disease. or cardiac muscle) that leaks from the muscle Cobalamin or cyanocobalamine or (vitamin into blood following muscle damage such as

B12) Water-soluble vitamin with a key role trauma or diseases which cause necrosis of in the normal functioning of the central and muscle fibers. peripheral nervous system (PNS) and the CVA Cerebral vascular accident or formation of red blood cells. Decerebrate posture Both arms and legs are Coma Unconscious pathologic state with extended, especially when painful stimuli inability to arouse from any stimuli to pro- are administered usually due to a lesion that duce appropriate responses. separates upper from lower brainstem. Complex partial seizures Alteration of con- Decorticate posture Flexion of one or both sciousness from bilateral cerebral hemi- arms and extension of ipsilateral or both legs sphere involvement often preceded by an due to lesion that isolates brainstem from aura or simple partial seizure with a feeling contralateral or bilateral cortical influences. of déjà vu, fear, euphoria, or visual distur- Deep tendon (DTR) Term used to bances without loss of consciousness. Once describe a monosynaptic consciousness is impaired, the person may elicited by tapping a tendon with resulting display automatisms such as smacking, . chewing or swallowing followed by amnesia Delirium Conscious state characterized by surrounding the seizure event. confusion with agitation and restlessness, Computerized tomography (CT) Neuroimag- sudden movements and rapid, fragmented ing technique based on computer process- slurred speech. ing of data from differential attenuation of Decline in cognitive abilities in x-ray beam passing through tissue (often the two or more areas of cognition confirmed & brain) that produces a series of slices by mental status exam that reduces normal through the tissue. daily functioning which cannot be explained Constructional apraxia Disturbances in orga- by delirium or psychiatric disorder deficits. nizing parts of a complex object. Dementia may be static (i.e., from anoxia Continuous positive airway pressure (CPAP) episode) or progressive (i.e., from Alzheim- machine Delivers a positive stream of air er’s disease). pressure via a face mask that stents open the Demyelination Primarily loss of the nerve airway preventing obstructive apnea. sheath in the peripheral or CNS with relative Corticobulbar tract Descending cortical motor sparing of the underlying axon. Segmental tract traveling to a brainstem motor nucleus. demyelination implies that the loss Corticospinal tract Descending cortical is patchy along the nerve leaving part of the motor tract primarily from motor cortex that axon with intact myelin. descends down the spinal cord to at General term to describe sensation of anterior horn cells or adjacent . light headedness or feeling off balance. Countercoup Injury to brain on opposite side Doll’s eyes maneuver Vestibulo-ocular reflex as head trauma that is performed usually in comatose patient Coup Injury occurring to brain on same side as where the head is rotated laterally but the head trauma eyes remain stationary and do not move with Cowdry type A inclusion body Intranuclear head. collection of virus particles belonging to Dominance Term that refers to cerebral herpes simplex, varicella-zoster, or Epstein- hemisphere that controls language and prin- Barr viruses. ciple limb involved in writing, eating, and Creatine kinase (CK) Also known as creatine throwing. phosphokinase (CPK), is an enzyme com- Glossary of Common Neurologic Terms 281

Dorsal column nuclei Nucleus gracilis and processing, such as flexible problem solving, cuneatus in the caudal medulla that contain organization and planning, mental manipu- 2nd order neuronal cell bodies for the dorsal lation of information, and word retrieval. columns in the spinal cord and usually con- Patients may lack spontaneity and often lack duct position and some pain and touch awareness of their deficits. sensations. Several involuntary movements of Dorsal horn Dorsal (posterior) aspect of the limbs or face that include chorea, athetosis, spinal cord gray matter that contains neurons tics, and . associated with peripheral afferent sensory Dysmetria Limb ataxia in directed movement fibers. that misses the target. Dorsal root Part of the peripheral afferent Dysphagia Impairment, but not total loss, of between the dorsal root ganglia speech expression or comprehension. and the dorsal horn of the spinal cord. Dysphonia Difficulty in speaking, often with a Dorsal root ganglia Cluster of 1st order low speech volume. peripheral afferent cell bodies Dystonia Strong, sustained and slow contrac- located at each segmental level near vertebral tions of muscle groups that cause twisting bodies. or writhing of a limb or the entire body. The Dressing apraxia Lesions only involving the contractions are often painful and may appear non-dominant parietal lobe that produce disfiguring. The dystonia lasts seconds to neglect on one side of the body in dressing minutes and occasionally hours producing a and grooming. dystonic posture. Duret hemorrhages Small areas of bleeding Efferent pathway Axons leading away from in the upper and pons secondary to the brain or spinal cord. raised above the tento- Electroencephalograph Instrument for record- rium producing displacement of the brain- ing minute electrical currents developed in stem downward that stretches and lacerates the brain by means of electrodes attached to pontine perforating branches of the basilar the . artery. Electromyography (EMG) Technique for “Dying-back” neuropathy Distal peripheral evaluating and recording the electrical activ- neuropathy characterized by dysfunction of ity produced by skeletal muscles during the longest sensory and motor axons such as movement or nerve stimulation. EMG is per- seen in a . formed using an electromyograph, to produce Impaired articulation of speech a record called an electromyogram. that sounds like “speaking with rocks in your Electronystagmograpy (ENG) or vide- mouth.” onystagmography (VNG) Technique for Dysequilibrium Sensation of being off balance recording electrical signals generated by that is mainly experienced when standing. eye movements or nystagmus during tests to The imbalance or unsteadiness usually devel- evaluate patients with vertigo. ops from diminished sensory input from the A diffuse infection of the brain proprioceptive, visual or vestibular systems parenchyma usually due to a virus but occa- or abnormal input from key motor centers, sionally from bacteria or protozoa. such as the basal ganglia and . Illness resulting from repetitive sei- Dysesthesias Abnormal skin sensations such as zures due to abnormal brain electrical activity creeping, tugging, burning, itching, tingling, that is often subdivided into specific seizure aching, or like crawling on the skin. types. Dysexecutive syndrome or frontal lobe syn- Epley maneuver or otoconia repositioning drome Damage to the lateral prefrontal cor- maneuver In patients with benign parox- tex produces deficits in higher level cognitive ysmal positional vertigo, a variation of the 282 Glossary of Common Neurologic Terms

Hallpike maneuver is performed to roll loose Gerstmann’s syndrome The inability to desig- otoconia around the posterior semicircular nate or name the different of the two canal eliminating the recurrent brief vertigo , confusion of the right and left sides of spells. the body and inability to calculate or to write. Extraocular movements Eye movements due Glasgow coma scale Simple scoring system of to contraction of extraocular eye muscles unconscious patients based on eye opening, rather than muscles that govern the iris and motor response and verbal response that is lens. useful for prognosis. Falx cerebri Rigid dural fold in midsagittal Term for supporting cells of CNS that plane that separates the two hemispheres. includes and oligodendroglia. Fasciculation Contraction of fascicle (group) Glioma Term used for CNS tumors of of muscle fibers innervated by single nerve or lineage. from one anterior horn neuron that produces Glioblastoma multiforme Most common and visible intermittent spontaneous twitching of most aggressive malignant primary brain part of a muscle but does not move the body tumor involving glial cells that is also called part. stage 4 glioma. Fetal alcohol syndrome Develops in infants Global aphasia Acquired loss of ability to born to mothers who consumed alcohol dur- comprehend or produce verbal messages. ing the . The most characteristic Gower’s maneuver Seen in muscular dystro- abnormalities involve growth and mental phy where an individual with weak proximal retardation, craniofacial structure abnormali- leg muscles place their hands on the ties, neurodevelopment abnormalities, and and climbing up their to stand. behavior problems. Gram stain Method of differentiating bacterial Fibrillation Spontaneous contraction (invisible species into two large groups (Gram positive to the eye but detected by EMG) of individ- and Gram negative) based on staining proper- ual denervated muscle fibers no longer under ties of their cell walls. the control of a . Grasp reflex Involuntary grasping of the hand Flaccid Limp muscle that lacks normal muscle when the palm is stimulated. This is normal tone. in babies but abnormal in older children and Foramen magnum Large opening at base of adults, and is often associated with diffuse skull where spinal cord and brainstem join. frontal lobe damage. Fovea Central part of macula of related Gray matter Term that refers to gray color of to sharpest vision for reading. part of CNS that contains neurons rather than Frenzel glasses Strong positive lenses used to white matter which contains mainly white detect nystagmus that inhibit patients from myelin sheaths covering axons. seeing clearly enough to fixate but allow the Guillain-Barré Syndrome Acute monophasic examiner to see the eye. autoimmune disease involving only myelin- Gadolinium Rare earth compound given intra- ated nerves in the PNS.Hallpike maneuver venously before magnetic resonance imag- or Dix Hallpike maneuver A test to detect ing (MRI) to detect brain areas that have a positional nystagmus performed by laying a broken blood-brain barrier (such as tumors). patient down with their head hanging below Ganglia Clusters of neurons all having similar the table. function, such as dorsal root ganglia. Hammer toes Cocking up of toes like gun Generalized seizure or grand mal sei- hammers often due to a distal sensorimotor zure Loss of consciousness and widespread polyneuropathy causing atrophy and weak- bilateral abnormal muscle contractions Typi- ness of intrinsic flexor toe muscles with cally in a tonic and clonic fashion usually overriding pull of more proximal extensor toe lasting one to several minutes. muscles. Glossary of Common Neurologic Terms 283

Hemianopia Refers to loss of vision in ½ Intracerebral hemorrhage Bleeding into the visual field in the vertical plane. If both eyes brain parenchyma that may extend into the are equally involved, it is called homony- ventricles and into the subarachnoid space mous hemianopia. due to rupture of cerebral blood vessels. Hemiparesis Incomplete weakness involving jerk Corticobulbar reflex produced by one side of body. tapping downward on the with resulting Horner’s syndrome Miosis, , and dimin- contraction of masseter muscles and upward ished sweating on the ipsilateral face due to jaw movement. When unusually brisk, the lesion in the three neuron pathway starting in jaw jerk implies an upper and traveling to the brainstem, abnormality in corticobulbar tract to fifth thoracic spinal cord, cervical sympathetic cranial nerve nuclei. ganglion, and sympathetic nerves along the Kernicterus Deposition of bile pigment in deep carotid and ophthalmic arteries. brain nuclei with neuronal degeneration from Hydrocephalus Abnormal enlargement of one neonatal jaundice. or more ventricles of the brain. Obstructive jerk (KJ) The is a deep hydrocephalus is when there is obstruction of tendon reflex in which the patellar tendon is CSF flow in ventricular system or subarach- tapped causing a brief extension of the leg. noid space. Hydrocephalus ex vacuo refers Korsakoff’s syndrome or Loss of to passive ventricular enlargement from loss the ability to learn new with a ten- of surrounding white matter and neurons. dency to fabricate answers. It is usually part Communicating hydrocephalus refers to non- of the Wernicke-Korsakoff encephalopathy obstructed pathway from spinal subarachnoid from alcoholism. space to lateral ventricles. Lacune or lacunar stroke Small infarction pri- Hypertonia Increased muscle tone or resistance marily located in the basal ganglia, thalamus, produced by passive movement of a limb on brainstem, internal capsule, and centrum a . semiovale. Hypotonia Decreased muscle tone or resistance Lateral geniculate body (nucleus) Thalamic produced by passive movement of a limb on nucleus that receives input from optic nerves a joint. and sends outward optic radiations to the Hypsarrhythmia Random, high voltage slow occipital cortex and upper brainstem. waves and spikes seen on electroencepha- Lateral medullary syndrome Infarction of logram (EEG) that vary from in time and dorsolateral medulla and inferior cerebellum location. due to occlusion of posterior inferior cerebel- Ice water caloric Test used in comatose lar artery, a branch of the vertebral artery. patients to determine whether the pathway Lenticular (lentiform) nucleus Combination from the vestibular inner to the 3rd and of the putamen and the globus pallidus. 6th is intact. When pathway is Leukomalacia Abnormal softening of white intact, ice water irrigated in one ear produces matter areas bilateral eye movement to the ipsilateral side. Lhermitteʼs sign Electrical sensation that runs Infantile spasms Brief, symmetric contrac- down the back from the neck into the limbs tions of neck, trunk and limb muscles seen in that is often elicited by bending the head infants (also called salaam seizures). forward. Ischemic penumbra Area of brain around an A form of inflammation of acute stroke that has insufficient blood flow the brain caused by an autoimmune disease to enable normal neuronal function but suf- that is often associated with a cancer out- ficient flow to prevent cell death. side the brain. Brain damage is due to a host Insomnia Chronic inability to fall asleep or immune response against various areas of maintain sleep the entire night. their own brain. 284 Glossary of Common Neurologic Terms

Limbic system Part of the brain involved in Mild Cognitive Impairment Global cogni- and which includes the tion functioning is near normal but patient limbic lobe (subcallosal area, cingulate gyrus, has subjective complaints or objective parahippocampus, uncus, and hippocam- evidence of cognitive deficits that cannot be pal formation), many nuclei of the nucleus related to other causes, such as depression or accumbens, the hypothalamus, mammillary . bodies, the amygdala, and the cingulate Miller-Fisher syndrome CNS autoimmune gyrus. related to Guillain-Barre syndrome and Lordosis Curvature of the spinal column with a characterized by a monophasic illness with forward convexity. ataxia, absence of DTR, and paralysis of eye Motor neurons in the movements. anterior horn of the spinal cord or brainstem Miosis Abnormal constriction of a pupil. that directly innervate muscles. Muscular dystrophy Muscle diseases that Lumbar puncture Placement of a hollow weaken the musculoskeletal system and needle with a stylet into the in hamper locomotion that are characterized the lower lumbar space to withdraw CSF or by progressive skeletal , instill medications. defects in muscle proteins, and the death of MRI Use of changing magnetic fields to create muscle cells and adjacent tissue. Most types brain images as brain slices in any plane. are due to a genetic mutation. overuse frequent, often Myalgia Muscle aches and that are not daily, chronic headaches in a patient with one cramps. type of who overuses medications Myasthenia gravis Most common synaptopa- such as triptans, butalbital, , and other thy affecting the and . is due to autoantibodies directed against the Melatonin Key molecule in circadian rhythms post-synaptic acetylcholine receptor interfer- produced by the that releases ing with normal neuromuscular transmission melatonin into blood and CSF only at night and causing ptosis, diplopia, and skeletal and not in daylight. muscle weakness. Meniere’s disease or endolymphatic Myelin Lipid-protein sheath that wraps hydrops abrupt attacks of vertigo lasting peripheral nerves that is made by Schwann hours developing without warning associated cells and central nerves that is made by with depressed unilateral hearing and loud oligodendroglia. tinnitus. Focal or diffuse inflammation within Meningioma Tumors arising from the menin- the spinal cord. ges, the membranous layers surrounding Myeloradiculopathy Disease process affect- the CNS, which are usually slow growing, ing the spinal cord, adjacent peripheral nerve benign, and rarely metastasize to other areas roots, and nerves. of the brain or body. Rapid, brief muscle jerks involv- Inflammation of the due ing specific muscles or the entire body that to viruses, bacteria, fungi, parasites, chemi- do not blend together and are shorter dura- cals, and neoplasms. tion than chorea. Nocturnal myoclonus is the Meralgia paresthica Sensory impairment and normal abrupt body jerks that occur when an dysthesias in the skin distribution of the lat- individual is falling asleep. The EEG may eral femoral cutaneous nerve of the . or may not have spikes correlating with the Mesial temporal sclerosis Progressive loss of myoclonus. neurons and gliosis in one hippocampus that General term implying disease of often causes complex partial seizures. muscle from any cause. Glossary of Common Neurologic Terms 285

Myotonia Abnormal sustained muscle contrac- circle) or abnormal (from inner ear, brain- tions with slow relaxation that have a charac- stem, and cerebellar dysfunction). teristic pattern on electromyogram. Obstructive sleep apnea Excessive daytime Narcolepsy Chronic neurologic sleep disorder sleepiness from recurrent episodes of partial characterized by excessive daytime sleepi- or complete upper airway collapse producing ness, disturbed nocturnal sleep, cataplexy difficulty in breathing, frequent sleep arous- (loss of voluntary muscle tone from als, and hypoxemia. such as laughing or anger), and elements of Obtundation Conscious state characterized by rapid eye movement (REM) sleep. Narco- a disorder of alertness associated with confu- lepsy is due to loss of hypocretin (or orexin) sion and slow reaction times (psychomotor neurons located in the . retardation) in which individuals can be Neglect Inability to attend normally to a portion aroused by verbal stimuli but respond poorly of extrapersonal or intrapersonal space or to questions with a prolonged delay in their both that cannot be explained by altered per- verbal or motor responses. ception. In visual neglect, the patient ignores OD Right eye objects, persons, or movement in the left or Oligoclonal bands Homogenous immuno- right of the environment. globulins produced in CSF or blood that have Neuraxis Longitudinal axis of the CNS that identical molecular configuration allowing runs from the rostral to the caudal them to travel as a specific band together on spinal cord. an electrophoresis gel. CSF oligoclonal bands Neuromyelitis optica or Devic’s disease CNS are common seen following CNS infections autoimmune disease mainly of or . and spinal cord due to recurring attacks of Oligodendrocyte CNS glial cell that provides CNS astrocytes in white matter from circu- support and insulates axons by creating a lating IgG1 antibodies against the astrocyte myelin sheath. Myelin increases axonal water channel aquaporin 4. conduction velocity via saltatory conduction Neuronophagia Destruction of neurons by of action potentials jumping from one node phagocytic cells. of Ranvier to the next and protects the axon Neuropathic pain Abnormal peripheral nerve from environmental toxins. pain that persists, becomes more severe, and Ophthalmoplegia Paralysis of eye movements. can expand from the region of original dis- Opioids Psychoactive chemical often derived comfort to show hypersensitivity to painful from the opium poppy that binds to triggers and change in character in how the receptors found principally in the central and pain is perceived. PNS and . Opioids are Neuropathy Term that describes disorders of often used to treat pain but have a high addic- peripheral nerves. tion potential. Nocioceptive Sensory receptors that respond to Oriented x 3 Oriented to person, place, and painful stimuli. time in mental status testing. Non REM sleep Characterized by little body Orthostatic hypotension Fall in blood pres- movement, dreaming is rare, and muscles are sure upon standing causing dizziness or even not paralyzed. . Non-convulsive Complex OS Left eye partial status epilepticus where the patient Otoconia Tiny calcium carbonate crystals has constant confusion and impaired aware- embedded in a gelatinous matrix above the ness but can move their limbs. macula of the utricle and saccule that move Nystagmus Oscillatory eye movements that with gravity changes bending attached may be physiologic (following spinning in a cells allowing detection of gravity. 286 Glossary of Common Neurologic Terms

Otorrhea CSF drainage from nose Pituitary adenoma Tumors that occur in the Papilledema Swelling of optic nerve disc from which may be tiny or enlarge elevated intracranial pressure. outside the pituitary gland. They often secrete Paraphasias Mispronounced or inappropriately not under hypothalamus feedback substituted words with sematic paraphasias control. being errors based on meanings of words Plaque Demarcated hypocellular area in brain (aunt for uncle) and literal paraphasias being white matter characterized by the loss of errors based on sounds (hook for took). myelin, relative preservation of axons, and Paresthesias Spontaneous firing of peripheral the formation of astrocytic, glial scars that is nerve fibers causing a tingling sensation. common in multiple sclerosis. Neurological syndrome charac- Plasmapheresis Process in which whole blood terized by , , and rigidity, is withdrawn from the person, the liquid the features of Parkinson’s disease, but often portion or plasma is removed from the blood due to other causes. and replaced. This is often done to remove Paroxysmal Sudden event, as in spikes on unwanted antibody from the blood in patients EEG. with an autoimmune disease. Past pointing Repeated missing a target by Polymerase chain reaction Molecular bio- going too far or off to one side when using chemical technology to amplify a single or a finger or toe with closed eyes that is due a few copies of a piece of deoxyribonucleic to dysfunction of the vestibular system or acid (DNA) across several orders of mag- cerebellum. nitude, generating thousands to millions of Patellar reflex KJ reflex is a deep tendon reflex copies of a particular DNA sequence that in which the patellar tendon is tapped causing allows identification of specific genes and a brief extension of the leg. thus infectious agents or gene mutations. Damage to nerves of Polyneuropathy Diffuse and symmetrical the PNS caused either by disease or trauma to distal dysfunction of sensory, motor, and the nerve or from side effects of systemic ill- autonomic nerve axons that usually begins in ness. The most common form is a symmetri- the feet. cal polyneuropathy, which mainly affects the Polysomnogram Measures an EEG, electrocar- feet and lower legs. diogram (EKG), extraocular eye movements, PNS All neural structures that lie outside the EMG, airflow oximetry, nasal pressure, spinal cord and brainstem include motor, sen- esophageal pressure, body position, snoring sory and autonomic nerves and their ganglia. sounds, and /abdominal movements during PERRLA Abbreviation for pupils equal, round, a nightʼs sleep to analyze sleep disturbances. and reactive to light and accommodation. Positron emission tomography (PET) Imag- Persistent vegetative state Chronic severe ing technique that detects emissions from disorder of consciousness in which patients injected radiolabeled compounds to create with severe brain damage are alive but in a a quantifiable image of blood flow, glucose state of only minimal arousal rather than true utilization or location of specific ligands that awareness. Most patients are unresponsive attach to brain receptors, etc. to external stimuli but a few do respond, in Postherpetic neuralgia Persistent of severe varying degrees, to stimulation. pain following that lasts more than Phlebitis Inflammation of veins. three months. Phonophobia Discomfort from noises that Posterior fossa Part of the intracranial cavity normally do not cause discomfort. that is located between the foramen magnum Abnormal eye pain from bright and tentorium cerebelli. It contains the brain- lights. stem and cerebellum. Glossary of Common Neurologic Terms 287

Prefrontal lobe Part of brain anterior to the paresthesias in the legs mainly in the evening motor and that is a multisen- and temporarily alleviated by movement. sory association cortex. Reticuloendothelial system or mononuclear Presyncope Feeling of light-headedness or of phagocyte system Class of mononuclear impending faint that may be associated with a phagocytic cells that are part of the body’s feeling of unsteadiness usually resulting from defense mechanisms and widely located hypoperfusion, or changes in blood chemical in lymph nodes, , , and brain composition to the brainstem. (). They engulf and destroy bac- Prion Abnormal protein configuration of a teria, viruses, other foreign substances, and normal host protein that causes transmis- worn-out or abnormal body cells. sible spongiform , like Rigidity Constant resistance to muscle stretch- Creutzfeldt-Jakob disease. ing in both flexors and extensors throughout Proprioception Sense of position of body part range of motion due to the stretching force relative to fixed object like a floor that is inducing some motor units to fire. In Par- unconscious and conscious. kinson’s disease, rapid flexion and extension Prosopagnosia Inability to recognize familiar of wrist or often elicits a ratchet-like (facial agnosia). feeling (cogwheel rigidity). Syndrome that affects Rinne test Comparison of conduction speech articulation, phonation, swallow- (placing a vibrating tuning fork on the mas- ing, and emotional lability due to bilateral toid process) to air conduction. Air conduc- dysfunction of corticospinal tracts in upper tion normally is heard better. brainstem or motor cortex. Rolandic fissure Fissure that separates the Psychomotor retardation Abnormal slowing motor cortex in the frontal lobe from the of mental behavior and limb movements that sensory cortex in the parietal lobe. is not due to mental retardation. Romberg sign Ability to stand with feet Ptosis Abnormal drooping of one or both together and eyes open, and the inability to . maintain posture with the eyes closed. Putamen Part of basal ganglia and part of the Rooting reflex Normal turning of infant’s face striatum and lentiform nucleus. and toward a nipple touching the Quadrantanopia Loss of vision in one quad- but abnormal “frontal release reflex” when rant of vision or ¼ of entire visual field. seen in adults upon touching the cheek. Radiculopathy Damage to a nerve root leaving Rostral Direction or position of neuroaxis the spinal cord that causes weakness, sensory toward the forebrain and away from the cau- loss or dysesthesias, and diminished reflex in dal spinal cord. corresponding myotome and . Saccadic eye movement Fast eye movement, Ramsay Hunt syndrome Acute facial weak- voluntary or reflex, usually accomplishing ness due to herpes-zoster virus reactivation foveal from the geniculate ganglion. Saltatory conduction Nerve REM sleep Characterized by rapid and random that moves down a myelinated nerve by movement of the eyes, dreaming with often jumping from to node of vivid dreams, low muscle tone, and a rapid, Ranvier, increasing conduction velocity to as low-voltage EEG. fast as 80 m/s. REM REM sleep is characterized by rapid and Semicircular canals Three canals at right random eye movements, dreaming, low mus- angles to each other located in the temporal cle tone and a rapid, low voltage EEG that bone detect angular acceleration and serve to occupies about 25 % of total normal sleep. keep eyes steady during head movement. Defined as an indi- vidual with uncomfortable dysesthesias and 288 Glossary of Common Neurologic Terms

Sciatica Term for radiating pain down a leg in a characteristic flexed posture. Rapid from damage to one or more lumbosacral passive limb movement initially produces nerve roots that form the . little resistance but then quickly has increas- Principal glia of the PNS and ing muscular resistance to a point when the functions to support axons by wrapping resistance suddenly disappears (“clasp-knife” around axons of motor and sensory neurons phenomena). to form a myelin sheath. Myelin increases Multiple genetic dis- axonal conduction velocity via saltatory eases involving the cerebellum characterized conduction of action potentials jumping from by a progressive cerebellar ataxia, unsteady one node of Ranvier to the next. For small gait, clumsiness, and slurred speech. Depend- diameter axons, the Schwann cell encases ing on the specific genetic abnormality, naked sensory axons to protect them. symptoms of cognitive abnormalities, other Scoliosis Condition in which a person’s spine or movement disorders, and visual disturbances is curved from side to side can be present. and classified as congenital, idiopathic (cause Status epilepticus More than 5 min of continu- unknown), or secondary to another primary ous clinical and/or electrographic seizure condition. activity or recurrent seizures without full Seizure Transient of recovery to baseline between seizures. abnormal excessive neuronal activity in the Stenosis Narrowing of lumen of artery or spinal brain that clinically may be as wild thrash- canal. ing movements (tonic-clonic seizure) or as a Strabismus Lack of eye alignment such that brief loss of awareness (absence seizure). the two visual axes assume positions relative Shingles or herpes zoster Vesicular rash that to each other different from that required by follows a dermatomal pattern due to vari- the physiologic task. cella-zoster virus. Straight leg raise test Test for lumbar radicu- Shunt Tubing used to move CSF that is lopathy in which passive elevation of a blocked along its pathway (usually a ven- straightened leg produces pain in the lower tricle) to the or jugular where back. it can be absorbed. Striate cortex Primary visual cortex Single photon emission computed tomogra- Striatum Combination of the caudate nucleus phy (SPECT) Imaging system that is similar and the putamen. to PET that qualitatively determines regional Stroke General term that implies death of cere- blood flow or brain metabolism relative to bral tissue from abnormalities of the blood other brain areas. supply. Skew deviation of vision Vertical and slightly Stupor or semi-coma Barely conscious state horizontal (diagonal) double vision that is the in which individuals require constant strong same in all fields of gaze due to a brainstem verbal or physical stimuli to remain aroused. lesion. Their responses are simple and often inaccu- Sleep Occurs in a recumbent posture, has a rate. When the stimulus stops, patients return low level of motor output, raised thresh- to unconsciousness. old to respond to sensory stimulation, and Presence of blood dreaming. in the meninges and CSF most often from Snout reflex Pouting of lips following tapping head trauma or ruptured saccular aneurysm. the lips. Subdural hematoma Following head trauma Spasticity Condition resulting from damage blood appears in the subdural space between to the corticospinal tract in which at rest the and arachnoid mater of the muscles are in midposition and limbs held meninges. Over time the hematoma may Glossary of Common Neurologic Terms 289

spontaneously contract or expand to become Triptans Migraine medications that are recep-

large enough to cause increased intracranial tor agonists acting at the 5-HT1B pressure and displace brain medially often receptor located on meningeal blood vessels producing headache, lethargy, and focal neu- and trigeminal nerve endings to reduce head- rologic signs such as hemiparesis. ache pain during an acute attack. Subfalcial space Space beneath the falx in Uncal herniation Movement of the uncal which the cingulate gyrus can herniate from gyrus of the medial temporal lobe under the increased intracranial pressure. tentorial notch in response to mass in the Suck reflex Normal sucking response of infants temporal-frontal lobes producing increased when a nipple touches the lips but abnormal intracranial pressure. “frontal-release” reflex in adults when touch- Neurons in the upper ing the lips elicits a sucking response. brain that synapse with lower motor neurons Sylvian fissure Major horizontal fissure that in the brainstem or spinal cord. separates the temporal lobe from adjacent Utricle Part of the inner ear that detects gravity parts of the frontal and parietal lobes. Valsalva maneuver Increase in intrapulmonic Synaptopathy Diseases that limit limits neu- pressure by forcible expiration against a romuscular transmission preventing muscle closed glottis that secondarily increases intra- contraction and leading to weakness. Syn- cranial pressure. aptopathies occur from chemical or biologic Ventricles Four CSF-filled cavities in the brain toxins, antibodies directed against synaptic (two lateral ventricles, third ventricle and receptor molecules, or genetic mutations in fourth ventricle) along the CSF pathway. the synaptic receptor or membrane channel. Vermis Midline part of the cerebellum that Tandem gait Walking to toe in a straight participates in truncal balance and gait. line. Vertigo Illusion of abnormal spinning move- Tentorium A fold of the dura mater form- ment by the individual or his environment. ing a partition between the and Vestibular neuritis Abrupt onset of idiopathic cerebellum. severe horizontal vertigo that causes severe Tics Abrupt, transient, repetitive, stereotypical ataxia, nausea, and vomiting that lasts a few movements of face and limbs or vocalizations weeks. that may be briefly voluntarily suppressed Vestibulo-ocular reflex A reflex eye movement but is often then followed by a burst of tics that stabilizes images on the retina during when the suppression is removed. head movement by producing an eye move- Tonsillar herniation Downward movement of ment in the direction opposite to head move- cerebellar tonsils into the foramen magnum ment, thus preserving the image on the center in response to increased intracranial pressure of the visual field. from localized mass in the posterior fossa. Wakefulness State characterized by an active Tonsils Most inferior part of the midline and deliberate sensorimotor discourse with cerebellum. the environment. Transient ischemic attack Focal neurologic Wallenberg’s syndrome or lateral medullary signs from transient occlusion of a cerebral infarction Unilateral infarction of the lateral artery that usually last less than 20 min but medulla from occlusion of the posterior infe- always less than 24 h. rior cerebellar artery usually causing acute Treponema pallidum The bacterium that dizziness, vertigo, nausea, nystagmus, skew causes syphilis deviation of vision, gait ataxia and ipsilateral Triceps jerk Deep tendon reflex elicited by limb ataxia. tapping the triceps tendon above the back of Watershed brain territory Cerebral cortex the elbow. located between the distal ends of the middle 290 Glossary of Common Neurologic Terms

and posterior cerebral arteries (parietal lobe) West’s syndrome Infants develop a triad of and middle and anterior cerebral arteries epileptic spasms (brief, symmetric contrac- (anterior frontal lobe) that are damaged when tions of neck, trunk and limb muscles), hypoperfusion of the brain occurs. hypsarrhythmia on EEG, and mental retar- Wernicke’s aphasia Language disorder in dation. Also known as infantile spasms or which there is loss of ability to comprehend hypsarrhythmia. verbal or written communications and abil- White matter Central that ity to speak in fluid sentences with normal contains mainly myelinated (white appear- melody that make no sense. ing) nerve fibers, but not their neuronal cell Wernicke’s encephalopathy An acute condi- bodies. tion presenting with triad of oculomotor Xanthochromia Yellow color of CSF superna- abnormalities, gait ataxia and confusion that tant that comes from lysed RBCs, bilirubin, develops in individuals deficient in thiamine or very elevated CSF protein concentration.

(vitamin B1 ), especially in alcoholics with low food intake. Index

A B Absence seizure, 190, 194, 196, 218 Babinski sign, 16, 19, 79, 82, 84, 121, 140, 161, 197, etiology of, 194 228, 231, 243 Abscess, brain, 24, 37, 132, 160, 164–166, 185, 228, 246 Back pain or trauma, 84, 85, 89 Acetylcholine receptor in myasthenia gravis, 55, 58 Bacterial meningitis, 6, 161, 162, 163 Acromegaly, 68, 183 Balance, normal, 14 Acute disseminated encephalomyelitis (ADEM), 130 Ballismus, 14, 148 Acute inflammatory demyelinating polyneuropathy Bell’s palsy, 70, 72 (AIDP), 128 Benign paroxysmal positional vertigo (BPPV), 264 Acute motor axonal neuropathy, 128–130 Blood-brain barrier, 7, 59, 125, 126, 153, 236 Acyclovir, 72, 163, 168, 170, 267 Border zone or watershed infarction, 104 antiviral , 168 Botulism, 29, 58, 60, 129 Adrenocorticotropic (ACTH), 183, 196 Brain abscess, 132, 164, 165, 237 Alcoholic cerebellar degeneration, 95, 239, 240 Brainstem, 4, 14, 41, 79, 273 Alcoholic coma, 236 Alcoholic polyneuropathy, 239 C Alcoholism, 68, 231, 235, 237 Carpal tunnel syndrome (CTS), 63, 68 cause of, 235 Cataplexy, 269, 273, 274 chronic, 96, 239 Cauda equina syndrome, 84, 85, 87 complications of, 236 Cerebellum, 31, 92, 162, 238 Alcohol withdrawal Cerebral seizures, 237 , 104 syndromes, 236, 237 hemorrhage, 103, 114, 185 Allodynia, 66, 170, 246, 248 ischemia, 104, 117, 119, 229, 230 Alzheimer’s disease, 139, 141, 142 thrombosis, 162 Alzheimer’s disease, 24, 114, 232 Cerebral death, 176, 207, 208 Amnesia, 139, 225, 226, 239 Cerebral edema, 114, 116, 164–166, 176, 177, 179, 185, Amyotrophic lateral sclerosis, 75–81 186, 211, 231 Anatomic locations, 14, 248 Cerebral , 186 , 212, 214 Cerebral palsy (CP), 189, 221 Anti-NMDAR limbic encephalitis, 173 Cerebrospinal fluid (CSF), 6, 107, 124, 262, 271 Aphasias, 10, 30, 80, 111, 135–137, 162, 175, 232 Channelopathy, 51 Broca’s aphasia, 107, 110, 113, 136, 137 Chiari syndrome, 214 Global aphasia, 137 Chorea, 14, 38, 148, 155, 209 Wernicke’s aphasia, 107, 133, 136–139 clocks, 270 Apraxia, 10, 137, 240 Clinical hypothesis, 72, 131, 167 Astereognosis, 278 Cognition, in normal aging, 140, 145 Ataxia, 30, 54, 96, 97, 238, 239 Coma, 5, 176, 199–210, 236, 280 gait, 236 characteristics, 200 spinocerebellar, 95 decorticate and decerebrate, 119, 205, 218, 226 truncal, 94 Major causes, 201 Athetosis, 4, 148 Metabolic, 200–203 Auditory nerve exam, 12 Management and prognosis, 219 Aura, 191, 237, 252, 267 Complex partial seizures, 280 migraine, 111, 253 Computed tomography (CT), 23, 35, 107, 112, 204

L. E. Davis, S. Pirio Richardson, Fundamentals of Neurologic Disease, 2nd Edition 291 DOI 10.1007/978-1-4939-2359-5, © Springer Science+Business Media, LLC 2015 292 Index

Concussion, 225, 230 dystonia, 4, 14, 62, 148, 173, 209, 251 Confusion, 154, 164, 168, 237 , 131, 149, 150, 168, 169, 236, 237 Congenital infections, 212 myoclonus, 14, 147, 149, 157, 171–173, 194, 209 Coordination exam, 14, 200 tics, 14, 147 Creatine kinase (CK), 43, 48, 80, 251 Creutzfeldt-Jakob disease (CJD), 170 F Cushing’s disease, 183 Fetal alcohol syndrome (FAS), 240, 241 Cytotoxic edema, 177, 279 , 179, 190, 191, 192 Folstein Mini Mental Status exam, 9 D Functional magnetic resonance imaging (fMRI), 37, 38, Decerebrate and Decorticate postures in coma, 119, 205, 254 218, 226 Deep tendon reflexes, 16, 19, 44, 60, 204, 280 G Delirium, 141, 168, 199 Gait evaluation in normal aging, 14 tremens, 237, 238 Gait ataxia, 95, 97, 100, 236–239 Dementia, 5, 24, 80, 124, 140, 141, 145, 271 Generalized convulsion, 197 diagnosis of, 140 Glasgow coma scale (GCS), 119, 225, 226, 228 multiinfarct, 104 Glioma, 177, 178 vascular, 144 Gower’s maneuver, 44 Demyelination, 27, 30, 64, 65, 125, 131 Graphesthia, 16 segmental, 64 Grasp reflex, 19, 213 Denervation, muscle, 42 Guillain-Barré Syndrome (GBS), 128 Dermatomyositis (DM), 46 Devicʼs disease (neuromyelitis optica), 127 Diabetic distal symmetrical polyneuropathy, 65 H Differential diagnosis, 1, 6, 78, 129 Hallpike maneuver, 263–265 Dizziness, 225, 259, 262 Hematoma, subdural, 30, 104, 114, 116, 225–232, 250 other causes of, 260 Hemorrhage, subarachoid, 30, 34, 37, 116, 117, 119, 201 primary, 262 Herpes simplex virus (HSV), 71, 72, 163, 166, 167, 169 (DRG), 63, 247 Hexosaminidase A deficiency, 218 Down syndrome, 219, 220, 221 Higher cortical function disorders, 133–144, 210 Drunkenness, 235 Horner’s syndrome, 98 Duchenne muscular dystrophy, 42, 43 Huntington’s disease, 155 Dying-back neuropathy, 64 Huntington’s disease, 99 Dysequilibrium, 259, 260, 262 Hypertensive hemorrhage, 104, 116 Dysexecutive syndrome or ‘frontal lobe syndrome’, 139 Hypertonia and hypotonia, 13, 20, 251 Dystonia, 4, 14, 148, 173, 251 Hyponatremia, 96, 168 cervical, 62 serum, 95 Dystrophin, 42, 44, 45 dysfunctional, 44 I protein, 43 Inflammatory myopathy, 47 Inner ear and exam, 261 E Insomnia, 170, 180, 227, 237, 271 Electroencephalogram (EEG), 24, 25, 190, 207, 219, symptoms of, 173 228, 237, 256 , 24, 221 Electromyogram (EMG), 25, 27 Ischemic penumbra, 104 Encephalitis, 30, 92, 131, 160, 166, 171 Ischemic , 92, 97, 103, 104, 107, 201, 255 Epidural hematoma, 30, 115 Interstitial edema, 176 Epilepsy, 49, 166, 189–192, 196, 237 posttraumatic, 230 Epley maneuver, 265, 266 L , 148, 149, 150 Lacunar stroke, 104, 107 Executive function, 134, 140, 142–144, 157, 217 Lambert-Eaton myasthenic syndrome (LEMS), 58 Extensor , 16 Language, 94, 133–135, 144, 241 Extrapyramidal signs, 147 Language abnormalities, 9, 10, 135 athetosis, 4, 148 Lateral medullary syndrome, 97 ballismus, 14, 148 Lateral protrusion of disc, 85 chorea, 4, 14, 131, 132, 147, 157, 209 Lennox-Gastaut syndrome, 196 Index 293

Levodopa, 152–155, 275, 276 Neuromyelitis optica (NMO), 82, 83, 122, 127, 132 with radiculopathy, 84, 85, 87 Neuropathic pain (NP), 73, 89, 245, 251 Lipid storage disease, 218 management, 249 Lumbar puncture (LP), 30, 32, 73, 118, 162 mechanisms, 248, 249 complications of, 33, 34, 35 Neuropsychological tests, 23, 24, 141, 217, 243 technique of, 32 , 38, 53, 156, 173, 208, 217, 227, 247 Lumbar radiculopathy, 87 excitatory, 247 Lumbar stenosis, 84, 87, 88, 89 glutamate, 80 Non-rapid eye movement sleep (NREM), 269 Normal neurologic aging, 9, 193, 227 M Nystagmus, 11, 97, 100, 196, 238, 259, 266, 267 Magnetic resonance imaging (MRI), 23, 35, 107, 163 directional-rotary, 265 Malformation artiovenous, 113–116, 231 vascular, 104 O Memory impairment syndromes, 9 Obstructive sleep apnea (OSA) Medication overuse headache (MOH), 255 with chronic headaches, 272 Medulla, 73, 92, 97, 271 Obtundation, 131, 199 dorsal, 260 mental, 167 Memory, 9, 96, 143 deficits, 239 P Meniere’s disease or endolymphatic hydrops, 267 Pain Meningioma, 7, 70, 180, 181 evaluation, 67, 68 Mental retardation, 164, 189, 196, 216–221 pathways, 73 Mental status exam, 9, 141 types, 85, 170 Mesencephalon, 91, 227 Paraparesis, 82, 124 fetal, 155 spastic, 215 Mesial temporal sclerosis, 192, 193 Paresthesia, 49, 65, 68, 82, 129, 243, 246, 253, 274 Migraine headache, 6, 23, 117, 252, 253 Parkinson’s disease (PD), 7, 13, 147, 150 Mild cognitive impairment (MCI), 9, 140, 141 Pediatric exam, 19, 20 Molecular genetic tests, 38 Peripheral nervous system (PNS), 27, 58, 63, 64, 67, Motor exam, 13, 14 121, 128, 236, 251 Multiple sclerosis (MS), 30, 70, 82, 83, 122, 128 myelin, 131 Muscle, 11, 12, 13, 16, 25, 27, 38, 41, 45 Peripheral nerve disorders, 64–79, 100 atonia, 270 Phenylalanine hydroxylase deficiency, 216 bulbar, 207 Phenylketonuria (PKU), 216, 217 , 38, 44, 45, 47, 80 Pituitary adenoma, 180, 182 dystrophin, 42 Polymerase chain reaction assays, 33 normal, 25 Pons, 91, 92, 95, 96, 99, 113, 176, 247 skeletal, 47, 238 ventrolateral, 96 skull, 249 Prenatal development, 45, 217 strength evaluation, 13, 45 Primary hyperkalemic periodic paralysis (hyperPP), 48, Muscular dystrophy, 41, 48 49 Duchenne, 42 Prion, and their diseases, 151, 171 Myasthenia gravis (MG), 29, 54, 58, 129, 173 Proprioceptive system in balance, 260–263 Myelin, 6, 28, 63, 64, 82, 96, 121–123, 129, 243 Psychogenic nonepileptic seizure, 193 sheath, 129 Myelination, 121, 212, 217 Myoclonus, 147, 149, 157, 171, 194 R Radiculopathy, 75, 84, 86, 186 chronic, 86 N Recombinant tissue plasminogen activator, 110 Narcolepsy, 25, 272, 273, 274 Rapid eye movement sleep, 273 diagnosis of, 274 Reflex exam, 11 Nerve biopsy, 67 Restless leg syndrome, 272 Nerve conduction tests, 27, 61, 66, 243 Neurologic exam, 1, 6, 9, 14, 23, 30, 67, 193, 197, 237, 250, 251, 254, 256 S pediatric, 20 Saccular aneurysm, 104, 116, 119 tests, 6, 35 Schwann cells, 43, 63, 65, 91, 121, 122 Neuromuscular junction (NMJ), 3, 14, 27, 29, 54, 55, 57, Secondary generalized seizure, 115, 164 60, 61, 78 Seizure, 25, 166, 173 294 Index

alcohol withdrawal, 237 T classification, 190 Tay-Sachs disease, 38, 211, 218 etiologies of, 190 Tension type headache, 179, 257 focal, 191 Teratogenic , 212 pathophysiology of, 189 , 238 Semicircular canals (SSC), 260, 261 Tics, 14, 147, 149, 157, 209 Sensory exam, 228 Tonsillar herniation, 176 Single photon/positron emission computed tomography cerebellar, 176 (SPECT or PET), 37 Transient ischemic attack (TIA), 110, 111, 193 , 41, 55, 80, 273 , 75 Skull fracture, 70, 159, 226–229 cervical, 127 basal, 228 post-infectious, 82 Sleep, 24, 25, 66, 107, 192, 199, 237, 255, 269, 273 Traumatic brain injury (TBI), 83, 114, 116, 139, 206, 225 irregularities, 253 Tremor, 4, 14, 131, 149, 150, 152, 153, 237 of, 269 cerebellar, 95 Smooth muscle, 41, 44, 61, 113 Triptans, 252, 255, 256 necrotic, 117 Trisomy 21 chromosome, 211 Spatial skills, 134 Spinal cord, 14, 16, 25, 32, 63, 211, 214, 243, 247, 249, U 275 Uncal herniation, 30, 176, 228 trauma, 231 Spinocerebellar , 38 myotoxicity, 47 V Status epilepticus, 25, 192, 197, 198 Varicella virus, 169, 170 convulsive, 197 Vasogenic edema, 107, 114, 176, 177, 185 Straight leg raising test, 86 Vertebral disk, 75 Stroke, 7, 70, 96, 104, 108, 141 Vertigo, 12, 94, 97, 98, 111, 262, 267 hemorrhagic, 95 episodic, 100 ischemic, 92, 95, 97, 104, 106 Vestibular neuritis, 262, 265 Stupor, 5, 161, 176, 199, 231, 236, 238, 273 Vestibular system, 259, 260, 262 Subacute combined degeneration, 75, 242 Viral meningitis, 161, 162, 163 Subarachnoid hemorrhage (SAH), 30, 34, 116 (cyanocobalamin) deficiency, 242 Subdural hematoma (SDH), 30, 112, 114, 116, 206, 226, 250 W chronic, 231, 232 Wallenberg’s syndrome, 97 Synapse, 53, 54, 64, 173, 248 , 64, 70, 71, 129, 130, 226, 243 cholingeric, 59 Wernicke’s aphasia, 107, 133, 136, 137, 290 cortical, 143 Wernicke’s encephalopathy and Korsakoff’s dysfunction, 64 syndrome, 238 hippocampal, 171 (WNV), 166, 169 peripheral acetylcholine, 59 neuroinvasive disease, 168 Synaptopathy, 54, 58 West’s syndrome, 196 , 215, 216, 246