Bedside Neurology: Clinical Approach Biman Kanti Ray
INDEX
Page numbers followed by f refer to figure, fc refer to flowchart, and t refer to table.
A
ABC system 45t
Abdomen, muscle of 24
Abduction 18
Abductor 28
digiti minimi 22, 22f, 23
pollicis
brevis 19, 20, 20f
longus 19, 19f
Abscess 80
epidural 86
Achromatopsia 224fc
Acid maltase deficiency, adult-onset 42
Acquired communication disorder 208
Adduction 18
Adductor 28, 84
brevis 28
longus 25, 28
magnus 28
pollicis 21, 21f
Adrenoleukodystrophy 80
Adrenomyeloneuropathy 54
Agnosia 220, 228fc, 229
apperceptive 223fc
associative 223fc
auditory 226
object 229fc
test for 229
word 229fc
Agraphia 219, 219f
Air conduction 150
Akinetic rigid state 240
Alcohol 54
Alexander's law 154
Alexia 218, 219, 219f
central 219
types of 218fc
with agraphia, localization of 220f
Alpha-gamma linkage 5
Alzheimer's disease 107, 217, 237, 243
Ammonia 107
Amyloidosis 54
Anal reflex 33, 34
Anisocoria 131, 132
Ankle 84
clonus 8
joint 28
plantar flexion 27
jerk 6, 31, 31f, 48, 79
Anosmia, causes of 107
Anosognosia 222
Anterior cord syndrome 79
Anterior horn
cell 4, 42, 43, 57, 73, 81, 88, 92, 104
alpha motor neurons of 9
disease 61, 94
Anterior spinal artery 76
infarction 79
thrombosis 82
Anterior visual pathway 118
lesion, examples of 118
Aphasia 206209, 224fc
agrammatic primary progressive 217
global 208
primary progressive 216, 217
type of 208
Apraxia 226
buccofacial 228
conceptual 227
constructional 225
dressing 225
ideational 227, 227fc, 228
ideomotor 227, 227fc, 228
test 228
constructional 225
dressing 225
types of 226
Arachnoid mater 71
Archicerebellum 166, 167
Arcuate fasciculus 216
Arcuate scotoma 111f
Areflexia 58, 80
global 48
Arnold Chiari malformation 165
Arteriovenous fistula, dural 82
Arteriovenous malformation 78, 88
Astereognosis 104, 232
Astigmatism 136
Asymmetric progressive course, subacute 59
Ataxia 166, 171, 176, 241
acute 178
chronic 178
etiologies for 178t
evaluation of 179fc
frontal 176
subacute 178
Atlantoaxial sublaxation 94
Atrophy 39, 48, 79
Auditory pathway 147
Autonomic dysfunction
presence of 194
symptoms of 48
Autonomic function tests 191
Autonomic nervous system 48
B
Babinski's response 34, 81
Babinski's sign 35
Babinski's trunk-thigh test 10
Back extensors, weakness of 39
Balint syndrome 225
Barrington's nucleus 64
Basal ganglia 9, 185, 186, 198, 199
circuitry 186, 186fc
components of 185f
disorder 200, 205
neurotransmitters 187
speech 249
Becker's muscular dystrophy 44
Bell's palsy 146
Bell-Magendie law 5
Biceps 16, 16f, 23
femoris, two heads of 26
jerk 29, 29f
Bihemispheric lesion 92, 93
Binocular diplopia 136
Bladder 63
activity, phases of 65, 65t
automatic 66
autonomous 67
capacity 66
control activity of 63
dysfunction 67fc
symptoms 66
innervation 64f
neck closure and emission 68
neurological control of 65
sensation 66
symptoms 97
upper motor neuron type of 79, 97, 99
Blind spot 108110
Blood vessels 113, 115
Bone
conduction 150
corpuscles 115
Bostan's plexus 71
Botulism 42
Brachioradialis 16, 16f, 23
Bradykinesia 187, 188, 191, 249
manifestations of 188
Bradyphrenia 190
Brain 6, 65, 100, 205
centers, higher 68
iron accumulation 193
level of 49
Brainstem 6, 45, 46, 46fc, 99, 100, 169t, 199, 204, 205
circuits 199
lesion 92, 142, 151
level of 49
localization 104
part of 164, 170
Breathing, abdominal 24
Brightness test 117
Broca's aphasia 208, 209, 215
Brown-Séquard syndrome 49, 49f, 78, 104
Brun's nystagmus 134
Bulbar muscle 44
weakness 35
Bulbar palsy 159, 159t, 165
Bulbar weakness 42
Burning 48
Burst neurons 123
C
Calcarine cortex 110
Calf hypertrophy 44
Callosal apraxia 228
Caloric tests 153
Canal paresis 153
Carbohydrate metabolism disorder 37
Card test 21
Caries spine 82, 86, 88
Carotid nerve 155
Cataplexy 201
Cataract 136
Cauda equina
characteristics of 81t
syndrome 81, 88
Cavernous sinus 123, 130, 131138
Cell
body 74, 75
lies 71
types of 169
Central cord
lesion 50
syndrome 78
Central lumber disc collapse 82
Central nervous system, parts of 45
Cerebellar
artery, superior 121
ataxia 182, 202
differential diagnosis of 177
circuitry 169, 171fc
cortex 169
disease 174
signs of 171
symptoms of 171
disorder 200, 207
dysarthria 207
hemisphere 168
lesion 173
nystagmus 175, 176t
origin, primary 177
pathology 191
peduncle
middle 169
superior 169
peduncles 168
inferior 169
pairs of 169t
region, midline 182
signs 57, 59, 61
stroke 153
tremor 174
white matter 169
Cerebellopontine angle 134, 144
lesions 151
Cerebellum 2, 3, 9, 85, 88, 97, 148, 153, 166, 178t, 199, 240
anatomy 167f
bedside examination of 173
circuit 199
connection of 169t
examination 99
organization of 168
physiologic neuroanatomy of 166
Cerebral
cortex 9, 12, 45, 46, 148
lesion 92, 104, 151
Cerebrocerebellum 168
Cerebrospinal fluid 60, 71, 92
Cervical
cord 42, 142
lateral column of 104
lesion 78, 94, 104
ganglia, middle 127
myelopathy 99
features suggestive of 91
myeloradiculopathy 80
region
lower 70
upper 70
spondylotic myelopathy 79
Chaddock's reflex 35
Charcot joints 79
Charcot-Marie-tooth disease 49
Chemotherapy toxicity 79
Chiari malformation 94, 178
Chiasma 108, 118
Chorda tympani, origin of 146
Chorea 162
Chronic inflammatory demyelinating
polyneuropathy 54
polyradiculoneuropathy 59
Cisternal segment 144, 146
Clarke's column 74, 75
Clavicular head 15
pectoralis major 15f
Clonus
and clasp-knife phenomenon 8
prerequisites of 8
Cochlear nerve
clinical examination of 149
lesion 151
Cochlear nucleus 147
Cogan's lid twitch sign 129
Cognitive deficit, multimodal 240
Color
anomia 224fc
disorders of 224
Communication disorders 206, 208
signs 206
symptoms 206
Compressive lesion 82, 82t, 93
Conceptual apraxia sample test 227fc
Conductive hearing loss, causes of 150
Congenital myopathy 42
muscular dystrophy 42
Consciousness, level of 153
Contralateral internal capsule lesion 104
Conus medullaris 81
syndrome 80, 81
characteristics of 81t
Copper 80
deficiency 54, 79
Cord compression 78
Corneal reflex 141, 141t, 145
Corona radiata 101
Corpus callosum damage, splenium of 219f
Cortex, division of 169t
Cortical sensations 52
Corticobasal degeneration 187, 193, 240
Corticobasal syndrome 247f
Corticospinal system 101
Corticospinal tract 3, 76, 91, 92, 100, 101, 102f, 167, 168
bilateral 100, 183
fiber, functions of 103
involvement 80
lesion, clinical manifestation of 103
pathways 11
Cotton wool spots 115
Cramp 36, 37, 48
Cranial fibers 160
Cranial motor nuclei 79
Cranial nerve 2, 106, 121123, 140, 160, 190, 196
causes of 130t-132t
examination of 59, 108
lesions 129
localization of 142
localization of 130t, 131t, 132t
multiple lower 159t
palsy, multiple 164
Cranial neuropathies 106
Cremasteric reflex 33
Creutzfeldt-Jakob disease 238f, 240242
Cricothyroid 157
Cryoglobulinemia 54
Cuneocerebellar tract 76, 167
Cytomegalovirus 54
infection 80
D
Dandy-Walker malformation 178
Deafness
conductive 149, 150
pure word 229
Deep pain sense 52
Deep tendon 29
reflex 57, 58, 84, 86, 87, 96, 99, 179, 181
interpretation of 32
Deltoid 13, 14f
Dementia 210, 240, 243, 251
cortical 237, 238, 238t, 243
history of 2
mixed 243
problems in 229
subcortical 237, 238, 238t
vascular 243
Dentate nucleus 171
Dentate-rubro-thalamic-fibers 182
Denticulate ligaments 71
Depression 238
Dermatomyositis 42
Desire, loss of 69
Detrusor hyperreflexia 66
Detrusor sphincter dyssynergia 66, 78
Diabetes 54
history of 193
mellitus 54, 56, 58, 242
Diaphragm 23
Diaphragmatic weakness, symptoms of 36
Diathesis, hemorrhagic 82
Diencephalon 185
Diplopia
bedside evaluation of 136, 137fc
pure vertical 136
Disc
color of 114
herniation 67, 79
intervertebral 72
margin of 114
prolapse 88
Distal interphalangeal joint 23
Distal limb muscles 74
Diurnal variation, history of 201
Dix-Hallpike maneuver 154
Doll's eye test 152
Dorsal
funiculi 74
horn gray matter 75
interossei 2123
occipito-temporal lesion 118
pons 132
premotor cortex 227
root ganglia 45, 46, 74
simultanagnosia 225
stream pathway, disorders of 224, 224fc
Dorsiflexion 84
Dorsolateral prefrontal cortex, functions of 231f
Duchenne muscular dystrophy 39, 42
Dynamic stretch reflex 7
Dysarthria 206, 208, 209, 249
Dysautonomia 190
Dysdiadochokinesia 173, 174, 181
Dysesthesia 80
painful 48
Dyskinesia 162, 191
Dyslexia
deep 219fc
surface 219fc, 245
Dysmetria 174
Dysphagia 147, 196, 203, 204, 206
Dysphonia 206, 207
Dyssynergia 174
E
Eaton-Lambert syndrome 42
Edinger-Westphal nuclei 121, 126
Eight and half syndrome 145
Ejaculation
physiology of 68, 69fc
two components of 68
Elbow 23
flexion of 30
joint 23
muscle of 16
Encephalopathy, autoimmune 240
Energization, test of 230
Epileptic drop attacks 201
Episodic memory 214
assessment 215
Erectile dysfunction 69, 81, 88
Exacerbation, exercise-related 36
Exaggerated supinator jerk 30
Executive functions
localization of 212, 212t
tests for 213
Extensor abductor 84
Extensor carpi
radialis 17f
longus and brevis 23
ulnaris 16, 17f, 23
Extensor digiti minimi 23
Extensor digitorum
brevis 27, 28f, 60
communis 23
longus 27, 28
Extensor hallucis
brevis 27
longus 27, 28, 28f
Extensor indicis proprius 23
Extensor plantar response 34
Extensor pollicis
brevis 19, 20, 20f
longus 19, 19f
Extorsion 120
Extramedullary lesion 82t, 142
Extraocular muscles 119
action of 120, 120t
Extrapyramidal disease 10
Extrapyramidal system 11
neuroanatomy of 185
physiology of 185
Eye
hypotropic 135
intorts, hypertropic 135
misalignment of 136
movement 126f
abnormal spontaneous 133, 134fc
functional classification of 121fc
normal 136
Eyelid function, disorders of 129
F
Fabry's disease 54
Face
dyskinesia of 205
recognition disorders 224
Facial
colliculus 123
expression, loss of 188
lesion 145
nerve 142, 144
branch 146
course of 143f, 144
genu of 142
reflex, examination of 145
nucleus 145
weakness, prominent 42
Facioscapulohumeral muscular dystrophy 42
Fascicle
involvement 132
segment 144
Fascicular portion 162
Fasciculation 37, 48, 79, 162
presence of 80
Fasciculus 121
medial longitudinal 148
Fatigue 36
Fatty acid metabolic disorder 37
Femoral nerve 26, 31
Fibers
annulospiral 4
ascending 140
extrafusal 4
intrafusal 4
mediating facial sweating 127
neuropathy, large 54
outgoing 169
types of 46, 54, 57
Filum terminale 71
Fingers
abduction of 23
adduction of 21, 23
extension of 23
flexion of 23
movement of 23
muscle of 21
nose-finger test 174
to nose test 181
First order neuron 74, 75, 127, 147
cell body of 75
Flaccid
bladder 67, 80
weakness 79
Flexes middle phalanges 17
Flexing knee 25
Flexion 18, 23
Flexor 28, 84
digitorum
longus 28
superficialis 18f, 23
muscles 74
reflex 7
bilateral 184
carpi radialis 17, 17f, 23
digitorum profundus 17, 18, 18f, 23
carpi ulnaris 17, 23
pollicis
brevis 19, 20
longus 19, 20, 20f
Floccular lesions 167
Flocculonodular lobe 167
Flower's spray endings 4
Fluent aphasia 245
Foley's catheter 86
Foot
dorsiflexors 80
eversion 27
inversion 27
muscle of 27
small muscles of 60
Foramen
magnum, region of 92
muscle of 16
Foster-Kennedy syndrome 107
Fovea 120
Frenzel glasses 154
Froment's maneuver 10
Frontal lobe 212, 230
functions 230f
tests for 232
gait 202
Frontal subcortical-thalamic circuit 243
Frontotemporal lobar degeneration 217
Fundoscopy 180
Fundus 184
G
Gag reflex 158
bilateral loss of 158
hyperactive 158
unilateral loss of 158
Gait 2, 39
abnormality 189
ataxia 171, 182, 184
cycle 198
disorder 198, 200202
high level 200
low level 200
middle level 200
examination of 201
measurement 199
mechanism of 198
neural control of 199
unsteadiness of 182
Gamma
aminobutyric acid 187
loop 12
motor neurons 73
neuron 8
Ganglion, distribution of 139
Gas 1
Gasserian ganglion 139
Gastric bypass 56
Gastrocnemius 27, 27f, 28
Gastrointestinal tract 88
Gegenhalten paratonia 10
Geniculate body, lateral 108
Genioglossus 162
Gerstmann syndrome 232
Girdle sensation 85
Glabella 190
Glabellar reflex 141, 145
Glioma 94
Glossopharyngeal nerve 155, 156f
course of 155
lesions of 159
Gluteal nerve, superior 25
Gluteus
maximus 25f, 28
medius 25, 28
minimus 28
Glycogen storage disease 42
Golgi cells 169
Golgi tendon
organs 8, 9
reflex 8
Gordon reflex 35
Gradenigo's syndrome 146
Granule cells 169
Graphesthesia 53
Gray matter columns 73
Great toe, muscle of 27
Gruber ligament 123
Guillain-Barré syndrome 42, 54, 67, 81, 205
Guillain-Mollaret triangle 171, 174
Gyrus 233
H
Hallucinations, auditory 226
Hammer toes 48
Hands
clawing of 23, 48
muscle of 21
small muscles of 99
Hard exudates 115
Head posture, abnormal 138
Head thrust test 152
Headache 81
Hearing loss 133, 149, 154
clinical assessment of 149
Heel-knee-shin test 174, 181
Hematoma, epidural 82
Hematomyelia 78, 82, 86
Hemianopia 112
bitemporal 111f
heteronymous 112
homonymous 111f, 112
Hemicord 78
lesion 78
Hemiparesis 101, 104, 200
causes of 105
Hemiplegia 101, 104
causes of 105
Hemisensory impairment 49f
Hemorrhage
blot 115
flame 115
subhyaloid 115
Hepatic disease, severe 54
Hering's law 121
Herpes zoster 54
Herring, nerve of 155
Heschl's gyrus 233
High cervical cord 92
lesion 42, 92, 94
Hip 84
abduction 28
abductor weakness 39
adductor 25, 25f
and knee flexors 80
extensor 39
external rotation of 25
flexors 88
girdle 39
muscle of 24
prominent weakness of 42
internal rotation of 25
joint 28
weakness of 39
Hoffmann reflex 32
Holmes rebound test 173
Horn cell, combined anterior 80
Horner's syndrome 123, 132, 177
ipsilateral 78
second order 133
third order 133
Human immunodeficiency virus 54, 80, 243, 251, 252
infection 54
Human T-cell leukemia virus 94
Hung reflex 33
Huntington's disease 212
Hydrocephalus, normal pressure 189, 243
Hyoglossi 162
Hyperkinetic movement disorder 202
Hypermetria 174
Hyperreflexia 80
Hypertension, history of 193
Hypertonia 10
Hypertrophy 39
mild 39
severe 39
Hypertropia, contralesional 135
Hypoglossal nerve 162
Hypomimia 194
Hyporeflexia 58, 80
Hypothalamic disease 69
Hypothalamus 214fc
Hypotonia 10, 58, 61, 86, 172
I
Illiopsoas 24, 24f, 28
Impulse control disorders 190
Infection 54
Infraspinatus 13, 14f
Inherited enzymatic defect 252
Injury, hyperextension 78
International Continence Society 66
Internuclear pathway 123
lesions 129
Interphalangeal joint
extensor of 21
proximal 23
Interspinous ligament 72
Intertransverse ligament 72
Intorsion 120
Intramedullary lesion 82t, 142
Inverse stretch reflex 7, 7f
neural circuitry of 8
Irradiation 7
J
Jacobson's nerve 155
Japanese encephalitis virus 79
Jaw jerk 141
Jendrassik maneuver 5
Joint
contracture, lack of significant 44
position
loss of 48
sense 59, 179
sense 51, 85
swelling 201
K
Kayser-Fleischer ring 190
Kearns-Sayre syndrome 42
Kennedy disease 42, 79
Kidney 88
Knee 84
jerk 6, 31, 31f, 79
inversion of 31
joint 28
muscle of 25
L
Language 190, 215
components of 215
deficit, history of 219
disorder
assessment of 215
test for 220
left hemisphere dominance for 216
localization of 216
problem 236, 248
Laryngeal muscle, weakness of 158
Laryngeal nerve
external 157
internal 157
superior 157
Larynx, elevation of 203
Lathyrism 83
Latissimus dorsi 15, 15f
Left medial occipital cortex 219f
Left optic
nerve 182
neuropathy 183
Leg
pendulousness of 10
rising sign 10
Leprosy 54
Leptomeningeal carcinomatosis 54, 59
Leptomeninges 71
Lesion 40, 82, 93, 233
large 78
level of 66, 104
location of 220
site of 42, 130, 135
Leukemia, acute 54
Levator excursion, normal 119
Levator palpebrae superioris 119
Levodopa responsiveness 191, 195
Lewy body 240
dementia 226
diffuse 243
disease 107
Lexical fluency test 230
Lhermitte's sign 50, 79
Lichtheim's model 215, 216f
Lid retraction 129
Ligaments, posterior longitudinal 72
Ligamentum flavum 72
Light reflex
pathway 125
test for 128
Light touch 50
Limb
afferent 158
ataxia 171
efferent 158
girdle
distribution 44
muscular dystrophy 44
kinetic apraxia 227, 228
muscles, proximal 74
observe deviation of 173
tremulousness of 182
weakness, symptoms of 36
Limbic cortex 234
Limbic lobe 214, 214fc
circuitry 214f
connections of 215f
Limbic system 3
Little finger, abduction of 23
Lobe 230
Loop test 231f
Lordotic posture 24
Lower cranial nerve, presence of 92
Lower extremities, muscle groups of 22, 28
Lower leg ankle, muscle of 26
Lower limb 10, 29, 51, 57, 84, 86, 87, 96, 100
bilateral 246
flexors, greater weakness of 80
involuntary flexion of 98
motor nerves of 81
weakness of 86
Lower lumbosacral nerve roots, distal collection of 81
Lower motor neuron 30, 36, 40t, 43, 57, 67, 82, 91, 103
bladder 66
lesion 80, 98
bilateral 163
paraparesis 81
pattern weakness, bilateral lumbosacral 80
signs 81, 92
Lower urinary tract 63
innervation of 63, 64t
Lumbar cord 81
Lumbar disc disease 80
Lumbricals 21, 21f
Lyme disease 54
Lymphoma 54, 88, 98
M
Macro square-wave jerks 131
Macula 113
Macular sparing
homonymous hemianopia 112f
test for 110
Mandibular division 140
Mandibular nerve 139
Mass reflex 7
Maxillary division 140, 143
McArdle disease 38
Mechanical dysphagia 204
Meckel's cave 139
Medial popliteal nerve 27
Medial prefrontal cortex 230
damage 231fc
Mediates segmental reflex 3
Medical Research Council 13
Medulla 103, 104
Medullary lesion 205
Membranous labyrinth
components of 148fc
transduces sound, anterior part of 147
Memory 234
assessment of 215
dysfunction, history of 214
localization of 215
long-term 213
role in 214
testing 233
types of 213, 213t
long-term 213fc
Meniere's disease 151, 153
Meningeal branch 157
Meninges 71
Meningioma 88, 94, 146
Mental function, higher 2, 58, 184, 250
Mesencephalic nucleus 140
Mesencephalon 185
Metabolic myopathy 42
Metacarpophalangeal joint 23
flexion of 21
Metachromatic leukodystrophy 80
Metastasis 80, 94
Metronidazole 58
Micrographia 188
Micturition
functional neuroanatomy of 63fc
reflex 63, 65fc
Midbrain 103
lesion 164
level 104
locomotor region 199
Middle ear mechanism 149
Migraine 1
Miller-Fisher syndrome 42
Mimic aphasia 216
Mitochondrial disorder 37, 80
Monocular diplopia 136
Mononeuritis multiplex 55
Monosynaptic pathway 7
Morquio disease 94
Motor cortex
primary 3, 101
supplementary 3, 101, 203
Motor function 144
examination of 140, 158
Motor loss 81
Motor neuron 63
disease 42, 81, 83
large diameter alpha 73
segmental lower 77
Motor neuronopathy 61
paraneoplastic subacute 79
Motor neuropathy 54
Motor nucleus 139
Motor paralytic bladder 67
Motor portion 139
Motor root 139
Motor system 2, 48, 58, 84, 85, 96, 184, 196
components of 3
Motor unit level 3, 4
Movement disorders 190
Müller muscle, weakness of 129
Müller's muscle 119, 127
Multifocal motor neuropathy 54, 62
Multifocal neuropathy 53, 54, 61
causes of 61t
Multiple system atrophy 193
Muscle 23, 25, 40, 42, 57, 81, 88
atrophy of 38, 38f
axial 74
disease 39, 44, 88, 92, 94
disorder 42
extensor 74, 80
hypertrophy of 39
location of 74
pain 37
paravertebral 28
prevertebral group of 28
stretch reflexes 29
wasting 80
Muscle fiber 4
elasticity of 9
Muscle power 12, 37, 93
grading of 13
loss of 40
Muscle spindle 4, 4f, 6, 8
neural connection of 4
Muscle tone 8, 9, 9fc, 37
bedside evaluation of 5
significance of 9
Muscle weakness 40
bedside evaluation of 3
differential diagnosis of 43fc
symptoms of 35t
Muscular atrophy, progressive 81
Muscular dystrophy 44, 200
Mutism 206, 208
Myasthenia gravis 42, 129, 142
Myasthenic crisis 42
Myelitis
acute necrotizing 85
acute transverse 85
Myeloma, multiple 98
Myeloneuropathy 80
Myelopathy 98
acute mid-dorsal tranasverse 86
compressive 85, 99
features suggestive of 81
femyelinating 83
signs of 80
Myeloradiculopathy, acute 86
Myerson sign 190
Myoedema 39
Myokymia 37, 48
Myoneural junction 136
Myopathic nerve muscle 41t
Myopathy 142
centronuclear 42
Myotonia 39
Myotonic dystrophy 42
N
Near response, test for 128
Near vision chart 109
Neck
extensors 28
flexors 28
muscle of 28
weakness, symptoms of 35
pain 97
stiffness 92
Neglect, types of 222
Neocerebellum 166, 168
Neoplastic lesion 98
Neoplastic-brain tumour 105
Nerve 1322, 25, 30, 31, 57, 204
Nerve fiber
afferent 45
layer 110
median 17, 20, 21
Nerve lesion 41
localization of 161t, 163t
Nerve root 42, 50, 71, 103
anterior 41, 104
lesion 41
mechanical compression of 54
Nervous system, examination of 96
Neural arch 71
Neural foramina 72
Neuroaxis involvment 239f
Neurocognitive disease 252
Neurofibroma 88, 94
Neuroleptic malignant syndrome 242
Neurological disorders 66
Neurological examination 1
Neuromuscular disorder, symptoms of 35
Neuromuscular disorders 37
Neuromuscular junction 36, 40, 42, 43, 59, 81, 205
disorder 41, 42, 92, 94
Neuromyelitis optica 78, 85
spectrum disorder 105
Neuron
alpha motor 9
integrator 123
internuncial 101
third-order 75, 127
types of 123
Neuropathy
distal acquired demyelinating symmetric 60
hereditary 54, 55
peripheral 59
Noncompressive lesion 82, 82t, 93
Noncompressive myelopathy 85, 94, 99
Noncorticospinal descending motor pathways 76fc
Nonfluent aphasia, progressive 244
Non-Hodgkin lymphoma 54
Nonmotor symptoms 172, 190
Nonsystemic vasculitis 59
Nuclear bag fibers 4
Nuclear chain fibers 4
Nuclear lesions 159
Nuclear portion 162
Nucleus 121
distribution of 139f
dorsalis 74
inferior vestibular 148
proprius 74
Nutritional deficiency 55, 58, 238
Nystagmus 133135, 172, 175
causes of 135
downbeat 172, 175
etiopathology of 135t
gaze-evoked 175
pathophysiology of gaze-evoked 175
periodic alternating 172, 175
peripheral 134
positional 154
rebound 172, 175
spontaneous 154
subtle vestibular 154
upbeat 175
vestibular 154
O
Oaraneoplastic syndromes 55
Obturator nerve 25
Occipital lobe 233
anatomical landmark of 233f
Ocular flutter 131, 175
Ocular media 118
Ocular motility
disturbances 172
test 124
Ocular motor
apraxia 118
control, laws of 121
nerves 119
Ocular muscle weakness 35
Ocular weakness, prominent 42
Oculocephalic reflex 152
Oculomotor abnormalities 172, 175
Oculomotor apraxia 225
Oculomotor dysfunctions
signs of 129
symptoms of 129
Oculomotor system, examination of 124
Oculopharyngeal muscular dystrophy 42
Oculosympathetic fibers 127
Oculosympathetic pathway 127, 128f
Olanzapine, low dose 242
Olfactory bulb 106
Olfactory cortex, primary 106
Olfactory fibers, afferent 106
Olfactory glomeruli 106
Olfactory hallucination, causes of 107
Olfactory nerve 106
Olivary tract 171
Omnipause neurons 123
One and half syndrome 130
Onuf's nucleus 64
Ophthalmic division 140
Ophthalmoparesis, bedside evaluation of 135, 136fc
Ophthalmoplegia, internuclear 129
Ophthalmoscopy, direct 114
Oppenheim's reflex 35
Opponens digiti minimi 22
Opponens pollicis 19, 20, 20f
Optic ataxia 225
Optic atrophy 114, 115f
causes of 115
consecutive 115
Optic cup 114
Optic disc 108, 113
edema, causes of 114
normal 113f
swelling 114
Optic nerve 108
disease 117
head 108, 118
lesion, localization of 118
Optic neuritis 119
sequential anterior ischemic 107
Optic neuropathy
causes of 119
ischemic 119
Optic radiation 108
Optic tract 108
Optokinetic nystagmus 125
Optokinetic pathway 124, 125
disorders of 131
Optokinetic tape 127f
Oral cavity 204
Orbicular oculi reflex 141
Orbicularis oris 145
Orbital apex 130, 131
Orbital space 121
Orbitofrontal cortex, functions of 232f
Orbitofrontal functions 231
Organophosphorus compounds 58
Organophosphorus triorthocresyl phosphate 80
Orientation and attention, tests for 211
Orthostatic hypotension 190
Oscillopsia, history of 133
Otolithic organs 148
Otosclerosis 149
P
Pain 50, 81
Palatal muscle, weakness of 158
Paleocerebellum 166, 167
Palmar interossei 21, 22f, 23
Papez circuit 214
Papilledema 114, 114f
Papillitis 114
Papilloedema 92
Papillomacular bundle 108
Paracentral scotoma 111f
Paralysis, diaphragmatic 24
Paraneoplastic myelopathy 79
Paraneoplastic necrotizing myelopathy 78
Paraneoplastic sensory neuronopathy 79
Paraparesis 70, 200
diagnosis of 83fc
hereditary spastic 79
Paraplegia 86
causes of acute onset 82
chronic 83
Parapontine reticular formation 123
Paraproteinemias 58
Parasagittal meningioma 81
Paraspinal muscle involvement 24
Parasympathetic nervous system 88
Paratonia 11
facilitatory 11
Paravermis 167
Parietal cortex
posterior 3
superior 227, 233
Parietal lobe 232, 233f
damage, left 232
functions of 233f
Parietal lobule, inferior 233
Parkinson disease 187
idiopathic 107, 201, 250
Parkinson plus syndrome 250
Parkinsonian disorders 190
Parkinsonism 185, 191, 192fc, 193fc
lower-body 188
plus syndromes 187
signs of 187
symptoms of 187
syndromes 188
type of secondary 188
Parosmia 107
causes of 107
Past pointing test 181
Patellar clonus 8
Pectoral nerve, medial 31
Pectoral reflex 31
Pectoralis major 15
Pectoralis sternal head 15f
Pedunculopontine nucleus 185, 199
Pelvic muscles, contraction of 68
Pelvic surgery, major 67
Pelvic trauma 67
Pendular knee jerk 32, 175
Penetrating trauma 78
Penile erection
parasympathetic innervation of 68fc
physiology of 68
sympathetic innervation of 68fc
Periaqueductal gray matter 63, 64
Peripheral alexia 218
substrates for 219fc
Peripheral lesion 159
Peripheral nerve 50, 57, 103, 177, 179
disease 45, 53
differential diagnosis of 55fc
signs of 47
symptoms of 47
Peripheral nervous system 45, 68
parts of 45
Peripheral vestibular
ataxia 177
disease 154
disorders 155
nystagmus 176t
system, components of 148
Perisylvian 207
Peroneal nerve
deep 26, 27
superficial 27
Peronei brevis 27
Peronei longus 27, 28
Pes cavus 48
Petroclinoid ligament 123
Petrous space 123
Pharyngeal branch 157
Pharyngeal muscle, weakness of 158
Photo stress recovery test 117
Physiological sexual function 68
Pia mater 71
Pill-rolling rest tremor 195
Pin hole test 117
Pisa sign 189
Plantar flexion 28
Plantar flexor muscles 80
Plantar reflex 33, 34
Plantar response, asymmetry of 34
Plantifiexion 84
Platinum-based chemotherapy 80
Platysma 28, 145
Plexus 50
lesion 41
Poliomyelitis 42, 79, 81
Polyarteritis nodosa 54, 59
Polymyositis 42
toxic myopathies 42
Polyneuropathy 42, 56, 92
demyelinating sensorimotor 60
pattern of 53
temporal course of 54
Polyradiculoneuropathy 53, 54
acute inflammatory demyelinating 54
Polyradiculopathy 41, 42, 53, 54, 92
asymmetrical 61
Pompe disease 42
Pons, upper 104
Pontine micturition center 64
Pontomedullary junction 148
Porphyria 48, 54
Posterior column 86
tract 74
Posterior cord syndrome 78
Posterior cortical atrophy 242
Posterolateral cord syndrome 79
Posteromarginal nucleus 74
Postinfectious myelopathy 83
Post-polio syndrome 81
Post-traumatic disc prolapse 86
Postural instability 189
Postural reflexes
loss of 187
test for 201
Postural tremor 195
Posture 189
Praxis 190, 232
anatomical localization of 226, 226fc
Precentral gyrus 3
Prefrontal cortex 3
functions of 230
Premotor cortex 3
Pressure
intracranial 114
pain 52
palsies 54
Priapism 69, 69fc
Procerus sign 188
Prosopagnosia 229fc
Pseudo Babinski sign 35
Pseudo Foster-Kennedy syndrome 107
Pseudoathetosis 48
Pseudobulbar involvement 164
Pseudobulbar palsy 159, 159t, 191
types of 165
Pseudobulbar signs 205
Pseudopapilledema 114
Pseudoptosis 129
Psychogenic erection 68, 88
Psychogenic gait 202
Pterygopalatine ganglion 143
Ptosis 129
Pupil 184
disorders of 131
examination of 128
Pupillary light reflex 127f
Pupillary pathways, anatomy of 125
Pure cognitive variety 241
Pure motor syndrome 81
Purkinje cell 167, 169, 170
Pursuit 121
disorder of 175
eye movements 124
system 124
Pyogenic bacterial infection 85
Pyramidal eminence 123
Pyramidal tract 101
lesion 173
signs 177
Pyridoxine toxicity 54, 80
Q
Quadrantanopia
homonymous 112
lower 111f
upper 111f
Quadriceps 26f, 80
femoris 26, 28
weakness 39
Quadriparesis 91
Quadriplegia, diagnosis of 95fc
R
Radial nerve 30
Radiation myelitis, late 78
Radiation-induced myelopathy 79
Radicular pain 97
Radioulnar joint 23
Ramsay Hunt syndrome 146
Range of motion 201
Reading
newspaper 235fc
substrate of 218fc
Reciprocal innervation 6
Sherrington's law of 6
Rectus femoris 28
Rectus muscle, ipsilateral lateral 123
Rectus subnucleus, medial 123
Recurrent laryngeal
branches 157
nerve 157
Red circular structure 117
Red nucleus 123, 164, 171
Red reflex 117
Reduced auditory acuity 216
Reflex 5, 29, 32, 37, 39, 87, 96, 141
abdominal 33, 61, 84
abnormal vestibulo-ocular 152
absent 79
accommodation 126
arc, components of 5
autonomic cardiovascular 191
bedside evaluation of 5
blink 141
bulbocavernosus 34, 87
center 158
deep 6
erection 68, 88
intersegmental 6
irradiation of 31
loss 81
neurogenic bladder 66
pathway 126
release 232
segmental 6
spread 30
superficial 6, 33, 57, 84, 87, 96, 99, 181
Residual urine volume 66
Respiratory muscle weakness, prominent 42
Reticulospinal tract 9
Retinal background 113, 115
Retinal pathology, severe 136
Retinal pigment epithelium 108
Retinopathy, diabetic 115f
Retrochiasmal lesion 118
Retrocochlear lesion 151
Retropulsion, tests 189
Reverse digit test 243
Rhomboid 14, 14f
Right parietal damage 232
Rigidity 10, 11t, 188
Rinne's test 150
findings of 150t
Romberg's test 152
Root 1316, 20, 21, 25, 31, 42, 57
ganglia, posterior 46
Rossolimo's sign 32
Rubrospinal tract 3, 167
S
Saccade 191
and pursuit 172
disorders of 130, 175
pathway, horizontal 124
system 123
Saccadic eye movements 124
Saccadic intrusions 175
Sarcoglycanopathies inclusion body myositis 42
Sarcoidosis 54, 59, 80, 83
Sartorius 28
Scapula
movement of 22
muscle of 13
winging of 15
Schwabach's test 150
findings of 150f
Schwannoma, acoustic 146
Sciatic nerve 25
Sclero-corneal junction, region of 141
Sclerosing panencephalitis, subacute 241
Sclerosis
amyotrophic lateral 80, 83
bulbar onset amyotrophic lateral 42
multiple 78, 79, 85, 94, 105
Scotoma 110
central 111f
centrocecal 111f
junctional 110
negative 110
types of 111t
Second order neuron 75, 127, 147
cell body of 75
Seizure 81
particularly tonic-clonic convulsion, history of 1
Semantic dementia 221, 221fc, 245
Semantic memory assessment 215
Semicircular canal 125
Sensorimotor pathways 186
Sensorimotor striatum 186
Sensory 84, 87
dysfunction 49
epithelium 148
examination 50, 99
extinction and neglect 222, 222t
fibers 156
function, examination of 141, 145
ganglion 50
gangliopathies 53
impairment 49, 77
inattention 53
motor 58
nerve 40
neural deafness 149, 150
neuronopathy 80
nucleus 140
paralytic bladder 67
portion 139
root 139
symptoms 57, 85, 88
tracts 47f
Sensory abnormalities 190
localization of 49
Sensory ataxia 48, 80, 174, 177, 182, 200, 202
causes of 177
pronounced 78
site of lesion in 177
Sensory loss 49f, 81, 91
Balaclava pattern of 92
cortical 191
glove and stocking distribution of 49f, 58
isolated nonlength dependent 80
suspended 49f, 78
Sensory system 2, 45, 48, 85, 97
bedside examination of 50
components of 45
localization 49f
Serratus anterior 14, 15f
Sexual dysfunction 63, 68, 69
Sherrington's law 121
Shoulder
abduction 22
adduction 22
extension 23
external rotation of 23
flexion 22
girdle
muscle of 13
weakness 39
internal rotation of 23
shaking test 10, 176
Simultanagnosia 225
test ventral 225
types of 225
Sjögren's syndrome 54, 80, 83, 85
Skeletal deformity 201
Sleep disorders 190
Small fiber neuropathy 54, 69
Small lesion 78
Snake bite 42
Snellen's chart 109
Soft exudates 115
Somatic motor 155
fibers 156
Somatic sensory 155
cortex, primary 101
fibers 156
Somatotopic organization of corticospinal tract 101
Spastic ataxic gait 181
Spastic dysarthria 206
Spastic gait 202
Spasticity 10, 11t
Spatial perception, disorder of 225
Speaker's native language 217
Speech
and language dysfunction 206
apraxia of 207, 209, 217, 244
defect, hypokinetic 207
disturbance 172
hypophonic 249
problem 247
slurring of 182, 184
Sphincter, internal 63
Spinal accessory nerve 160
Spinal artery
posterior 76
segmental 76
Spinal cord 3, 45, 46, 46fc, 64, 70, 71, 73f, 78, 103, 148
anterior horn cell of 4
blood supply of 76
circuit 199
complete transection of 77
cross-sectional anatomy of 73
descending tracts of 76
disease 66, 69
distal bulbous part of 81
extent of 70
lesion 69, 93
acute 81
localization of 77
pathway 68
physiologic neuroanatomy of 70
posterior column in 177
segments 71
structures of 71
symptoms 85
tracts 73f
trauma 78, 82
tumor 83
lower 67
Spinal hemisection 49
Spinal lemniscus 75
Spinal muscular atrophy 39, 42
Spinal shock 66
stage 85, 86
Spinal stenosis 54
Spinal tract, nucleus of 139
Spinal transection 49
Spinal veins 77
Spine
and cranium 2, 57, 85
extensors leads, weakness of 24
extensors of 24
Spinobulbar muscular atrophy 79
Spinocerebellar tract 74, 75, 79
isolated injury of 79
Spinocerebellum 167, 168
Spinomuscular atrophy 42, 79
Spino-olivary tract 74, 76
Spinoreticular tract 74, 76
Spinotectal tract 74, 76
Spinothalamic column 86
Spinothalamic tract 75
anterior 74
lateral 74
Spinous process 71
Square wave jerks 175, 191
Stapedius, weakness of 145
Star walking test 152
Static stretch reflex 7
Steppage gait 26, 202
Stereognosis 52
Sternal head 15
Sternocleidomastoid 29
action of 160
Sternomastoid weakness 160t
Steroid 42
Stewart Holmes test 173
Stiffness 36
Stiff-Person syndrome 11
Stress incontinence 66
Stretch reflex 6f, 7
neural circuitry of 7
Striatal foot 189
Striatal toe 189
Stroke 1
aphasia 217t
recurrent 2
Styloglossi 162
Stylomastoid foramen 146
Stylopharyngeus muscle 158
Subarachnoid space 121, 123, 131, 132, 138, 146, 165
intracranial outside 165
Subdural hematoma 105
Subscapularis 14, 14f
Substantia gelatinosa 74
Substantia nigra 164, 185
Subthalamic nucleus 185
Supinator jerk 30, 30f
inverted 30
Suprahyoid 28
Supranuclear control 160
Supranuclear lesion 146, 159
Supranuclear palsy
progressive 187, 193
types of 250
Supranuclear pathway 123
lesions 129
Suprapontine lesion 66
Suprasegmental level 3
Suprasegmental motors system, sescending 3
Suprasegmental reflex 6
Supraspinal descending fibers 9
Supraspinous ligament 72
Swallowing dysfunction, symptoms of 204, 204t
Swallowing reflex 203
Swallowing, normal physiology of 203
Sweat below lesion, ipsilateral loss of 78
Swinging flashlight test 117
Syncope 201
Syringomyelia 75, 78, 83
Systemic lupus erythematosus 54, 85
Systemic vasculitis 54
T
Tabes dorsalis 79
Tactile agnosia 226
Tactile localization 53
Tandem walking test 152
Tay-Sachs disease 252
Telencephalon 185
Temporal gyrus
left superior 229fc
superior 216
Temporal lobe 69, 233
anatomical landmark of 234f
connections 234
epilepsy 107
left 220
Tensor fascia lata 25, 28
Teres major 14
Thalamus 45, 46
ventral posterolateral nucleus of 75
Thenar eminence muscles 19
Thigh, muscle of 25
Thoracic nerve, long 14
Thoracic region
lower 70
upper 70
Thorax, muscle of 23
Thumb
abduction 18f
adduction 19f
extension 18f
flexion 18f
muscle of 18
opposition 19f
Thyroid
disorders 191
gland 88
Tibial nerve 27, 28, 31
Tibialis anterior 26, 26f, 28, 60
Tibialis posterior 27, 27f, 28
Tinnitus 151, 154
Toe
extensors of 27
to finger test 174, 181
Tone 80, 87
abnormalities of 10, 11fc
examination of 9, 39
Tongue
abnormal movement of 162
atrophy 162f
extrinsic muscles of 162
intrinsic muscles of 162
paralysis of 163
Tonsils, enlarged 204
Topagnosia 232
Toxic myopathy 42
Toxins 54, 58, 80
Trail making test 231, 243
Transverse myelitis 78, 82
Trapezius muscle 28
action of 160
weakness 161t
bilateral 161
unilateral 161
Tremor 162, 171, 187
at-rest 187
endpoint 171
goal-directed 182
intention 174
kinetic 171
Triceps jerk 30, 30f
Trigeminal ganglion 139, 140
Trigeminal innervated muscles
bilateral weakness of 142
unilateral weakness of 142
Trigeminal nerve 139
Tropical spastic paraparesis 79
Tropical spastic paraplegia 83
Truncal ataxia 171
Truncal muscles 87
weakness, symptoms of 36
Trunk 84
extensors of 84
flexor of 84
posture 201
Tuberculosis 2, 54
Tumor, intramedullary 78
Tuning fork tests 149
Turning 'en bloc 189, 200
Tympanic branch 155
U
Ulnar nerve 17, 21, 22
Uncinate seizures 107
Uncus 214
Upper lid elevation 127
Upper limb 10, 29, 51, 84, 87
bilateral 246
dystonia, left 247f
Upper motor neuron 30, 36, 40t, 43, 66, 82, 91
facial lesion 146
involvement 54
ipsilateral 78
lesion 40, 163
signs 81, 91
Urethra, control activity of 63
Urge incontinence 66
Urinary tract infection 67
Urinary urgency 196
Urine, retention of 85
V
Vagus nerve 155, 156, 157f
course of 157
lesion 159
bilateral 159
unilateral 158
Valley sign 39
Varicella zoster virus 78
infection 146
Vasculitis 54
Vastus intermedius 26
Vastus lateralis 26
Vastus medialis 26
Ventral funiculi 74
Ventral pons, fascicle involvement of 132
Ventral posteromedial nucleus 140
Ventral simultanagnosia 225
Ventral stream disorder 224
Ventral temporal lobe 220
Verbal fluency test 243
Verbal memory testing 215
Vertebral body 72
anatomy 72f
Vertebral column
components of 72
structure of 71
Vertebrobasilar transient ischemic attack 201
Vesibulo ocular system, neural circuitry of 126fc
Vestibular ataxia 182
Vestibular disorders, central 155
Vestibular function, bedside tests of 151
Vestibular nucleus 125, 125f
superior 148
Vestibular ocular system 124
Vestibular syndrome 154
acute 154
causes of 155
Vestibular system 147
clinical examination of 151
connections of 148, 149fc
Vestibular tone 148
Vestibulocerebellum 167, 168
Vestibulocochlear nerve 147
Vestibulo-ocular reflex 120, 124, 152, 172
normal 152
tests of 152
Vestibulo-ocular system 125
Vestibulospinal reflexes, tests of 151
Vestibulospinal tract 9
Vibration
loss 52
sense 48, 52, 85
Visceral motor 155
fibers 156
Visceral sensory 155
fibers 156
Vision
blurring of 182
cognitive aspect of 220
color 109, 117, 180
double 137
field of 180
loss of 116, 116fc
pathways of basics of 221f
Visual acuity 108, 180, 182, 184
diminished 116
severe loss of 114
Visual agnosia, types of 223fc
Visual attention deficits 222
Visual defects, higher cortical 118
Visual deficits, higher order 222
Visual field 109
abnormalities 110, 110fc
testing 117
Visual fixation 154
Visual hallucinations 226
Visual memory testing 215
Visual object agnosia 221fc
test for 223
Visual pathway
disorders, higher order 223fc
lesion, anterior 182
posterior 118
Visual perception deficits, lower order 222
Visual symptoms 172
Visuospatial dysfunction 247
Vitamin
B12 58, 79
deficiency 54, 79, 80, 83
E 80
deficiencies 54
W
Waddling gait 202
Warfarin therapy 82
Wartenberg's sign 32
Weakness
distal symmetrical 58
distribution of 42
moderate 96
Weber's test 150
findings of 150t
Wernicke's aphasia 208, 215
West Nile virus infection 79
White matter tracts 74
Wilbrand knee 108
Wilson's disease 190, 191
Winging 15
Withdrawal reflex 3, 7
Woking memory 215
Wrist 23
clonus 8
joint, muscle of 16
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