Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (81 page)

References

1.  Mayeux R, Denaro J, Hemenegildo N, et al. A population-based investigation of Parkinson’s disease with and without dementia: relationship to age and gender.
Arch Neurol.
1992;49:492.

2.  Lippa CF, Duda JE, Grossman M, et al. DLB and PDD boundary issues: diagnosis, treatment, molecular pathology, and biomarkers.
Neurology.
2007;68:812.

3.  de Lau LM, Schipper CM, Hofman A, et al. Prognosis of Parkinson disease: risk of dementia and mortality: the Rotterdam Study.
Arch Neurol.
2005;62:1265.

4.  Huang X, Chen P, Kaufer DI, et al. Apolipoprotein E and dementia in Parkinson disease: a meta-analysis.
Arch Neurol.
2006;63:189.

5.  Burton EJ, McKeith IG, Burn DJ, et al. Brain atrophy rates in Parkinson’s disease with and without dementia using serial magnetic resonance imaging.
Mov Disord.
2005;20:1571.

6.  Portet F, Scarmeas N, Cosentino S, et al. Extrapyramidal signs before and after diagnosis of incident Alzheimer disease in a prospective population study.
Arch Neurol.
2009;66:1120.

7.  Melzer TR, Watts R, MacAskill MR, et al. Grey matter atrophy in cognitively impaired Parkinson’s disease.
J Neurol Neurosurg Psychiatry.
2012;83:188.

HUNTINGTON DISEASE

Huntington disease (HD) is a neurodegenerative disease presenting with choreiform movements, psychiatric disorder, and dementia (see HD in the section on Disorders of Movement).

DISORDERS OF ALTERED MENTAL STATE

COMA AND STUPOR

   Definition

Coma is defined as unconsciousness lasting for more than 6 hours. There is no response to external stimuli, including pain and no voluntary movements. Stupor is defined as a decreased level of consciousness in which there is only response to pain.

   Clinical Presentation

Patients with coma or stupor are poorly or nonresponsive to external stimuli. The causes are many and can be divided into several etiologic categories (see “Causes” below). The goal of diagnostic testing is to identify treatable conditions including infection, metabolic abnormalities, seizures, intoxications/overdose, and surgical lesions as rapidly as possible. Diagnosis is made on physical and neurologic examination, history, neuroimaging, and laboratory testing.
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   Causes

Poisons, Drugs, or Toxins

   Sedatives (especially alcohol, barbiturates)

   Enzyme inhibitors (especially salicylates, heavy metals, organic phosphates, cyanide)

   Other (e.g., paraldehyde, methyl alcohol, ethylene glycol)

Cerebral Disorders

   Brain contusion, hemorrhage, infarction, seizure, or aneurysm

   Brain mass (e.g., tumor, hematoma, abscess, parasites)

   Subdural or epidural hematoma

   Venous sinus occlusion