A practical guide for the diagnosis and management of elderly patients with neurological disease.

Klappentext

Traditional methods in the clinical practice of neurology have dominated clinical teaching in this specialty for about 100 years. Essentially these methods involve meticulous attention to detail and the recording of clinical facts. Thus the clinical history must be recorded chronologically, preferably in the patient's own words, and of the nervous sys­ followed by a carefully structured examination tem set out in such a way as to allow the precise localisation of the lesion or system involved. Clinical neurology taught and practised in this way has bred generations of neurologists throughout the world and raised the standards in the specialty to a level where clinical skills are probably unexcelled in any other specialty. With increasing availability and reliance upon non-invasive imaging techniques, the need for these skills in large areas of neurological practice has diminished. But perhaps more importantly, the classical clinical methods in neurology were developed when the elderly population was much smaller and when the specialty of geriatrics did not exist. As a result, much of the methodology is irrelevant or unreliable in of geriatrics will frequently the elderly population and the student find himself searching in vain in the textbooks of neurology for help in assessing an elderly patient with an atypical presentation (for example disturbance of balance or recurrent confusional episodes) of some common neurological disorder.

Inhalt

1 The Neurological Examination of The Elderly Patient.- History-taking.- The General Examination.- Temperature.- Blood Pressure.- Aids, Appliances and Chairs.- The Neurological Examination.- 2 The Investigation of the Elderly Patient.- Lumbar Puncture.- Computed Tomography (CT) Scan.- Electroencephalography (EEG).- Electromyography (EMG) and Nerve Conduction Velocity (NCV).- Evoked Potential Recording.- Myelography.- Angiography.- Magnetic Resonance Imaging (MRI).- 3 "Confusion" and Dementia.- History.- Examination.- Tests of Memory.- Tests of Language Function.- Visuo-spatial Disorientation.- Physical Examination.- Acute and Subacute Organic Brain Syndromes.- Confusional States due to Drugs.- Nocturnal Behavioural Disturbance.- Nutritional and Toxic Confusional States.- Dementia: Chronic Organic Brain Syndromes.- Senile Dementia of the Alzheimer Type (SDAT).- The Vascular (Arteriosclerotic or Multi-infarct) Dementias.- "Reversible Dementias".- Subcortical Dementia.- Parkinson's Disease and Dementia.- Dementia of Frontal Type.- Normal Pressure Hydrocephalus.- Pseudodementia.- 4 Disturbances of Gait and Balance, and Falls.- Maintenance of Posture and the Effects of Age and Age-related Disease.- Sensory.- Motor.- Musculo-skeletal Changes.- Neuropathies.- Subacute Combined Degeneration of the Cord.- Gait Dyspraxia.- Treatment.- 5 Headache and Facial Neuralgia.- Headache.- Extracranial Headache.- Intracranial Headache.- Psychogenic Headache.- Facial Neuralgia.- Trigeminal Neuralgia.- Post-herpetic Neuralgia.- Migrainous Syndromes.- Atypical Facial Pain.- 6 Some Visual Problems.- Episodic Visual Disturbance.- Amaurosis fugax.- Migraine.- Epilepsy.- Persistent and Progressive Visual Disturbance.- Prechiasmal (and Retrobulbar) Lesions.- Retrochiasmal Lesions.- Double Vision.- Visual Hallucinations and Disorders of Visual Perception.- 7 Incontinence.- Urinary Incontinence.- Normal Control of the Bladder.- The Effect of Ageing.- History of Urinary Incontinence.- Examination and Investigation.- The Causes of Urinary Incontinence.- Faecal Incontinence.- Normal Control of Defaecation.- History of Faecal Incontinence.- Examination.- Conclusion.- 8 Parkinsonism and Abnormal Movement Disorders.- The Presenting Symptoms and Signs of Parkinsonism.- The Examination of the Patient with Parkinsonism.- The Tremor.- Hypokinesia.- Rigidity.- Other Signs in Parkinsonism.- Disorders of Gait.- Disorders of Higher Mental Function.- Autonomic Function.- Eye Signs.- Assessment.- Course.- Parkinson's Disease and Senile Parkinsonism.- Management.- Abnormal Movement Disorders: Dystonias.- Dystonia.- Facial Dyskinesia.- Dystonic Dysarthria.- 9 Attacks of Loss of Consciousness and Disturbance of Memory.- Attacks of Loss of Consciousness.- History, Examination and Investigation.- Epilepsy.- Cardiac Dysrrhythmias.- Postural Hypotension.- Cough and Micturition Syncope.- "Drop Attacks".- Vertebro-basilar Ischaemia.- Post-stroke "Narcolepsy" and Drowsiness.- Hypothermia.- Amnesic States.- Wernicke's Encephalopathy and Korsakoff's Psychosis.- Transient Global Amnesia.- Amnesia in Diffuse Cerebral Disorder.- 10 Loss of Use in the Upper Limb.- The History.- The Examination.- The Signs.- "Numbness".- Abnormal Involuntary Movements.- Tremor.- Choreo-athetosis.- Dystonia.- Dyspraxia.- 11 Neurological Presentations of General Medical Disorders.- Diabetesm Mellitus.- Hypoglycaemia.- Thyroid Disease.- Disorders of Water and Mineral Metabolism.- Disorders of Calcium Metabolism.- Alcohol and Alcoholism.- Nutritional and other Vitamin Deficiencies.- Neuropsychiatric Manifestations of Malignant Disease.- Herpes Zoster.- Myeloma and Dysproteinaemias.- Drugs.- References and Further Reading.