Clinical neuroanatomy

384 Pages·2013·56.824 MB·English

by  Waxman, Stephen G

a LANGE medical book
Clinical
Neuroanatomy
Twenty-Seventh Edition
Stephen G. Waxman, MD, PhD
Bridget Marie Flaherty Professor of Neurology, Neurobiology, & Pharmacology
Director, Center for Neuroscience & Regeneration Research
Yale University School of Medicine
New Haven, Connecticut
New York Chicago San Francisco Lisbon London Madrid Mexico City
Milan New Delhi San Juan Seoul Singapore Sydney Toronto
Copyright © 2013 by McGraw-Hill Education. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication
may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.
ISBN: 978-0-07-179798-6
MHID: 0-07-179798-X
The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-179797-9,
MHID: 0-07-179797-1.
All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in
an editorial fashion only, and to the benefi t of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this
book, they have been printed with initial caps.
McGraw-Hill Education eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. To
contact a representative please e-mail us at [email protected].
Previous editions copyright © 2010, 2003, 2000 by The McGraw-Hill Companies, Inc.
Notice
Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The
author and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in
accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the
author nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein
is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information
contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised
to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is
accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular
importance in connection with new or infrequently used drugs.
TERMS OF USE
This is a copyrighted work and McGraw-Hill Education, LLC. and its licensors reserve all rights in and to the work. Use of this work is subject to these terms.
Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse
engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without
McGraw-Hill Education’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited.
Your right to use the work may be terminated if you fail to comply with these terms.
THE WORK IS PROVIDED “AS IS.” McGRAW-HILL EDUCATION AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE
ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION
THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS
OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.
McGraw-Hill Education and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation
will be uninterrupted or error free. Neither McGraw-Hill Education nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission,
regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill Education has no responsibility for the content of any information accessed
through the work. Under no circumstances shall McGraw-Hill Education and/or its licensors be liable for any indirect, incidental, special, punitive, consequential
or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation
of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise.
For Wendy and Rosalie, new lights in my life.

This page intentionally left blank
Contents
Preface xi
I II
S E C T I O N S E C T I O N
BASIC PRINCIPLES 1 INTRODUCTION TO CLINICAL
THINKING 33
1. Fundamentals of the Nervous System 1
General Plan of the Nervous System 1 4. The Relationship Between Neuroanatomy
Peripheral Nervous System 5
and Neurology 33
Planes and Terms 5
Symptoms and Signs of Neurologic Diseases 33
References 6
Where is the lesion? 36
2. Development and Cellular Constituents What is the lesion? 38
of the Nervous System 7 Clinical Illustration 4–1 39
Cellular Aspects of Neural Development 7 Clinical Illustration 4–2 39
Neurons 7 The Role of Neuroimaging and Laboratory
Neuronal Groupings and Connections 11 Investigations 39
Neuroglia 11 The Treatment of Patients with Neurologic
Degeneration and Regeneration 15 Disease 40
Neurogenesis 17 Clinical Illustration4–3 40
References 18 Clinical Illustration4–4 40
Clinical Illustration4–5 41
3. Signaling in the Nervous System 19 References 41
Membrane Potential 19
Generator Potentials 20
III
Action Potentials 20 S E C T I O N
The Nerve Cell Membrane Contains
SPINAL CORD AND SPINE 43
Ion Channels 21
The Effects of Myelination 22
Conduction of Action Potentials 23 5. The Spinal Cord 43
Synapses 24 Development 43
Clinical Illustration 3–1 24 External Anatomy of the Spinal Cord 43
Synaptic Transmission 26 Spinal Roots and Nerves 46
Excitatory and Inhibitory Synaptic Actions 27 Internal Divisions of the Spinal Cord 48
Synaptic Plasticity and Long-Term Potentiation 27 Pathways in White Matter 50
Presynaptic Inhibition 28 Clinical Illustration 5–1 55
The Neuromuscular Junction and Reflexes 56
the End-Plate Potential 28 Lesions in the Motor Pathways 60
Neurotransmitters 29 Examples of Specific Spinal Cord Disorders 63
Case 1 31 Case 2 64
References 32 Case 3 64
References 65
vii
viii
Contents
6. The Vertebral Column and Other Structures Clinical Illustration 10–1 140
Surrounding the Spinal Cord 67 Physiology of Specialized Cortical Regions 142
Investing Membranes 67 Basal Ganglia 143
Spinal Cord Circulation 68 Internal Capsule 144
The Vertebral Column 69 Case 11 147
Clinical Illustration 6–1 69 Case 12 147
Clinical Illustration 6–2 71 References 147
Lumbar Puncture 71
11. Ventricles and Coverings of the Brain 149
Imaging of the Spine and Spinal Cord 73
Ventricular System 149
Case 4 73
Meninges and Submeningeal Spaces 150
Case 5 74
CSF 152
References 77
Barriers in the Nervous System 154
Skull 156
IV Case 13 160
S E C T I O N
Case 14 161
ANATOMY OF THE BRAIN 79 References 162
12. Vascular Supply of the Brain 163
7. The Brain Stem and Cerebellum 79
Arterial Supply of the Brain 163
Development of the Brain Stem Venous Drainage 165
and Cranial Nerves 79 Cerebrovascular Disorders 169
Brain Stem Organization 79 Clinical Illustration 12–1 175
Cranial Nerve Nuclei in the Brain Stem 82 Case 15 177
Medulla 82 Case 16 178
Pons 87 References 181
Midbrain 88
Vascularization 89
Clinical Illustration 7–1 90 V
S E C T I O N
Cerebellum 91
FUNCTIONAL SYSTEMS 183
Clinical Illustration 7–2 92
Clinical Illustration 7–3 92
Clinical Illustration 7–4 96 13. Control of Movement 183
Case 6 98 Control of Movement 183
Case 7 98 Major Motor Systems 183
References 98 Motor Disturbances 189
Case 17 193
8. Cranial Nerves and Pathways 99
Case 18 194
Origin of Cranial Nerve Fibers 99
References 194
Functional Components of the Cranial Nerves 99
Anatomic Relationships of the Cranial Nerves 102 14. Somatosensory Systems 195
Case 8 116 Receptors 195
Case 9 116 Connections 195
References 118 Sensory Pathways 195
Cortical Areas 196
9. Diencephalon 119
Pain 196
Thalamus 119
Case 19 199
Hypothalamus 121
Case 20 200
Subthalamus 126
References 200
Epithalamus 127
Circumventricular Organs 128 15. The Visual System 201
Case 10 129 The Eye 201
References 129 Visual Pathways 205
The Visual Cortex 209
10. Cerebral Hemispheres/Telencephalon 131
Clinical Illustration 15–1 210
Development 131
Case 21 214
Anatomy of the Cerebral Hemispheres 131
References 214
Microscopic Structure of the Cortex 136
ix
Contents
16. The Auditory System 215 VI
S E C T I O N
Anatomy and Function 215
Auditory Pathways 215 DIAGNOSTIC AIDS 267
Case 22 218
References 219 22. Imaging of the Brain 267
Skull X-Ray Films 267
17. The Vestibular System 221
Angiography 267
Anatomy 221
Computed Tomography 268
Vestibular Pathways 221
Magnetic Resonance Imaging 270
Functions 221
Magnetic Resonance Spectroscopy 273
Case 23 224
Diffusion-Weighted Imaging 273
References 224
Functional MRI 274
18. The Reticular Formation 225 Positron Emission Tomography 275
Anatomy 225 Single Photon Emission CT 276
Functions 225 References 276
References 228
23. Electrodiagnostic Tests 277
19. The Limbic System 229 Electroencephalography 277
The Limbic Lobe and Limbic System 229 Evoked Potentials 278
Olfactory System 229 Transcranial Motor Cortical Stimulation 280
Hippocampal Formation 230 Electromyography 280
Clinical Illustration 19–1 232 Nerve Conduction Studies 283
Functions and Disorders 236 References 284
Septal Area 236
24. Cerebrospinal Fluid Examination 285
Case 24 239
Indications 285
References 239
Contraindications 285
20. The Autonomic Nervous System 241 Analysis of the CSF 285
Autonomic Outflow 241 Reference 286
Autonomic Innervation of the Head 247
Visceral Afferent Pathways 248
VII
Hierarchical Organization of the Autonomic S E C T I O N
Nervous System 249
DISCUSSION OF CASES 287
Transmitter Substances 251
Case 25 255
25. Discussion of Cases 287
References 255
The Location of Lesions 287
21. Higher Cortical Functions 257 The Nature of Lesions 288
Frontal Lobe Functions 257 Cases 289
Language and Speech 257 References 303
Cerebral Dominance 262
Memory and Learning 262
Epilepsy 262 Appendix A: The Neurologic Examination 305
Clinical Illustration 21–1 264
Appendix B: Testing Muscle Function 313
Case 26 265
Case 27 266 Appendix C: Spinal Nerves and Plexuses 329
References 266
Appendix D: Questions and Answers 347
Index 355