Brainstem Dysfunction Midbrain Isolated cranial nerve (CN) III or CN IV palsy is rarely due to a midbrain lesion, despite the location of the nuclei. Midbrain lesions can produce partial or complete palsies of these cranial nerves plus hemiparesis from…
Diagnosis of Cerebellar Lesions The first important distinction in clinical practice is among lesions that primarily affect the vermis, that primarily affect the cerebellar hemispheres, or that diffusely affect the cerebellum. The second important distinction is between lesions that affect…
Basal Ganglia Lesions of the basal ganglia typically produce movement disorders, with the predominant results being abnormalities of tone and involuntary movement. For clinical purposes, the important classification is into the following two categories: ■ Akinetic rigid syndromes (too little…
Anatomy of the Peripheral Neuromuscular System The essential features of the peripheral neuromuscular system are motor nerves, sensory nerves, autonomic nerves, the neuromuscular junction (NMJ), and muscle fibers. Motor neurons originate in the spinal cord and brainstem and innervate skeletal…
Spinal Cord Organization The spinal cord serves as a conduit for information relayed between the brainstem and peripheral nervous system. In addition to this purely conductive function, there is substantial neural processing at segmental levels of the spinal cord. This…
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…
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…
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…
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…
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…