Skip to main content

The Nervous System

  • Chapter
Book cover Family Medicine

Abstract

Patients come to their family physician with a variety of symptoms and underlying disease states, often with psychic overlay, and all of this must be dealt with in detail before approaching the problem as a possible neurological one. The family physician’s knowledge of the patient and family is essential for a comprehensive neurological evaluation of the complaint. To proceed with a neurological examination without a complete database is inconsistent with the principles of family medicine. The competent family physician must incorporate “Where is the lesion?” into “What is wrong with the patient?” by gaining proficiency with the neurological examination. The main purpose of this chapter is to update recent diagnostic and therapeutic advances in disease of the nervous system.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 74.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Sutula TP. Epileptic seizures Part I. diagnosis. Fam Pract Recert 1985; 7 (12): 25–38.

    Google Scholar 

  2. Drugs for epilepsy. Medical Letter 1986; 28: 91–4.

    Google Scholar 

  3. Penry JK, Newmark ME. The use of antiepileptic drugs. Ann Intern Med 1979; 90: 207–18.

    Article  PubMed  CAS  Google Scholar 

  4. Ellenberg JH, Hirtz DG, Nelson KB. Do seizures in children cause intellectual deterioration? N Engl J Med 1986; 314: 1085–8.

    Article  PubMed  CAS  Google Scholar 

  5. Shinnar S, Vining EPG, Mellits ED, et al. Discontinuing antiepileptic medication in children with epilepsy after two years without seizures. N Engl J Med 1985; 313: 976–80.

    Article  PubMed  CAS  Google Scholar 

  6. Jaffe A. McCormick M, DeAngelis C. Which children with febrile seizures need lumbar puncture ? Am J Dis Child 1983; 137: 1153–6.

    Article  PubMed  Google Scholar 

  7. Consensus Panel. Febrile Seizures: long-term management of children with fever-associated seizures. Pediatr Rev 1981;2:209— 12.

    Google Scholar 

  8. Hirtz DG, Young JL, Ellenberg JH, Nelson KB. Survey on the management of febrile seizures. Am J Dis Child 1986; 140: 909–14.

    PubMed  CAS  Google Scholar 

  9. Cavines VS, O’Brien P. Current concepts: headache. N Engl J Med 1980; 302: 446–50.

    Article  Google Scholar 

  10. Diamond S. Medina V. Headache. Ciba Clin Symp 1981; 33 (2): 1–32.

    CAS  Google Scholar 

  11. Saper JR. Migraine. Classification and pathogenesis. JAMA 1978; 239: 2380–3.

    Article  PubMed  CAS  Google Scholar 

  12. Saper JR. Migraine. Treatment. JAMA 1978; 239: 2480–4.

    Article  CAS  Google Scholar 

  13. Solomon GD, Steel JG, Spaccavento ZJ. Verapamil prophylaxis of migraine. JAMA 1983; 250: 2500–2.

    Article  PubMed  CAS  Google Scholar 

  14. Meyers JS, Hardenberg J. Clinical effectiveness of calcium entry blockers in prophylactic treatment of migraine and Cluster head-aches. Headache 1983; 23: 266–77.

    Article  Google Scholar 

  15. Meyers JS. Calcium Channel blockers in the prophylactic treatment of vascular headache. Ann Intern Med 1985; 102: 395–7.

    Article  Google Scholar 

  16. Ziegler DK. Tension headache. Med Clin North Am 1978; 62: 495–505.

    PubMed  CAS  Google Scholar 

  17. Raskin N. Headaches associated with organic disease of the nervous system. Med Clin North Am 1978; 62: 459–66.

    PubMed  CAS  Google Scholar 

  18. Kraus JF, Fife D, Cox P, Ramstein K, Conroy C. Incidence, severity and external causes of pediatric brain injury. Am J Dis Child 1986; 140: 687–93.

    PubMed  CAS  Google Scholar 

  19. Rutherford WH, Merrett JD, McDonald JR. Sequelae of concus-sion caused by minor head injuries. Lancet 1977; 1: 1–4.

    Article  PubMed  CAS  Google Scholar 

  20. Lyle DM, Pierce JP, Freeman EA, et al. Clinical course and out-come of severe head injury in Australia. J Neurosurg 1986;65:15— 8.

    Google Scholar 

  21. Kalstis JV, Pitts ZH. Complications associated with use of mega-dose corticosteroids in head injured adults. J Neurosurg Nurs 1980; 12: 166–71.

    Article  Google Scholar 

  22. Rowland TW, Donnelly JH, Jackson AH, Jamroz SB. Brain death in the pediatric intensive care unit. Am J Dis Child 1983; 137: 547–50.

    Article  PubMed  CAS  Google Scholar 

  23. Yatsu FM, Coull BM. Stroke. Curr Neurol 1981; 3: 159.

    Google Scholar 

  24. Sacco RL, Wolf PA, Kannel WB, McNamara PM. Survival and recurrence following stroke. The Framingham Study. Stroke 1982; 13: 290–5.

    Article  PubMed  CAS  Google Scholar 

  25. Kistler VP, Ropper AH, Heros RC. Therapy of ischemic cerebral vascular disease due to atherothrombosis. N Engl J Med 1984;311: 27–33, 100–5.

    Google Scholar 

  26. Donahue RP, Abbott RD, Reem DM, Yanko K. Alcohol and hem-orrhagic stroke. JAMA 1986; 255: 2311–4.

    Article  PubMed  CAS  Google Scholar 

  27. Mohr VP. Transient ischemic attacks and the prevention of stoke. N Engl J Med 1978; 299: 93–5.

    Article  PubMed  CAS  Google Scholar 

  28. Sheng FC, Busuttil RW. Carotid surgery in stroke prevention. Am Fam Physician 1986; 33 (4): 109–24.

    PubMed  CAS  Google Scholar 

  29. Chambers BR, Norris JW. Outcome in patients with asymptomatic neck bruits. N Engl J Med 1986; 315: 860–5.

    Article  PubMed  CAS  Google Scholar 

  30. Blaisdell WF, Glickman M, Trankey DD. Ulcerated atheroma of the carotid artery. Arch Surg 1974; 108: 491.

    Article  PubMed  CAS  Google Scholar 

  31. Barnett HVM. The pathophysiology of transient cerebral ischemic attacks. Med Clin North Am 1979; 63: 649–79.

    PubMed  CAS  Google Scholar 

  32. Olsson JE, Brechter HB, Bäcklund H, et al. Anticoagulant vs. antiplatelet therapy as prophylactic against cerebral infarction in transient ischemic attacks. Stroke 1980; 11: 4–9.

    Article  PubMed  CAS  Google Scholar 

  33. Weksler BB, Pett SB, Alonso D. et al. Differential inhibition by aspirin of vascular and platelet Prostaglandin synthesis in athero-sclerotic patients. N Engl J Med 1983; 308: 800–5.

    Article  PubMed  CAS  Google Scholar 

  34. The American-Canadian Co-Operative Study Group. Persantine aspirin trial in cerebral ischemia. Part II. Endpoint results. Stroke 1985; 16: 406–15.

    Article  Google Scholar 

  35. The EC/IC Bypass Study Group. Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. N Engl J Med 1985; 313: 1191–200.

    Article  Google Scholar 

  36. Lavin P. Management of hypertension in patients with acute stroke. Arch Intern Med 1986; 146: 66–68.

    Article  PubMed  CAS  Google Scholar 

  37. Genton E. Barnett HVM, Fields W, Gent M, Hook J. Cerebral ischemia: the role of thrombosis and anti-thrombotic therapy. Stroke 1977; 8: 147–75.

    Article  Google Scholar 

  38. Keith DS, Phillips SJ, Whisnant JP, Nishimaru K, O’Fallon WM. Heparin therapy for recent transient focal cerebral ischemia. Mayo Clin Proc 1987; 62: 1101–1106

    Article  PubMed  CAS  Google Scholar 

  39. Walker A, Robins M, Weisfeld F. The national survey of stroke. Clinical findings. Stroke 1981; 12: 44.

    Google Scholar 

  40. Martin GJ, Biller J. Nonseptic cerebral emboli of cardiac origin. Arch Intern Med 1984; 144: 1979–99.

    Google Scholar 

  41. Sherman DG, Dyken ML, Fisher M, Harrison MJG, Hart RG. Cerebral embolism. Arch Intern Med 1986; 146: 471–2.

    Google Scholar 

  42. Adams HP, Jergenson D, Kassell N, Sage AL. Pitfalls in the recognition of subarachnoid hemorrhage. JAMA 1980; 244: 794–6.

    Article  PubMed  Google Scholar 

  43. Sundt TM, Whisnant JP. Subarachnoid hemorrhage from intracranial aneurysm. N Engl J Med 1978; 299: 116–22.

    Article  PubMed  Google Scholar 

  44. Legman JF, DeLateur BJ, Fowles RS. Stroke. Does rehabilitation affect outcome? Arch Phys Med Rehabil 1975; 56: 375–8.

    Google Scholar 

  45. Ferguson RK, Vlasses PH. Hypertensive emergencies and urgen-cies. JAMA 1986; 255: 1607–13.

    Article  PubMed  CAS  Google Scholar 

  46. Huysmans FTM, Thien T, Koene RA. Acute treatment of hypertension with slow infusion of diazoxise. Arch Intern Med 1983; 143: 882–4.

    Article  PubMed  CAS  Google Scholar 

  47. Weiner HL. Neurology for the house officer. New York: Waverly Press, 1983.

    Google Scholar 

  48. Samuels MA, Sargent RK. Neurologie emergencies. Patient Care 1981; 15 (9): 12–63.

    Google Scholar 

  49. Folstein MJ. Folstein SE, McHugh PR. “Mini-mental State”: a practical method for grading the cognitive State of patients for the clinician. J Psychiatr Res 1975; 12: 189–98.

    Article  PubMed  CAS  Google Scholar 

  50. Marton KJ, Gean Ad. The spinal tap: a new look at an old test. Ann Intern Med 1986; 104: 840–7.

    Article  PubMed  CAS  Google Scholar 

  51. Niesen H, Gyldenstad C, Harmsen A. Cerebral abscess: etiology, and pathogenesis, symptoms, diagnosis and treatment: a review of 200 cases from 1935–1976. Acta Neurol Scand 1982; 65: 609–22.

    Article  Google Scholar 

  52. Weisberg L. Subdural empyema: Clinical and Computer tomo-graphic correlations. Arch Neurol 1986; 43: 497–500.

    Article  PubMed  CAS  Google Scholar 

  53. Swartz MN. Neurosyphilis. In: Sparling FP, Holmes KK, Mardh P-A, Wiesner PJ, eds. Sexually transmitted diseases. New York: McGraw Hill, 1984: 318–33.

    Google Scholar 

  54. Dans PE, Cafferty L, Otter SE, Johnson RJ. Inappropriate use of the cerebrospinal fluid venereal disease research laboratory (VDRL) test to exclude neurosyphilis. Ann Intern Med 1986; 104: 86–9.

    Article  PubMed  CAS  Google Scholar 

  55. Snider WD, Simpson DM, Nielson S, Gold JW, Wetroka CE, Posner JB. Neurological complcations of acquired immune defi-ciency Syndrome: analysis of 50 patients. Ann Neurol 1983; 14: 403–18.

    Article  PubMed  CAS  Google Scholar 

  56. Corey L, Spear PG. Infections with herpes simplex viruses. N Engl J Med 1986; 314: 686–91, 749–57.

    Google Scholar 

  57. Baringer JR. Herpes simplex virus encephalitis. In: Johnson RT. ed. Current therapy in neurologic disease 1985–1986. St. Louis: CV Mosby, 1986: 154–7.

    Google Scholar 

  58. Whitley RJ, Alford CA, Hirsch MS, et al. Vidarabine versus aey-clovir therapy in herpes simplex encephalitis. N Engl J Med 1986; 314: 144–9.

    Article  PubMed  CAS  Google Scholar 

  59. Lichtenstein PK, Heubi JE, Daugherty CC, et al. Grade I Reye’s Syndrome: a frequent cause of vomiting and liver dysfunction after Varicella and upper respiratory tract infection. N Engl J Med 1983; 309: 133–9.

    Article  PubMed  CAS  Google Scholar 

  60. Drugs for parkinsonism. Medical Letter 1986; 28: 62–4.

    Google Scholar 

  61. Scully RE, ed. Multiple system atrophy with parkinsonism. Case records of the Massachusetts General Hospital. N Engl J Med 1983; 308: 1406–14.

    Google Scholar 

  62. Murray TJ. Essential tremor. Can Med Assoc J 1981; 124: 1559–65.

    PubMed  CAS  Google Scholar 

  63. Orme MLE, Tallis RC. Metachopramide and tardive dyskinesia in the elderly. Br Med J 1984; 289: 397–8.

    Article  CAS  Google Scholar 

  64. Tarsy D, Baldessarini RJ. Tardive dyskinesia. Annu Rev Med 1984; 35: 605–23.

    Article  PubMed  CAS  Google Scholar 

  65. McDonald Nl. Multiple sclerosis: the present position. Acta Neurol Scand 1983; 68: 65–76.

    Article  Google Scholar 

  66. Rudick RA, Schiffer RB, Schwetz KM, Herndon RM. Multiple sclerosis: the problem of incorrect diagnosis. Arch Neurol 1986; 43: 578–83.

    Article  PubMed  CAS  Google Scholar 

  67. Moulin D, Paty DW, Ebert GC. The predictive value of cerebrospinal fluid electrophoresis in “possible” multiple sclerosis. Brain 1983; 106: 809–16.

    Article  PubMed  Google Scholar 

  68. Birk N, Rudick R. Pregnancy and multiple sclerosis. Arch Neurol 1986; 43: 719–26.

    Article  PubMed  CAS  Google Scholar 

  69. Rose AS. Long-term care of patients with multiple sclerosis: a neurologist’s perspective. Neurology 1980; 30: 59–60.

    Article  PubMed  CAS  Google Scholar 

  70. McDonald JV, Salagar OM, Rubin P, Lapham LW, Bakemeier RF. Central nervous system tumors. In: Clinical oncology for medical students and physicians. 6th ed. American Cancer Society 1983; 262–78.

    Google Scholar 

  71. Honig PJ, Charmey EB. Children with brain tumor headaches. Am J Dis Child 1982; 136: 121–4.

    Article  PubMed  CAS  Google Scholar 

  72. Flores LE, Williams DL, Bell BA, O’Brien M, Ragal AH. Delay in the diagnosis of pediatric brain tumors. Am J Dis Child 1986; 140: 684–6.

    PubMed  CAS  Google Scholar 

  73. Frisen L. The neurology of visual aeuity. Brain 1980; 103: 639–70.

    Article  PubMed  CAS  Google Scholar 

  74. Sweet WH. The treatment of trigeminal neuralgia (tic douloureux). N Engl J Med 1986; 115: 174–7.

    Article  Google Scholar 

  75. Wolf SM, Wagner JH, Davidson S, Forsythe A. Treatment of Bell’s palsy with Prednisone: a prospective randomized study. Neurology 1978; 28: 158–61.

    Article  PubMed  CAS  Google Scholar 

  76. Harner SG, Laws ER, JR. Clinical findings in patients with acous-tic neurinoma. Mayo Clin Pract 1983; 58: 721–8.

    CAS  Google Scholar 

  77. Consensus Conference. The Utility of therapeutic plasmapheresis for neurological disorders. JAMA 1986; 256: 1333–7.

    Article  Google Scholar 

  78. Schmidek HH. Cervical spondylosis. Am Fam Physician 1986; 33 (5): 89–99.

    PubMed  CAS  Google Scholar 

  79. Rowland LP. Looking for the cause of amyotrophic lateral sclerosis. N Engl J Med 1984; 311: 979–81.

    Article  PubMed  CAS  Google Scholar 

  80. DeLisa JA, Mikulic MA, Miller RM, Melnick RR. Amyotrophic lateral sclerosis: comprehensive management. Am Fam Physician 1979; 19 (3): 137–42.

    PubMed  CAS  Google Scholar 

  81. Dyck PJ. The causes, Classification and treatment of peripheral neuropathy. N Engl J Med 1982; 307: 283–6.

    Article  PubMed  CAS  Google Scholar 

  82. Newsum JK, Smith RM, Crocker D. Intubation for acute respiratory failure in Guillain-Barre Syndrome. JAMA 1979; 242: 1650–1.

    Article  PubMed  CAS  Google Scholar 

  83. Flaggman PD, Kelly JJ. Brachial plexus neuropathy. An electro-physiologic evaluation. Arch Neurol 1980; 37: 160–4.

    Article  PubMed  CAS  Google Scholar 

  84. Raff MC, Asbury AK. Ischemic mononeuropathy and mono-neuropathy multiplex in diabetes mellitus. N Engl J Med 1968; 279: 17–22.

    Article  PubMed  CAS  Google Scholar 

  85. Hinge HH. Jensen TL, Kjaer M, Marquardsen S, Olivarius BF. The prognosis of transient global amnesia. Arch Neurol 1986; 43: 673–6.

    Article  PubMed  CAS  Google Scholar 

  86. Ferrante JA, Schaffer TC. Lumbar puncture. In: Mayhew HE, Rodgers LA, eds. Basic procedures in family practice. New York: John Wiley & Sons, 1984: 264–70.

    Google Scholar 

Download references

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1988 Springer Science+Business Media New York

About this chapter

Cite this chapter

Ferrante, J.A., Middleton, D.B. (1988). The Nervous System. In: Taylor, R.B. (eds) Family Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-1998-7_12

Download citation

  • DOI: https://doi.org/10.1007/978-1-4757-1998-7_12

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4757-2000-6

  • Online ISBN: 978-1-4757-1998-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics