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Rohkamm, Color Atlas of Neurology © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license. Rohkamm, Color Atlas of Neurology © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license. Color Atlas of Neurology Reinhard Rohkamm, M.D. Professor Neurological Clinic Nordwest-Krankenhaus Sanderbusch Sande, Germany 172 illustrations by Manfred Güther Translation revised by Ethan Taub, M.D. Thieme Stuttgart · New York Rohkamm, Color Atlas of Neurology © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license. Library of Congress Cataloging-in-Publication Dataisavailablefromthepublisher. Importantnote:Medicineisanever-chang- ingscienceundergoingcontinualdevelop- ment.Researchandclinicalexperienceare Thisbookisanauthorizedtranslationofthe continuallyexpandingourknowledge,in 2ndGermaneditionpublishedandcopyrighted particularourknowledgeofpropertreat- 2003byGeorgThiemeVerlag,Stuttgart,Ger- mentanddrugtherapy.Insofarasthisbook many. Title of the German edition: mentionsanydosageorapplication,read- TaschenatlasNeurologie ersmayrestassuredthattheauthors,edi- tors,andpublishershavemadeeveryeffort toensurethatsuchreferencesareinaccor- Original translator: Suzyon O’Neal Wandrey, dancewiththestateofknowledgeatthe Berlin,Germany timeofproductionofthebook. Nevertheless,thisdoesnotinvolve,imply, Translator/editor: Ethan Taub, M.D., Zürich, orexpressanyguaranteeorresponsibility Switzerland onthepartofthepublishersinrespectto anydosageinstructionsandformsofappli- cationsstatedinthebook.Everyuserisre- questedtoexaminecarefullythemanufac- turers‘ leaflets accompanying each drug andtocheck,ifnecessaryinconsultation withaphysicianorspecialist,whetherthe dosageschedulesmentionedthereinorthe contraindicationsstatedbythemanufac- turersdifferfromthestatementsmadein thepresentbook.Suchexaminationispar- ticularly important with drugs that are eitherrarelyusedorhavebeennewlyre- leased on the market. Every dosage scheduleoreveryformofapplicationused isentirelyattheuser’sownriskandre- sponsibility.Theauthorsandpublishersre- questeveryusertoreporttothepublishers anydiscrepanciesorinaccuraciesnoticed. ©2004GeorgThiemeVerlag, Someoftheproductnames,patents,andregis- Rüdigerstrasse14,70469Stuttgart,Germany tereddesignsreferredtointhisbookareinfact http://www.thieme.de registered trademarks or proprietary names ThiemeNewYork,333SeventhAvenue, eventhoughspecificreferencetothisfactisnot NewYork,NY10001USA alwaysmadeinthetext.Therefore,theappear- http://www.thieme.com ance of a name without designation as pro- prietaryisnottobeconstruedasarepresenta- tionbythepublisherthatitisinthepublic domain. Coverdesign:Cyclus,Stuttgart Thisbook,includingallpartsthereof,islegally Typesetting by primustype R. Hurler GmbH, protectedbycopyright.Anyuse,exploitation, Notzingen orcommercializationoutsidethenarrowlimits Printed in Germany by Grammlich, Pliez- setbycopyrightlegislation,withoutthepub- hausen lisher’sconsent,isillegalandliabletoprosecu- tion.Thisappliesinparticulartophotostatre- production,copying,mimeographing,prepara- ISBN3-13-130931-8(GTV) tion of microfilms, and electronic data pro- ISBN1-58890-191-2(TNY) 1 2 3 4 5 cessingandstorage. Rohkamm, Color Atlas of Neurology © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license. Preface tion and support over several years of work. The nervous system and the muscles are the Thanks are also due to the radiologists, Drs. seatofmanyprimarydiseasesandareaffected Benno Wördehoff and Ditmar Schönfeld, for secondarilybymanyothers. providingimagestobeusedintheillustrations. Thispocketatlasisintendedasanaidtothede- This book would never have come about tectionanddiagnosisofthesymptomsandsigns withoutthefascinationforneurologythatwas of neurological disease. The text and illustra- instilledinmeinallthestagesofmyclinical tionsareprintedonfacingpages,tofacilitate training;Ilookbackwithspecialfondnesson learningofthepointspresentedineach. thetimeIspentasaResidentintheDepartment Thebookbeginswithasummaryofthefun- ofNeurologyattheUniversityofNewMexico damentalsofneuroanatomyinChapter1.Chap- (Albuquerque). Above all, I thank the many ter2concernsthefunctionsofthenervoussys- patients,pastandpresent,whohaveentrusted temandthecommonlyencounteredsyndromes mewiththeircare. in clinical neurology. Individual neurological Finally,cordialthanksareduetothepublishers, diseasesarediscussedinChapter3.Theclinical GeorgThiemeVerlag,fortheirbenevolentand neurological examination is best understood surefootedassistancethroughoutthedevelop- oncethematerialofthefirstthreechaptersis mentofthisbook,andfortheoutstandingqual- mastered;itisthereforepresentedinthelast ityofitsproduction.Amongthemanymembers chapter,Chapter4. ofthestafftowhomwearegrateful,wewould Thechoiceoftopicsfordiscussionisdirected liketosingleoutDr.ThomasScherb,withwhom towardquestionsthatfrequentlyariseinclinical wewereabletodevelopourinitialideasabout practice.Someoftheillustrationshavebeenre- theformatofthebook,aswellasDr.Clifford producedfrompreviousworksbyotherauthors, BergmanandGabrieleKuhn,whosawthisedi- becausetheyseemedtoustobeoptimalsolu- tionthroughtoproductionwithassurance,ex- tionstotheproblemofvisuallydepictingadiffi- pertise,andthenecessarydoseofhumor. cultsubject.Inparticular,wewouldliketopay Wededicatethisbooktoourfamilies:Christina, tributeheretothegraphicoriginalityofthelate Claire,andBen(R.R.)andBirgit,Jonas,andLukas Dr.FrankH.Netter. (M.G.). Manypeoplehavelentusahandinthecreation ofthisbook.OurcolleaguesattheSanderbusch NeurologicalClinicwerealwaysreadytohelpus ReinhardRohkamm,Sande facethedifficulttaskofgettingthebookwritten ManfredGüther,Bermatingen whilemeetingtheconstantdemandsofpatient Autumn2003 care.I(R.R.)wouldparticularlyliketothankour Oberärzte (Senior Registrars), Drs. Helga Best andRobertSchumann,fortheirskillfulcoopera- Rohkamm, Color Atlas of Neurology © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license. Rohkamm, Color Atlas of Neurology © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license. Contents 1 Fundamentals 1 Overview............................... 2 CentralNervousSysstem ................ 24 Skull ................................... 4 AnatomicalandFunctionalOrganization . 25 Meninges............................... 6 BrainStem ............................. 26 CerebrospinalFluid...................... 8 CranialNerves .......................... 28 SpineandSpinalCord................... 30 BloodVessels ........................... 10 CarotidArteries......................... 11 PeripheralNervousSystem .............. 32 AnteriorCirculationoftheBrain ......... 12 DermatomesandMyotomes............. 33 VertebralandBasilarArteries............ 14 BrachialPlexus ......................... 34 PosteriorCirculationoftheBrain ........ 16 NervesoftheUpperLimb ............... 35 IntracranialVeins ....................... 18 LumbarPlexus.......................... 36 ExtracranialVeins....................... 20 NervesoftheLowerLimb ............... 37 SpinalCirculation ....................... 22 2 Normal and Abnormal Function of the Nervous System 39 MotorFunction ......................... 40 CranialNerves .......................... 74 Reflexes ................................ 41 SkullBaseSyndromes ................... 75 MotorControl .......................... 42 Smell................................... 76 MotorExecution ........................ 44 Taste ................................... 78 CentralParalysis ........................ 46 Visualpathway ......................... 80 PeripheralParalysis ..................... 50 VisualFieldDefects ..................... 82 Cerebellum ............................. 54 OculomotorFunction.................... 84 VestibularSystem....................... 56 OculomotorDisturbances................ 86 Vertigo ................................. 58 Nystagmus ............................. 88 GaitDisturbances ....................... 60 PupillomotorFunction .................. 90 Tremor................................. 62 PupillaryDysfunction ................... 92 Dystonia................................ 64 TrigeminalNerve ....................... 94 Chorea,Ballism,Dyskinesia,Myoclonus .. 66 FacialNerve ............................ 96 Myoclonus,Tics......................... 68 FacialNerveLesions..................... 98 Hearing ................................ 100 BrainStemSyndromes .................. 70 DisturbancesofDeglutition.............. 102 MidbrainSyndromes.................... 71 PontineSyndromes ..................... 72 Sensation............................... 104 MedullarySyndromes................... 73 SensoryDisturbances ................... 106 Rohkamm, Color Atlas of Neurology © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license. Contents Pain.................................... 108 DisturbancesofOrientation.............. 132 DisturbancesofMemory ................ 134 Sleep................................... 112 Dementia............................... 136 NormalSleep ........................... 113 Pseudo-neurologicalDisorders........... 138 SleepDisorders ......................... 114 AutonomicNervousSystem(ANS)........ 140 DisturbancesofConsciousness........... 116 Organization............................ 141 AcuteDisturbancesofConsciousness..... 116 Hypothalamus .......................... 142 Coma................................... 118 LimbicSystemandPeripheralANS....... 144 ComalikeSyndromes,Death ............. 120 HeartandCirculation ................... 148 Respiration ............................. 150 BehavioralManifestationsofNeurological Thermoregulation....................... 152 Disease................................. 122 GastrointestinalFunction................ 154 Language ............................... 124 BladderFunction,SexualFunction ....... 156 Aphasia ................................ 126 Agraphia,Alexia,Acalculia,Apraxia ...... 128 IntracranialPressure .................... 158 SpeechDisorders ....................... 130 3 Neurological Syndromes 165 CentralNervousSystem ................. 166 Metastases ............................. 262 Stroke.................................. 167 Trauma................................. 266 Headache............................... 182 CerebellarDiseases...................... 276 Epilepsy:SeizureTypes ................. 192 Myelopathies ........................... 282 Epilepsy:Classification .................. 196 MalformationsandDevelopmental Epilepsy:PathogenesisandTreatment ... 198 Anomalies.............................. 288 NonepilepticSeizures ................... 200 NeurodegenerativeDiseases ............. 296 ParkinsonDisease:ClinicalFeatures...... 206 Encephalopathies ....................... 306 ParkinsonDisease:Pathogenesis......... 210 ParkinsonDisease:Treatment ........... 212 PeripheralNerveandMuscle............. 316 MultipleSclerosis ....................... 214 PeripheralNeuropathies................. 316 CNSInfections .......................... 222 Myopathies............................. 334 BrainTumors ........................... 254 NeuromuscularDisorders................ 346 4 Diagnostic Evaluation 349 DiagnosticEvaluation ................... 350 CerebrovascularUltrasonography, HistoryandPhysicalExamination........ 350 DiagnosticImaging,andBiopsy NeurophysiologicalandNeuro- Procedures ............................. 353 psychologicalTests...................... 352 5 Appendix 355 References.............................. 409 Index................................... 415 Rohkamm, Color Atlas of Neurology © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license. 1 Fundamentals ! Anatomy ! Physiology Rohkamm, Color Atlas of Neurology © 2004 Thieme All rights reserved. Usage subject to terms and conditions of license.