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Bickerstaff’s Neurological Examination in Clinical Practice PDF

395 Pages·2013·122.55 MB·English
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Bickerstaff’s INK=10] ce} Lote | rete) => <-laaliatsiacelamia G@iitaliers) i ae-leace Editor-in-Chief Editor (Sixth Edition) Kameshwar Prasad John Spillane Co-Editor Ravi Yadav Seventh Adapted Edition WILEY Bickerstaff's Neurological Examination in Clinical Practice SEVENTH ADAPTED EDITION Editor-in-Chief KAMESHWAR PRASAD Department of Neurology All India Institute of Medical Sciences New Delhi Co-Editor RAVI YADAV Department of Neurology National Institute of Mental Health and Neurosciences Bengaluru Editor (Sixth Edition) JOHN SPILLANE Opus s re Ahmed WILEY Bickerstaff’s Neurological Examination in Clinical Practice Copyright © 2013 by Wiley India Pvt. Ltd., 4435/7, Ansari Road, Daryaganj, New Delhi-110002. Copyright © 1963, 1968, 1973, 1980, 1989, 1996 by Blackwell Science Ltd. All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or trans- mitted in any form or by any means, electronic, mechanical, photocopying, recording or scanning without the written permission of the publisher. Seventh Reprint Adapted Edition: 2014 ISBN: 978-81-265-3898-0 Limits of Liability: While the publisher and the authors have used their best efforts in preparing this book, Wiley and the authors make no representation or warranties with respect to the accuracy or completeness of the contents of this book, and specifically disclaim any implied warranties of merchantability or fitness for any particular purpose. There are no warranties which extend beyond the descriptions contained in this paragraph. No warranty may be created or extended by sales representatives or written sales materials. The accuracy and completeness of the information provided herein and the opin- ions stated herein are not guaranteed or warranted to produce any particular results, and the advice and strategies contained herein may not be suitable for every individual. Neither Wiley India nor the authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages. Disclaimer: The contents of this book have been checked for accuracy. Since deviations cannot be precluded entirely, Wiley or its authors cannot guarantee full agreement. As the book is intended for educational purpose, Wiley or its authors shall not be responsible for any errors, omissions or damages arising out of the use of the information contained in the book. This publication is designed to provide accurate and authoritative information with regard to the subject matter covered. It is sold on the understanding that the Publisher is not engaged in rendering professional services. Trademarks: All brand names and product names used in this book are trademarks, registered trademarks, or trade names of their respective holders. Wiley is not associated with any product or vendor mentioned in this book. Please consult full prescribing information before issuing prescriptions for any products mentioned in this publication. No part of this book may be reproduced in any form without the written permission of Wiley India Pvt. Ltd. www.wileyindia.com Printed at: SDR Printers Contents Preface, ix Preface to the Sixth Edition, xi Part 1: The Introductory Stages, 1 Chapter 1 Approaching a neurological problem, 3 Chapter 2 Equipment, 6 Chapter 3 The history, 8 Chapter 4 First impressions, 13 Chapter 5 The general physical and mental examination, 20 Part 2: The Cranial Nerves, 41 Chapter 6 The first cranial nerve: the olfactory nerve, 43 Chapter 7 The second cranial nerve: the optic nerve, 46 Chapter 8 The third, fourth and sixth cranial nerves: the oculomotor, trochlear and abducent nerves, 62 Chapter 9 The fifth cranial nerve: the trigeminal nerve, 84 Chapter 10 The seventh cranial nerve: the facial nerve, 91 Chapter 11 The eighth cranial nerve: the auditory nerve, 99 Chapter 12 The ninth and tenth cranial nerves: the glossopharyngeal and vagus nerves, 109 Chapter 13 The eleventh cranial nerve: the accessory nerve, 115 Chapter 14 The twelfth cranial nerve: the hypoglossal nerve, 119 Part 3: The Motor System, 123 Chapter 15 Muscle bulk, 125 Chapter 16 Muscle tone, 134 Chapter 17 Muscle power, 140 Chapter 18 Posture, stance, spinal movement and gait, 161 Chapter 19 Involuntary movements, 169 Part 4: The Sensory System, 185 Chapter 20 Basic principles for examination of sensation, 187 Chapter 21 Pain, touch and temperature, 194 Chapter 22 The proprioceptive sensations, 198 Chapter 23 Stereognosis, discriminative sense and graphaesthesia, 202 Chapter 24 Common patterns of abnormal sensation, 205 Part 5: The Motor-Sensory Links, 213 Chapter 25 The reflexes, 215 Chapter 26 Coordination, 234 Part 6: Examinations of Particular Difficulty, 243 Chapter 27 The unconscious patient, 245 Chapter 28 Disorders of speech, 263 Chapter 29 Apraxia, 274 Chapter 30 Agnosia and disorders of the body image, 277 Chapter 31 The autonomic nervous system, 283 Part 7: The Investigation of Neurological Problems (Excluding Neuroradiology and Imaging), 291 Chapter 32 Towards a balanced attitude (some introductory observations), 293 Chapter 33 General medical investigations, 297 Chapter 34 The cerebrospinal fluid, 300 Chapter 35 The clinical value of electroencephalography, 311 Chapter 36 Peripheral electrophysiology, 319 Chapter 37 Biopsy, 326 Part 8: Localization of Lesions, 331 Chapter 38 Localization of lesions affecting various parts of the nervous system, 333 Part 9: Appendices, 349 Appendix A Checklist for history taking and neurological examination for undergraduates, 351 Appendix B Recording the neurological examination, 364 Appendix C Screening neurological examination , 367 Appendix D A suggested scheme for the examination of higher cerebral function, 370 Index Preface Thousands of students of medicine and neurology around the world have read Bickerstaff’s Neurological Examination in Clinical Practice. As students of medicine and neurology, we considered this very popular, and much praised book, as a bible for the techniques of neurological examination. So, when we received an invitation to edit the seventh edition of the book, we considered it a great hon- aut indeed. We were also conscious of our responsibility to retain the inherent character and simple language of the book. Neurological examination often presents a challenge to students, residents or practitioners. Medical students often fear coming across a neurology case in their examinations and general practi- tioners and physician specialists promptly refer a neurology case to a neurologist if the presentation demands neurological exam- ination. This is because there is a common perception that neu- rological examination is lengthy, cumbersome, time-consuming and difficult. This book is intended to dispel this perception. It describes techniques and examinations in an easy, clear way with free-flowing language. The main target audience of the book remains trainees in neu- rology and general medicine, but this edition is also intended for undergraduate medical students for whom we have added an appendix containing a brief checklist of the essential items under- graduate students will need for history taking and neurological examination. Continuing with the thoughtful omission of some chapters such as Paediatric Neurology in the fifth edition and Indi- cation for Full Investigation in sixth edition, we have, for the sev- enth edition, omitted the chapter on Neuroradiology and Imaging, since to adequately cover the advances in neuroradiology would have required an expansion of the chapter far beyond the scope of the book. Instead, we have added a section on Tests of Lobar Functions in Chapter 5 and a new chapter on Localization — both very useful additions to the book. The section on lobar functions will be useful for trainees in neurology when dealing with patients of neurodegenerative diseases or diseases affecting higher mental functions. The chapter on localization will be helpful for all stu- dents in determining the site of a lesion after they have gathered the clinical findings following the neurological examination. We have also added many new figures and changed the illustrations to make them more attractive. We have added a ‘Causes List’ in many chapters to help students generate diagnostic hypotheses in patients with different clinical findings. We hope students will also find the video clips (represented by video icons {§ at relevant places in the book) in the free companion CD-ROM to illustrate various movement disorders useful. We hope these changes will enhance the usefulness and popular- ity of an already much-praised book and expand the target student base. Grateful thanks to Dr. Vallika Devi for her hard work, patience, sincerity and flexibility. Our thanks are also due to the production team, Wiley India, for the excellent work and Dr. Bharathi for ensur- ing good quality neuroanatomy figures. We are also thankful to the, Department of Mental Health Education, NIMHANS, Bengaluru for the help in the production of both photographs and videos. We enjoyed editing the book and hope that students, both under- graduates and postgraduates, will find the book more useful and enjoyable to read than previous editions. Kameshwar Prasad Ravi Yadav April 2013 Preface to the sixth edition The date recorded inside my first copy of Neurological Examination in Clinical Practice reminds me of its purchase in 1973 when just embarking upon the initial nervous steps into neurology. Little did I anticipate the possibility, let alone the reality, of succeeding Dr Bickerstaff at the Midland Centre nor the double honour of an invitation to join him for the fifth edition of his much praised book. A few years on and Edwin has graciously handed over the reins for this sixth edition. The task remains unchanged - to outline the techniques of neu- rological examination, the principal methods of investigation and to suggest how the latter may be best applied. The book was never intended to be a comprehensive text of neurology, nor of neurological diagnosis. The temptation, therefore, to expand this edition along those lines has been firmly resisted. Many older methods of investigation have been superseded, and are there- fore omitted. To have properly updated the chapter on ‘Indica- tions for full investigation’ in a way to adequately complement the advances in neuroradiology and imaging, alone, would have required an expansion in the text far beyond the above declared aims. So, rather than change the character of the book that chapter has been omitted. The wish has been to modernize the text and illustrations, as required, but to maintain the overall balance of the book, in particular so that it remains affordable for those to whom it has always been directed, trainees in neurology and gen- eral medicine. Grateful thanks are due to Dr David Yates for providing the new CT and MRI scans, to the Oxford University Press for permission to reproduce four more illustrations originally published in The Atlas of Clinical Neurology, additional to those already acknowledged in the preface to the fifth edition. This applies to Figs 14.1d, 15.1, 15.2 and 15.3a. The collaboration of the Department of Medical Pho- tography of Sandwell Hospital NHS Trust is gratefully acknowl- edged for provision of the new illustrations of the limb reflexes. The obliging subject, our registrar, prefers to avoid formal identifi- cation lest this should adversely affect his career! To Stuart Taylor, commissioning editor at Blackwell Science, grateful thanks for the help and encouragement in planning this new edition and thanks

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