· III Duus’ Topical Diagnosis in Neurology An atom y, Physiology, Sign s, Sym ptom s 5th edition Math ias Baeh r, MD Professor of Neu rology an d Ch airm an Dep artm en t of Neu rology Un iversit y of Gött in gen Göt tin gen , Germ any Mich ael Frotsch er, MD Hertie Sen ior Research Professor for Neu roscien ce an d Ch airm an Dep artm en t of Stru ct u ral Neu robiology Cen ter for Molecu lar Neu robiology Ham bu rg (ZMNH) Un iversit y of Ham bu rg Ham bu rg, Germ any W ith tribu t ion s by W ilh elm Ku eker Fou n din g au th or Peter Du u s 40 illu stration s, m ost in color, by Professor Gerh ard Sp itzer an d Barbara Gay Th iem e Stu t tgart · New York IV · Library of Congress Cataloging-in-Publication Data Baeh r, Math ias [Du us’ n eu rologisch -topisch e Diagn ostik En glish ] Duu s’ topical diagn osis in n eu rology : an atom y, Physiology, sign s, sym ptom s/Math ias Baeh r, Mich ael Frotsch er ; w ith tribution s by Wilh elm Ku eker ; tran slated by Eth an Tau b ; Illu strated by Gerh ard Spitzer 5th , rev ed p ; cm Rev tran slation of th e 8th Germ an ed c20 03 In cludes in dex ISBN 978-3-13-612805-3 (GTV : alk pap er) Nervou s system Diseases Diagn osis Neu roan atom y An atom y, Path ological Nervou s system Path ophysiology I Frotsch er, M (Mich ael), 1947- II Du us, Peter, 1908- Top ical diagn osis in n eu rology III Title IV Title: Topical diagn osis in n eu rology [DNLM: Nervou s System Diseases–diagn osis Nervou s System –an atom y & h istology Nervous System –physiopath ology WL 141 B139d 2011] RC347.D8813 2011 616.8’04754 dc22 2011016421 1st Brazilian (Portuguese) edition 1985 2nd Brazilian (Portuguese) edition 1990 1st Chinese edition 1996 1st English edition 1983 2nd English edition 1989 3rd English edition 1998 1st French edition 1998 1st Germ an edition 1976 2nd Germ an edition 1980 3rd Germ an edition 1983 4th Germ an edition 1987 5th Germ an edition 1990 6th Germ an edition 1995 7th Germ an edition 2001 8th Germ an edition 20 03 9th Germ an edition 2009 1st Greek edition 1992 2nd Greek edition 2009 1st Indonesian edition 1996 1st Italian edition 1987 1st Japanese edition 1982 2nd Japanese edition 1984 3rd Japanese edition 1988 4th Japanese edition 1999 1st Korean edition 1990 Th is book is an auth orized an d revised tran slation of th e 9th Germ an edition pu blish ed an d copyrigh ted 20 09 by Georg Th iem e Verlag, Stu ttgart, Germ any Title of th e Germ an edition : Neu rologisch -topisch e Diagn ostik An atom ie— Fu n ktion —Klin ik Con tribu tor: Wilh em Ku eker, MD, Radiological Clin ic, Dep artm en t of Neu roradiology, Un iversity Hospital Tü bin gen , Germ any 1st Portuguese edition 2008 4th edition tran slated by Eth an Tau b, MD, Klin ik im Park, Zu rich , Sw itzerlan d Updates tran slated by Geraldin e O’Su llivan , Dublin , Rep of Irelan d 1st Russian edition 1996 2nd Russian edition 2009 Illustrators: Gerh ard Spitzer, Fran kfurt/M, Germ any; Barbara Gay, Stu ttgart, Germ any 1st Polish edition 1990 1st Spanish edition 1985 1st Turkish edition 2001 © 2012 Georg Th iem e Verlag, Rü digerstrasse 14, 70469 Stu ttgart, Germ any h ttp://w w w.th iem e.de Th iem e New York, 333 Seven th Aven u e, New York, NY 10 01 USA h ttp://w w w.th iem e.com Cover design : Th iem e Pu blish in g Grou p Typesettin g by prim u stype Hu rler, Notzin gen , Germ any Prin ted in Ch in a by Everbest Prin tin g Co., Ltd ISBN 978 13-612805 Im po rtant note : Medicin e is an ever-ch an gin g scien ce un dergoin g tin u al developm en t Research an d clin ical experien ce are tin u ally exp an din g our kn ow ledge, in p articu lar ou r kn ow ledge of proper treatm en t an d dru g th erapy In sofar as th is book m en tion s any dosage or application , readers m ay rest assu red th at th e auth ors, editors, an d p ublish ers h ave m ade every effort to en su re th at su ch referen ces are in accordan ce w ith the state of know ledge at the time of production of the book Neverth eless, th is does n ot involve, im ply, or express any gu aran tee or respon sibility on th e p art of th e p ublish ers in respect to any dosage in stru ction s an d form s of application s stated in th e book Every user is requested to examine carefully th e m an ufactu rers’ leaflets accom panyin g each dru g an d to ch eck, if n ecessary in sultation w ith a physician or specialist, w h eth er th e dosage sch edules m en tion ed th erein or th e train dication s stated by th e m an ufactu rers differ from th e statem en ts m ade in th e presen t book Su ch exam in ation is particu larly im portan t w ith drugs th at are eith er rarely used or h ave been n ew ly released on th e m arket Every dosage sch edu le or every form of ap plication used is en tirely at th e user’s ow n risk an d respon sibility Th e au th ors an d pu blish ers requ est every user to rep ort to th e pu blish ers any discrepan cies or in accuracies n oticed If errors in th is w ork are fou n d after p ublication , errata w ill be posted at w w w.th iem e.com on th e p roduct description page Som e of th e p roduct n am es, paten ts, an d registered design s referred to in th is book are in fact registered tradem arks or p roprietary n am es even th ough specific referen ce to th is fact is n ot alw ays m ade in th e text Th erefore, th e app earan ce of a n am e w ith ou t design ation as proprietary is n ot to be stru ed as a represen tation by th e p ublish er th at it is in th e pu blic dom ain Th is book, in clu din g all parts th ereof, is legally p rotected by copyrigh t Any u se, exploitation , or com m ercialization ou tside th e n arrow lim its set by copyrigh t legislation , w ith ou t th e pu blish er’s sen t, is illegal an d liable to prosecu tion Th is ap plies in p articu lar to ph otostat reprodu ction , copyin g, m im eograph in g, preparation of m icrofilm s, an d electron ic data processin g an d storage V Preface In 20 05 w e pu blish ed a com plete revision of Du us’ textbook of topical diagn osis in n eu rology, th e first n ew edition sin ce th e death of its origin al auth or, Professor Peter Du u s, in 1994 Feedback from readers w as extrem ely positive an d th e book w as tran slated in to n u m erou s lan gu ages, provin g th at th e cept of th is book w as a su ccessful on e: com bin in g an in tegrated p resen tation of basic n eu roan atom y w ith t h e su bject of n eurological syn drom es, in cludin g m odern im agin g tech n iqu es In th is regard w e th an k ou r n eu roradiology colleagu es, an d especially Dr Kueker, for providin g us w ith im ages of very h igh qu ality In th is fifth edition of “Du u s,” w e h ave preserved th e rem arkably effect ive didactic cept of th e book, w h ich particularly m eets th e n eeds of m edical stu den ts Modern m edical cu rricula require in tegrative kn ow ledge, an d m edical stu den ts sh ould be tau gh t h ow to apply th eoret ical kn ow ledge in a clin ical settin g an d, on th e oth er h an d, to recogn ize clin ical sym ptom s by delvin g in to th eir basic kn ow ledge of n euroan atom y an d n eu rophysiology Our book fulfils th ese requ irem en ts an d illust rates th e im portan ce of basic n eu roan atom ical kn ow ledge for subsequ en t practical w ork, as it in clu des actu al case st udies We h ave color-coded th e section h eadin gs to en able readers to dist in gu ish at a glan ce betw een n euroan atom ical (blu e) an d clin ical (green ) m aterial, w ith ou t disruptin g th e th em atic tin uity of th e text Alth ou gh th e book w ill be u sefu l to advan ced stu den ts, also physician s or n eurobiologists in terested in en rich in g th eir kn ow ledge of n eu roan atom y w ith basic in form ation in n eu rology, or for revision of th e basics of n eu roan atom y w ill ben efit even m ore from it Th is book does n ot preten d to be a textbook of clin ical n eu rology Th at w ou ld go beyon d th e scope of th e book an d also t radict th e basic cept described above First an d forem ost w e w an t to dem on strate h ow, on th e basis of th eoretical an atom ical kn ow ledge an d a good n eurological exam in ation , it is p ossible to localize a lesion in th e n ervou s system an d com e to a decision on fu rth er diagn ostic step s Th e cau se of a lesion is in itially irrelevan t for th e p rim ary topical diagn osis, an d elucidation of th e etiology takes place in a secon d stage Our book tain s a cursory overview of th e m ajor n eurological disorders, an d it is n ot in ten ded to replace th e system atic an d com preh en sive coverage offered by stan dard n eu rological textbooks We h ope th at th is n ew “Duu s,” like th e earlier edition s, w ill m erit th e appreciation of its au dien ce, an d w e look forw ard to receivin g readers’ com m en ts in any form Professor M Baehr Professor M Frotscher VI · Preface Contents Elements of the Nervous System Info rm atio n Flo w in the Nervo us System Functio nal Gro ups o f Ne uro ns Ne uro ns and Synapses Neu ron s Syn apses 2 Glial Cells De velo pm ent o f the Ne rvo us Syste m Ne uro transm itters and Recepto rs Somatosensory System Periphe ral Co m po ne nts o f the So m ato senso ry Syste m and Peripheral Regulato ry Circuits Recep tor Organ s Periph eral Nerve, Dorsal Root Gan glion , Posterior Root Periph eral Regulatory Circuits Central Co m po ne nts o f the So m ato senso ry System Posterior an d An terior Spin ocerebellar Tracts Motor System 12 12 14 18 24 Posterior Colu m n s An terior Spin oth alam ic Tract Lateral Spin oth alam ic Tract Oth er Afferen t Tracts of th e Spin al Cord 28 30 30 31 Central Pro ce ssing o f So m ato senso ry Info rm atio n 32 So m ato se nso ry Deficits due to Le sio ns at Specific Sites alo ng the So m ato senso ry Pathw ays 32 25 Ce ntral Co m po nents o f the Mo to r System and Clinical Syndro m es o f Le sio ns Affecting Them Motor Cortical Areas Corticospin al Tract (Pyram idal Tract) Corticon u clear (Corticobulbar) Tract Oth er Cen tral Com p on en ts of th e Motor System Lesion s of Cen tral Motor Path w ays Peripheral Co m po nents o f the Mo to r System and Clinical Syndro m e s o f Lesio ns Affecting Them Clin ical Syn drom es of Motor Un it Lesion s 12 36 36 38 39 39 41 43 44 Co m plex Clinical Syndro m e s due to Le sio ns o f Specific Co m po nents o f the Ne rvo us Syste m Spin al Cord Syn drom es Vascular Spin al Cord Syn drom es Nerve Root Syn drom es (Radicu lar Syn drom es) Plexus Syn drom es Periph eral Nerve Syn drom es Syn drom es of th e Neu rom u scu lar Ju n ction an d Mu scle 36 45 45 56 57 62 67 72 Contents · VII Brainstem Surface Anato m y o f the Brainstem Medu lla Pon s Mid brain 74 74 75 75 Cranial Ne rves 77 Origin , Com p on en ts, an d Fu n ction s 77 Olfactory System (CN I) 81 Visual System (CN II) 84 Eye Movem en ts (CN III, IV, an d VI) 89 Trigem in al Nerve (CN V) 103 Facial Nerve (CN VII) an d Nervu s In term ediu s 109 Cerebellum Internal Structure Cerebellar Cortex Cerebellar Nu clei Afferen t an d Efferen t Projection s of th e Cerebellar Cortex an d Nu clei 159 159 160 162 Co nne ctio ns o f the Ce re be llum w ith Other Parts o f the Nervo us Syste m 162 Thalam us Nu clei Position of th e Th alam ic Nuclei in Ascen din g an d Descen din g Path w ays Fu n ction s of th e Th alam u s Syn drom es of Th alam ic Lesion s Th alam ic Vascular Syn drom es 172 172 172 176 176 177 Epithalam us 177 Subthalam us 178 120 126 132 Brainstem Diso rders 145 Isch em ic Brain stem Syn drom es 145 Cerebellar Functio n and Ce rebe llar Syndro m es Vestibulocerebellum Sp in ocerebellu m Cerebrocerebellu m 158 164 164 165 166 Cerebellar Diso rders 167 Cerebellar Isch em ia an d Hem orrh age 167 Cerebellar Tum ors 167 Diencephalon and Autonomic Nervous System Lo catio n and Co m po nents o f the Die ncephalo n 170 113 Topo graphical Anato m y o f the Brainstem 134 In tern al Stru ctu re of th e Brain stem 134 Surface Anato m y 158 Vestibulococh lear Nerve (CN VIII)—Coch lear Com p on en t an d th e Organ of Hearin g Vestibulococh lear Nerve (CN VIII)— Vestibular Com pon en t an d Vestibular System Vagal System (CN IX, X, an d th e Cran ial Portion of XI) Hyp oglossal Nerve (CN XII) 74 170 Hypo thalam us Location an d Com pon en ts Hyp oth alam ic Nu clei Afferen t an d Efferen t Projection s of th e Hyp oth alam u s Fu n ction s of th e Hyp oth alam u s 178 178 179 Peripheral Auto no m ic Ne rvo us Syste m Fu n d am en tals Sym path etic Nervou s System Parasym path etic Nervous System Auton om ic In nervation an d Fun ction al Distu rban ces of In dividu al Organ s Visceral an d Referred Pain 188 188 190 192 180 184 193 199 VIII · Contents Limbic System Anato m ical Overview 202 In tern al an d Extern al Con n ection s 203 Majo r Co m po nents o f the Lim bic System Hip p ocam p u s Microan atom y of th e Hip pocam p al Form ation Am ygdala Basal Ganglia 203 203 202 Functio ns o f the Lim bic Syste m 206 Types of Mem ory 206 Mem ory Dysfu n ction —th e Am n estic Syn drom e an d Its Cau ses 208 203 205 Prelim inary Rem arks o n Term ino lo gy 214 The Ro le o f the Basal Ganglia in the Mo to r System : Phylo genetic Aspe cts 214 214 Functio n and Dysfunctio n o f the Basal Ganglia 219 Clin ical Syn drom es of Basal Gan glia Lesion s 219 Co m po nents o f the Basal Ganglia and The ir Connectio ns 215 Nu clei 215 Con n ection s of th e Basal Gan glia 217 Cerebrum De velo pm ent 226 Gro ss Anatom y and Subdivisio n o f the Cerebrum 228 Gyri an d Su lci 228 Histo lo gical Organizatio n of the Cerebral Co rte x 231 Lam in ar Arch itecture 231 Cerebral White Matter 235 Projection Fibers 235 10 Association Fibers 236 Com m issu ral Fibers 238 Functio nal Lo calizatio n in the Cerebral Co rte x Prim ary Cortical Fields Association Areas Fron tal Lobe High er Cortical Fu n ction s an d Th eir Im pairm en t by Cortical Lesion s Coverings of the Brain and Spinal Cord; Cerebrospinal Fluid and Ventricular System Co ve rings o f the Brain and Spinal Co rd Du Mater Arach n oid Pia Mater 260 260 262 262 226 Cerebro spinal Fluid and Ventricular System Stru ctu re of th e Ven tricu lar System Cerebrospin al Flu id Circu lation an d Resorp tion Distu rban ces of Cerebrosp in al Flu id Circu lation —Hydroceph alu s 238 239 247 248 248 260 263 263 263 266 Contents · IX 11 Blood Supply and Vascular Disorders of the Central Nervous System Arteries o f the Brain Extradu ral Course of th e Arteries of th e Brain Arteries of th e An terior an d Middle Cran ial Fossae Arteries of th e Posterior Fossa Collateral Circu lation in th e Brain 270 270 273 275 278 Veins o f the Brain 279 Su perficial an d Deep Vein s of th e Brain 279 Du ral Sin u ses 280 Blo o d Supply o f the Spinal Co rd 281 Arterial An astom otic Netw ork 281 Ven ous Drain age 283 Further Reading Index 270 Cerebral Ische m ia Arterial Hypoperfusion Particular Cerebrovascular Syn drom es Im paired Ven ou s Drain age from th e Brain 283 283 295 302 Intracranial Hem o rrhage In tracerebral Hem orrh age (Non trau m atic) Su barach n oid Hem orrh age Su bdu ral an d Ep id u ral Hem atom a 305 305 307 311 Vascular Syndro m es o f the Spinal Co rd Arterial Hypoperfusion Im paired Ven ou s Drain age Sp in al Cord Hem orrh age an d Hem atom a 312 312 312 314 315 319 X · Contents Abbreviations 5-HT3 ACA ACTH ADH AIDS AMPA ARAS Asp BAEP BPPV CA CCA CNS CRF CSF CT DREZ ECA ECG EEG EMG EPSP FLAIR fMRI FSH GABA GH (STH) GHRH Glu Gn RH Gpe GPi HIV HMSN Hz ICA INO IP IPSP LH seroton in an terior cerebral artery adren ocorticotrop ic h orm on e (corticotropin ) an tidiu retic h orm on e acqu ired im m u n odeficien cy syn drom e α-am in o-3-hydroxy-5-m ethyl-4-isoxazolepropion ate acid ascen din g ret icu lar act ivatin g system aspartate brain stem au ditory evoked poten tials ben ign paroxysm al p osition in g vertigo corn u am m on is com m on carotid artery cen tral n ervou s system corticotropin -releasin g factor cerebrospin al flu id com p uted tom ography dorsal root en try zon e (also called t h e Redlich –Oberstein er zon e) extern al carotid artery electrocardiography/electrocardiogram electroen ceph alography/elect roen ceph alogram electrom yography/electrom yogram excitatory postsyn aptic poten tial flu id-at ten uated inversion recovery fu n ction al m agn etic reson an ce im agin g follicle-stim u latin g h orm on e γ-am in obu tyric acid grow t h h orm on e (som atot ropic h orm on e) grow th -h orm on e-releasin g h orm on e glutam ate gon adotrop in -releasin g h orm on e globu s pallidu s globu s pallidu s, in tern al segm en t h u m an im m u n odeficien cy viru s h ereditary m otor an d sen sory polyn eu ropathy Hertz in tern al carotid artery in tern uclear oph th alm oplegia in terph alan geal in h ibitory postsyn aptic poten tial luten in izin g h orm on e LPH LTM MCA MD MEG MIF m l MLF MP MRF MRI MSH NMDA PCA PET PICA PIF PPRF PRF PRL Py rCBF r.n rtPA SCD SNg sp -th SRIF STM STN T3 T4 Th TRH TSH VA VEP VI VL VOR VPL VPM lipotropin lon g-term m em ory m iddle cerebral artery m edial dorsal n u cleu s of th e th alam u s m agn etoen ceph alography m elan ocyte-stim u latin g h orm on ein h ibitin g factor m edial lem n iscu s m edial lon gitu din al fasciculu s m etacarp oph alan geal m elan ocyte-stim u latin g h orm on ereleasin g factor m agn etic reson an ce im gin g m elan ocyte-stim u latin g h orm on e N-m ethyl- D-aspartate posterior cerebral artery posit ron em ission tom ography posterior in ferior cerebellar artery prolactin -in h ibitin g factor (= dop am in e) param edian pon tin e reticular form ation prolactin -releasin g factor prolactin pyram idal tract region al cerebral blood flow red n ucleus recom bin an t tissue plasm in ogen activator subacu te com bin ed degen eration su bstan tia nigra spin oth alm ic tract som atotropin in h ibit in g factor sh ort-term m em ory subt h alm ic n u cleu s triiodothyron in e tetraiodothyron in e (thyroxin e) th alam u s thyrotropin -releasin g h orm on e thyroid-stim u latin g h orm on e ven tral an terior n u cleus visual evoked poten tials ven tral in term ediate n ucleu s ven tral lateral n u cleus vestibulo-ocular reflex ven tral posterolateral n ucleu s of th e th alam u s ven tral p osterom edial n u cleus of th e th alam u s 1 Elements of the Nervous System Information Flow in the Nervous System Neurons and Synapses Neurotransmitters and Receptors Functional Groups of Neurons Glial Cells Development of the Nervous System 320 · Index artery(ies) cerebral p osterior in farct 298–299 occlu sion 152, 153 ch iasm atic, sup erior 279 ch oroidal an terior 145, 272, 273–274, 274, 279 isch em ia 296 posterior 145, 146 lateral 274, 277, 298 m edial 277, 298 occlu sion 153, 298 circle of Willis 278–279, 279 com m u n icatin g 278 an terior 274, 278, 279 posterior 91, 145, 271, 272, 273, 278, 279 em boli 296 facial 271 Heu bn er’s 275, 279 hypophyseal in ferior 182 su perior 183, 279 hypoth alam ic 183 in tercostal, posterior 283 labyrin th in e 145, 272, 276 occlu sion 30 lin gu al 271 m am illary 279 m axillary 271 m en in geal an terior 260 m iddle 260–261 p osterior 260 occipital 278 occipitotem poral 277 of Perch eron 277, 299 oph th alm ic 91, 271, 273, 278, 279 em boli 296 p araven tricu lar 279 p erforatin g, occlusion 155 radicular an terior 283 great (of Adam kiew icz) 53, 283, 283 recu rren t, of Heubn er 275, 279 segm en tal lu m bar 282 th oracic 282 sp in al an terior 145, 146, 272, 272, 275, 281–282, 282, 283 syn drom e 55, 55 p osterolateral 282, 282 in farction 312 su bclavian 64, 271, 282 occlu sion 147 su lco-com m issural 281–282, 282 su praoptic 182, 279 tem poral, su perficial 271 th alam ogen icu late 277 isch em ia 299 th alam operforatin g an terior 277, 299 in farction 299 p osterior 274, 277, 279, 299 thyroid, su perior 271 vertebral 108, 145, 146, 270, 271, 272–273, 272, 275, 276, 282, 283 occlu sion 147, 150 art h rosis, un covertebral 58 asom atogn osia 255 astasia 165, 166, 30 th alam ic 177 astereogn osis 29, 32, 255 astrocytes astrocytom a 167 cystic 167 p ilocytic 167 ataxia 30 Friedreich 49 gait 166 lim b 307 stan ce 166 tru n cal 165 ath etosis 219 atrop hy, m u ltip le system 220 atten tion disturban ces 176 au diom etry 119 au ditory perception 113 axon al tran sport axon s 2–3 m yelin ation 3–4 B Babin ski sign 41, 48, 49 Balin t syn drom e 255 ballism 219, 223 ban d of Baillarger extern al 231, 232 in tern al 231, 232 baroceptors 12 barrels, cortical 235 basket cells 7, 160, 232 basoph il cells 185 bedw ettin g 198 beh avior trol 255–257 Bell palsy 111, 112 Ben edikt syn drom e 152–153, 155 ben ign paroxysm al position al vertigo (BPPV) 124–125 Betz cells 37 Bielsch ow sky test 93, 94 Bin g–Horton syn drom e 108 bladder dysfu n ction 195–198 n eurogen ic 196–197 n on n eu rogen ic 197–198 fu n ction 195 in n ervation 193–195, 193, 194 obstru ction in fravesical 197 n eck 196 blin k reflex 102, 110 blood p ressu re regu lation 14 4, 184 blood–CSF barrier 263 body am ygdaloid 83 gen iculate lateral 76, 76, 84–85, 85, 86, 87, 96, 100, 118, 172, 173–174, 173, 175, 204 m edial 76, 76, 117, 118, 172, 173– 174, 173, 175 Lew y 219–220 m am illary 76, 171, 175, 178, 179, 202, 216, 279 pedu n cle 180 restiform 162 trapezoid 117, 118, 137, 139, 140–141 bon e petrou s 89 sph en oid 89 borreliosis 264 Bow m an ’s glan d 81 brach ia jun ctiva 75 brach ialgia paresth etic n octu rn a 67 brach iofacial w eakn ess 41–42 brach iu m pon tis 75 brain stem an atom y 74–76, 76, 134–145, 134–137 blood su pply 145 fiber n ection s 138, 139 disorders 145–155 in farct 95, 95, 97, 97, 146, 298 su bclavian steal syn drom e 147 vascu lar syn drom es 302 Broca aph asia 249–253 case presen tation 250–251, 250–251 Broca’s area 248–249 in farct 250–251 Brodm an n ’s cytoarch itectu ral m ap 233 Brow n –Séqu ard syn drom e 49–50, 49, 56 bu lb en d, of Krau se 12–13, 13 olfactory 81–82, 82, 83 bu n dle m acu lar 87 m edial forebrain 83, 84, 179, 180, 180, 181, 190 C cacosm ia 84 CAG trin ucleotide repeat, in Hu n tin gton disease 221, 222 Cajal–Retzius cells 227, 228, 231 callosotom y 253 can al carotid 82 hypoglossal 82, 133, 134 optic 82 sem icircu lar 115, 120 can alolith iasis 125 capsu le extern al 236 in tern al 28, 29, 38, 171, 216, 227, 236 Index · 321 gen u 37 lesion s 42–43, 42, 288 cardiorespiratory fun ction 145 carotid-cavern ou s fistula 273 carp al tu n n el syn drom e 67, 68 cau da equ in a 45, 54 syndrom e 53, 54, 61, 62 cavern om a 306 cells acidoph il 185 air, eth m oid 89 basket 7, 160, 232 basoph il 185 Betz 37 Cajal–Retziu s 227, 228, 231 ch an delier 232 ch rom oph obe 185 Deiters 115, 116 double bou quet 232 gran ule 160, 160, 161, 231, 232 h air 115, 116, 118, 120–121 m itral 82 olfactory 81 bipolar 82 Pillar 116 Purkin je 160, 160, 161 pyram idal 203–205, 231–233 Ren sh aw 4 Schw an n tu fted 82 cen ter ciliospin al 102 gaze, lesion s 98 p on tin e m icturition 195 cen tral sp astic paresis 41 cerebellum 158–168, 217 blood su pply 276 n ection s 161, 162–164 floccu lon odu lar lobe 122–123, 159, 159 fu nction 164 h em orrh age 167, 306–307, 306 in tern al structu re 159 cortex 159–160, 159 n uclei 160 isch em ia 167 in farction case presen tation 301, 301 surface an atom y 158–159, 158, 159 syndrom es 164–166 vascu lar 299 tu m ors 167–16 cerebrocerebellum 159 fu nction s 166 lesion s 166–167 cerebrospin al fluid (CSF) 263–266 circu lation 263–266, 263 bottlen ecks 266 disturban ces 264–267 fin din gs in diseases 264 p ressu re 264, 305 see also hydroceph alu s; in tracran ial hyp erten sion resorption 266 sh un t 268, 305 volum e 264 cerebrum an atom y 228–230, 228, 229, 230 n ection s 232, 233 develop m en t 226–227, 226, 228 evolu tion 226–227, 227 fu n ction al localization 238–248, 238 h istological organ ization 231–235, 231, 234 isch em ia 283–289, 295–297 diagn osis 286–289 w h ite m atter 235–237 ch an delier cells 232 ch arley-h orse 61 Ch arlin n eu ralgia 108 ch em oceptors 12 ch iasm , optic 84, 86, 87, 89, 103, 171, 179, 182, 183, 216 lesion s 86 ch olin ergic system 188 ch orda tym pan i 109, 111, 112, 113, 114 ch orea 219, 221 ch rom oph obe cells 185 cin gulu m 203, 237, 238 circle of Willis 278–279, 279 circulation an terior 270 cerebrospin al fluid 263, 263 bottlen ecks 264 distu rban ces 264–267 collateral 278–279, 278 arterial circle of Willis 278–279, 279 extern al-carotid-to-vertebral collateralization 278 extern al-to-in tern al collateralization 278 im portan ce of 285 posterior 270 cistern (s) 262 am bien t 204 cistern a m agn a 262 Clarke’s colu m n 26 classical dition in g 207 clau stru m 29, 37, 215, 216 claw h an d 67 clivu s 89 clon u s 41 cluster h eadach e 108 coch lea 114, 115, 116 colliculu s(i) brach iu m 137 facial 76, 109 in ferior 76, 76, 96, 117, 118, 139, 141 su perior 76, 76, 96, 97, 137, 141 colon in n ervation 194 colu m n (s) Clarke’s 26 cortical 242–24 prim ary au ditory cortex 245–246 prim ary visu al cortex 245 p osterior 25, 26, 28–30, 33 lesion s 29–30, 34 syn drom es 46–47, 46, 49, 49 com m a of Sch u ltz 31, 41 com m issu re an terior 82, 171, 183, 202, 216, 236, 237, 238, 253 h aben u lar 177 of th e forn ices 202 p osterior 171 com p lex region al pain syn drom e 67 com p ression brach ial plexus 63 p eriph eral n erves 67 sp in al cord 52, 52 com p uterized tom ograp hy (CT) 288– 289, 302–303 es 84 gestive m yopathy 312–314 sciou sn ess 14 4, 176, 299, 308 tin en ce 195 us m edullaris 45, 54 us syn drom e 53, 54 convergen ce of in form ation tran sfer cordotom y 31 corn eal reflex 105 ligh t test 92 corn u Am m on is 203–205 coron a radiata 28, 236 corp ora cavern osa 199 corp us callosu m 171, 175, 180, 216, 217, 227, 237, 238 agen esis 253 lesion s 209 su rgical tran section 249 corp us striatu m 217, 218 corp uscles Golgi–Mazzon i 14, 14 Meissn er 12, 13 Ru ffin i 13, 13 Vater–Pacin i 12, 13–14, 13 cortex au ditory 245–246, 246 lesion s 246 cerebellar 159–160, 160 afferen t inpu t 160 cerebral agran ular 233 association areas 247–248, 247 Brodm an n ’s cytoarch itectu ral m ap 233 developm en t 226–227, 226, 227 fron tal lobe 247–24 fun ction al localization 238–246, 238, 241, 242, 243, 244, 245 gran u lar 233 h igh er fun ction s 24 8–257 h istological organ ization 231 lam in ar arch itectu re 231–235, 232, 234 lesion s 41–42, 42, 242–246, 248– 257 prim ary cortical fields 239–247 gustatory 246 h ipp ocam pal 203 lim bic 202, 202 m otor 36, 36, 37, 240–242 322 · Index cortex n eocerebellar 163 orbitofron tal 206 prefron tal 248, 255 lesion s 255–257 prem otor 248 som atosen sory, p rim ary 240–244 lesion s 24 striate 85, 24 vestibu lar 246–247 visu al 85, 24 4–245, 244, 245 lesion s 245 cran iosacral system 188 crista am pu llaris 120, 120 crocodile tears 111 cru cerebri 38, 75, 76, 171 cu bital tun n el syn drom e 8, 68 cu lm en 158, 159, 161 cun eu s 230 Cu sh in g syn drom e 186–188 D decu ssation lem n iscal 135 pyram idal 38, 39, 75, 76, 135, 139 su perior cerebellar pedu n cles 137 tegm en tal 137 Deiters cells 115, 116 Dejerin e syn drom e 147, 150, 151 case p resen tation 151 dem en tia 208 den drites den dritic spin es derm atom es 17, 17, 18, 200 sen sory deficits 17, 18 developm en t 8–9 cerebru m 226–227, 226, 228 déviation juguée 98 diabetes in sipidu s 184 diagon al ban d of Broca 83 diap h ragm 69 diap h ragm a sellae 260 dien ceph alon 8, 170–172, 171 digital su btraction an giograp hy (DSA) 289, 290, 290, 291, 304, 309 dip lopia 92, 92 discon n ection syn drom es 253–254 olfactory system 253 visu al system 253–254 disin h ibition 6, disk(s) in tervertebral degen eration 58–62, 59 h ern iation 57, 58, 59–61 m assive prolapse 61, 62, 62 protru sion 57, 60 optic 87 lesion s 86 tactile, of Merkel 13, 13 divergen ce of in form ation tran sfer dizzin ess 123–124 dop am in e dou ble bou qu et cells 232 Duch en n e–Erb palsy 63 du ct coch lear 114–115, 115, 116 en dolym ph atic 115 p erilym ph atic 115 du m bbell tu m ors 56, 57 du m ater 260–261, 261, 284 blood su pply 260–261 in n ervation 262 orbital 262 spin al 261 arterioven ou s fistu la 312–314, 313 dysarth ria 149, 249, 306 scan n in g 167 dysarth roph on ia 167 dysdiadoch okin esia 166, 299 dysequilibriu m 123–124, 165 dysgrap h ia 249 dyslexia 249 dysm etria 166, 299 dysph agia 149 dyssyn ergia 166 dyston ia 219, 223 focal 223 gen eralized 223 excitation 6, excitatory postsyn aptic poten tial (EPSP) exercise-dep en den t w eakn ess 72 exotropia 92 exteroceptors 12 extin ction ph en om en on 255 eye in n ervation p arasym path etic 102, 103, 194 sym path etic 102, 103, 104, 194 eye m ovem en ts 89–102 accom m odation 99–101 an atom ical substrate 10 0–101, 100 ju gate 90, 94–99, 118 an atom ical basis 96 reflex gaze m ovem en ts 98–99 convergen ce 99–101 an atom ical substrate 10 0–101, 100 optokin etic nystagm u s 98–99 pu pillary striction 10 sm ooth pu rsu it m ovem en ts 98 volun tary 98 F E ear 115 in n er 114–117 m iddle 114 edem a cerebral 284 vasogen ic 302 Edin ger–Westph al n u cleus 77, 78, 90, 101, 103, 142 electroen cep h alograp hy 238 em boli 285, 295–299 p aradoxical 285 see also isch em ia; th rom boses em bolism 147 em in en ce, collateral 204 en cep h alitis 209, 264 case presen tation 209, 209–210 en d bu lbs of Krau se 12–13, 13 en dolym ph 115 en don eu riu m 14 en op h th alm os 102, 191 en teroceptors 12 en u resis 198 epicon u s 54 syn drom e 53, 54 epidu ral h em atom a 311, 312 sp in al 314 epin euriu m 14 epiphysis 76, 171, 177, 178 epith alam us 171, 172, 177–178 epith eliu m olfactory 81, 83 p igm en t 103 equ ilibriu m distu rban ces 123–124, 165 esotropia 92 eth m oid air cells 89 falx cerebelli 260 falx cerebri 260, 281 fascia den tata 203, 204 fascicu lus arcu ate 235, 236, 237 cu n eatus (of Bu rdach ) 26, 28, 28, 31 fron totem p oral 236, 237 gracilis (of Goll) 26, 28, 28, 31 len ticular 178 lon gitu din al dorsal (of Sch ü tz) 83, 137, 181, 181, 190 in ferior 237, 237 m edial (MLF) 95–96, 96, 118, 121, 122, 123, 135, 137, 138, 139, 142, 164–165 lesion s 97, 150, 152 su perior 236–237, 237 m am illotegm en tal 182 occip ital, vertical 237, 237 occipitofron tal in ferior 236, 237 su perior 237 of Meyn ert 181 olfactory 79 optic 79 propriu s 20, 20 sem ilu n ar 41 subth alam ic 178 th alam ic 178 u n cin ate (of Ru ssell) 122, 160, 236, 237, 237 see also tract(s) fecal in tin en ce 198 fecal reten tion 198 fen estra coch leae 114, 115 vestibu li 114, 115 Index · 323 fiber(s) 14, 77, 78 an n u lospiral 41 association 233, 236–238, 236, 237 cerebral arcu ate 236, 237, 237 clim bin g 160, 160, 161 com m issural 233, 237, 238 corticon uclear 137, 156 corticop on tin e 75 corticosp in al 137, 156 cran ial n erve 77–78 Golgi 41 gu statory 111–112, 113, 130, 173 in tracortical 237 m ossy 160, 160, 161 m yelin ated 235 parallel 159, 160 pon tin e 75 projection 235 radial glial 227 radicu lar 90, 91 subcortical 237 trigem in al 104–107, 105, 106 lesion s 107 m otor 107 pain 106–107 som atosen sory 104–105, 105, 106 tem peratu re 106–107 vestibulocerebellar 121 visceral afferen t 186 efferen t 186 see also n erve(s); n eu ron (s) fim bria h ipp ocam pi 204, 205 fissure collateral 230 h ippocam pal 204 lon gitu din al, cerebral 228, 230 in ferior 236 su perior 236 orbital, su perior 82, 89 posterolateral 159 sylvian 228, 229 fistula arterioven ou s 312–314 case presen tation 313, 313 carotid-cavern ou s 273 fixation reflex 98 floccu lu s 122, 159, 159 flow er-spray en din gs 22 Foix–Alajou an in e disease 312 foliu m (a) 158, 161 food in take 145 foram en (in a) in terven tricular, of Mon ro 170, 171, 262 in tervertebral 59, 60 jugular 82, 131 laceru m 82 m agn u m 131 of Lu sch ka 75, 76, 158 of Magen die 75, 76, 158 ovale 82, 114 rotu n du m 82, 114 sten oses 57, 58, 59, 60, 61 stylom astoid 111 forceps m ajor 237, 238 m in or 237, 238 forn ix 171, 175, 180, 181, 203, 205, 216 crux 171 fossa in terpedun cular 75 p osterior 158 rh om boid 74–75 fovea 84 Foville syn drom e 147 free n erve en din gs 13, 13 Friedreich ataxia 49 fu n ction al m agn etic reson an ce im agin g (fMRI) 239, 243 fu n ction al n eu ral n etw orks 239 fu n icular m yelosis 34, 34, 47–4 8, 48 fu n icu lu s, p osterior 28, 28, 31 G G-p rotein -cou pled receptors 5, gag reflex 145 galactorrh ea 186 γ m otor n eu ron s 22–24, 22, 43 static an d dyn am ic 24 gam m a-am in obu tyric acid (GABA) receptors gan glion (a) basal 39, 214 n ection s 217–219, 218 fun ction 219 h em orrh age 177, 305, 305 lesion s 219–223 n uclei 215–217, 215, 216, 217 phylogen etic aspects 214–215 celiac 189, 191 cervical m iddle 190 sup erior 63, 103, 104, 129, 190 cervicoth oracic (stellate) 190 ciliary 100, 101, 103, 105, 189, 192 dorsal root 16 syn drom e of 46, 46 gen icu late 109, 111, 112, 113, 114 glossoph aryn geal in ferior (extracran ial) 126, 127, 130 su perior (in tracran ial) 126, 127, 130 m esen teric in ferior 189, 191, 193, 198 su perior 189, 191 otic 113, 114, 189, 192 pterygopalatin e 105, 109, 112, 113, 114, 189, 192 sp iral 117, 117, 118 su bm an dibular 112, 114, 189, 192 trigem in al (gasserian ) 79, 82, 89, 91, 103–104, 105, 141 vagal in ferior (n odose) 127, 128, 129, 130, 131 sup erior (jugu lar) 127, 128, 129, 131 vestibu lar (of Scarpa) 117, 121, 122 gap ju n ction gastroin testin al m otility 14 gaze 92, 93, 95–97, 96 diagn ostic direction s of 91, 92 h orizon tal 95 disturban ces 95–96 lesion s of gaze cen ters 98 reflex gaze m ovem en ts 98–99 vertical 96–97 vertical gaze palsy 176 see also eye m ovem en ts gen italia, m ale dysfu n ction 198–199 in n ervation 193, 194, 198, 199 gen u facial n erve extern al 109 in tern al 109 Gerstm an n syn drom e 255 glan d(s) adren al 194 Bow m an ’s 81 lacrim al 112, 114, 189, 194 n asal 112, 114 p in eal 178 salivary 189 parotid 114, 189, 194 sublin gu al 112, 114, 194 subm an dibu lar 112, 114, 194 sw eat 104, 189 glial cells 7–8 globu s pallidu s 40, 171, 172, 174, 175, 178, 178, 214, 215, 215, 216, 217, 218 glu tam ate an tagon ists 160 receptors glycin e receptors Golgi ten don organ s 13, 14 Golgi–Mazzon i corpu scle 14, 14 Gordon reflex 41 Graden igo syn drom e 108 gran u le cells 160, 160, 161, 231, 232 gran u lization 233 gray m atter syn drom e 47, 47 Gray type I syn apses Gray type II syn ap ses grow th -h orm on e-secretin g aden om a 186 Gu illain –Barré syn drom e 264 gyn ecom astia 186 gyru s(i) 228–229 am bien t 82, 83 cin gu late 175, 202 den tate 203–205, 204, 230 fron tal, m iddle 229 fu siform 230 lin gu al 230 occipitotem poral lateral 230 m edial 230 orbital 230 p arah ipp ocam pal 82, 204, 230 p araterm in al 230 p ostcen tral 28, 29, 30 324 · Index gyru s(i) precen tral 36, 36, 37, 230 rectu s 230 sem ilu n ar 82, 83 tem poral in ferior 230 sup erior 231 tran sverse, of Hesch l 117, 118, 231 H h aben u la 177 h air cells 115, 116, 118, 120–121 h eadach e 302, 304, 308 clu ster 108 occipital 306 h earin g 113–119 diagn ostic evalu ation 119 disorders 119–120, 126 h eart in n ervation 191, 194 referred p ain 199 regu lation 184 h elicotrem a 115, 115, 116 h em an gioblastom a 167 h em atom a epidu ral 311, 312, 314 rem oval 306, 311 sp in al cord 314 su bdural 311, 311 h em atom yelia 47, 314 h em ian esth esia 24 4, 299, 30 h em ian opic ligh t reflex test 88 h em ian opsia 245 bin asal 86 bitem poral 86 h om onym ous 86, 88, 296, 297, 299 h em iataxia 177, 299 h em iballism 178 case presen tation 223, 223 h em icran iectom y 285 h em ihyp esth esia 24 4, 296, 297 h em ip aresis bilateral 43 tralateral 43, 24 4, 296, 297, 299, 305 flaccid 43, 24 sp astic 43, 24 h em ip legia altern atin g 147, 148 sp astic tralateral 42–43, 148 ip silateral 43 h em orrh age 305–311 basal gan glia 177, 305, 305 cerebellar 167, 306–307, 306 in tracerebral 305–307 hyperten sive 305–306 in traven tricu lar ru ptu re 305 n on hyperten sive 306 septal n uclei 209 sp in al cord 314 su barach n oid (SAH) 267, 267, 307– 310, 309 diagn osis 308–309 gradin g 308, 309 rebleedin g 310 see also h em atom a h eparin 304 Herin g’s law 94–95 h erpes sim plex en ceph alitis 209, 264 case presen tation 209, 209–210 h erpes zoster 46 oticu s 112 Heu bn er’s artery 275, 279 h ipp ocam pu s 202, 203–205, 204, 216, 227, 227 activation 205 n ection s 205 h om u n cu lus 28, 241 m otor 36–37 h orn Am m on ’s 203–205, 204 an terior 135 an terior h orn cells 43, 123 in h ibition by Ren sh aw cells 4 syn drom e 48, 48 in ferior 204, 216 p osterior 24–25, 30, 217 lesion s 34 syn drom e 47, 47 Horn er syn drom e 63, 102, 104, 149, 191–192 cau ses 192 h ou rglass tu m ors 57 Hu n tin gton disease 221 case p resen tation 222, 222 hydroceph alu s 266–268, 309 active 266–267 ch ildren 268 com m un icatin g 266 diagn osis 268 epidem iology 268 ex vacu o 267 hypersecretory 266 m alresorptive 266 case presen tation 267, 267 n on com m un icatin g 266 n orm al pressure (NPH) 267 case presen tation 265, 265 occlusive 266 treatm en t 26 8, 309 types of 266–267 hydrom yelia 47 hypercolum n s 245 hyperkin esia 219 ch oreiform 221 hyperosm ia 84 hyperreflexia 41 detrusor m u scle 196 hyperten sion arterial 286, 305 in tracran ial 268, 285, 296, 297, 305 treatm en t 305, 306 hyperth erm ia 184 hypertropia 92 hypokin esia 219, 220 hypom im ia 221 hypophysis 171 hyporeflexia 167 hyposm ia 84 hypoth alam ic–pitu itary axis 185, 186 distu rban ces 185–186 hypoth alam u s 170, 171, 172, 178–188, 216 n ection s 180–183, 180, 181, 190 fu n ction s 184–185 n u clei 179–180, 179 hypoth erm ia 184 hypoton ia 44, 167 hypotropia 92 I im poten ce 186, 198–199 in tin en ce fecal 198 u rin ary 196–197 overflow 196 stress 196–197 u rge 196 in cu s 115 in dusiu m griseu m 202, 227, 227 in farction brain stem 95, 95, 97, 97, 146, 298 Broca’s area 250–251 cerebellar, case presen tation 301, 301 cerebral artery 256, 290, 290, 291, 296–297, 298–299 em bolic 285 h em odyn am ic 285–286 case p resen tation 287, 287 lacu n ar 286 case p resen tation 288, 288 m idbrain 95, 95, 97, 97 pon tin e 154 oral region 155 septal n u clei 209 spin al cord 55, 55, 282, 312 su bth alam ic n u cleus 223 territorial 285, 290, 291 th alam ic 209 case p resen tation 211, 211, 30 0, 300 Wern icke’s area 252 see also isch em ia in form ation flow in form ation processin g 2, in fu n dibu lum 178, 279 in h ibition 6, forw ard 6, recu rren t 6, in h ibitory p ostsyn aptic poten tial (IPSP) in n ervation 68, 69–71 eye p arasym path etic 102, 103 sym path etic 102, 103, 104 som atosen sory 16–17 in sula 29, 37, 216, 228, 231 in tern eu ron (s) 20, 232 GABAergic 205 Index · 325 in tervertebral disks see disks in testin e in n ervation 194 in tracran ial hyperten sion 266–267, 285, 296, 297, 305 treatm en t 305, 306 see also hydroceph alu s in trafu sal m uscle fibers 13 isch em ia cerebellar 167 cerebral 283–289, 295–297 diagn osis 286–289 p eriph eral n erves 67 p rolon ged reversible isch em ic n eurological defect (PRIND) 284 sp in al cord 55, 55 stroke 284 tran sien t isch em ic attack (TIA) 284, 290 see also in farction isocortex 204, 231 J jackson ian seizures 32–33, 42, 24 K kain ate receptors kidn ey in n ervation 194 Klum pke palsy 63 Korsakoff syn drom e 208 L labyrin th 116, 120 lacrim al glan d 112, 114, 189 in n ervation 194 lam in a basilar 116, 117, 118 ten sion regu lation 119 m edullary extern al 171 in tern al 171 tectal 76, 171 term in alis 171 lan guage 248–249 au tom atic 249 n on au tom atic 249 see also aph asia lem n iscu s lateral 118, 137, 138, 139 lesion s 151, 152, 153 m edial 26, 27, 28, 29, 33, 106, 118, 127, 129, 135, 137, 138, 139, 140, 142, 174, 217 lesion s 33, 150, 151, 152, 153, 155 sp in al 30, 33, 106 trigem in al 33, 106, 142 lateral 137 lesion s 33 leu koaraiosis 286 Lew y bodies 219–220 ligam en t, sp iral 116 ligan d-gated ion ch an n els ligan d-gated receptors lim bic system an atom y 202–203 n ection s 203 fu n ction s 206–208 lim en in su lae 83 lin gu la 159, 161 lobe(s) flocculon odu lar 122–123, 159, 159 fron tal 228, 228, 229, 247, 248 occipital 97, 228, 228, 229 p arietal 228, 228, 229, 247–248 tem poral 228, 228, 229 locu s ceruleu s 137, 143 lun g in n ervation 191 Lym e disease 264 lym p h om a 52, 52 M m acules 87, 115, 121 saccu lar 115, 120–121 u tricular 115, 120–121 m agn etic reson an ce im agin g (MRI) 289, 290, 290, 291, 303–304 fu n ction al (fMRI) 239, 243 m agn etoen ceph alography 239 m alleu s 115 m assa in term edia 171, 172, 180, 181 m ech an oreceptors 12 Meckel’s cave 260 m edu lla 38, 74–75, 134, 135, 136–140 adren al 191 syn drom es 147, 149 m edu lloblastom a 167, 168 m em bran e basilar 115, 116, 116 Reissn er’s 115, 116, 118 tectorial 116, 118 tym pan ic 115 m em ory 206 dysfu n ction 208–209 episodic 206–207 exp licit (declarative) 207 fron tal-lobe-type fun ction s 207–208 im plicit (n on declarative) 207 lon g-term (LTM) 206–208 su btypes 206–207 n eural su bstrates 206 sem an tic 206–207 sh ort-term (STM) 206 Squ ire’s taxon om y of 207–208 tests of 206 typ es of 206–208 Men del–Bekh terev reflex 41 Mén ière’s disease 119–120 m en in ges 260, 261 m en in giom a 57 m en in gitis bacterial 264 fu n gal 264 tu bercu lou s 264 viral 264 Merkel’s disks 13, 13 m esen ceph alon m esocortex 202 m etastases, drop 167 Meyer’s loop 87, 88 m icroan eu rysm s 305 m icroan giopath ic leu koen ceph alopathy 286 m icroelectrode recordin g 238 m icroglial cells m icrovascu lar decom p ression 107 m ictu rition 193, 195 m idbrain 75–76, 136, 137, 141–143 in farct 95, 95, 97, 97 Millard–Gu bler syn drom e 147, 151 m iosis 191 m odiolu s 116 m on key h an d 67 m on oplegia 43 m otor en d p late 4 m otor system cen tral com pon en ts 36–43 lesion s 41–43 perip h eral com p on en ts 43–4 m otor u n it 44 m ultiple sclerosis 86, 88, 88, 96 CSF fin din gs 264 trigem in al n eu ralgia an d 108 m ultiple system atrophy 220 m uscle spin dles 13, 14, 20–21 m uscle ton e 24 abn orm alities 41, 219, 221 m uscle(s) abdu ctor digiti qu in ti 70 abdu ctor p ollicis brevis 69 lon gus 70 addu ctor brevis 71 lon gu s 71 m agn u s 71 pollicis 70 an eu s 70 biceps brach ii 60, 69 biceps fem oris 71 brach ialis 69 brach ioradialis 60, 70 ciliary 100 strictor p h aryn geu s 127 coracobrach ialis 69 deltoid 69 detrusor 193, 195 areflexia 196 detru sor-sph in cter dyssyn ergia 196 hyp erreflexia 196 in stability 196 digastric 108 dilator pu pillae 103, 104 exten sor carp i radialis 70 u ln aris 70 exten sor digiti qu in ti 70 exten sor digitoru m 70 brevis 61, 71 lon gus 71 326 · Index m uscle(s) exten sor h allu cis brevis 71 lon gu s 61, 71 exten sor in dicis propriu s 70 exten sor pollicis brevis 70 lon gu s 70 extraocu lar 89–92, 89, 91, 123 pareses 92, 93 flexor carpi radialis 69 u ln aris 70 flexor digiti qu in ti brevis 70 flexor digitoru m brevis 71 lon gu s 71 profun dus 69, 70 sup erficialis 69 flexor h allu cis lon gus 71 flexor pollicis brevis 70 lon gu s 69 gastrocn em iu s 71 gem elli 71 gen ioglossu s 133, 134 glu teu s m axim u s 71 m ediu s 71 m in im us 71 gracilis 71 hyp oglossu s 134 hyp oth en ar 60 iliop soas 70 in fraspin atus 69 in n ervation 68, 69–71 in terossei dorsal 70 palm ar 70 latissim u s dorsi 69 len gth regu lation 20–21, 22 dysfu n ction 41 target values 22–24 levator palpebrae 89 su perioris 90 scapu lae 69 lu m bricals 70 m asseter 105, 107 m en tal 105 oblique in ferior 89, 90, 92 sup erior 89, 92 paresis 93, 95 obtu rator extern u s 71 in tern us 71 om ohyoid 133 oppon en s digiti qu in ti 70 oppon en s pollicis brevis 70 orbitalis 104 p alm aris lon gu s 69 p ectin eu s 71 p ectoralis m ajor 69 m in or 69 p elvic floor 195 p eron eal 71 p eron eus brevis 61 lon gu s 61 piriform is 71 plan tar, of th e foot 71 pron ator teres 60, 69 quadratus fem oris 71 quadricep s fem oris 70 rectu s in ferior 89, 90, 92 lateral 89, 92 paresis 93 m edial 89, 90, 92, 100, 101 paresis 93 sup erior 89, 90, 92 rh om boids 69 sartoriu s 70 scalen e 69 an terior 64 segm en t-in dicatin g 58, 60, 61 sem im em bran osu s 71 sem iten din osus 71 serratu s an terior 69 soleu s 71 stapediu s 114 stern oclein om astoid 132 stern othyroid 133 styloglossus 134 styloph aryn geu s 127 su bscap ularis 69 su pin ator 70 su prasp in atu s 69 syn drom es 72 tarsal in ferior 104 su perior 104 tem poralis 105, 107 ten sion regulation 20–21, 22 ten sor fasciae latae 71 ten sor tym p an i 114 teres m ajor 69 m in or 69 th en ar 60 thyrohyoid 133 tibialis an terior 61, 71 posterior 71 trapeziu s 132 triceps brach ii 60, 70 triceps su rae 61, 71 vastu s lateralis 61 m edialis 61 see also sph in cter m u scu lar dystroph ies 72 m yasth en ia 72 gravis 72 m ydriasis 102 m yelin sh eath 3–4, m yelitis p arain fectiou s 51, 51 tran sverse 50 m yopathy 72 N n asal glan ds 112, 114 n eglect 255 case p resen tation 256, 256 n eocerebellu m 159 n eocortex 226–227, 227 n erve(s) abdu cen s (CN VI) 80, 81, 82, 89, 89, 91, 91, 96, 151 p alsy 93, 94 accessory (CN XI) 75, 80, 81, 82, 122, 126, 131–132, 131 lesion s 132 alveolar, in ferior 105 au ricu lar great 19, 63 posterior 109, 111 au ricu lotem p oral 105, 106 axillary 19, 64, 66, 69 bu ccal 105 cardiac 191 cervical 19, 69 tran sverse 19, 63 clu n eal 19 coccygeal 15, 65 coch lear 111, 117, 118 cran ial 77–78, 77–82 n u clei 77, 78, 79 see also specific nerves cutan eous an tebrach ial lateral 19 m edial 19 posterior 19 brach ial m edial 19 posterior 19 fem oral lateral 19, 65 posterior 19, 65 facial (CN VII) 80, 81, 82, 109–111, 109, 111 lesion s 110–111, 111 m otor com pon en t 109–111 palsy 43, 110–111, 110, 148 cen tral 110 idiopath ic 111, 112 fem oral 19, 65, 66, 70 fibu lar 19 fron tal 105 gen itofem oral 19, 65 glossop h aryn geal (CN IX) 75, 80, 81, 82, 112, 126–127, 127, 129–131, 189 bran ch es 126 lesion s 126–127 syn drom e 126–127 glu teal in ferior 65, 66, 71 sup erior 65, 66, 71 hyp ogastric 198 hyp oglossal (CN XII) 63, 75, 80, 81, 82, 132–134, 133, 135 lesion s 134, 150 palsy 43, 134, 148, 150 Index · 327 iliohyp ogastric 19, 65 ilioin gu in al 19, 65 in tercostal 19, 70 in tercostobrach ial 19 laryn geal recu rren t 128, 129 su perior 128 lin gual 105, 111, 113, 114 lu m bar 19 m an dibular 17, 19, 82, 104, 105, 106 m axillary 17, 19, 82, 104, 105, 106, 114 m edian 19, 64, 66, 69, 70 lesion s 67 palsy 67, 68 m u sculocu tan eous 64, 66, 69 m ylohyoid 105 n asociliary 105 obtu rator 19, 65, 66, 71 occipital greater 19, 63 lesser 19, 63 oculom otor (CN III) 75, 79, 81, 82, 89, 90, 91, 96, 100, 103, 189, 279 palsy 93, 94, 148 olfactory (CN I) 79, 81–82, 81, 82, 83 oph th alm ic 17, 19, 82, 89, 104, 105, 106 optic (CN II) 77, 79, 81, 82, 84, 85, 87, 91, 100, 103 lesion s 86, 101 pectoral lateral 64, 69 m edial 64, 69 pelvic 198 perip h eral 14, 14, 4, 66 lesion s 18, 67 differen tial diagn osis 68 som atosen sory in n ervation 16–17 syn drom es 67–6 8, 67 peron eal 66 com m on 19, 65–66, 65 deep 19, 71 lesion s 66 su perficial 19, 71 p etrosal great 111, 113, 114 lesser 106, 114 p h ren ic 63, 64, 69 p lan tar lateral 19 m edial 19 pterygoid lateral 106 m edial 106 p uden dal 65, 71, 193, 198, 199 p ulm on ary 191 radial 19, 64, 66, 70 palsy 67 sacral 19 sap h en ous 19, 66 scapu lar, dorsal 64, 69 sciatic 65–66, 65, 66, 71 lesion s 66 sp in al 15–16, 57 sp lan ch n ic greater 189, 191 lesser 189, 191 pelvic 189, 193, 193 su bclaviu s 64 su boccipital 63 su bscapu lar 64 su praclavicular 19, 63 su prascap ular 64, 69 su ral 19 th oracic 19 lon g 64, 69 th oracodorsal 64, 69 tibial 65–66, 65, 66, 71 lesion s 66 trigem in al (CN V) 17, 19, 33, 75, 80, 81, 82, 91, 103–109, 137, 146 lesion s 33–34, 107–108 troch lear (CN IV) 76, 79, 81, 82, 89, 89, 90–91, 91, 142 n uclear lesion 95, 95 p alsy 93, 94 tym pan ic 126 u ln ar 19, 64, 66, 70 lesion s 68 p alsy 67, 68 vagus (CN X) 75, 80, 81, 82, 112, 122, 126, 127, 128–131, 129, 131, 189, 192 bran ch es 128 lesion s 128–129 vestibu lar 91, 111, 120, 122 vestibu lococh lear (CN VIII) 80, 81, 82, 113–126 zygom atic 114 see also fiber(s); n eu ron (s) n erve p lexu s see p lexu s n erve roots 16, 57 accessory 131–132 cran ial 131, 131 lesion s 132 spin al 131, 132 coch lear 117 dorsal root en try zon e (DREZ) 24 facial 109 oculom otor 155, 156 spin al 15–16, 15 an terior 14, 15, 44 posterior 14–15, 15, 16 syn drom es 57–62 cervical 58–59, 59, 60 lu m bar 59–62, 60, 61, 62 posterior 46, 46 trigem in al 106, 108, 154 u n m yelin ated p ortion s 108 vestibu lar 117, 121 n ervou s system auton om ic 188–190 parasym path etic 184, 188, 189, 192– 193, 194–195 hypoth alam ic trol 188–190 sym p ath etic 184, 188, 189, 190–192, 194–195 an atom y 190, 191 hypoth alam ic trol 188–190 lesion s 191–192 n ervu s in term ediu s 78, 79, 80, 109, 111–112, 111, 189 n eural tu be n euralgia Ch arlin 108 glossop h aryn geal 127 trigem in al 107–108, 108, 302 idiopath ic 107 n eurin om a 57 n eu roblasts n eu roborreliosis 264 n eurodevelopm en t 8–9 n eu roglia 235 n eurohypophysis 171, 178, 179, 181, 182 n eu rom a, acou stic 120, 125–126, 167, 168 n eu ron al m igration disorders 227 n eu ron (s) 2–4, association 20 cellular proliferation com m issu ral 20 EE 246 EI 246 excitatory fu n icu lar 20, 30 GABAergic glu tam atergic grow th of cellu lar processes in h ibitory m otor 20, 37–38 α 43, 123 γ 22–24, 22, 43, 123 static an d dyn am ic 24 postgan glion ic 188 pregan glion ic 188 program m ed cell death pyram idal 37 see also fiber(s); in tern eu ron (s); n erve(s) n eu ron al m igration n eu ropathy, vestibu lar 125 n eu ropeptides n eu rosecretion 185 n eu rosyph ilis 264 n eurotran sm itters excitatory in h ibitory syn aptic tran sm ission NMDA receptor n ociceptors 12 n ode of Ranvier n odu lu s 159, 159, 161 n orep in eph rin e n otch , preoccip ital 229 n u cleu s(i) abdu cen s 78, 89, 91, 137 lesion s 152 accessory 77, 78, 90, 100, 131, 135 am biguu s 77, 78, 127, 129–130, 129, 131, 135, 140 lesion s 149 arcu ate 135 basal, of Mayn ert 178 cau date 171, 214, 215, 215, 216, 217 h ead 37, 38, 40, 175, 215, 216, 227 tail 38, 204, 215, 216 328 · Index n eu ron (s) cen tral, su perior 143 cerebellar 160–162 coch lear 75, 77, 79, 135 dorsal 117, 118 lesion s 149 ven tral 117, 118 collicu lus in ferior 217 sup erior 137 cun eate 26, 27, 33, 77, 106, 135, 136, 138, 139 accessory 27, 135 Darksh evich ’s 96–97, 96 den tate 122, 137, 139, 142, 161, 162, 163, 166, 174 Edin ger–Westp h al 77, 78, 90, 101, 103, 142 em boliform 122, 137, 142, 160–162, 161, 165, 175 facial 78, 109, 110, 111, 137 lesion s 151, 152 fastigial 40, 122, 137, 160, 161, 165 globose 122, 137, 160–162, 161, 165 gracile 26, 27, 33, 77, 106, 135, 136, 138, 139 h aben ular 83, 171, 177–178, 205 hyp oglossal 75, 77, 78, 132–134, 133, 135, 140 lesion s 134 hyp oth alam ic 143, 179–180, 179 dorsom edial 179, 180, 180 in fu n dibu lar 179, 180 lateral (tu berom am illary) 180 m am illary 180 paraven tricu lar 179, 179, 181, 184 posterior 179, 180 preoptic 179, 179 sup raoptic 179, 179, 181, 184 tu beral 179, 180 ven trom edial 179, 180, 180 in term ediolateral 178, 191 in terpedun cular 83 in terstitial, of Cajal 96–97, 96, 122 len tiform /len ticu lar 37, 38, 217 m am illary body 171 m esen cep h alic 77, 79, 106, 127 ocu lom otor 77, 78, 89, 90, 90, 91, 100, 137, 142 of Darksh evich 122 of Perlia 90, 100, 101, 142 olivary 118, 136 accessory 138, 139 in ferior 75, 135 sup erior 137 p ara-abdu cen s 97 p araven tricu lar 182 p on tin e 40, 137, 154, 161, 163 posterior com m issu re 96 prestitial 96 pretectal 103, 141 pu lposus 58 rap h e 217 dorsalis 143 m agn u s 143 pon tis 143 red 40, 91, 122, 137, 138, 139, 141– 142, 163, 163, 166, 217 syn drom e of 152–153, 155 reticu lar lateral 136 of th e th alam us 171, 172 reticu lar form ation 127 au ton om ic 14 4–145 salivatory in ferior 77, 78, 113, 114, 127, 130, 14 su perior 77, 78, 112, 113, 114, 14 septal 209 lesion s 212, 212 Stillin g’s 26 su bth alam ic 171, 178, 178, 215, 216, 217 in farct 223 su prach iasm atic 178 su praoptic 182 tegm en tal 40, 83 p edu n cu lop on tin e 143 th alam ic 171, 172–176, 173, 174, 175 an terior 172, 173, 174, 175, 181, 203 cen trom edian 172, 173, 175, 176, 178, 217 dorsal 175 in term ediate 175 m edial 175, 206 oral 175 su perficial 175 in tralam in ar 173, 176 lateral 172, 174, 175 dorsal 172, 173 posterior 172, 173 lesion s 176–177 m edial 174, 175 dorsal 173 n on specific 173, 176 reticular 171, 172 sp ecific 173–174 ven tral 172, 174, 176 an terior (VA) 172, 173, 174, 176 in term ediate (VI) 173 lateral (VL) 172, 173, 176 oral 174 posterolateral (VPL) 28, 30, 172, 173, 173, 176 posterom edial (VPM) 112, 172, 173, 173, 176 th oracic 26, 31 tractus solitarius 77, 79, 112, 113, 114, 127, 140 lesion s 149 trigem in al 75, 103–107, 106, 127, 135, 137, 139, 140, 141 lesion s 149, 152, 153 m otor 77, 78, 106, 137, 141, 153 prin cipal sen sory 77, 79, 106, 127, 137, 141, 153 troch lear 77, 78, 89, 90 lesion 95, 95 vagal 75, 77, 78 dorsal 129, 130, 135, 140, 143, 149, 192 vestibu lar 75, 77, 79, 120, 121–123, 121, 137, 140, 141, 161 in ferior (of Roller) 96, 121, 121, 137, 149 lateral (of Deiters) 40, 96, 121, 121, 137 lesion s 149, 152 m edial (of Sch w albe) 96, 121, 121, 137 su perior (of Bekh terev) 96, 121, 121, 137 n utrition al in take regulation 185 nystagm u s 124, 149, 165, 30 com p lex 165 gaze-evoked 165 optokin etic 98–99 periodic altern atin g 165 reboun d 165 O obex 76 ocu lom otor disturban ces 165 olfactory system 81–84, 227 discon n ection 253 oligoden drocytes 3, 4, olive 75, 138, 150, 161, 163 accessory 138 in ferior 40, 76, 136, 139 lesion s 138 op h th alm op legia extern al 94 in tern al 94 in tern u clear (INO) 95–96, 97 Oppen h eim reflex 41 optic radiation (of Gratriolet) 84–85, 85, 86, 100 lesion s 88 optokin etic nystagm us 98–99 organ of Corti 115, 116, 118 vestibu lar 160 oscillop sia 124 osm oceptors 12 osteoch on drosis 58 cervical 58–59 lum bar 59 oxytocin 182–183, 185 P pain perception 240 ph an tom 242 referred 199–20 visceral 199 paleocerebellu m 27, 159 paleocortex 202, 226–227, 231 palsy abdu cen s n erve 93, 94 accessory n erve 132 brach ial plexu s low er (Klu m p ke) 63 u pper (Du ch en n e–Erb) 63 bulbar, p rogressive Index · 329 facial 43, 110–111, 110, 148 cen tral 110 idiopath ic 111, 112 hyp oglossal 43, 134, 148, 150 m edian 67, 67, 68 oculom otor 93, 94, 148 peron eal 66 radial 67 sup ran u clear, progressive 220 tibial 66 toch lear 93, 94 u ln ar 67, 68, 68 vertical gaze palsy 176 Pan coast tu m or 192 p an creas in n ervation 194 p an hypop itu itarism 185–186 Papez circu it 203, 203 p apilledem a 86, 167, 262, 302 p aragram m atism 249 p aralysis flaccid 4–45 spastic spin al 48–49, 48 p araparesis 297 flaccid 313 spastic 313 spin al cord com pression an d 52, 52 p araplegia 43 p aresis eye m u scles 92, 93, 95 flaccid 42, 67, 312 facial 111 leg 297 spastic 41, 312 stern oclein om astoid m u scle 132 trapezius m u scle 132 up per lim b 42 see also h em iparesis Parin aud syn drom e 97 Parkin son disease 219–221 akin etic-rigid 220–221 fam ilial 220, 220 idiopath ic 219–220 case p resen tation 221 m ixed-typ e 221 trem or-dom in an t 221 Parkin son -plu s syn drom e 220 parkin son ism 219–221 parosm ias 84 parotid glan d 114, 189 in n ervation 194 path , perforan t 204, 205 path w ay au ditory 117, 118 cortico-striato-pallido-th alam ocortical 218–219 corticopon tocerebellar 140 dien ceph alobu lbar 129 gustatory 112, 113 olfactory 82–83, 83 reticu lar, descen din g 14 sym path etic, cen tral 135, 137, 142 lesion s 149, 152 visu al 84, 85 lesion s 86 som atotopic organ ization 85–86 see also tract(s) pedun cles cerebellar 74–75, 159 in ferior 76, 118, 135, 137, 138, 139, 149, 159, 162 lesion s 149, 152, 153, 154 m iddle 75, 76, 137, 138, 139, 146, 152, 154, 159, 163, 217 su perior 75, 76, 137, 138, 139, 146, 153, 159, 163–164, 217 cerebral 38, 75, 141, 142–143 lesion s 42, 43 syn drom e of 153, 156 m am illary body 180 pen u m bra 285 perfu sion p ressu re 285 perikaryon perin eu rium 14 periosteu m 284 perip h eral n erves see n erve(s) peritrich ial n erve en din gs 12, 13 perseveration 257 ph otoreceptors 84 pia m ater 261, 262–263 Pillar cells 116 pin eal glan d 178 pin ealocytes 178 pituitary glan d an terior lobe (aden ohypophysis) 183 p osterior lobe (n eu rohyp ophysis) 171, 178, 179, 181, 182 plate cortical 227 cribriform 82, 82 qu adrigem in al 76, 76, 141 plegia 4 plexus 14–15, 16 brach ial 63–64, 64, 69–70 lesion s 63–64 cau ses 63–64 low er (Klu m pke p alsy) 63 u pper (Duch en n e–Erb palsy) 63 bu ccal 109 cardiac 191 carotid extern al 190 in tern al 191 cervical 62, 63, 69 syn drom es 62 ch oroid 171, 204, 216 hyp ogastric 189, 193, 199 in ferior 193 su perior 193 lu m bosacral 65 lesion s 65–66 lu m bar 65, 65, 70–71 sacral 65–66, 65, 71 ven ou s an terior extern al spin al 284 an terior in tern al spin al 284 epidural 283 posterior extern al vertebral 284 p oikiloth erm ia 184 p oliom yelitis 48 p olyn euritis 68 p olyn eu ropath ies 68 p olyradicu litis 264 p olysen sory m ism atch 124 p on s 38, 75, 76, 136, 137, 140–141 lesion s 42, 43, 98, 99 oral region in farct 155 param edian in farct 154 p on tocerebellu m 159 Pop e’s blessin g 67 p ositron em ission tom ography (PET) 239, 289 p osth erp etic n eu ralgia 46 p ostsyn aptic m em bran e 4–5 p recociou s pu berty 178 p replate 227, 228 p resu bicu lu m 204 p resyn aptic m em bran e 4–5 p rim in g effect 207 p rogram m ed cell death p rogressive sup ran u clear p alsy 220 p rolactin om a 186 case presen tation 187, 187 p rolon ged reversible isch em ic n eu rological defect (PRIND) 284 p roprioceptors 12 p rosen ceph alon 8, 226 p rosopagn osia 255 p seu do-depressive patien ts 257 p seu do-psych op ath ic patien ts 257 ptosis 94, 191 p ulvin ar 76, 172, 173, 174, 174, 175 p up illary striction 10 p up illary ligh t reflex 84, 101 afferen t path w ay lesion s 101 efferen t p ath w ay lesion s 101–102 regulation 101–102 Pu rkin je cells 160, 160, 161, 162 pu tam en 40, 174, 175, 178, 214, 215, 215, 216, 217 pyram idal cells 203–205, 231–233 pyram idalization 233 pyram ids cerebellar 159, 161 m edu llary 38, 39, 40, 75, 76 decu ssation 38, 39, 75, 76, 135, 139 lesion s 42, 43 Q qu adran tan op sia 88, 245 qu adriparesis 43 qu adriplegia 43 R radiation au ditory 117, 118, 174 callosal 238 optic 173, 236, 245 th alam ocin gulate 203, 203 radicu lar lesion s 17, 18, 57–62 differen tial diagn osis 68 330 · Index radion u clide stu dies 289 ram u s com m u n ican s gray 190, 191 w h ite 190, 191 Rath ke’s pou ch 179 rebou n d p h en om en on 167 receptor organ s 12–14 skin 12–13, 13 recess in fun dibu lar 171 optic 171 rectu m em ptyin g disorders 198 in n ervation 194, 198, 198 Redlich –Oberstein er zon e 24 referred pain 199–20 reflex(es) an kle-jerk 61 an tagon ist m u scle relaxation 18–19, 21–22 biceps 23, 60 blin k 102, 110 corn eal 105 ligh t test 92 crossed exten sor 20 fixation 98 fligh t 19–20 gag 145 h em ian op ic ligh t reflex test 88 in trin sic 18, 23 m asseteric (jaw -jerk) 107 m on osyn aptic 18, 24 p olysyn aptic 19–20, 20, 21 p roprioceptive 18 p up illary ligh t reflex 84, 101 regu lation 101–102 qu adriceps (kn ee-jerk) 21, 23, 61 sn eeze 105 stapediu s 110 su ck 105–106 triceps 23, 60 triceps su rae 23 vestibu lo-ocular (VOR) 124, 165 viscerocu tan eou s 20 0, 200 reflex sym p ath etic dystrophy 67 Reissn er’s m em bran e 115, 116, 118 release-in h ibitin g factors 183, 183 releasin g factors 183, 183 Ren sh aw cells 4 resp iration 14 reticu lar form ation 31, 39, 40, 83, 122, 127, 135, 137, 140, 143–145, 143, 149, 161, 163, 175 param edian pon tin e (PPRF) 95 retin a 84, 85, 87 retin op athy 245 retrobu lbar n euritis 86 retrograde tran sport 3, rh om ben ceph alon rib 64 cervical 64 rigidity 220 Rin n e test 119 rods 84 Rom berg sign 30, 46, 48, 49 Rom berg test 166 roots see n erve roots S saccadic p ursuit m ovem en ts 165 saccu le 115, 120 salivary glan ds 112, 114, 189 salivation 112 regu lation 14 saltatory duction scala m edia 115 tym pan i 115, 115, 116 vestibu li 115, 115, 116 scalen e syn drom e 63–64, 64 Sch w an n cells Sch w artz–Bartter syn drom e 184–185 sciatica 61–62 seizures ep ileptic 302 jackson ian 32–33, 42, 244 sella turcica 91 sen sorim otor area 32 sen sory flict 124 sen sory deficits dissociated 31, 47 lesion s alon g som atosen sory path w ays 32–34, 33 periph eral n erve lesion s 18, 19, 67 radicular lesion s 17, 18 septum p ellu cidu m 171, 216 seroton in receptor Sh errin gton ’s law 95 sin gle-ph oton em ission com pu terized tom ography (SPECT) 289 sin u s(es) 280–281, 281 cavern ous 89, 281, 281 fron tal 89 occipital 280 petrosal in ferior 281, 281 su perior 91, 281, 281 sagittal in ferior 280, 281 su perior 261, 280, 280, 281, 303, 303 sigm oid 280, 281 sph en oid 89 sph en oparietal 281 straigh t 280, 280, 281 th rom boses 302–304 case p resen tation 303, 303 tran sverse 280, 280, 281 skin receptors 12–13, 13 segm en tal in n ervation 17 sen sory deficits 17–18 periph eral n erve lesion s 18, 19 radicular lesion s 17, 18 sleep–w ake cycle 14 sn eeze reflex 105 social beh avior trol 255–257 som a som atosen sory system cen tral com pon en ts 24–31 cen tral processin g 32–34 lesion s 32–34, 33 perip h eral com p on en ts 12–24 speech 249 sph in cter an al 71 extern al 198, 198 in tern al 198 pu pillae 100, 103 ureth ral extern al 193, 195 dysfu n ction 198 in tern al 193, 195 vesical 71 spin al au tom atism s 50 spin al cord 45 blood sup ply 281–283, 282, 283 arterial hypoperfu sion 312 im paired ven ous drain age 312– 314 com p ression 52, 52 cordotom y 32 h em orrh age 314 in farction 55, 55, 282, 312 syn drom es 45–55 an terior sp in al artery syn drom e 55, 55 cau da equ in a syn drom e 53, 54, 61, 62 u s syn drom e 53, 54 epicon u s syn drom e 53, 54 h em isection syn drom e 9–50, 49 tran section syn drom es 50–53, 50 acute 50, 50 cervical 53 in com plete 51, 51 lu m bar 53 progressive 52 th oracic 53 vascu lar 56–57, 312–314 tu m ors 56–57 epidu ral lym ph om a 52, 52 extradural 56, 56 in tradu ral extram edullary 56–57, 56 in tradu ral in tram edu llary 56, 56, 57 ven ou s drain age 283, 284 spin al sh ock 49, 50 spin ocerebellu m 159 fu n ction s 165 lesion s 165–166 split-brain patien ts 253 spon dylarth rosis 58 stapes 115 Steele–Rich ardson –Olszew ski syn drom e 220 Stein ert–Batten –Cursch m an n dystrophy 72 stereocilia 115, 116 stereogn osis 32 stereotaxy 238 Index · 331 Stillin g’s n ucleu s 26 stratu m gan glion are 160 gran ulosu m 160 m oleculare 159–160 zon ale 171 striae lon gitu din al 83 lateral 202, 227 m edial 202, 227 m edullares 75, 76, 83, 118, 177, 181 th alam i 84, 171 olfactory lateral 83 m edial 82, 83 term in alis 180–181, 180, 205, 237 striatu m 217 stroke 284 see also in farction ; isch em ia su bacu te com bin ed degen eration (SCD) 34, 34, 47–48 su barach n oid h em orrh age (SAH) 267, 267, 307–310, 309 diagn osis 308–309 gradin g 308, 309 rebleedin g 310 su bclavian steal syn drom e 147 su bdural h em atom a 311, 311 su bicu lu m 204, 205 su blin gu al glan d 112, 114 in n ervation 194 su bm an dibular glan d 112, 114 in n ervation 194 su bstan ce in n om in ate 178 perforated 279 an terior 83 su bstan tia gelatin osa 26, 31, 135 n igra 2, 39, 40, 91, 137, 141, 142, 217, 218 lesion s 155, 156 su bth alam u s 172, 178, 178 su ck reflex 105–106 Sudeck syn drom e 67 su lcu s(i) 228–229 an terolateral 76 calcarin e 85, 87, 230, 230 callosal 230 cen tral 229, 230, 230 cin gu late 230, 230 collateral 230 fron tal in ferior 229 sup erior 229 h ip pocam pal 230 hyp oth alam ic 171 lateral 228, 229 lu n ate 229 m edian , p osterior 76 occipitotem poral 230 olfactory 230 orbital 230 p arieto-occipital 229, 230, 230 p ostcen tral 229 p osterolateral 76 p recen tral 229 rh in al 230 tem poral in ferior 229 su perior 229 sw allow in g 14 4–145 sw eat glan d 104, 189 sym path ectom y 192 syn apses 4–5 asym m etrical axo-axon al axoden dritic axosom atic ch em ical electrical inp ut m otor tracts 41 stru ctu re 4–5, sym m etrical syn aptic tran sm ission 5–6, syn aptogen esis 8–9 syn drom e(s) am n estic 208–209 an terior h orn 8, 48 an terior spin al artery 55, 55 Balin t 255 basal gan glia lesion s 219–223 basis pon tis cau dal (Millard–Gu bler/Foville) 147, 161 m idportion 152, 154 Bin g–Horton 108 Brow n –Séqu ard 49–50, 49, 56 carpal tu n n el 67, 68 cen tral spastic paresis 41 cerebral pedu n cle (Weber) 153, 156 cerebrovascular 295–302 com bin ed an terior h orn an d pyram idal tract 48, 48 com bin ed involvem en t of p osterior colu m n s, spin ocerebellar tracts, an d (possibly) pyram idal tracts 49, 49 com bin ed posterior colu m n an d corticosp in al tract 47–48, 48 com plex region al p ain 67 corticospin al tract 48–49, 48 costoclavicular 63 cu bital tun n el 68, 68 discon n ection 253–254 olfactory system 253 visual system 253–254 dorsal root gan glion 46, 46 flaccid paralysis 4–45 fron tal brain 174 Gerstm an n 255 glossoph aryn geal 126–127 Graden igo 108 gray m atter 47, 47 Guillain –Barré syn drom e 264 Horn er 63, 102, 104, 149, 191–192 causes 192 hyperabdu ction 63 in ap propriate ADH secretion (SADH) 184–185 Korsakoff 208 m edu llary dorsolateral (Wallen berg) 147, 149, 150, 299 case presen tation 150 m edial (Dejerin e) 147, 150, 151 case presen tation 151 m u scle 72 n erve root (radicu lar) cervical root 58–59, 59, 60 differen tial diagn osis 68 lu m bar root 59–62, 60, 61, 62 posterior root 46, 46 n eurom uscu lar ju n ction 72 Parin au d 97 Parkin son -plus 220 p eriph eral n erves 67–6 8, 67 p lexu s 62–67 brach ial 63–64, 64 cau ses 63–64 low er (Klu m pke palsy) 63 up per (Du ch en n e–Erb palsy) 63 cervical 62, 63 lu m bosacral 65–66 lu m bar 65, 65 sacral 65–66, 65 p on tin e tegm en tum caudal 148, 152 oral 149, 153 p osterior colu m n 46–47, 46 p osterior h orn 47, 47 red n ucleu s (Ben edikt) 152–153, 155 scalen e 63–64, 64 sp in al cord 45–55 cauda equin a syn drom e 53, 54, 61, 62 u s syn drom e 53, 54 ep icon us syn drom e 53, 54 h em isection syn drom e 49–50, 49 teth ered cord 197, 197 tran section syn drom es 50–53, 50 acu te 50, 50 cervical 53 in com plete 51, 51 lu m bar 53 progressive 52 th oracic 53 vascular 56–57, 312–314 th alam ic 176–177 case presen tation 177 vascu lar 295–302 syn kin esia, facial 111 syrin ges 47 syrin gobu lbia 47 syrin gom yelia 47 system adren ergic 188 ascen din g reticular activatin g (ARAS) 143–14 4, 176 ch olin ergic 188 cran iosacral 188 descen din g reticu lar 190 extrapyram idal 214 olfactory 81–84, 227 discon n ection 253 332 · Index system pyram idal 214 th oracolu m bar 188 vagal 126–132 ven tricular 262, 262 vestibu lar 120, 124 lesion s 124–126 visu al 84–88, 233 discon n ection 253 see also lim bic system ; n ervous system T tabes dorsalis 46–47 tapetum 217 taste 111–112, 130 taste bu d 113 tectu m 75–76, 141 tegm en tu m m idbrain 141–142 pon tin e 140 cau dal, syn drom e of 148, 152 oral, syn drom e of 149, 153 tela ch oroidea 76, 171 teleceptors 12 telen cep h alon 8, 226 tem p eratu re regu lation 184 ten din ous rin g 89 ten toriu m 260, 281 cerebelli 158 teth ered cord syn drom e 197, 197 th alam ocortical reciprocity 235–236 th alam u s 26, 28, 29, 33, 37, 38, 40, 161, 163, 170–177, 171, 215, 217, 218, 235 blood su pply 277 fu n ction s 176 in farction 209 case presen tation 211, 211, 30 0, 300 n uclei 171, 172–176, 173, 174, 175 lesion s 176–177 syn drom es 176–177 vascular 299 th erm oreceptors 12 th oracolum bar system 188 th rom bolysis case presen tation basilar artery 293–294, 293, 294, 295 m iddle cerebral artery 291, 292, 293 th rom boses 302–304 diagn osis 302–304 see also em boli tic douloureux 107 ton otopy 245 ton sil, cerebellar 159 tract(s) bu lboth alam ic 28 cerebello-olivary 162 cerebelloreticu lar 162 cerebelloru bral 138 corticobu lbar 39 corticom esen ceph alic 38, 39, 138 corticon uclear 38, 39, 127, 133, 133, 138, 138, 139 lesion s 148, 153 corticopon tin e 38, 137, 138, 156, 161, 163, 166 corticop on tocerebellar 39 corticospin al 29, 37, 38–39, 38, 40, 138, 138, 139, 163 an terior 31, 38, 39, 40, 41, 138, 139 lateral 31, 38, 39, 41, 138, 139, 282 lesion s 148, 154 syn drom es of 47–4 9, 48 cu n eocerebellar 165 den tatorubral 161, 163 den tatoth alam ic 161, 163, 174, 174 den tatoth alam ocortical 166 dorsolateral 31 extrapyram idal 127 fastigiobulbar 160, 162 fron top on tin e 37, 40, 138 fron toth alam ic 37 h aben u loin terp edu n cu lar 83 Lissau er 31 m am illotegm en tal 181, 190 m am illoth alam ic 171, 174, 175, 181, 182, 203, 203, 216 m otor 40 lateral 39–40 lesion s 42–43, 42 m edial 39–40 syn ap ses 41 occipitom esen ceph alic 40 occipitopon tin e 138 olfactory 82, 83, 279 olivocerebellar 138, 139, 161, 162, 163, 166 olivospin al 31, 40, 41 optic 75, 76, 84, 85, 171, 216 lesion s 86–87, 88 p arietopon tin e 138 p arietotem p oropon tin e 40 p on tocerebellar 161, 163 pyram idal 37, 38–39, 38, 129, 135, 137 an terior 135 lateral 135 lesion s 42, 43, 150, 151 sign s 41 syn drom es of 8, 48, 49, 49 reticulospin al 31, 40, 41, 122, 161, 164–165 ru broreticu lar 142, 165 ru brospin al 31, 40, 41, 135, 137, 138, 138, 139, 142, 161, 165 sem ilu n ar 31 spin o-olivary 25, 31, 31, 138, 161 spin ocerebellar an terior 25, 26–27, 26, 27, 31, 135, 136, 137, 138, 139, 161, 164, 165 lesion s 149, 152 lateral 25 posterior 25, 25, 26, 27, 31, 75, 135, 136, 137, 138, 139, 161, 162, 165 syn drom e of 49, 49 sp in oreticu lar 31 spin otectal 25, 31, 31, 136, 137 spin oth alam ic 138, 140, 142, 174 an terior 25, 26, 27, 30, 31, 136, 282 lesion s 30, 33, 33 lateral 25, 26, 27, 29, 30–31, 31, 106, 135, 136, 137, 139, 282 lesion s 30–31, 33–34, 33, 149, 151, 152, 153 sp in ovestibular 31 su praoptico-hypophyseal 181, 182 tectocerebellar 164 tectospin al 31, 40, 41, 135, 137, 139– 140 lesion s 153 tegm en tal cen tral 40, 135, 137, 138, 139, 161, 163 lesion s 138, 149, 152, 153 tem p oropon tin e 37, 138 th alam ocin gu late 203 th alam ocortical 28, 30, 161, 163 trigem in al 77, 79, 127, 129, 137, 138, 139, 142 trigem in oth alam ic dorsal 141 ven tral 141 tu berohypop hyseal 181 vestibu losp in al 31, 40, 41, 161, 164– 165 lateral 121, 123 m edial 122, 123 see also fascicu lus; p ath w ay tractus retroflexu s 181 solitariu s 135, 137 tran sien t isch em ic attack (TIA) 284, 290–291 trau m a brach ial plexu s lesion s 63 perip h eral n erves 67 trem or 220, 221 in ten tion (action ) 166–167 trian gle hypoglossal 75, 76 of Guillain an d Mollaret 163 vagal 75, 76 trigem in al n euralgia 107–108, 108, 302 idiopath ic 107 trigon e, olfactory 82 trun k brach ioceph alic 271, 283 costocervical 282, 283 in ferolateral 278 trun k thyrocervical 282, 283 tu be, auditory 115 tu ber 158, 159, 161 cin ereu m 171, 279 tubercles 75 cu n eate 74, 76 facial 75 gracile 74, 76 Index · 333 tuberculu m cin ereu m 75, 76 tum ors cerebellar 167–16 Pan coast 192 pitu itary 186–188 case presen tation 187, 187 sp in al cord 56–57 du m bbell (h ou rglass) tu m ors 56, 57 ep idu ral lym ph om a 52, 52 extradural 56, 56 in tradu ral, extram edullary 56–57, 56 in tram edu llary 56, 56, 57 U ultrason ograp hy 289 un cus 83, 230 urin ary tin en ce 195 see also in tin en ce urin ary u rgen cy 196 utricle 115, 120 uvu la 159, 161 V vasodilation 191, 192 vasopressin (ADH) 182, 183, 184, 185 vasosp asm 310 Vater–Pacin i corp uscles 12, 13–14, 13 vein (s) 279–281, 280 an astom otic in ferior (of Labbé) 279, 280 sup erior (of Trolard) 279, 280 basal (of Rosen th al) 279, 280 basivertebral 284 cen tral, posterior 284 cerebral an terior 280 great (of Galen ) 217, 280, 280 in tern al 279, 280 m iddle deep 280 su perficial 279, 280 su perior dorsal 279, 280 m iddle 280 th rom boses 302–304 cortical 279 in tervertebral 284 jugular, in tern al 281 occipital, in tern al 280 of th e septum pellu cidu m 280 oph th alm ic in ferior 281 su perior 281 radicu lar an terior 284 p osterior 284 spin al an terior 284 p osterior 284 p osterolateral 284 striate 280 su lcal 284 su lcocom m issu ral 284 th alam ostriate 216, 280 vertebral 284 velu m , m edullary an terior 137 su perior 76, 146, 159 ven ous ou tflow obstru ction acu te 302–304 ch ron ic 304–305 ven tricle fou rth 76, 135, 262, 263 floor 74–75, 76 roof 75, 135 lateral 86, 215, 216, 227, 262, 263 th ird 171, 262, 263 ven tricu lar system 262, 263 verm is 122, 158 in ferior 159 lesion s 165 su perior 158 vertigo 123–125 p osition al 124–125 ben ign paroxysm al (BPPV) 124– 125 cen tral 125 p roprioceptive 124 rotatory 125 vestibu lar 124 vestibular system 120, 124 lesion s 124–126 vestibulocerebellu m 159 fu n ction s 164–165 lesion s 165 vestibulu m 114 Virch ow –Robin space 262 visceral p ain 199 visceroceptors 12 visu al system 84–88, 235 discon n ection 253–254 vitam in B12 deficien cy 46, 47 vom itin g 145 W Wallen berg syn drom e 147, 149, 150, 299 case p resen tation 150 w allerian degen eration 67 w ater balan ce 184–185 Weber syn drom e 153, 156 Weber test 119 Wern icke aph asia 253 case p resen tation 252–253, 252 Wern icke’s area 248 in farct 252 w h ite m atter 235–237 Wilson disease 219 case p resen tation 224, 224 w in dow oval 114, 115 rou n d 114, 115 Wiscon sin Card Sortin g Test 257 Word Flu en cy Test 257 w rist drop 67 Z zon a in certa 171, 178, 178 zon es of Head 199, 199, 20 334 · Index ... in g Grou p Typesettin g by prim u stype Hu rler, Notzin gen , Germ any Prin ted in Ch in a by Everbest Prin tin g Co., Ltd ISBN 978 13-612805 Im po rtant note : Medicin e is an ever-ch an gin... activate in h ibitory in tern eu ron s th at th en in h ibit oth er prin cipal n eu ron s Wh en an in h ibitory n eu ron in h ibits an oth er in h ibitory n euron , th e result in g decrease in in... 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