Integrated Neuroscience and Neurology: A Clinical Case History Problem Solving Approach

645 Pages·2014·137.99 MB·English

by  Elliott M. Marcus

I N T E G R AT E D N EU RO S C I E N C E
A N D N EU RO L O GY

INTEGRATED
NEUROSCIENCE
AND NEUROLOGY
A CLINICAL PROBLEM SOLVING APPROACH
SECOND EDITION
Elliott M. Marcus, MD*
PROFESSOR EMERITUS OF NEUROLOGY, UNIVERSITY OF MASSACHUSETTS SCHOOL OF MEDICINE
LECTURER IN NEUROLOGY, TUFTS UNIVERSITY SCHOOL OF MEDICINE
CHAIRMAN EMERITUS DEPARTMENT OF NEUROLOGY, SAINT VINCENT HOSPITAL
AND FALLON CLINIC, WORCESTER, MA
*DECEASED.
Stanley Jacobson, PhD
PROFESSOR OF ANATOMY AND CELLULAR BIOLOGY, TUFTS UNIVERSITY
HEALTH SCIENCES CAMPUS, BOSTON, MA; AND FULBRIGHT SCHOLAR
Thomas D. Sabin, MD
PROFESSOR OF NEUROLOGY, TUFTS UNIVERSITY SCHOOL OF MEDICINE
TUFTS MEDICAL CENTER, BOSTON, MA
1
2014
IN MEMORIAM
many papers on diagnosis and treatment of seizure disorders.
He retired in 1998 and continued active teaching of neurol-
ogy residents and medical students at UMass until just before
his death.
Even as non-Hodgkin’s lymphoma took its toll on
Dr.  Marcus, he pushed himself, discussing his contri-
butions to a forthcoming book that he and Dr. Stanley
Jacobson, a Professor of Anatomy and Cellular Biology at
Tufts Medical School and a friend and colleague for over
40 years, were collaborating on and telling friends to make
sure the work continued beyond the span of his limited
days. He wanted to live and be there to teach and to be
there for his grandchildren.
Friends and colleagues said he was dedicated to his
work, loved his family, and inspired generations of doctors.
Dr. Thomas Sabin, a Professor of Neurology at Tufts Medical
School, described Dr. Marcus as a superb neurologist and
someone with a brilliant intellect.
Dr. David Chad, a Professor of Neurology and Pathology
at UMass Medical School, said Dr. Marcus’s passion for neu-
rology and teaching was always evident. Dr. Marcus often
Dr. Elliott Marcus, Professor of Neurology at University of traveled from Florida more than a decade after his official
Massachusetts (Emeritus). At 78, Dr. Marcus—a neurolo- retirement in 1998 to work with neurology students. He
gist and educator for five decades at Tufts Medical Center, would talk with them, letting them learn through conversa-
Tufts University School of Medicine, and the University of tions, rather than just giving the answers. Chad said, “He had
Massachusetts Medical School at Saint Vincent Hospital— a Socratic method of teaching; he let students sort of find the
died on July 25, 2011, in Massachusetts General Hospital in truth,” Chad said. “He would open the subject up. He would
Boston. bring out the key issues to be discussed. He wouldn’t stand up
Even as the end drew near, Dr. Elliott Marcus pressed on and give the answers. He’d ask questions and give feedback.
with his life’s work: sharing the knowledge he had gleaned He was an excellent communicator. He loved sharing what he
through a lifetime of dedicated study and teaching neuro- knew. He brought scholarship to his teaching.” Dr. Cynthia
science. He received his undergraduate education at Yale Brown, who first met Dr. Marcus in 1980 as a resident neurol-
University and earned an MD from Tufts University School ogist at UMass Medical School and Saint Vincent Hospital,
of Medicine. He was trained in neurology at Tufts Medical described neurology as a “very intellectual specialty.” “To have
Center and also served with distinction for 2 years in the someone as bright and inspiring as Dr. Marcus helps to vali-
US Army. He taught at Tufts University School of Medicine date one’s choice to be a neurologist,” she said. “He’s really a
from 1964 to 1976, where he was the “father” of neuroscience doctor’s doctor, and it is very sad to think that the upcom-
teaching to medical students. He then moved to Saint Vincent ing classes of medical students will not be able to have his
Hospital in Worcester, Massachusetts, in 1976, where he was tutorials.”
Chief of Neurology. He also was a Professor of Neurology at Boston Globe, 2011
the University of Massachusetts and an active member of that Melvin Mason
department. He was a clinical neurologist and he published Stanley Jacobson

1
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Library of Congress Cataloging-in-Publication Data
Marcus, Elliott M., 1932–2011, author.
Integrated neuroscience and neurology : a clinical case history problem solving approach / by Elliott M.
Marcus, Stanley Jacobson, Thomas Sabin.—Second edition.
p. ; cm.
Includes bibliographical references and index.
ISBN 978–0–19–974443–5 (alk. paper)
I. Jacobson, Stanley, 1937– author. II. Sabin, Thomas D., author. III. Title.
[DNLM: 1. Nervous System Diseases—diagnosis. 2. Nervous System Diseases—therapy.
3. Nervous System—anatomy & histology. 4. Nervous System Physiological Phenomena. WL 140]
RC346
616.8—dc23
2013039951
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light of the possibility of human error or changes in the practice of medicine, neither the author, nor
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To our families for their infinite patience and understanding,
and to our students, teachers, and colleagues

CONTENTS
Preface xi 17. Cerebral Cortex: Cytoarchitecture, Physiology,
and Overview of Functional Localization 325
18. Motor System and Movement: Part I: Reflex Activity,
SECTION ONE Central Pattern Generators, and Cerebral
Cortical Motor Functions 347
INTRODUCTION TO BASIC
NEUROBIOLOGY 19. Motor Systems: Part II: Basal Ganglia and
Movement Disorders 371
1. Overview of the Nervous System 3 20. Motor Systems: Part III: Cerebellum and Movement
and Major Fiber Pathways of the Cerebellum 395
2. Overview of Localization of Function and
Neurological Diagnosis 22 21. Somatosensory Function and the Parietal Lobe 414
3. Neurocytology: Cells of the Central Nervous System 45 22. Limbic System 422
4. Neuroembryology and Congenital Malformations 72 23. Visual System 444
5. Skeletal Muscle and Nerve-Muscle Junction 91 24. Speech, Language, Cerebral Dominance,
and the Aphasias 460
25. Case History Problem Solving:
Part IV: Cortical Localization 476
SECTION TWO
26. Cerebral Hemispheres: Neuropathology and
REGIONAL APPROACH TO NEUROANATOMY
Clinical Correlation I. Vascular Syndromes 482
AND FUNCTIONAL LOCALIZATION
27. Cerebral Hemispheres: Neuropathology and
Clinical Correlation II. Nonvascular Syndromes 505
6. Spinal Cord: Structure and Function 111
28. Case History Problem Solving:
7. Atlas of the Spinal Cord 133
Part IV: Cerebral Hemispheres 538
8. A Survey of Diseases of Peripheral Nerve and
Nerve Root 138
9. Spinal Cord: Clinical Considerations 162
SECTION FOUR
10. Case History Problem Solving: Part I: Spinal
COMPLEX FUNCTIONS
Cord, Nerve Root, Peripheral Nerve, and Muscle 193
11. Functional Anatomy of the Brain Stem  199 29. Alterations in Consciousness: Seizures, Sleep,
12. The Cranial Nerves 221 and Coma 549
13. Brain Stem: Clinical Considerations 252 30. Learning, Memory, Amnesia, Dementia, Instinctive
14. Case History Problem Solving: Behavior, and the Effects of Early Experience 575
Part II: Brain Stem and Cranial Nerves 281 31. Case History Problem Solving: Part V: General Cases 598
15. Diencephalic Nuclei, Functional Localization, 32. Case History Problem Solving: Part VI:
and Atlas of the Diencephalon 288 Case History Review with Correlation to Illustrations 605
33. Atlas of the Cerebrum 614
SECTION THREE
Index 619
MAJOR SYSTEMS
16. Hypothalamus, Neuroendocrine System,
and Autonomic Nervous System 311
ix