Understanding Neurology : a problem-orientated approach Summary:
By John Greene, Ian Bone
- Publisher: Manson Publishing Ltd
- Number Of Pages: 128
- Publication Date: 2007-01-01
- ISBN-10 / ASIN: 1840760613
- ISBN-13 / EAN: 9781840760613
This book takes a problem-oriented approach to the evaluation of
common symptoms presenting to medical students. It begins with guidance
in history taking and examination leading the student on to neurological examination.
The following sections outline all the common presenting symptoms, such
as forgetfulness, dizziness or pain, and relate them to the spectrum of
neurological conditions and diseases.
Some case histories are used to illustrate problems and the book ends
with a section of MCQ’s. This is the second in a new series which aims
to help medical students to think like doctors. By combining a symptom
and problem-based approach with systematic coverage, the book will
appeal to instructors and students on traditional and integrated
courses. Contents Table of Contents History taking and Physical Examination Neurological Investigations The Problems:
Blackouts
Acute Confusional States
Forgetfulness (memory)
Speech and Language Problems
Loss of Vision and Double Vision
Dizziness and Vertigo
Weakness
Tremor and Other Involuntary Movements
Poor Coordination
Headache
Neck Pain and Back Ache
Numbness and Tingling
MCQ’s Index
While traditional neurology textbooks tend to be
organized by disease process, patients, being unaware
of this, arrive with a complaint, (e.g. headache,
dizziness, memory problems), that requires an
explanation. This multi-author book adopts a
problem-oriented approach to the commonly
presenting complaints seen by neurologists. We have
drawn on the experience of practising clinicians in a
busy department based in the Southern General
Hospital, Glasgow.
The problem-based approach illustrates the
manner in which clinicians, in the real world, focus
on particular elements of history and examination in
order to narrow down their differential diagnosis and
by so doing formulate a diagnostic approach or
sometimes (quite often actually) offer no more than
confident professional reassurance.
This is not a comprehensive textbook of these
neurological conditions in themselves, nor a manual
of neuro-therapeutics. Neurology is a speciality
requiring a ‘good listener’ and a capable examiner, no
more and no less.
We hope that this book will demystify what
should have never been mysterious in the first place
and prove useful to medical undergraduates. It should
also be of benefit to junior doctors preparing for
MRCP. If trainee neurologists also derive benefit from
reading it, so much the better!
John Greene and Ian Bone
Index
Note: page numbers in bold refer to
the main discussion of a topic; those
in italic refer to content of tables
abdominal reflex 24
abducens nerve (VIth cranial nerve)
21, 120, 121, 128
accessory nerve (XIth cranial nerve)
22
acetylcholine 77, 150
acetylcholine receptor antibodies 56
achromatopsia, central 108
acoustic neuroma 56–8
acromegaly 58
Adamkiewicz, artery 48, 49
Addenbrooke’s Cognitive
Examination (ACE) 14, 20, 90, 99
adrenocorticotrophic hormone
(ACTH) 58
age 9, 136, 204
agnosia 108
agraphaesthesia 112, 220
akinetic mutism 13
alcohol use 81–2, 122, 137, 176, 181
alcohol withdrawal 80
alexia without agraphia 97, 108
allergies 10
Alzheimer’s disease 16, 18, 89, 90, 91,
108
amaurosis fugax 107
amblyopia 118, 125
aminoglycosides 176
analgesics, overuse 193–4, 201–2
aneurysms, cerebral 32–3, 80, 121,
127
angiography
cerebral 38–9
CT 30
digital subtraction (DSA) 38–9
fluorescein 60
interventional 39
magnetic resonance (MRA) 34
spinal 48–9, 51
angular gyrus 94
anisocoria 109
ankle
movements 154
reflexes 24, 156
anosomia 152
anterior ischaemic optic neuropathy
107
antibody tests 56
anticholinergic drugs 77, 80
antipsychotics 165
Anton’s syndrome 108
anxiety 71, 131, 132, 136, 137,
146–7
aphasias 45, 96–8, 101
apraxias 16, 17
arcuate fasciculus 94
arousal 11
arrhythmias, cardiac 135, 137, 138
arteriovenous fistula, dural 51,
211–12
arteriovenous malformations 38–9
ascending reticular activating system
(ARAS) 76–7
astereognosia 112, 220
asterixis 168
ataxia 122, 131–2, 136, 176–81
acute of childhood 182–3
aetiologies 122, 137
cerebellar 133, 176, 178, 179, 180,
204
clinical scenarios 182–5
differential diagnosis 178
examination 178, 180–1
Friedreich’s 178
investigations 181–2, 181
sensory 178, 179, 180–1, 182
vestibular 176
atherosclerosis, basilar artery 115–16
athetosis 168
atrial fibrillation 107
attention/concentration 11, 14
anatomy 76–7
assessment 15, 45, 77–8
audiometry 22, 60–1, 138, 139
auditory/vestibular nerves 22, 132–3
aura, migraine 188, 192
auras, epileptic seizures 70–1
awareness 11, 13
Babinski sign 24
back pain 204
balance 133, 170, 176
assessment 138, 139
Balint’s syndrome 108
ballism 168
barbiturates 80
basal ganglion 164
behavioural changes 13–14, 15, 79
benign intracranial hypertension 196
Benton Facial Recognition Test 46
benzodiazepines 80
biceps reflex 24, 156
bladder function 152, 159, 206
blink reflex 53
blood oxygen level dependent (BOLD)
imaging 36
Boston Diagnostic Aphasia
Examination 45
Boston Naming Test 45
brachial plexus 222
brachioradialis reflex 24
brain
anatomical landmarks 29
herniation 12
perfusion pressure 65–6
tumours 15, 56–8, 102, 187, 195,
195
see also named parts of the brain
brainstem auditory evoked potentials
(BSAEPs) 43–4
brainstem lesions 121
brainstem reflexes 13
Broca’s aphasia 97, 99
Broca’s area 69, 94, 95
Brown–Séquard syndrome 159, 182,
208, 222
bulbar muscles 152
C-reactive protein 112, 126, 142
calcium, muscle contraction 150
calcium channel antibodies 56
calculation, ability 16
caloric testing 61
CAPE sensory deficit 209
carbon dioxide retention 80
cardiac disease 122
altered consciousness 64, 66, 66–7,
67, 74
confusional states 80
dizziness/vertigo 135, 136, 137, 138
weakness/fatigue 148
carotid artery stenosis 34, 107
carotid sinus hypersensitivity 66–7,
138
carpal tunnel syndrome 223
cauda equina lesions 205–6, 222
cavernous sinus 58
thrombosis 122, 198, 199
cerebellar disorders 170, 176, 177
cerebellar system
function, assessment 26
testing 125
cerebellar tremor syndromes 167
cerebello-pontine angle 56–8
cerebellum 102, 133, 140, 176–7, 178
236
cerebral arteries
atherosclerosis 115–16
CT angiography 30–1
cerebral ischaemia 35
cerebral oedema 187, 195
cerebral venous thrombosis 108
cerebrospinal fluid (CSF)
blood in sample 197
lumbar puncture 52
obstruction 187
oligoclonal banding 227
pressure 195, 195, 196
protein level 187
cerebrospinal fluid (CSF) examination
181
cerebrovascular disease 35–7, 81–2,
100, 200
cervical spine disorders 193, 204–5,
210–11
Charcot joints 180
Charcot–Marie–Tooth disease 56
Chiari malformations 56–7, 225–6,
227
chickenpox 182–3
choline 36
chorea 163, 167–8
Clock Drawing Test 46–7
clonus 24, 168
Cogan’s lid twitch sign 123
cognitive function 14
distributed 14–16, 14
history taking 18, 88–9
localized 14, 16–18
cognitive testing 19–20, 44–6, 89–90
language assessment 99
colour vision 108, 110
computed tomography (CT) 28–30
angiography 30
brain anatomical landmarks 29
spinal cord 49–50
computed tomography perfusion
(CTP) 31
concentration see
attention/concentration
confabulation 78
confrontation 59, 110, 111
confusional states 76
causes 79–80, 79
clinical assessment 77–9
clinical scenarios 81–5
definition 76
fluctuations 78
with lethargy/retardation 77, 80
pathophysiology 77
consciousness
anatomy 12–13
brainstem tests 13
levels of 11
consciousness, altered
diagnosis 42, 65
mechanisms 65
see also epilepsy; syncope
conus medullaris 222
coordination 156, 176–85
tests 26
copying, shapes 17
corneal reflex 13, 21, 140
corpus callosum 16, 97
Corsi Block Test 45
corticobasal degeneration 165
cramps 151, 161
cranial nerves
examination 20–2, 112, 125, 140,
190, 204
eye movements 120–1
palsies 22, 23, 128, 196
see also individual nerves
cranio-cervical junction lesions 56–7
creatine kinase (CK) 84, 156
Creutzfeldt–Jakob disease 108
Cushing’s syndrome 58
cytotoxic drugs 152
deafness see hearing loss
delirium 13, 77, 78
delirium tremens 80
delusions 13
dementia 16, 18, 47, 88, 89–90, 91,
108
demyelination 107, 121, 122
Denny–Brown sensory neuropathy 182
depression 91–2, 144–5
dermatomes 152–3
dextrose, intravenous infusion 92–3
diabetes mellitus 128, 136, 144, 224–5
diet 9, 181, 183
digit span 45, 77, 86, 90
digital subraction angiography (DSA)
38–9
diplopia see double vision
discrimation tests 25
disequilibrium 131, 136
disinhibition 15
Dix–Hallpike positional test 141, 143
dizziness 131–42
anatomy and physiology 132–4
and anxiety 131, 132, 136, 137
clinical scenarios 143–6
examinations 138–41
history taking 134–7
postural 65–6, 73, 132, 144–5
specific investigations 141
symptom complexes 134, 135
timing/duration of symptoms 135–6,
137
Doll’s eye test 125, 141
dopaminergic neurones 164, 172, 174
Doppler ultrasound 39–40, 112
dorsal root ganglion 214, 215
double vision (diplopia) 21, 112,
118–29, 192
causes 121, 152
clinical scenarios 127–9
examinations 21, 122–5
history taking 121–2
investigations 126, 126
drug abuse 80, 137
drug history 10, 18, 89
drugs
analgesia overuse 191, 193–4,
201–2
causing confusional states 77, 80,
83–4
causing dizziness/imbalance 137,
176
causing headache 187, 196
causing weakness/fatigue 152
inducing tremor/parkinsonism 165,
167
and syncope 65
Duchenne muscular dystrophy (DMC)
148
dural venous sinus
cavernous 58
thromboses 122, 198, 199
dysaesthesia 220
dysarthria 95, 98, 102, 178, 180
dysdiadochokinesia 125, 180
dysgraphia 98, 99
dyskinesia 165
dyslexias 97–8
dysphasias 76, 95, 96
dyssynergia 180
dystonia 168
ear disorders 60–1, 176, 178
Eaton–Lambert syndrome 55, 56
echocardiography 112
eclampsia 200
elaborated disease 221
elbow movement 154
electrocardiography (ECG) 66, 67, 73,
112, 142
electroencephalography (EEG) 40–3
abnormal rhythms 40
ataxia 181–2
confusional states 77
epilepsy 41–2, 68, 68, 69, 70, 72–3
intracranial recordings 42
normal rhythms 40
sleep-deprived 42
video 42, 73
visual loss 112
electromyography 54–5, 156–7
Index 237
electronystagmography 61
electroretinography (ERG) 60
embolism, cerebral arteries 107
emotion 13, 76, 79
expression 22, 165
employment history 10, 152
encephalitis, HSV 80, 84–5
epilepsy 64
classification of seizures 68–71
classification of syndromes 70–1
clinical diagnosis 64–5
diagnostic difficulties 42, 64
EEG diagnosis 41–2, 68, 68, 69,
72–3
memory disorders 75, 88
risk factors 65
Erb’s point 52
erythrocyte sedimentation rate (ESR)
112, 114, 142, 194
evoked potentials 43–4, 52
executive function 45
extraocular muscles 118–19
eye movements
disorders 124–5, 152, 204
examination 21, 140
muscles 118–19
nerve supply 120–1
F waves 53
facial expression 22, 165
facial muscles 21, 22, 122
facial nerve (VIIth cranial nerve)
21–2, 136, 140
facial recognition 18, 46, 108
facial sensation 122, 216
falls 66, 83
family, reporting of signs/symptoms
18, 89
family history 10, 18
ataxias 181
epilepsy 65
weakness 152
FAS letter fluency 15
fatigue 148, 151–2
finger-to-nose test 180, 219
fingers
movements 154
reflexes 156
sensory loss 222–3
folic acid 181
forced pull-back test 26, 170
frontal lobe 15, 19, 176
full blood count 112, 114, 142
functional neuroimaging 36–7, 100,
170, 172, 174
fundoscopy 20, 104, 110, 112, 140
gag reflex 13
gait 19, 26, 154
ataxic 180
Parkinson’s disease 165, 170
spinal cord lesion 158–9
gamma camera 36–7
Gerstmann’s syndrome 16
giant cell (temporal) arteritis 106,
108–9, 114, 194, 201
glabellar reflex 19
Glasgow Coma Scale 11, 11
glossopharyngeal nerve (IXth cranial
nerve) 22
Goldmann perimetry 58
graphaesthesia 25, 219
grasp reflex 19
growth hormone 58
Guillain–Barré syndrome 52
H waves 53
Hallpike manoeuvre 61
hallucinations 13, 78, 192
hands 154, 154, 155, 222–3
head
injury 65, 79, 193
pain sensitive structures 188, 189
sensory innervation 216
see also brain
headache 187
acute onset types 196–200
analgesic overuse 191, 193–4,
201–2
classification 187, 187
clinical assessment 188–90, 189,
190, 191
clinical scenarios 201–2
diagnostic criteria 187–8, 188
with dizziness/vertigo 134, 135, 142
insidious worsening types 191–6
red flag symptoms/signs 191, 195
hearing loss 136
assessment 22, 60–1, 138–40
conductive 22, 61
sensorineural 22, 61, 140
with vertigo 140
heel-shin test 219
heel-to-knee test 180
hemianopia 58, 104–6, 108
bitemporal 105, 106, 115–16
homonymous 97, 105, 106
hemicrania, chronic paroxysmal 191,
193
hemiparesis/hemiplegia 100, 192
hereditary motor and sensory
neuropathies (HMSN) 56
herpes simplex virus (HSV)
encephalitis 80, 84–5
hip flexion/extension 154
hippocampus 16, 87, 90
history taking 8–10
cognitive disorders 18, 88–9
concepts 8
informant interview 18, 89
Holmes tremor 167
Horner’s syndrome 122, 123, 192,
204, 207, 211
Humphrey field analyser 59
Huntingtin gene 173
Huntington’s disease (HD) 19, 47,
164, 168, 173
hydrocephalus 57, 58
hydrops 134, 135, 142
hyperalert state 79
hyperalertness 14
hyperreflexia 182
hypertension 122–3, 128
benign intracranial 196
causing headache 200
malignant 200
hyperventilation 71, 136, 137
hypoaesthesia 220
hypodynia/allodynia 220
hypoglossal nerve (XIIth cranial
nerve) 22
hypotension, postural 65–6, 138,
144–5
hypoxia 80
infective diseases 79–80, 84–5, 182–3,
187
inflammatory disorders 187
informant interview 18, 89
inherited disorders 10
ataxias 178, 181
migraine 192
peripheral nerves/muscle 152
insight, loss of 18
intellectual ability 45
ischaemic lactate test 56
Ishihara plates 110
‘Jacksonian March’ 69
jaw claudication 114, 194
jaw jerk 21
joint position sense 219
Judgement of Line Orientation Test
46
knee
movements 154
reflexes 24, 156, 180
Korsakoff’s syndrome 87, 88,
92–3
laboratory tests 47
double vision 126
headache 190
238
laboratory tests (continued)
peripheral nervous system disorders
56
visual loss 112
lactate levels 36, 56
language 16
anatomy and physiology 94–5
pathology 95–6
language disorders 89, 96–7
causes 98, 98
clinical assessment 16, 18, 45,
98–100
clinical scenarios 100–2
stroke 100
left hemisphere function 16, 96–8
Letter Cancellation Test 45
lid retraction 123
limb coordination 26
limb examination 190
muscle power 23–4, 23
reflexes 24, 156, 156, 219
spinal cord lesions 204–5
limbic system 16, 77, 87
long QT syndrome 66, 67, 74
lower motor neurone (LMN)
disorders 156, 161, 204–5, 206,
207, 209
lumbar puncture 52, 112, 197
lung tumour 160
lymphadenopathy 123
McArdle’s disease 151
magnetic resonance angiography
(MRA) 34
magnetic resonance imaging (MRI)
31–6
advantages/disadvantages 32
Alzheimer’s disease 91
dementia 88, 89, 91
diffusion and perfusion-weighted 35
fluid-attenuated recovery (FLAIR)
34
functional 36, 100
Korsakoff’s syndrome 93
language disorders 99–100
paramagnetic enhancement 32–3
pituitary lesions 58
spinal cord 50–1, 209
syringomelia 226
magnetic resonance spectroscopy
(MRS) 36
mamillary bodies 87, 88
Marcus Gunn pupil 109
mass lesions
causing headache 195
see also tumours
median nerve lesions 154, 155, 223
medications see drugs
memory 16
and attention 78
episodic 16, 18, 87, 88
semantic 16, 45, 87, 88, 89, 90
short-term 86–7, 88
taxonomy 86–7
memory disorders 86–93
causes 87
clinical assessment 16, 18, 46,
88–90
clinical scenarios 91–3
in epilepsy 75, 88
types 87–8
Ménière’s disease 135, 136, 137, 137,
176
meningioma, optic chiasm 115–16
meningitis 79–80
mental status, assessment 11–20
mesencephalic arteries 79
metabolic disorders 80, 151, 170, 214
migraine 9, 108, 188, 191–3, 201–2
Mini-Mental State Examination
(MMSE) 20, 45, 89–90, 99
mitochondrial diseases 56
mononeuritis multiplex 222
mood 22, 76, 79
assessment 13
motor neurone disease (MND) 148,
161
motor sequencing 15
motor system
anatomy 150
examination 23–4, 140, 154, 154,
156, 156
motor tics 168
motor unit, structure 149–50
movements
involuntary 19, 167–8
see also tremor
routine tests 154, 154
multiple sclerosis (MS) 9, 52, 104,
107, 181, 184–5, 204, 227
multiple system atrophy (MSA) 165,
170, 174
muscle
biopsy 56, 156
contraction 149–50
cramps 151, 161
fasciculations 51–2, 151, 161
structure 149
tone 23, 112, 156, 180
muscle strength 23–4, 23, 154, 154
muscle wasting 154, 161
myasthenia 55, 56, 121, 122, 123,
128–9
myelography, contrast 48
myoclonus 168
myopathy 151, 156, 157
myotomes 152, 152
myotonia 54
N-acetyl aspartate (NAA) 36
naming 45, 99
National Adult Reading Test (NART)
45
nausea 135, 135
neck pain 204
neglect 17, 97, 220
nerve biopsy 55–6
nerve conduction studies 40, 51–2,
52–3, 156
nerve plexuses 214
lesions 151, 222
nerve roots 207, 214, 215
lesions 151, 152, 206, 206–7
nervous system, anatomy 11
neurofibroma, thoracic 158–9
neuroleptic malignant syndrome 83–4
neuromuscular junction (NMJ)
disorders 55, 122, 123, 154
neurophysiology 40, 156–7
peripheral nerve disorders 52–3
spinal cord lesions 51–2
neuropsychology 44–6
noradrenaline 77
numbers, understanding 16
numbness and tingling 214, 217–24
nutritional disorders 181, 183
nystagmus 21, 136, 180
dizziness/vertigo 138, 140–1
down-beating 56
quantitative assessment 61
occipital cortex 97, 105, 106
occupational history 10, 152
oculomotor nerve (IIIrd cranial nerve)
21, 120
nucleus 121, 133
palsy 127
oedema
cerebral 187, 195
periocular 122
olfactory nerve (Ist cranial nerve) 20
onset of symptoms 9
ophthalmoplegia 124–5
opiates 80
opsoclonus-myoclonus 181
optic chiasm 58, 104–6, 107, 115–16
optic disc 104, 108
optic nerve (IInd cranial nerve) 20,
104, 109
optic neuritis 106, 113
optic radiation 106
orbit 59–60, 118–19
orbital apex 118, 119
orientation, tests 45
oscillopsia 136
pain, muscular 151
pain sensitivity 25, 219
palmomental reflex 19
Pancoast tumour 160
panic attacks 71
papillitis 104
papilloedema 104, 108
paraneoplastic syndromes 181, 182
paraphasias 97, 99
parieto-temporal cortex 133
parkinsonism, drug-induced 165, 167
Parkinson’s disease (PD) 19, 22, 163,
164, 165, 171–2
drugs 80
tremor 165, 166
Parkinson’s plus disorders 165–6, 174
paroxysmal disorders 9
perception 78
perfusion, cerebral 65–6
perineum, sensation 205–6, 222
peripheral nerve disorders
classification 151
differentiation from root lesions
206, 206–7
investigations 52–6
patterns of deficits 154–5, 154,
222–3
peripheral nerves 214, 215
peroneal nerve lesions 206
petit mal seizures 68, 70
phaeochromocytoma 200
physical examination 19
pinprick examination 25
pituitary apoplexy syndrome 198–9
pituitary fossa 58
plantar response 24, 156
point-to-point test 26
polymodal association cortex 76
polyneuropathies 222, 224–5
polyopia 118
polysomnography 43
popliteal nerve, lateral 154
positional sensation 25
positron emission tomography (PET)
38
postoperative confusion 80
postural dizziness/hypotension 65–6,
73, 132, 144–5
postural stability 26, 170
pout reflex 19
praxis 16
pre-eclampsia 200
presenting complaint 8–10
presyncope 65–6, 73, 136, 144–5
primary sensory cortex 76–7
prochloroperazine 83–4, 165
progressive supranuclear palsy (PSP)
165
prolactin 58
pronator drift 24, 181, 219
pronunciation 45, 94–5, 97
proprioception 177–8, 215
deficits 132, 140
testing 220
proptosis 21, 108, 109, 122, 123
prosopagnosia 18, 108
pseudoathetosis 181
psychogenic nonepileptic seizures
(PNES) 64, 65, 71, 71–2
psychomotor activity 14
pterygoids 21
ptosis 21, 122, 123
pull-back test 26, 170
pulmonary disease 148, 160
pupil, responses 13, 21, 109, 122, 123
pyramidal signs 170
quadrantanopia 58, 105, 106
radial nerve lesions 154, 155
radiculopathies 151, 152
radiology, spinal cord 48, 209
Raven’s Progressive Matrices 45
reading 45, 94–5, 97–8, 99
rebound phenomenon 180
recall, delayed 89–90
reduplicative phenomena 78
reflexes 24, 156, 156, 219
brainstem 13
loss 222
primitive 19, 170
spinal roots 207
repetition 96, 99
respiratory alkalosis 71
respiratory movements 13
reticular activating system 14
retina 60, 104
Rey–Osterrieth complex figure 46, 90
right hemisphere function 16–18
rigidity 23, 170
Rinne’s test 22, 60, 138–40
Romberg’s test 26, 132, 138–9, 181,
219
saccades 125
sacral root lesions 204–5
sarcomere, structure 149–50
sarcoplasmic reticulum 150
scalp 190, 194, 216
scotoma 110, 192
seizures
psychogenic nonepileptic 64, 71,
71–2, 74
see also epilepsy
semantic memory 16, 45, 87, 88, 89,
90
semicircular canals 132
sensory cortex 216
sensory loss 17, 125, 140, 214–28
assessment 25–6, 112, 217–24, 219
and dizziness 140
nonorganic (elaborated) disease 221
peripheral nerve lesions 154–5,
224–5
spinal cord lesions 158–9, 207,
221–2
terminology 220
sensory nerve fibres, classification 215
sensory pathways 214–17
sensory receptors 214
septicaemia 79
serial 7’s 90
shoulder abduction 154
single photon emission computed
tomography (SPECT) 36–7, 100,
172, 174
sinusitis 193
sleep disorders 43
smoking 182
Snellen chart 20, 110
social history 10, 18
somatosensory evoked potentials
(SSEPs) 44, 52
speech
anatomy and physiology 94–5
assessment 98–9
disorders 78, 95–8, 102, 152, 178,
180
fluency 15, 99
sphincter function 205–6, 208, 222
spinal cord
anatomy 47–8, 153, 204, 215
dermatomes 152–3
imaging/investigations 47–51
sensory pathway 214–17
spinal cord lesions
anatomical localization 207–9
clinical scenarios 210–12, 225–7
investigations 48–52, 209
level localization 206–7
sensory loss 158–9, 207, 205,
221–2
tumours 158–9
weakness 152, 153, 158–9, 160
spinal sympathetic function 206
spino-thalamic tracts 209, 215
stance 26
stapedial reflex decay 60–1
Steele–Richardson–Olszeweki
syndrome 165
stereognosis 25, 219
sternocleidomastoid muscle 22
Index 239
steroids 152
strabismus 125
straight leg raising 205
stress 146–7
see also anxiety
‘stretch’ tests 205
stroke 35–7, 81–2, 100, 200
Stroop Test 45
subarachnoid haemorrhage (SAH) 80,
197, 202
substantia nigra 164
‘sundowning’ 78
sural nerve, biopsy 56
swallowing disorders 152
sweating 206
symptoms
aggravating/relieving factors 9
associated 9
duration 9
frequency 9
mode of onset 9, 18
syncopal attacks 65–7, 71
syringomelia 225–6, 227
systemic disease
causing headache 195
causing weakness/fatigue 148
taste 21
temperature sensation 25, 158, 219
temporal arteries 190
temporal arteritis 106, 108–9, 114,
194, 201
tendon reflexes 24, 180, 182
thalamic nuclei 216
thalamus 77, 79, 87, 88, 164
thiamine 88, 181
thought, content/organization 13, 78
thrombosis
anterior spinal artery 209
dural venous sinus 122, 198, 199
thumb abduction 154
thyroid disorders 123
thyroid function tests 142
time orientation 78, 92
Tinel’s sign 206, 222, 223
tinnitus 136
Token Test 45
Tolosa–Hunt syndrome 122
tongue, examination 22
‘top of the brainstem’ syndrome 79
touch sensitivity tests 25, 219
Tourette’s syndrome 168
Trail Making Test 45
transient ischaemic attack (TIA) 192
trauma, head 65, 79, 193
tremor 163
classification 163–4, 163
clinical assessment 169–70
tremor (continued)
essential 166, 166, 170
Parkinson’s disease/Parkinson’s plus
disorders 165–6, 166, 171–2
physiological 166–7
triceps reflex 24, 156
trigeminal nerve (Vth cranial nerve)
21, 140, 216
trochlear nerve (IVth cranial nerve)
21, 120, 121
tropia 124–5, 125
tumours
brain 15, 56–8, 102, 187, 195, 195
headache 195, 195
lung 160
orbit 60
paraneoplastic syndromes 181
spinal cord 158–9
visual loss 106, 107, 115–16
2-point discrimination 26, 219
Uhthoff’s phenomenon 107, 227
ulnar nerve lesions 154, 155, 206,
222–3, 224
ultrasound 39–40, 112
upper motor neurone (UMN)
disorders 156, 158–9, 205, 206,
207, 208
vagus nerve (Xth cranial nerve) 22,
214
vascular disease
confusional states 79
double vision 121, 122, 127, 128
headache 187, 195, 200, 202
spinal 51, 211–12
visual loss 107, 116–17
vasovagal syncope 64, 65–6, 71
verbal fluency 15, 99
verbal function, assessment 45
verbal reasoning 45, 78
vertebrobasilar migraine 192
vertigo 131
benign positional 134, 135, 143–4
clinical assessment 134–41
defined 131
symptom complexes 134, 135
vestibular nerve 22, 132–3
vestibular system
anatomy 132–4
disorders 176
testing 61
vestibulo-ocular reflex 61
vestibulo-spinal tract 133
vestibulocochlear nerve (VIIIth cranial
nerve) 22, 132–3, 136
vibration, sensitivity 25, 219
video-telemetry 42
vision, and headache 193
visual acuity testing 10, 20, 110
visual evoked responses 43, 60, 112
visual field defects 19, 58, 104–6
visual field testing 20, 58–9, 110–11,
115
visual loss
aetiologies 106, 107
clinical assessment 106–12, 112
clinical scenarios 113–17
with diplopia 122
higher cortical dysfunction 108,
108, 112
temporal arteritis 114, 194
visual neglect 17
visual object agnosia 18
visual symptoms
epilepsy 71
migraine 192
presyncope 65–6
visuo-perceptual function 16–18,
46–7, 89
vitamin B1 (thiamine) 88, 181
vitamin B12 181, 183
vomiting 135, 136
Wallenburg, lateral medullary
syndrome 222
weakness
anatomical localization 151, 152–4,
156
clinical assessment 151–7
clinical scenarios 158–61
non-neurological causes 148
symptoms arising from differing
distributions 148
Weber’s test 22, 60, 138–40
Wechsler Adult Intelligence Scale-
Revised (WAIS-R) 45
Wechsler Memory Scale-Revised 46
Wernicke’s aphasia 96, 99, 101
Wernicke’s area 16, 94, 97
Wernicke’s encephalopathy 80, 92–3,
122
Wilson’s disease 167
Wisconsin Card Sorting Test 45
writing disorders 16, 98, 99
xanthochromia 19
http://ifile.it/gxicrky/9781840760613.pdf