Abstract
The majority of patients referred to neurologists and a large proportion of patients seen by primary care providers complain of headaches, dizziness or vertigo, episodes of loss of consciousness, sleep disorders and other transient symptoms such as confusion, amnesia, weakness, blurred vision, numbness or tingling sensations and muscle cramps or pain in the extremities. Since most residency programs focus on in-patient experience, the graduating resident is often unprepared for the deluge of patients with such complaints. He or she must be able to sift through the history to extract the critical information and, most important, to ask the pertinent questions which elicit diagnostic information. Lurking within this patient load are undoubtedly a significant number with serious illnesses which must be detected and treated promptly. Many of them either do not have abnormal laboratory values that easily facilitate making a diagnosis or they provide misleading neuroimaging data that, if totally relied upon, result in misdiagnosis.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Notes
- 1.
Adapted from International Headache Society. The International Classification of Headache Disorders (ICHD-3) [13].
- 2.
Adapted from International Headache Society. The International Classification of Headache Disorders (ICHD-3) [13]. Cephalgia 2013;33:629–88
- 3.
Adapted from International Headache Society. The International Classification of Headache Disorders (ICHD-3) [13].
- 4.
Adapted from International Headache Society. The International Classification of Headache Disorders (ICHD-3) [13].
- 5.
Adapted from International Headache Society. The International Classification of Headache Disorders (ICHD-3) [13].
- 6.
Adapted from International Headache Society. The International Classification of Headache Disorders (ICHD-3) [13].
- 7.
Adapted from International Headache Society. The International Classification of Headache Disorders (ICHD-3) [13].
- 8.
Adapted from International Headache Society. The International Classification of Headache Disorders (ICHD-3) [13]. Cephalgia 2013;33:629–88
- 9.
Adapted from International Headache Society. The International Classification of Headache Disorders (ICHD-3) [13].
- 10.
Adapted from International Headache Society. The International Classification of Headache Disorders (ICHD-3) [13].
- 11.
Adapted from International Headache Society. The International Classification of Headache Disorders (ICHD-3) [13].
- 12.
Adapted from International Headache Society. The International Classification of Headache Disorders (ICHD-3) [13].
- 13.
Church A, Peterson F. Nervous and Mental Diseases. 3rd edition. London and Philadelphia, WB: Saunders; 1901.
References
Headache
Afridi SK, Matharu MS, Lee L, et al. A PET study exploring the laterality of brainstem activation in migraine using glyceryl trinitrate. Brain. 2005;128:932–9.
Charles A. The pathophysiology of migraine: implications for clinical management. Lancet Neurol. 2018;17(2):174–82.
Zucconi M, Ferri R. ESRS sleep medicine textbook. Assessment of sleep disorders and diagnostic procedure. 2014.
Dodick DW. Chronic daily headache. N Engl J Med. 2006;354:158–65.
Frese A, Eikermann A, Frese K, et al. Headache associated with sexual activity. Neurology. 2003;61:796–800.
Friedman DI, Jacobsen DM. Diagnostic criteria for idiopathic intracranial hypertension. Neurology. 2002;59:1492–5.
Greif S, Mandel S, Langer DJ, Ortiz RA. Spontaneous intracranial hypotension: spontaneous intracranial hypotension remains an underdiagnosed etiology of new‐onset headache. Pract Neurol. 2014;6:24–7.
Gelfand AA, Gelfand JM, Prabakhar P, Goadsby PJ. Ophthalmoplegic “migraine” or recurrent ophthalmoplegic cranial neuropathy: new cases and systematic review. J Child Neurol. 2012;27:759–66.
Loder E. Triptan therapy in migraine. N Engl J Med. 2010;363:63–70.
Schievink W. Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension. JAMA. 2006;295:2286–96.
Silberstein SD, Lipton RB, Goadsby PJ. Headache in clinical practice. 2nd ed. London: Martin Dunitz; 2002.
Sprenger T, Boeker H, Tolle TR. Specific hypothalamic activation during a cluster headache attack. Neurology. 2004;62:516–7.
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3d edition (beta version). Cephalalgia. 2013;33(9):629–808.
Waeber C, Moskowitz MA. Migraine as an inflammatory disorder. Neurology. 2005;64(Suppl 2):S9–15.
Weiss HD, Stern BJ, Goldberg J. Post-traumatic migraine: chronic migraine precipitated by minor head or neck trauma. Headache. 1991;31:451–9.
Vertigo
Vollesen ALH, Snoer A, Beske RP, Guo S, Hoffmann J, Jensen RH, Ashina M. Effect of infusion of calcitonin gene-related peptide on cluster headache attacks: a randomized clinical trial. JAMA Neurol. 2018;75(10):1187–97. https://doi.org/10.1001/jamaneurol.2018.1675.
Baloh RW, Honrubia V. Clinical neurophysiology of the vestibular system. 4th ed. New York, NY: Oxford University Press; 2011.
Brandt T, Daroff RB. The multisensory physiological and pathological vertigo syndromes. Ann Neurol. 1980;7:195–203.
Fife TD, Tusa RJ, Furman JM, et al. Assessment: vestibular testing techniques in adults and children. Neurology. 2000;55:1431–41.
Fife TD. Dizziness in the outpatient care setting. Continuum (Minneap Minn). 2017;23(2):359–95.
Furman JM, Cass SP. Balance disorders. A case study approach. Philadelphia, PA: F.A. Davis; 1996.
Halmagyi GM, Curthoys IS. A clinical sign of canal paresis. Arch Neurol. 1988;45:737–9.
Hotson JR, Baloh RW. Acute vestibular syndrome. N Engl J Med. 1998;339:680–5.
Kim JS, Zee DS. Benign paroxysmal positional vertigo. N Engl J Med. 2014;370:1138–47.
Thompson AJ, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis: 2017 revisions of the McDonald’s criteria. Lancet Neurol. 2018;17(2):162–73.
Near-Syncope, Syncope and Seizure
Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE commission on classification and terminology, 2005-2010. Epilepsia. 2010;51(4):676–85.
Cheshire WP. Syncope. Continuum (Minneap Minn). 2017;23(2):335–58.
Chung SS, Gerber P, Kirlin KA. Ictal eye closure is a reliable indicator for psychogenic nonepileptic seizures. Neurology. 2006;66:1730–1.
Fisher RS, Acevedo C, Arzimanoglou A, et al. ILAE official report: a practical clinical definition of epilepsy. Epilepsia. 2014;55:475–82.
Fisher RS, Cross J, French JA, et al. Operational classification of seizure types by the international league against epilepsy. Position paper of the ILAE commission for classification and terminology. Epilepsia. 2017;58(4):531–42.
Grubb BP. Postural tachycardia syndrome. Circulation. 2008;117:2814–7.
Grubb BP. Neurocardiogenic syncope. N Engl J Med. 2005;352:1004–10.
Grubb BP, Olshansky B, editors. Syncope: mechanisms and management. Armonk, NY: Futura; 1997.
Thijs RD, Wagenar WA, Middlekoop HAM, et al. Transient loss of consciousness through the eyes of a witness. Neurology. 2008;71:1713–8.
Scheffer IE, Berkovic S, Capovilla G, et al. ILAE classification of the epilepsies: position paper of the ILAE commission for classification and terminology. Epilepsy. 2017;58:512–21.
Wyllie E, Gidal BE, Goodkin HP, et al. Wyllie’s treatment of epilepsy principles and practice. 6th ed. Philadolphia: Wolters Kluwer; 2017.
Sleep Disorders
American Academy of Sleep Medicine, editor. International Classification of Sleep Disorders. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.
Dauvilliers Y, Arnulf I, Mignot E. Narcolepsy with cataplexy. Lancet. 2007;369:499–511.
Kryger M, Roth T, Dement W. Principles and practice of sleep medicine. 6th ed. Philadelphia, PA: Elsevier; 2017.
Lodi R, Tonon C, Vignatelli L, et al. In vivo evidence of neuronal loss in the hypothalamus of narcoleptic patients. Neurology. 2004;63:1513–5.
Ripley B, Overeem A, Fujiki N, et al. CSF hypocretin/orexin levels in narcolepsy and other neurologic conditions. Neurology. 2001;57:2253–8.
Silber MH. Chronic insomnia. N Engl J Med. 2005;353:803–10.
Yaggi HK, Concato J, Kernan WN, et al. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med. 2005;353:2034–41.
Zucconi M, Ferri R. ESRS Sleep Medicine Textbook chapter B1; 2014.
Transient Neurologic Symptoms
Critchley M. Types of visual perseveration. “Paliopsia” and illusory visual spread. Brain. 1951;74:267–99.
Demirkiran M, Jankovic J. Paroxysmal dyskinesias: clinical features and classification. Ann Neurol. 1995;38:571–9.
Fisher CM. Transient global amnesia. Arch Neurol. 1982;39:605–8.
Geller TJ, Bellur SN. Peduncular hallucinosis. Magnetic resonance imaging confirmation of mesencephalic infarction during life. Ann Neurol. 1987;21:602–4.
Gonzalez-Martinez V, Comte F, de Verbizier D, Carlander B. Transient global amnesia. Arch Neurol. 2010;67:510–1.
Ishiyama G, Ishiyama A, Jacobson K, Baloh RW. Drop attacks in older patients secondary to an otologic cause. Neurology. 2001;57:1103–6.
Klijn CJM, Kapelle J, Van Schooneveld MJ, et al. Venous stasis retinopathy in symptomatic carotid artery occlusion. Stroke. 2002;33:695–701.
Siatkowski RM, Zimmer B, Rosenberg PR. The Charles Bonnet syndrome. Visual perceptive dysfunction in sensory deprivation. J Clin Neuro Ophthalmol. 1990;10:215–8.
Venance SL, Cannon SC, Fialho D, et al. The primary periodic paralyses: diagnosis, pathogenesis and treatment. Brain. 2006;129:8–17.
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Alpert, J.N. (2019). Common Symptoms in the Neurology Clinic. In: The Neurologic Diagnosis. Springer, Cham. https://doi.org/10.1007/978-3-319-95951-1_11
Download citation
DOI: https://doi.org/10.1007/978-3-319-95951-1_11
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-95950-4
Online ISBN: 978-3-319-95951-1
eBook Packages: MedicineMedicine (R0)