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Brainstem, Cerebellum, and Cranial Nerves

Brainstem Brainstem anatomy includes associated connections with the cerebellum, spinal cord, and hemispheres. In addition, cranial nerve anatomy and function are integral to brainstem anatomy. Clinical diagnosis of brainstem dysfunction requires an understanding of motor and sensory pathways through the brainstem and a working knowledge of segmental anatomy at different levels of the brainstem. Table 2.4.1 presents the localization and clinical features of some important brainstem…

Basal Ganglia and Thalamus

Basal Ganglia The basal ganglia are composed of the following deep nuclei, which have complex interrelationships: ■ Globus pallidus ■ Putamen ■ Caudate nucleus ■ Subthalamic nucleus ■ Claustrum ■ Substantia nigra The neostriatum consists of the putamen and caudate nucleus. The lentiform nucleus consists of the globus pallidus and putamen; it is called “lentiform” because its geometry is similar to that of an optical lens.…

Cerebral Hemispheres

Introduction The cerebral hemispheres contain the very essence of our being. They allow us to speak, form complex thought, interact with the world, have interpersonal relationships, understand humor, and more. They accomplish this through complex organization and specificity. A theme throughout the organization of the nervous system is that everything is arranged in a highly organized and predictable manner. Nothing in the nervous system is an…

Overview of a Systems-Based Approach

Neuroanatomy is an enormous field, with textbooks devoted solely to the subject. In this book, we presume the reader has a foundation in basic neuroanatomy and neurophysiology. Here we will take the clinical approach to neuroanatomy. We will organize by locations but also by functional systems. Subsequent chapters cover the individual segments of the nervous system. General Principles Symmetry With few exceptions, the nervous system is…

Documenting and Presenting Findings

Purpose The principal reason for documenting the history and examination findings is communication, whether with other providers, with patients, or with themselves when they see the patient again in a future encounter. These different communications used to have different content—a letter to a referring provider, clinic notes for the examiner, and layperson level notes for patients. Now, there is usually a single document to meet all…

Synthesis of the Assessment and Plan

Synthesis of assessment and plan includes methods to determine the information we want to convey as well as the method for presenting the information. We will consider these separately. Development of the Assessment and Plan Assessment is formulated by considering the information that has been obtained from the history and physical examination (H&P) within the context of the reason the patient as being seen. The assessment…

Medical Examination in Neurologic Patients

Many specialists, including neurologists, are first trained in general medicine. As such, they interpret their findings in the context of the entire body. For this reason, they must remain facile in performance and interpretation of the general medical examination. However, they do not perform the entire examination on every patient but rather select specific portions for focus that are appropriate to their study. For example, if…

The Neurologic Examination

Mental Status Mental status examination consists of evaluating level of consciousness, cognitive function, and language. The neurologist obtains a great deal of information regarding mental status as they take a history. Questions may be answered clearly or not, the historical details may be remembered in chronological order or not, patients may lose focus, or forget details that they would be expected to remember such as children’s…

Taking a History

Chief Complaint The chief complaint is the reason for the encounter. The encounter always has a defined purpose, even if the visit is for a medical screening of an individual with no known medical complaints or issues. This should be documented prominently in the encounter note so that the purpose of the visit is clear. History of Present Illness In taking a history, the neurologist asks…

COVID-19-Directed Medications

Bamlanivimab With Etesevimab and Casirivimab With Imdevimab Monoclonal antibodies were first conceived as a target for disease-causing pathogens in the early 1900s by Elie Metchnikoff. This idea led to the developmental theory of immunology, in which Metchnikoff was awarded the Nobel Prize for Physiology or Medicine in 1908. Additional discoveries and techniques through the 1990s led to the progressive improvement in using monoclonal antibodies, ultimately leading…

Response of the HealthCare Systems to the Pandemic

This chapter focuses on the changes made at Henry Ford Health System (HFHS) in response to the coronavirus disease 19 (COVID-19) pandemic. This has been described as a “low-chance, high-impact” event that has stressed health-care systems worldwide and has required that they take measures to maintain and improve their institutional resilience. The discussion touches upon similar experiences undertaken at other health systems across the country. The…

Treatment Approach, Pharmacological Agents and Vaccines

Acknowledgment We acknowledge the contribution by Dr. Mayur Ramesh of the Infection Diseases Service at Henry Ford Hospital, Detroit, Michigan, USA. Treatment Approach for the Hospitalized Patient With COVID-19 Introduction The goal of this chapter is to inform the neurologist of the disease-specific treatments that exist and are recommended for the patient with COVID-19. The proposed approach to management is tiered according to the severity of…

COVID-19 and Headache Disorders

Headache is the most common neurological symptom presenting in patients infected with COVID-19. In large retrospective studies of international populations, the incidence of headache is greater than 70%. Understanding, diagnosing, and treating these patients remain a challenge. Epidemiology Headache is the fifth most common COVID-19 symptom after fever, cough, myalgia/fatigue, and dyspnea, and the most frequent neurological manifestation. The prevalence of headache in COVID-19 patients is…

COVID-19 Infection: Impaired Olfaction, Movement Disorders, Encephalopathy, and Neuropsychiatric Manifestations

Introduction Beyond the possibility of life-threatening consequences of pulmonary invasion and respiratory failure, COVID-19 infection imparts a wide range of neurological and neuropsychiatric consequences for many infected persons. This chapter reviews several of the problems that arise from central nervous system (CNS) involvement in patients with COVID-19. The emerging clinical experience and its medical literature have revealed several common and a few rare neurological outcomes caused…

Neuro-Oncologic Care During the COVID-19 Pandemic

Introduction Neuro-oncology is a multidisciplinary specialty dedicated to caring for those faced with neoplasms in the nervous system. Neuro-oncologists are often fellowship-trained neurologists or medical oncologists. The bulk of care is directed at primary brain tumors of which the majority have no cure and limited effective treatments, metastatic cancer to the brain and spine, central nervous system (CNS) lymphoma, and complications of cancer or cancer treatment…

Pediatric Neurology and the COVID-19 Pandemic

Introduction: The Reduced Burden of COVID-19 on Childhood Because children with COVID-19 are often asymptomatic or exhibit respiratory illness of only mild-to-moderate degree, the extent of disease in childhood is difficult to define with accuracy. In reports skewed toward hospitalized and severely ill individuals from China, Italy, Spain, and the United States, children are found to comprise only 1%–2% of COVID-19 cases. On the other hand,…

COVID-19 and Neuromuscular Disorders

SARS-CoV-1 caused severe acute respiratory syndrome in 2002–03 and this epidemic affected close to 8000 patients worldwide. Aggressive public health efforts to contain the virus along with relative lack of easy transmissibility limited the original outbreak. Very few neurologic complications were reported during this epidemic limited to large vessel strokes, axonal peripheral neuropathy, myopathy, and one case of olfactory neuropathy. Neurologic complications with SARS developed 2–3…

COVID-19 and Autoimmune Demyelinating Diseases

Abbreviations AQP4 aquaporin 4 CNS central nervous system CSF cerebrospinal fluid FDA US food and drug administration IgG immunoglobulin G IVIG human immunoglobulin IVMP intravenous methylprednisolone MOG myelin oligodendrocyte glycoprotein MS multiple sclerosis NMO neuromyelitis optica NMOSD neuromyelitis optica spectrum disorder PLEX plasmapheresis SARS-CoV-2 severe acute respiratory syndrome coronavirus 2 Conflict of Interest All authors declare they have no known conflicts of interest. Acknowledgments The authors…

COVID-19 and Seizures

Introduction Over time as human civilization has grown, it has faced several pandemics over thousands of years. To name a few, lately, since the beginning of the 21st century, pandemics have included swine flu (H1N1) in 2009 and two novel coronaviruses—severe acute respiratory syndrome (SARS) in 2002 and Middle East respiratory syndrome (MERS) in 2015 —before the current novel coronavirus disease 2019 (COVID-19) infection caused by…