A Physiological Approach to Clinical Neurology

A Physiological Approach to Clinical Neurology deals with the mechanism of various neurological symptoms and signs in terms of disordered physiology. Topics covered by this book include pain and other sensations; weakness; the tendon jerk and the stretch reflex; and disordered control of motor neurons. The disorders of basal ganglia and cerebellum are also considered, along with consciousness and unconsciousness; the mechanism of epilepsy; and the relationship between brain and mind. This book is comprised of 11 chapters and begins by introducing the reader to the clinical analysis of sensory and motor disorders. The discussion then turns to the perception of pain and other kinds of sensation; the clinical approach to the problem of weakness; and the clinical significance of the tendon jerk. In the chapters that follow, appraisal of a neurophysiological thought is applied to common neurological disorders such as Parkinson's disease, hemiballismus, epilepsy, and developmental anomalies like platybasia. The last chapter explores the phenomena of mind and its connection to the brain as well as its influence on the body, paying particular attention to perception, memory, and emotion. This monograph is intended for those who are proceeding into the clinical years of a medical course, to those who are studying for senior qualifications in internal medicine or neurology, and to those who are merely curious about the cause of neurological phenomena that they observe daily in their patients.

PrefaceAcknowledgments1-Pain and other Sensations Sensory Symptoms The Perception of Different Kinds of Sensation Segregation or Integration of Neural Pathways? Sensory Pathways in the Central Nervous System The Perception of Pain Visceral Pain Referred Pain Phenomena Associated with Pain Common Patterns of Pain Indifference or Insensitivity to Pain Clinical History-Taking in Relation to Pain The Interpretation of Sensory Symptoms and Signs Principles of Management of Painful Syndromes Summary2-Weakness Asthenia Paralysis or Paresis A Pure Pyramidal Lesion An Upper Motor Neurone Lesion Monoplegia, Hemiplegia, Paraplegia, Quadriplegia The Lower Motor Neurone The Neuromuscular Junction Muscle Metabolic Abnormalities Hysterical Weakness Transient Paralysis The Clinical Approach to the Problem of Weakness Summary3-The Tendon Jerk; a Phasic Stretch Reflex The Stretch Reflex The Historical Importance of Decerebrate Rigidity The Muscle Spindle Afferent Fibers from Muscle Phasic Muscle Reflexes The H Reflex The Tendon Jerk The Clinical Significance of the Tendon Jerk Summary4-Tonic Stretch Reflexes: the Mechanism of Muscle Tone and Movement Spinal Cord Influences on Tonic and Phasic Reflexes Supraspinal Control of Motor Neurones Reticulospinal Tracts Vestibulospinal Tract Other Extrapyramidal Tracts Effects of Extrapyramidal Tracts on the Stretch Reflex The Motor Cortex and Pyramidal Tract The Tonic Stretch Reflex in Man The Normal Control of Movement Summary5-Disordered Control of Motor Neurones Frequency Control of Motor Neurones Physiological or Action Tremor Action Tremor and Alternating Tremor in Parkinson's Disease The Mechanism of Physiological Tremor Lesions of the Lower Motor Neurone Lesions of the Upper Motor Neurone Spasticity The Extensor Plantar Response Extrapyramidal (Parkinsonian) Rigidity The Cogwheel Phenomenon Phasic Stretch Reflex in Parkinson's Disease Summary6-The Basal Ganglia and their Disorders The Extrapyramidal Motor System Parkinson's Disease The Nature of the Disturbance in Parkinson's Disease Hemiballismus Chorea Athetosis Dystonia Summary7-The Cerebellum and its Disorders Developmental History Anatomical Connexions The Integrating Action of the Cerebellar Cortex The Effect of the Cerebellum on Spinal Motor Systems The Symptoms and Signs of Human Cerebellar Disease Archicerebellar Syndrome Palaeocerebellar Syndrome Neocerebellar Syndrome Disorders of the Cerebellum Summary8-Vertigo The Vestibular System and its Connexions The Syndrome of Vestibular Damage Nystagmus The Causes of Vertigo History-Taking in Patients with Vertigo Examination of Patients with Vertigo Special Investigations Caloric Tests of Vestibular Function Electronystagmography Hearing Tests Diagnosis Summary9-Consciousness and Unconsciousness The Ascending Reticular Activating System The Source of Consciousness Sleep-Loss of Consciousness Clinical Examination of the Unconscious Patient Common Causes of Coma Summary10-The Mechanism of Epilepsy The Epileptic Neurone The Hereditary Tendency to Epilepsy Factors in Seizure Production Factors in Seizure Prevention The Mechanism of Seizures Tonic Seizures Focal Seizures and Major (Grand Mal) Seizures Minor (Petit Mal) Seizures Myoclonus Summary11-The Relationship between Drain and Mind Perception Memory Entry Portal for Memory Long-Term Storage of Memory Emotion Response Prepositional Thought Dementia Focal Cerebral Symptoms The Influence of the Mind on the Body General Conclusions SummaryIndex