Index

cerebral arteries atherosclerosis 115–16 CT angiography 30–1

cerebral ischaemia 35 cerebral oedema 187, 195

cerebral venous thrombosis 108 cerebrospinal fluid (CSF)

blood in sample 197 lumbar puncture 52 obstruction 187 oligoclonal banding 227 pressure 195, 195, 196 protein level 187

cerebrospinal fluid (CSF) examination 181

cerebrovascular disease 35–7, 81–2, 100, 200

cervical spine disorders 193, 204–5, 210–11

Charcot joints 180 Charcot–Marie–Tooth disease 56 Chiari malformations 56–7, 225–6,

227

chickenpox 182–3 choline 36

chorea 163, 167–8

Clock Drawing Test 46–7 clonus 24, 168

Cogan’s lid twitch sign 123 cognitive function 14

distributed 14–16, 14 history taking 18, 88–9 localized 14, 16–18

cognitive testing 19–20, 44–6, 89–90 language assessment 99

colour vision 108, 110

computed tomography (CT) 28–30 angiography 30

brain anatomical landmarks 29 spinal cord 49–50

computed tomography perfusion (CTP) 31

concentration see attention/concentration

confabulation 78 confrontation 59, 110, 111 confusional states 76

causes 79–80, 79 clinical assessment 77–9 clinical scenarios 81–5 definition 76 fluctuations 78

with lethargy/retardation 77, 80 pathophysiology 77

consciousness anatomy 12–13 brainstem tests 13 levels of 11

consciousness, altered diagnosis 42, 65 mechanisms 65

see also epilepsy; syncope conus medullaris 222 coordination 156, 176–85

tests 26 copying, shapes 17

corneal reflex 13, 21, 140 corpus callosum 16, 97 Corsi Block Test 45

corticobasal degeneration 165 cramps 151, 161

cranial nerves

examination 20–2, 112, 125, 140, 190, 204

eye movements 120–1 palsies 22, 23, 128, 196 see also individual nerves

cranio-cervical junction lesions 56–7 creatine kinase (CK) 84, 156 Creutzfeldt–Jakob disease 108 Cushing’s syndrome 58

cytotoxic drugs 152

deafness see hearing loss delirium 13, 77, 78 delirium tremens 80 delusions 13

dementia 16, 18, 47, 88, 89–90, 91, 108

demyelination 107, 121, 122 Denny–Brown sensory neuropathy 182 depression 91–2, 144–5

dermatomes 152–3

dextrose, intravenous infusion 92–3 diabetes mellitus 128, 136, 144, 224–5 diet 9, 181, 183

digit span 45, 77, 86, 90

digital subraction angiography (DSA)

38–9

diplopia see double vision discrimation tests 25 disequilibrium 131, 136 disinhibition 15

Dix–Hallpike positional test 141, 143 dizziness 131–42

anatomy and physiology 132–4 and anxiety 131, 132, 136, 137 clinical scenarios 143–6 examinations 138–41

history taking 134–7

postural 65–6, 73, 132, 144–5 specific investigations 141 symptom complexes 134, 135

timing/duration of symptoms 135–6,

137

Doll’s eye test 125, 141

dopaminergic neurones 164, 172, 174 Doppler ultrasound 39–40, 112 dorsal root ganglion 214, 215

double vision (diplopia) 21, 112,

118–29, 192 causes 121, 152

clinical scenarios 127–9 examinations 21, 122–5 history taking 121–2 investigations 126, 126

drug abuse 80, 137 drug history 10, 18, 89 drugs

analgesia overuse 191, 193–4, 201–2

causing confusional states 77, 80, 83–4

causing dizziness/imbalance 137, 176

causing headache 187, 196 causing weakness/fatigue 152 inducing tremor/parkinsonism 165,

167

and syncope 65

Duchenne muscular dystrophy (DMC) 148

dural venous sinus cavernous 58

thromboses 122, 198, 199 dysaesthesia 220

dysarthria 95, 98, 102, 178, 180 dysdiadochokinesia 125, 180 dysgraphia 98, 99

dyskinesia 165 dyslexias 97–8 dysphasias 76, 95, 96 dyssynergia 180 dystonia 168

ear disorders 60–1, 176, 178 Eaton–Lambert syndrome 55, 56 echocardiography 112

eclampsia 200 elaborated disease 221 elbow movement 154

electrocardiography (ECG) 66, 67, 73,

112, 142

electroencephalography (EEG) 40–3 abnormal rhythms 40

ataxia 181–2 confusional states 77

epilepsy 41–2, 68, 68, 69, 70, 72–3 intracranial recordings 42

normal rhythms 40 sleep-deprived 42 video 42, 73

visual loss 112 electromyography 54–5, 156–7

oscillopsia 136

pain, muscular 151 pain sensitivity 25, 219 palmomental reflex 19 Pancoast tumour 160 panic attacks 71 papillitis 104 papilloedema 104, 108

paraneoplastic syndromes 181, 182 paraphasias 97, 99 parieto-temporal cortex 133

parkinsonism, drug-induced 165, 167 Parkinson’s disease (PD) 19, 22, 163,

164, 165, 171–2 drugs 80

tremor 165, 166

Parkinson’s plus disorders 165–6, 174 paroxysmal disorders 9

perception 78 perfusion, cerebral 65–6

perineum, sensation 205–6, 222 peripheral nerve disorders

classification 151 differentiation from root lesions

206, 206–7 investigations 52–6

patterns of deficits 154–5, 154, 222–3

peripheral nerves 214, 215 peroneal nerve lesions 206 petit mal seizures 68, 70 phaeochromocytoma 200 physical examination 19 pinprick examination 25

pituitary apoplexy syndrome 198–9 pituitary fossa 58

plantar response 24, 156 point-to-point test 26 polymodal association cortex 76 polyneuropathies 222, 224–5 polyopia 118

polysomnography 43 popliteal nerve, lateral 154 positional sensation 25

positron emission tomography (PET)

38

postoperative confusion 80

postural dizziness/hypotension 65–6, 73, 132, 144–5

postural stability 26, 170 pout reflex 19

praxis 16 pre-eclampsia 200

presenting complaint 8–10 presyncope 65–6, 73, 136, 144–5 primary sensory cortex 76–7 prochloroperazine 83–4, 165

progressive supranuclear palsy (PSP) 165

prolactin 58

pronator drift 24, 181, 219 pronunciation 45, 94–5, 97 proprioception 177–8, 215

deficits 132, 140 testing 220

proptosis 21, 108, 109, 122, 123 prosopagnosia 18, 108 pseudoathetosis 181

psychogenic nonepileptic seizures (PNES) 64, 65, 71, 71–2

psychomotor activity 14 pterygoids 21

ptosis 21, 122, 123 pull-back test 26, 170 pulmonary disease 148, 160

pupil, responses 13, 21, 109, 122, 123 pyramidal signs 170

quadrantanopia 58, 105, 106

radial nerve lesions 154, 155 radiculopathies 151, 152 radiology, spinal cord 48, 209 Raven’s Progressive Matrices 45 reading 45, 94–5, 97–8, 99 rebound phenomenon 180 recall, delayed 89–90 reduplicative phenomena 78 reflexes 24, 156, 156, 219

brainstem 13 loss 222 primitive 19, 170 spinal roots 207

repetition 96, 99 respiratory alkalosis 71 respiratory movements 13

reticular activating system 14 retina 60, 104

Rey–Osterrieth complex figure 46, 90 right hemisphere function 16–18 rigidity 23, 170

Rinne’s test 22, 60, 138–40 Romberg’s test 26, 132, 138–9, 181,

219

saccades 125

sacral root lesions 204–5 sarcomere, structure 149–50 sarcoplasmic reticulum 150 scalp 190, 194, 216 scotoma 110, 192

seizures

psychogenic nonepileptic 64, 71,

71–2, 74

see also epilepsy

semantic memory 16, 45, 87, 88, 89, 90

semicircular canals 132 sensory cortex 216

sensory loss 17, 125, 140, 214–28 assessment 25–6, 112, 217–24, 219 and dizziness 140

nonorganic (elaborated) disease 221 peripheral nerve lesions 154–5,

224–5

spinal cord lesions 158–9, 207, 221–2

terminology 220

sensory nerve fibres, classification 215 sensory pathways 214–17

sensory receptors 214 septicaemia 79

serial 7’s 90

shoulder abduction 154

single photon emission computed tomography (SPECT) 36–7, 100,

172, 174 sinusitis 193 sleep disorders 43 smoking 182

Snellen chart 20, 110 social history 10, 18

somatosensory evoked potentials (SSEPs) 44, 52

speech

anatomy and physiology 94–5 assessment 98–9

disorders 78, 95–8, 102, 152, 178, 180

fluency 15, 99

sphincter function 205–6, 208, 222 spinal cord

anatomy 47–8, 153, 204, 215 dermatomes 152–3 imaging/investigations 47–51 sensory pathway 214–17

spinal cord lesions

anatomical localization 207–9 clinical scenarios 210–12, 225–7 investigations 48–52, 209

level localization 206–7 sensory loss 158–9, 207, 205,

221–2 tumours 158–9

weakness 152, 153, 158–9, 160 spinal sympathetic function 206 spino-thalamic tracts 209, 215 stance 26

stapedial reflex decay 60–1 Steele–Richardson–Olszeweki

syndrome 165 stereognosis 25, 219

sternocleidomastoid muscle 22