Clinical Electrophysiology: A Handbook for Neurologists was designed for residents, neurology attendings, and intensive care specialists. It was conceived as a bridging tool that enables the clinical electrophysiological investigation to be tied in with the neurological consultation. This helps the clinician to order the appropriate electrical test, understand the meaning of the interpretation, and then integrate these findings with the clinical question to arrive at a diagnosis. It may further provide information on the differential diagnosis, the prognosis (where warranted), further relevant investigations, and some brief comments on treatment. A brief clinical reference list is included.
The book is organized by the presenting neurological problem in a clinical setting. For each case the authors provide a possible electrophysiological result. This is interpreted and tied to the patient’s symptoms to yield a clinical solution. The handbook avoids theoretical discussion to provide a direct practical guide that:
- Begins with the patient’s symptoms.
- Uses a range of electrophysiological modalities.
- Shows different test results for similar symptoms.
- Relates clinical observation to electrophysiological testing.
In making this portable aid, the authors placed emphasis on the inpatient clinical setting, giving the appropriate symptoms and signs, and pertinent electrophysiology results that might be found. The discussion that follows is specific to the figure given. Hence, for example, confused patients may have any of a number of EEG findings, but the discussion and prognosis are directed only to the one pattern under discussion, for example, triphasic waves. Diagnostic questions (particularly on chronic conditions) that would largely be encountered in the outpatient clinic, or investigated after patients’ discharge, are not included. Hence, chronic neuropathies, palsies, Parkinson’s disease, and most genetic conditions are omitted. Similarly, conditions without electrophysiologic relevancies or those warranting other types of tests (CT, MRI, and ultrasound) are not included. Although a comprehensive tome addressing all neurological testing would clearly be useful, it would not be easily portable.For immediate relevance to neurology consults, the authors avoided general discussions of the neurological examination, disease entities and electrophysiology in general, as there are a number of excellent books that address these issues in detail. The authors recommend, of course, supplemental use of these tomes as they are essential to the understanding of clinical neurology.
The book is organized by the presenting neurological problem, for example, confusion, coma, abnormal movements, or difficulty weaning off a respirator, limb numbness, or weakness. Within these topics, there may be some general diagnostic considerations, definitions of terms, but of principal importance, the authors provide a test result that may be encountered. For example in a comatose patient, the authors give an EEG showing an invariant alpha frequency pattern. There follows an interpretation of the illustrated finding, differential diagnosis, prognosis, and references. In this way, the “vignette” starts with a clinical problem and reaches a diagnostic, prognostic, or therapeutic end.
Because the handbook is “problem-oriented,” it is not a comprehensive treatment of neurologic problems. It is briefer and covers mostly what a hospital clinician might encounter on neurology consultation rounds in a typical year. The last section, however, is a “casebook,” which provides several rarer, but classic, cliniconeurophysiological problems. The casebook format provides more clinical information and leaves the reader to test him or herself as the case unfolds. More information on the electrophysiological findings can be found in the respective section in the handbook.
Contents
Part 1: Central Nervous System Disorders
Section A: Altered consciousness: confusion, delirium and unresponsiveness; agitation hallucination and abnormal behavior
1. Diffuse and frontal fast activity—beta, 4
2. Diffuse slow activity—theta, 6
3. Diffuse slow activity—delta, 8
4. Frontal intermittent rhythmic delta activity, 12
5. Occipital intermittent rhythmic delta activity, 14
6. Triphasic waves, 16
7. Low-voltage fast record without dominant alpha frequencies, 18
8. Alpha coma, 20
9. Spindle coma, 22
10. Low-voltage suppressed pattern, 24
11. Burst/suppression, 26
12. Diffuse slowing—toxic encephalopathy—baclofen, 28
13. Diffuse slowing—metabolic encephalopathy—lithium, 30
14. Diffuse slowing—metabolic encephalopathy—hypoglycemia, 32
15. Diffuse slowing—limbic encephalopathy, 34
16. Focal arrhythmic (polymorphic) delta activity, 36
Section B: Periodic patterns of epileptiform discharges, or seizures
17. Pseudoperiodic lateralized epileptiform discharges, 40
18. Bilateral independent pseudoperiodic epileptiform discharges, 44
19. Generalized periodic epileptiform discharges, 46
Part 2: Seizures
Section A: The Diagnosis of confusional events due to seizures
20. Frontal lobe simple and complex partial seizures, 52
21. Temporal lobe simple and complex partial seizures, 54
22. Parietal lobe simple partial seizures, 56
23. Occipital lobe simple partial seizures, 5
Section B: Status epilepticus
24. Complex partial status epilepticus—frontal , 62
25. Complex partial status epilepticus—temporal, 64
26. Simple partial status epilepticus—parietal, 66
27. Simple partial status epilepticu—occipital, 68
28. Generalized nonconvulsive status epilepticus, 70
Part 3: Conditions of Prolonged Unresponsiveness
Section A: Locked-in syndrome, minimally conscious state, vegetative state, and coma: disorders of consciousness and responsiveness
29. Clinical definitions of impaired responsiveness, 76
Section B: Prolonged unresponsive states
30. Locked-in syndrome—brainstem hemorrhage, 82
31. Vegetative state—postanoxia, 84
32. Minimally conscious state—after large, multifocal strokes, 88
33. Catatonia—psychogenic unresponsiveness/conversion disorder, 90
34. Somatosensory evoked potential Prognosis in anoxic coma, 92
35. Somatosensory evoked potential Prognosis in head trauma, 94
Section C: Evoked Potentials in Consultative Neurology
36. Somatosensory evoked potentials in midbrain lesion—absent cortical responses, 98
37. Somatosensory evoked potentials in diffuse cortical anoxic injury—absent cortical and subcortical responses, 100
38. Somatosensory evoked potentials in prolonged cardiac arrest—absence of all waves above the brachial plexus, 102
39. Somatosensory evoked potentials after prolonged cardiac arrest—absence of all responses except cervical N9, 104
40. Somatosensory evoked potentials—median and tibial after traumatic spinal cord injury, 106
41. Visual evoked potentials in worsening vision, 108
42. Brainstem auditory evoked potentials—in worsening hearing, 110
Part 4: Peripheral Nervous System Disease
Section A: weakness and/or respiratory failure in ICU and on the ward
43. Causes of paralysis and respiratory failure in the ICU, 115
44. The clinical evaluation of neuromuscular disorders, 116
45. Laboratory evaluation of neuromuscular disorders, 117
Section B: Segmental weakness and/or sensory loss
46. Evaluation of segmental peripheral neurological disorders, 120
Section C: Respiratory failure/diffuse weakness
47. Amyotrophic lateral sclerosis/motor neuropathy, 122
48. Critical Illness neuromyopathy, 124
49. Brachial plexopathy, 128
50. Femoral neuropathy, 130
51. Sensory neuropathy/ganglionopathy, 132
52. Lumbar radiculopathy, 134
53. Guillain-Barre´ Syndrome—demyelinating polyneuropathy, 136
54. Myasthenia gravis—neuromuscular junction, 140
55. Myositis—irritable myopathy, 142
56. Statin-induced myopathy—toxic myopathy/myalgia, 146
Part 5: The Casebook of Clinical/Neurophysiology Consults
57. Occipital blindness and seizures—why?, 150
58. Unresponsiveness—coma, vegetative state, or locked-in state?, 152
59. Unresponsiveness—organic or psychogenic?, 154
60. Patient with a frontal brain tumor—psychiatric depression, paranoia, tumor growth, or status epilepticus?, 156
61. Patient with idiopathic generalized epilepsy on valproate—Metabolic encephalopathy or status epilepticus?, 158
62. Unresponsiveness—psychogenic, encephalopathy, or limbic encephalitis?, 160
63. Respiratory weakness—toxic or metabolic?, 162
64. Failure to wean from a ventilator/internal ophthalmoplegia—bulbar dysfunction, neuromuscular junction problem, or polyneuropathy?, 166
65. Progressive sensory loss and painful gait—radiculopathy, toxic or infectious neuropathy, or myopathy?, 170
66. Slowly progressive leg and arm weakness—radiculopathy, plexopathy, ALS, or CIDP/AMN?, 174
67. Progressive thigh pain and leg weakness—radiculopathy, vasculitis, neuropathy, or amyotrophy?, 178
Index
Product Details
- Paperback: 200 pages
- Publisher: Wiley-Blackwell; 1 edition (November 2, 2010)
- Language: English
- ISBN-10: 1405185295
- ISBN-13: 978-1405185295
- Product Dimensions: 9.6 x 7.4 x 0.7 inches