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Adamasn Vdi ctor's Principolfe s Neurology :(1,-""' -'""'"'" Antc.u rt.a mi1 11 -" -:f;::?'A ntc.u nt..o fn eck oft honr'.s . � .' - Supraclanv'isc.u lar . ' Ulnna.r Femobrraaln ch_/ ofg enitofne.m oral (lumbo-inn.g}u inal Scrobtraaln ocfph e rinne.a l Latc.u nt..o ft high lnter&m meedd.c. u nt'.s . oft hi(gfhr foemm onr.a}l --- Lat.nc.ou ftc .a lf (frcoomm mopne ronne.a)l Sapheunsno.--------, (frfoemm onr.a}l Deeppe ronne.a l � Greateorc cinpeirvteasl (frcoomm mon --- Supeirfailpc eronne.a l ; ___.....-Lessne.}r peronne.a}l (frcoomm mopne roneal n.) \:: ,..?- Greaautr icnu.l ar Med&. l aptl.a nnt'asr. -- Surna.l ,T; � � Antc.u nt..o fn eck (frpooms ttibial n.} (frtoimb ni.a)l Figur9e -.1T he cutaneoufsi eldosf periphernaelr ves. (Reproducbeyd p ermissiforno mH aymakeWr, WoodhalBl: PeripNheerrIvanelj u,2r nide eds.Ph iladelpShiaau,n de1rs9,5 3.) Posctu nt..o fa rm (frorma dni.a)l lnf.lat. clunne'asl. Obturna.t or Medc.u nt..o ft high Posctu nt..o ft high (frfoemm onr.a)l Lactu.nt ..oc fa-- lf-- - 1 (frocmo mmofne monr.a)l Saphenno.--u --s-- ---LI (frfoemm onr.a)l Surna.(l f rtoimbn i.a)l Surna.l Calcanberaann cohfe s sur&a tli bial n's. Figur9e-. 1( oCntuie)dn L2 • L3 81 82 84 85 L5 Figeu 9r-3D.is tribuotfi otsnhe en sosrpyi nraolo tosnt hesu rfaocfe the bo(ddye rmtao mes()R.e produbcyep de rmissfiroonmS i nclair.) Adamsa ndV ictor's PRINCIPLOEFS NEUROLOGY TENTHE DITION NOTICE Mediciinsea ne ver-chansgciinegn Acsen .e wr esearacnhdc liniceaxlp erience broadeonu rk nowledgceh,a ngeisnt reatmeanntdd rugt heraaprye r equired. Thea uthoarn dt hep ublisohfet rh iwso rkh avec heckewdi ths ourcbeesl ieved tob er eliaibnlt eh eierff orttsop roviidnef ormattihoaints c ompleatned g ener alliyn a ccorwdi tht hes tandaradcsc eptaettd h et imoef p ublicatHioowne.v er, inv iewo ft hep ossibiolfih tuym an erroorr c hangeisnm edicaslc iencneesi, thetrh ea uthonro rt hep ublishneorra nyo thepra rtwyh o hasb eeni nvolved int hep reparatoirop nu blicatoifto hni wso rkw arrantthsa tth ei nformation containheedr eiinsi ne verrye speacctc uraotrce o mpletaen,dt hedyi sclaailml responsibifloiartn yye rroorrso missioonrfs o trh er esulotbst ainferdo mu seo f thei nformation coinntt haiiwsno erdk R.e aderarse e ncouragteocd o nfirtmh e informatcioonnt ainheedr eiwni tho thesro urceFso.re xamplaen di np articu larr,e adearrsea dvisetodc hectkh ep roducitn formatsihoenei tn cludiendt he packagoefe acdh rugt hepyl atno a dminister tob ec ertatihnat th ein formation containientd h iwso rki sa ccuraatnedt hacth angehsa ven otb eenm adei nt he recommenddeods eo ri nt hec ontraindicfaotraid omininss tratiTohins.r ecom mendatiiosno fp articuimlpaorr tancienc onnectiwoint hn ewo ri nfrequently usedd rugs. AllaHn.R oppeMrD, ProfessoofrN eurology HarvarMde dicaSlc hool RaymondD .A damsM asteCrl inician ExecutiVviec eC haiorf N eurology Brighaamn dW omen'sH ospital BostonM,a ssachusetts MartiAn.S amuelMsD, MiriaSmy dneyJ osephP rofessoofrN eurology HarvarMde dicaSlc hool ChairD,e partmeonftN eurology Brighaamn dW omen'sH ospital BostonM,a ssachusetts JoshuPa.K leiMnD,, P hD AssistaPnrto fessoofrN eurologayn dR adiology HarvarMde dicaSlc hool ChiefD,i visioofnH ospitNaelu rology Brighaamn dW omen'sH ospital BostonM,a ssachusetts New York ChicagoS anF rancisActoh ensL ondonM adrid [!II MexicoC ityM ilanN ew DelhiS ingaporeS ydneyT oronto Medical Copyri©g h2t01b4yM cGraw-Hieldlu catiAolnlr. i ghrtess ervEexdc.e patsp ermitutnedde trh eUn iteSdt atCeosp yriAgchtto f1 97n6op, a rotft hisp ublicamtaiyob ne reproduocred di stribinu atneydf ormo rb ya nym eanso,rs torienda d atabasoerr etriesvysatle wmi,t hotuhtep riowrri ttepne rmissoifto hne p ublisher. 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Prefacvei i sECTI5ON D erangemenotfsI ntellect, Acknowledgmenitxs , Behavioarn,d L anguagCea usedb yD iffuse andF ocaCle rebrDails eas4e1 9 THEC LNIICAMLE THODO F PART 1: NEUROLOGY1, 20 Deliriaunmd O theArc uteC onfusional 1 Approactho t heP atiewnitt h State4s2 1 NeurologDiics eas3e , 21 Dementitah,e A mnesiScy ndromea,n dt he 2 ImagingE,l ectrophysiologic, NeurologoyfI ntelligaenndcM ee mory4 34 andL aboratoTreyc hniques 22 NeurologDiics ordeCrasu sedb y Lesionisn forN eurologDiica gnos1is3, SpecifPiacr tosf t heC erebru4m5 5 CARDNIALM ANFIETSATIONOSF 23 DisordeorfsS peecha ndL anguag4e8 6 PART 2: NEUORLOGIDCI SAESE4,1 sECTI6ON D isordeorfsE nergyM,o od,a nd sECTIO1N D isordeorfsM otili4t3y Autonomiacn dE ndocrinFeu nctio5n0s7 3 MotorP araly4si5s 24 FatiguAes,t heniAan,x ietayn,d D epressi5o0n8 4 AbnormalitoifeM so vementa ndP osture 25 TheL imbiLco besa ndt heN eurologoyf Causedb y Diseasoeft heB asaGla ngli6a4 Emotio5n1 8 5 Ataxiaan dD isordeorfCs erebelFluanrc ti8o1n 26 Disordeorfst heA utonomiNce rvouSsy stem, 6 Tremor, MyocloFnoucsaD,ly stoniaasn,d RespiratainodnS ,w allowi5n3g0 Tic9s2 27 TheH ypothalamaunsd N euroendocrine 7 DisordeorfsS tancaen dG ai1t1 5 Disorde5r6s3 GROWTHA NDD EVLEOPMETN SECTI2ON P aina ndO therD isorders PART 3: OFT HEN ERVOUSS YSTEMA NDT HE ofS omatiSce nsatioHne,a dachea,n d NEUROLOGYO FA GING57 7 Backach1e2 7 28 NormalD evelopmeanntd D eviatioinns 8 Pain1 28 Developmeonftt heN ervouSsy stem5 79 9 OtherS omatiSce nsati1o5n0 29 TheN eurologoyfA ging6 06 10H eadachaen dO therC raniofacPiaailn1 s6 8 MAJORC ATEGORIOEFS PART 4: 11P aini nt heB ackN,e cka,n dE xtremit1i9e8s NEUROLOGICD ISAESE6 15 sECTI3ON D isordeorfst heS pecial 30 DisturbanocfeC se rebrospiFnlauli d, IncludiHnygd rocephalPusse,u dotumor Sense2s2 5 Cerebrain,d L ow-PressuSyrned rome6s1 7 12D isordeorfsS mella ndT ast2e2 6 31 IntracraNneioapll asmasn dP araneoplastic 13D isturbanocfeV si sio2n3 5 Disorde6r3s9 14D isordeorfsO culaMro vementa ndP upillary 32 Infectioofnt sh eN ervouSsy stem( Bacterial, Functi2o6n0 FungalS,p irochetPaalr,a sitaincd) 15D eafnesDsi,z zineasnsd,D isordeorfs Sarcoido6s9i7s Equilibr2i9u0m 33 ViraIln fectioofnt sh eN ervouSsy stem, SECTI4ON E pilepasnyd D isordeorfs ChroniMce ningitainsd,P rioDni seas7e4s3 Consciousn3e1ss7 34 CerebrovascDuilsaera s7e7s8 16E pilepasnyd O theSre izurDei sorde3r1s8 35 CraniocereTbrraaulm a8 85 36 MultipSlcel erosainsd O therI nflammatory 17C oma andR elateDdi sordeorfs DemyelinatDiinsge as9e1s 5 Consciousn3e5s7s 37 InheritMeedt abolDiics easoefst heN ervous 18F aintneasnsd S yncop3e8 3 System9 46 19S leeapn dI tAsb normalit3i9e5s v vi Contents 38 DevelopmentDails easoefst heN ervous 46 Diseasoesft heP eripheNrearlv es1 310 System1 003 47 Diseasoesft heC ranial Ne1r3v9e1s 39 DegeneratDiivsee asoefst heN ervous 48 DiseasoesfM uscl1e4 07 System1 060 49 MyasthenGiraa viasn dR elated Disoorfd ers 40 TheA cquireMde tabolDiics ordeorfst he theN euromusculJaurn cti1o4n 72 NervouSsy stem1 132 50 TheM yotoniaPse,r iodPiacr alysCersa,m ps, 41 Diseasoefst heN ervouSsy stemC ausedb y Spasmsa,n dS tateosf P ersistMeunstc le Nutritional De1f1i6c1i ency FibeArc tivi1t4y9 0 42 Alcohoaln dA lcoholi1s1m8 6 PART 6:P SYCHIATRIDCI SORDER1S5 07 43 Disordeorfst heN ervouSsy stemC ausedb y 51 AnxietDyi sordeHryss,t erainad,P ersonality DrugsT,o xinsa,n dC hemicaAlg ent1s2 00 Disorde1r5s0 9 PART 5:D IESASEOSF S PINACLO R,D 52 Depressiaonnd B ipolDairs eas1e5 29 PERIPAHLEN RERVE,A NDM USCLE1 235 53 SchizophreDneilau,s ionaanldP aranoid 44 Diseasoefst heS pinaClo rd1 237 State1s5 43 45 ElectrophysiaonldoL gaibco ratoAriyd si nt he Inde1x5 61 DiagnosoifsN euromusculDairse as1e2 88 As ther esotf m edicinceh angesso, d oesn eurologyr.e quirmeosr et hane vera typeo fi ntegrataimoonn g Neurologdiica gnosainsdt reatmehnatsb eens ov astly knowledgoefc lininceaulr oscientcreasd,i tinoenuarlo l alterbeydm odernne uroimagmionlge,c ulbairo logayn,d ogy,a ndt hee xpandisncgi entliiftiecr atounr dei sease genetitchsat th eo rigianuatlh oorfst hisb ookR,a ymond mechanisms.O nlya textt hath asb eent houghtfully D Adamsa ndM auricVei ctowro,u ldb arelrye cognize construcftoertd h ee ducatneedu rologciasnft u lftihlils thep ractiocfet so dayS.e culairn tereisntn eurologince eda ndw e hopet hawte haved ones oi nt hiesd ition. diseasiessa lsoex pandinbge causoef t hel argneu m Furthermoirnae p,p ropricaotnef ormittoty h em ethods bero fp roblemosft heb rains,p inaclo rdn,e rveasn,d by whichp hysicioabntsa ini nformatiMocnG,r aw-Hill muscletsh aatr iswei tha ginga ndf romt het reatmenth asm adea ni nvestmenitnt heiArc cesMse dicinewe b andc ontrooflo thenro,n -neuroldoigsieca,s Wehse.r eas sitteh awti lhli ghlioguhrtb ooka sw elals s everoatlh er cancearn dh eardti seahsaed o ccupifeodr emopsots i neurolotgeyx tCso.m binewdi tht hesbeo oks willbe tionisn t hem indso fi ndividuwailtsh idne velopeds ophisticasteeadr cfhu nctiotnesa,c hincgu rricfuolsrat u societAilezsh,e imPearr,kin sona,n dr elatdeids easaerse dentasn dr esidenatnsd,h, o pfulely int hef uturea, f orm centrtaolt hem odern conversationt haeqb uoaulti otfy ofi nteracwtiitohun s ,t hea uthorAnso.t heri ncepthiaosn lifMeo.r eovetrh,e d esirteo un derstantdh ew orkings beent hea dditioofcn o lofri guraensdp hotogratpoht shi s ofth e braiann dt og ain insighitnst hou manb ehaviore ditiionno rdetro m aket hev isumaalt erimaolr ea cces hasb ecomae preoccupaotfit ohnep ubliAct. t hes ame siblaen da pproprifaotrte h ew ebv ersion. timet,h em annerin whichi nformatbiootnh,a ccurate To theseen dsw,e offetrh ec urrelnOtt he ditioofn ando therwiisset ,r ansmittaebdo uthte nervoussy stem PrincoifN peluersot lom oegyett hen eedosf t hes easoned andn eurolodgiisce asheassc hangeAdc.c estsoi nformaasw elals t hea spirinnge urologniesutr,o surgeionnt,er tiona boutd iseasaecsc,e ptterde atmenatnsd, c linicanli stp,s ychiatripsetd,i atriceimaenr,g encpyh ysician, symptomasn ds ignusb,i quitoculsluyt ttehresI nternet.p hysiatrainsdat ll,c liniciwahnos haven eedo fa com Physicinaonws lesfsr equensteleyk a comprehensivper ehensdiivsec ussoinon ne urolopgriocb lemWse. b egin understandoifna g d iseasoer c lasosf d iseas"etsh,e witha n explanatoifot nh efun ctioninogf t hen ervous wholset oriyf"y ouw ilblu,t i nstefaadv orra piadc cetsos systeams i tp ertaitnosn eurolodgiisce ains et hefi rst singalnes wertsoa clinipcraolb lem. parto fth e bookf,o llowbeyd d etaildeeds criptoifo ns Form any reasonpsa,r ticultahrell ya sotf t hese thec linical aosfnp eeucrtosl oigniy t gsr eadti versiItny . regarditnhgen aturoef m edicailnf ormatiworni,t ian g almla tterwse, h avep utt hep atieanntd r elioeffs uffer textbooonkn eurolohgaysb ecomae c ompleexn terprisien.g f romn eurolodgiisce aisnea centrpalla cTeh.e b ook We havee vena skeodu rselivfet sh eriesa rolfeo ra textism eantt ob ep ractiwciatlh oubte inpgr escripatnidv e booki nt hem odern erae,s peciaolnlewy r ittbeyn o nly readabwliet houbte intgo oe xhaustiWvhee.n theriesa threaeu thorYse.ti ,n i dentiftyhiecn hga racteroifst thiec sd igressiitoh na,sb eenp urposesltyr ucturetdo c omplete capabclleini ciaonn,e w ho ise quippetdoh elpp atientsa pictuorfea particudliasre asWee. h avea lsroe tained and playa rolien s ociettoyt hef ulleesxtt enpto ssibleh,i storaiscpaelc otfsm anyd iseastehsaa tr ec entrtaotl h e we continuourseltuyrn tot hen eedf orc arefculiln icalu nderstandoiftn hges peciaalntdyi tpsl acienm edicine. analysitsh ati sc ombinewdi tha deepkn owledgeo f Byt aking an inclusainvdey ets ensibclhyo secnl ini diseasThees.e a res titlhleb asifso rh igh-quaplriatcyt icec ala pproacwhe, d o note scheowr c ritictihzeme o dern andt eachinEgv.e ni ft hec urregnota losf e fficieanncdy movementto h omogenimzeed icinei no rdetro a ttain economiyn m edicianreet ob em etn,e uroloigssy o c om uniformiotfyp ractiWcee .o urselvheasv ew itnessed plethxa tt hec onfidiemnptl ementaotfia o pnl aonf d iag over3 5y eartsh eu nappealiansgp ecotfsi diosyncratic nostiocrt herapeuatcitci oqnui cklfyi ndist seblefy ond practicwehsi,c hw ereb asedo n limitedb asiincf orma algorithflmosw, c hartasn,d g uidelines.g oTahloe fo ur tioann do n a superfiucnidaelr standoifnn ge urology. textbotohke refiostr oep rovindeeu rolokgniocw ledigne Nonetheltehsesc ,o mplexoiftn ye urolodgiisce aseessp,e ana ssemblweady th att ranscefnadcsta sn di nformatiocni alnloyw ,p uttsh ep ractitiionan peors itioofcn h oosing andt o prestehnikntso wledgei na contetxhta cta nnot amongm anyo ptiofnosdr i agnoasnidst reatmetnhtaa tr e bea ttainbeyd d isembodideedt aiWlhsi.l et heb iologiequivaloernf to,rw hicthh er esulatrseu ncertaCilni.ni cal calb aseosf n eurolodgiisce asaerse b eindgi scoveretdr iaalbso unind neuroloagnyd s eta directfioorcn li nical rapidltyhe,m ajocro ntribuotfit ohnec linicnaelu rologisptr actiicnle a rgpeo pulatibountsa ,r ed ifficutloat p ply remainass,i t i sf ort hew holeo fm edicinae s:y ntheosfi s toi ndividpuaatli enTthse.n eedf ora coheremnett hod knowinhgo w tol istteont hep atiewnhte,r et of intdh e ofc liniwcoarlk i so ner easowne haver etainaeudt hor saliennetu rolosgiigcn asn,d w hatt oa cquifrreo ml aborashipr athetrh ane ditormiaanla gementth atc haracter tortye satnsd i maging. izemsa nyt extbooiknos t hearr eaosf m edicinLei.m ited Theries a lwayas r isokf s ucha bookb eings imply authorsphiepr mitas uniforsmt yloefw ritianngd l evel archivBault.t hed ynaminca tureo fm odern neurologyo fe xpositaicorno ssusb jemcatt tearn dc haptheera dings. vii