Editors Sudesh Prabhakar
MD DM FAMS FIAN
Director Neurology, Fortis Hospital Mohali, Punjab, India
Former Professor and Head Department of Neurology Postgraduate Institute of Medical Education and Research Chandigarh, Punjab, India
Gagandeep Singh
MD DM
Department of Neurology Dayanand Medical College and Hospital Ludhiana, Punjab, India
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Differential Diagnosis in Neurology
First Edition: 2016
9789351529026
Printed at
Dedicated to
6Our families who supported us all through, our teachers who still continue to inspire us, and our patients who will always form the foundation of this volume
Special mention
Jagjit S Chopra
Indu Prabhakar
Neena Johar
Amol N Singh
Contributors
Editors
- Sudesh Prabhakar MD DM FAMS FIAN
- Director Neurology, Fortis Hospital
- Mohali, Punjab, India
- Former Professor and Head
- Department of Neurology
- Postgraduate Institute of Medical Education and Research
- Chandigarh, Punjab, India
- Gagandeep Singh MD DM
- Professor and Head
- Department of Neurology
- Dayanand Medical College and Hospital
- Ludhiana, Punjab, India
Contributing Authors
- Suvarna Alladi DM
- Additional Professor, Department of Neurology
- Nizam's Institute of Medical Sciences
- Hyderabad, Telangana, India
- Craig S Anderson MBBS FRACP PhD FAFPHM FAHMS
- Professor, Stroke Medicine and Clinical Neurosciences
- Head, Department of Neurology
- Senior Director, The George Institute, Royal Prince Alfred Hospital and University of Sydney
- Sydney, Australia
- SSK Ayyar MD DM FAAN FICP
- Senior Consultant, Department of Neurology
- Vijaya Health Centre
- Chennai, Tamil Nadu, India
- Inder D Bahia MBBS
- Senior Consultant, Theriac Medical Consultancy
- Bakersfield, California, United States
- Kiran Bala MD DM DNB
- Senior Professor, Department of Neurology
- Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences
- Rohtak, Haryana, India
- Amit Batla MBBS MD DM
- Clinical Teaching Fellow, UCL Institute of Neurology
- London, England, United Kingdom
- Madhuri Behari MD DM
- Professor, Department of Neurology
- All India Institute of Medical Sciences
- New Delhi, India
- Archana Bethala MBBS MD DM
- Senior Resident, Department of Neurology
- Nizam's Institute of Medical Sciences
- Hyderabad, Telangana, India
- Kailash P Bhatia MRCP FRCP
- Professor of Neurology, Sobell Department of Motor Neuroscience and Movement Disorders
- UCL Institute of Neurology
- London, England, United Kingdom
- Rohit Bhatia MD DM DNB
- Additional Professor, Department of Neurology
- All India Institute of Medical Sciences
- Meghna Bhatnagar MBBS MCN
- Ipswich, Suffolk, United K ingdom
- Kalyan B Bhattacharyya MD DM MAMS FIAN FRCP
- Professor, Department of Neuromedicine
- RG Kar Medical College and Hospital
- Kolkata, West Bengal, India
- Sanjeev K Bhoi MD DM
- Assistant Professor, Department of Neurology
- Sanjay Gandhi Postgraduate Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Anirban Biswas MBBS DLO
- Consultant Neurotologist, Vertigo Clinic, Belle Vue Clinic, and Vertigo and Deafness Clinic
- Kolkata, West Bengal, India
- Wesley Chan MD MSc
- Resident Department of Ophthalmology and Visual Sciences Dalhousie University
- Halifax, Nova Scotia, Canada
- Poodipedi S Chandra MCh
- Professor, Department of Neurosurgery
- All India Institute of Medical Sciences
- New Delhi, India
- Rima M Chaudhari DM
- Post DM Research Fellow, Department of Neurology
- All India Institute of Medical Sciences
- New Delhi, India
- Neera Chaudhry MBBS MD DM
- Professor, Department of Neurology
- GB Pant Hospital
- New Delhi, India
- Pavan K Cherukuri MD
- Senior Resident, Department of Neurology
- Nizam's Institute of Medical Sciences
- Hyderabad, Telangana, India
- Fiona E Costello MD FRCP
- Associate Professor Clinical Neurosciences/Surgery (Ophthalmology)
- Cumming School of Medicine
- University of Calgary
- Calgary, Alberta, Canada
- Chandi P Das MBBS MD DM FRACP
- Senior Staff Specialist, Department of Neurology
- Canberra Hospital
- Faculty Australian National University
- Canberra, Australia
- Shyamal K Das MBBS MD DM
- Professor, Department of Neurology
- Burdwan Medical College
- Burdwan, West Bengal, India
- Deepa Dash MD DM
- Assistant Professor, Department of Neurology
- All India Institute of Medical Sciences
- New Delhi, India
- Sarita B Dave MD
- Physician, New York Eye and Ear Infirmary
- New York, United States
- Divyaraj GollahalliM.Phil Clinical Psychology
- Senior Research Fellow, Department of Neurology
- Nizam's Institute of Medical Sciences
- Hyderabad, Telangana, India
- Mohammed Faruq MBBS PhD
- Scientist, Department of Genomics and Molecular Medicine
- CSIR-Institute of Genomics and Integrative Biology
- New Delhi, India
- Malay K Ghosal MBBS MD
- Professor, Department of Psychiatry
- Medical College, Kolkata Kolkata, West Bengal, India
- Chanchal Goyal MBBS PhD MA
- Senior Research Fellow, Department of Neurology
- All India Institute of Medical Sciences
- New Delhi, India
- Manoj Goyal MD DM
- Assistant Professor, Department of Neurology
- Postgraduate Institute of Medical Education and Research
- Chandigarh, Punjab, India
- Vinay Goyal MD DM
- Professor, Department of Neurology
- All India Institute of Medical Sciences
- New Delhi, India
- Assistant Professor, Department of Neurology
- Postgraduate Institute of Medical Education and Research
- Chandigarh, Punjab, India
- Shakir Husain MBBS MD DM FINR
- Senior Consultant
- Department of Interventional Neurology and Stroke
- Max Superspeciality Hospital
- New Delhi, India
- Director, Neurointervention Training Program Scientific Advisor and Consultant
- Interventional Neuroradiology, Department of Neurology RKU - Universitäts- und Rehabilitationskliniken Ulm Germany
- Jayantee Kalita MD DM
- Professor, Department of Neurology
- Sanjay Gandhi Postgraduate Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Bhavna Kaul MD DM
- Assistant Professor, Department of Neurology
- Vardhaman Mahavir Medical College and Safdarjang Hospital
- New Delhi, India
- Satish V Khadilkar MD DM DNB FIAN
- Professor, Department of Neurology
- Grant Medical College and Sir JJ Group of Hospitals
- Mumbai, Maharashtra, India
- Parampreet S Kharbanda MBBS MD DM
- Professor, Department of Neurology
- Postgraduate Institute of Medical Education and Research
- Chandigarh, Punjab, India
- Dheeraj Khurana MD DM
- Professor, Department of Neurology
- Postgraduate Institute of Medical Education and Research
- Chandigarh, Punjab, India
- Sudhir Kothari MD DM
- Head, Department of Neurology
- Poona Hospital and Research Centre
- Pune, Maharashtra, India
- Suresh Kumar MD DM Fellow Epilepsy (UCLA), Fellow Sleep (ISDA)
- Professor and Head, Department of Neurology
- Sree Balaji Medical College and Hospital
- Chennai, Tamil Nadu, India
- Vivek Lal MD DM
- Professor and Head, Department of Neurology
- Postgraduate Institute of Medical Education and Research
- Chandigarh, Punjab, India
- Netravathi M MBBS DM
- Associate Professor, Department of Neurology
- National Institute of Mental Health and Neurosciences
- Bangalore, Karnataka, India
- Prashant Makhija MD DM
- Consultant, Department of Neurology
- Seven Hills Hospital
- Mumbai, Maharashtra, India
- Sahil Mehta MBBS MD DM
- Assistant Professor, Department of Neurology
- Postgraduate Institute of Medical Education and Research
- Chandigarh, Punjab, India
- Usha K Misra MD DM
- Professor, Department of Neurology
- Sanjay Gandhi Postgraduate Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Manish Modi MD DM
- Additional Professor, Department of Neurology
- Postgraduate Institute of Medical Education and Research
- Chandigarh, Punjab, India
- Jagarlapudi M Murthy MD DM
- Chief, Department of Neurology
- The Institute of Neurological Sciences
- Care Outpatient Centre, CARE Hospital
- Hyderabad, Telangana, India
- Madakasira V Padma MD DM FAMS FNASc
- Professor, Department of Neurology
- All India Institute of Medical Sciences
- New Delhi, India
- Pramod K Pal MBBS MD DNB DM FIAN
- Professor, Department of Neurology
- National Institute of Mental Health and Neurosciences
- Bangalore, Karnataka, India
- Sandip Pal DM
- Professor, Department of Neurology
- Medical College Hospital
- Kolkata, West Bengal, India
- Professor, Department of Neurology
- Christian Medical College
- Ludhiana, Punjab, India
- Awadh K Pandit MBBS MD DM
- DBT-INCRE-Fellow, Department of Neurology
- All India Institute of Medical Sciences
- New Delhi, India
- Abhishek Pathak MBBS MD DM
- Senior Resident, Department of Neurology
- All India Institute of Medical Sciences
- New Delhi, India
- Gunchan Paul MBBS MD IDCCM
- Assistant Professor, Department of Critical Care Medicine Dayanand Medical College and Hospital Ludhiana, Punjab, India
- Birinder S Paul MD DM
- Associate Professor, Department of Neurology
- Dayanand Medical College and Hospital
- Ludhiana, Punjab, India
- Apoorva Pauranik DM
- Professor, Department of Neurology
- Mahatma Medical College
- Indore, Madhya Pradesh, India
- Vinod Puri MBBS MD DM
- Director, Professor, and Head
- Department of Neurology
- GB Pant Hospital
- New Delhi, India
- Sarbani S Raha MD
- Consultant, Child Neurology and Epilepsy Clinic
- KGP Children Hospital
- Vadodara, Gujarat, India
- Ellajosyula Ratnavalli MBBS MD DM
- Consultant Neurologist, Department of Neurology
- Manipal Hospital
- Bangalore, Karnataka, India
- K Ravishankar MD
- Consultant In-charge
- Dr Ravishankar's Headache and Migraine Clinic
- Jaslok and Lilavati Hospitals
- Mumbai, Maharashtra, India
- Naveen Sankhyan DM
- Assistant Professor, Department of Pediatrics
- Postgraduate Institute of Medical Education and Research
- Chandigarh, Punjab, India
- P Satishchandra MBBS DM FAMS FICN FRCP
- Director, Vice Chancellor, and Senior Professor
- Department of Neurology
- National Institute of Mental Health and Neuro Sciences
- Bangalore, Karnataka, India
- Kishore V Shetty MD DM DNB
- Consultant Neurologist, Dr LH Hiranandani Hospital
- Mumbai, Maharashtra, India
- Simon D Shorvon MA MD FRCP
- Professor, UCL Institute of Neurology
- National Hospital for Neurology and Neurosurgery
- London, England, United Kingdom
- Garima Shukla DM
- Professor, Department of Neurology
- All India Institute of Medical Sciences
- New Delhi, India
- Rakesh Shukla MBBS MD DM MHAMS
- Professor, Department of Neurology
- King George's Medical University
- Lucknow, Uttar Pradesh, India
- Inderpal Singh MBBS MD MRCP MSc FRCP
- Consultant Physician and Geriatrician
- Department of Geriatric Medicine
- Aneurin Bevan University Health Board
- Ystrad Mynach, United Kingdom
- Shaily Singh MBBS MD DM
- Fellow, University of Calgary
- Calgary, Alberta, Canada
- Pratibha Singhi MBBS MD FIAP FAMS
- Senior Professor, Department of Pediatrics
- Postgraduate Institute of Medical Education and Research
- Chandigarh, Punjab, India
- Preeti Singla MBBS MD DM
- Consultant, Department of Neurology
- Ajanta hospital and IVF Centre
- Lucknow, Uttar Pradesh, India
- Associate Professor, Department of Neurology
- Jawaharlal Institute of Postgraduate Medical Education and Research
- Puducherry, India
- Achal K Srivastava MBBS MD DM
- Professor, Department of Neurology
- All India Institute of Medical Sciences
- New Delhi, India
- Prem S Subramanian MD PhD
- Professor, University of Colorado School of Medicine
- Aurora, Colorado, United States
- Paulin Sudhan MBBS
- Research Coordinator, Department of Neurology
- Christian Medical College
- Ludhiana, Punjab, India
- Sheetal Suresh MD Fellow Sleep Medicine (ISDA)
- Senior Consultant Physician
- Department of Internal Medicine
- Fortis Malar Hospitals, Adyar, Apollo NOVA
- Chennai, Tamil Nadu, India
- Vrajesh Udani MD
- Consultant, Child Neurology and Epilepsy
- Department of Pediatrics and Neurology
- Hinduja National Hospital
- Mumbai, Maharashtra, India
- Venugopalan Y Vishnu MD DM (Resident)
- Senior Resident, Department of Neurology
- Postgraduate Institute of Medical Education and Research
- Chandigarh, Punjab, India
- Jie Yang MD PhD
- Associate Professor, Department of Neurology
- Nanjing Medical University
- Associate Chief Physician, Nanjing First Hospital
- Nanjing, Jiangsu, China
- Sireesha Yareeda MBBS MD
- Senior Resident, Department of Neurology
- Nizam's Institute of Medical Sciences
- Hyderabad, Telangana, India
- Zeid Yasiry MBChB MSc
- Assistant Lecturer, University of Babylon
- Babylon, Iraq
A multitude of thoughts came across our minds as we started writing this prelude.
Firstly, an embracing sense of satisfaction overwhelms us not just on the completion of a monumental task but because we, as editors, were able to co-ordinate the superb efforts of 81 expert contributors. All of them are tall experts in their respective fields, and so busy, that we wondered whether they would find the time to write a chapter for the book. Indeed, the hard work put in by them and their colleagues are not limited to the few weeks they put in towards writing the chapter but a lifetime applied to a particular area of clinical neurology. Suffice to mention it here, “A book is only as compelling, spirituous, and influential as its authors”.
Secondly, when we began the book, there was a concern whether a book of this kind was really required. However, after two years of working on the project, we are more convinced that the publication of this book is both timely and a pressing need. Timely—because this is an era when the art of bedside clinical neurology is fading and the practice of neurology is being increasingly marginalized by a plethora of investigative approaches. The time is appropriate to systematically and rationally integrate the complexities of contemporary laboratory, imaging, and neurophysiological investigations with traditional bedside neurology. This is what this book is intended for and we do not hesitate in claiming that this book is one of its kind.
Thirdly, a curiosity—who would read the book? In this aspect too, the publication of this book is justified as we are informed of an increasing number of students pursuing postgraduate studies in neurology—every year, over 160 DM Neurology students are taken in across the country. We believe that this book targets the postgraduate students in neurology as well as internal medicine, and fosters professional competence even for the accomplished neurologists, and practicing physicians. We also hope that this number will be ever-increasing.
The book seems a befitting tribute to our teachers who taught us the fine art of bedside neurology at a time when technologies were few and far apart, and to our patients who were ever accommodating of our scholarship—all to proclaim that mastering the clinical approach is the only way forward in clinical neurology.
Finally, a resolve to continue our commitment, and we promise to come back to you with the revised edition—to keep pace with the most up-to-date information in the dynamic and expanding field of clinical neurology.
Sudesh Prabhakar
Gagandeep Singh
15Acknowledgments
Many people have contributed in various ways and without their support this book would not have been possible.
First and foremost, we wish to acknowledge our great and obvious debt to more than 80 distinguished group of contributing authors who generously gave their time and expertise, and presented the material in an esoteric manner, taken from their real-life clinical experiences.
The remarkable wisdom and grace of our illustrious and eminent teachers who have always been instrumental in providing valuable direction and counsel, deserves our special gratitude.
We especially wish to recognize and never forget our patients who will always remain the foundation of all our work and knowledge. We owe tremendous thanks and appreciation to them. May we remember the words of St. Bernadette Soubirous, “Every human being is precious in God's eyes.”
We were ably assisted by Dr Parveen Goel, neuropsychologist who worked with enthusiasm, alacrity, and intelligence.
Our gratitude to the Jaypee Brothers Medical Publishers for considering the publication; to the team, which supported us in the book project; and most of all to our families—who resolutely endured us as we set aside all family chores in editing the book.
Our thanks go to all those people, each of whom helped in their own unique ways in bringing this book to fruition.