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The development of guidelines to chytrid fungus definition generic mentax 15mg overnight delivery help determine which patients require X-rays has provided physicians the ability to fungus jock itch cure buy cheap mentax 15 mg safely reduce the number of radiographs ordered fungus gnat eggs soil buy mentax online. Risk stratification into "sick" or "not sick," or "stable" or "unstable" is part of this process. In trauma patients, the mnemonic A-B-C-D-E-F-G is addressed in the primary and secondary surveys (Table 1. They may provide information about the circumstances leading 12 Principles of Emergency Medicine up to the present condition, and should be kept updated as much as possible. At times, histories and physical examinations must be abbreviated and more focused than one might prefer. Treatment may need to be initiated based on limited information, previous episodes, physician experience, or physician speculation. As quickly as possible, attempts should be made to learn this information from the patient, prehospital care providers, family members, nursing home or skilled facilities. When in doubt, always do what is medically indicated for the patient, rather than making assumptions that may be incorrect. If a patient has a painful condition, it is good practice to address issues of pain control as early as possible. This is true not only for patients presenting with abdominal pain, but in patients with traumatic injuries who would benefit from adequate analgesia. Waiting to administer pain medication to a patient with a clinical fracture until after the X-ray is reviewed is inappropriate. As previously mentioned, reassess patients after each intervention, whether following intubation for airway control or the administration of analgesia. Continued reassessment of all patients, particularly the sickest or those at greatest risk for decompensation, is critical. All patients should be treated sensitively, with attention paid to their fears and anxieties. Add to this the long wait, the uncertainty, and the likelihood that someone will be less than pleasant results in an emergency experience rarely seen favorably by patients. Respectful treatment, Approach to the emergency patient without discrimination or condescension, should be integral to our approach towards all patients. This is especially true for challenging conditions or those with unclear or rapidly changing diagnostic and treatment approaches. Special patients Elderly Individuals over 85 years of age are the fastest growing segment of the population. With advances in medical care, and the increasing importance placed on disease prevention, diet and exercise, this portion of the population will continue to grow at a tremendous rate. It has been repeatedly established that the majority of medical care expenses are spent on the geriatric population during their last few years of life. Geriatric patients are at risk for falls, functional decline, changes in cognition, as well as cardiac, pulmonary, and vascular emergencies. They have reduced physiologic reserve, and often are too ill, weak, or complicated to use medical offices for even routine care. The best solution is to integrate social services into the care of all geriatric patients. From a social perspective, geriatric patients prefer being referred to as "young" rather than "old" (as in 75 years young), and prefer being referred to as "older" rather than "old. Many geriatric patients are not able to mount a febrile response to sepsis or infections. Geriatric patients commonly use over-the-counter medications, increasing their risk of adverse drug reactions. Polypharmacy is a frequent concern in the geriatric population, increasing the likelihood of drug­drug interactions. Primary providers are often unaware of all medications their elderly patients take, as physician colleagues, consultants, and urgent care providers may prescribe additional medications without them knowing. Many drugs interact with warfarin, commonly prescribed in the geriatric population. Eyesight often fails in the geriatric population, so it is important to check this and consider outpatient referrals to optometry. Difficulties with eyesight may result in the inability to read food or medication instructions, especially insulin doses. Difficulty with vision in low light makes it nearly impossible for elderly patients to reliably comment on their stools turning darker (hematochezia or melena).

Its acute effects include a sense of relaxation fungus gnats yellow sticky cards discount mentax online mastercard, mild euphoria fungus gnats rockwool cheap mentax online visa, perceptual distortions fungus gnats bananas discount generic mentax uk, and amplifications of regular life experiences (eating, music, sex). In some users, cannabis causes dysphoric mood, anxiety, panic attacks, and paranoia. Inhalants Inhalants are a large group of volatile hydrocarbons that are used in many household products, such as glue, shoe polish, spray paint, and gasoline. Symptoms of alcohol withdrawal usually start about 8 hours after the last drink, tend to peak within 24 hours, and resolve in a week. Long-term use of inhalants may lead to white matter changes, cerebral atrophy, and cognitive impairment. Sedatives, Anxiolytics, and Hypnotics Benzodiazepines and barbiturates are commonly misused and abused. A psychiatric disorder reflects a dysfunctional brain, and one way to treat such a disorder is through the use of pharmacologic compounds that can help restore order in disorderly brains. This chapter reviews the 4 main classes of drugs used to treat major mental illnesses: antidepressants, mood stabilizers, sedative hypnotics, and antipsychotics, followed by brief comments on a few drugs used to treat alcohol, opiate, and nicotine dependence. Tertiary amines have greater affinity for the serotonin transporter, and secondary amines are relatively more potent at the norepinephrine transporter. However, tertiary amines are demethylated to secondary amines during hepatic metabolism. Presynaptic autoreceptors are desensitized in 10 to 14 days with subsequent enhancement of serotonin transmission. An overdose can be fatal, with death most commonly occurring as a result of cardiac arrhythmia. In contrast to the serotonergic system, the firing rate of noradrenergic neurons remains inhibited with long-term treatment, suggesting that somatodendritic -2 receptors do not desensitize. The relationship between plasma level and response has been clarified for the tricyclics, rendering serum levels a helpful tool in assessing the adequacy of a therapeutic trial. In addition, they are not recommended for treating depression in children because of a lack of efficacy and reported serious side effects. Side Effects the tricyclic and tetracyclic compounds have various adverse actions mediated by other receptors. Blocking muscarinic receptors results in anticholinergic side effects, such as dry mouth, constipation, and urinary retention. Amitriptyline is the most anticholinergic, while desipramine is the least anticholinergic in this class. Tricyclics act on fast sodium channels and can cause adverse effects such as orthostatic hypotension, tachycardia, and cardiac conduction problems. Other side effects include sexual dysfunction, increased sweating, headache, carbohydrate craving and weight gain, fine rapid tremors, and delirium. This can result in a sudden catecholamine increase and a potentially fatal hypertensive reaction. Pharmacologic Treatment of Psychiatric Disorders 385 amines within the cytoplasm only (not in vesicles). Initial use leads to an increase in synaptic catecholamine (serotonin, dopamine, and norepinephrine) levels. High synaptic norepinephrine levels stimulate the presynaptic somatodendritic -2 noradrenergic autoreceptor, which results in a decreased firing rate of the presynaptic noradrenergic neuron. Other frequent side effects include dizziness, headache, dry mouth, insomnia, constipation, blurred vision, nausea, peripheral edema, forgetfulness, fainting spells, hesitancy of urination, weakness, and myoclonic jerks. These include foods containing high tyramine levels, such as aged cheese, cream cheese, cottage cheese, red wine, banana peel, bean curd, fava beans, sausage, pepperoni, salami, and sauerkraut. In addition, large amounts of caffeine, chocolate, nuts, and soy sauce should be used only with caution. Mechanism of Action Abnormalities in central serotonin function have been hypothesized to underlie disturbances in mood, anxiety, Table 45. Enhancement of serotonin within the gastrointestinal tract can provoke nausea and diarrhea.

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Mechanisms exist to fungus around nails discount 15mg mentax free shipping remove the neurotransmitter from the synaptic cleft by either hydrolyzing the neurotransmitter in the cleft (ie fungus gnats larvae order mentax online now, acetylcholinesterase) or pumping the neurotransmitter into either the presynaptic terminal or the glia fungus gnats in drains buy mentax now, which then completes the cycle of chemical neurotransmission in neuronal communication. The presynaptic terminal is a complex and highly regulated structure within the neuron. Action potentials occur as a result of opening and closing of specific voltage-gated ion channels. Myelination leads to a much faster conduction velocity due to saltatory conduction than can be achieved by increasing axonal diameter. Cellular Signaling 215 are filled with the neurotransmitter and then eventually are docked along the plasma membrane by a series of specialized synaptic proteins. Key Peripheral Nervous System Neurotransmitter System: Neuromuscular Junction Alpha motor neurons in the anterior horn of the spinal cord innervate skeletal muscle and use acetylcholine as their neurotransmitter. Acetylcholine diffuses across the synaptic cleft and binds to nicotinic acetylcholine receptors, which then open a nonselective cation channel that depolarizes the muscle membrane. The depolarizing wave across the muscle membrane enters T tubules and activates a voltage-gated calcium channel that causes calcium influx and muscle contraction via the interaction of troponin, tropomyosin, actin, and myosin. Acetylcholinesterase (inhibited by pyridostigmine) resides in the synaptic cleft and hydrolyzes acetylcholine to inactivate it. Various myasthenic syndromes help illustrate the function of the neuromuscular junction. In autoimmune myasthenia gravis, autoantibodies may target either the acetylcholine receptor or a closely associated muscle-specific kinase. In Lambert-Eaton myasthenic syndrome, autoantibodies target the presynaptic P/Q voltage-gated calcium channel, thus hampering adequate presynaptic calcium levels for exocytosis. Many forms of congenital myasthenic syndromes are caused by mutations in various components of the neuromuscular junction, including the acetylcholine receptor, acetylcholinesterase, and choline acetyltransferase (protein that pumps acetylcholine into synaptic vesicles). The neuromuscular junction comprises the presynaptic motor nerve terminal, the postsynaptic myocyte structures, and an enveloping Schwann cell. The central nervous system glutamatergic synapses comprise a presynaptic glutamatergic axonal nerve terminal, a postsynaptic dendritic spine, and an enveloping astrocytic process. Glutamate is formed from glutamine and packaged into synaptic vesicles that are released via exocytosis in a calcium-dependent fashion. When fully activated, the postsynaptic spine depolarizes and has increased intracellular calcium, a signal involved in synaptic plasticity. This is the main receptor responsible for fast excitatory neurotransmission in the brain. This binding is necessary because, at normal resting membrane potential, there is a magnesium ion in the pore that Table 24. Cellular Signaling 219 is released on depolarization and results in calcium influx into the postsynaptic terminal. This local influx of calcium can lead to synapse-specific changes in the postsynaptic neuron that are considered to be the cellular basis for learning and memory. It is produced by decarboxylation of l-glutamate by glutamic acid decarboxylase; antibodies against this enzyme are associated with stiff person syndrome. The vast neuromodulatory neurotransmitter system is distributed throughout the central nervous system, and the key points are listed in Table 24. The speed of action potential propagation along an axon is determined by several factors: axonal diameter (larger is faster), temperature (warmer is faster), and myelination. Postsynaptic receptors are often ligand-gated ion channels, which open and either depolarize (excitatory effect) or hyperpolarize (inhibitory effect) the postsynaptic neuron. Alpha motor neurons in the anterior horn of the spinal cord innervate skeletal muscle and use acetylcholine as their neurotransmitter. The unique morphology of neurons demands elaborate cytoarchitecture, energy production, and cellular processing machinery that are unparalleled in other parts of the body. In this chapter, a broad overview of cellular processes related to cytoskeleton, axonal transport, protein processing, and energy metabolism within the nervous system are discussed. Foreshadowing subsequent chapters, many diseases of the nervous system are due to breakdowns of the intricate processes that are outlined in this chapter. Cellular Structure the plasma membrane of neurons is formed by a lipid bilayer that forms a barrier between the internal and external cellular environment.

See also Amnesia; Confusion; Delirium; Dementia attentional disturbances and antifungal ingredients order 15 mg mentax visa, 356­ 357 classification and diagnosis of brain fungus definition purchase mentax without prescription, 364t fungus mycelium order genuine mentax online, 364­ 365 with complicating illnesses, 363 drug-induced, 362­ 363 emotional, mood, and affect disturbances and, 358 etiology of, 360­ 361 impulse and activity disturbances and, 358­ 359 infectious and postoperative, 363­ 364 loss of insight and, 359 management of, 365 memory disturbances and, 357 perceptual disturbances and, 357 with reduced alertness and psychomotor activity, 360­ 361 social behavior disturbances and, 359 thought disturbances and, 357­ 358 Congenital disorders, involving muscle, 1244­ 1246 Congenital fiber type disproportion, 1248 Congenital fiber type predominance, 1248 Congenital insensitivity to pain, 123 Congenital myasthenic syndromes, 1260t, 1261­ 1262 Congenital polymyopathies, 1246t, 1246­ 1249 Conjugate gaze, 222, 225­ 226, 226t paralysis of, 226­ 228 Connective tissue diseases, with polymyositis and dermatomyositis, 1205 polyneuropathy and, 1139, 1141 Conradi-Hunerman syndrome, 856 Ё Consciousness altered states of, 303­ 306. See also Motor neuron(s), upper decussation of, 41­ 42 somatotopic organization of, 42­ 43 termination of, 45 Corticosteroid psychosis, 978 Corticosteroids. See Muscle cramps Cramp-fasciculation syndrome, 1278 Cranial arteritis, 149t, 159, 215, 235, 730, 731 Cranial nerve(s), 1178­ 1189. See also specific nerves crossing of, in basilar artery occlusion, 680, 681t, 682 injury of, with head injury, 748­ 749 in meningitis, bacterial, 595t multiple cranial nerve palsies and, 1188f, 1188t, 1188­ 1189 Cranial nerve tests, 6­ 7 Cranial neuropathy, with corneal lattice dystrophy, 1161 Craniectomy, decompressive, to lower intracranial pressure, 768 Craniocerebral trauma. See Head injury Craniocervical junction, anomalies at, myelopathy and, 1077 Craniofacial dysostosis, 856 Craniofacial pain, 144­ 165, 161, 162t, 163­ 165. See Neural development Developmental abnormalities, visual, 216 Developmental diseases, 850­ 891, 851t. See Aphasia Dysphonia, 417, 427­ 428 spasmodic, 91, 428­ 429 Dysphoric symptoms, in opioid addiction, 1019 Dyspnea, 475 Dysraphism, 859f, 859­ 861 Dyssynergia, 75, 76 Dystasia, areflexic, hereditary, 1157 Dystonia, 66f, 66­ 67 acute generalized dystonic reactions, 67 cervical, idiopathic, 91, 92f, 93 dopa-responsive, 67 juvenile, 930­ 931 hereditary, 931 with hereditary metabolic disease, 834­ 836 identity with athetosis and chorea, 68­ 69 occupational, 94 oromandibular, 91 paroxysmal, nocturnal, 342 paroxysmal choreoathetosis and, 68 periodic, 68 with phenothiazines, 1025 rapid-onset dystonia-parkinsonism, 67 symptomatic (secondary), 91 Dystonia musculorum deformans, 929­ 930 Dystonia-parkinsonism, hereditary, 930­ 931 Dystonic gait, 102t, 104­ 105 Dystonic tremor, 84 Dystroglycan, 1216 Dystrophia myotonica, 1221­ 1223 Dystrophinopathies, 1213, 1214t, 1216 E Eastern equine encephalitis, 637 Eaton-Lambert syndrome. See also specific techniques in myasthenia gravis, 1254 Embolic infarction, 700­ 704, 701t clinical picture in, 702f, 702­ 703 course and prognosis of, 703 laboratory findings in, 703 treatment and prevention of, 703­ 704 Embolism, fibrocartilaginous, 1072 Embryonal period, 493 Emergency reactions, 458­ 459 Emery-Dreifuss muscular dystrophy, 1217, 1217f Emotional disturbances. See also Psychiatric disorders; specific disorders in acute confusional states, 358 acute fear, anxiety, elation, and euphoria and, 449­ 450 aggressiveness, anger, rage, and violence and, 446­ 448 altered sexuality and, 449 differential diagnosis of, 450 disinhibition of emotional expression, 445­ 446 in hallucinating and deluded patients, 444­ 445 placidity and apathy and, 448­ 449 with temporal lobe lesions, 399 Emotional lability, 445­ 446 Empty delta sign, 734 Empty sella syndrome, 577 Empyema, subdural, 603­ 604 Encephalitis bacterial. See Viral encephalitis von Economo, 653 sleep disturbance due to, 340 Encephalitis lethargica, 340, 653 Encephalitis periaxialis diffusa, 782f, 782­ 783 Encephaloceles, 859f, 859­ 861 Encephalomyelitis disseminated, multiple sclerosis versus, 786 following rabies vaccine, 792 hemorrhagic, acute necrotizing, 792­ 793, 793f myalgic, 436 paraneoplastic, 583t, 585f, 585­ 586 postinfectious, postvaccinal, 790­ 792, 791f, 791­ 792 Encephalopathy dialysis, 971 hepatic (portal-systemic), 967­ 969 hypertensive, 728­ 730, 729f seizures due to, 290 hypoglycemic, 965­ 966 hypoxic, seizures due to, 291 ischemic-hypoxic (ischemic-anoxic), 959­ 963, 962f in meningitis, bacterial, 595t metabolic, seizures due to, 290 myoclonic, of infants (infantile opsoclonus-myoclonus syndrome), 827­ 828 neonatal, hypoxic-ischemic damage and, 875­ 876 with nicotinic acid deficiency, 991 pancreatic, 980 punch-drunk, 763­ 764, 906 with sepsis and burns, 971 septic, 363 spongiform, transmissible, 653­ 656. See Carotid endarterectomy Endemic typhus, 623 Endocarditis bacterial septic embolism resulting from acute, 703 subacute, 608 nonbacterial, thrombotic (marantic) cerebral embolism and, 735 embolic infarction due to, 701 Endocrine diseases. See also specific disorders fatigue associated with, 435 myopathy, 1097, 1235­ 1238 psychoses, 1330­ 1331 Endolymph, 247f Endorphins, 117­ 118 End-plate potentials, 1093f, 1093­ 1094 in myasthenia gravis, 1254 End-plate spikes, in electromyography, 1102 Endurance, lack of, 1198 Enkephalin, 118 Enterovirus meningitis, 633 Entrapment neuropathies, 1171­ 1172 Enuresis, 513 nocturnal, 349, 513 Envenomations, 1260t, 1280­ 1281 Environmental agnosia, 407 Enzymes in cerebrospinal fluid, 16 originating in muscle cells, serum levels of, 1096­ 1097 Eosinophilia-myalgia syndrome, 1211 Eosinophilic fasciitis, 1210 Eosinophilic monomyositis, 1210 Eosinophilic myositis, 1210 Eosinophilic polymyositis, 1210 Ependyma, abnormalities of, 543­ 544 Ependymitis, in meningitis, bacterial, 595t Ependymoblastomas, 567 Ependymomas, 547, 558, 567­ 568, 568f spinal, 1080, 1080f Epicondylitis, medial and lateral, 188 Epicritic pain system, 111 Epidemic labyrinthitis, 263 Epidemic myalgia, 1203 Epidemic neuromyasthenia, 1203 Epidemic typhus, 623 Epidemic vertigo, 263 Epidermal nevus syndrome, 872 Epidermoid cysts, 570 suprasellar, 573­ 574 Epidural abscesses cranial, 604­ 605 spinal, 605, 1060­ 1061 back pain with, 181 Epidural hematoma, acute, 755t Epidural hemorrhage, acute, 757­ 758, 758f Epilepsia partialis continua, 87, 281 Epilepsia procursiva, 278 Epilepsy. See Trigeminal nerve Figure writing, testing of, 137 Fingerprint body myopathy, 1248 Fire ant stings, 1034 Fish poisoning. See Elderly people Germinomas, 569 Gerontologic neurology, 523 Gerstmann syndrome, 402, 511 Gerstmann-Straussler-Scheinker Ё syndrome, 653, 656 Gestes, 91 Giant-cell arteritis, 149t, 159, 215, 235, 730, 731 Giddiness, 258 Gigantism, 487, 1159 Gilles de la Tourette syndrome, 95­ 97, 1296 Glasgow Coma Scale, 753, 754t, 755t, 766 Glaucoma, 204­ 205 acute, headache and, 146 angle-closure, 204 Glioblastoma multiforme, 553­ 555, 554f Gliomas, 569 of brainstem, 578, 578f of optic nerves and chiasm, 578­ 579 Gliomatosis cerebri, 556f, 556­ 557 Global amnesia. See Transient global amnesia Globoid cell leukodystrophy, 815t, 1154t in infants, 806t, 809, 809f Glomus jugulare tumors, 574 Glossodynia, 1187 Glossopharyngeal nerve, 1185 Glossopharyngeal neuralgia, 163, 325­ 326, 1185 Glottic spasm, 428­ 429 Glove-and-stocking sensory loss, 138 Glucocerebrosidase deficiency. See Familial spastic paraplegia Heredofamilial brachial plexopathy, 1166 Herniation of brain. See Brain herniation of intervertebral discs cervical, 184­ 186, 185f lumbar, 174­ 179, 175t, 177f, 178f of spinal cord, through dural tear, 1079 Herpes occipitocollaris, 642 Herpes simplex virus infections congenital, 883 encephalitis due to, 632, 638­ 640, 639f seizures due to, 290 trigeminal neuropathies and neuritis due to, 1179 Herpes zoster infections, 641­ 644 congenital, 883 craniofacial pain due to, 163 ganglionitis due to, 1166 neuritis due to, 1166 ocular, 233 plexitis due to, 1166 trigeminal neuropathies and neuritis due to, 1179 Herpes zoster ophthalmicus, 233 Heteromodal cortices, 389 Heteroplasmy, 798 Heterotopia, 853, 853f Heterotypical cortex, 386 Heubner arteritis, 616 Hexacarbon intoxication, 1039, 1132 Hexosaminidase A deficiency. See specific imaging methods Imipramine (Tofranil) for depression, 1314 for narcolepsy, 348 for nocturnal enuresis, 349 for restless legs syndrome and periodic leg movements of sleep, 339 Immature personality, 1302t Immunosuppressive drugs, 1041­ 1042. See also specific drugs for multiple sclerosis, 788­ 789 for myasthenia gravis, 1257 Impotence, 471 Impulse, disturbances of, in acute confusional states, 358­ 359 Inadequate personality, 1302t Inarticulation, congenital, 508 Inclusion body myopathy, 1209­ 1210 Incontinence, urinary, with frontal lobe lesions, 393 with normal pressure hydrocephalus, 535 Incontinentia pigmenti, 859 Incoordination, cerebellar, 76­ 77. See also Ataxia Indomethacin for headache, 156 migrainous, 156­ 157 for pain, 124t Indomethacin-responsive headache, 155 Industrial toxins, 1039 Infancy, 495­ 496 Infant(s). See also Neonates craniospinal deformities in, 852­ 853 floppy, 879t, 879­ 880 hereditary metabolic diseases in, 805, 806t, 807­ 816, 825 hydrocephalus in, treatment of, 537­ 538 hypertrophic neuropathy in, 1155­ 1156 meningitis in, bacterial, 596 muscular dystrophy in, 880 neural development in, 497 patient approach for, 8 premature, germinal matrix hemorrhage in, 874f, 874­ 875 seizures in, 288 shaken baby syndrome and, 761 spinal muscle atrophy in, 1249 spinal muscular atrophy in, 880 Wernicke-beriberi disease in, 988 Infantile opsoclonus-myoclonus syndrome. See Encephalopathy, myoclonic, of infants Infantile spasms, 87, 280, 288 Infarction atherothrombotic. See Atheroembolic infarction; Embolic infarction migrainous, 152 in muscle, 1282 of spinal cord, 1068­ 1070 Infections, 592­ 628. See also Brain abscesses; Spinal abscesses; specific infections bacterial, 593­ 620. See also specific infections myelitis secondary to, 1059­ 1061 cestode, 626t, 626­ 627 confusional states with, 363 fatigue associated with, 435 fungal. See Viral infections; specific infections Infectious mononucleosis encephalitis due to, 637 meningitis and, 633­ 634 Infectious vasculitis, 730 Infiltrative ophthalmopathy, 1236 Inflammatory diseases of brain arteries, 730­ 734 cerebral hemorrhage associated with, 727­ 728 Inflammatory myopathy, 1241t Influenza, myositis associated with, 1203 Infranuclear palsy, 222 Infundibulitis, 483 Inhibin, 481 Inner speech, 413 Insertional activity, in electromyography abnormal, 1103 normal, 1102 Insight, loss of, in acute confusional states, 359 in frontal lobe disorders, 394 Insomnia, 338­ 340 familial, fatal, 340­ 341, 653, 656 primary, 338 secondary (situational), 338­ 340 situational, 339 treatment of, 340 Insular cortex, regulation of visceral function by, 457 Integrin muscular dystrophy, 1224­ 1225, 1225t Intelligence. See also specific specific substances alcohol, 1004­ 1007 by antibiotics, 1042 by antineoplastic and immunosuppressive agents, 1039­ 1042 by bacterial toxins, 1030­ 1032 barbiturate, 1021­ 1023 by heavy metals, 1034­ 1039 by plants, venoms, bites, and stings, 1032­ 1034 Intracerebral hemorrhage, traumatic, 760­ 761 Intracranial arteries dilatation of, headache due to, 146 dissection of, occlusive cerebrovascular disease due to, 706 Intracranial hemorrhage, 711t, 711­ 728 arteriovenous malformations of brain and, 722­ 725 cavernous malformations and, 726, 726f dural arteriovenous fistulas and, 725f, 725­ 726 primary (hypertensive), 711f, 711­ 716 clinical picture in, 712­ 714 laboratory findings in, 714­ 715 pathogenesis of, 712 treatment of, 715­ 716 subarachnoid. See also Athetosis; Ballismus; Chorea; Dystonia Ion channels, disorders of, 286t, 1265­ 1275 Iowa pupil, gauge, 241 Iridocyclitis, headache and, 146 Irritability, 439 Isaacs syndrome, 1104, 1278 Ischemia brain. See also Fatigue Latent nystagmus, 238 Lateral epicondylitis, 188 Lateral (femoral) cutaneous nerve of thigh, neuropathy affecting, 1170 Lateral lemniscus, 248f Lateral medullary syndrome, 678f­ 679f, 678­ 680 Lateral medullary tractotomy, for pain, 126 Lateral pathway, 45 Lateral recess, 168 stenosis of, 179 Lateral sinus thrombophlebitis, septic, 605 Lateral sinus thrombosis, 734­ 735 Lathyrism, 1033, 1083­ 1084 Laughing, pathologic (forced; pseudobulbar; spasmodic), 445t, 445­ 446, 450 Laurence-Moon-Biedl syndrome, 211 Lazarus sign, 306 Lead intoxication, 1034­ 1036, 1132 Lead-pipe rigidity, 63 Leber amaurosis, 857 Leber hereditary optic atrophy, 214, 857, 949­ 950 Leeuwenhoek disease, 474 Leg monoplegia, 50 Leg movements, periodic, during sleep, 339 Leigh disease, 814t, 843 nonketotic form of, 802 Legionella, 602 Lennox-Gastaut syndrome, 272, 274, 280, 287 treatment of, 296 Lens, of eye, 205 Lentiviruses, 644 Leprosy, 1150­ 1151 Leprous polyneuritis, 1150f, 1150­ 1151 Leptomeningitis.