Localization in Clinical Neurology · 7th Edition by Brazis, Paul W. -- Read -- Imperial Library of Trantor

Figure 2-1 Figure 2-2 Figure 2-3 Figure 2-4 Figure 2-5 Figure 2-6 Figure 2-7 Figure 2-8 Figure 2-9 Figure 2-10 Figure 2-11 Figure 2-12 Figure 2-13 Figure 2-14 Table 2-1: Main Entrapment Neuropathies of the Upper Limbs Table 2-2: Main Entrapment Neuropathies of the Lower Limbs

References

Chapter 3: Cervical, Brachial, and Lumbosacral Plexuses

Chapter 3 Introduction The Cervical Plexus

Anatomy Lesions of the Cervical Plexus Figure 3-1 Figure 3-2

The Brachial Plexus

Anatomy

Branches Originating from the Spinal Roots Branch Originating from the Trunk of the Brachial Plexus Branch Originating from the Divisions of the Brachial Plexus Branches Originating from the Cords of the Brachial Plexus

Lesions of the Brachial Plexus Neuralgic Amyotrophy Total Plexus Paralysis Upper Plexus Paralysis (Erb–Duchenne Type) Middle Plexus Paralysis Lower Plexus Paralysis (Déjerine-Klumpke Type) Lesions of the Cords of the Brachial Plexus

Lesions of the Lateral Cord Lesions of the Medial Cord Lesions of the Posterior Cord

Brachial Mononeuropathies Thoracic Outlet Syndrome (Cervicobrachial Neurovascular Compression Syndrome)

Vascular Signs and Symptoms Neuropathic Signs and Symptoms

Figure 3-3

The Lumbosacral Plexus

Anatomy Lesions of the Lumbosacral Plexus Lesions of the Entire Lumbosacral Plexus Lesions of the Lumbar Segments Lesions of the Sacral Plexus Figure 3-4

References

Chapter 4: Spinal Nerve and Root

Anatomy of the Spinal Nerves and Roots

Figure 4-1

Principles of Spinal Nerve and Root Localization

Sensory Symptoms Motor Signs Reflex Signs Figure 4-2

Etiologies of Spinal Nerve and Root Lesions

Table 4-1: Neurologic Signs and Symptoms with Nerve Root Irritation or Damage from Disc Disease

The Localization of Nerve Root Syndromes

Lesions Affecting the Cervical Roots

Lesions Affecting C1 Lesions Affecting C2 Lesions Affecting C3 Lesions Affecting C4 Lesions Affecting C5 Lesions Affecting C6 Lesions Affecting C7 Lesions Affecting C8

Lesions Affecting the Thoracic Roots

Lesions Affecting T1 Lesions Affecting Segments T2–T12

Lesions of the Lumbar and Sacral Roots

Lesions Affecting L1 Lesions Affecting L2 Lesions Affecting L3 Lesions Affecting L4 Lesions Affecting L5 Lesions Affecting S1 Lesions Affecting S2–S5

The Localization of Lumbosacral Disc Disease

Figure 4-3 Table 4-2: Differential of Neurogenic from Vascular Claudication

References

Chapter 5: Spinal Cord

Anatomy of the Spinal Cord

Gross Anatomy and Relationship to Vertebral Levels Cross-Sectional Anatomy of the Spinal Cord

Lamina

Major Ascending and Descending Tracts of the Spinal Cord

Ascending Tracts Descending Tracts

Corticospinal Tract Corticorubrospinal Tract Lateral Reticulospinal Tract Vestibulospinal Tract Medial Reticulospinal Tract Arterial Supply to the Spinal Cord

Extraspinal System (Extramedullary Arteries) Intraspinal System (Intramedullary Arteries)

Figure 5-1 Figure 5-2

Venous Drainage of the Spinal Cord Physiology of the Spinal Cord Circulation Lesions of the Spinal Cord

Complete Spinal Cord Transection (Transverse Myelopathy)

Sensory Disturbances Motor Disturbances Autonomic Disturbances Hemisection of the Spinal Cord (Brown-Séquard Syndrome)

Lesions Affecting the Spinal Cord Centrally Posterolateral Column Disease Posterior Column Disease Anterior Horn Cell Syndromes Combined Anterior Horn Cell and Pyramidal Tract Disease Figure 5-3 Table 5-1: Transverse Myelopathy Table 5-2: Brown-Séquard Syndrome Table 5-3: Central Spinal Cord Syndrome Table 5-4: Posterolateral Column Syndrome Table 5-5: Posterior Column Syndrome Table 5-6: Anterior Horn Cell Syndromes Table 5-7: Combined Anterior Horn Cell and Pyramidal Tract Syndromes

Vascular Disorders of the Spinal Cord and Spinal Canal

Arterial Spinal Cord Infarction Venous Spinal Cord Infarction Vascular Malformations of the Spinal Cord Hemorrhages Affecting the Spinal Canal Extramedullary Cord Lesions and Their Differentiation from Intramedullary Cord Lesions

Pain Disturbances of Motor Function Sensory Disturbances Disturbances of Sphincter Function Autonomic Manifestations

Table 5-8: Clinical Manifestations of Spinal Cord Ischemia Table 5-9: Causes of Arterial Spinal Cord Infarction Table 5-10: Causes of Venous Spinal Cord Infarction Table 5-11: Clinical Guidelines to Differentiate Intramedullary and Extramedullary Tumors

Localization of Spinal Cord Lesions at Different Levels

Foramen Magnum Syndrome and Lesions of the Upper Cervical Cord Lesions of the Fifth and Sixth Cervical Segments Lesions of the Seventh Cervical Segment Lesions of the Eighth Cervical and First Thoracic Segments Lesions of the Thoracic Segments Lesions of the First Lumbar Segment Lesions of the Second Lumbar Segment Lesions of the Third Lumbar Segment Lesions of the Fourth Lumbar Segment Lesions of the Fifth Lumbar Segment Lesions of the First and Second Sacral Segments Conus Medullaris Lesions Cauda Equina Lesions Neurogenic Bladder with Spinal Cord Lesions Sexual Function Fecal Incontinence Figure 5-4 Table 5-12: Myelopathies Figure 5-5 Figure 5-6

References

Chapter 6: Cranial Nerve I (The Olfactory Nerve)

Anatomy of the Olfactory Pathways

Figure 6-1 Figure 6-2

Localization of Lesions Affecting the Olfactory Nerve

Lesions Causing Anosmia The Foster–Kennedy Syndrome Lesions Causing Parosmia and Cacosmia Table 6-1: Conditions Associated with Disturbance of Olfaction

References

Chapter 7: Visual Pathways

Anatomy of the Visual System

The Retina The Optic Nerves and Optic Chiasm The Optic Tracts and Lateral Geniculate Bodies The Optic Radiations The Visual Cortex and Visual Association Areas Vascular Supply of the Visual Pathways Figure 7-1 Figure 7-2 Figure 7-3 Figure 7-4 Figure 7-5 Figure 7-6 Figure 7-7 Figure 7-8 Figure 7-9 Figure 7-10 Table 7-1: Arterial Supply of Visual Pathway Structures

Localization of Lesions in the Optic Pathways

Changes in Visual Perception

Visual Acuity Contrast Sensitivity Perception of Color Visual Fields

Types of Visual Field Defects Localization of Visual Field Defects

Other Changes in Visual Perception

Objective Findings with Lesions of the Optic Pathways

Ophthalmoscopic Appearance of the Retina and Optic Nerve Pupillary Light Reflex

Optic Neuropathy

Optic Neuritis Neuromyelitis Optica Anterior Ischemic Optic Neuropathy Mass Lesions of the Orbit

Figure 7-11 Table 7-2: Clinical Features and Etiologies of Bilateral Superior or Inferior Altitudinal Defects and Bilateral Central or Cecocentral Scotomas Figure 7-12 Figure 7-13 Table 7-3: Compressive Chiasmal Syndromes Table 7-4: Other Causes of Chiasmal Syndrome Figure 7-14 Table 7-5: Syndromes Causing Increased Intracranial Pressure Table 7-6: The Clinical Features of Papilledema Table 7-7: The Stages of Papilledema Table 7-8: Etiologies of a Relative Afferent Pupillary Defect Table 7-9: The Clinical Features of Optic Neuropathy Table 7-10: Features of Typical Optic Neuritis Table 7-11: Clinical Features of Neuromyelitis Optica Table 7-12: Typical Clinical Features of Nonarteritic Anterior Ischemic Optic Neuropathy Table 7-13: Signs and Symptoms in Visual Pathway Lesions

References

Chapter 8: The Localization of Lesions Affecting the Ocular Motor System

Chapter 8 Introduction Ocular Motor Muscles and Nerves

Orbital Muscles Diplopia Testing for Diplopia

Subjective Testing Objective Testing

Childhood Strabismus Disease of the Ocular Muscles Retinal Disease Causing Diplopia Ocular Motor Nerves and Localization of Lesions

Oculomotor Nerve (Cranial Nerve III) Trochlear Nerve (Cranial Nerve IV) Abducens Nerve (Cranial Nerve VI) Multiple Ocular Motor Nerve Palsies

The Pupil

Sympathetic and Parasympathetic Innervation Pupillary Inequality (Anisocoria) Simple Anisocoria Sympathetic Dysfunction (Horner Syndrome) Parasympathetic Dysfunction Argyll-Robertson Pupil The Flynn Phenomenon Periodic Pupillary Phenomena (Episodic Anisocoria)

Figure 8-1 Table 8-1: Ocular Causes of Monocular Diplopia Table 8-2: Etiologies of Esotropia/Exotropia and Acquired Horizontal Diplopia Table 8-3: Etiologies of Binocular Vertical Diplopia and Hypertropia/Hyperphoria Figure 8-2 Table 8-4: Classification of Childhood Strabismus Syndromes Table 8-5: Typical Features of Graves Ophthalmopathy Table 8-6: Differential Diagnosis of Orbital Pseudotumor Table 8-7: Clinical Differential Diagnosis of Orbital Myositis and Thyroid Eye Disease Figure 8-3 Figure 8-4 Figure 8-5 Table 8-8: The Localization of Oculomotor Nerve Lesions Table 8-9: Etiologies of Third Nerve Palsies (TNP) by Topographical Localization Figure 8-6 Figure 8-7 Figure 8-8 Table 8-10: The Localization of Trochlear Nerve Lesions Table 8-11: Etiologies for a Fourth Nerve Palsy Based on Clinical Topographical Localization Figure 8-9 Table 8-12: The Localization of Abducens Nerve Lesions Table 8-13: Etiology of a Sixth Nerve Palsy by Topographical Localization Figure 8-10 Figure 8-11 Table 8-14: Clinical Findings in Horner Syndrome Table 8-15: Etiologies of Horner Syndrome Table 8-16: Associated Signs and Symptoms of Carotid Artery Dissection Table 8-17: Clinical Features of a Tonic Pupil Table 8-18: Etiologies of a Tonic Pupil Table 8-19: Clinical Characteristics of Abnormalities of the Iris Structure Table 8-20: Etiologies of Abnormalities of Iris Structure Table 8-21: Environmental Agents and Drugs Associated with Mydriasis or Miosis Table 8-22: Pupillary Signs in the ICU

Supranuclear Control of Eye Movements

The Vestibular System

The Vestibuloocular Reflex Head Position Caloric Testing, Nystagmus, and Tests of Vestibular Dysfunction

Full-Field Optokinetic Reflex Smooth Pursuit System Anatomy of the Pursuit System Lesions Affecting Smooth Pursuit The Saccadic System Mechanical Properties of Saccadic Eye Movements

Anatomy of the Saccadic System The Neural Integrator Collicular System Higher-Level Control of the Saccades The Basal Ganglia Summary of the Saccadic Pathways The Role of the Cerebellum on Eye Movements Abnormal Saccades

Convergence System Fixation System Gaze Palsies

Conjugate Gaze Palsies Horizontal Conjugate Gaze Palsy Vertical Conjugate Gaze Palsy Disconjugate Gaze Palsies

Figure 8-12 Figure 8-13 Figure 8-14 Figure 8-15 Figure 8-16 Figure 8-17 Table 8-23: Localization of Lesions Impairing Horizontal Pursuit Eye Movements Table 8-24: Localization of Lesions Causing Impaired Horizontal Conjugate Saccadic Eye Movements Table 8-25: Ophthalmic Findings with the Dorsal Midbrain Syndrome Table 8-26: Etiologies of Vertical Gaze Impairment Table 8-27: Clinical Findings Noted with Internuclear Ophthalmoplegia (INO)

Nystagmus and Other Ocular Oscillations

Oscillopsia Optokinetic Drum Jerk Nystagmus Systems Classification of Nystagmus Vestibular Nystagmus Gaze-Holding Nystagmus Visual Stabilization Nystagmus Clinical Classification of Nystagmus

Monocular Eye Oscillations and Asymmetric Binocular Eye Oscillations Dysconjugate Bilateral Symmetric Eye Oscillations Horizontal Dysconjugate Eye Oscillations Binocular Symmetric Conjugate Eye Oscillations Binocular Symmetric Pendular Conjugate Eye Oscillations Binocular Symmetric Jerk Nystagmus Predominantly Vertical Jerk Nystagmus Binocular Symmetric Jerk Nystagmus Present in Eccentric Gaze or Induced by Various Maneuvers

Saccadic Intrusions Lid Nystagmus Table 8-28: Etiologies of See-Saw Nystagmus Table 8-29: Etiologies of Periodic Alternating Nystagmus Table 8-30: Etiologies of Downbeat Nystagmus Table 8-31: Etiologies of Upbeat Nystagmus

The Eyelids

Ptosis Eyelid Retraction and Lid Lag Table 8-32: Etiologies of Ptosis Table 8-33: Etiologies of Apraxia of Eyelid Opening Table 8-34: Clinical Features of Aponeurotic Ptosis Table 8-35: Etiologies of Upper Lid Retraction and Lid Lag Table 8-36: Lower Eyelid Retraction

References

Chapter 9: Cranial Nerve V (The Trigeminal Nerve)

Anatomy of Cranial Nerve V (Trigeminal Nerve)

Motor Portion Sensory Portion

Maxillary Division Mandibular Division

Figure 9-1 Figure 9-2 Figure 9-3 Figure 9-4 Figure 9-5

Clinical Evaluation of Cranial Nerve V Function

Sensory Evaluation Motor Evaluation Reflex Evaluation

Localization of Lesions Affecting Cranial Nerve V

Supranuclear Lesions Nuclear Lesions Lesions Affecting the Preganglionic Trigeminal Nerve Roots Lesions Affecting the Gasserian Ganglion Raeder’s Paratrigeminal Syndrome Gradenigo Syndrome The Cavernous Sinus Syndrome The Superior Orbital Fissure Syndrome

Lesions Affecting the Peripheral Branches of the Trigeminal Nerve Jaw Drop References

Chapter 10: Cranial Nerve VII (The Facial Nerve)

Anatomy of Cranial Nerve VII (Facial Nerve)

Motor Division Nervus Intermedius (Wrisberg) Anatomy of the Peripheral Course of the Facial Nerve

Meatal (Canal) Segment Labyrinthine Segment Horizontal (Tympanic) Segment Mastoid (Vertical) Segment

Vascular Supply of the Facial Nerve Figure 10-1 Table 10-1: Facial Nerve Anatomy Table 10-2: Muscles of Facial Expression

Clinical Evaluation of Cranial Nerve VII Function

Motor Function Sensory Function Reflex Function Parasympathetic Function Table 10-3: House–Brackmann Classification of Facial Function

Localization of Lesions Affecting Cranial Nerve VII

Supranuclear Lesions (Central Facial Palsy) Nuclear and Fascicular Lesions (Pontine Lesions)

Millard–Gubler Syndrome Foville Syndrome Eight-And-A-Half Syndrome Isolated Peripheral Facial and Abducens Nerve Palsy

Posterior Fossa Lesions (Cerebellopontine Angle Lesions) Lesions Affecting the Meatal (Canal) Segment of the Facial Nerve in the Temporal Bone Lesions Affecting the Facial Nerve Within the Facial Canal Distal to the Meatal Segment but Proximal to the Departure of the Nerve to the Stapedius Muscle Lesions Affecting the Facial Nerve Within the Facial Canal Between the Departure of the Nerve to the Stapedius and the Departure of the Chorda Tympani Lesions Affecting the Facial Nerve in the Facial Canal Distal to the Departure of the Chorda Tympani Lesions Distal to the Stylomastoid Foramen Table 10-4: Etiologies of Peripheral Facial Nerve Palsies Table 10-5: Etiologies of Bilateral Facial Nerve Palsies Table 10-6: Peripheral Facial Paralysis Red Flags

Abnormalities of Tear Secretion Abnormalities of Eyelid Closure

Insufficiency of Eyelid Closure Excessive Eyelid Closure and Blepharospasm

Abnormal Facial Movements and Their Localization

Dyskinetic Movements Dystonic Movements (Blepharospasm and Blepharospasm with Oromandibular Dystonia) Hemifacial Spasm Postparalytic Spasm and Synkinetic Movements Miscellaneous Movements

Facial Myokymia Focal Cortical Seizures Tics and Habit Spasms Fasciculations Myoclonus

References

Chapter 11: Cranial Nerve VIII (The Vestibulocochlear Nerve)

Anatomy of Cranial Nerve VIII

Auditory Pathways

First-Order Neurons Second-Order Neurons Third-Order Neurons Fourth-Order Neurons

The Vestibular System

Medial Longitudinal Fasciculus Medial Vestibulospinal Tract Lateral Vestibulospinal Tract Cerebellum Reticular Formation

Figure 11-1

Clinical Evaluation of Cranial Nerve VIII Function

Sensorineural Deafness

Weber Test Rinne Test Schwabach Test

Vertigo and Vestibular Function

Definition of Characteristics of Symptoms Associated Auditory Symptoms Associated Symptoms Suggesting Central Neurologic Dysfunction Etiologic Search

Localization of Lesions Causing Deafness and Vertigo

Localization of Lesions Causing Sensorineural Deafness

Cerebral Lesions Brainstem Lesions Peripheral Nerve Lesions and the Cerebellopontine Angle Syndrome

Localization of Lesions Causing Vertigo

Peripheral Causes of Vertigo

Benign Paroxysmal Positioning Vertigo Peripheral Vestibulopathy Ménière Disease Vertigo Secondary to Middle Ear Disease Vertigo Secondary to Viral Infections Vertigo Secondary to Trauma

Central Causes of Vertigo

Vascular Causes of the Central Vestibular Syndrome Multiple Sclerosis Wernicke Encephalopathy Cerebellopontine Angle Tumors Vestibular Epilepsy Other Central Nervous System Disorders Systemic Causes of Dizziness and Vertigo Figure 11-2

References

Chapter 12: Cranial Nerves IX and X (The Glossopharyngeal and Vagus Nerves)

Anatomy of Cranial Nerve IX (Glossopharyngeal Nerve)

Figure 12-1

Clinical Evaluation of Cranial Nerve IX

Motor Function Sensory Function Reflex Function Autonomic Function

Localization of Lesions Affecting the Glossopharyngeal Nerve

Supranuclear Lesions Nuclear and Intramedullary Lesions Extramedullary Lesions

Cerebellopontine Angle Syndrome Jugular Foramen Syndrome (Vernet Syndrome) Lesions within the Retropharyngeal and Retroparotid Space

Glossopharyngeal (Vagoglossopharyngeal) Neuralgia

Anatomy of Cranial Nerve X (Vagus Nerve) Clinical Evaluation of Cranial Nerve X

Motor Function Sensory Function Reflex Function

Localization of Lesions Affecting the Vagus Nerve

Supranuclear Lesions Nuclear Lesions and Lesions within the Brainstem Lesions within the Posterior Fossa Lesions Affecting the Vagus Nerve Proper Lesions of the Superior Laryngeal Nerve Lesions of the Recurrent Laryngeal Nerve Syncope from Glossopharyngeal or Vagal Metastasis Arnold’s Nerve Cough Reflex Table 12-1: Syndromes That Occur due to Lesions within the Posterior Fossa

References

Chapter 13: Cranial Nerve XI (The Spinal Accessory Nerve)

Anatomy of Cranial Nerve XI (Spinal Accessory Nerve)

Figure 13-1

Clinical Evaluation of Cranial Nerve XI Function

Sternocleidomastoid Muscle Trapezius Muscle

Localization of Lesions Affecting Cranial Nerve XI

Supranuclear Lesions Nuclear Lesions Infranuclear Lesions

Lesions within the Skull and Foramen Magnum Jugular Foramen Syndrome (Vernet Syndrome) and Associated Syndromes Lesions of the Spinal Accessory Nerve within the Neck

Table 13-1: Syndromes Involving Cranial Nerves IX through XII Table 13-2: Etiologies of the Floppy Head or Dropped Head Syndrome

References

Chapter 14: Cranial Nerve XII (The Hypoglossal Nerve)

Anatomy of Cranial Nerve XII (The Hypoglossal Nerve) Clinical Evaluation of Cranial Nerve XII Localization of Lesions Affecting Cranial Nerve XII

Supranuclear Lesions Nuclear Lesions and Intramedullary Cranial Nerve XII Lesions Peripheral Lesions of Cranial Nerve XII Abnormal Tongue Movements

Dysarthria

Table 14-1: Motor Speech Disorders

References

Chapter 15: Brainstem

Chapter 15 Introduction Medulla Oblongata

Anatomy of the Medulla Vascular Supply of the Medulla

Paramedian Bulbar Branches Lateral Bulbar Branches

Medullary Syndromes

Medial Medullary Syndrome (Dejerine’s Anterior Bulbar Syndrome) Lateral Medullary (Wallenberg) Syndrome Opalski (Submedullary) Syndrome Lateral Pontomedullary Syndrome

Figure 15-1 Figure 15-2 Figure 15-3 Table 15-1: Ocular Motor Abnormalities in Wallenberg Lateral Medullary Syndrome

The Pons

Anatomy of the Pons Vascular Supply of the Pons

Paramedian Vessels Short Circumferential Arteries Long Circumferential Arteries

Pontine Syndromes

Ventral Pontine Syndromes Dorsal Pontine Syndromes Paramedian Pontine Syndromes Lateral Pontine Syndromes

Figure 15-4

The Mesencephalon

Anatomy of the Mesencephalon Vascular Supply of the Mesencephalon

Paramedian Vessels Circumferential Arteries

Mesencephalic Syndromes

Ventral Cranial Nerve III Fascicular Syndrome (Weber Syndrome) Dorsal Cranial Nerve III Fascicular Syndromes (Benedikt Syndrome) Dorsal Mesencephalic Syndromes Top of the Basilar Syndrome

Figure 15-5 Figure 15-6

References

Chapter 16: The Cerebellum

Anatomy of the Cerebellum

Figure 16-1 Figure 16-2

Vascular Supply of the Cerebellum

Figure 16-3

Clinical Manifestations of Cerebellar Dysfunction

Hypotonia Ataxia or Dystaxia Cerebellar Dysarthria Tremor Ocular Motor Dysfunction Nonmotor Manifestations Table 16-1: Causes of Acute Ataxia Table 16-2: Causes of Episodic/Recurrent Ataxia Table 16-3: Causes of Chronic Ataxia

Cerebellar Syndromes

Rostral Vermis Syndrome Caudal Vermis Syndrome Hemispheric Syndrome Pancerebellar Syndrome

Syndromes of Cerebellar Infarction

Inferior Cerebellar Infarct (Posterior Inferior Cerebellar Artery) Ventral Cerebellar Infarct (Anterior Inferior Cerebellar Artery) Dorsal Cerebellar Infarct (Superior Cerebellar Artery)

References

Chapter 17: The Localization of Lesions Affecting the Hypothalamus and Pituitary Gland

Anatomy of the Region

Main Hypothalamic Nuclear Groups Connections of the Hypothalamus Figure 17-1 Figure 17-2 Table 17-1: Connections of the Human Hypothalamusa Figure 17-3

Clinical Manifestations of Hypothalamic or Pituitary Dysfunction

Disturbances of Temperature Regulation

Physiologic Rhythms Hypothermia Hyperthermia Neuroleptic Malignant Syndrome Poikilothermia

Disturbances of Alertness and Sleep

Coma, Hypersomnia, or Akinetic Mutism Narcolepsy Insomnia Circadian Abnormalities

Autonomic Disturbances

Cardiac Manifestations Respiratory Abnormalities Gastrointestinal Abnormalities Diencephalic Epilepsy Unilateral Anhidrosis or Hyperhidrosis

Disturbances of Water Balance

Diabetes Insipidus (Decreased ADH Release but Normal Thirst) Essential Hypernatremia (Decreased ADH Release with Absence of Thirst) Inappropriate Secretion of ADH (SIADH) (Elevated ADH Release with Normal Thirst) Reset Osmostat Hyponatremia Primary Polydipsia or Hyperdipsia (Excessive Water Drinking in the Absence of Hypovolemia or Hypernatremia)

Disturbances of Caloric Balance and Feeding Behavior

Obesity Emaciation

Disturbances of Reproductive Functions

Hypogonadotropin Hypogonadism Nonpuerperal Galactorrhea Precocious Puberty Excessive or Uncontrollable Sexual Behavior

Other Endocrine Disturbances Disturbances of Memory Disturbances of Emotional Behavior and Affect

Rage and Fear: Inappropriately Dysinhibited Behavior Apathy: Chronic Fatigue Depression

Gelastic Seizures Headache

Episodic Headaches

Chronic Pain Impaired Visual Acuity, Visual Field Defects Diplopia: Pupillary Changes Table 17-2: Clinical Manifestations of Hypothalamic or Pituitary Dysfunction Table 17-3: Presenting Complaints in 1,000 Cases of Pituitary Adenoma

Clinical Findings Resulting from Lesions in Various Areas of the Hypothalamus and in the Pituitary Gland

Table 17-4: Clinical Findings with Lesions in Various Regions of the Hypothalamus or in the Pituitary Gland

References

Chapter 18: The Anatomic Localization of Lesions in the Thalamus

Functional Anatomy of the Thalamus

Table 18-1: Source and Destination of Thalamic Connectionsa Figure 18-1

Vascular Supply of the Thalamus

Table 18-2: Vascular Supply of the Thalamus Figure 18-2

Localization of Ischemic Thalamic Lesions

Paramedian Territory Thalamogeniculate (Lateral Thalamic or Inferolateral Thalamic) Territory Tuberothalamic (Anterolateral Thalamic) Territory Territory of the Posterior Choroidal Arteries

Clinical Manifestations of Lesions in the Thalamus

Disturbances of Alertness Autonomic Disturbances Disturbances of Mood and Affect Memory Disturbances

Impaired Time Perception

Sensory Disturbances

Paresthesias and Pain Loss of Sensory Modalities

Motor Disturbances

Postural Disturbances Disturbances of Ocular Motility

Disturbances of Complex Sensori-Motor Functions Disturbances of Executive Function

Topographic Localization of Thalamic Lesions

Anterior Thalamic Region Medial Thalamic Region Ventrolateral Thalamic Region Posterior Region

References

Chapter 19: Basal Ganglia

Anatomy of the Basal Ganglia

Inputs into the Striatum (Caudate and Putamen)

Cortical Projections to the Neostriatum Thalamostriatal Projections Nigrostriatal Projections Raphe Nuclei-Striatal Projections

Striatal Efferents Pallidal Afferents and Efferents Nigral Afferents and Efferents Figure 19-1 Figure 19-2

Lesions of the Basal Ganglia Dyskinesias

Chorea Tardive Dyskinesia and Other Tardive Syndromes Orofacial Dyskinesia Abdominal Dyskinesias Ballismus Akathisia Athetosis Dystonia Torticollis

Writer’s Cramp, Musician’s Dystonia, the Yips, and Other Focal Dystonias Blepharospasm Spasmodic Dysphonia

Paroxysmal Dyskinesias Myoclonus Painful Legs and Moving Toes Restless Legs Syndrome and Periodic Limb Movements of Sleep Tics Tremor Table 19-1: Causes of Chorea Table 19-2: Differential Diagnosis of Orofacial Dyskinesia Table 19-3: Classification of Dystonias Table 19-4: Classification of Dystonia Table 19-5: Classification of Myoclonus

Hypokinetic and Bradykinetic Disorders

Parkinsonism Stiff-Man (Stiff-Person) Syndrome Cortical-Basal Ganglionic (Corticobasal) Degeneration Progressive Supranuclear Palsy (Steele–Richardson–Olszewski Syndrome) Lewy Body Dementia Multiple Systems Atrophy Paraneoplastic Movement Disorders

References

Chapter 20: The Localization of Lesions Affecting the Cerebral Hemispheres

Chapter 20 Introduction Anatomy of the Cerebral Hemispheres

Figure 20-1 Figure 20-2 Figure 20-3 Figure 20-4 Table 20-1: Cerebral Hemispheric Connections Figure 20-5 Figure 20-6

Symptoms and Signs Caused by Cerebral Hemispheric Lesions

Vegetative Disturbances Disturbances of Attention

Unilateral Inattention Nonspatial Inattention

Emotional Disturbances Memory Disturbances Sensory Disturbances

Smell and Taste Vision Disturbances in the Processing of Auditory Information Disturbances of Somatosensory Perception

Disturbances of Sensorimotor Integration and of Movement Execution (Parietal, Frontal)

Apraxias Other Motor Disturbances of the Extremities or Face

Other Motor Disturbances

Motor Disturbances of Language Disturbances of Goal-Oriented Behavior (Executive Function Loss) Disturbances Related to Interhemispheric Disconnection (Callosal Syndrome) Gait Disorders Dementia

Table 20-2: Clinical Manifestations of Cerebral Hemispheric Lesions Figure 20-7 Figure 20-8 Figure 20-9 Figure 20-10 Figure 20-11 Figure 20-12 Figure 20-13 Figure 20-14 Figure 20-15 Table 20-3: Classification of the Aphasias Figure 20-16 Figure 20-17 Figure 20-18 Figure 20-19 Table 20-4: Clinical, Anatomic, Molecular, and Genetic Findings in Dementing Disorders Table 20-5: Clinical Features Differentiating Pseudo-Dementia from Dementia Table 20-6: Consequences of Localized Cerebral Hemispheric Lesions

References

Chapter 21: Localization of Lesions in the Autonomic Nervous System

Organization of the Autonomic Nervous System

Sympathetic Nervous System Parasympathetic Nervous System Enteric Nervous System

Central Autonomic Network Medial Prefrontal Cortex Insular Cortex Central Nucleus of the Amygdala Hypothalamus Periaqueductal Gray Region Parabrachial Nuclear Complex Nucleus Ambiguus Nucleus Tractus Solitarius Localization Principles

Figure 21-1 Table 21-1: Basic Characteristics of Sympathetic and Parasympathetic Systems Table 21-2: Main Effects of Diffuse Sympathetic Stimulation Table 21-3: Main Effects of Cholinergic Stimulation Table 21-4: Cardinal Signs of Autonomic Dysfunction Table 21-5: Clinical Presentation of Autonomic Disorders

References

Chapter 22: Vascular Syndromes of the Forebrain, Brainstem, and Cerebellum

Arterial Blood Supply

The Internal Carotid Artery The Anterior Choroidal Artery The Anterior Cerebral Artery The Middle Cerebral Artery The Posterior Cerebral Artery Collateral Circulation Figure 22-1 Figure 22-2 Figure 22-3

Syndromes of the Cerebral Arteries

Transient Ischemic Attacks The Carotid Artery Syndrome The Anterior Choroidal Artery Syndrome The Anterior Cerebral Artery Syndrome The Middle Cerebral Artery Syndrome

Vertebrobasilar Artery Syndromes of the Brainstem and Cerebellum The Posterior Cerebral Artery Syndrome Syndromes of Thalamic Infarction Border Zone Ischemia

Table 22-1: Symptoms of Transient Ischemic Attacks Table 22-2: Microemboli in Carotid Artery Syndrome Figure 22-4

Lacunar Infarcts Cerebral Hemorrhage Syndromes

General Features of the Clinical Syndrome Specific Signs by Location

Putaminal Hemorrhage Lobar Hemorrhage Thalamic Hemorrhage Cerebellar Hemorrhage Pontine Hemorrhage Caudate Hemorrhage Mesencephalic Hemorrhage Lateral Tegmental Brainstem Hemorrhage Medullary Hemorrhage Internal Capsular Hemorrhage Intraventricular Hemorrhages

Table 22-3: Etiologies of Spontaneous Intracerebral Hemorrhage

Syndromes Related to Cerebral Aneurysms

Cavernous Internal Carotid Artery Aneurysms

Unruptured Cavernous Internal Carotid Artery Aneurysm

Posterior Communicating Artery Aneurysms Middle Cerebral Artery Aneurysms Vertebrobasilar Territory Aneurysms

Subarachnoid Hemorrhage References

Chapter 23: The Localization of Lesions Causing Coma

Chapter 23 Introduction The Unresponsive Patient

Exhibit 343

Anatomic Substrate of Alertness

Figure 23-1

Signs with Localizing Value in Coma

Respiratory Patterns

Posthyperventilation Apnea Cheyne–Stokes Respiration Hyperventilation with Brainstem Injury Apneustic Breathing Cluster Breathing Ataxic Breathing “Ondine’s Curse”

Temperature Changes The Pupils Eye Movements

Abnormalities of Lateral Gaze Abnormalities of Vertical Gaze

Motor Activity of the Body and Limbs Figure 23-2 Figure 23-3 Figure 23-4 Table 23-1: Spontaneous Eye Movements in Comatose Patients Figure 23-5

Clinical Presentations of Coma-Inducing Lesions Depending on Their Location

Metabolic Encephalopathy (Diffuse Brain Dysfunction) Supratentorial Structural Lesions

Lateral Herniation Central Herniation

Subtentorial Structural Lesions Psychogenic Unresponsiveness Figure 23-6 Figure 23-7 Figure 23-8 Figure 23-9

Diagnosis of Death Caused by Brain Destruction

Figure 23-10 Table 23-2: Determination of Irreversible Cessation of Brain Function in Infants and Children

References

Appendix

Remarks Glossary

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