Clinical Neurology: A Primer

Front Cover
......Page 1
Clinical Neurology......Page 4
Copyright
......Page 5
Contents......Page 6
Foreword......Page 10
Preface......Page 12
Acknowledgements......Page 14
Reviewers......Page 16
chapter 1 - Clinically Oriented Neuroanatomy:
......Page 18
CONCEPT OF THE MERIDIANS OF LONGITUDE 
AND PARALLELS OF LATITUDE......Page 19
THE MERIDIANS OF LONGITUDE: LOCALISING THE PROBLEM ACCORDING TO THE DESCENDING MOTOR AND ASCENDING SENSORY PATHWAYS......Page 21
THE PARALLELS OF LATITUDE: FINDING THE SITE 
OF PATHOLOGY WITHIN THE STRUCTURES OF THE CENTRAL AND PERIPHERAL NERVOUS SYSTEMS......Page 28
REFERENCES......Page 46
chapter 2 - The Neurological History......Page 48
THE UNDERLYING PATHOLOGICAL PROCESS: MODE OF ONSET, DURATION AND PROGRESSION OF SYMPTOMS......Page 50
THE NATURE AND DISTRIBUTION OF SYMPTOMS......Page 52
PAST HISTORY, FAMILY HISTORY AND SOCIAL HISTORY......Page 58
THE PROCESS OF TAKING THE HISTORY......Page 59
REFERENCES......Page 60
THE MOTOR EXAMINATION......Page 61
THE SENSORY EXAMINATION......Page 77
EXAMINING CEREBELLAR FUNCTION......Page 82
CLINICAL CASES......Page 83
REFERENCES......Page 85
THE OPTIC NERVE, CHIASM, RADIATION AND THE OCCIPITAL CORTEX......Page 86
THE 3RD, 4TH AND 6TH CRANIAL NERVES......Page 90
CONTROL OF EYE MOVEMENTS, THE PUPIL AND EYELID OPENING: SYMPATHETIC AND PARASYMPATHETIC INNERVATION OF THE PUPIL AND EYELID......Page 94
THE TRIGEMINAL (5TH) NERVE......Page 96
THE FACIAL (7TH) NERVE......Page 98
THE GLOSSOPHARYNGEAL (9TH) NERVE......Page 100
THE VAGUS (10TH) NERVE......Page 102
THE HYPOGLOSSAL (12TH) NERVE......Page 103
THE ‘RULE OF 4’ OF THE BRAINSTEM......Page 104
REFERENCES......Page 112
THE FRONTAL LOBES......Page 113
THE PARIETAL LOBES......Page 115
THE CEREBELLUM......Page 122
THE TEMPORAL LOBES......Page 123
TESTING HIGHER COGNITIVE FUNCTION......Page 124
REFERENCES
......Page 126
LEVEL OF CERTAINTY OF DIAGNOSIS......Page 127
AVAILABILITY OF TESTS TO CONFIRM OR EXCLUDE CERTAIN DIAGNOSES......Page 132
THE POSSIBLE COMPLICATIONS OF TESTS......Page 134
SEVERITY AND URGENCY: THE POTENTIAL CONSEQUENCES OF A PARTICULAR ILLNESS NOT BEING DIAGNOSED AND TREATED......Page 135
THE BENEFIT VERSUS RISK PROFILE OF ANY POTENTIAL TREATMENT......Page 136
REFERENCES......Page 137
THE HISTORY AND INTERMITTENT DISTURBANCES......Page 139
GENERAL PRINCIPLES OF CLASSIFICATION OF INTERMITTENT DISTURBANCES......Page 144
EPISODIC DISTURBANCES WITH FALLING......Page 145
FALLING WITHOUT LOSS OF CONSCIOUSNESS......Page 148
EPISODIC DISTURBANCES WITHOUT FALLING......Page 150
REFERENCES......Page 160
CLINICAL FEATURES CHARACTERISTIC OF EPILEPSY......Page 163
CONFIRMING THAT THE PATIENT HAS HAD A SEIZURE OR SUFFERS FROM EPILEPSY......Page 164
CHARACTERISATION OF THE TYPE OF SEIZURE......Page 167
ASSESSING THE FREQUENCY OF SEIZURES......Page 173
ESTABLISHING AN AETIOLOGY......Page 174
DECIDING WHETHER TO TREAT OR NOT......Page 175
CHOOSING THE APPROPRIATE DRUG, DOSE AND ONGOING MONITORING OF THE RESPONSE TO THERAPY......Page 176
ADVICE REGARDING LIFESTYLE......Page 177
CONSIDERATION OF SURGERY IN PATIENTS WHO FAIL TO RESPOND TO DRUG THERAPY......Page 179
COMMON TREATMENT ERRORS......Page 180
REFERENCES......Page 181
chapter 9 - Headache and Facial Pain......Page 185
WHAT QUESTIONS TO ASK......Page 187
A SINGLE (OR THE FIRST) EPISODE OF HEADACHE......Page 192
RECURRENT HEADACHES......Page 199
WHEN TO WORRY......Page 208
INVESTIGATING HEADACHE......Page 209
FACIAL PAIN......Page 210
REFERENCES......Page 213
MINOR STROKE OR TRANSIENT ISCHAEMIC ATTACK: 
DOES THE DEFINITION MATTER?......Page 218
PRINCIPLES OF MANAGEMENT......Page 219
DECIDING THE PROBLEM IS CEREBRoVASCULAR DISEASE......Page 220
DIFFERENTIATING BETWEEN HAEMORRHAGE AND ISCHAEMIA......Page 222
HAEMORRHAGIC STROKE......Page 223
ISCHAEMIC CEREBRoVASCULAR DISEASE......Page 225
THREE STROKE SYNDROMES THAT SHOULD NOT BE MISSED......Page 232
THREE OF THE ‘MORE COMMON’ RARER CAUSES OF STROKE, PARTICULARLY IN THE YOUNG......Page 233
MANAGEMENT OF ISCHAEMIC CEREBROVASCULAR DISEASE......Page 235
MANAGEMENT OF ACUTE ISCHAEMIC STROKE......Page 236
URGENT MANAGEMENT OF SUSPECTED TIA OR MINOR ISCHAEMIC STROKE......Page 239
SECONDARY PREVENTION......Page 241
MANAGEMENT OF PATIENTS WITH ANTICOAGULATION-ASSOCIATED INTRACRANIAL HAEMORRHAGE......Page 243
REFERENCES......Page 244
chapter 11 - Common Neck, Arm 
and Upper Back Problems......Page 249
NECK PAIN......Page 250
PROBLEMS AROUND THE SHOULDER AND UPPER ARM......Page 252
PROBLEMS IN THE FOREARMS AND HANDS......Page 259
REFERENCES
......Page 273
BACK PAIN......Page 276
PROBLEMS IN THE UPPER LEG......Page 277
PROBLEMS IN THE LOWER LEGS AND FEET......Page 281
REFERENCES
......Page 295
DIFFICULTY WALKING......Page 298
ABNORMAL MOVEMENTS......Page 310
REFERENCES......Page 319
ASSESSMENT OF PATIENTS WITH A DEPRESSED 
CONSCIOUS STATE......Page 322
ASSESSMENT OF THE CONFUSED OR DEMENTED PATIENT......Page 327
DISORDERS OF MUSCLE AND THE NEUROMUSCULAR JUNCTION......Page 332
MULTIPLE SCLEROSIS......Page 340
MALIGNANCY AND THE NERVOUS SYSTEM......Page 343
INFECTIONS OF THE NERVOUS SYSTEM......Page 347
REFERENCES
......Page 349
KEEPING UP-To-Date......Page 353
RETRIEVING USEFUL INFORMATION FROM THE INTERNET......Page 356
GENERAL NEUROLOGY WEBSITES......Page 359
WEBSITES RELATED TO THE MORE COMMON NEUROLOGICAL PROBLEMS......Page 360
MAJOR NEUROLOGY JOURNAL WEBSITES......Page 362
RESOURCES FOR PATIENTS......Page 363
REFERENCES......Page 365
Appendices......Page 367
appendix A
......Page 368
appendix B......Page 370
appendix C......Page 372
appendix D......Page 377
appendix E......Page 379
appendix F......Page 386
appendix G......Page 387
appendix H......Page 390
appendix I......Page 395
Glossary
......Page 397
A
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C
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D
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E
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F
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H
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I
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L
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M
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N
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P
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R
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S
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T
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U
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W
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Z
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Colorplates
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