E-Book, Englisch, 1008 Seiten, ePub
ISBN: 978-3-13-258134-0
Verlag: Thieme
Format: EPUB
Kopierschutz: 6 - ePub Watermark
Key features:
- Nearly 1,000 pages of up-to-date clinical information - More than 50% of the book has been totally revised and updated for this edition - Easy-to-use index provides quick access to content - Written by two experienced clinical neurologists and teachers
One of the best basic works to address the entire field of neurology, this practical book has become a major text and reference for neurology students and residents the world over. The book also appeals to general practitioners, neurology specialists, and even neurosurgeons needing a quick reference on an unfamiliar neurological problem.
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Autoren/Hrsg.
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Weitere Infos & Material
Clinical Syndromes
1. Clinical Syndromes in Neurology
Clinical Neurology
2. Diseases Mainly Affecting the Brain and its Coverings
3. Diseases Mainly Affecting the Spinal Cord
4. Autonomic and Trophic Disorders
5. Demyelinating Diseases
6. Injury to the Nervous System by Specific Physical Agents
7. Epilepsy, Other Episodic Disorders of Neurologic Function, and Sleep Disorders
8. Polyradiculitis and Polyneuropathy
9. Diseases Affecting the Cranial Nerves
10. Spinal Radicular Syndromes
11. Lesions of Individual Peripheral Nerves
12. Headache and Facial Pain
13. Pain Syndromes of the Limbs and Trunk
14. Myopathies
15. References
Appendix
Scales for the Assessment of Neurologic Diseases
Glossary
Index
1 Clinical Syndromes in Neurology Because of the anatomical construction of the nervous system and the manner in which functions are assigned to its components, lesions in specific areas of the central or peripheral nervous system are regularly associated with characteristic symptoms and signs. An acquaintance with these recurring patterns allows one to trace individual findings or constellations of findings back to the responsible dysfunctional component of the nervous system (Table 1.1). Table 1.1 Components of the nervous system Central Peripheral Brain (not including cranial nerve nuclei) Cranial nerve nuclei Spinal cord (not including anterior horn ganglion cells) Anterior horn ganglion cells Nerve roots Brachial and lumbar plexuses Peripheral nerves Motor end plates Muscles The following discussion will concern the most important typical constellations of findings (syndromes): central paresis, peripheral paresis, monoparesis, hemiparesis, paraparesis, quadriparesis, anterior horn lesion, radicular lesion, polyradiculopathy, polyneuropathy, plexus lesion, lesion of a single peripheral nerve, dysfunction of the neuromuscular junction (motor end plate), myopathy. Differentiation of Central and Peripheral Paresis Central and peripheral forms of paresis may be differentiated from each other by the criteria listed in Table 1.2. Table 1.2 Characteristics of central and peripheral paresis Feature Central paresis Peripheral paresis Proprioceptive muscle reflexes Increased Decreased Exteroceptive muscle reflexes Decreased Decreased Babinski sign Present Absent Muscle atrophy Absent (or mild atrophy of disuse) Present Muscle tone Increased (i.e., spasticity; not yet present in acute phase) Decreased Bodily Distribution of Paresis The distribution of paresis in the body enables a number of inferences to be made about the nature and anatomical localization of the responsible lesion. Monoparesis Monoparesis is defined as isolated weakness of an entire limb or of a major part of it. Possible causes are listed in Table 1.3. Table 1.3 Sites of lesions causing monoparesis, and corresponding clinical features Site of lesion Clinical features Central nervous system Spastic paresis (increased muscle tone, increased reflexes) No muscle atrophy Possibly a purely motor deficit (e.g., contralateral leg paresis due to ischemia in the territory of the anterior cerebral artery) Anterior horn of spinal cord(chronic lesion) Paresis of individual muscles with accompanying atrophy and decreased tone No sensory deficit Possibly accompanied by fasciculations Decreased proprioceptive muscle reflexes (but may be increased in amyotrophic lateral sclerosis) Brachial or lumbar plexus Mixed sensory and motor deficit Decreased muscle tone Muscle atrophy, decreased proprioceptive muscle reflexes Sensory deficit for all modalities Multiple peripheral nerves Same as in plexus lesions in a single limb Muscle Hardly ever a pure monoparesis; if so, then flaccid Purely motor deficit, sometimes with muscle atrophy Hemiparesis Hemiparesis may be due to any of the causes listed in Table 1.4. Para- and Quadriparesis Paraparesis is weakness affecting both lower limbs, and quadriparesis is weakness affecting all four limbs (but sparing the head). These may be due to any of the causes listed in Table 1.5. Table 1.4 Sites of lesions causing hemiparesis, and corresponding clinical features Site of lesion Clinical features Cerebrum Spastic hemiparesis, possibly also involving facial muscles, characterized by: Increased muscle tone Increased reflexes Pyramidal tract signs No atrophy Usually associated with a sensory deficit Brain stem Spastic hemiparesis, as above Face involved or not, depending on level of lesion Cranial nerve deficits contralateral to hemiparesis Upper cervical spinal cord Spastic hemiparesis, as above Face spared Possible ipsilateral loss of position and vibration sense and contralateral loss of pain and temperature sense below the level of the lesion (Brown-Sequard syndrome) Table 1.5 Sites of lesions causing para- or quadriparesis,and corresponding clinical features Site of lesion Clinical features Cerebrum (bilateral lesion) Clinical picture of “bilateral hemiparesis,” or paraparesis due to a bilateral parasagittal cortical lesion Corticobulbar pathways in the brain stem (bilateral lesion) (e.g., lacunar state, p. 178) Bilateral spasticity with only mild weakness Spastic, small-stepped gait hyperreflexia, pyramidal tract signs No sensory deficit Usually accompanied by pseudobulbar signs (dysarthria, hyperreflexia of the facial musculature) Corticospinal pathways in the spinal cord (bilateral lesion) Para- or quadriparesis Face spared Hyperreflexia, pyramidal tract signs No sensory deficit Only mild weakness Lesions Affecting the Anterior Horn Ganglion Cells Lesions selectively affecting the efferent neurons (ganglion cells) of the anterior horn of the spinal cord (p. 425 ff.) produce the characteristic clinical findings listed in Table 1.6. Table 1.6 Clinical features of an isolated lesion of the anterior horn ganglion cells Muscle atrophy Weakness Fasciculations (in chronic phase) Intact sensation Decreased or absent reflexes But: hyperreflexia and pyramidal tract signs in amyotrophic lateral sclerosis, which involves not only the anterior horns but also the corticospinal pathways (thus the term “lateral” sclerosis, as these pathways are lateral in the spinal cord) Lesions Affecting a Spinal Nerve Root Lesions affecting a spinal nerve root (p. 717 ff.) always produce both motor and sensory deficits. Individual spinal nerve roots always supply more than one muscle, and no muscle is supplied exclusively by a single root. Thus, the motor deficit produced by a monoradicular lesion has the following characteristics: There is always more than one affected muscle. No affected muscle is ever totally paralyzed. Nevertheless, certain muscles are predominantly supplied by a single root and are, therefore, weakened to a particularly severe degree by a corresponding monoradicular lesion. Proprioceptive muscle reflexes partially subserved by the affected root may be decreased or even absent (cf. Table 1.4). The sensory deficit lies within the corresponding sensory dermatome (cf. Table 1.1) and thus usually has a band-like cutaneous distribution. Pain, if present, is referred into the dermatome of the affected root. Although the deficit is mixed (both motor and sensory), the clinical picture may be dominated by either the motor deficit or the sensory deficit in individual cases. Atrophy of the affected muscles is evident about 3 weeks after the onset of weakness. Fig. 1.1a-g Cutaneous sensation. Fields of sensory innervation of peripheral nerves and spinal nerve roots, depicted on the left and right sides of the body, respectively. 1 Trigeminal n. 2 Great auricular n. 3 Transverse cutaneous n. 4 Supraclavicular nn. 5 Anterior cutaneous branches of the intercostal nn. 6 Superior lateral cutaneous...
