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Myelopathies

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Radiculopathy and Degenerative Spine Disease

Basic Anatomy 1. Describe the difference between the dorsal and ventral rami of the spinal cord. Nerve roots are attached to each segment of the spinal cord. Those that exit from the posterior lateral sulcus are called the dorsal roots, whereas the ventral roots emerge anterior over a wider area. Short mixed spinal nerves are formed when a pair of dorsal roots and ventral roots unites…

Peripheral Neuropathies and Motor Neuron Diseases

Acknowledgments The authors would like to acknowledge the contributions of Dr. Yadollah Harati who authored this chapter in the previous edition. 1. What are the most common diseases affecting the peripheral nerve? Alcohol Amyloid Diabetes Environmental toxins and drugs Guillain–Barré Hereditary Infections Nutritional Paraneoplastic Rheumatic (collagen vascular) Systemic disease Trauma Tumors 2. What is the anatomy of a peripheral nerve? The outer layer of a peripheral…

Neuromuscular Junction Diseases

Acknowledgment Previous editions of this chapter were coauthored by Tetsuo Ashizawa, MD. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles Become membership If you are a member. Log in here

Myopathies

Acknowledgments The authors would like to acknowledge the contributions of Dr. Yadollah Harati who authored this chapter in the previous edition. Introduction 1. What is a myopathy? A myopathy is a disorder in which there is a primary functional or structural impairment of skeletal muscle. 2. What signs and symptoms are suggestive of a myopathy? Proximal symmetric weakness, which may be acute, subacute, or chronic Reduced,…

Clinical Neuroanatomy

Embryology 1. How is the neural tube formed? Beginning around the 18th gestational day, a midline notochordal thickening anterior to the blastopore forms the neural plate. A midsagittal groove called the neural groove appears in the plate, and the sides elevate to form the neural folds. As the folds fuse, the neural tube is formed. Some cells at the edges of the fold do not fuse…

Clinical Neuroscience

Introduction 1. Why is it important to understand the cellular, molecular, and genetic mechanisms that govern normal and abnormal nervous system function? To select the most appropriate diagnostic tests and interpretation of test results To optimize drug therapy by mechanisms of action, interactions, side effect profiles To educate patients and their families about their diseases and prognoses To aid in the critical review of rational drug…

Functional Disorders

Overview of Functional Disorders Functional disorder is a disorder of the function of the patient without a neurologic cause. The etiology is in the mind of the patient, usually subconsciously but sometimes with conscious intent. Conversion disorder is considered to be a subconscious and neurologic manifestation as a representation of the underlying psychiatric etiology. Malingering implies the conscious intent to deceive. There is usually some secondary…

Tumors With Neurologic Involvement and Remote Effects of Tumors

Clinical Presentation of Tumors With Neurologic Involvement Tumors of the central nervous system (CNS) have protean manifestations. Although they commonly present with focal neurologic findings, they can often be more insidious in onset, with more subtle manifestations. Intracranial tumors (benign or malignant, or supra- or infratentorial) often present with evidence of intracranial hypertension or elevated intracranial pressure. Patients have headache with nausea or vomiting and focal…

Infectious Diseases

Overview of Infectious Disease Neuroinfectious diseases are a prominent aspect of acute care neurology. For many patients, there is not a specific localization but rather a mode of presentation that raises suspicion for infections of the nervous system. Effects of systemic infections on the nervous system are even more common than direct infections, and neurologists are often asked to diagnose neurologic symptoms in patients with systemic…

Autoimmune Disorders

Overview of Autoimmune Disorders Autoimmune disorders rely on clinical diagnosis including localization. However, there is no specific examination finding that indicates autoimmune pathogenesis. The diagnosis of most autoimmune disorders is syndromic and is supported by careful examination, laboratory studies, and usually imaging. In general, most autoimmune disorders have localization that is in either not confined to a singular neurologic localization or is not confined to neurologic…

Visual Disorders

Approach to Differential Diagnosis Assessment of the Visual Disturbance Visual disturbance usually falls into one of several categories but sometimes it is in more than one category, depending on whether visual loss is accompanied by other deficits. Types of visual loss include ■ Monocular loss, ■ Binocular loss, ■ Hemianopia, ■ Diplopia, and ■ Positive visual disturbance. Monocular Visual Loss Monocular visual loss is due to…

Movement Disorders

Movement disorders are impairments of movement not due to corticospinal tract dysfunction, although some movement disorders can be associated with corticospinal findings as a component (e.g., multiple system atrophy; MSA). Movement disorders may involve increased (hyperkinetic) or decreased (hypokinetic) movement. The key to diagnosis for most of these is clinical presentation, history, and examination. There are no scans for many of these disorders that are diagnostic.…

Headache

The diagnosis of headache depends on the report of head pain and on a specific classification of the headache depending on details of the history and examination. Headache is classified as primary or secondary. Principles The brain itself has no pain sensation. Headaches are caused by irritation, disruption, inflammation, or compression of other structures within the head and skull: ■ Skin, subcutaneous tissues, muscle ■ Eyes,…

Neuromuscular Disorders

Clinical Presentations of Neuromuscular Disorders Neuromuscular conditions produce motor and/or sensory disturbance, but the key to suspicion of this localization is the history and examination. To illustrate, the findings in the following scenarios direct the search to a neuromuscular process. Scenario 1: Weakness of the legs knowing nothing else about the presentation, weakness of the legs could be due to a midline cerebral lesion, a thoracic…

Seizure Disorders

Classification of Seizures and Epilepsy A seizure is a set of clinical symptoms due to abnormal electrical activity of the brain. Epilepsy is a syndrome where there have been recurrent unprovoked seizures or a single unprovoked seizure with findings to indicate that there is a comparable risk of subsequent seizure as would be seen in a patient with two unprovoked seizures. Therefore, all patients with epilepsy…

Stroke and Other Vascular Disorders

Introduction Stroke is the most common serious neurologic disorder, the fifth leading cause of death in the United States and second in the world, and the most common cause of neurologic disability in adults. Over 800,000 strokes occur each year in the United States, which is more than one each minute. Many additional, small strokes, perhaps as many as 11 million per year in the United…

Speech and Language Disorders

Introduction Speech and language are important to our human existence, and they affect our ability to communicate with other people. Speech involves the articulation of language sounds via the vocal apparatus. Language involves the manipulation of symbols in the production and comprehension of communication. Aphasias are acquired disorders of language secondary to brain disease. The aphasias include specific syndromes in which language functions are affected by…