Table Of ContentNEUROLOGY
AND
NEUROSURGERY
ILLUSTRATED
Fifth Edition
Kenneth W. Lindsay, PhD FRCS
Formerly Consultant Neurosurgeon, Institute of Neurological Sciences,
Southern General Hospital, Glasgow
Ian Bone, FRCP FACP
Formerly Consultant Neurologist, Institute of Neurological Sciences,
Southern General Hospital, Glasgow Honorary Clinical Professor,
University of Glasgow, Glasgow, UK
Geraint Fuller, MD FRCP
Consultant Neurologist, Department of Neurology, Gloucester Royal
Hospital, Gloucester, UK
CHURCHILL LIVINGSTONE
Front Matter
NEUROLOGY AND NEUROSURGERY ILLUSTRATED
Kenneth W. Lindsay PhD FRCS
Formerly Consultant Neurosurgeon, Institute of Neurological
Sciences, Southern General Hospital, Glasgow Ian Bone FRCP FACP
Formerly Consultant Neurologist, Institute of Neurological
Sciences, Southern General Hospital, Glasgow; Honorary Clinical
Professor, University of Glasgow, Glasgow, UK
Geraint Fuller MD FRCP
Consultant Neurologist, Department of Neurology, Gloucester
Royal Hospital, Gloucester, UK
Illustrated by
Robin Callander FFPh FMAA AIMBI Medical Illustrator, Formerly
Director of Medical Illustration, University of Glasgow, Glasgow,
UK
Foreword by
J. van Gijn MD FRCPE
Emeritus Professor of Neurology, Utrecht, The Netherlands FIFTH
EDITION
EDINBURGH
LONDON
NEW
YORK
OXFORD
PHILADELPHIA ST LOUIS SYDNEY TORONTO 2011
Commissioning Editor: Timothy Horne Senior Development Editor:
Ailsa Laing Project Manager: Nancy Arnott Designers: Erik Bigland,
Jim Farley
Copyright
CHURCHILL LIVINGSTONE ELSEVIER
© 2010 Elsevier Ltd. All rights reserved.
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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 1986
Second edition 1991
Third edition 1997
Fourth edition 2004
Fifth edition 2010
ISBN 978-0-44306957-4
International ISBN 978-0-443-06978-9
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of
Congress Notices
Knowledge and best practice in this field are constantly changing. As
new research and experience broaden our understanding, changes in
research methods, professional practices, or medical treatment may
become necessary.
Practitioners and researchers must always rely on their own
experience and knowledge in evaluating and using any information,
methods, compounds, or experiments described herein. In using such
information or methods they should be mindful of their own safety and
the safety of others, including parties for whom they have a
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With respect to any drug or pharmaceutical products identified,
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method and duration of administration, and contraindications. It is the
responsibility of practitioners, relying on their own experience and
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To the fullest extent of the law, neither the Publisher nor the
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Printed in China
FOREWORD
Students often tend to regard diseases of the nervous system as a
difficult subject. This book has surely dispelled that traditional belief, as
testified by the success of the four previous editions, spanning almost a
quarter of a century. The authors have managed to make the nervous
system and its disorders accessible in several ways. First and foremost,
they have used every possible opportunity to include illustrations,
especially simple line drawings, whenever the subject allowed it. In this
way the structure and functions of the nervous system, baffling at first
sight, are lucidly explained, part by part. Thanks to their didactic
guidance, the student will eventually find the matter less complicated
than the street map of inner London. Secondly, the text has been
restricted to bare essentials. Students do not have to wade through a
wilderness of words in order to grasp the key elements they need to
know.
Finally,
between
the
traditional
signposts
of
physical
examination, technical investigations and traditional disease categories,
the authors have made ample room for a didactic discussion of the
variety of symptoms that bring patients to the neurologist or
neurosurgeon - from loss of smell to problems of memory. After all, the
patient is the point of departure in medicine. Like a convenient travel
guide that leads the tourist to memorable sights, the book will teach the
student – and remind the physician - how to understand, recognize and
treat disorders of the brain, spinal cord, nerves and muscle. In this fifth
edition the authors have taken account of new developments, while
preserving the admirable clarity and simplicity that make it stand out
from other textbooks.
J. van Gijn, MD FRCP FRCP(Edin) , Emeritus Professor of
Neurology, Utrecht, The Netherlands
PREFACE
It has been 24 years since the first edition of Neurology and
Neurosurgery Illustrated was published. On writing each new edition, we
are always surprised at the number of changes required. For this edition
there is an additional change. Ian Bone has retired from clinical practice
and Geraint Fuller has joined to edit and update this edition. As in all
previous editions there have been updates in many areas.
With
the
increasing
trend
to
sub-specialise
within
clinical
neuroscience, we have become increasingly dependent on colleagues for
advice. The following have provided many valuable suggestions –
Laurence
Dunn,
Patricia
Littlechild
and
Jerome
St
George
(neurosurgery),
Colin
Smith
(neuropathology),
Alison
Wagstaff
(neuroanaesthetics),
Donald
Hadley
(neuroradiology)
and
Roy
Rampling (oncology). We would like to offer sincere thanks to all.
Finally we are indebted to Ailsa Laing of Elsevier for her patience and
gentle encouragement.
2010
K.W. Lindsay, I. Bone, G. Fuller
Table of Contents
Front Matter
Copyright
FOREWORD
PREFACE
Chapter
1:
GENERAL
APPROACH
TO
HISTORY
AND
EXAMINATION
Chapter 2: INVESTIGATIONS OF THE CENTRAL AND PERIPHERAL
NERVOUS SYSTEMS
Chapter 3: CLINICAL PRESENTATION, ANATOMICAL CONCEPTS
AND DIAGNOSTIC APPROACH
Chapter 4: LOCALISED NEUROLOGICAL DISEASE AND ITS
MANAGEMENT A. INTRACRANIAL
Chapter 5: LOCALISED NEUROLOGICAL DISEASE AND ITS
MANAGEMENT B. SPINAL CORD AND ROOTS
Chapter 6: LOCALISED NEUROLOGICAL DISEASE AND ITS
MANAGEMENT C. PERIPHERAL NERVE AND MUSCLE
Chapter 7: MULTIFOCAL NEUROLOGICAL DISEASE AND ITS
MANAGEMENT
FURTHER READING
INDEX
SECTION I
GENERAL APPROACH TO HISTORY AND
EXAMINATION
NERVOUS SYSTEM – HISTORY
An accurate description of the patient’s neurological symptoms is an
important aid in establishing the diagnosis; but this must be taken in
conjunction with information from other systems, previous medical
history, family and social history and current medication. Often the
patient’s history requires confirmation from a relative or friend.
The following outline indicates the relevant information to obtain for
each symptom, although some may require further clarification.
NERVOUS SYSTEM – EXAMINATION
Neurological disease may produce systemic signs and systemic disease
may affect the nervous system. A complete general examination must
therefore accompany that of the central nervous system. In particular,
note the following
CNS examination is described systematically from the head downwards
and includes:
