The integrated nervous system: a systematic diagnostic case-based approach

✍ Scribed by Hendelman, Walter J;Skinner, Christopher R(Contributor);Humphreys, Peter(Contributor)

• Publisher: CRC Press
• Year: 2017;2018
• Tongue: English
• Leaves: 363
• Edition: 2
• Category: Library

✦ Synopsis

This innovative textbook is modelled on problem-based learning. It bridges the gap between academic neuroanatomy and clinical neurology and effectively takes the reader from the classroom to the clinic, so that learning can be applied in practice.



This second edition has been updated and expanded to include many more clinical cases within both the book and the accompanying Wweb site. Significant additions include



abbreviated presentation of the history and neurologic examination of all the cases on the web site (now numbering over 50) within the text at the end of each of the clinical chapters.



new 'maps' -- visual representations of the clinical motor, sensory and reflex findings.



the web site further expands the cases - presenting them in detail, and providing an 'expert' commentary to discuss the reasoning for the localization and etiological diagnosis.

This book and the associated Web site will be of practical value to all the professionals who deal with people who have neurological conditions, as well as being invaluable to medical students and residents. This includes physiatrists (rehabilitation medicine specialists), physiotherapists, occupational therapists and speech therapists, and nurses who specialize in the care of neurological patients. We think that this text will also be of value for family physicians and specialists in internal medicine and pediatrics, all of whom must differentiate between organic pathology of the nervous system and other conditions.

✦ Table of Contents

Cover......Page 1
Half Title......Page 2
Title Page......Page 4
Copyright Page......Page 5
Table of Contents......Page 6
Preface......Page 7
References......Page 8
Organization of the Book and Integration with the Web Site......Page 9
Support......Page 11
Authors......Page 12
Introduction......Page 14
Section Section 1: The Basics of Neurological Problem Solving......Page 16
1.1 Neurobasics......Page 18
1.1.1 The Neuron......Page 19
1.1.4 Synapse and Neurotransmission......Page 21
1.2 Nervous System Overview......Page 22
1.2.2.1 Sensory Aspects......Page 23
1.2.2.3 Reflexes......Page 24
1.2.2.4 The ANS......Page 26
1.2.3 The Brainstem......Page 27
1.2.4 The Reticular Formation......Page 30
1.2.5 The Cerebellum......Page 31
1.2.6 The Diencephalon......Page 32
1.2.7.1 The Basal Ganglia......Page 33
1.2.7.2 The Cerebrum......Page 35
1.2.9 The Limbic System......Page 37
Suggested Reading......Page 38
2.3 The Cranial Nerves......Page 39
2.3.2 CN II: Visual System......Page 40
2.3.2.1 Pupillary Light Reflex......Page 41
2.3.4 CN III, IV and VI......Page 42
2.3.8.1 Auditory System......Page 43
2.3.9.1 Gag Reflex......Page 44
2.3.11 CN XII......Page 45
2.4.1 Motor Regulation......Page 46
2.4.2 Motor System Examination......Page 47
2.4.3.1 The Corticospinal Tract for Complex, Precise Movements......Page 49
2.4.4 Pathways for Nonvoluntary (Associated and Postural) Movements......Page 50
2.5.1 Posterior Column Pathway: Vibration, Proprioception and Discriminative Touch......Page 51
2.5.2 Spinothalamic Pathway: Pain and Temperature......Page 53
2.6 Higher Mental Functions......Page 54
2.6.2.3 Language......Page 55
2.6.2.7 Emotions......Page 56
2.8 Sleep......Page 57
Suggested Reading......Page 58
3.1 Introduction......Page 59
3.3 Sample Case......Page 60
3.5 Main Clinical Points......Page 61
3.7 Localization Process......Page 62
3.7.A Muscle Disease......Page 63
3.7.B NMJ......Page 64
3.7.C.1 Investigations......Page 65
3.7.D.1 Investigations......Page 66
3.7.E Brainstem......Page 67
3.7.G Cortex......Page 68
3.7.G.1 Investigations......Page 69
3.7.H.1 Cerebellum......Page 70
3.7.H.2 Basal Ganglia......Page 71
3.7.I Localization Shortcuts......Page 72
3.8 Etiology......Page 73
3.8.A.3 Migraine......Page 74
3.8.C Vascular......Page 75
3.8.D Drugs and Toxins......Page 76
3.8.F Metabolic......Page 78
3.8.H Neoplastic......Page 79
3.8.I Degenerative Diseases......Page 80
3.8.J Genetic Diseases......Page 81
3.9 Case Summary......Page 82
3.11 Implementation......Page 83
Suggested Reading......Page 84
Section Section 2: Applying the Basics to Clinical Cases......Page 85
4.1 Fifi......Page 87
4.3 Main Clinical Points......Page 88
4.4 Relevant Neuroanatomy......Page 89
4.5 Localization Process......Page 90
4.5.1 Peripheral Nerves......Page 92
4.6.C Vascular......Page 94
4.6.G Inflammatory/Autoimmune......Page 95
4.6.I/J Degenerative/Genetic......Page 97
4.7.1 Guillain–Barré Syndrome......Page 98
4.7.3 Treatment/Outcome......Page 99
4.8.1 Case 4e-1: Oskar, Age 52......Page 100
4.8.3 Case 4e-3: Felix, Age 5......Page 101
4.8.4 Case 4e-4: Nasreen, Age 7......Page 102
4.8.6 Case 4e-6: Caroline, Aged 51......Page 103
4.9 Summary of Key Neuroanatomical and Neurophysiological Information......Page 104
4.10 Chapter-Related Questions......Page 105
Web sites......Page 106
5.2 Clinical Data Extraction......Page 107
5.4 Relevant Neuroanatomy......Page 108
5.5 Localization......Page 110
5.5.1.3 Brown–Sequard Syndrome......Page 113
5.5.1.4 Syringomyelia......Page 114
5.6.B Traumatic Spinal Cord Injury......Page 115
5.6.C Vascular Injury......Page 116
5.6.F Metabolic Injury......Page 117
5.6.J Genetic Disorders......Page 118
5.7.1 Case Evolution......Page 119
5.8.1 Case 5e-1: Jean-Pierre, Age 35......Page 120
5.8.2 Case 5e-2: Anne, Age 18......Page 121
5.8.3 Case 5e-3: Indira, age 68......Page 122
5.8.4 Case 5e-4: John, Age 80......Page 123
Suggested Reading......Page 124
6.1 Ernesto......Page 126
6.3 Review of the Main Clinical Points......Page 127
6.4.2.1 Auditory Component......Page 128
6.4.2.2 Vestibular Component......Page 131
6.5 Localization......Page 134
6.6.D Toxic Injury (Including Drugs)......Page 135
6.6.J Genetic Disorders......Page 136
6.7.2 Investigations......Page 137
6.7.4 Pathology......Page 139
6.8.2 Case 6e-2: Esther, Age 80......Page 140
6.8.4 Case 6e-4: Brenda, Age 9......Page 141
6.9 Summary of Key Anatomical Information......Page 143
6.10 Chapter-Related Questions......Page 144
Suggested Reading......Page 145
7.1 Bernie......Page 146
7.3 Main Clinical Points......Page 147
7.4.1 Descending Motor Pathways......Page 148
7.4.2 Basal Ganglia: The ‘Accelerator’ and the ‘Brake’......Page 149
7.4.3 Cerebellum: The ‘Steering Wheel’......Page 152
7.4.4 Neurotransmitters Involved in Movement Control......Page 154
7.5.2 Basal Ganglia Circuitry......Page 155
7.6.A Paroxysmal......Page 157
7.6.E Infectious......Page 158
7.6.I/J.1 The Parkinsonian Syndrome......Page 159
7.6.I/J.2 The SN......Page 161
7.7 Summary and Supplementary Information......Page 162
7.7.1 Approach to the Investigation of Patients with Parkinsonism/Dystonia......Page 164
7.7.3 Treatment/Outcome......Page 165
7.8.2 Case 7e-2: Tadeusz, Age 49......Page 166
7.8.3 Case 7e-3: Kheder, Age 8......Page 167
7.8.4 Case 7e-4: Deepa, Age 1......Page 168
7.8.6 Case 7e-6: Mordecai, Age 18......Page 169
7.9 Summary of key Neuroanatomical and Neurophysiological Information......Page 170
Web sites......Page 171
8.2 Clinical Data Extraction......Page 172
8.4.1 Cerebral Circulation......Page 173
8.4.2.1 Carotid......Page 176
8.4.2.2 Central Source Emboli......Page 177
8.4.4 MCA......Page 178
8.4.6 PCA......Page 179
8.4.7 Basilar Artery......Page 180
8.5 Localization......Page 182
8.6.C Vascular Disorders......Page 183
8.6.D Toxic Injury......Page 184
8.6.J Genetic Disorders......Page 185
8.7.1 Case Evolution......Page 186
8.8.1 Case 8e-1: BJ, Age 67......Page 187
8.8.2 Case 8e-2: Amy, Age 72......Page 188
8.8.4 Case 8e-4: John, Age 67......Page 189
8.8.5 Case 8e-5: Vic, Age 8......Page 190
8.9 Summary of Key Neuroanatomical and Neurophysiological Information......Page 191
Suggested Reading......Page 192
9.1.1 Physical Examination......Page 193
9.1.5 Fundoscopy......Page 194
9.3 Review of the Main Clinical Points......Page 195
9.4.2 The Ventricular System and CSF Circulation......Page 196
9.4.3 Cerebral Vasculature (Venous)......Page 199
9.4.4.1 Pathway......Page 201
9.5.3 Enlarged Blind Spots......Page 203
9.6.C Vascular......Page 204
9.6.1.1 Space-Occupying Lesion......Page 205
9.6.2.F Inflammatory/Autoimmune......Page 206
9.7.2 Investigations......Page 207
9.7.3 Diagnosis, Management and Outcome......Page 208
9.8.2 Case 9e-2: Jiři, Age 52......Page 209
9.8.3 Case 9e-3: Srinivas (Srini), Age 2 days......Page 210
9.8.4 Case 9e-4: Eduarda, Age 17......Page 211
9.8.5 Case 9e-5: Minh, Age 14......Page 212
9.9 Summary of Key Neuroanatomical Information......Page 213
Suggested Reading......Page 214
10.1 Patty......Page 215
10.4 Relevant Neuroanatomy......Page 216
10.5 Localization......Page 221
10.6.1.1 Etiological Considerations......Page 222
10.6.F Metabolic......Page 223
10.6.G Inflammatory/Autoimmune......Page 224
10.7.1 Hepatic Encephalopathy......Page 226
10.7.2 Laboratory Investigations......Page 227
10.7.4 Basic Approach to the Localization of Brain Lesions Causing Coma......Page 228
10.7.4.3 Respiratory Pattern......Page 229
10.7.4.4 Limb Movement Patterns and Reflex Postures......Page 230
10.7.5 General Comments Concerning Assessment of Coma Levels......Page 231
10.8 E-cases......Page 232
10.8.1 Case 10e-1: Hector, Age 55......Page 233
10.8.3 Case 10e-3: Maggie, Age 16......Page 234
10.9 Summary of Key Anatomical and Neurophysiological Information......Page 235
10.10 Chapter-Related Questions......Page 236
Suggested Reading......Page 237
11.1 Didi......Page 238
11.6 Etiology – Didi’s Disease Process......Page 239
11.6.A.1 Disturbances in Neuronal Membrane Function......Page 240
11.6.A.2 Neurophysiology of Neuronal Membranes......Page 241
11.6.A.3 Synaptic Transmission......Page 242
11.6.A.4 Neurotransmitters......Page 243
11.6.A.5 Mechanisms of Epileptic Seizures......Page 245
11.6.A.6 Types of Epileptic Seizure......Page 247
11.6.F Metabolic – Lack of Substrate......Page 248
11.7.1 Additional Information......Page 249
11.8.1 Case 11e-1: Omar, Age 23......Page 251
11.8.4 Case 11e-4: Francesca, Age 22......Page 252
11.8.6 Case 11e-6: Dillon, Age 2......Page 254
11.10 Chapter-Related Questions......Page 255
Web sites......Page 257
12.1 Armand......Page 258
12.4.1 Cognitive Function......Page 259
12.4.2 Implications of Dementia on Functional Status......Page 260
12.4.3 Pathophysiology of Dementia......Page 261
12.6.B Traumatic Brain Injury......Page 263
12.6.C Vascular Disorders......Page 264
12.6.G Inflammatory/Autoimmune......Page 265
12.6.I.1 Alzheimer’s Disease......Page 266
12.6.I.3 DLB......Page 267
12.6.J Genetic Disorders......Page 268
12.7.A Case Evolution......Page 269
12.8.1 Case 12e-1: Louise, Age 61......Page 270
12.8.3 Case 12e-3: Sharon, Age 82......Page 271
12.8.5 Case 12e-5: Luc, Age 10......Page 272
12.10 Chapter-RELATED Questions......Page 273
Suggested Reading......Page 274
13.1 Mickey......Page 276
13.3.1 Characterizing Mickey’s Disorder......Page 278
13.4.1 Neuroanatomical Substrates of Behaviour......Page 279
13.4.1.2 Basal Ganglia Circuit......Page 280
13.4.1.4 Limbic System......Page 281
13.4.1.5 Monoaminergic and Cholinergic Diffuse Projection......Page 284
13.4.2 Neurochemical Substrates of Behaviour......Page 285
13.6.A Paroxysmal......Page 286
13.6.G Inflammatory/Autoimmune......Page 287
13.6.J.1 Genetic Neurobehavioral Disorders......Page 288
13.7.1 Additional Information......Page 290
13.8.1 Case 13e-1: Chunhua, Age 15......Page 291
13.8.2 Case 13e-2: Ariyan, Age 13......Page 292
13.8.4 Case 13e-4: Eddie, Age 14......Page 293
13.8.5 Case 13e-5: Dan, Age 22......Page 294
13.8.6 Case 13e-6: Naomi, Age 18......Page 295
13.10 Chapter-Related Questions......Page 296
Web sites......Page 297
Section Section 3: Supplementary Considerations: Rehabilitation and Ethics......Page 298
14.2 Team......Page 300
14.3.1 Brain Injury......Page 302
14.3.2 Spinal Cord Injury......Page 304
14.3.4 Pediatrics......Page 308
Web Sites......Page 310
15.2 Case Study, Part A......Page 311
15.2.2 Discussion......Page 312
15.3 Case Study, Part B......Page 314
15.4 Case Study, Part C......Page 315
15.4.2 Discussion......Page 316
15.5 Case Study, Part D......Page 317
15.5.2 Discussion......Page 318
15.6.2 Discussion......Page 319
15.7 Summary......Page 320
Web Sites......Page 321
Glossary......Page 322
Texts......Page 334
Atlases......Page 335
Neuroanatomical/Clinical Texts......Page 336
NEUROLOGIC EXAMINATION......Page 337
CLINICAL TEXTS......Page 338
Brain Facts......Page 339
The Dana Foundation......Page 340
Part III: Cerebrovascular System and Cerebrospinal Fluid......Page 341
Chapter 4......Page 342
Chapter 5......Page 343
Chapter 6......Page 344
Chapter 9......Page 345
Chapter 10......Page 346
Chapter 11......Page 348
Chapter 12......Page 349
Chapter 13......Page 350
Index......Page 351