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Functional and Dissociative Neurological Symptoms and Disorders

This chapter brings together an integrated clinical approach for the patient who presents with a functional or dissociative (psychogenic) neurological disorder that is with symptoms that are inconsistent or incongruent with recognized neurological disease. We focus on the most common symptoms presenting to neurologists: blackouts, weakness, sensory disturbance, and movement disorders. We discuss scientific advances in understanding the etiology and mechanisms of these symptoms and how…

Neurological Problems of Pregnancy

Diseases of the nervous system develop and continue despite pregnancy. The good neurologist maintains a broad perspective, balancing the needs of the woman, her fetus, and her loved ones. Insofar as this audience creates an atmosphere for performance, the clinician may feel like a stage character prompted by cues from scattered, incomplete, and occasionally contradictory findings reported in the literature. Still, neurologists who enjoy drama find…

Cerebral Palsy

History What we now recognize as cerebral palsy has been known throughout history from ancient Egyptian, Greek, and Roman times to the present ( ). However, early writers did not always recognize the cerebral origin of the disorder. Cerebral palsy was often confused with poliomyelitis because both caused debilitating conditions. Osler’s 1889 monograph clearly distinguished the upper motor neuron (UMN) origin of cerebral palsy from the…

Neurological Problems in the Newborn

Neurological problems in the newborn infant can arise from innate processes such as genetic abnormalities or disorders of nervous system development or can be the result of acquired brain injury from external insults. Both innate and acquired brain injury in the newborn have lifelong important impact on the developing person and his or her family ( ). The increasing incidence of preterm delivery worldwide, currently estimated…

Disorders of Skeletal Muscle

Disorders of skeletal muscle encompass a variety of illnesses that cause weakness, pain, and fatigue in any combination. They vary from the protean symptoms of muscle pain and fatigue that often defy any explanation to the muscular dystrophies, which one recognizes instantly on clinical grounds. Motor neuron disease (e.g., spinal muscular atrophies), neuromuscular junction disorders (myasthenia gravis, Lambert-Eaton syndrome, and congenital myasthenia), and certain polyneuropathies (e.g.,…

Disorders of Neuromuscular Transmission

Normal muscle contraction and force production require the efficient transmission of an electrical impulse from a motor axon to the muscle fibers it innervates. The neuromuscular junction (NMJ), a specialized synapse with a complex structural and functional organization, is the site of electrochemical conversion of nerve impulses into muscle fiber action potentials. The NMJ is particularly vulnerable to autoimmune disorders caused by circulating immune factors (myasthenia…

Disorders of the Autonomic Nervous System

Acknowledgments We thank Ian Worcester for preparing the manuscript and acknowledge our friend and teacher David Robertson, whose authorship of this chapter in the fifth edition we built upon. Supported by Advancing a Healthier Wisconsin Endowment, Grant 5520298, and NIH-NIDDK R01DK083538. The term autonomic nervous system , meaning “self-driven,” refers to an intellectually convenient but physiologically artificial division of the neuraxis. Autonomic functions are “self-driven” only…

Disorders of Peripheral Nerves

Clinical Approach to Disorders of Peripheral Nerves Peripheral nerve disorders are common neurological problems caused by dysfunction of peripheral motor, sensory, or autonomic nerves. The causes of neuropathies are disparate and their clinical presentations highly variable. The main causes of neuropathy are entrapments, systemic diseases, inflammatory and autoimmune disorders, inherited disorders, ischemic settings, paraneoplastic conditions, deficiency states, infections, and toxins. Structure of Peripheral Nerves The peripheral…

Disorders of Nerve Roots and Plexuses

Disorders of Nerve Roots The spinal nerve roots serve as the transition from the peripheral nervous system to the central nervous system (CNS). Each spinal nerve is derived from anterior (ventral) and posterior (dorsal) nerve roots; the anterior roots carrying efferent motor information from anterior horn cells of the spinal cord, and the posterior nerve roots carrying afferent sensory information as the central axons of the…

Disorders of Bones, Joints, Ligaments, and Meninges

The bones, joints, ligaments, and meninges that support and protect the tissues of the nervous system can give rise to numerous illnesses that affect the nervous system. These disorders sometimes border on other medical disciplines unfamiliar to the neurologist and hence can be enigmatic or difficult to diagnose. They may involve cognitive functions, disrupt cerebrospinal fluid (CSF) flow dynamics, or slowly compress and distort central and…