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Clinics in Neurology
Alaka Deshpande
CHAPTER 1:
Nervous System: An Introduction
▮ BASIC NEUROANATOMY AND PHYSIOLOGY
▮ THE NEURON
Dendrites
Axon
Synapse
Nerve Fiber
Myelinated Fibers
Motor System
CHAPTER 2:
Localization of the Lesion
▮ INTRODUCTION
▮ MOTOR PATHWAY
Precentral Gyrus
Corona Radiata
Internal Capsule
Midbrain
Pons
Medulla Oblongata
▮ SENSORY PATHWAYS
Anatomical Organization of the Sensory Pathways
▮ CORTICAL SENSATIONS
▮ HIGHER FUNCTIONS
▮ CRANIAL NERVES
Motor System Examination
Sensory System Examination
Reflexes
▮ CLINICAL LOCALIZATION OF THE LESION IN THE CORTICOSPINAL PATHWAY
Millard-Gubler Syndrome
Foville's Syndrome
Jackson Syndrome
Examination of Sensory System
▮ CLINICAL LOCALIZATION OF SENSORY DEFICIT
Paralysis—A Clinical Approach
▮ EXAMINATION OF CENTRAL NERVOUS SYSTEM AT THE BEDSIDE
Higher Functions
Speech
Cranial Nerve Examination
Motor System Examination
▮ ETIOLOGY OF THE LESIONS
CHAPTER 3:
Cerebrovascular Disorders
▮ DEFINITION
▮ EPIDEMIOLOGY
▮ HEMODYNAMICS
▮ PATHOLOGY
Diseases of the Cerebral Arteries
Diseases of Cerebral Veins
Diseases of the Blood
Diseases of the Heart
Transient Ischemic Attacks
Cerebral Infarction
Investigations
▮ GOAL OF THERAPY
Immediate Support
Thrombolysis
Contraindications to tPA
Antiplatelet Agents
Anticoagulants
Neuroprotection
▮ CEREBRAL HEMORRHAGE
Salient Clinical Features
Causes of the Intracerebral Hemorrhage
Common Sites of Cerebral Hemorrhage
Putamen
Thalamic Hemorrhage
Pons—Pontine Hemorrhage
Cerebellum—Cerebellar Hemorrhage
Lobar Hemorrhage
Specific Investigation
Management
▮ INTRACRANIAL HEMORRHAGES
Investigations
Management
CHAPTER 4:
Dysfunctions of Urinary Bladder
▮ INTRODUCTION
▮ NERVE SUPPLY TO THE BLADDER
Parasympathetic Nerve Supply
Sympathetic Supply
▮ PHYSIOLOGY OF MICTURITION
Incontinence
What are the Different Types of Incontinence?
Retention of Urine
CHAPTER 5:
Paraplegia
▮ INTRODUCTION
▮ SPASTIC PARAPLEGIA
▮ FLACCID PARAPLEGIA
▮ QUADRIPLEGIA
▮ SPINAL CORD
Blood Supply of the Spinal Cord
▮ Clinical Approach
Localization of the Lesion
▮ ACUTE UPPER MOTOR NEURON (SPASTIC) PARAPLEGIA
▮ ACUTE TRANSVERSE MYELITIS
Investigations
Management
Nursing Care
▮ DEMYELINATION
Multiple Sclerosis
▮ DEVIC'S SYNDROME/NEUROMYELITIS OPTICA
Specific Investigations
Management
▮ VASCULAR LESIONS
Investigations
Treatment
▮ IMMUNE-MEDIATED DISEASES
▮ ACUTE CORD COMPRESSION: COMPRESSIVE MYELOPATHY
Cord Compression
Extramedullary Cord Compression: Salient Features
Causes of Extramedullary Cord Compression
Paravertebral Space
Verterbrae
Intervertebral Disc
Spinal Meninges
Trauma
▮ FROIN'S SYNDROME
Management
▮ INTRAMEDULLARY LESIONS
Management
Paraplegia in Extension
Paraplegia in Flexion
▮ BROWN-SÉQUARD SYNDROME
▮ NONCOMPRESSIVE MYELOPATHIES
Subacute Combined Degeneration
Clinical Manifestations
Pathogenesis
Investigations
Etiology of B12 Deficiency
Lack of Intrinsic Factor
Malabsorption
Other
Treatment
Other Nutritional Deficiencies Affecting Nervous System
Other Noncompressive Myelopathies
▮ LATHYRISM
▮ HTLV-1-ASSOCIATED MYELOPATHY
▮ VACUOLAR MYELOPATHY DUE TO HIV
▮ SPASTIC PARAPLEGIA—(CORTICAL)
Can a Cerebral Lesion Cause Paraplegia?
CHAPTER 6:
Syringomyelia
▮ INTRODUCTION
▮ SYRINGOMYELIA
▮ UPPER LIMB EXAMINATION: SIGNS OF LMN LESION
Sensory System—Dissociate Sensory Loss
▮ LOWER LIMBS EXAMINATION: SIGNS OF UMN LESION
▮ SYRINGOBULBIA
Pathogenesis
▮ SYRINGOMYELIA CLASSIFICATION
Investigation
Treatment
CHAPTER 7:
Motor Neuron Disease
▮ INTRODUCTION
Amyotrophic Lateral Sclerosis (ALS)
Epidemiology
Pathology
Clinical Manifestations
Investigation
Treatment
Progressive Muscular Atrophy
Progressive Bulbar Paralysis
Primary Lateral Sclerosis
▮ PROGNOSIS
▮ MADRAS MOTOR NEURON DISEASE
CHAPTER 8:
Flaccid Paraplegias
▮ INTRODUCTION
▮ FLACCID PARAPLEGIA
Flaccid Paraplegia of Acute Onset
Acute Anterior Poliomyelitis Syndrome
Acute Cauda Equina Syndrome
▮ GUILLAIN-BARRÉ SYNDROME
Immunopathogenesis
Clinical Presentation
Investigations
Management
Intravenous Immunoglobulin
Plasmapheresis
▮ DISEASES OF THE PERIPHERAL NERVES
General Symptomatology
Trophic Changes
Investigations
Management
▮ CAUDA EQUINA SYNDROME
Clinical Presentation
Tabes Dorsalis
CHAPTER 9:
Diseases of the Muscles
▮ MUSCLE DISORDERS
Polymyositis
Myopathies
Mitochondrial Myopathies
Glycogen Storage Myopathies
Acquired Myopathies
Metabolic—Chanellopathies
CHAPTER 10:
Extrapyramidal Disorders
▮ EXTRAPYRAMIDAL
Neuroanatomy of Basal Ganglia
Pathophysiology
▮ PARKINSON'S DISEASE
Clinical Features
Facies
Bradykinesia/Hypokinesia
Gait and Attitude
Tremors
Rigidity
▮ MANAGEMENT
Medical Treatment
Rationale of Therapy
Surgical Treatment
Other Surgical Therapies
Supportive Therapy
Other Involuntary Movements
CHAPTER 11:
Cerebellar Disorders
▮ CEREBELLUM
▮ CLINICAL FEATURES OF A CEREBELLAR LESION
Hypotonia
Incoordination
Cerebellar Ataxia
Cerebellar Speech
Nystagmus
Friedreich's Ataxia
CHAPTER 12:
Unconsciousness—COMA
▮ CONSCIOUSNESS
Functions of Reticular Formation
▮ COMA
▮ CAUSES OF UNCONSCIOUSNESS/COMA
Morphological Lesions
Hemispheric Lesions
Affecting the Internal Milieu
▮ CLINICAL APPROACH TO AN UNCONSCIOUS PATIENT
Vital Support
Determination of Severity and Nature of Coma
Examination of the Pupil
The Ocular Movements
Neck Rigidity
Fundoscopy
Medical History and Neurological Evaluation
Clinical Examination
▮ INVESTIGATIONS
▮ MANAGEMENT
Supportive Care
Treat the Cause
Physiotherapy
CHAPTER 13:
Meningitis
▮ MENINGITIS
▮ PATHOPHYSIOLOGY
▮ CLINICAL PROFILE
Pyogenic Meningitis
Tuberculous Meningitis
Pathogenesis
Clinical Profile
Viral Meningitis
Diagnosis
▮ MANAGEMENT
Pyogenic Meningitis
▮ DURATION OF TREATMENT
Bacterial Meningitis
Tuberculous Meningitis
Viral Meningitis
Fungal Meningitis
Treatment of Cryptococcal Meningitis (Table 5)
CHAPTER 14:
Encephalitis and Brain Abscess
▮ ENCEPHALITIS
Treatment
▮ BRAIN ABSCESS
Clinical Presentation
Investigations
Treatment
CHAPTER 15:
Myasthenia Gravis
▮ MYASTHENIA GRAVIS
▮ PATHOPHYSIOLOGY
▮ CLINICAL PRESENTATION
▮ TREATMENT
Drug Therapy of MG
CHAPTER 16:
Speech/Language Disorders
▮ INTRODUCTION
▮ DEVELOPMENT OF LANGUAGE IN CHILDREN
▮ APRAXIA
▮ LANGUAGE DISORDER
Broca's Aphasia (Fig. 1)
Wernicke's Aphasia
Global Aphasia
Pure Word Deafness
Transcortical Aphasias
CHAPTER 17:
Seizure Disorders
▮ INTRODUCTION
▮ CLASSIFICATION OF SEIZURES
Generalized Seizures
Tonic, Clonic, Tonic-clonic (Grand Mal)
Absence (Petit Mal)
Focal Seizures
Focal Seizures without Dyscognitive Features
Focal Seizures with Dyscognitive Features
▮ EPILEPTOGENESIS
▮ BASIC MECHANISM
Seizure Initiation
▮ CAUSES OF SEIZURES IN ADULTS
▮ INVESTIGATIONS
▮ MANAGEMENT
CHAPTER 18:
Cranial Nerves
▮ INTRODUCTION
▮ NUCLEI OF THE CRANIAL NERVES
Motor Nuclei
Sensory Nuclei
▮ COURSE
Olfactory Pathway
Major Projections of the Olfactory Areas
▮ FUNCTION
▮ TESTING
▮ SPECIAL METHODS
▮ CLINICAL MANIFESTATIONS
▮ ETIOLOGY
▮ COURSE
▮ FUNCTION
▮ TESTING
Vision
Color Vision
Field of Vision
Physiologic Blind Spot
Confrontation Test
Ophthalmoscopy
Reflexes
▮ REFLEXES
Pupillary Light Reflex
Convergence Reflex
▮ LESIONS OF THE OPTIC PATHWAY
Optic Nerve
Causes
▮ LESIONS OF THE OPTIC TRACT
1 and 3: Optic Chiasm
4: Optic Tract
5: Optic Radiations
6: Visual Cortex
▮ COURSE
▮ FUNCTIONS
▮ SYMPTOMS
▮ EXAMINATION
Inspection
Testing Extraocular Muscle Movements
Versions
▮ NYSTAGMUS
Types of Nystagmus
Pendular Nystagmus
Jerk Nystagmus
Rare Forms of Nystagmus
Optokinetic Nystagmus
Vestibulo-ocular Reflex
Vergence
▮ LESIONS OF THE THIRD NERVE
▮ COURSE
▮ TESTING
Lesions
▮ COURSE
▮ HORIZONTAL GAZE CENTER
▮ FUNCTION
▮ LESIONS
▮ INTERNUCLEAR OPHTHALMOPLEGIA
▮ COURSE
▮ CEREBELLOPONTINE ANGLE TUMORS
▮ TESTING
Sensory
Motor
▮ LESIONS
▮ COURSE
▮ FUNCTIONS
Motor
Sensory
▮ TESTING
Taste
▮ LESIONS
▮ ETIOLOGY
▮ RAMSAY HUNT's SYNDROME
▮ MANAGEMENT
▮ COURSE
▮ FUNCTIONS
▮ TESTING
▮ COCHLEAR COMPONENT
Rinne's Test
Weber's Test
▮ VESTIBULAR NERVE
▮ CALORIC TEST
▮ LESIONS
▮ CONDITIONS AFFECTING VESTIBULAR FUNCTION
Peripheral Causes
Central Causes
▮ COURSE OF THE IX AND X NERVES
▮ FUNCTIONS OF THE IX AND X NERVES
Vagus Nerve Functions
Testing Glossopharyngeal and Vagus
▮ LESIONS
▮ COURSE
▮ COURSE
▮ FUNCTION
▮ TESTING
▮ LESIONS
▮ COURSE
▮ FUNCTION
▮ TESTING
▮ LESIONS
▮ CLINICAL SYNDROMES
INDEX
TOC
Index
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