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    Understanding Neurology : a problem-orientated approach

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    تاريخ التسجيل : 26/10/2009

    Understanding Neurology : a problem-orientated approach

    مُساهمة من طرف General Practitioner في 19/02/10, 07:48 pm





    Understanding Neurology : a problem-orientated approach Summary:






    By John Greene, Ian Bone




    • Publisher: Manson Publishing Ltd
    • Number Of Pages: 128
    • Publication Date: 2007-01-01
    • ISBN-10 / ASIN: 1840760613
    • ISBN-13 / EAN: 9781840760613

    This book takes a problem-oriented approach to the evaluation of
    common symptoms presenting to medical students. It begins with guidance
    in history taking and examination leading the student on to neurological examination.
    The following sections outline all the common presenting symptoms, such
    as forgetfulness, dizziness or pain, and relate them to the spectrum of
    neurological conditions and diseases.
    Some case histories are used to illustrate problems and the book ends
    with a section of MCQ’s. This is the second in a new series which aims
    to help medical students to think like doctors. By combining a symptom
    and problem-based approach with systematic coverage, the book will
    appeal to instructors and students on traditional and integrated
    courses. Contents Table of Contents History taking and Physical Examination Neurological Investigations The Problems:
    Blackouts

    Acute Confusional States

    Forgetfulness (memory)

    Speech and Language Problems

    Loss of Vision and Double Vision

    Dizziness and Vertigo

    Weakness

    Tremor and Other Involuntary Movements

    Poor Coordination

    Headache

    Neck Pain and Back Ache

    Numbness and Tingling


    MCQ’s Index

    While traditional neurology textbooks tend to be
    organized by disease process, patients, being unaware
    of this, arrive with a complaint, (e.g. headache,
    dizziness, memory problems), that requires an
    explanation. This multi-author book adopts a
    problem-oriented approach to the commonly
    presenting complaints seen by neurologists. We have
    drawn on the experience of practising clinicians in a
    busy department based in the Southern General
    Hospital, Glasgow.
    The problem-based approach illustrates the
    manner in which clinicians, in the real world, focus
    on particular elements of history and examination in
    order to narrow down their differential diagnosis and
    by so doing formulate a diagnostic approach or
    sometimes (quite often actually) offer no more than
    confident professional reassurance.
    This is not a comprehensive textbook of these
    neurological conditions in themselves, nor a manual
    of neuro-therapeutics. Neurology is a speciality
    requiring a ‘good listener’ and a capable examiner, no
    more and no less.
    We hope that this book will demystify what
    should have never been mysterious in the first place
    and prove useful to medical undergraduates. It should
    also be of benefit to junior doctors preparing for
    MRCP. If trainee neurologists also derive benefit from
    reading it, so much the better!
    John Greene and Ian Bone



    Index
    Note: page numbers in bold refer to
    the main discussion of a topic; those
    in italic refer to content of tables
    abdominal reflex 24
    abducens nerve (VIth cranial nerve)
    21, 120, 121, 128
    accessory nerve (XIth cranial nerve)
    22
    acetylcholine 77, 150
    acetylcholine receptor antibodies 56
    achromatopsia, central 108
    acoustic neuroma 56–8
    acromegaly 58
    Adamkiewicz, artery 48, 49
    Addenbrooke’s Cognitive
    Examination (ACE) 14, 20, 90, 99
    adrenocorticotrophic hormone
    (ACTH) 58
    age 9, 136, 204
    agnosia 108
    agraphaesthesia 112, 220
    akinetic mutism 13
    alcohol use 81–2, 122, 137, 176, 181
    alcohol withdrawal 80
    alexia without agraphia 97, 108
    allergies 10
    Alzheimer’s disease 16, 18, 89, 90, 91,
    108
    amaurosis fugax 107
    amblyopia 118, 125
    aminoglycosides 176
    analgesics, overuse 193–4, 201–2
    aneurysms, cerebral 32–3, 80, 121,
    127
    angiography
    cerebral 38–9
    CT 30
    digital subtraction (DSA) 38–9
    fluorescein 60
    interventional 39
    magnetic resonance (MRA) 34
    spinal 48–9, 51
    angular gyrus 94
    anisocoria 109
    ankle
    movements 154
    reflexes 24, 156
    anosomia 152
    anterior ischaemic optic neuropathy
    107
    antibody tests 56
    anticholinergic drugs 77, 80
    antipsychotics 165
    Anton’s syndrome 108
    anxiety 71, 131, 132, 136, 137,
    146–7
    aphasias 45, 96–8, 101
    apraxias 16, 17
    arcuate fasciculus 94
    arousal 11
    arrhythmias, cardiac 135, 137, 138
    arteriovenous fistula, dural 51,
    211–12
    arteriovenous malformations 38–9
    ascending reticular activating system
    (ARAS) 76–7
    astereognosia 112, 220
    asterixis 168
    ataxia 122, 131–2, 136, 176–81
    acute of childhood 182–3
    aetiologies 122, 137
    cerebellar 133, 176, 178, 179, 180,
    204
    clinical scenarios 182–5
    differential diagnosis 178
    examination 178, 180–1
    Friedreich’s 178
    investigations 181–2, 181
    sensory 178, 179, 180–1, 182
    vestibular 176
    atherosclerosis, basilar artery 115–16
    athetosis 168
    atrial fibrillation 107
    attention/concentration 11, 14
    anatomy 76–7
    assessment 15, 45, 77–8
    audiometry 22, 60–1, 138, 139
    auditory/vestibular nerves 22, 132–3
    aura, migraine 188, 192
    auras, epileptic seizures 70–1
    awareness 11, 13
    Babinski sign 24
    back pain 204
    balance 133, 170, 176
    assessment 138, 139
    Balint’s syndrome 108
    ballism 168
    barbiturates 80
    basal ganglion 164
    behavioural changes 13–14, 15, 79
    benign intracranial hypertension 196
    Benton Facial Recognition Test 46
    benzodiazepines 80
    biceps reflex 24, 156
    bladder function 152, 159, 206
    blink reflex 53
    blood oxygen level dependent (BOLD)
    imaging 36
    Boston Diagnostic Aphasia
    Examination 45
    Boston Naming Test 45
    brachial plexus 222
    brachioradialis reflex 24
    brain
    anatomical landmarks 29
    herniation 12
    perfusion pressure 65–6
    tumours 15, 56–8, 102, 187, 195,
    195
    see also named parts of the brain
    brainstem auditory evoked potentials
    (BSAEPs) 43–4
    brainstem lesions 121
    brainstem reflexes 13
    Broca’s aphasia 97, 99
    Broca’s area 69, 94, 95
    Brown–Séquard syndrome 159, 182,
    208, 222
    bulbar muscles 152
    C-reactive protein 112, 126, 142
    calcium, muscle contraction 150
    calcium channel antibodies 56
    calculation, ability 16
    caloric testing 61
    CAPE sensory deficit 209
    carbon dioxide retention 80
    cardiac disease 122
    altered consciousness 64, 66, 66–7,
    67, 74
    confusional states 80
    dizziness/vertigo 135, 136, 137, 138
    weakness/fatigue 148
    carotid artery stenosis 34, 107
    carotid sinus hypersensitivity 66–7,
    138
    carpal tunnel syndrome 223
    cauda equina lesions 205–6, 222
    cavernous sinus 58
    thrombosis 122, 198, 199
    cerebellar disorders 170, 176, 177
    cerebellar system
    function, assessment 26
    testing 125
    cerebellar tremor syndromes 167
    cerebello-pontine angle 56–8
    cerebellum 102, 133, 140, 176–7, 178
    236
    cerebral arteries
    atherosclerosis 115–16
    CT angiography 30–1
    cerebral ischaemia 35
    cerebral oedema 187, 195
    cerebral venous thrombosis 108
    cerebrospinal fluid (CSF)
    blood in sample 197
    lumbar puncture 52
    obstruction 187
    oligoclonal banding 227
    pressure 195, 195, 196
    protein level 187
    cerebrospinal fluid (CSF) examination
    181
    cerebrovascular disease 35–7, 81–2,
    100, 200
    cervical spine disorders 193, 204–5,
    210–11
    Charcot joints 180
    Charcot–Marie–Tooth disease 56
    Chiari malformations 56–7, 225–6,
    227
    chickenpox 182–3
    choline 36
    chorea 163, 167–8
    Clock Drawing Test 46–7
    clonus 24, 168
    Cogan’s lid twitch sign 123
    cognitive function 14
    distributed 14–16, 14
    history taking 18, 88–9
    localized 14, 16–18
    cognitive testing 19–20, 44–6, 89–90
    language assessment 99
    colour vision 108, 110
    computed tomography (CT) 28–30
    angiography 30
    brain anatomical landmarks 29
    spinal cord 49–50
    computed tomography perfusion
    (CTP) 31
    concentration see
    attention/concentration
    confabulation 78
    confrontation 59, 110, 111
    confusional states 76
    causes 79–80, 79
    clinical assessment 77–9
    clinical scenarios 81–5
    definition 76
    fluctuations 78
    with lethargy/retardation 77, 80
    pathophysiology 77
    consciousness
    anatomy 12–13
    brainstem tests 13
    levels of 11
    consciousness, altered
    diagnosis 42, 65
    mechanisms 65
    see also epilepsy; syncope
    conus medullaris 222
    coordination 156, 176–85
    tests 26
    copying, shapes 17
    corneal reflex 13, 21, 140
    corpus callosum 16, 97
    Corsi Block Test 45
    corticobasal degeneration 165
    cramps 151, 161
    cranial nerves
    examination 20–2, 112, 125, 140,
    190, 204
    eye movements 120–1
    palsies 22, 23, 128, 196
    see also individual nerves
    cranio-cervical junction lesions 56–7
    creatine kinase (CK) 84, 156
    Creutzfeldt–Jakob disease 108
    Cushing’s syndrome 58
    cytotoxic drugs 152
    deafness see hearing loss
    delirium 13, 77, 78
    delirium tremens 80
    delusions 13
    dementia 16, 18, 47, 88, 89–90, 91,
    108
    demyelination 107, 121, 122
    Denny–Brown sensory neuropathy 182
    depression 91–2, 144–5
    dermatomes 152–3
    dextrose, intravenous infusion 92–3
    diabetes mellitus 128, 136, 144, 224–5
    diet 9, 181, 183
    digit span 45, 77, 86, 90
    digital subraction angiography (DSA)
    38–9
    diplopia see double vision
    discrimation tests 25
    disequilibrium 131, 136
    disinhibition 15
    Dix–Hallpike positional test 141, 143
    dizziness 131–42
    anatomy and physiology 132–4
    and anxiety 131, 132, 136, 137
    clinical scenarios 143–6
    examinations 138–41
    history taking 134–7
    postural 65–6, 73, 132, 144–5
    specific investigations 141
    symptom complexes 134, 135
    timing/duration of symptoms 135–6,
    137
    Doll’s eye test 125, 141
    dopaminergic neurones 164, 172, 174
    Doppler ultrasound 39–40, 112
    dorsal root ganglion 214, 215
    double vision (diplopia) 21, 112,
    118–29, 192
    causes 121, 152
    clinical scenarios 127–9
    examinations 21, 122–5
    history taking 121–2
    investigations 126, 126
    drug abuse 80, 137
    drug history 10, 18, 89
    drugs
    analgesia overuse 191, 193–4,
    201–2
    causing confusional states 77, 80,
    83–4
    causing dizziness/imbalance 137,
    176
    causing headache 187, 196
    causing weakness/fatigue 152
    inducing tremor/parkinsonism 165,
    167
    and syncope 65
    Duchenne muscular dystrophy (DMC)
    148
    dural venous sinus
    cavernous 58
    thromboses 122, 198, 199
    dysaesthesia 220
    dysarthria 95, 98, 102, 178, 180
    dysdiadochokinesia 125, 180
    dysgraphia 98, 99
    dyskinesia 165
    dyslexias 97–8
    dysphasias 76, 95, 96
    dyssynergia 180
    dystonia 168
    ear disorders 60–1, 176, 178
    Eaton–Lambert syndrome 55, 56
    echocardiography 112
    eclampsia 200
    elaborated disease 221
    elbow movement 154
    electrocardiography (ECG) 66, 67, 73,
    112, 142
    electroencephalography (EEG) 40–3
    abnormal rhythms 40
    ataxia 181–2
    confusional states 77
    epilepsy 41–2, 68, 68, 69, 70, 72–3
    intracranial recordings 42
    normal rhythms 40
    sleep-deprived 42
    video 42, 73
    visual loss 112
    electromyography 54–5, 156–7
    Index 237
    electronystagmography 61
    electroretinography (ERG) 60
    embolism, cerebral arteries 107
    emotion 13, 76, 79
    expression 22, 165
    employment history 10, 152
    encephalitis, HSV 80, 84–5
    epilepsy 64
    classification of seizures 68–71
    classification of syndromes 70–1
    clinical diagnosis 64–5
    diagnostic difficulties 42, 64
    EEG diagnosis 41–2, 68, 68, 69,
    72–3
    memory disorders 75, 88
    risk factors 65
    Erb’s point 52
    erythrocyte sedimentation rate (ESR)
    112, 114, 142, 194
    evoked potentials 43–4, 52
    executive function 45
    extraocular muscles 118–19
    eye movements
    disorders 124–5, 152, 204
    examination 21, 140
    muscles 118–19
    nerve supply 120–1
    F waves 53
    facial expression 22, 165
    facial muscles 21, 22, 122
    facial nerve (VIIth cranial nerve)
    21–2, 136, 140
    facial recognition 18, 46, 108
    facial sensation 122, 216
    falls 66, 83
    family, reporting of signs/symptoms
    18, 89
    family history 10, 18
    ataxias 181
    epilepsy 65
    weakness 152
    FAS letter fluency 15
    fatigue 148, 151–2
    finger-to-nose test 180, 219
    fingers
    movements 154
    reflexes 156
    sensory loss 222–3
    folic acid 181
    forced pull-back test 26, 170
    frontal lobe 15, 19, 176
    full blood count 112, 114, 142
    functional neuroimaging 36–7, 100,
    170, 172, 174
    fundoscopy 20, 104, 110, 112, 140
    gag reflex 13
    gait 19, 26, 154
    ataxic 180
    Parkinson’s disease 165, 170
    spinal cord lesion 158–9
    gamma camera 36–7
    Gerstmann’s syndrome 16
    giant cell (temporal) arteritis 106,
    108–9, 114, 194, 201
    glabellar reflex 19
    Glasgow Coma Scale 11, 11
    glossopharyngeal nerve (IXth cranial
    nerve) 22
    Goldmann perimetry 58
    graphaesthesia 25, 219
    grasp reflex 19
    growth hormone 58
    Guillain–Barré syndrome 52
    H waves 53
    Hallpike manoeuvre 61
    hallucinations 13, 78, 192
    hands 154, 154, 155, 222–3
    head
    injury 65, 79, 193
    pain sensitive structures 188, 189
    sensory innervation 216
    see also brain
    headache 187
    acute onset types 196–200
    analgesic overuse 191, 193–4,
    201–2
    classification 187, 187
    clinical assessment 188–90, 189,
    190, 191
    clinical scenarios 201–2
    diagnostic criteria 187–8, 188
    with dizziness/vertigo 134, 135, 142
    insidious worsening types 191–6
    red flag symptoms/signs 191, 195
    hearing loss 136
    assessment 22, 60–1, 138–40
    conductive 22, 61
    sensorineural 22, 61, 140
    with vertigo 140
    heel-shin test 219
    heel-to-knee test 180
    hemianopia 58, 104–6, 108
    bitemporal 105, 106, 115–16
    homonymous 97, 105, 106
    hemicrania, chronic paroxysmal 191,
    193
    hemiparesis/hemiplegia 100, 192
    hereditary motor and sensory
    neuropathies (HMSN) 56
    herpes simplex virus (HSV)
    encephalitis 80, 84–5
    hip flexion/extension 154
    hippocampus 16, 87, 90
    history taking 8–10
    cognitive disorders 18, 88–9
    concepts 8
    informant interview 18, 89
    Holmes tremor 167
    Horner’s syndrome 122, 123, 192,
    204, 207, 211
    Humphrey field analyser 59
    Huntingtin gene 173
    Huntington’s disease (HD) 19, 47,
    164, 168, 173
    hydrocephalus 57, 58
    hydrops 134, 135, 142
    hyperalert state 79
    hyperalertness 14
    hyperreflexia 182
    hypertension 122–3, 128
    benign intracranial 196
    causing headache 200
    malignant 200
    hyperventilation 71, 136, 137
    hypoaesthesia 220
    hypodynia/allodynia 220
    hypoglossal nerve (XIIth cranial
    nerve) 22
    hypotension, postural 65–6, 138,
    144–5
    hypoxia 80
    infective diseases 79–80, 84–5, 182–3,
    187
    inflammatory disorders 187
    informant interview 18, 89
    inherited disorders 10
    ataxias 178, 181
    migraine 192
    peripheral nerves/muscle 152
    insight, loss of 18
    intellectual ability 45
    ischaemic lactate test 56
    Ishihara plates 110
    ‘Jacksonian March’ 69
    jaw claudication 114, 194
    jaw jerk 21
    joint position sense 219
    Judgement of Line Orientation Test
    46
    knee
    movements 154
    reflexes 24, 156, 180
    Korsakoff’s syndrome 87, 88,
    92–3
    laboratory tests 47
    double vision 126
    headache 190
    238
    laboratory tests (continued)
    peripheral nervous system disorders
    56
    visual loss 112
    lactate levels 36, 56
    language 16
    anatomy and physiology 94–5
    pathology 95–6
    language disorders 89, 96–7
    causes 98, 98
    clinical assessment 16, 18, 45,
    98–100
    clinical scenarios 100–2
    stroke 100
    left hemisphere function 16, 96–8
    Letter Cancellation Test 45
    lid retraction 123
    limb coordination 26
    limb examination 190
    muscle power 23–4, 23
    reflexes 24, 156, 156, 219
    spinal cord lesions 204–5
    limbic system 16, 77, 87
    long QT syndrome 66, 67, 74
    lower motor neurone (LMN)
    disorders 156, 161, 204–5, 206,
    207, 209
    lumbar puncture 52, 112, 197
    lung tumour 160
    lymphadenopathy 123
    McArdle’s disease 151
    magnetic resonance angiography
    (MRA) 34
    magnetic resonance imaging (MRI)
    31–6
    advantages/disadvantages 32
    Alzheimer’s disease 91
    dementia 88, 89, 91
    diffusion and perfusion-weighted 35
    fluid-attenuated recovery (FLAIR)
    34
    functional 36, 100
    Korsakoff’s syndrome 93
    language disorders 99–100
    paramagnetic enhancement 32–3
    pituitary lesions 58
    spinal cord 50–1, 209
    syringomelia 226
    magnetic resonance spectroscopy
    (MRS) 36
    mamillary bodies 87, 88
    Marcus Gunn pupil 109
    mass lesions
    causing headache 195
    see also tumours
    median nerve lesions 154, 155, 223
    medications see drugs
    memory 16
    and attention 78
    episodic 16, 18, 87, 88
    semantic 16, 45, 87, 88, 89, 90
    short-term 86–7, 88
    taxonomy 86–7
    memory disorders 86–93
    causes 87
    clinical assessment 16, 18, 46,
    88–90
    clinical scenarios 91–3
    in epilepsy 75, 88
    types 87–8
    Ménière’s disease 135, 136, 137, 137,
    176
    meningioma, optic chiasm 115–16
    meningitis 79–80
    mental status, assessment 11–20
    mesencephalic arteries 79
    metabolic disorders 80, 151, 170, 214
    migraine 9, 108, 188, 191–3, 201–2
    Mini-Mental State Examination
    (MMSE) 20, 45, 89–90, 99
    mitochondrial diseases 56
    mononeuritis multiplex 222
    mood 22, 76, 79
    assessment 13
    motor neurone disease (MND) 148,
    161
    motor sequencing 15
    motor system
    anatomy 150
    examination 23–4, 140, 154, 154,
    156, 156
    motor tics 168
    motor unit, structure 149–50
    movements
    involuntary 19, 167–8
    see also tremor
    routine tests 154, 154
    multiple sclerosis (MS) 9, 52, 104,
    107, 181, 184–5, 204, 227
    multiple system atrophy (MSA) 165,
    170, 174
    muscle
    biopsy 56, 156
    contraction 149–50
    cramps 151, 161
    fasciculations 51–2, 151, 161
    structure 149
    tone 23, 112, 156, 180
    muscle strength 23–4, 23, 154, 154
    muscle wasting 154, 161
    myasthenia 55, 56, 121, 122, 123,
    128–9
    myelography, contrast 48
    myoclonus 168
    myopathy 151, 156, 157
    myotomes 152, 152
    myotonia 54
    N-acetyl aspartate (NAA) 36
    naming 45, 99
    National Adult Reading Test (NART)
    45
    nausea 135, 135
    neck pain 204
    neglect 17, 97, 220
    nerve biopsy 55–6
    nerve conduction studies 40, 51–2,
    52–3, 156
    nerve plexuses 214
    lesions 151, 222
    nerve roots 207, 214, 215
    lesions 151, 152, 206, 206–7
    nervous system, anatomy 11
    neurofibroma, thoracic 158–9
    neuroleptic malignant syndrome 83–4
    neuromuscular junction (NMJ)
    disorders 55, 122, 123, 154
    neurophysiology 40, 156–7
    peripheral nerve disorders 52–3
    spinal cord lesions 51–2
    neuropsychology 44–6
    noradrenaline 77
    numbers, understanding 16
    numbness and tingling 214, 217–24
    nutritional disorders 181, 183
    nystagmus 21, 136, 180
    dizziness/vertigo 138, 140–1
    down-beating 56
    quantitative assessment 61
    occipital cortex 97, 105, 106
    occupational history 10, 152
    oculomotor nerve (IIIrd cranial nerve)
    21, 120
    nucleus 121, 133
    palsy 127
    oedema
    cerebral 187, 195
    periocular 122
    olfactory nerve (Ist cranial nerve) 20
    onset of symptoms 9
    ophthalmoplegia 124–5
    opiates 80
    opsoclonus-myoclonus 181
    optic chiasm 58, 104–6, 107, 115–16
    optic disc 104, 108
    optic nerve (IInd cranial nerve) 20,
    104, 109
    optic neuritis 106, 113
    optic radiation 106
    orbit 59–60, 118–19
    orbital apex 118, 119
    orientation, tests 45
    oscillopsia 136
    pain, muscular 151
    pain sensitivity 25, 219
    palmomental reflex 19
    Pancoast tumour 160
    panic attacks 71
    papillitis 104
    papilloedema 104, 108
    paraneoplastic syndromes 181, 182
    paraphasias 97, 99
    parieto-temporal cortex 133
    parkinsonism, drug-induced 165, 167
    Parkinson’s disease (PD) 19, 22, 163,
    164, 165, 171–2
    drugs 80
    tremor 165, 166
    Parkinson’s plus disorders 165–6, 174
    paroxysmal disorders 9
    perception 78
    perfusion, cerebral 65–6
    perineum, sensation 205–6, 222
    peripheral nerve disorders
    classification 151
    differentiation from root lesions
    206, 206–7
    investigations 52–6
    patterns of deficits 154–5, 154,
    222–3
    peripheral nerves 214, 215
    peroneal nerve lesions 206
    petit mal seizures 68, 70
    phaeochromocytoma 200
    physical examination 19
    pinprick examination 25
    pituitary apoplexy syndrome 198–9
    pituitary fossa 58
    plantar response 24, 156
    point-to-point test 26
    polymodal association cortex 76
    polyneuropathies 222, 224–5
    polyopia 118
    polysomnography 43
    popliteal nerve, lateral 154
    positional sensation 25
    positron emission tomography (PET)
    38
    postoperative confusion 80
    postural dizziness/hypotension 65–6,
    73, 132, 144–5
    postural stability 26, 170
    pout reflex 19
    praxis 16
    pre-eclampsia 200
    presenting complaint 8–10
    presyncope 65–6, 73, 136, 144–5
    primary sensory cortex 76–7
    prochloroperazine 83–4, 165
    progressive supranuclear palsy (PSP)
    165
    prolactin 58
    pronator drift 24, 181, 219
    pronunciation 45, 94–5, 97
    proprioception 177–8, 215
    deficits 132, 140
    testing 220
    proptosis 21, 108, 109, 122, 123
    prosopagnosia 18, 108
    pseudoathetosis 181
    psychogenic nonepileptic seizures
    (PNES) 64, 65, 71, 71–2
    psychomotor activity 14
    pterygoids 21
    ptosis 21, 122, 123
    pull-back test 26, 170
    pulmonary disease 148, 160
    pupil, responses 13, 21, 109, 122, 123
    pyramidal signs 170
    quadrantanopia 58, 105, 106
    radial nerve lesions 154, 155
    radiculopathies 151, 152
    radiology, spinal cord 48, 209
    Raven’s Progressive Matrices 45
    reading 45, 94–5, 97–8, 99
    rebound phenomenon 180
    recall, delayed 89–90
    reduplicative phenomena 78
    reflexes 24, 156, 156, 219
    brainstem 13
    loss 222
    primitive 19, 170
    spinal roots 207
    repetition 96, 99
    respiratory alkalosis 71
    respiratory movements 13
    reticular activating system 14
    retina 60, 104
    Rey–Osterrieth complex figure 46, 90
    right hemisphere function 16–18
    rigidity 23, 170
    Rinne’s test 22, 60, 138–40
    Romberg’s test 26, 132, 138–9, 181,
    219
    saccades 125
    sacral root lesions 204–5
    sarcomere, structure 149–50
    sarcoplasmic reticulum 150
    scalp 190, 194, 216
    scotoma 110, 192
    seizures
    psychogenic nonepileptic 64, 71,
    71–2, 74
    see also epilepsy
    semantic memory 16, 45, 87, 88, 89,
    90
    semicircular canals 132
    sensory cortex 216
    sensory loss 17, 125, 140, 214–28
    assessment 25–6, 112, 217–24, 219
    and dizziness 140
    nonorganic (elaborated) disease 221
    peripheral nerve lesions 154–5,
    224–5
    spinal cord lesions 158–9, 207,
    221–2
    terminology 220
    sensory nerve fibres, classification 215
    sensory pathways 214–17
    sensory receptors 214
    septicaemia 79
    serial 7’s 90
    shoulder abduction 154
    single photon emission computed
    tomography (SPECT) 36–7, 100,
    172, 174
    sinusitis 193
    sleep disorders 43
    smoking 182
    Snellen chart 20, 110
    social history 10, 18
    somatosensory evoked potentials
    (SSEPs) 44, 52
    speech
    anatomy and physiology 94–5
    assessment 98–9
    disorders 78, 95–8, 102, 152, 178,
    180
    fluency 15, 99
    sphincter function 205–6, 208, 222
    spinal cord
    anatomy 47–8, 153, 204, 215
    dermatomes 152–3
    imaging/investigations 47–51
    sensory pathway 214–17
    spinal cord lesions
    anatomical localization 207–9
    clinical scenarios 210–12, 225–7
    investigations 48–52, 209
    level localization 206–7
    sensory loss 158–9, 207, 205,
    221–2
    tumours 158–9
    weakness 152, 153, 158–9, 160
    spinal sympathetic function 206
    spino-thalamic tracts 209, 215
    stance 26
    stapedial reflex decay 60–1
    Steele–Richardson–Olszeweki
    syndrome 165
    stereognosis 25, 219
    sternocleidomastoid muscle 22
    Index 239
    steroids 152
    strabismus 125
    straight leg raising 205
    stress 146–7
    see also anxiety
    ‘stretch’ tests 205
    stroke 35–7, 81–2, 100, 200
    Stroop Test 45
    subarachnoid haemorrhage (SAH) 80,
    197, 202
    substantia nigra 164
    ‘sundowning’ 78
    sural nerve, biopsy 56
    swallowing disorders 152
    sweating 206
    symptoms
    aggravating/relieving factors 9
    associated 9
    duration 9
    frequency 9
    mode of onset 9, 18
    syncopal attacks 65–7, 71
    syringomelia 225–6, 227
    systemic disease
    causing headache 195
    causing weakness/fatigue 148
    taste 21
    temperature sensation 25, 158, 219
    temporal arteries 190
    temporal arteritis 106, 108–9, 114,
    194, 201
    tendon reflexes 24, 180, 182
    thalamic nuclei 216
    thalamus 77, 79, 87, 88, 164
    thiamine 88, 181
    thought, content/organization 13, 78
    thrombosis
    anterior spinal artery 209
    dural venous sinus 122, 198, 199
    thumb abduction 154
    thyroid disorders 123
    thyroid function tests 142
    time orientation 78, 92
    Tinel’s sign 206, 222, 223
    tinnitus 136
    Token Test 45
    Tolosa–Hunt syndrome 122
    tongue, examination 22
    ‘top of the brainstem’ syndrome 79
    touch sensitivity tests 25, 219
    Tourette’s syndrome 168
    Trail Making Test 45
    transient ischaemic attack (TIA) 192
    trauma, head 65, 79, 193
    tremor 163
    classification 163–4, 163
    clinical assessment 169–70
    tremor (continued)
    essential 166, 166, 170
    Parkinson’s disease/Parkinson’s plus
    disorders 165–6, 166, 171–2
    physiological 166–7
    triceps reflex 24, 156
    trigeminal nerve (Vth cranial nerve)
    21, 140, 216
    trochlear nerve (IVth cranial nerve)
    21, 120, 121
    tropia 124–5, 125
    tumours
    brain 15, 56–8, 102, 187, 195, 195
    headache 195, 195
    lung 160
    orbit 60
    paraneoplastic syndromes 181
    spinal cord 158–9
    visual loss 106, 107, 115–16
    2-point discrimination 26, 219
    Uhthoff’s phenomenon 107, 227
    ulnar nerve lesions 154, 155, 206,
    222–3, 224
    ultrasound 39–40, 112
    upper motor neurone (UMN)
    disorders 156, 158–9, 205, 206,
    207, 208
    vagus nerve (Xth cranial nerve) 22,
    214
    vascular disease
    confusional states 79
    double vision 121, 122, 127, 128
    headache 187, 195, 200, 202
    spinal 51, 211–12
    visual loss 107, 116–17
    vasovagal syncope 64, 65–6, 71
    verbal fluency 15, 99
    verbal function, assessment 45
    verbal reasoning 45, 78
    vertebrobasilar migraine 192
    vertigo 131
    benign positional 134, 135, 143–4
    clinical assessment 134–41
    defined 131
    symptom complexes 134, 135
    vestibular nerve 22, 132–3
    vestibular system
    anatomy 132–4
    disorders 176
    testing 61
    vestibulo-ocular reflex 61
    vestibulo-spinal tract 133
    vestibulocochlear nerve (VIIIth cranial
    nerve) 22, 132–3, 136
    vibration, sensitivity 25, 219
    video-telemetry 42
    vision, and headache 193
    visual acuity testing 10, 20, 110
    visual evoked responses 43, 60, 112
    visual field defects 19, 58, 104–6
    visual field testing 20, 58–9, 110–11,
    115
    visual loss
    aetiologies 106, 107
    clinical assessment 106–12, 112
    clinical scenarios 113–17
    with diplopia 122
    higher cortical dysfunction 108,
    108, 112
    temporal arteritis 114, 194
    visual neglect 17
    visual object agnosia 18
    visual symptoms
    epilepsy 71
    migraine 192
    presyncope 65–6
    visuo-perceptual function 16–18,
    46–7, 89
    vitamin B1 (thiamine) 88, 181
    vitamin B12 181, 183
    vomiting 135, 136
    Wallenburg, lateral medullary
    syndrome 222
    weakness
    anatomical localization 151, 152–4,
    156
    clinical assessment 151–7
    clinical scenarios 158–61
    non-neurological causes 148
    symptoms arising from differing
    distributions 148
    Weber’s test 22, 60, 138–40
    Wechsler Adult Intelligence Scale-
    Revised (WAIS-R) 45
    Wechsler Memory Scale-Revised 46
    Wernicke’s aphasia 96, 99, 101
    Wernicke’s area 16, 94, 97
    Wernicke’s encephalopathy 80, 92–3,
    122
    Wilson’s disease 167
    Wisconsin Card Sorting Test 45
    writing disorders 16, 98, 99
    xanthochromia 19
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