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E-raamat: Clinical Neurophysiology

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(Emeritus Professor of Neurology, Mayo Clinic), (Professor of Neurology, Consultant in Neurology, Department of Neurology, Mayo Clinic)
  • Formaat: 944 pages
  • Sari: Contemporary Neurology Series
  • Ilmumisaeg: 31-Mar-2016
  • Kirjastus: Oxford University Press Inc
  • Keel: eng
  • ISBN-13: 9780190259648
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Clinical NeurophysiologySuurem pilt
  • Formaat: 944 pages
  • Sari: Contemporary Neurology Series
  • Ilmumisaeg: 31-Mar-2016
  • Kirjastus: Oxford University Press Inc
  • Keel: eng
  • ISBN-13: 9780190259648
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Clinical neurophysiologic testing is an important component of evaluating patients with complaints that may be attributed to diseases of the central or peripheral nervous system. This classic volume in the Contemporary Neurology Series covers the basic concepts underlying each of the testing techniques and provides comprehensive descriptions of the methods and wide range of electrophysiologic testing available for patients with epilepsy, neuromuscular diseases, movement disorders, demyelinating diseases, sleep disorders, autonomic disorders and those undergoing orthopedic and neurosurgical procedures. This text details the role of each study, the interpretation of findings, and their application clinical problems.

This text describes the multiple diagnostic procedures for diverse diseases of the neuromuscular system, including: electroencephalography (EEG); electromyography and nerve conduction studies; single fiber EMG; polysomnography; surface EMG patterns, blood pressure, pulse, sweat measures; vestibular function testing; deep brain stimulator physiology; and intraoperative monitoring. It is a practical textbook for neurologists, physiatrists and clinical neurophysiologists in clinical or research practice or in training.

Key Features of the New Edition Include: 1. Fully updated chapters to reflect new research and techniques in clinical neurophysiology. 2. Updated images illustrating key elements of techniques and basic concepts.

3. Case examples for practical application.

Arvustused

"There is no other volume of clinical neurophysiology that is as concise, complete, and readable. The graphics capture the essence of the disorders being demonstrated and new chapters have added breadth to the spectrum of clinical neurophysiological topics covered." --Kerry Levin, MD, Director, Department of Neurology, Cleveland Clinic, Cleveland, OH "The 4th edition of Clinical Neurophysiology in the "black book" series continues its reputation for being a comprehensive reference in clinical neurophysiology. The book is richly illustrated. Topics of basic neurophysiology, volume conduction, digital signal processing and electrical safety are covered. EEG, nerve conduction study, needle EMG, evoked potentials, sleep, autonomic testing and hearing/balance are covered in groups of chapters which include comprehensive presentations of techniques along with both normal and abnormal findings. Advanced and emerging topics of intraoperative monitoring, ICU EEG and neuromuscular ultrasound are also covered. This book should be in the library of every neurology and physical medicine rehabilitation residency and clinical neurophysiology fellowship program." --John C. Kincaid, MD, Professor of Neurology, Indiana University and IU Health, Indianapolis, IN

Preface xxix
Acknowledgments xxxi
Contributors xxxii
Section
1. Basic Neurophysiology
1 Basics Of Neurophysiology
3(28)
Squire M. Stead
Jasper R. Daube
Introduction
4(1)
The Cell Membrane
4(6)
Transmembrane Ion Gradients
Active Transport
Equilibrium Potential
Ion Channels
Neuronal Excitability
Resting Potential
10(1)
Steady State
Sodium Pump
Role of Extracellular Calcium
Role of Glial Cells
Local Potentials
11(5)
Ionic Basis
Characteristics of Local Potentials
Action Potentials
16(6)
Threshold
Ionic Basis of Action Potentials
Excitability
Propagation
Patterns of Activity
Synaptic Transmission
22(5)
Biosynthesis, Storage, Release, and Reuptake of Neurochemical Transmitters
Postsynaptic Effects of Neurochemical Transmitters
Classic Neurotransmission
Neurdmodulation
Electrical Synapses
Clinical Correlations
27(2)
Pathophysiological Mechanisms
Energy Failure
Ion Channel Blockade
Summary
29(2)
2 Electrophysiological Generators In Clinical Neurophysiology
31(4)
Terrence D. Lagerlund
Structural Generators
31(3)
Peripheral Nerves
Muscles
Sweat Glands
Spinal Cord
Brain Stem
Special Sensory Receptors
Optic and Auditory Pathways
Cerebral Cortex
Summary
34(1)
3 Waveforms And Artifacts
35(16)
Devon I. Rubin
Jasper R. Daube
Introduction
35(1)
Continuous Waveforms
36(2)
Frequency
Distribution
Intermittent Waveforms
38(2)
Frequency
Configuration
Combinations Of Waveforms
40(1)
Alterations In Waveforms
41(1)
Physiological Alteration Of Waveforms
41(2)
Single Potential
Continuous Waves
Signal Display
Artifactual Waveforms
43(2)
Physiological Artifacts
Nonphysiological Artifacts
Summary
45(6)
Section
2. Clinical Electroencephalography
Part A: Adult EEG
4 Adult EEG-Normal And Benign Variants
51(25)
Jeffrey W. Britton
Introduction
51(1)
Recording The Electroencephalogram
51(1)
Display Of EEG Activity
52(1)
EEG Montages Activation Procedures
53(1)
Hyperventilation
Photic Stimulation
Sleep
Other Activating Procedures
Artifacts
58(1)
Normal EEG Activity Of Adults
58(1)
Awake State
The EEG in Older Adults
The Adult EEG in Drowsiness and Sleep
Benign Variants
67(1)
Variants During Wakefulness
Benign Variants During Drowsiness and Sleep
Summary
73(3)
5 Adult EEG-Artifacts And The EEG
76(21)
Jeffrey W. Britton
Introduction
76(1)
Physiologic Artifacts
77(1)
Artifacts Associated with the Eye
Myogenic and Tremor Artifacts
Cardiovascular Artifacts
Respiratory Artifact
Sweat Artifact and Galvanic (Sympathetic) Skin Response
Glossokinetic Potentials
Tremor Artifact
Technical And Equipment Artifacts
89(1)
Electrode Artifact
Electrode Plug, Jack Box, Filtering Effects, and Amplifier Connection Errors
Environmental Artifacts
94(1)
60-Hz Artifact
Laptop Computer and Cell Phone Artifact
Intravenous Drip Artifact
Artifacts Stemming from Movement, Manipulation, Patting
Artifact from Intermittent Compression Devices (ICDs), Ventilators, Percussion Beds
Summary
96(1)
6 Adult EEG-Epileptiform Activity
97(13)
Katherine H. Noe
Joseph F. Drazkowski
Introduction
97(1)
Overview Of Epileptiform Activity
98(1)
Generalized Epileptiform Activity
98(1)
Generalized 3 Hz Spike and Wave
Generalized Atypical Spike and Wave
Generalized Slow Spike and Wave
Generalized Paroxysmal Fast Activity
Photoparoxysmal Response
Focal Epileptiform Activity
102(1)
Spike and Sharp Waves
Temporal Intermittent Rhythmic Delta Activity
Periodic Lateralized Epileptiform Discharges
ICTAL Discharges
104(1)
Summary
105(5)
7 Adult EEG-Abnormal Non-Epileptiform Activity
110(19)
Joseph I. Sirven
Barbara F. Westmoreland
Introduction
110(1)
Types Of Abnormal EEG Abnormalities
111(1)
Slow-Wave Abnormalities
Asymmetry
Asymmetrical or Altered Reactivity
Suppression
Periodic Patterns
Focal Intracranial Processes Causing EEG Abnormalities
113(1)
The EEG in Focal Intracranial Lesions
Vascular Disorders
Tumors
Head Trauma
Inflammatory and Infectious Disorders
Other Focal Cerebral Lesions
Transient Disorders
Electroencephalographic Manifestations Of Diffuse Disorders
118(1)
Slow-Wave Abnormalities
Specific Patterns
Generalized Periodic Patterns
Coma Patterns
Evaluation For Suspected Brain Death
123(1)
Conclusion
124(5)
Part B: Pediatric EEG
8 Pediatric EEG-Normal Maturational Changes
129(16)
Katherine C. Nickels
Introduction
129(1)
Developmental Changes In Preterm And Term Neonatal Infants
130(1)
Preterm Infant EEG Patterns
Term Infant Neonatal EEG Patterns
Developmental Changes During Infancy, Childhood, And Adolescence
134(1)
Awake Background Findings
Hyperventilation
Photic Responses
Drowsiness
Sleep
Benign Variants In Children
137(1)
Posterior Slow Waves Associated with Eye Blinks or Slow Lambdas of Youth
O Waves or Cone-Shaped Waves
Posterior Slow Waves of Youth
14 Hz and 6 Hz Positive Spike Bursts
6 Hz Spike and Slow Wave
Case Examples
140(3)
Summary
143(2)
9 Pediatric EEG-Epileptiform Activity
145(22)
Lily C. Wong-Kisiel
Elaine C. Wirrell
Introduction
145(1)
Epileptiform Abnormalities
146(1)
Generalized Epileptiform Activity
Other Epilepsy Syndromes with Generalized Discharges
Focal Epileptiform Activity
Benign Focal Sharp Waves and Benign Focal Epilebsies
Other Sharp Waves by Location and Etiologies
Electrical Status Epilepticus in Sleep (ESES)
Hypsarrhythmia
Periodic Patterns
Non-Epileptiform Abnormalities
159(1)
Generalized Non-Epileptiform Abnormalities
Focal Non-Epileptiform Abnormalities
Summary
163(4)
Part C: EEG-Special Studies And Surgical Monitoring
10 Computer-Assisted Ambulatory Electroencephalography
167(9)
Jerry J. Shih
William O. Tatum
Introduction
167(1)
Historical And Technical Aspects
167(2)
Clinical Applications
169(1)
Seizure Diagnosis
Pediatric Population
Psychogenic Nonepileptic Seizure Assessment
Seizure Quantification
Presurgical Assessment
Summary
173(3)
11 Prolonged Video Electroencephalography
176(9)
Cheolsu Shin
Introduction
176(1)
Equipment
177(1)
Clinical Application
178(1)
Epileptic vs. Non-epileptic Events
Non-epileptic Behavioral Events (Psychogenic Seizures)
Classification of Seizure Type
Quantification of Seizures
PVEEG and Surgical Evaluation
PVEEG in the Intensive Care Units
Summary
183(2)
12 Electroencephalographic Special Studies
185(11)
Gregory A. Worrell
Terrence D. Lagerlund
Introduction
185(1)
Quantitative Methods Of Electroencephalographic Analysis
186(1)
Fourier (Spectral) Analysis
Spike, Sharp-Wave, High-Frequency Oscillation, and Seizure Detection
Montage Reformatting
Cross-Correlation Analysis
Cross-Spectral Analysis
Mutual Information Analysis
Interpolation Techniques
Topographical Displays (Mapping)
Multivariate Statistical Methods and Topographical Analysis
Multivariate Statistical Methods and Directed Transfer Function
Cortical Projection Techniques
Source Dipole Localization
Magnetoencephalography
193(1)
Summary
194(2)
13 Epilepsy Surgery Evaluation: EEG And SPECT
196(13)
Joseph F. Drazkowski
Background
196(1)
Presurgical Selection And Evaluation
197(1)
Clinical Evaluation
Imaging Studies
Intracarotid Amobarbital
Routine EEG In The Surgical Evaluation Of Patients With Seizures
198(1)
Preoperative Video-EEG Monitoring
199(1)
Presurgical Evaluation With Continuous Or Chronic Intracranial Monitoring
200(1)
Depth Wire Electrodes
Subdural Electrode Monitoring
Intraoperative Electrocorticography
203(3)
High Frequency Oscillations (HFO's) In Pre-Surgical Epilepsy Evaluation
206(1)
Summary
206(3)
14 EEG Trend Analysis In The ICU
209(13)
Amy Z. Crepeau
Introduction
209(1)
Utility Of Trend EEG
209(2)
Technical Requirements
211(1)
Rhythmic And Periodic Patterns Of Indeterminate Significance
211(1)
Periodic Lateralized Epileptiform Discharges
Generalized Periodic Epileptiform Discharges
Rhythmic Delta Activity
Stimulation Induced Rhythmic, Periodic, or Ictal Discharges
Triphasic Waves
Quantitative EEG
216(1)
Non-Seizure Indications For Trend EEG In The ICU
217(2)
Summary
219(3)
15 Digital Signal Processing
222(14)
Terrence D. Lagerlund
Digital Computers In Clinical Neurophysiology
222(1)
Digital Clinical Neurophysiology
Digital Electroencephalography
Construction of Digital Systems
Digitization
225(1)
Principles of Analog-to-Digital Conversion
Common Uses Of Digital Processing
228(1)
Averaging
228(1)
Evoked Potentials and Nerve-Conduction Studies
Repetitive Transient Waveforms
Movement-Associated Potentials
Digital Filtering
231(1)
Types of Digital Filters
Characteristics of Digital Filters
Time And Frequency Domain Analysis
231(1)
Interval Analysis
Autocorrelation Analysis
Fourier (Spectral) Analysis
Statistical Analysis
Pattern Recognition
Summary
234(2)
16 Clinical Applications: Assessing Central Nervous System Symptoms
236(21)
Elson L. So
Introduction
236(2)
Assessment Of Motor Symptoms Of Central Origin
238(1)
Assessment Of Sensory Symptoms Of Central Origin
238(2)
Assessing Impairment Of Consciousness And Cognition
240(2)
Assessing Impairment Of Visceral Function And Sleep
242(1)
Identifying Disease Types
242(1)
Prognosis
243(1)
Assessing Clinical Disorders With EEG
243(1)
Electroencephalographic Evaluation of Impaired Consciousness or Delirium
Electroencephalographic Evaluation of Cognitive Dysfunction
Electroencephalographic Evaluation of Seizures and Other Paroxysmal Disorders
EEG in the Intensive Care Unit
Intraoperative EEG
EEG in the Newborn
EEG in the Epilepsy Monitoring Unit
Summary
251(6)
Section
3. Clinical Electromyography
Part A: Nerve Conduction Studies
17 Motor Nerve Conduction Studies: Compound Muscle Action Potentials
257(35)
Lyell K. Jones
James C. Watson
Introduction
258(1)
General Clinical Applications
258(1)
Recording CMAPs During Motor NCS
258(1)
Type of Recording Electrode
Location of Recording Electrode
Stimulation
261(1)
Type of Stimulating Electrode
Position of Stimulating Electrode
CMAP Measurements
263(1)
Amplitude and Area
Duration
Latency
Conduction Velocity
Potential Errors in CMAP Measurements
Normal Values in CMAP Recordings
Physiological Variables Affecting The CMAP
267(1)
Temperature
Age and Anthropomorphic Variables
Pathophysiology Of CMAP Changes In Disease
269(1)
Mechanisms of Conduction in Myelinated Fibers
Mechanisms of Slow Conduction in Disease
Findings In Peripheral Nerve Disorders
270(1)
Findings in Focal Lesions
Findings in Diffuse Peripheral Nerve Damage and Peripheral Neuropathies
Findings in Specific Focal Mononeuropathies
Plexopathies
Radiculopathies
Summary
287(5)
18 Sensory Nerve Conduction Studies: Sensory Nerve Action Potentials
292(20)
Eric J. Sorenson
Introduction
292(1)
Pathophysiology Of SNAPs
293(1)
Normal SNAPs
Abnormal SNAPs
Clinical Importance of SNAPs
Methods Of Sensory Nerve Conduction Studies
297(1)
Nerve Stimulation
Recording the Potential
Averaging
Measurements
301(1)
Technical Factors
302(1)
Noise and Shock Artifact
Submaximal Stimulation
Recording and Stimulating Distance
Temperature
Distance Between Recording Electrode and Nerve
Measurement
Interelectrode Distance
Planning The Study And Findings In Diseases
306(1)
Radiculopathy
Plexopathy
Common Mononeuropathies
Myopathy
Disorders of the Neuromuscular Junction
Motor Neuron Diseases
Summary
310(2)
19 Late Responses: F Waves And H Reflexes
312(16)
Ruple S. Laughlin
F-Waves
312(1)
Recording
Stimulation
Measurement and Interpretation
Pitfalls of F-Waves
Clinical Applications
H-Reflex
318(1)
Physiological Basis
H-Reflex Technique
Soleus Technique
Gastrocnemius Technique
Flexor Carpi Radialis Technique
Pediatric H-Reflexes
323(1)
Clinical Applications
324(1)
Utility in Assessing Proximal Nerve Conduction
Central Nervous System Excitability
Summary
326(2)
20 Repetitive Nerve Stimulation Studies
328(19)
Kathleen D. Kennelly
Introduction
328(1)
Anatomy And Physiology Of The Neuromuscular Junction
329(2)
Technique Of Repetitive Stimulation
331(1)
Recording Electrode Placement
Immobilization
Nerve Stimulation
Stimulation Rates
Repetitive Stimulation after Exercise
Displaying the Results
Measurements
337(1)
Decrement
Increment/Facilitation
Criteria Of Abnormality
338(1)
Selection Of Nerve-Muscle Combinations
338(2)
Pitfalls Of Repetitive Stimulation
340(1)
Clinical Correlations
340(4)
Summary
344(3)
21 Cranial Reflexes And Related Testing
347(14)
Benn E. Smith
Introduction
347(1)
Blink Reflex
348(1)
Neuroanatomy
Methods
Applications
Lateral Spread Of The Facial Nerve Response: Assessment Of Facial Synkinesis And Hemifacial Spasm
353(1)
Jaw Jerk (Masseter Reflex)
354(1)
Neuroanatomy
Methods
Applications
Masseter Inhibitory Reflex
356(1)
Methods
Applications
Great Auricular Sensory Nerve Conduction Studies
357(1)
Methods
Applications
Trigeminal Contact Heat-Evoked Potentials
358(1)
Summary
358(3)
22 Quantitative Motor Unit Number Estimates
361(21)
Eric J. Sorenson
Jasper R. Daube
Introduction
361(2)
Histological Assessment Of Motor Units
363(1)
Motor Unit Number Estimation By Standard EMG
363(1)
Interference Pattern
Recruitment Analysis
MUNE By Standard Motor NCS
364(1)
Quantitative MUNE
365(1)
Underlying Assumptions of Quantitative MUNE
Surface Averaging of Needle EMG MUPs
MUNE from All-or-None Increments in the CMAP
Statistical (STAT) MUNE
Clinical Applications
377(1)
Summary
378(4)
23 Technical Issues And Potential Complications Of Nerve Conduction Studies
382(15)
Devon I. Rubin
Introduction
382(1)
Nerve Stimulaton Problems
383(1)
Imprecise Nerve Localization
Submaximal Stimulation
Overstimulation
Reversal of Cathode-Anode Orientation
Nerve Recording Problems
386(1)
Electrode Size
Electrode Placement (Motor NCS)
Electrode Placement (Sensory NCS)
Motor Artifact During Sensory NCS
Distance Measurement Errors
Cool Limb Temperature
Repetitive Nerve Stimulation Technical Problems
389(1)
Anomalous Nerve Anatomy
389(1)
Martin-Gruber Anastomosis
Accessory Fibular (Peroneal) Nerve
Riche-Cannieu Anastomosis
Superficial Radial Sensory Supply to Dorsal-Medial Hand
Risks Of Nerve Conduction Studies
392(1)
Pacemakers and Cardiac Defibrillators
Peripheral Intravenous Lines
Needle Stimulation
Summary
393(4)
Part B: Needle Electromyography
24 Needle Electromyography
397(40)
Devon I. Rubin
Introduction
398(1)
Goals Of Needle EMG
398(1)
Technique Of Needle Examination
398(1)
Clinical Evaluation
Conducting The Needle Examination
399(1)
Preparing the Patient
Muscle Selection
Needle Insertion
Needle Movement
Recording Display During Needle Examination
Data Collection from a Resting Muscle
Data Collection from a Contracting Muscle
Measurement of MUPs
Needle Electrode Characteristics
403(1)
Standard Concentric Electrodes
Monopolar Electrodes
Single-Fiber Electrodes
Macroelectrodes EMG
Waveform Recognition
404(1)
Pattern Recognition
Semi-Quantitative EMG
EMG Waveforms
405(1)
Normal EMG Waveforms
406(1)
End Plate Activity
Normal Motor Unit Potentials (MUPs)
MUP Recruitment
MUP Configuration
Rise Time
Duration and Amplitude
Phases
Stability
Abnormal Spontaneous EMG Waveforms
414(1)
Insertional Activity Abnormalities
Fibrillation Potentials
Myotonic Discharges
Complex Repetitive Discharges
Fasciculation Potentials
Myokymic Discharges
Neuromyotonic Discharges (Neuromyotonia)
Cramp Potentials (Cramp Discharge)
Synkinesis
Abnormal Voluntary MUPs
425(1)
Abnormal Recruitment
Long-Duration MUPs
Short-Duration MUPs
Polyphasic MUPs
Mixed Patterns: Long-Duration and Short-Duration MUPs
Varying or Unstable MUPs
Doublets (Multiplets)
Abnormal Waveforms-disorders Of Central Control
431(1)
Tremor
Dystonia, Rigidity, Spasticity, Stiff-Man Syndrome
Patterns Of Abnormalities
432(2)
Summary
434(3)
25 Quantitative Electromyography
437(28)
Benn E. Smith
Introduction
438(1)
Motor Unit Potential Characteristics
439(2)
Characteristics Of The Recording Equipment
441(2)
Properties Of MUPS Evaluated Using Standard Electrodes
443(1)
Duration
Area
Amplitude
Spike Duration
Phases and Turns
Stability and Variation
Rise Time
Properties Of MUPS Measurable Only With Special Electrodes
446(2)
Quantitative Analysis Of Single MUPS
448(1)
Manual Analysis
Computer-Assisted Quantitative Analysis of User-Selected MUP
Automated Analysis of Single MUPs
Automated Decomposition EMG
Multiple Motor Unit Action Potential
Decomposition-based Quantitative EMG
MUP Characterization Techniques
Muscle Characterization Techniques
MUP vs. Muscle Characteristic Techniques
Interference Pattern Analysis
456(1)
Method
Analysis
Utility
Turns And Amplitude Analysis Of The Interference Pattern
458(1)
Power-Spectrum Analysis
459(2)
Automated Methods Of Analysis Of Spontaneous Activity
461(1)
Summary
461(4)
26 Single Fiber Electromyography
465(19)
Brian A. Crum
C. Michel Harper Jr
Introduction
465(1)
Selectivity Of Recording Muscle Fiber Action Potentials
466(1)
Surface Electrode Recording of CMAP
Concentric Needle Recording
Single Fiber Recording
SFEMG Equipment
467(1)
Needle Electrode
Amplifier
Display, Trigger, and Delay
Software
Technique
468(1)
Voluntary Activation SFEMG
Stimulated SFEMG
SFEMG Measurements
469(1)
Jitter
Blocking
Fiber Density
Duration
Pitfalls Of SFEMG
474(1)
General
Unstable Trigger
False Trigger
Incorrect Measurement Position
Damaged Fiber
Split Fiber or Ephaptic Activation
Neurogenic Blocking
Pitfalls Unique to Stimulated
SFEMG Clinical Applications Of SFEMG
477(1)
Primary Disorders of Neuromuscular Transmission
Primary Disorders of Muscle
Primary Disorders of Nerve or Motor Neurons
Summary
481(3)
27 Neuromuscular Ultrasound In The EMG Lab
484(11)
Andrea J. Boon
Introduction
484(1)
Ultrasound Imaging Of Nerve And Muscle: Basic Principles
485(1)
Diagnostic Imaging Of Nerves
486(1)
Entrapment Neuropathies
Polyneuropathies
Diagnostic Imaging Of Muscles
488(1)
Utility of ultrasound in the workup of respiratory disorders
Diaphragm Features on Ultrasound
Diaphragm Thickness
Needle EMG of Diaphragm
Ultrasound Guidance During Electrodiagnostic Testing
491(1)
Ultrasound Guidance for Nerve Conduction Studies
Ultrasound Guidance for Needle EMG
28 Pitfalls And Potential Complications Of Needle EMG
495(7)
Devon I. Rubin
Introduction
495(1)
Needle EMG Technique Pitfalls
496(1)
Muscle Identification
Needle Electrode Size
Needle Movement
Level of Voluntary Contraction
Pain Associated with Needle EMG
Recording Problems
497(1)
Filter Settings
Artifacts
Potential Risks During Needle EMG
498(1)
Anticoagulation or Bleeding Disorders
Cutaneous Issues
Lymphedema
Peri-pleural Muscles
Pacemakers or Defibrillators
Prosthetic Cardiac Valves
Summary
500(2)
29 Application Of Clinical Neurophysiology: Assessing Peripheral Neuromuscular Conditions
502(37)
Devon I. Rubin
Jasper R. Daube
Clinical Neurophysiology In The Assessment Of Peripheral Nervous System Disorders
503(1)
Confirming a Clinical Diagnosis
Excluding Alternate Diagnoses
Localizing the Disease
Identifying Disease in Patients Who Are Difficult to Examine Clinically
Identifying Subclinical Disease
Characterizing Disease Pathophysiology
Defining Disease Severity
Defining Stage and Evolution of Disease
Determining Prognosis
Identifying Disease Types
Assessing Clinical Disorders
507(1)
Radiculopathies
507(1)
Cervical and Lumbosacral Radiculopathies
Thoracic Radiculopathies
Common Focal Mononeuropathies
509(1)
Carpal Tunnel Syndrome
Ulnar Neuropathy
Fibular/Peroneal Neuropathy
Peripheral Neuropathy
512(1)
Defining Pathophysiology of Peripheral Neuropathies (Axonal vs. Demyelinating)
Axonal Neuropathies
Assessment of Specific Plexus Components
Demyelinating Neuropathies
Brachial Plexopathy
517(4)
Generalized Weakness
521(1)
Myopathy
522(3)
Myalgias, Muscle Stiffness, And Episodic Muscle Weakness
525(1)
Neuromuscular Junction Disorders
525(2)
Polyradiculopathy
527(1)
Motor Neuron Disease
528(1)
Facial Weakness
529(1)
Anomalous Innervation
529(1)
Martin-Gruber Anastomosis
Riche-Cannieu Anastomosis-"All Ulnar Hand"
Accessory Fibular/Peroneal Nerve
Summary
533(6)
Section
4. Evoked Potentials
30 Somatosensory Evoked Potentials
539(28)
James C. Watson
Jonathan L. Carter
Introduction
539(1)
Generators And Origin Of SEPS
540(2)
SEP Waveforms-A Combination of Near and Far Field Potentials
SEP Waveforms-Neuroanatomical Origins
Methods
542(1)
Nerve Stimulation Variables
Stimulation Intensity
Stimulation Intensity and Rate
Unilateral and Bilateral Stimulation
Recording
542(2)
Methods and Montages
Averaging
Peak Nomenclature
544(5)
Median and Ulnar Mixed-Nerve SEPs
Tibial Mixed-Nerve SEPs
SEP Interpretation
549(2)
Factors That Affect the Amplitude and Latencies of the Evoked Response
Localization
551(1)
Latency Prolongation
Amplitude Reduction
Clinical Applications
551(11)
Disorders of the Peripheral Nervous System
Disorders of the CNS
SEP Findings in Coma and Prognostic Implications SEP Findings in Brain Death
SEPs Recorded in the Intensive Care Unit
Summary
562(5)
31 Visual Evoked Potentials
567(12)
Jonathan L. Carter
Introduction
567(1)
Visual System Anatomy And Physiology
568(1)
Visual Evoked Potentials: Methods
569(1)
Stimulation
Recording
Factors Affecting The VEP Response
570(2)
Visual Acuity
Pupillary Size
Age and Gender
Patient Cooperation
Sedation and Anesthesia
Interpretation Of VEPs
572(1)
Localization Of Visual System Lesions
573(4)
Anterior Visual Pathway (Prechiasmatic or Chiasmatic) Lesions
Visual Evoked Potentials in Multiple Sclerosis
Other Anterior Visual Pathway Lesions
Posterior Visual Pathway (Retrochiasmatic) Lesions
Multifocal Visual Evoked Potentials
577(1)
Summary
577(2)
32 Brainstem Auditory Evoked Potentials In Central Disorders
579(13)
Jonathan L. Carter
Introduction
579(1)
Auditory Anatomy And Physiology
580(1)
Generators Of The Brainstem Auditory Evoked Potentials (BAEPS)
580(1)
Brainstem Auditory Evoked Potentials: Methods
581(2)
Stimulation
Recording
Factors Affecting The BAEP Response
583(2)
Age and Gender
Auditory Acuity
Stimulus Rate
Stimulus Intensity
Stimulus Polarity
Interpretation Of BAEPS
585(1)
Clinical Applications
585(5)
Acoustic Neuroma
Demyelinating Disease
Intrinsic Brainstem Lesions
Coma and Brain Death
Intraoperative Monitoring
Summary
590(2)
33 Motor Evoked Potentials
592(14)
Jeffrey A. Strommen
Andrea J. Boon
Introduction
592(1)
Technique
593(7)
MEP Stimulation
Technical Aspects of Electrical Stimulation
Technical Aspects of Magnetic Stimulation
MEP Recording
MEP Measurements
MEP Pharmacology
600(1)
Applications
600(3)
Demyelinating Disease
Stroke
Spinal Cord Injury
Intraoperative Monitoring
Other Disorders
Contraindications And Risks
603(1)
Summary
603(3)
34 Contact Heat Evoked Potentials
606(11)
Benn E. Smith
Introduction
606(1)
Generators
607(1)
Methods
608(1)
Normal Values
609(1)
Clinical Applications
609(3)
Small Fiber and Other Neuropathies
Meralgia Paresthetica
Spinal Cord Disease
Summary
612(5)
Section
5. Assessment Of Autonomic Function
35 Autonomic Physiology
617(11)
William P. Cheshire Jr
Introduction
617(1)
Symptoms And Diseases
618(1)
General Organization Of The Autonomic System
619(2)
Visceral Afferents
Visceral Efferents
Sympathetic Function
621(1)
Functional Anatomy of the Sympathetic Outflow
Assessment of Sympathetic Function in Humans
Sympathetic Innervation Of The Skin
622(1)
Muscle Sympathetic Activity
623(1)
Autonomic Control Of Heart Rate
623(1)
Cardiovascular Reflexes
624(1)
Arterial Baroreflexes
Cardiopulmonary Reflexes
Venoarteriolar Reflexes
Ergoreflexes
Maintenance Of Postural Normotension
625(1)
Summary
625(3)
36 Quantitative Sudomotor Axon Reflex And Related Tests
628(7)
Phillip A. Low
Introduction
628(1)
Laboratory Evaluation Of Autonomic Function
628(1)
Quantitative Sudomotor Axon Reflex Test
628(5)
Physiology and Technique of QSART
Normal Pattern
Abnormal Patterns
Significance of the Test
Applications
Limitations and Pitfalls of QSART
Other Methods Of Sweat Measurement
633(1)
Silicone Imprints
QDIRT
Neuropad
Summary
633(2)
37 Evaluation Of Adrenergic Function
635(8)
Phillip A. Low
Introduction
635(1)
Skin Vasomotor Reflexes
636(1)
Beat-To-Beat Blood Pressure Response To The Valsava Maneuver
636(2)
Beat-To-Beat Blood Pressure Response To Tilt-Up
638(1)
Technique
Findings
Composite Autonomic Severity Score (CASS)
Venoarteriolar Reflex
639(1)
Denervation Supersensitivity
639(1)
Plasma Norepinephrine
640(1)
Sustained Handgrip
640(1)
Baroreflex Indices
640(1)
Summary
641(2)
38 Thermoregulatory Sweat Test
643(15)
Robert D. Fealey
Introduction
643(1)
Role Of Thermoregulatory Sweat Testing: Clinical Syndromes And Problems Evaluated
644(3)
Small Fiber Neuropathy
Diabetic Peripheral Neuropathies
Severity of Autonomic Failure
Central Disorders
Hyperhidrotic Disorders
Method
647(4)
Thermoregulatory Sweat Distribution
651(1)
Reporting Results
652(1)
Technical Difficulties And Pitfalls In Interpretation
652(2)
Summary
654(1)
Appendix: Sweat Test Procedure
654(4)
39 Cardiovagal Reflexes
658(16)
William P. Cheshire Jr
Introduction
658(1)
Heart Rate Response To Deep Breathing
659(3)
Physiological Basis
Technique
Methods of Analysis
Reproducibility
Factors Affecting the Heart Rate Response to Deep Breathing
Problems and Controversies
The Valsalva Maneuver
662(5)
Normal Response and Physiological Basis
Technique
The Valsalva Ratio
Vagal Baroreflex Sensitivity
Factors Affecting the Valsalva Response
Pitfalls of the Valsalva Maneuver
Cardiovagal Scoring
667(1)
Power Spectrum Analysis
668(1)
Heart Rate Response To Standing
668(1)
Other Tests Of Cardiovagal Function
669(1)
Summary
669(5)
40 Electrophysiology Of Pain
674(19)
Paola Sandroni
Introduction
674(1)
Quantitative Sensory Test
675(4)
Autonomic Tests
679(2)
Microneurography
681(1)
Laser Evoked Potentials
682(1)
Contact Heat Evoked Potentials
683(3)
Summary
686(7)
Section
6. Clinical Neurophysiology Of Movement Disorders
41 Movement-Related Potentials And Event-Related Potentials
693(7)
Rene L. Utianski
John N. Caviness
Movement-Related Cortical Potentials
693(4)
Technique
Normal Waveforms
Individual Variation
Abnormalities in Disease
Contingent Negative Variation
Event-Related Potentials
697(1)
The P300
The N400
Summary
698(2)
42 Long Latency Reflexes And The Silent Period
700(7)
Jay A. Van Gerpen
John N. Caviness
Introduction
700(1)
Long Latency Reflexes (LLRs)
700(3)
LLRs to Stretch
LLRs to Mixed Nerve Stimulation
Cutaneous Reflexes
The Flexor Reflex
The Silent Period
703(2)
Mixed Nerve Silent Period
Cutaneous Silent Period
Summary
705(2)
43 Electrophysiology Of Movement Disorders
707(23)
Bryan T. Klassen
James H. Bower
Joseph Y. Matsumoto
Jay A. Van Gerpen
John N. Caviness
Introduction
708(1)
Techniques
708(2)
Surface EMG
Electroencephalography EEG-EMG Polygraphy with Back-Averaging
Elicited Responses
Surface EMG: Normal Patterns
710(1)
Tremor
710(5)
Recording Techniques
Abnormal Patterns
Myoclonus
715(10)
Recording Techniques
Abnormal Patterns
Psychogenic Jerks
725(1)
Startle Disorders
725(1)
Periodic Limb Movements Of Sleep
725(1)
Dystonia
726(1)
Recording Techniques
Abnormal Patterns
TICS, Chorea, And Athetosis
727(1)
Voluntary Movement Abnormalities
727(1)
Summary
728(2)
44 Deep Brain Stimulation Electrophysiology
730(17)
Bryan T. Klassen
Introduction
730(1)
Deep Brain Stimulation System Components
731(1)
Mechanism Of Action
732(1)
Principles Of Stereotaxy
732(1)
Regional Microanatomy
733(2)
Ventralis Intermedius (VIM) Nucleus of the Thalamus
Subthalamic Nucleus (STN)
Globus Pallidus Pars Interna
Microelectrode Recording
735(4)
Recording from Ventralis Intermedius (Vim) Nucleus of the Thalamus
Recording from Subthalamic Nucleus (STN)
Recording from Globus Pallidus Pars Interna
Intraoperative Test Stimulation
739(2)
Stimulation of Ventralis Intermedius (Vim) Nucleus of the Thalamus
Stimulation of Subthalamic Nucleus (STN)
Stimulation of Globus Pallidus Pars Interna
Postoperative Programming
741(1)
Indications For Deep Brain Stimulation
741(1)
Parkinson's Disease
Essential Tremor
Dystonia
Emerging Indications
Summary
742(5)
Section
7. Assessment Of Sleep
45 Assessment Of Sleep And Sleep Disorders
747(28)
Michael H. Silber
Cameron D. Harris
Introduction
748(1)
Techniques Used In Studying Sleep
748(7)
Polysomnography
Multiple Sleep Latency Test
Maintenance of Wakefulness Test
Actigraphy
Portable Monitoring
Staging Of Sleep
755(5)
Sleep Stages
Arousals
Body Position
Summary Statistics for Sleep Variables
Assessing Respiration During Sleep
760(4)
Definitions
Airflow
Respiratory Effort
Snoring Sounds
Blood Gases
Cardiac Rhythm
Summary Statistics for Respiratory Variables
Assessing Movements In Sleep
764(2)
Periodic Limb Movements
REM Sleep Without Atonia
Bruxism
Assessing Other Physiological Variables
766(1)
Core Temperature
Esophageal pH Measurements
Performance Of A Sleep Study
766(1)
Assessing Sleep Disorders
767(2)
Disorders of Excessive Somnolence
Parasomnias
Summary
769(6)
Section
8. Intraoperative Monitoring
46 Cerebral Function Monitoring
775(13)
Elson L. So
Introduction
775(1)
Technical Factors In Intraoperative EEG Monitoring
776(2)
Effects Of Anesthesia On Electroencephalography
778(3)
Symmetrical EEG Patterns During Anesthesia
Preoperative Focal Abnormalities Seen with Anesthesia
Clinical Applications
781(1)
EEG Changes During Carotid Endarterectomy
781(2)
SEP Recording During Carotid Endarterectomy
783(1)
Other Monitoring Techniques During Carotid Endarterectomy
784(1)
EEG Monitoring During Cardiac Surgery
785(1)
Bispectral Analysis Of EEG For Monitoring Depth Of Anesthesia
785(1)
EEG Monitoring For Epilepsy Surgery
786(1)
Summary
786(2)
47 Brain Stem And Cranial Nerve Monitoring
788(11)
Brian A. Crum
Introduction
788(1)
Methods
789(3)
Electromyography
Nerve Conduction Studies
Evoked Potentials
Applications
792(4)
Monitoring During Middle Cranial Fossa Surgery
Monitoring During Posterior Cranial Fossa Surgery
Monitoring During Head and Neck Surgery
Summary
796(3)
48 Spinal Cord Monitoring
799(34)
Jeffrey A. Strommen
Andrea J. Boon
Introduction
799(1)
General Principles Of Intraoperative Monitoring
800(2)
Equipment And Electrical Safety
802(1)
Monitoring Methods-Somatosensory Evoked Potentials
802(7)
Stimulation Techniques
Recording Techniques
Physiological and Technical Issues
Application and Interpretation of SEP Changes
Motor Evoked Potentials
809(5)
Stimulation Techniques
Recording Techniques
Physiological/Technical Considerations
Applications and Interpretation of MEP Changes
Electromyography And Nerve Conduction Studies
814(2)
Recording Techniques
Physiological and Technical Effects
Applications and Interpretation of Findings
Types Of Spinal Surgeries
816(11)
Primary Spine Disease
Cervical Spine Disease
Thoracic Spine Disease and Scoliosis Surgery
Lumbosacral Spine Disease
Primary Neural Disease
Dorsal Rhizotomy
Cauda Equina and Tethered Cord
Vascular Diseases
Summary
827(6)
49 Peripheral Nervous System Monitoring
833(18)
Jeffrey A. Strommen
C. Michel Harper
Introduction
833(1)
Methods
834(4)
Nerve Conduction Studies
Electromyography
Somatosensory Evoked Potentials and Motor Evoked Potentials
Applications
838(9)
Entrapment Neuropathies
Repair of Traumatic Peripheral Nerve Injury
Prevention of Injury During Peripheral Nerve Surgery
Peripheral Nerve Tumor Surgery
Selecting Fascicles for Biopsy
Summary
847(4)
Section
9. Assessment Of The Vestibular And Acoustic System
50 Audiogram, Acoustic Reflexes, And Evoked Otoacoustic Emissions
851(9)
Christopher D. Bauch
Wayne O. Olsen
Introduction
851(1)
Purpose And Role Of Audiogram, Acoustic Reflexes, And EOAEs
852(1)
Audiogram
852(2)
Speech-Reception Thresholds
Word Recognition
Acoustic Reflex
854(2)
CN VIII vs. Cochlear Findings
Disorders of CN VII
Disorders of Brain Stem
Evoked Otoacoustic Emissions
856(3)
Neonatal Screening
Auditory Neuropathy Spectrum Disorder
Pseudohypacusis
Applications
859(1)
Summary
859(1)
51 Brain Stem Auditory Evoked Potentials In Peripheral Acoustic Disorders
860(9)
Christopher D. Bauch
Wayne O. Olsen
Introduction
860(1)
Stimuli
861(1)
Electrodes
861(1)
Interpretation
861(2)
Absolute Latencies
Interaural Latency Differences
Interpeak Intervals
Applications
863(4)
Cochlear Microphonic Recording
Summary
867(2)
52 Vertigo And Imbalance
869(46)
David A. Zapala
Introduction
869(2)
Functional Anatomy And Physiology
871(3)
Angular Head Movements and the VOR
Head Tilts
Linear Translations and Accelerations
Labyrinthine Innervation Patterns
Clinical Features Of Vestibulopathy And Central Compensation
874(2)
Laboratory Examination: VOR-Based Measures
876(17)
Recording Method
Preparation for Testing
Videonystagmography Test Battery
Computerized Rotary Chair Tests
Laboratory Examination: VSR & Ocular-Otoloth-based Measures
893(12)
Vestibular Evoked Myogenic Potentials
Computerized Dynamic Posturography
Clinical Applications Of Vestibular Testing: Assessing Sensorineural Syndromes Of The Labyrinth
905(3)
Superior Nerve Syndrome
Superior SCC Dehiscence
Basement Syndrome
Posterior Syndrome
Split Syndrome
Global Syndrome
Vestibular Rehabilitation
908(1)
Summary
908(7)
Section
10. Electrical Concepts And Safety
53 Electricity And Electronics In Clinical Neurophysiology
915(14)
Terrence D. Lagerlund
Basic Principles And Definitions In Electricity
916(1)
Electrical Charges and Force
Electric Potential
Electric Current and Resistors
Capacitors
Coils (Inductors)
Circuit Analysis
917(2)
Kirchhoff's First Law
Rules for Seats of Electromotive Force, Resistors, Capacitors, and Inductors
Kirchhoff's Second Law
Resistive-Capacitive And Resistive-inductive Circuits
919(1)
Resistive-Capacitive Circuits and Time Constant
Resistive-Inductive Circuits and Time Constant
Circuits Containing Inductors And Capacitors
920(2)
Inductive-Capacitive Circuits
Inductive-Resistive-Capacitive Circuits
Root-Mean-Square Potentials or Currents
Calculation of Reactance
Calculation of Impedance and the Phenomenon of Resonance
Filter Circuits
922(2)
High-Pass Filters
Low-Pass Filters
Transistors And Amplifiers
924(3)
Semiconductors and Doping
Diodes and Rectification
Transistors and Amplification
Differential Amplifiers
Summary
927(2)
54 Volume Conduction
929(18)
Terrence D. Lagerlund
Devon I. Rubin
Jasper R. Daube
Principles
930(1)
Sources Of Electrical Potentials
930(2)
Cortically Generated Potentials in Volume Conductors
Peripherally Generated Potentials in Volume Conductors
Current Sources: Monopoles, Dipoles, And Quadrupoles
932(5)
Spatial Distributions of Potentials
Volume Conduction Theory: Electrical Properties In Volume Conductors
937(1)
Effect of Volume Conductor Resistive-Capacitive Properties on EEG
Effect of Volume Conductor Resistive-Capacitive Properties on Nerve Conduction Studies and Needle EMG
Distant Recordings in Volume Conductors
Applications Of Volume Conduction Principles
938(6)
SEP and Brain Stem Auditory Evoked Potential Applications
Effect of Volume Conduction on Electroencephalography (EEG) Applications
Dipole Source Localization in EEG
Nerve Conduction Study Applications
Needle EMG Applications
Summary
944(1)
Appendix
944(3)
Calculating Potentials in Infinite Homogeneous Media
Potentials in Nonhomogeneous Media
Homogeneous Sphere Model
Multiplanar and Multiple Sphere Models
55 Electrical Safety In The Laboratory And Hospital
947(12)
Terrence D. Lagerlund
Introduction
947(1)
Electric Power Distribution Systems
948(1)
Electric Shock
948(3)
Requirements for Electric Current to Flow Through the Body
Physiological Effect of Electric Current
Factors Reducing Risk of Electric Shock
Factors Increasing Risk of Electric Shock in Hospitals
Leakage Current
951(1)
Origins
Methods by Which Leakage Current Reaches Patients
Methods to Reduce Leakage Current Reaching Patients
Electrical Safety Principles And Implementation
952(3)
Equipment Grounding
Tests for Equipment Grounding and Leakage Current
Rules for Electrical Safety
Electrical Safety Procedures for Technicians
Electrical Stimulation Safety
955(2)
Stimulating Near Pacemakers and Other Implanted Electrical Devices
Transcranial Electric and Magnetic Stimulation
Therapeutic Cortical and Deep Brain Stimulation
Summary
957(2)
Index 959
Devon Rubin is professor of neurology and consultant in the department of neurology at Mayo Clinic Jacksonville, where he serves as the director of the EMG laboratory. He completed his neurology and clinical neurophysiology training at Mayo Clinic, Rochester, MN. His special interest and area of expertise is in education in clinical neurophysiology, and he has developed and authored numerous, unique interactive digital EMG teaching tools. He has been the recipient of the Mayo Clinic Distinguished Educator Award for recognition of his excellence in education.

Jasper Daube is a clinical neurologist and clinical neurophysiologist with degrees from Princeton University, University of Rochester School of Medicine, University of Wisconsin, and Mayo Clinic. His special interests include neuromuscular diseases. He is an Honorary Member and Distinguished Neurology Teacher of the American Neurological Association; has won the Presidential Award and Neurology Teacher Award; and President American Association of Electrodiagnostic Medicine.
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