Neurology E-Book

An Illustrated Colour Text

Geraint Fuller, Mark R. Manford

• Publisher: Churchill Livingstone
• Year: 2011
• ISBN:
  9780702048883
• Edition: 3
• Topic: Medicine
• Subtopic: Internal Medicine & Diagnosis

An introductory textbook of neurology in the Illustrated Colour Text series, making full use of all the usual features of the series - double page spreads, short paragraphs, summary boxes, attractive use of colour etc.

• Clear explanation of neurological examination - often found very taxing by students.
• Demonstrates how to approach common neurological presentations, such as blackouts and numbness, before moving on to a comprehensive coverage of syndromes and diseases.
• Concentrates on the core curriculum which the medical student really needs to know.

• Updated management in the light of new evidence and new drugs most notably in Parkinson's disease, epilepsy and multiple sclerosis.
• Images, particularly MRI scans, updated with more modern and higher resolution images.
• Includes a new double-page spread on Sleep.
• Extra material added on giddiness to include the head thrust test and Epley's manoeuvre.

Organization of the nervous system

The practice of clinical neurology depends on an appreciation of the structure and function of the nervous system. However, a detailed knowledge of neuroanatomy is not essential. This section will outline some of the important neuroanatomy needed for clinical neurology. Some areas, for example the anatomy of the visual system, will be described in the relevant section.

The levels of the nervous system

The nervous system is very complicated, in terms of both its structure and its physiology. Fortunately, when things go wrong they can be categorized on the basis of a relatively simple scheme of neuroanatomy. The nervous system can be thought of as having different levels (Fig. 1). The distribution and type of the clinical problem will often point to the affected level. For example, a patient who is confused must have a disturbance affecting the cerebral hemispheres. There are some situations when the level cannot immediately be determined: for example, a patient with foot drop could have a problem in the peripheral nerve, nerve root, spinal cord or cerebral hemisphere. Terminology used to describe disturbances at different levels is given in Box 1.

Fig. 1 Levels of the nervous system.

Box 1 Terminology

Abnormalities in the different levels of the nervous system can be referred to according to different terms. One commonly used system is described here. The suffix -opathy can be replaced by -itis if there is thought to be an inflammatory basis to the disturbance.

Encephalopathy: abnormality of the brain (may be refined by terms such as focal, diffuse, metabolic or toxic).

Myelopathy: abnormality of the spinal cord.

Radiculopathy: abnormality of a single nerve root.

Polyradiculopathy: abnormality of many nerve roots.

Plexopathy: abnormality of a plexus (brachial or lumbar).

Polyneuropathy or neuropathy: abnormality of many nerves.

Mononeuropathy: abnormality of a single named nerve.

Mononeuritis multiplex: an abnormality of multiple named nerves.

Myopathy: abnormality of muscle (myositis or polymyositis – inflammation of muscle).

Meningitis: inflammation of the meninges.

These terms can be combined with one another or other qualifiers to produce descriptions such as focal encephalopathy, or meningoencephalomyelitis (inflammation of the meninges, brain and spinal cord).

The central nervous system

The cerebral hemispheres

The cerebral hemispheres contain the apparatus of higher function. The dominant hemisphere (left in right-handed people) controls speech and the non-dominant hemisphere provides more spatial awareness. Different lobes undertake different functions (Fig. 2):

Frontal – motor control of the opposite side of the body, insight and control of emotions and, in the dominant hemisphere, output of speech.

Temporal – memory and emotions and, in the dominant hemisphere, comprehension of speech.

Parietal – sensation of the opposite side of the body and appreciation of space, especially in the non-dominant hemisphere.

Occipital – appreciation of vision.

Fig. 2 Lobes of the brain.

The basal ganglia

The basal ganglia are interconnected deep nuclei including the putamen, caudate, globus pallidum and substantia nigra with complicated interrelations. They are involved in the integration of motor and sensory ...