NOTE: Page numbers followed by f and t indicate figures and tables.
Abadie sign, 383
abdominal muscles, strength testing of, 235–236
abdominal reflexes, eliciting of, technique for, 277–278, 277f
abduction-adduction
of thigh, 236
abductor pollicis brevis, method for testing, 386, 387f
aberration
abortive clonus, 259
accommodation, 146–151. See also refraction
accommodation reflex, 146, 146f, 146t
aceruloplasminemia, 4
acetylcholine, movements and, 3
acrobrachycephaly, 24–25, 24f, 25t
acromegaly, 8
action potential, 47
acuity, visual
of retina, 93
tests of, 99
acute bacterial meningitis, CSF in, 541
acute motor neuropathies, neurologic signs in, time of onset of, 260t
acute retrobulbar neuritis, differential diagnosis of, 113–114, 113f
acute spinal cord transection, paralysis and sensory deficits immediately after, 281–282
adduct, 120
ADHD. See attention deficit/hyperactivity disorder
Adie pupils, differential diagnosis of, 152t
Adie tonic pupil syndrome, 152t, 158
affect, alterations in, 453
affective responses, 425–426
affective status, in conversion disorder, 563–564
afferent axons, dispersion of, 50, 50f
afferents
from eye to brain, 91
of trigeminal nerve, functions of, 373–375, 373f, 374f
age, pupil size and, 7
ageusia (loss of taste). See also taste
testing for, technique of, 346–347
aging
clinical features of, 453
mental status in, features of, 448–455
neurologic signs in, 453–455, 454t
primitive reflexes in, 452–453, 453f, 454t
agnosias
association circuit vs. sensory pathways, 406
definition of, 428
diagnostic value of, 447–448
localization of, review of, 431
nomenclature of, 405
tactile, vs. stereognosis, 406–407
tactile finger, 429
testing for, technique of, 429
types of, 428
word, 441–442
agonist-antagonist contraction, in plantar reflex, 269f, 270–271
agraphognosia (agraphesthesia), 428
air-bone conduction test of Rinne, in hearing screening, 352–353
akathisia, 297
alcoholic use disorder, 9
alexia, 441–442
alopecia, 9
alternating heterotropia, cover-uncover test in, analysis of, 137f, 138
amblyopia, suppression, 105, 140–141
amblyopia ex anopsia, 105, 140–141
amnesias
organic, types of, 579
psychogenic, 579
transient global, 579
ampullary crista, 356–357, 357f
Amsler grid, in central vision screening, 99, 100f
amyoplasia, 253
anal wink, 278
anesthesia dolorosa, 370
aneurysms, 16
angiography
of CNS, 556
ankle movements, strength testing of, 236–237
ankle reflex
with patient sitting, 247f
with patient supine, 247f
annulus of Zinn, 126, 126f, 128–129
anosmia
causes of, 343
definition of, 339
differential diagnosis of, 343, 344f
anosognosia, 430
antalgic gait, 330
anterior interosseous neuropathy (Kiloh-Nevin syndrome), 387
anterior lobe, 310
anterograde degeneration, 112
anteropulsion, 330
antigravity muscle principle, 231–232, 232f
antigravity muscle system, 232
antihelix, 9f
antitragus, 9f
apallic syndrome, 466
Apgar score, 462
clinical testing for, 438–439
definition of, 437–438
dementia vs., clinical findings in, 451–452
expressive, 438
general classification of, 439, 439t
lesions causing, general localization of, 440, 440f
neurologic findings associated with, review of, 442–443
overview of, 428
sensory, 438
aphonia, 437
aplasia, 253
apnea, testing for, in brain-death protocol, 505–506
apraxias
arm, testing for, technique of, 433
Bruns, testing for, technique of, 433
constructional. See constructional apraxia
definition of, 432
diagnostic value of, 447–448
dressing. See dressing apraxia
face-tongue, testing for, technique of, 432
gait, testing for, technique of, 433
global, in children, testing for, technique of, 433
motor deficits vs., 432
oculomotor, Cogan syndrome of, 171
overview of, 428
testing for, technique of, 432–433
writing and speaking, testing for, technique of, 433
apraxic gait, 331
ARAS. See ascending reticular activating system
Archimedes spiral, in movement disorders assessment, 297
arcus cornealis, 4
areflexia, after interruption of reflex arc, clinical and EMG signs of, 251–257
Argyll Robertson pupil
differential diagnosis of, 152t
tabes dorsalis with, 152t, 158
arm apraxia, testing for, technique of, 433
arm dystaxia, clinical tests for, 315–316, 316f, 317f
overshooting and checking of, 316–318, 317f, 318f
arm muscles, upper arm, strength testing of, 231f, 234
arm-dropping test, in hemiplegia detection in unconscious patient, 486, 486f
arm-pull tests
double-crossed, for psychogenic arm monoparesis, 567, 568f
for overshooting of arms, 318, 318f
arms
monoparesis of
Monrad-Krohn cough test for, 567
psychogenic, double-crossed arm pull test for, 567, 568f
reversed hands test for, 568, 569f
radicular pain in, 394
arteries. See also specific arteries
palpation of, 16
arteriography, of CNS, 556
arteriovenous malformations or fistulae, 16
arthropod borne viruses, in CSF, 541
articulation
phonation vs., 204–205
ascending reticular activating system (ARAS), 467
asomatognosia, 429
associated movements, 7
association circuit, sensory pathways vs., 406
association nuclei, of thalamus, 72, 78t
astasia-abasia, 332
features of, 565–566
astereognosis
definition of, 406
examination for, 406–407
asterixis, tremor vs., 291–292
asthenia, cerebellar dysfunction and, 313
asymmetric tonic neck reflex (ATNR), 176–177, 176f
ataxias
Bruns, 331
Bruns, testing for, technique of, 433
cerebellar dysfunction and, 81, 313–314
definition of, 313
truncal, 324–325
ataxic gaits, cerebellar, 330
ataxic tremor, clinical characteristics of, 287f, 288
athetosis, 294
ATNR. See asymmetric tonic neck reflex
atrophy
definition of, 253
denervation, of muscle, 253
disuse, of muscle, 253
with LMN lesion, 193
myopathic, 253
optic. See optic atrophy
atropine, 7
attention deficit/hyperactivity disorder (ADHD), 297–298
attention span, in sensorium examination, 425
attitude, in neurologic examination, 35–36
auditopalpebral reflex, testing of
in hearing screening, 353
in unconscious patient, 497
auditory canals, external, caloric irrigation of, vestibular nystagmus due to, 359–360
auditory dysfunction, laboratory tests for, 354
auditory pathway, integrity of, clinical and laboratory tests in establishing, 572
auditory receptive cortex, 43f, 45
autism, head size and, 31
automatic breathing, volitional breathing and, Ondine curse and dichotomy between, 221–222, 221f
automatic speech, 438
autonomic motor axons, interruption of, deficit and release phenomena after, 285
autonomic nerves, 41
autonomic system, transtentorial herniation effects on, 478–479, 479f
autotopagnosia (asomatognosia), 429
axial rotation, of eyeballs
law of, 184
axonal degeneration, pathogenesis of, 112–113
axonal pathways, in spinal cord, 57–58, 57f
afferent, dispersion of, 50, 50f
autonomic motor, interruption of, deficit and release phenomena after, 285
functional types of, 63t
nonvisual, 94
peripheral, pain and temperature sensations in relation to types of, 380–381, 382f
Babinski sign, 266–267, 271, 272f
back, large muscles of, strength testing of, 236
back pain
low. See low back pain
lumbar puncture and, 532
back pain posture, 330
backache syndrome, 389
backward displacement test, for psychogenic foot drop, 569
bacterial meningitis, acute, CSF in, 541
BAERs. See brainstem auditory evoked responses
ballottement, 19
basal motor connections, lesions of, deficit and release phenomena after, 295
basal motor nuclei
connections of, and laterality of clinical signs, 83–84, 83f
gaits, 331
laterality of, 82–84, 83f, 84t
lesions of, clinical signs of, 82–83
movement disorders and, clinicopathologic correlations between, 293t
basilar syndrome, 175
basis medullae, 58
basis mesencephali, 58
basis pontis, 58, 60, 60f, 61t
beard, inspection of, 9
bedside screening tests
for cognitive deficits in dementia, 448–450, 449t, 450f
for pathologic fatigability of cranial nerve muscles, 217
behavioral mannerisms, stereotyped, 298
behaviors
definition of, 1
corollaries of, 3
neurologic examination as standardized assessment of, 1–3
Bell palsy, 172
Bell phenomenon, 171–172
bella donna, 7
bellows, for speech, 204
benign fasciculations, 254, 286
benign paroxysmal positioning vertigo (BPPV), 355, 361–362
bent-knee leg-raising test (Kernig sign), 390, 392
in nuchal rigidity testing, in unconscious patient, 492
Bernard-Horner syndrome, 156–157, 156f
biceps reflex, 244f
bilateral foot-drop gait, 329
bilateral transtentorial herniation, 475, 476f
Biot breathing, 478
bleeding, lumbar puncture and, 532
blepharoptosis, 158–159
blind person’s gait, 330
blind spot
papilledema and, 101
physiologic, mapping of, 100–101, 101f
quantitative mapping of, 104, 104f
blindness
anatomic basis of, 94f
causes of, 148–149
cortical, neuro-ophthalmologic findings in, 105–106
psychogenic, 571–572
word, 441–442
blinking
rate of, 7
in unconscious patient, 483
blood
in CSF, 537
intravascular, brain herniation and, 470–471
blood pressure, measurement of, with suspected cerebrovascular disease, 17
blurred vision, 148
causes of, 149
nystagmus and, 178
bobbing, ocular, nystagmus and, 181
body contours
inspection of, 229–230
in neurologic examination, 1
body scheme
agnosias of, testing for, technique of, 429–430
concept of, 429
body surface, inspection of, 9
bones, of skull. See also specific bones
anterior fontanel and intracranial pressure changes, 22
functional arthrology of, 21, 21f
suture and fontanel closure, 23, 23t
synarthroses pliancy of infant’s cranium, 21–22
Borrelia burgdorferi, in CSF, 542
botulism, 252
BPPV. See benign paroxysmal positioning vertigo
brachial plexus, extremity nerves of
motor distribution of, 55
motor innervation of, mnemonic for, 56
brachioradialis reflex, 244f
brachium conjunctivum, 311, 311f
brachycephaly, 23–25, 24f, 25t
bradykinesia, 291
brain
afferents from eye to
optic nerve in, 91
trigeminal nerve in, 91
behavior and, 3
cranial nerves attachment to, mnemonic for, 65f, 67–68
cutting and separating from brainstem, 42, 42f
cutting and separating from spinal cord, 41, 42f
embryonic, horizontal section of, 73f
facial malformation syndromes and, 9–10
functions of, localization of, dynamic techniques for, 553
impairment of, “soft” signs of, examples of, 592t
intracranial partitions and compartments of, anatomy of, 469, 470f
lesions in, localization of, dynamic techniques for, 553
sagittal section of, 465f
sensorium within, location of, 424
size of
relation to head size, 30–31, 30f
brain death
causes of, 505
definition of, vs. definition of death, 503–504
diagnosis of
minimum criteria in, 506, 507f
neurologic examination in, 503–508, 509t
pitfalls and precautions in, 508
ethical considerations in, 504, 504t
protocol for. See brain-death protocol
brain disease, diffuse
clinical features of, 453
neurologic signs in, 453–455, 454t
brain herniations
consciousness effects of, 472–473
fluid pools of intracranial space responses to increased pressure, 470–472, 471f
internal, causes and consequences of, 469
transfalcine, anatomy of, 471f, 472
transforaminal. See transforaminal herniation
transtentorial. See transtentorial herniation
vascular complications of, 479, 480t
brain-death protocol, 504, 504t
apnea testing in, 505–506
assumptions underlying, 504–505
confirmatory tests for, 506
in infants and children, 506
initiation of, 505
neurologic specialist role in, 504t, 505
brain-impaired persons, chronic dysfunction of sensorium in, testing for, 422–423, 423t
brainstem
anatomic organization of, 58, 59f–60f, 61t
cranial nerve nuclei of, 61t
cross-sectional organization of, 59, 59f–60f
cutting and separating from rest of brain, 41–42, 42f
lesions of, localizing diagnosticon for, 223, 223f
longitudinal subdivisions of, 58, 59f
neurons of, functional significance of, 61–62
tracts of, 61t
functional significance of, 61–62
transverse subdivisions of, 58, 59f
union of lemnisci in, 77f, 78–79
white matter of, 59f, 60f, 61, 61t
brainstem auditory evoked responses (BAERs), 354
branchial arch sector
in embryogenesis, 10, 10f, 11f
malformations of, 11
branchial cleft cysts, 10
branchial cranial nerves, 64, 64f, 66–67, 67t
distribution of, “elimination” mnemonic for, 69–70, 69t
breath-holding spells, 511f, 514–515
breathing
and volitional breathing, Ondine curse and dichotomy between, 221–222, 221f
Biot, 478
drive for, origin of, 220
emotional, 220
Kussmaul, 478
neuroanatomy of, 220–221, 221f, 222f
neurology of, 219–222
psychogenic dysfunctions of, 565
in unconscious patient, 483
volitional, 220
and automatic breathing, Ondine curse and dichotomy between, 221–222, 221f
breathing apparatus, functions of, 219–220
breech delivery, spinal cord transection in infant during, 220, 222f
Brissaud reflex, 272
broad-based gait, 315
broad-based stance, 315
Brudzinski signs, in nuchal rigidity testing, in unconscious patient, 492
bruits, auscultation of head and neck for, 16–17, 17f
Bruns ataxia, 331
testing for, technique of, 433
bulbar paralysis, 218
bulbocavernosus reflexes, 278
café-au-lait spots, 9
calcarine cortex, dual banks of, 94–95, 94f, 95f
calculation, in sensorium examination, 425
caloric irrigation
of external auditory canals, vestibular nystagmus due to, 359
results of, 360
technique for, 360
in unconscious patient, 497–498
camptocormia, 332
canthal compression, self-production of pathologic diplopia by, 121–123, 122f, 123f
canthus
lateral
limbus relation to, 5
medial
anatomic variations of, 5–6, 5f, 6f
limbus relation to, 5
caput succedaneum, 27
cardiac dysrhythmia syncope, 511f, 516–517
carotid artery stenosis, 4
carotid sinus hypersensitivity, reflexogenic syncope and, 511f, 515–516, 515t
carotid sinus massage test, 515–516
carotid sinus syncope, mechanisms of, 515, 515t
carotid sympathetic nerve, 150
carotid transient ischemic attacks, 514f, 516
carpal tunnel syndrome, 386–387, 386f
carphologia, 484
cartilaginous connective tissue, 21
limbus relation to, 5
cataracts, 149
cat’s cry syndrome, 208
caudal vermis syndrome, 323t, 325–326
causalgia, 370
CCAS. See cerebellar cognitive affective syndrome
central circular macula, 93, 93f
central field of vision
color vision in, 97
self-demonstration of, 96–97
central nervous system (CNS). See also neuraxis
angiography of, 556
arteriography of, 556
conjunctions of cranial nerves with, 160, 160f
infections of, increased intracranial pressure due to, 530
parts of, 41
sensorimotor decussations of, 85t
venography of, 556
central ocular motor systems, 91
cortical pathway, for vertical eye movements, 171–172
examination of
asymmetric tonic neck reflex, 176–177, 176f
bilateral destruction of frontal corticotegmental pathway for horizontal gaze, 171
corticopontine pathway for voluntary conjugate horizontal eye movements, 168f, 170–171
destructive cerebral lesions, 174, 174f
eye movement systems tested by neurologic examination, 167–170, 168f, 168t
eye speed, 167
head- and eye-centering center, concept of, 173–174, 174f
irritative cerebral lesions, 174, 174f
LMN, internuclear, and UMN lesion comparison, 172
rostral midbrain syndrome, 175, 175t
nystagmus. See nystagmus
central olfactory pathways, 341–342, 342f
central retinal artery occlusion, 109t
central retinal vein occlusion, 109t
central sensory pathways, lesions of, negative and positive sensory phenomena related to, 369–370
central vision, clinical testing of, 99–102, 100f, 101f
location of lesions causing scotomas or quadrantic/hemianopic field defects, 102
mapping physiologic blind spot in, 100–101, 101f
tangent screen testing in, 100, 100f
of visual acuity, 99
cephalohematoma, 27
cephalon, 30
cerebellar ataxia, 81
cerebellar ataxic gaits, 330
cerebellar cognitive affective syndrome (CCAS), 307
cerebellar disease, motor function in, testing of, 209
cerebellar dystaxia, sensory dystaxia vs., 401–402, 402t
cerebellar hemisphere syndrome, 322, 323t, 325–326
cerebellar lesions. See cerebellum, disease, dysfunction, or lesions of
cerebellar pathways, 61
cerebellar signs, laterality of, 81, 82f
cerebellopontine angle, 348
cerebellum
afferents to, 81
anatomy of, 309–313
circuits of, 312
cutting and separating from rest of brain, 42, 42f
disease, dysfunction, or lesions of, 307
arm dystaxia, clinical tests for, 315–316, 316f, 317f
clinical signs of, 313–319, 323f
clinical tests for, 315–319, 320f
decomposition of movement, 318
detection of, 313–314
dystaxia of station and gait, clinical tests for, 315
endurance effects of, 319
eye movement effects, 314–315
hypotonia, clinical tests for, 319
laterality of clinical signs of, 81, 82f
leg dystaxia, clinical tests for, 318
localization of, circuitry for, 319, 321f
overshooting and checking tests of arms, 316–318, 317f, 318f
speech effects of, 314
strength effects of, 319
functions of, 307–308
recapitulation of, 311–312
phylogenesis of, 309–310, 310t, 323t
syndromes of
case examples, 319–326, 321t, 323f, 323t, 324f, 325f
etiologic implications of, 326
types of, 323t
white matter of, pathways in, 74
cerebral aqueduct, 530
cerebral cortex, 42
functional localization in, 43f, 45
cerebral disconnection syndromes, 74
cerebral dysfunction, auditory tests for, 353–354
cerebral gaits, 331–332
cerebral lesions, destructive, effects on head and eye position, 174, 174f
cerebral lobes, boundaries of, 43f, 44
cerebral localization
clinicopathologic correlation in, 445–447
lobes of cerebrum, 445
localization and clinicopathologic correlation in, 446f, 447f
cerebral palsy, speech with, 208
cerebral ptosis, 159
cerebral shock, hypotonia due to, 265
cerebro–cerebello–cerebral circuit, 81, 82f
cerebrospinal fluid (CSF)
abnormal proteins in, identification of, 539f, 540
in acute bacterial meningitis, 541
appearance of, 536
blood in, 537
brain herniation and, 470–471
cloudiness of, 536–537
collection of, 536
composition of, 527, 528t, 529f
flow of, cessation of, during lumbar puncture, 536, 536t
formation of, 525–526
functions of, 526–527
glucose content of, 538–540, 539f
hydrocephaly and, 31–32
infectious agents in, identification of, 541–542
laboratory examination of, 538–541, 539f
location of, 525
lumbar puncture for. See lumbar puncture
neoplastic cells in, identification of, 539f, 540
origin of, 525
pressure of
increased, 529–530
low, syndrome of, 530–531
manometry registration of increased, 535–536, 535f
profiles in normal persons and diseases, 528t
in viral meningitis, 541
xanthochromia in, 537–538
cerebrovascular disease, blood pressure measurement in patients with suspected, 17
cerebrum
connections of, 73f
cortical connections of, 72–74
cutting and separating from diencephalon, 42
definition of, 42
fissures and sulci of, 43–44, 43f
inferomedial temporo-occipital region of, 10
lobes of, 445
sagittal section of, 73f
transtentorial herniation of, anatomy of, 471f, 472, 473f
white matter of, 74
cervical cord injury, positioning of unconscious patient with, 492
cervical cord lesions, lumbar puncture in, contraindications to, 531
cervical plexus, motor distribution of, 54
cervical rigidity, testing of, technique for, 489, 491f
Chaddock maneuver, 267
chewing
difficulty in, case example, 194
functional anatomy of, 191–192, 192f
trigeminal nerve and, 191
Cheyne-Stokes breathing, 478, 479f
children
brain-death protocol in, 506
global apraxia in, testing for, technique of, 433
hyperactive, 297–298
chin
inspection of, 8
choline, 551
chorea, 294
choreiform gait, 331
chromatic aberration, 145, 145f
chronic hydrocephalus, 332
ciliary ganglia, 153
ciliospinal center of Budge, 156
circumflex nerve, 55
clasp-knife spasticity, 261–262, 262f
cleft lip, 10–11
clonus
abortive, 259
clinical interpretation of, 259
definition of, 259
eliciting of, technique for, 258, 259f
tremor vs., 291
cloture (closure)
of neurologic examination, 603–604
club-foot gait, 329
CNS. See central nervous system
coagulopathies, lumbar puncture in, contraindications to, 531
cochlea, components of, 349, 350f
cochlear division, of vestibulocochlear nerve, 349–350, 350f, 351f
cochlear ganglion, 350
central connections of, 350, 351f
lesions of, symptoms and causes of, 351
peripheral course of, 350
Cogan syndrome of oculomotor apraxia, 171
cognitive cerebellum, 307
cognitive deficits, in dementia, bedside screening tests for, 448–450, 449t, 450f
cogwheel phenomenon, 262
cold, response to, in unconscious patient, testing of, 498
coma
consciousness and, 461–462
definition of, 462
neurologic examination in, 509t
comatose patient, neurologic examination in, inspection in, 483
comfort, of patient, in neurologic examination, 604
commands, in neurologic examination, 1
commissural pathways, 74
common peroneal nerve, 56
common peroneal nerve palsy, 388, 388f
compression neuropathy of, 276, 276f
foot drop and, 276
communication
by language, 438
neurons in, 46
complete bitemporal hemianopia, 94f
complete homonymous hemianopia, 94f
complete nasal hemianopia, 94f
complete temporal hemianopia, 98
complex behaviors, in neurologic examination, 1
complex regional pain syndrome (CRPS), 370
compression
canthal, self-production of pathologic diplopia by, 121–123, 122f, 123f
nerve root
from herniation of intervertebral disc, clinical findings in, 392–394, 393f
leg-raising tests for, 390–392, 391f
compression damage to, 275, 276f
compression neuropathy, of common peroneal nerve, 275, 276f
computed tomography (CT)
indications for, 544–546, 546f
magnetic resonance myelography and, 550
MRI vs., 545t, 546–547, 547f, 548f
risks associated with, 546
structures visualized by, 544, 545f, 545t
concha, 9f
concussion, acute dysfunction of sensorium after, testing for, 421–422, 422t
conduction hearing loss, 352
neurosensory hearing loss vs., analysis of patients for, 353
cone receptors, 93
confrontation testing, of peripheral visual fields
positioning of examiner and patient in, 103, 103f
quantitative mapping of visual fields and blind spot in, 104, 104f
technical pointers for, 103–104, 104f
conjugate ocular fixation and conjugate movement, law of, 185
consciousness
brain herniations and. See brain herniations
definitions of, 461
depressed
FOUR score in tracking, 462, 463t
Glasgow Coma Scale in tracking, 462, 463f
evaluation of, 461–464
intermittent disturbances of. See also syncope
medical history in, 512
neurologic examination in, 510–518
minimally conscious state, neurologic examination in, 509t
operations establishing, 461
pathologic alterations in levels of, 461–462
pathways for
operational demonstration of, 467, 467f
thalamocortical, 467–468, 468f, 468t
in sensorium examination, 425
consensual light reflex, 152
consonants, voiceless, 206
constructional apraxia
identification of, patient analysis for
clinical deficits, 435
medical history in, 433
motor examination in, 433, 433f
neurologic signs, 435
neuropathologic considerations, 436–437, 437f
principle of parsimony, 435–436, 436f
sensory examination in, 433–434, 434f
test battery for, 434–435, 434f
left-sided, identification of, patient analysis for, localizing significance of, 435
testing for, technique of, 433
contractions
agonist-antagonist, in plantar reflex, 269f, 270–271
myotatic, 249
contralateral cerebral sensorimotor innervation, law of, 177
contralateral deficits, 74
contralateral law, in decussations of, sensory and motor pathways, 77f, 84, 85t
contralaterality
of pathway for volitional movements, 79–81, 80f
of sensory pathways, 74–79
of somatosensory pathways, 76–77, 77f
in visual fields, 73f, 74–76, 75f, 76f
conus medullaris distribution, 408, 409f
convergence, 146
convergence spasm, 564
convergent lens, 148
conversion disorder
affective status in, 563–564
clinical features of, 561–564, 562t, 563t
factitious disorder vs., 562–563
malingering vs., 562–563
medical history in, 563
primary gain in, 561–562
secondary gain in, 561–562
symptoms and signs of, 562t
coordination, 307–308
corectasia, 8f
corectopia, 7
cornea, 4
rings of, 4
size of, 7
corneal light reflection test (Hirschberg test), in ocular malalignment evaluation, 133–134, 133f
corneal reflex
anatomy of, 376
clinical interpretation of, 376
in sensory function testing of trigeminal nerve in unconscious patient, 496–497
Cornelia de Lange syndrome, 13f, 15
corneomandibular reflex (von Sölder phenomenon), 376–377
corpus striatum, subdivisions of, 83f
cortex
calcarine, dual banks of, 94–95, 94f, 95f
cerebral, 42
functional localization in, 43f, 45
motor, cerebellum and, 81, 82f
vestibular, 358
cortical blindness, neuro-ophthalmologic findings in, 105–106
cortical connections, ontogeny of, 72–74, 73f
cortical degeneration syndromes
asymmetrical, 444
focal, 444
cortical pathway, for vertical eye movements, 171–172, 172f
cortical-subcortical gait, 332
corticobulbar component, of pyramidal tract, 79, 80f
corticofugal motor tracts, 58, 61
corticopontine tract/pathway, 58, 61, 74
for voluntary conjugate horizontal eye movements, 168f, 170–171
corticospinal component, of pyramidal tract, 79, 80f
corticostriatal pathway, 74
corticothalamic pathway, 74
cough test, Monrad-Krohn, for arm monoparesis, 567
coughing, 220–221
counter-rolling law, 186
counter-rolling system of eyes
self-demonstration of, 169
testing of
by neurologic examination, 168t, 169
technique for, 497
for vestibulo-ocular reflex, in unconscious patient, 497
cover-uncover test, in ocular malalignment evaluation, 135–136, 135f
for alternating heterotropia, 137f, 138
for latent ocular deviations, 137f, 138–139
for monocular heterotropia, 137–138, 137f
for neuromuscular heterotropia, 139–140
cramps, 254
cranial nerves (CrNs), 41
I. See olfactory nerve
II. See optic nerve
V. See trigeminal nerve
VIII. See vestibulocochlear nerve
IX. See glossopharyngeal nerve
X. See vagus nerve
XI. See spinal accessory nerve
XII. See hypoglossal nerve
anatomic review of, 62–70
attachment to brain, mnemonic for, 65f, 67–68
branchial, 64, 64f, 66–67, 67t
distribution of, “elimination” mnemonic for, 69–70, 69t
conjunction syndromes of
fate of, 65–66
functional components of, 62, 63t
mnemonic classification of, 63t, 64, 64f
motor. See motor cranial nerves
muscles of, fatigability of, bedside tests for, 217
of brainstem, 61t
palsies, multiple, signs and symptoms of, 217
somite (somatic set) of, 63t, 64–66, 66f
nerve components of, 66t
in speech. See speech
SSSS of, 63t, 64, 65f, 66f, 75f
craniosynostoses, 24–25, 24f, 25t
craniosynostotic plagiocephaly, 26f, 27
cranium. See skull
creatine, 551
cremasteric reflexes, eliciting of, technique for, 277–278, 277f
CrNs. See cranial nerves
crossed knee peroneal palsy, 276
CRPS. See complex regional pain syndrome
cruising gaits, 328
crus helix, 9f
Cryptococcus spp., in CSF, 541
CSF. See cerebrospinal fluid
CT. See computed tomography
dancing bear gait, 332
DaTscan, 554
deaf mutism, 206
deafness
delayed speech related to, 354
psychogenic, 573
death
brain. See brain death
definition of, 503
decerebrate rigidity, 232
pathophysiologic explanation of, 476, 476t, 477f
decorticate posture vs., 475f, 477–478, 478f
deviation of, comparative strength of, 476, 476t
vestibular system in, 477
declarative speech, 438
decomposition of movement, 318
decorticate posture, decerebrate posture vs., 475f, 477–478, 479f
decussated somatosensory (GSA) pathway, 78
decussations
in neuraxis, 73f, 74, 75f, 76f
of sensory and motor pathways
of CNS, 85t
contralateral law of, 77f, 84, 85t
of somatosensory pathways, 73f, 75f, 76, 77f
de-efferented state, neurologic examination in, 500. See also locked-in syndrome
deep pain perception, 383
deep reflexes, superficial reflexes vs., 266
deep sensory modalities, 58
deep white matter, 42
deficit and release phenomena
after interruption of autonomic motor axons, 285
after lesions of basal motor connections, 295
after lesions of motor pathways, 284–285
after lesions of somatomotor axons, 370–371
after lesions of somatomotor neurons, 371
after lesions of somatosensory axons, 371
after lesions of visceral motor neurons, 371
after lesions of visceromotor neurons, 371
after LMN lesions, 284–285
pathophysiology of, 284
theory of, 284
deficit phenomena, 369
deficits
ipsilateral, 74
motor, vs. apraxia, 432
deformational plagiocephaly, 26, 26f
degeneration
anterograde, 112
axonal, pathogenesis of, 112–113
retrograde, 112–113
déjà pensée, 342
déjà vu, 342
Dejerine syndrome, 322
delayed pain, testing for, 383
delirium
consciousness and, 461–462
definition of, 461–462
dementia vs., 455
mania vs., 455
delirium tremens, 462
delusions, 426
dementia
aphasia vs., clinical findings in, 451–452
chronic dysfunction of sensorium in, testing for, 422–423, 423t
clinical features of, 453
cognitive deficits in, bedside screening tests for, 448–450, 449t, 450f
delirium vs., 455
diagnosis of, algorithm for, 451f
mania vs., 455
mental status in, features of, 448–455
neurologic signs in, 453–455, 454t
primitive reflexes in, 452–453, 453f, 454t
denervation atrophy, of muscle, 253
denticulate ligaments, 487, 488f
depolarization, 47
dermatomal dislocations, limb development and, 51, 52f
dermatomal distributions
review of, 407
dermatomes, 49
sensory innervation areas by, 51, 52f
Descemet membrane, 4
developmental gaits, 328–329
diabetic retinopathy, 109t
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
on conversion disorder diagnosis, 563, 563t
on distinction among conversion disorder, factitious disorder, and malingering, 562–563
diarthroses, 21
diaschisis, 265
cutting and separating from cerebrum, 42
embryonic, transverse section of, 71f
nuclear subdivisions of, 71, 71f
diffuse brain disease
clinical features of, 453
neurologic signs in, 453–455, 454t
diffuse symmetrical polyneuropathies, 384, 385f
diffusion weighted imaging, 550
diffusion weighted magnetic resonance imaging, 550
digital position sense, testing of, technique for, 398–399, 398f, 399f
digits, of hand, muscles acting on, 56
diplegia, spastic, 281
diplegic gait, spastic, 330–331
diplopia, 170
clinical analysis of, 142–144, 142f
monocular, 572
ocular alignment and, 119–122, 120f, 121f, 122f, 123f
pathologic, self-production of, by canthal compression, 121–123, 122f, 123f
physiologic, self-production of, 121, 121f
direct light reflex, 152, 154–155
directional scratch test, in dorsal column function evaluation, 402–403
disability, intellectual, delayed speech related to, 354
discriminative sensory modalities, loss of, review of, 431
discs
intervertebral, herniation of, nerve root compression from, clinical findings in, 392–394, 393f
anomalies of, papilledema confused with, 110, 110t
blurred, causes of, 115f
dislocations, dermatomal, limb development and, 51, 52f
distortions, perceptual, 426–427
disuse atrophy, of muscle, 253
divergent lens, 148
dizziness, 355–356. See also vertigo
hyperventilation and, 363
workup for patient with, 363, 363t
dolichocephaly, 23–24, 24f, 25t
doll’s eye maneuver, 169
dorsal column gait, 329
dorsal columns
dysfunction of, tests for
directional scratch test, 402–403
stereognosis, 403
two-point discrimination, 403
general concept of, 397–398
lesions of, 400
in proprioception, 397–398
dorsal root ganglia, 49–50, 49f
dorsolateral tract of Lissauer, 57f, 58
double hemianopia, neuro-ophthalmologic findings in, 105–106
double hemiplegia, 281
double stimulation, 105
double vision, lumbar puncture and, 532
double-crossed arm pull test, for psychogenic arm monoparesis, 567, 568f
dragging monoplegic gait, psychogenic, 566
dressing apraxia
identification of, patient analysis for
clinical deficits, 435
localizing significance of, 435
medical history in, 433
motor examination in, 433, 433f
neurologic signs, 435
neuropathologic considerations, 436–437, 437f
principle of parsimony, 435–436, 436f
sensory examination in, 433–434, 434f
test battery for, 435
testing for, technique of, 433
dromedary gait, 331
drugs
extrapyramidal movement syndromes due to, tardive dyskinesias and, 295
tremor due to, clinical characteristics of, 291
DSM-5. See Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
ductions, definition of, 125
dysarthria, 206, 209–210, 209t, 215–216, 314, 437
dysdiadochokinesia, 316
dysesthesias, 370
dyskinesias, tardive, drug-induced extrapyramidal movement syndromes and, 295
dyslexia, 441–442
dysmetria rapid alternating-movements tests for, 316, 316f, 317f
dysmodulation, clinical effect of, factors in determination of, 81
dysphagia, 209–210
psychogenic, 565
dysphasia, 437
dysphonia, 206, 209–210, 209t, 437
spasmodic, 565
dysprosody, 206, 208, 209t, 437, 441
differential diagnosis of, 443
expressive, 443
global, 443
receptive, 443
testing for, 443
dysrhythmias
finger-tapping test for, 316
respiratory, 565
dystaxia
arm, clinical tests for, 315–316, 316f, 317f
cerebellar, vs. sensory, 401–402, 402t
cerebellum dysfunction and, 313–314
finger-to-nose test for, 315–316
leg, clinical tests for, 318
rapid alternating-movements tests for, 316, 316f, 317f
of station and gait, clinical tests for, 315
dystonia, 294
focal, 294
dystonic equinovarus gait, 331
ears
inspection of, 8
echolalia, 209t
edema
scalp
detection of, with pitting test, 19
in infants, 27
Edinger-Westphal nucleus, 153
EEG. See electroencephalogram
effector integrity, in sensory testing of unconscious patient, 495
effectors
efferent neuron activation of, 47
types of, 1–3
efferents, from cerebellum, 81, 82f, 311
Ekbom syndrome, 297
elbow, flexion/extension of, strength testing of, 231f, 234
elective mutism, 206
electrical tests, for pathologic fatigability in myasthenia gravis, 218
electromyographic syndrome of LMN lesions, 256
electromyography (EMG)
in areflexia, after interruption of reflex arc, 251–257
in hyporeflexia, after interruption of reflex arc, 251–257
in latencies of muscle stretch reflexes, 248
electronystagmography, 182
emboli, 109t
embryogenesis, of face, 10, 10f
EMG. See electromyography
emmetropic eye, 145f
emotional breathing, 220
emotional tremor, clinical characteristics of, 290
electroencephalogram (EEG), in operational demonstration of pathways for consciousness, 467, 467f
encephalon, 30
encephalopathies, metabolic, increased intracranial pressure due to, 530
endurance, cerebellar lesions effects on, 319
engagement principle, 232
enhanced ptosis, 159
enophthalmos, 7
enteroviruses, in CSF, 541
entrapment neuropathies, examination of, 384–385
special features in, 385–388, 386f, 387f, 388f
EOMs. See extraocular muscles
epidermoid tumors, implantation of, in lumbosacral canal, lumbar puncture and, 532
epilepsia partialis continua, 292
epilepsy
definition of, 298
partial continual, tremor vs., 292
epileptic seizures, psychogenic seizures vs., 577, 578t
episcleral ganglia, 153
eponymic conjunction syndromes of cranial nerves, 160, 160f
Epstein-Barr virus, in CSF, 541
erythrochromia, 537
erythrophagocytosis, 537
esophoria, 147
essential palatal tremor, symptomatic palatal tremor vs., 290
essential (familial) tremor, clinical characteristics of, 290
ethics
in brain death considerations, 504, 504t
in neurologic examination, 35–36
ethmoid bone, 20f
exaggerated overreaction, in psychogenic disorders of somatic sensation, 576
excitatory neurotransmitters, 47
exclamatory speech, 438
exophoria, 148
expressive aphasia, 438
expressive dysprosody, 443
extensor nerves, 56
extensor plantar response, 271, 272f
absence of, in patients with UMN lesions, reasons for, 275–276, 276f
external auditory canals, caloric irrigation of, vestibular nystagmus due to, 359–360
external occipital protuberance, 16
exteroception, 338
extraocular muscles (EOMs). See also specific muscles
axial rotation model of, 124, 124f
eyeball rotation model of, 125, 125f, 126f
of medial and lateral rectus muscles, 125–126, 126f
oblique muscles
inferior oblique muscle, 130
superior oblique muscle, 128–129, 129f
on-center/off-center pull of, law of, 184
peripheral innervation of, 149–151, 150t
positive tonic oppositional innervation of, law of, 184–185
pull of, eyeball rotation model demonstrating, 125, 125f, 126f
rectus muscles
inferior rectus muscle, 126f, 128
lateral rectus muscle, 125–126, 126f
medial rectus muscle, 125–126, 126f
superior rectus muscle, 126–128, 127f, 128f
tonic innervation of, 132
extrapyramidal movement syndromes, drug-induced, tardive dyskinesias and, 295
extrapyramidal system, 80, 82, 83f
extremities. See also arms; legs
circumferential measurement of, in muscle size determination, 253
random spontaneous symmetrical movements of, in unconscious patient, 483
somatosensory functions of, examination of, 380–383
temperature sensation from, testing of, 377f, 380
eye movements
central, clinical tests for, 186t
cerebellar lesions effects on, 314–315
control of, central systems for, laws governing, 185–186
horizontal, vs. vertical eye movements, different pathways for, law of, 185
non-nystagmoid repetitive, uncommon, nystagmus and, 181–182
range of, evaluation of, technique for, 134–135, 134f, 135f
reflex control of, vs. volitional control of, law of, 186
speed of, 167
systems tested by neurologic examination
counter-rolling system of eyes, 168t, 169
fixation (position holding) system, 168, 168t
ocular fixation system, 169
proprioceptive system, 169
saccadic system, 167–168, 168f, 168t
smooth pursuit system, 168t, 169
types of, 125
vertical
cortical pathway for, 171–172, 172f
vs. horizontal eye movements, different pathways for, law of, 185
volitional control of, vs. reflex control of, law of, 186
voluntary conjugate horizontal, corticopontine tract/pathway for, 168f, 170–171
eyeballs
anatomy of, 92f
axial rotation of
law of, 184
intraocular muscles of, 153–154
protrusion of, 7
rotation model demonstrating pull of extraocular muscles, 125, 125f, 126f
size of, 7
eyebrows, inspection of, 9
eyelid-release test, in hemiplegia detection in unconscious patient, 485–486, 485f
eyelids
blinking of, 7
in unconscious patient, 483
drooping of, 7
elevation of, clinical evaluation of, 158, 159t
eyeball rotation and, 7
iris relation to margin of, 3–5, 4f, 5f
relation to limbus, initial inspection of, 133
tonic closure of, in unconscious patient, 483
eyes. See also pupils; vision
afferents to brain, 91
counter-rolling system of, 168t, 169
drifting to sides, in unconscious patient, 483
emmetropic, 145f
examination of, 3
ancillary tests, 187t
eyelid margin and iris relation, 3–5, 4f, 5f
intercanthal and interorbital distances, 6, 6f
medial canthus anatomic variations, 5–6, 5f, 6f
palpebral fissure height, 7, 8f
pupillary size, 7
external, nomenclature of, 3–4, 4f
movements of. See eye movements
normal, refraction by, 145f, 146
optic nerve in, 91
position of
destructive cerebral lesions effects on, 174, 174f
irritative lesions effects on, 174, 174f
vectors determining, origin of, 173
primary position of, 119, 120f
syndrome of parasympathetic paralysis of, 155–156
syndrome of sympathetic paralysis of, 156–157, 156f
trigeminal nerve in, 91
FABER test, 388
face
branchial arch sector of, 10, 10f, 11f
frontonasal process sector of, 10, 10f, 11f
initial examination of, 36
inspection of
for facial malformation syndromes, 9–12, 10f, 11f
movements of. See facial movements
muscles of. See facial muscles
syndrome of sympathetic paralysis of, 156–157, 156f
transverse sectors of, 11, 11f
UMN paralysis of, 197–198, 198t
face-tongue apraxia, testing for, technique of, 432
facial angiofibromas, 9
facial gestalt, 11
facial hemangiomas, 9
facial malformation syndromes
facial movements
functional anatomy of, 194–195, 194f, 195t
unilaterality of, tests for, 197–198, 198t
facial muscles
facial nerve in innervation of, 195, 195t
functions of, 195
facial nerve (CrN VII)
functions of
intra- and extra-axial anatomy of, 195–197, 195f, 196f, 197f
motor functions of, 194–200
clinical testing of, 198–199
review of, 346
UMN innervation of, 197–198, 198t
facial palsy, 199–200, 199f, 200f
testing of taste in, 347–348
facial sensation, loss of, differentiation of, 378–379, 378f
facial weakness, analysis of patients with, 199–201, 199f, 200f
faciociliary reflex, 157
factitious disorder
conversion disorder vs., 562–563
imposed on another, psychogenic disorders vs., 582
malingering vs., 562–563
psychogenic disorders vs., 582
factitious fevers, 579
“false” localizing signs
causes of, 593–594
concept of, 593
familial cortical myoclonic tremor and epilepsy (FCMTE), 292
familial tremor, clinical characteristics of, 290
farsighted, 146
fasciculations
definition of, 256
motor units and, 253
FCMTE. See familial cortical myoclonic tremor and epilepsy
femoral nerve, 56
festinating gait, 331
fetuses, pain in, 383
fevers, factitious, 579
definition of, 256
fibrous connective tissue, 21
finger flexion reflex
Hoffman method, 245f
Tromner method, 245f
finger muscles, strength testing of, 234–235, 235f
finger test, in temperature discrimination testing, 377, 377f
fingers
abduction-adduction of, 234, 235f
extension of, 235
flexion of, 235
strength testing of, 234–235, 235f
finger-tapping speed, in movement disorders assessment, 296, 296f
finger-tapping test, for dysrhythmia, 316
finger-to-nose test
postural tremor during, 315–316
tremor of arms during, 315–316
fissures
fixation (position holding) system, testing of, by neurologic examination, 168, 168t
flaccidity. See hypotonia
flail-foot gait, 329
flexion reflex
in plantar stimulus, 271
triple, 271
flexor nerves, 56
flipping-hand gait, 330
nocturnal, 330
floccillation, 484
flocculonodular lobe, 310
flocculonodular lobe syndrome, 325
flutter, ocular, nystagmus and, 181
fMRI. See functional magnetic resonance imaging
focal dystonia, 294
focal neuropathies, 384–385, 385f
intracranial pressure and, 22, 24
pliancy of infant, 21–22
foot
foot drop
common peroneal palsy and, 276
psychogenic, backward displacement test for, 569
foot-drop gait, 329
bilateral, 329
foramen magnum, 20f
forced-choice sensory tests, yes or no, 399–400
forearm muscles, strength testing of, 232f, 234
forebrain, in control of volitional and emotional breathing, 220
FOUR score. See Full Outline of UnResponsiveness score
four-glance, instant screening, in neurologic examination of unconscious patient, 483–484
free movement, 233
free will, notion of, 285
fricatives, 206
Froment maneuver, 290
frontal corticotegmental pathway, for horizontal gaze, bilateral destruction of, 171
frontal gait, 331–332
frontonasal dysplasia, 12, 13f
frontonasal process sector
in embryogenesis, 10, 10f, 11f
malformations of, 11
frontoparietal tegmental pathway, in saccades control, law of, 185
fronto-tegmental corticobulbar pathways, 167, 168f
Full Outline of UnResponsiveness (FOUR) score, 462, 463t
functional magnetic resonance imaging (fMRI), 553–554
functional neurologic symptom disorder. See conversion disorder
fund of information, in sensorium examination, 425
funduscopy, vascular lesions disclosed by, 109t
gadolinium, MRI with, 548f, 550
gag reflex, 208
gait apraxia, testing for, technique of, 433
gaits
alterations in, in diffuse brain disease, aging, and dementia, 453
antalgic, 330
apraxic, 331
ataxic
cerebellar, 330
sensory, 329
basal motor nuclei, 331
blind person’s, 330
broad-based, 315
cerebral, 331–332
choreiform, 331
club-foot, 329
cortical-subcortical, 332
cruising, 328
dancing bear, 332
developmental, 328–329
diplegic, spastic, 330–331
dorsal column, 329
dromedary, 331
dystaxia of, clinical tests for, 315
dystonic equinovarus, 331
examination for, importance of, 328
festinating, 331
flail-foot, 329
flipping-hand, 330
nocturnal, 330
foot-drop, 329
bilateral, 329
frontal, 331–332
heel-drop, 329
hemiparetic, psychogenic, 566
hemiplegic, 330
psychogenic, 566
hyperesthetic, 330
ignition failure, 332
inspection of, 230
in-toed, 329
lordotic waddling, 329
magnetic, 332
mature, 328
monoplegic, dragging, psychogenic, 566
neuromuscular, 329
painful sole, 330
paraplegic, 331
parkinsonian, 331
pigeon-toed, 329
primary progressive freezing, 331–332
psychogenic, 332–333
psychogenic disturbances of, 565–567, 566t
scissors, 331
sensory, 329–330
spastic, 330–331
spastic diplegic, 330–331
crouch, 331
spastic-ataxic, 331
spastic-athetoid, 331
steppage, 329
tabetic, 329
toddler’s, 328
toe-drop, 329
toe-walking, 329
ganglia
cochlear, 350
of peripheral nervous system, 41
sensory, 50
gaze
horizontal, frontal corticotegmental pathway for, bilateral destruction of, 171
supranuclear paralysis of, 171
GBS. See Guillain–Barré syndrome
GCS. See Glasgow Coma Scale
Gegenhalten. See paratonia
general somatic efferent (GSE), 49, 49f
general somatosensory afferents (GSAs), 49, 49f
general visceral efferent (GVE), 49, 49f
general viscerosensory afferents (GVAs), 49, 49f
geniculocalcarine tract, 94, 94f, 95f, 96f
genioglossus muscle, action of, 213–214, 214f
genu recurvatum, 264
Gerstmann syndrome, 443–444
giant polyphasic motor units, 256
glabellar tap reflex, 377
glands
neuron communication with, 46
secretions of, 1
Glasgow Coma Scale (GCS), 462, 463f
glaucoma, 149
global aphasia, 440f, 442, 442f
global apraxia, in children, testing for, technique of, 433
global dysprosody, 443
globus hystericus, 565
glossopharyngeal nerve (CrN IX)
LMN innervation of pharynx and larynx by, 201–202, 201f
motor functions of, 201–205
testing of, 207–209, 208f, 209t
peripheral distribution of, 201f
testing of, in unconscious patient, 498
UMN innervation of, 204
glossopharyngeal syncope, 511f, 515
glucose, in CSF, examination of, 538–540, 539f
gnosias, 405
Goldman test, 104
Gower sign, 329
granulations, Pacchionian, 530
grasps, pincer, 125
gray matter, tegmental, 59f, 60, 60f, 61t
growth curve, for occipitofrontal circumference, 28, 28f
GSA pathway. See decussated somatosensory pathway
GSAs. See general somatosensory afferents
GSE. See general somatic efferent
Guillain–Barré syndrome (GBS), 197
gustation. See taste
GVAs. See general viscerosensory afferents
GVE. See general visceral efferent
hair, inspection of, 9
hallucinations, 426
localizing significance of, 427
hammers, percussion, in eliciting muscle stretch reflex, 242–243, 242f
hamstring muscles, strength testing of, 236
hamstring nerve, 56
hands
digits of, muscles acting on, 56
infant’s discovery of, 176–177, 176f
paralysis of, psychogenic, reversed hands test for, 568, 569f
Hardikar syndrome, 4
harelip, 10
head
auscultation of, for bruits, 16–17, 17f
initial, 36
misshapen
craniosynostoses, 24–25, 24f, 25t
in neonates, 27
MRI of, 546–550, 547f, 548f, 549t, 550f
palpation of, 16
shapes of, 25t
size of
abnormal, successive plots of, 29, 29f
brain size relation to, 30–31, 30f
intelligence and, 30–31
transillumination of infant’s
technique of, 19
head and eye position
destructive cerebral lesions effects on, 174, 174f
irritative lesions effects on, 174, 174f
vectors determining, origin of, 173
head- and eye-centering center, concept of, 173–174, 174f
head- and eye-centering mechanism, law of, 185
head- and eye-centering tendency, self-demonstration of, 173
head drop, 332
head injuries
acute sensorial dysfunction after, detection of, 421–422, 422t
olfactory-related consequences of, 342–343, 343f
head ptosis, 332
headaches
intermittent disturbances of, 512
lumbar puncture and, 532
organic, signs of, definable lesions and, 580
hearing
loss of. See hearing loss
pathways of, 77
testing of
air-bone conduction test of Rinne in, 352–353
auditopalpebral reflex/startle response to sound in, 353
in cerebral dysfunction evaluation, 353–354
otoscopy in, 351–352
sound-lateralizing test of Weber in, 353
technique for, 351–353
threshold/sensitivity in, 351
in unconscious patient, 497–498
vibrating tuning fork in, 352
tinnitus and, 354
vestibulocochlear nerve (CrN VIII) in, 349
cochlear division of, anatomy of, 349–350, 350f, 351f
hearing loss
conduction, 352
vs. neurosensory, analysis of patients for, 353
laboratory tests for, 354
neurosensory, 352
vs. conduction, analysis of patients for, 353
heart
inadequate return of blood to, mechanical/hypovolemic syncope due to, 511f, 513–514, 514f
sensorium within, location of, 423–424
heel-drop gait, 329
heel-tapping tests, for leg dystaxia, 318
heel-to-shin test, for leg dystaxia, 318
helix, 9f
hemianopia, 98
complete bitemporal, 94f
complete homonymous, 94f
complete nasal, 94f
complete temporal, 98
detection of, 105
double, neuro-ophthalmologic findings in, 105–106
head shape with, 25
hemianopic field defects, lesions causing, location of, 102
hemiballismus, 294
hemifacial spasm, 198
hemiparalysis, 79
hemiparesis, 79
hemiparetic gait, psychogenic, 566
hemiplegia, 79
double, 281
head shape with, 25
hypoventilation in, 222
paradoxical, 475
in unconscious patient, detection of
arm-dropping test in, 486, 486f
eyelid-release test in, 485–486, 485f
flaccidity of cheek in, 485
inspection in, 484
leg-dropping test in, 486, 487f
limb-dropping test in, 486–487, 486f, 487f
wrist-dropping test in, 486, 486f
hemiplegic distribution, standard, 280–281
hemiplegic gait, 330
psychogenic, 566
hemisensory distribution, 409, 412f
hemispatial inattention, left-side, 429–430
hemorrhage, subgaleal, 27
of equal innervation of corresponding extraocular muscles, 185
herniations
brain. See brain herniations
herniation transtentorial. See transtentorial herniation
of intervertebral disc, nerve root compression from, clinical findings in, 392–394, 393f
transforaminal. See transforaminal herniation
herpes simplex virus, in CSF, 541
heterophorias
definition of, 138
refractive errors in relation to, 147–148
heterotropias
alternating, cover-uncover test in, analysis of, 137f, 138
clinical classification of, 139–141
concomitant, vs. paralytic heterotropias, 141–142, 142t
cover-uncover test in, for latent ocular deviations, 137f, 138–139
definition of, 136
monocular, cover-uncover test in, analysis of, 137–138, 137f
neuromuscular, clinical tests for, cover-uncover test, 139–140
non-paralytic, vs. paralytic heterotropias, 141–142, 142t
paralytic, vs. non-paralytic heterotropias, 139–141, 142t
refractive errors in relation to, 147–148
high achiever syndrome, 563–564
hip girdle, strength testing of, 236
hippus, 152
hips
extension of, 236
flexion of, 236
Hirschberg test, in ocular malalignment evaluation, 133–134, 133f
histrionic underreaction, in psychogenic disorders of somatic sensation, 576
HIV, in CSF, 541
hoarseness, motor function of, testing of, 208
Holmes tremor, 288
homonymous, definition of, 98
homunculus, sensorimotor, in paracentral regions, inversion of, 76, 76f
Hoover test, for psychogenic leg monoparesis, 569–570, 569f
horizontal eye movements, vertical eye movements vs., different pathways for, law of, 185
horizontal gaze
frontal corticotegmental pathway for, bilateral destruction of, 171
pathway, interruption of, 170
Horner syndrome, 156–157, 156f
hydrocephalus (hydrocephaly)
chronic, 332
definition of, 31
head and brain size and, 31–32, 31f
normal pressure, 332
hydrocephalus ex vacuo, 32
hydrocephaly. See hydrocephalus
hygiene, personal, alterations in, 453
hyperactivity, in children, 297–298
hyperalgesia, 369–370
hypercupremia, 4
hyperdynamic circulatory states, 16
hyperekplexia, neonatal, 260
neurophysiologic mechanisms of, 370
hyperesthetic gait, 330
hyperexplexia, 294
hyperkinesias
named types of, continuum between, 295
non-tremor types of, 293–295, 293t
hypernasal speech, 207
hyperpathia, 370
hyperpolarization, 47
hyperreflexia
clinical analysis of, 258–260, 258f, 259f
hypersensitivity, carotid sinus, reflexogenic syncope and, 511f, 515–516, 515t
hypertensive retinopathy, 109t
hyperthermesthesia, 369–370
hyperthyroidism
blinking and, 7
lid lag and, 7
definition of, 261
hypertrophy, use, 253
hypertropia, definition of, 136, 137f
hyperventilation
dizziness due to, 363
indications for, 363
normal results of, 363
technique for, 363
hypoglossal nerve (CrN XII)
clinical testing of, 215–216
motor functions of, 213–216
hypokinesia, 291
Hypomelanosis of Ito, 9
hyponasal speech, 206–207
hypopigmented whorls, 9
hypoplasia, 253
hyporeflexia, after interruption of reflex arc, clinical and EMG signs of, 251–257
hypotension, orthostatic, 511f, 514
hypothyroidism
eyebrows in, 9
muscle stretch reflexes in, eliciting of, quadriceps reflex, 248
voice effects of, 209
hypotonia (flaccidity), 12, 12f
causes of, 263f
peripheral, differentiation of, 257t, 265
cerebellar dysfunction and, 313–314
cerebral or spinal shock and, 265
clinical tests for, 319
inspection for, 319
hypotropia, definition of, 136, 137f
hypoventilation, in hemiplegia, 222
hysteria, visual field constriction with, 102
hysterical mutism, 206
iatrogenic infection, lumbar puncture and, 532
ice-bag test, in ptosis evaluation, 159
ictal phase, 512
ignition failure gait, 332
illusions, 426
immunopathies, CSF findings in, 539f, 540
inattention
to double simultaneous cutaneous stimuli, 430
hemispatial, left-side, 429–430
incontinentia pigmenti, 9
infants
brain-death protocol in, 506
hand discovery by, 176–177, 176f
neuromuscular heterotropia and vision of, 140–141
pain in, 383
plantar responses in, 273
scalp edema in, 27
spinal cord transection in, during breech delivery, 220, 222f
synarthroses pliancy in, 21–22
transillumination of head of
technique of, 19
infectious agents, in CSF, identification of, 541–542
inferior oblique muscle, action of, 130
inferior rectus muscle, action of, 126f, 128
inferomedial temporo-occipital region of cerebrum, 10
inhibitory transmitters, 47
innervation. See also specific types
of ocular muscles, 149–151, 150f, 150t, 151f, 156f
original, law of, 51, 52f, 53t–54t
segmental
of muscles, 53t–54t
tonic, of extraocular muscles, 132
insight, in sensorium examination, 425
inspections. See also specific areas
of body contours, 229–230
of comatose patient, 483
in establishing consciousness, 461
of facial malformation syndromes, 9–12, 10f, 11f
of gait, 230
of hair of scalp, eyebrows, and beard, 9
importance of, 3
in neurologic examination, 1
of nose, mouth, chin, and ears, 8, 9f
of skin of face and general body surface, 9
of station, 230
of trigeminal nerve motor function, 193
intellectual disability, delayed speech related to, 354
intelligence, head size and, 30–31
intention tremor, clinical characteristics of, 287f, 288
intercanthal distance, 6
in facial malformation syndromes, 7
interdigital nerve entrapment (Morton metatarsalgia), 388
interhemispheric fissure, 43
intermediolateral horn, 49, 57f
internal ophthalmoplegia, examination of, 155–156
internuclear lesions, of ocular pathways, 172
internuncial neurons, 50–51, 50f
interoception, 338
interorbital distance, 6
in facial malformation syndromes, 7
interventricular foramen of Monro, increased intracranial pressure due to, 530
intervertebral disc, herniation of, nerve root compression from, clinical findings in, 392–394, 393f
in-toed gait, 329
intorsion, definition of, 128, 128f
intracranial pressure
anterior fontanel and, 22
craniosynostoses and, 24–25
increased, 529–530
causes of, 530
lumbar puncture in, contraindications to, 531–532
Pascal law and, 530
signs of, 530
symptoms of, 529
suture closure and, 23
intracranial space, fluid pools of, responses to increased pressure, 470–472, 471f
intralaminar nuclei, of thalamus, 72, 78t
intraocular muscles
of eyeball, 153–154
positive tonic oppositional innervation of, law of, 184–185
intravascular blood, brain herniation and, 470–471
involuntary movement disorders. See also specific types
akathisia, 297
attention deficit/hyperactivity disorder, 297–298
deficit and release phenomena after lesions of basal motor connections, 295
drug-induced extrapyramidal movement syndromes, tardive dyskinesias and, 295
epilepsy, 298
evaluation of, general tests in, 296–297, 296f
hyperactivity, 297–298
hyperkinesias, 295
introduction to, 285
non-tremor types of hyperkinesias, 293–295, 293t
by operational definition, 299–300
psychogenic vs. other motility disturbances, 298–299
rating scales for, 295
restless-legs syndrome, 297
self-mutilation, 298
stereotyped behavioral mannerisms, 298
tremors. See tremors
involuntary movements
definition of, 285–286
examples of, 286
identification of, clinical operations for, 286
ipsilateral deficits, 74
iris
eyelid margins and relation to, 3–5, 4f, 5f
irritative lesions, effects on head and eye position, 174, 174f
Isaacs syndrome, 254
isocoria, 7
jaw
closure of
in chewing, 191
weakness of, testing for, 193–194
lateral movement of, in chewing, 191–192, 192f
jaw reflex, 243f
Jendrassik maneuver, for reinforcing muscle stretch reflex, 248–249
jerk nystagmus, 178–180
direction of, 359
jerks, myoclonic, 286
judgment, in sensorium examination, 425
in nuchal rigidity testing, in unconscious patient, 492
Kiloh-Nevin syndrome, 387
kinetic tremor, clinical characteristics of, 287f, 288
Kinnier Wilson pupil, 7
Klippel-Trenaunay-Weber syndrome, 9
knee reflex
counterpressure method for, 246f
in hypothyroidism, 248
with patient sitting, 245f
with patient supine, 245f
pull method (of Jendrassik) for reinforcing, 246f
knees
extensors of, 236
flexors of, 236
knuckle rub tests, for pain response, in unconscious patient, 498
Korsakoff syndrome, 579
Kussmaul breathing, 478
labyrinth, orientation of, 357f
lacrimal glands, 69
lacrimal punctum, canthus dystopia and, 6
lactate, 551
lamina cribrosa, 93
language
communication by, 438
right hemisphere in, 443
larynx
LMN innervation of
glossopharyngeal nerve in, 201–202, 201f
neurologic examination of, 207–208, 208f
latent nystagmus, 179
lateral canthus, apex of, 3, 4f
lateral cleft lip, 10–11
lateral femoral cutaneous nerve, 387–388, 388f
lateral lemniscus, 78
lateral medullary syndrome, 322
lateral medullary wedge syndrome of Wallenberg, 409, 411f, 411t
lateral pterygoid muscles, weakness of, testing for, 193–194
lateral rectus muscles, action of, 125–126, 126f
lateral ventricles, 42
laterality
of clinical signs of lesions of basal motor nuclei, 82–84, 83f, 84t
lateropulsion, 330
law of Bell and Magendie, 49
law of contralateral cerebral sensorimotor innervation, 177
law of contralateral hemispheric sensory and motor connections, 77f, 84, 85t
law of diplopia, 142–143, 142f
law of original innervation, 51, 52f, 53t–54t
law of projection of the visual image, 92
law of respect, for unconscious patient, 499–500
law of sensation, 92
lead-pipe rigidity, 262
left-side hemispatial inattention, 429–430
leg monoparesis, psychogenic
Hoover test for, 569–570, 569f
Raimiste leg adduction-abduction synkinesis for, 570–571, 570f
leg-dropping test, in hemiplegia detection in unconscious patient, 486, 487f
leg-raising tests, for nerve root compression, 390–392, 391f
legs
dystaxia of, clinical tests for, 318
elevation of, pain and limitations of, 391–392
origin of, localization of, 390, 390f
pain radiating down
case example, 389–390
examination techniques in, 390–394
lemnisci, 59f, 60f, 61, 61t, 78
origins and names of, 380t
union of, in brainstem, 77f, 78–79
length–strength principle, 230–231, 231f
lenses
convergent, 148
divergent, 148
negative and positive, refraction by, 145, 145f
thickening of, 146
lesions. See also specific types
aphasias due to, general localization of, 440, 440f
of basal motor connections, deficit and release phenomena after, 295
of basal motor nuclei, clinical signs of, laterality of, 82–84, 83f, 84t
brain, localization of, dynamic techniques for, 553
brainstem, localizing diagnosticon for, 223, 223f
cerebellar, 307. See also cerebellum, disease, dysfunction, or lesions of
cerebral, destructive, effects on head and eye position, 174, 174f
cervical cord, lumbar puncture in, contraindications to, 531
cochlear nerve, lesions of, 351
definable, organic headaches associated with, signs of, 580
detection of, in neurologic examination, 594–595, 594t, 596f
optimum diagnostic management, 595t, 596–597
optimum preventative management, 595t, 598
optimum therapeutic management, 595t, 598
site of, 594t, 595–596, 597f–601f
type of lesion, 595t, 596, 602f
expanding, increased intracranial pressure due to, 530
irritative, effects on head and eye position, 174, 174f
LMN. See lower motoneuron lesions
of motor pathways, deficit and release phenomena after, 284–285
obstructive, increased intracranial pressure due to, 530
of ocular pathways
internuclear, 172
LMN, 172
UMN, 172
peripheral nerve
analysis of, general anatomico-physiologic principles in, 370–372
autonomic release of irritation phenomena after, 285
quadrantic/hemianopic field defects due to, location of, 102
scotomas due to, location of, 102
of sensory pathways, negative and positive sensory phenomena related to, 369–370
UMN. See upper motoneuron lesions
unilateral vagal, motor function of, testing of, 208
levator palpebrae muscle, 158
Lhermitte sign, 492
lid lag, hyperthyroidism and, 7
ligaments. Seespecific types
light reflex, 154–155
light touch sensation, testing of, 380, 380t
limb-dropping test, in hemiplegia detection in unconscious patient, 486–487, 486f, 487f
limbic cerebellum, 307
limbic nuclei, of thalamus, 72, 78t
limbs, development of, dermatomal dislocations related to, 51, 52f
canthi and caruncle relation to, 5
medial canthus relation to, 5–6, 5f, 6f
relation to eyelid, initial inspection of, 133
lips
inspection of, 8
LMNs. See lower motoneurons
lobes. Seespecific lobes
lobule, 9f
locked-in syndrome, 281
clinical features of, 500
neurologic examination in, 500, 509t
longitudinal subdivisions, of brainstem, 58, 59f
lordotic waddling gait, 329
low back pain
backache syndromes, 389
differential diagnosis of, 394
examination techniques in
ancillary studies in, 394
case example, 389–390
organic, signs of, 580
low cerebrospinal fluid (CSF) volume (pressure) syndrome, 530–531
lumbar puncture and, 532
lower motoneuron (LMN) lesions
case example, 282–283
clinical syndrome of, 256
deficit and release phenomena after, 284–285
EMG syndrome of, 256
of hypoglossal nerve, 214, 214f
muscle stretch reflexes in relation to, warning about presence or absence of, 281
muscular paralysis due to, synonyms for, 219t
of ocular pathways, 172
of trigeminal nerve, 193
lower motoneuron (LMN) paralysis, vs. UMN paralysis, 80–81
lower motoneurons (LMNs), 50–51, 50f
definition of, 80
in innervation of pharynx and larynx, glossopharyngeal and vagus nerves in, 201–202, 201f, 202f
pyramidal tract and concept of, 80
in tongue weakness, 216
lumbar puncture, 531–535
collection and appearance of CSF during, 536
complications of, 532
contraindications to, 531–532
CSF flow during, cessation of, 536, 536t
indications for, 531
preparation for, 533
psychological, 533
technique for
fluctuations in meniscus in manometer, 534–535, 534f
needle insertions and manometry, 533–534
patient positioning, 529f, 533
lumbar skin, infection of, lumbar puncture in, contraindications to, 531
lumbosacral canal, implantation of epidermoid tumors in, lumbar puncture and, 532
lumbosacral plexus, motor distribution of, 56
Lyme disease, in CSF, 542
macrencephaly, 30
macrognathia, 8
macrophthalmia, 7
macrostomia, 8
macula lutea, 93f
maculae
otoliths of, 356–357
macular degeneration, 149
magnetic gait, 332
magnetic resonance imaging (MRI)
CT vs., 545t, 546–547, 547f, 548f
diffusion weighted, 550
functional, 553–554
indications for, 547–550, 548f, 550f
risks associated with, 550
magnetic resonance myelography, CT and, 550
magnetic resonance spectroscopy, 551–552, 551f
Magnus-deKleijn reflex, 176–177, 176f
make-a-fist test, for psychogenic wrist drop, 568, 568f
malingering
conversion disorder vs., 562–563
factitious disorder vs., 562–563
visual field constriction with, 102
mandibular test, for pain response, in unconscious patient, 498
maneuvers, in neurologic examination, 1
mania
delirium vs., 455
dementia vs., 455
mannerisms, behavioral, stereotypes, 298
manometers, fluctuations in meniscus in, during lumbar puncture, 534–535, 534f
manometry, in lumbar puncture, 533–534
fluctuations in meniscus in manometer during, 534–535, 534f
increased pressure registered by, clinical evaluation of, 535–536, 535f
Mask of Trigeminus, 373–374, 373f
masked facies, 198
masseter, 191
mastoiditis, 18
mature gait, 328
mechanical/hypovolemic syncope, inadequate return of blood to heart and, 511f, 513–514, 514f
medial canthus, apex of, 3, 4f
medial longitudinal fasciculus (MLF), 59f, 60f, 61, 168f, 170
interruption of, effects of, 170–171
syndrome, signs and symptoms of, 171
medial medullary infarction, 322
medial rectus muscles, action of, 125–126, 126f, 146
median cleft face syndrome, 12, 13f
median cleft lip, 10
median labial tubercle, 8
median nerve, 55
median nerve entrapment, at wrist, 386–387, 386f
cutting and separation of, 42, 42f
medulla oblongata, transverse section of, 58, 59f
medullocervical junction, 41
megalocephaly, 30
neurologic examination in patient with, 32–33
membranous bones, 20
memory
cerebral localization of, 447, 447f
in sensorium examination, 425
Memory Impairment Scale, 449
meningeal irritation
absence of meningeal irritation signs in presence of, 492
in unconscious patient, signs of, 487–488, 489f, 492
meningitis
bacterial, acute, CSF in, 541
tuberculous, CSF in, 542
viral, CSF in, 541
meningoceles, 27
meningoencephaloceles, 27
mental image, projection of, by mind, 91–92, 92f
mental status
aging and, features of, 448–455
in dementia, features of, 448–455
mental status examination
deriving information from, 419
interview technique in, 419
in neurologic examination, 601
sensorium in, 420–421, 421f. See also sensorium
mental symptoms, in neurologic examination, 2f
meralgia paresthetica, 387–388, 388f
mesencephalon. See midbrain
metabolic encephalopathies, increased intracranial pressure due to, 530
metatarsalgia, Morton, 388
neurologic examination in patient with, 32–33
microcornea, 7
micrognathia, 8
microphthalmia, 7
microstomia, 8
micturition syncope, 511f, 514
midbrain (mesencephalon), 58, 60, 60f, 61t
coronal section of, 465f
cutting and separation of, 42, 42f
lesions of, decerebrate rigidity and, 475–477, 475f, 476t, 477f
transverse section of, 58, 60f
midline nuclei, of thalamus, 72, 78t
mild intellectual developmental disorder, 12, 13f
minimally conscious state, 502
neurologic examination in, 509t
Mini-Mental State Examination (MMSE), 449–450, 449t, 450f
mixed tremors, clinical characteristics of, 287f, 288
MLF. See medial longitudinal fasciculus
MMSE. See Mini-Mental State Examination
MOCA. See Montreal Cognitive Assessment
modulate, 81
monocular diplopia, 572
monocular heterotropia, cover-uncover test in, analysis of, 137–138, 137f
mononeuropathies, 384–385
monoparesis
arm
Monrad-Krohn cough test for, 567
psychogenic, double-crossed arm pull test for, 567, 568f
reversed hands test for, 568, 569f
leg, psychogenic
Hoover test for, 569–570, 569f
Raimiste leg adduction-abduction synkinesis for, 570–571, 570f
monoplegia, 281
monoplegic gait, dragging, psychogenic, 566
Monrad-Krohn cough test, for arm monoparesis, 567
Montreal Cognitive Assessment (MOCA), 449
Morton metatarsalgia, 388
motility disturbances, psychogenic vs. other, 298–299
motion detection, 93
motor aphasia, 438, 440–441, 440f
motor blocks, 332
motor cortex, cerebellum and, 81, 82f
motor cranial nerves
facial nerve (CrN VII). See facial nerve
glossopharyngeal nerve (CrN IX). See glossopharyngeal nerve
hypoglossal nerve (CrN XII). See hypoglossal nerve
sequential screening examination of, 224, 224t
spinal accessory nerve (CrN XI). See spinal accessory
trigeminal (CrN V). See trigeminal nerve
vagus nerve (CrN X). See vagus nerve
motor deficits, apraxia vs., 432
motor function
alterations in, in diffuse brain disease, aging, and dementia, 454t, 455
general tests for, 296–297, 296f
psychogenic disorders of, 564–571
oculomotor signs of, 564–565
range of, 564
transtentorial herniation effects on, 474
motor neurons
lower. See lower motoneurons
upper. See upper motoneurons
motor neuropathy, 252
acute, neurologic signs in, time of onset of, 260t
motor pathways, lesions of, deficit and release phenomena after, 284–285
motor symptoms, in neurologic examination, 2f
motor systems
central ocular. See central ocular motor systems
examination of, 603
in constructional and dressing apraxia identification, 433, 433f
peripheral ocular, 91
somatic, examination of, 229–306
motor units
fasciculations and, 253
giant polyphasic, 256
mouth, inspection of, 8
movement disorders
evaluation of, general tests in, 296–297, 296f
involuntary. See involuntary movement disorders
lesions of basal motor nuclei and, clinicopathologic correlations between, 293t
psychogenic vs. other, 298–299
movements
decomposition of, 318
involuntary. See involuntary movements
peripheral nerves and, 3
resistance to, in unconscious patient, 487–489, 488f, 489f
sensation as basis of, 79
voluntary
definition of, 285
identification of, clinical operations for, 286
MRI. See magnetic resonance imaging
MSRs. See muscle stretch reflexes
mucous glands, 69
multiple sclerosis, CSF findings in, 539f, 540
multiple tic syndrome of Gilles de la Tourette, 295
Munchausen syndrome. See factitious disorder
muscle cells, 2–3
neuron communication with, 46
muscle contraction myotonia, 239
muscle spindles, 240
effects of stretch on, 240–241, 240f
innervation of, 241
muscle stretch reflexes (MSRs)
absence of, 248
alterations in, in diffuse brain disease, aging, and dementia, 455
definition of, 241
eliciting of
clinical problem in, analysis of, 248–249
failure of, responses to, 248
in hypothyroidism, 248
in neurologic examination, 243–248, 243f–247f
percussion hammer in, 242–243, 242f
reinforcement in, 248
grading of, 249t
hyperactive (hyperreflexia), clinical analysis of, 258–260, 258f, 259f
hypotonic, 319
latencies of, recording of, 248
nomenclature for, 245f, 247f, 249
pendulous, 319
range of motion of, testing of, 265–266
in relation to UMN and LMN lesions, warning about presence or absence of, 281
scaling and recording, stick figure in, 249–250, 249t, 250f
superficial reflexes. See superficial reflexes
in unconscious patient, 499
muscle tone
definition of, 261
disorders of, 260–266
origin of, 261
self-demonstration of, 261
muscles. See also specific muscles
aplasia of, 253
atrophy of, 253
denervation atrophy of, 253
disuse atrophy of, 253
hypoplasia of, 253
percussion of, results of, 238–239
segmental innervation of, 53t–54t
size of
determination of, circumferential measurement of extremities in, 253
neuromuscular disease effects on, 253
strength testing of
abdominal muscles, 235–236
ankle movements, 236–237
back muscles, 236
hip girdle, 236
neck flexors and extensors, 233
recording examination findings, 237, 237t
rostrocaudal sequence in, 233
during routine physical examination vs. complete examination, 237
shoulder girdle muscles, 233–234, 234t
thigh muscles, 236
toe movements, 236–237
use hypertrophy of, 253
muscular dystrophy, head size and, 31
musculocutaneous nerve, 55
mutism, 206, 209–210, 209t, 437
psychogenic, 565
myasthenia gravis, 252
fatigability in, electrical tests for, 218
mydriatics, 154
myelography, magnetic resonance, CT and, 550
myoclonic jerks, 286
myoclonus
palatal, 290
rhythmic, tremor vs., 292
tremor vs., 292
myoedema, percussion, 238–239
myo-inositol, 551
myokymia, 254
myopathic atrophy, 253
myopathic ptosis, 159
myotatic contractions, 249
myotomes, 49
migration of, 51
myotonia
muscle contraction, 239
percussion, 239