Overview For multisystem disorders, the diagnosis often depends on identifying the combination of neurologic and nonneurologic manifestations. For example, neuropathy plus macrocytic anemia should raise concern for B12 or folate deficiency. Confusion, neuropathy, and gastrointestinal (GI) distress might raise concern…
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Reflex Physiology Reflexes are used for examination purposes, but they demonstrate integral and sometimes complex functioning of the nervous system. Reflexes can be physiologic and pathologic. Physiologic reflexes use pathways that are normally functioning in a patient of the particular…
Physiology and Localization of Gait The bipedal gait is complex and depends on action of almost all parts of the nervous system. Gait is initiated in different ways depending on the purpose of the movement, whether intentional or reflexive. Gait…
Localization of Coordination Control and Deficits Coordination is a prominent part of the examination. Whereas coordination is typically considered to be a test of cerebellar function, coordination deficits can be produced by a wide range of lesions. Coordination depends on…
Sensory Systems Localization Two pathways, the dorsal columns and the spinothalamic tract, carry sensory information from the periphery to the brain, and they carry two distinct sets of information. Dorsal Columns The dorsal columns pathway is responsible for fine touch…
Motor System Localization Identification and description of motor deficits is critical for the understanding of neurologic localization. The assessment of the presence of weakness and other motor deficits provides an excellent basis for approaching the localization of brain lesions. Elements…
Neuromuscular Transmission Defects Neuromuscular transmission defects present with weakness and fatigability. The tendency to fatigue early and the absence of sensory symptoms are clues to these disorders. These defects are due to impaired synaptic transmission, either from impaired acetylcholine (ACh)…
Approach to Diagnosis Neuromuscular disorders have specific clinical findings, as discussed here, but part of the task of neuromuscular localization is ruling out a lesion of the spinal cord or brain. Central disorders producing peripheral manifestations usually affect systems other…
Spinal Cord Anatomy and Localization Localizing a lesion to a specific location within the cord is key to diagnosis. The differential diagnosis is narrowed by deciding exactly how the cord is affected through the following signs: ■ Corticospinal tract deficits…