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Diagnostic Dilemmas

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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.

Keywords

Case reports Dementia Demyelinating Infection Metabolic Neoplasm Vascular 

References

  1. 1.
    Arvanitakis Z. Update on Frontotemporal Dementia. Neurologist. 2010;16:16–22.CrossRefGoogle Scholar
  2. 2.
    Baloh RW, Honrubia V, Kerber KA. Baloh and Honrubia’s clinical neurophysiology of the vestibular system. 4th ed. New York City: Oxford University Press; 2011.Google Scholar
  3. 3.
    Berman BD. Neuroleptic malignant syndrome. A review for neurohospitalists. Neurohospitalist. 2011;1(1):41–7.CrossRefGoogle Scholar
  4. 4.
    Biousse V, Bousser MG. Cerebral venous thrombosis. Neurologist. 1999;5:326–49.CrossRefGoogle Scholar
  5. 5.
    Blennow K. A Review of fluid biomarkers for Alzheimer’s disease: Moving from CSF to Blood. Neurol Ther. 2017;6(suppl 1):15–24.CrossRefGoogle Scholar
  6. 6.
    Bogousslavsky J, Regli F, Uske A. Thalamic infarcts: clinical syndromes, etiology and prognosis. Neurology. 1988;38:837–48.CrossRefGoogle Scholar
  7. 7.
    Bongianni M, Orru C, Groveman BR, et al. Diagnosis of human prion disease using real-time quaking-induced conversion testing of olfactory mucosa and cerebrospinal fluid samples. JAMA Neurol. 2017;74:155–62.CrossRefGoogle Scholar
  8. 8.
    Burger L, Kalvin N, Smith JL. Acquired lesions of the fourth cranial nerve. Brain. 1970;93:567–74.CrossRefGoogle Scholar
  9. 9.
    Caplan LR. Top of the basilar syndrome, Neurology.1980;30:72–9.Google Scholar
  10. 10.
    Clarke JL, Perez HR, Jacks LM, et al. Leptomeningeal metastasis in the MRI era. Neurology. 2010;74:1449–554.CrossRefGoogle Scholar
  11. 11.
    Critchley M. The parietal lobes. New York: Hafner; 1966.Google Scholar
  12. 12.
    Cummings JL. Dementia and depression: an evolving enigma. J Neuropsychiatry Clin Neurosci. 1989;1:236–42.CrossRefGoogle Scholar
  13. 13.
    Dalmau J, Graus F. Antibody-mediated encephalitis. N Engl J Med. 2018;378:840–51.CrossRefGoogle Scholar
  14. 14.
    Dhawan PS, Leong D, Tapsell L, et al. King-Devick test identifies real-time concussion and asymptomatic concussion in youth athletes. Neurol Clin Pract. 2017;7:464–73.PubMedGoogle Scholar
  15. 15.
    Druschky A, Erbguth F, Strauss R. Central nervous system involvement in thrombotic thrombocytopenic purpura. Eur Neurol. 1998;40(4):220–4.CrossRefGoogle Scholar
  16. 16.
    Ducros A, Boukobza M, Porcher R, et al. The clinical and radiological spectrum of reversible cerebral vasoconstriction syndrome. A prospective series of 67 patients. Brain. 2007;130:3091–101.CrossRefGoogle Scholar
  17. 17.
    Grotta JC, Albers GW, Broderick JP. Stroke. Pathophysiology diagnosis and management. 6th ed. Cambridge MA: Elsevier; 2015.Google Scholar
  18. 18.
    Hecaen H, De Ajuriaguerra J. Balints syndrome: psychic paralysis of visual fixation and its minor forms. Brain. 1954;77:373–400.CrossRefGoogle Scholar
  19. 19.
    Höglinger GU, Respondek G, Stamelou M et al. Clinical diagnosis of progressive supranuclear palsy: The movement disorder society criteria. Mov Disord. 2017;32(6):853–64.Google Scholar
  20. 20.
    Hu WT, Mandrekar JN, Parisi JE, et al. Clinical features of pathologic subtypes of behavioral-variant frontotemporal dementia. Arch Neurol. 2007;64:1611–6.CrossRefGoogle Scholar
  21. 21.
    Hyun KW, Jeong IH, Joung AR, et al. Evaluation of the 2015 diagnostic criteria for neuromyelitis optica spectrum disorder. Neurology. 2016;86:1772–9.CrossRefGoogle Scholar
  22. 22.
    Jankovic J, Tolosa E, editors. Parkinson’s disease and movement disorders. 5th ed. Baltimore: Williams and Wilkins; 2007.Google Scholar
  23. 23.
    Jensen MB, Chacon MR, Aleu A. Cervicocerebral arterial dissection. Neurologist. 2008;14:5–6.CrossRefGoogle Scholar
  24. 24.
    Johnson RT, Gibbs CJ. Creutzfeldt-Jakob disease and related transmissible spongiform encephalopathies. N Engl J Med. 1998;339:1994–2004.CrossRefGoogle Scholar
  25. 25.
    Joseph FG, Lammie GA, Scolding NJ. CNS lupus: A study of 41 patients. Neurology. 2007;69:644–54.CrossRefGoogle Scholar
  26. 26.
    Kalra S, Silman A, Akman-Demir G, et al. Diagnosis and management of neuro-Behcet’s disease, international consensus recommendations. J Neurol. 2014;261(9):1662–76.CrossRefGoogle Scholar
  27. 27.
    Kaplan P. The clinical features, diagnosis and prognosis of nonconvulsive status epilepticus. Neurologist. 2005;11:348–61.CrossRefGoogle Scholar
  28. 28.
    Lazo KG, Mandel S, Pramanik B, et al. Posterior reversible encephalopathy syndrome (PRES): a case report and review of the literature. Pract Neurol. 2016:44–7.Google Scholar
  29. 29.
    Lee VH, Wijdicks EFM, Manno EM, Rabenstein AA. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol. 2008;65:205–10.PubMedGoogle Scholar
  30. 30.
    Leehey M. Fragile X-associated tremor/ataxia syndrome (FXTAS). Clinical phenotype, diagnosis and treatment. J Investig Med. 2009;57(8):830–6.CrossRefGoogle Scholar
  31. 31.
    Levine JS, Branch W, Rauch J. The antiphospholipid syndrome. N Engl J Med. 2002;346:752–63.CrossRefGoogle Scholar
  32. 32.
    Little JR, Dale AJD, Okazaki H. Meningeal carcinomatosis. Arch Neurol. 1974;30:138–43.CrossRefGoogle Scholar
  33. 33.
    Luk C, Jones S, Thomas C, et al. Diagnosing sporadic Creutzfeldt-Jakob disease by detection of abnormal prion protein in patient urine. JAMA Neurol. 2016;73(ie):1454–60.CrossRefGoogle Scholar
  34. 34.
    Mayeux R. Early Alzheimer’s disease. N Engl J Med. 2010;362:2194–201.CrossRefGoogle Scholar
  35. 35.
    McKeith IG, Dickson DW, Boeve BF, et al. Diagnosis and management of dementia with Lewy bodies: Fourth Consensus Report of the DLB Consortium. Neurology. 2017;89:88–100.CrossRefGoogle Scholar
  36. 36.
    Mendes GAS, Oliviera MF, Pinto FCG. The timed up and go test as a diagnostic criterion in normal pressure hydrocephalus. World Neurosurg. 2017;105:456–61.CrossRefGoogle Scholar
  37. 37.
    Pachner AR, Steere AC. The triad of neurologic manifestations of Lyme disease. Neurology. 1985;35:47–53.CrossRefGoogle Scholar
  38. 38.
    Perkoff GT. Alcoholic myopathy. Annu Rev Med. 1971;22:125–32.CrossRefGoogle Scholar
  39. 39.
    Postuma RB, Berg D, Stern M, et al. MDS clinical criteria for Parkinson’s disease. Mov Disord. 2015;30(12):1591–601.CrossRefGoogle Scholar
  40. 40.
    Powers WJ. Primary angiitis of the central nervous system, diagnostic criteria. Neurol Clin. 2015;33:515–26.CrossRefGoogle Scholar
  41. 41.
    Roos KL. Neurosyphilis. Semin Neurol. 1992;12:209–12.CrossRefGoogle Scholar
  42. 42.
    Saha KC, Fife TD. Mal de debarquement syndrome. Review and proposed diagnostic criteria. Neurol Clin Pract. 2014;5:209–15.CrossRefGoogle Scholar
  43. 43.
    Salgado AV, Furlan AJ, Keys TF. Mycotic aneurysm, subarachnoid hemorrhage, and indications for cerebral angiography in infective endocarditis. Stroke. 1987;18:1057–60.CrossRefGoogle Scholar
  44. 44.
    Scheld WM, Whitley RJ, Marra CM. Infections of the central nervous system. Philadelphia: Lippincott Williams and Wilkins; 2004.Google Scholar
  45. 45.
    Schwartz MA, Selhorst JB, Ochs AL, et al. Oculomasticatory myorhythmia: a unique movement disorder occurring in Whipple’s disease. Ann Neurol. 1986;20(6):677–83.CrossRefGoogle Scholar
  46. 46.
    Sigsbee B, Deck MDF, Posner JB. Nonmetastatic superior sagittal sinus thrombosis complicating systemic cancer. Neurologist. 1979;29:139–46.CrossRefGoogle Scholar
  47. 47.
    Smith DE, Beckham JD, Tyler KL, Pastula DM. Zika virus disease for neurologists. Neurol Clin Pract. 2016;6:515–22.CrossRefGoogle Scholar
  48. 48.
    Steiner I, Kennedy PGE, Pachner AR. The neurotropic herpes viruses: herpes simplex and varicella-zoster. Lancet Neurol. 2007;6:1015–28.CrossRefGoogle Scholar
  49. 49.
    Stern RA, Daneshvar DH, Baugh CM, et al. Clinical presentation of chronic traumatic encephalopathy. Neurologist. 2013;81:1122–9.CrossRefGoogle Scholar
  50. 50.
    Stiebel-Kalish H, Kalish Y, Bar-On RH, et al. Presentation, natural history and management of carotid cavernous aneurysms. Neurosurgery. 2005;57:850–7.CrossRefGoogle Scholar
  51. 51.
    Terushkin V, Stern BJ, Judson MA, et al. Neurosarcoidosis. Neurologist. 2010;16:2–15.CrossRefGoogle Scholar
  52. 52.
    Thompson AG, Banwell BL, Barkhof F, et al. Diagnosis of multiple sclerosis. 2017 revisions of the McDonald’s criteria. Lancet Neurol. 2018;17:162–73.Google Scholar
  53. 53.
    Toothaker TB, Rubin M. Paraneoplastic neurological syndromes. A review. Neurologist. 2009;15:21–33.CrossRefGoogle Scholar
  54. 54.
    Victor M, Adams RD, Collins GH. The Wernicke-Korsakoff syndrome. 2nd ed. Philadelphia: FA Davis; 1989.Google Scholar
  55. 55.
    Walker RH. The non-Huntington’s disease choreas. Five new things. Neurol Clin Pract. 2016;6:150–6.CrossRefGoogle Scholar
  56. 56.
    Wilkins RH, Brody LA. The thalamic syndrome. Arch Neurol. 1969;20:559–62.CrossRefGoogle Scholar
  57. 57.
    Williams DR, Lees AT. Progressive supranuclear palsy: clinicopathological concepts and diagnostic challenges. Lancet Neurol. 2009;8:270–9.CrossRefGoogle Scholar
  58. 58.
    Wingerchuk DM, Lennon VA, Luccinetti CF, et al. The spectrum of neuromyelitis optica. Lancet Neurol. 2007;6:805–15.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of NeurologyUniversity of Texas Medical, School at HoustonHoustonUSA

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