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 [ندعوك للتسجيل في المنتدى أو التعريف بنفسك لمعاينة هذا الرابط] |
