Neurological Examination. Made Easy

258 Pages·2019·3.774 MB·English

by  Fuller Geraint

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2015v1.0
NEUROLOGICAL
EXAMINATION
MADE EASY
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NEUROLOGICAL
EXAMINATION
MADE EASY
GERAINT FULLER
MD FRCP
Consultant Neurologist
Gloucester Royal Hospital
Gloucester, United Kingdom
SIXTH EDITION
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Edinburgh London New York Oxford Philadelphia St Louis Sydney 2020
© 2019, Elsevier Limited. All rights reserved.
The right of Geraint Fuller to be identified as author of this work has been asserted
by him in accordance with the Copyright, Designs and Patents Act 1988.
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This book and the individual contributions contained in it are protected under
copyright by the publisher (other than as may be noted herein).
First edition 1993
Second edition 1999
Third edition 2004
Fourth edition 2008
Fifth edition 2013
Sixth edition 2020
ISBN: 9780702076275
International ISBN: 9780702076282
Notices
Practitioners and researchers must always rely on their own experience and
knowledge in evaluating and using any information, methods, compounds or
experiments described herein. Because of rapid advances in the medical sci-
ences, in particular, independent verification of diagnoses and drug dosages
should be made. To the fullest extent of the law, no responsibility is assumed
by Elsevier, authors, editors or contributors for any injury and/or damage to
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Printed in China
Last digit is the print number: 9 8 7 6 5 4 3 2 1
CONTENTS
Preface vii
Acknowledgements viii
How to use this book ix
1. History and examination 1
2. Speech 11
3. Mental state and higher function 20
4. Gait 35
5. Cranial nerves: General 41
6. Cranial nerve I: Olfactory nerve 45
7. Cranial nerves: The eye 1 – pupils, acuity, fields 46
8. Cranial nerves: The eye 2 – fundi 62
9. Cranial nerves III, IV, VI: Eye movements 77
10. Cranial nerves: Nystagmus 87
11. Cranial nerves V and VII: The face 91
12. Cranial nerve VIII: Auditory nerve 99
13. Cranial nerves IX, X, XII: The mouth 103
14. Cranial nerve XI: Accessory nerve 108
15. Motor system: Introduction 110
16. Motor system: Tone 115
17. Motor system: Arms 118
18. Motor system: Legs 130
vi CONTENTS
19. Motor system: Reflexes 139
20. Motor system: What you find and what it means 148
21. Sensation: General 155
22. Sensation: What you find and what it means 168
23. Coordination 174
24. Abnormal movements 178
25. Special signs and other tests 187
26. The autonomic nervous system 196
27. The unconscious or confused patient 199
28. Summary of standard neurological examination 215
29. Passing clinical examinations 217
Bibliography for further reading and reference 230
Index 231
PREFACE
Many medical students and junior doctors think that neurological
examination is extremely complicated and difficult (and some-
times frightening!).
This is because they find it hard to remember what to do, are
not sure what they are looking for, do not know how to describe
what they find and do not know what it means.
The aim of this book is to provide a simple framework to allow
a medical student or junior doctor to perform a straightforward
neurological examination. It explains what to do, pointing out
common problems and mistakes, what you might find, and then
discusses what the findings might mean.
However, just as you cannot learn to drive by reading a book,
this book cannot replace conventional bedside teaching and clini-
cal experience, and I hope it will encourage you to see patients.
Neurological Examination Made Easy aims to provide advice on
your examination technique to ensure your clinical findings are
robust, and will help you analyse your findings to help you come
to an anatomical or syndromic diagnosis. Inevitably, when trying to
simplify the range of neurological findings and their interpretation,
not all possible situations can be anticipated. This book has been
designed to try to accommodate most common situations and
tries to warn of common pitfalls; however, despite this, there will
be some occasions where incorrect conclusions will be reached.
Neurology is still a very clinical specialty where the core clinical
skills of taking a history and of neurological examination remain
central when making a diagnosis – indeed many neurological diag-
noses are entirely dependent on the clinical assessment alone.
Developing these skills takes time but will be very rewarding for
you as the doctor and very beneficial for your patients. Neurologi-
cal Examination Made Easy will give you an excellent foundation
in learning the skills needed for neurological examination and an
introduction to the thought processes needed in their interpretation.
ACKNOWLEDGEMENTS
I would like to thank all my teachers, particularly Dr Roberto
Guiloff, who introduced me to neurology. I am grateful to the
many medical students at Charing Cross and Westminster Medi-
cal School who have acted as guinea pigs in the preparation of
the previous editions of this book and to the colleagues who have
kindly commented on the text. I am also most appreciative of
all the constructive comments made about the earlier editions of
the book by students, mainly from Bristol University, junior doc-
tors and colleagues, and particularly from those neurologists who
were involved in translating it into other languages.
In learning to be a clinical neurologist and in writing this book,
I am indebted to a wide range of textbooks and scientific papers
that are too many to mention.
This book is dedicated to Cherith.