Topical Diagnosis in Neurology

Preface

In 2005 we publishedacomplete revision of Duus’ Although the book will be useful to advanced textbook of topical diagnosis in neurology,the first students, also physicians or neurobiologists inter- newedition since the death of its original author, estedinenriching their knowledge of neu- Professor PeterDuus, in 1994.Feedbackfromread- roanatomywith basic information in neurology,or ers wasextremelypositive and the book wastrans- for revision of the basics of neuroanatomywill lated intonumerous languages, proving that the benefit even morefromit. conceptofthis book wasasuccessful one: combin- This book does notpretend to be atextbook of ing an integrated presentation of basic neu- clinical neurology.That would go beyond the scope roanatomywith the subject of neurological syn- of the book and also contradict the basic concept dromes, including modern imaging techniques. In described above.Firstand foremostwewant to de- this regard we thank our neuroradiology col- monstratehow,onthe basis of theoretical ana- leagues, and especiallyDr. Kueker,for providing us tomical knowledge and agood neurological exami- with images of very high quality. nation, it is possible to localize alesion in the In this fifthedition of “Duus,” we have preserved nervous system and come to adecision on further the remarkablyeffective didactic conceptofthe diagnostic steps. The cause of alesion is initially book,whichparticularly meets the needs of medi- irrelevant for the primarytopical diagnosis, and cal students. Modern medical curricula requirein- elucidation of the etiology takes place in asecond tegrative knowledge,and medical studentsshould stage. Our book contains acursoryoverviewofthe be taught howtoapplytheoretical knowledge in a major neurologicaldisorders, and it is notintended clinical settingand, on the other hand, to recognize to replace the systematic and comprehensive clinical symptoms by delving intotheir basic coverage offeredbystandardneurological text- knowledge of neuroanatomyand neurophysiology. books. Our book fulfils these requirementsand illustrates We hope that this new“Duus,” likethe earlier the importance of basic neuroanatomical knowl- editions, will merit the appreciation of its edge for subsequent practical work,asitincludes audience, and we look forward to receiving read- actual case studies. We have color-codedthe sec- ers’ commentsinany form. tion headings to enable readers to distinguish at a glance between neuroanatomical (blue) and clinical (green) material, without disrupting the the- Professor M. Baehr matic continuity of the text. Professor M. Frotscher

Contents

1 Elements of the Nervous System ...... 2

Information Flow in the Nervous System . 2 Functional Groups of Neurons ...... 7

Neurons and Synapses ...... 2 Glial Cells ...... 7 Neurons ...... 2 Development of the Nervous System ...... 8 Synapses ...... 4

Neurotransmitters and Receptors ...... 7

2 Somatosensory System ...... 12

Peripheral Components of the Somato- Posterior Columns ...... 28 sensory System and Peripheral Regulatory Anterior Spinothalamic Tract ...... 30 Circuits ...... 12 Lateral Spinothalamic Tract ...... 30 Receptor Organs ...... 12 Other Afferent Tracts of the Spinal Cord .... 31 Peripheral Nerve, Dorsal Root Ganglion, Central Processing of Somatosensory Posterior Root ...... 14 Information ...... 32 Peripheral Regulatory Circuits ...... 18 Somatosensory Deficits due to Lesions at Central Components of the Somato- Specific Sites along the Somatosensory sensory System ...... 24 Pathways ...... 32 Posterior and Anterior Spinocerebellar Tracts ...... 25

3 Motor System ...... 36

Central Components of the Motor System Complex Clinical Syndromes due to and Clinical Syndromes of Lesions Affect- Lesions of Specific Components of the ing Them ...... 36 Nervous System ...... 45 Motor Cortical Areas ...... 36 Spinal Cord Syndromes ...... 45 Corticospinal Tract (Pyramidal Tract) ...... 38 Vascular Spinal Cord Syndromes ...... 56 Corticonuclear (Corticobulbar) Tract ...... 39 Nerve Root Syndromes (Radicular Other Central Components of the Motor Syndromes) ...... 57 System ...... 39 Plexus Syndromes ...... 62 Lesions of Central Motor Pathways ...... 41 Peripheral Nerve Syndromes ...... 67 Syndromes of the Neuromuscular Junction Peripheral Components of the Motor and Muscle ...... 72 System and Clinical Syndromes of Lesions Affecting Them ...... 43 Clinical Syndromes of Motor Unit Lesions ... 44

4 Brainstem ...... 74

Surface Anatomy of the Brainstem ...... 74 Vestibulocochlear Nerve (CN VIII)—Cochlear Medulla ...... 74 Component and the Organ of Hearing ...... 113 Pons ...... 75 Vestibulocochlear Nerve (CN VIII)— Midbrain ...... 75 Vestibular Component and Vestibular System ...... 120 Cranial Nerves ...... 77 Vagal System (CN IX, X, and the Cranial Origin, Components, and Functions ...... 77 Portion of XI) ...... 126 Olfactory System (CN I) ...... 81 Hypoglossal Nerve (CN XII) ...... 132 Visual System (CN II) ...... 84 Eye Movements (CN III, IV, and VI) ...... 89 Topographical Anatomy of the Brainstem . 134 Trigeminal Nerve (CN V) ...... 103 Internal Structure of the Brainstem ...... 134 Facial Nerve (CN VII) and Nervus Brainstem Disorders ...... 145 Intermedius ...... 109 Ischemic Brainstem Syndromes ...... 145

5 Cerebellum ...... 158

Surface Anatomy ...... 158 Cerebellar Function and Cerebellar Syndromes ...... 164 Internal Structure ...... 159 Vestibulocerebellum ...... 164 Cerebellar Cortex ...... 159 Spinocerebellum ...... 165 Cerebellar Nuclei ...... 160 Cerebrocerebellum ...... 166 Afferent and Efferent Projections of the Cerebellar Cortex and Nuclei ...... 162 Cerebellar Disorders ...... 167 Cerebellar Ischemia and Hemorrhage ...... 167 Connections of the Cerebellum with Cerebellar Tumors ...... 167 Other Parts of the Nervous System ...... 162

6 Diencephalon and Autonomic Nervous System ...... 170

Location and Components of the Hypothalamus ...... 178 Diencephalon ...... 170 Location and Components ...... 178 Hypothalamic Nuclei ...... 179 Thalamus ...... 172 Afferent and Efferent Projections of the Nuclei ...... 172 Hypothalamus ...... 180 Position of the Thalamic Nuclei in Functions of the Hypothalamus ...... 184 Ascending and Descending Pathways ...... 172 Functions of the Thalamus ...... 176 Peripheral Autonomic Nervous System ... 188 Syndromes of Thalamic Lesions ...... 176 Fundamentals ...... 188 Thalamic Vascular Syndromes ...... 177 Sympathetic Nervous System ...... 190 Parasympathetic Nervous System ...... 192 Epithalamus ...... 177 Autonomic Innervation and Functional Subthalamus ...... 178 Disturbances of Individual Organs ...... 193 Visceral and Referred Pain ...... 199

7 Limbic System ...... 202

Anatomical Overview ...... 202 Functions of the Limbic System ...... 206 Internal and External Connections ...... 203 Types of Memory ...... 206 Memory Dysfunction—the Amnestic Major Components of the Limbic System . 203 Syndrome and Its Causes ...... 208 Hippocampus ...... 203 Microanatomy of the Hippocampal Formation ...... 203 Amygdala ...... 205

8 Basal Ganglia ...... 214

Preliminary Remarks on Terminology .... 214 Function and Dysfunction of the Basal Ganglia ...... 219 The Role of the Basal Ganglia in the Motor Clinical Syndromes of Basal Ganglia System: Phylogenetic Aspects ...... 214 Lesions ...... 219 Components of the Basal Ganglia and Their Connections ...... 215 Nuclei ...... 215 Connections of the Basal Ganglia ...... 217

9 Cerebrum ...... 226

Development ...... 226 Association Fibers ...... 236 Commissural Fibers ...... 238 Gross Anatomy and Subdivision of the Cerebrum ...... 228 Functional Localization in the Cerebral Gyri and Sulci ...... 228 Cortex ...... 238 Primary Cortical Fields ...... 239 Histological Organization of the Cerebral Association Areas ...... 247 Cortex ...... 231 Frontal Lobe ...... 248 Laminar Architecture ...... 231 Higher Cortical Functions and Their Cerebral White Matter ...... 235 Impairment by Cortical Lesions ...... 248 Projection Fibers ...... 235

10 Coverings of the Brain and Spinal Cord; Cerebrospinal Fluid and Ventricular System ...... 260

Coverings of the Brain and Spinal Cord ... 260 Cerebrospinal Fluid and Ventricular Dura Mater ...... 260 System ...... 263 Arachnoid ...... 262 Structure of the Ventricular System ...... 263 Pia Mater ...... 262 Cerebrospinal Fluid Circulation and Resorption ...... 263 Disturbances of Cerebrospinal Fluid Circulation—Hydrocephalus ...... 266

11 Blood Supply and Vascular Disorders of the Central Nervous System ...... 270

Arteries of the Brain ...... 270 Cerebral Ischemia ...... 283 Extradural Course of the Arteries of the Arterial Hypoperfusion ...... 283 Brain ...... 270 Particular Cerebrovascular Syndromes ...... 295 Arteries of the Anterior and Middle Cranial Impaired Venous Drainage from the Brain .. 302 Fossae ...... 273 Intracranial Hemorrhage ...... 305 Arteries of the Posterior Fossa ...... 275 Intracerebral Hemorrhage (Nontraumatic) .. 305 Collateral Circulation in the Brain ...... 278 Subarachnoid Hemorrhage ...... 307 Veins of the Brain ...... 279 Subdural and Epidural Hematoma ...... 311 Superficial and Deep Veins of the Brain ..... 279 Vascular Syndromes of the Spinal Cord ... 312 Dural Sinuses ...... 280 Arterial Hypoperfusion ...... 312 Blood Supply of the Spinal Cord ...... 281 Impaired Venous Drainage ...... 312 Arterial Anastomotic Network ...... 281 Spinal Cord Hemorrhage and Hematoma ... 314 Venous Drainage ...... 283

Further Reading ...... 315

Index ...... 319

I PositiveRomberg sign: The patient cannotstand pulses can circumvent the lesion by wayofthe for anylength of time with feet together and ipsilateral portion of the pathway.Alesion of the eyes closedwithout wobbling and perhaps fal- anterior spinothalamic tract at a cervical level, ling over.The loss of proprioceptive sense can however, will produce mild hypesthesia of the con- be compensated for,toaconsiderable extent, by tralateral lowerlimb. opening the eyes (whichisnot the case, for ex- ample, in apatient with acerebellar lesion). LateralSpinothalamic Tract

The fibers in the posterior columns originateinthe The free nerveendings of the skin arethe periph- pseudounipolar neurons of the spinal ganglia, but eral receptors for noxious and thermal stimuli. the fibers in the anterior and posterior These endings constitutethe end organs of thin spinothalamictracts do not; theyare derivedfrom group Afibers and of nearly unmyelinated group C the second neurons of their respective pathways, fibers that are, in turn, the peripheral processes of whichare located within the spinal cord pseudounipolar neurons in the spinal ganglia. The (Fig. 2.16c, d,p.26). central processes pass in the lateral portion of the posterior rootsintothe spinal cordand then divide Anterior Spinothalamic Tract longitudinallyintoshort collaterals that terminate within one or twosegmentsinthe substantia The impulses arise in cutaneous receptors (per- gelatinosa, making synaptic contact with funicular itrichial nerveendings, tactile corpuscles) and are neurons (second neurons) whose processes form conducted along amoderatelythicklymyelinated the lateral spinothalamic tract (Fig. 2.16d,p.26). peripheral fibertothe pseudounipolar dorsal root These processes cross the midline in the anterior ganglion cells, and thence by wayofthe posterior spinal commissurebeforeascending in the con- root intothe spinal cord. Inside the cord, the cen- tralateral lateral funiculus to the thalamus. Likethe tral processes of the dorsal root ganglion cells posterior columns, the lateral spinothalamic tract travel in the posterior columns some 2–15seg- is somatotopicallyorganized; here, however, the mentsupward, while collaterals travel 1or2seg- fibers from the lowerlimb lie laterally, while those mentsdownward, making synaptic contact onto from the trunk and upper limb lie moremedially cells at various segmental levels in the gray matter (Fig. 2.20). of the posterior horn (Fig. 2.16c,p.26). These cells The fibers mediating pain and temperaturesen- (the second neurons) then give rise to the anterior sation lie so close to eachother that theycannotbe spinothalamic tract, whose fibers cross in the ante- anatomicallyseparated.Lesions of the lateral rior spinal commissure, ascend in the contralateral spinothalamic tract thus impair both sensorymod- anterolateral funiculus, and terminateinthe ven- alities, though notalways to the same degree. tral posterolateral nucleus of the thalamus,together with the fibers of the lateral spinothalamic tract Central continuation of the lateral spinothalamic and the medial lemniscus (Fig. 2.17,p.27). The tract. The fibers of the lateral spinothalamic tract thirdneurons in this thalamic nucleus then project travel up through the brainstemtogether with their axons to the postcentral gyrus in the those of the medial lemniscus in the spinal lemnis- thalamocortical tract. cus,whichterminates in the ventral posterolateral nucleus of the thalamus (VPL,pp. 172, 173; see Lesions of the anterior spinothalamic tract. As ex- Fig. 6.4,p.174,and Fig. 2.19). The thirdneurons in plainedabove,the central fibers of the firstneu- the VPL project via the thalamocortical tract to the rons of this tract ascend avariable distance in the postcentral gyrus in the parietal lobe(Fig. 2.19). ipsilateral posterior columns, giving offcollaterals Pain and temperatureare perceivedinarough along the waytothe second neurons, whose fibers manner in the thalamus, but finer distinctions are then cross the midline and ascend further in the notmade until the impulses reachthe cerebral cor- contralateral anterior spinothalamic tract. It fol- tex. lows that alesion of this tract at alumbar or thoracic levelgenerallycauses minimal or no im- Lesions of the lateral spinothalamic tract. The pairment of touch, because manyascending im- lateral spinothalamic tract is the main pathway for

Fig. 2.20 Somatotopic Posterior funiculus organization of spinal Semilunar tract cord tracts in cross sec- Fasciculus Fasciculus Substantia gelatinosa (comma of Schultz) cuneatus gracilis tion. The laminae of Rexed Dorsolateral tract (of Burdach) (of Goll) S are also designated with (Lissauer’s tract) L T Roman numerals (cytoar- Posterior spinocerebellar C chitectural organization of tract the spinal graymatter). Lateral corticospinal tract I–III S IV L Low Thoracic nucleus er V T Rubrospinal and Tru limb VI U n pper k reticulospinal tracts C limb S X VII C T L Reticular formation VIII Anterior spino- IX cerebellar tract Lateral spinothalamic tract Olivospinal tract

Spinotectal tract in

Spino-olivary tract Pa Pressure Anterior spinothalamic tract mperature Touch Te Vestibulospinal tract Reticulospinal tract Tectospinal tract Anterior corticospinal tract

pain and temperaturesensation. It can be neuro- various targetstructures in the brainstemand deep surgicallytransected to relieve pain (cordotomy); subcortical nuclei. These pathways,whichoriginate this operation is muchless commonlyperformed in the dorsal horn of the spinal cord(second afferent todaythan in the past, because it has been sup- neuron) and ascend in its anterolateral funiculus, planted by less invasive methods and also because include the spinoreticular, spinotectal, spino- the relief it provides is oftenonlytemporary. The olivary, and spinovestibular tracts.The spinovesti- latter phenomenon, long recognizedinclinical ex- bular tract is found in the cervical spinal cord, from perience, suggests that pain-related impulses C4 upward, in the area of the (descending) vesti- might also ascendthe spinal cordalong other bulospinal tract and is probablyacollateral pathway routes, e.g., in spinospinal neurons belonging to of the posterior spinocerebellar tract. the fasciculus proprius. Figure2.20 is aschematic drawing of the various If the lateral spinothalamic tract is transected in sensory(ascending) tracts, as seen in across sec- the ventral portion of the spinal cord, pain and tion of the spinal cord. The motor(descending) temperaturesensation aredeficient on the op- tracts arealso indicated,sothat the spatial rela- positeside one or twosegmentsbelowthe levelof tionships between the various tracts can be appre- the lesion, while the sense of touchispreserved ciated.Finally, in addition to the ascending and de- (dissociated sensory deficit). scendingtracts, the spinal cordalso contains aso- calledintrinsic apparatus, consisting of neurons Other Afferent Tracts of the Spinal that project upwardand downward over several Cord spinal segmentsinthe fasciculus proprius (Fig. 2.9, p. 20). In addition to the spinocerebellar and spinothalamic tracts discussedabove,the spinal cord contains yetother fiberpathways ascending to

CentralProcessing of Although the different sensorymodalities are already spatiallysegregated in the thalamus, con- SomatosensoryInformation scious differentiation among them requires the participation of the cerebral cortex.Higher func- Figure2.17 traces all of the sensorypathways dis- tions, suchasdiscrimination or the exact determi- cussedabove,inschematicallysimplifiedform and nation of the siteofastimulus, arecortex-depend- in spatial relation to one another,astheyascend ent. from the posterior rootstotheir ultimatetargets in the brain. The sensory thirdneurons in the Aunilateral lesion of thesomatosensorycortex pro- thalamus send their axons through the posterior duces asubtotal impairment of the perception of limb of the internal capsule (posterior to the py- noxious, thermal, and tactile stimuli on the op- ramidal tract) to the primarysomatosensorycor- positeside of the body;contralateral discrimina- tex, whichislocated in the postcentral gyrus tion and position sense, however, aretotallylost, as (Brodmann cytoarchitectural areas 3a, 3b, 2, and 1). theydepend on an intact cortex. The thirdneurons that terminateheremediate superficial sensation, touch, pressure, pain, Stereognosis. Therecognition by touchofanobject temperature, and (partly) proprioception (Fig. 2.19, laid in the hand (stereognosis) is mediated notjust p. 29). by the primarysensorycortex,but also by association areas in the parietal lobe, in whichthe in- Sensorimotorintegration. In fact, notall of the dividual sensoryfeatures of the object, suchasits sensoryafferent fibers from the thalamus termi- size, shape,consistency,temperature, sharpness/ nateinthe somatosensorycortex;some terminate dullness, softness/hardness, etc., can be integrated in the primarymotorcortex of the precentral and compared with memories of earlier tactile ex- gyrus. Thus, the sensoryand motorcortical fields periences. overlap to some extent, so that the precentral and postcentral gyri aresometimes together desig- Astereognosis. Injurytoanareainthe inferior por- nated the sensorimotorarea.The integration of tion of the parietal lobeimpairs the ability to rec- function occurring hereenables incoming sensory ognize objects by touchwith the contralateral information to be immediatelyconverted to outgo- hand. This is calledastereognosis. ing motorimpulses in sensorimotorregulatorycir- cuits, about whichwewill have moretosay later. The descending pyramidal fibers emerging from these circuitsgenerallyterminatedirectly— SomatosensoryDeficits due to without anyintervening interneurons—on motor Lesions at SpecificSites along neurons in the anterior horn. Finally, even though the SomatosensoryPathways their functions overlap, it should be remembered that the precentral gyrus remains almostentirelya motorarea, and the postcentral gyrus remains al- Figure2.21 shows some typical sites of lesions mostentirelya(somato)sensoryarea. along the somatosensorypathways;the corresponding sensory deficits arediscussedbelow. Differentiationofsomatosensorystimuli by their I A cortical or subcortical lesion in the sen- origin and quality. It has already been mentioned sorimotorareacorresponding to the arm or leg that somatosensoryrepresentation in the cerebral (a and b,respectively,inFig. 2.21)causes pares- cortex is spatiallysegregated in somatotopic fash- thesia (tingling, etc.) and numbness in the con- ion: the inverted sensoryhomunculus has been tralateral limb, whichare morepronounceddis- encountered in Figure2.19 and will be seen again tallythan proximally. An irritative lesion at this in Figure9.19,p.240. But somatosensoryrepresen- sitecan produce asensoryfocal seizurewhen tation in the cerebral cortex is also spatiallysegre- spontaneous (epileptic) discharge of the in- gatedbymodality:pain, temperature, and the flamed/damaged nervecells occurs; because other modalities arerepresented by distinct areas the motorcortex lies directlyadjacent, thereare of the cortex. oftenmotordischargesaswell (jacksonian

Fig. 2.21 Potential sites of lesions along the so- b matosensorypathways. Forthe corresponding clinical syndromes, see text, p. 32 ff.

a Thalamus

Spinal lemniscus (anterior and lateral spinothalamic tract)

Lateral spinothalamic tract

Trigeminal lemniscus Principal sensory nucleus of the trigeminal n. g Spinal nucleus and Medial lemniscus tract of the trigeminal n. f Gracile nucleus and cuneate nucleus

Lateral spinothalamic tract

Anterior spinothalamic tract Posterior column pathways h k

seizure, see textbooksofneurology for the brainstemimpairs pain and temperaturesensa- classification of epileptic seizures). tion on the oppositeside of the body and face, I A lesionofall sensorypathwaysbelowthe but does notimpair other somatosensorymod- thalamus (c)eliminates all qualities of sensa- alities. tion on the oppositeside of the body. I If the mediallemniscus and anterior I If all somatosensorypathways areaffected ex- spinothalamic tract (f)are affected,all soma- ceptthe pathway for pain and temperature(d), tosensorymodalities of the contralateral half of thereishypesthesia on the oppositeside of the the body areimpaired,exceptpain and body and face, but pain and temperaturesensa- temperature. tion areunimpaired. I Lesionsofthe spinal nucleus and tractofthe I Conversely, a lesion of the trigeminal lemniscus trigeminal nerve and of the lateral spino- and of the lateral spinothalamic tract (e)inthe thalamic tract (g)impair pain and temperature

sensation on the ipsilateral half of the face and alities remain intact (dissociated sensorydefi- the contralateral half of the body. cit). I Posterior column lesions (h)cause loss of posi- I Alesion affecting multiple adjacent posterior tion and vibration sense, discrimination, etc., roots (j)causes radicular pain and paresthesiae, combinedwith ipsilateral ataxia (see Case Pre- as well as impairment or loss of all sensory sentation 1). modalities in the affected area of the body,in I If the posterior horn of the spinal cord is af- addition to hypotonia or atonia, areflexia, and fected by alesion (i), ipsilateral pain and ataxia if the rootssupplythe upper or lower temperaturesensation arelost, but other mod- limb.

Case Presentation 1: Subacute Combined Degeneration

An 80-year-old woman washospitalized because of marked shortness of breath with dyspnea. The patient reported that she had been suffering from an increasingly unsteady gait and burning sensations throughout her body forabout ayear and ahalf. The shortness of breath had developed in the previous month and had worsened dramatically in the past fewweeks. The only previous disease reportedbythe patient was“stomachinflammation.” On detailed examination by the admitting neurologist, the patient wasinobviously poor condition, dehydrated and with marked dyspnea. Neurological examination revealed spastic tetraparesis, whichwas more marked in thelegs, with increased intrinsic muscle reflexesdespitethe presence of obvious muscle atrophy, especially on thetrunk. There wasalso evidence of severe spinal ataxia, severely dis- turbed position sense, and hypesthesia and hypalgesia that increased distally belowabout T8. Vibration sense in the legs wasalmost absent (pallanesthesia). The neurologist ordered pulmonary function tests because of the dyspnea, Fig. 2.22 Advanced subacutedegeneration (funicular along with MRI of the cervical and thoracic spine because of myelosis) with symptoms of paraplegia. On MRI of the the neurological abnormalities. cervical spine (C6 level), signal enhancement is seen in the The pulmonaryfunction tests revealed markedly posterior and anterolateral columns. This appearance is diminished expiratoryvolume and reduced vital capacity. typical of advanced funicular myelosis. Blood gases confirmed global respiratoryinsufficiency with

reduced O2 and elevatedCO2levels. Blood chemistryre- vealed amarkedly reduced vitamin B12 level, and vitamins classical posterior and pyramidal tracts but also the anterior B6,C,D,and folic acid were also low. MRI of the cervical and horns (quadriplegic syndrome). thoracic spine showedmarked signal enhancement in the The patient’srespiratoryinsufficiency wasthe result of posterior and lateral columns and also in the anterior horns paresis of the respiratorymuscles (destruction of the inner- (Fig. 2.22). vating motorneurons). Discussion with her family physician revealed that the Because of the poor blood gases, the patient required con- patient had known chronic atrophic gastritis with intrinsic trolled ventilation forseveral weeks. Aftercorrection of the

factor deficiency but that she had obtainedvitamin B12 re- dehydration, electrolytedisturbances, and hypovitamino- placement therapyveryirregularly in recent years. All of the sis, the patient recovered slowly and wastransferred to a findings together confirmed the diagnosis of advanced sub- geriatric rehabilitation clinic 2months following her initial acutecombined degeneration, whichinvolved notonly the hospitalization.

thalami to the habenular nuclei, whichemit efferent projections to the autonomic (salivatory)nu- Thalamic Centromedian nucleus fasciculus of the thalamus clei of the brainstem, thus playing an important role in nutritional intake.

The epiphysis (pineal gland) contains specialized Putamen cells, called pinealocytes. Calcium and magnesium salts aredeposited in the epiphysis from approxi- matelyage 15 years onward,making this structure Lenticular visible in plain radiographs of the skull (an impor- fasciculus tant midline markerbeforethe eraofCTand MRI). Subthalamic fasciculus Epiphyseal tumors in childhood sometimes cause Globus pallidus precocious puberty;itisthus presumedthat this Basal nucleus organinhibits sexual maturation in some way, and of Meynert Zona incerta that the destruction of epiphyseal tissue can re- Ansa lenticularis move this inhibition. In lowervertebrates, the Subthalamic Innominate epiphysis is a light-sensitiveorgan that regulates nucleus substance circadian rhythms. In primates, light cannotpene- Fig. 6.7Fiber connections in the subthalamus. MD = tratethe skull, but the epiphysis still indirectlyre- medial dorsal nucleus of the thalamus; VL =ventral lateral ceivesvisual input relating to the light–darkcycle. nucleus; IC =internal capsule. Afferent impulses travel from the retina to the suprachiasmatic nucleus of the hypothalamus, from which, in turn, further impulses areconducted to joinedmorerostrallybythe ansa lenticularis. The the intermediolateral nucleus and, via postgan- subthalamus also containsthe zona incerta, aros- glionic fibers of the cervical sympathetic chain, to tral continuation of the midbrain reticular forma- the epiphysis. tion. The major connections of the putamen, pal- lidum, subthalamus, and thalamus aredepicted in Fig. 6.7.

Subthalamus Function. The subthalamic nucleus (corpus Luysii) is, functionallyspeaking, acomponent of the basal Locationand components. Thesubthalamus is ganglia and has reciprocal connections with the found immediatelycaudal to the thalamus at an globus pallidus (p. 217). Lesions of the subthalamic early stageofembryological development and nucleus produce contralateral hemiballism then moveslaterallyasthe brain develops. It com- (p. 223 f.). prises the subthalamic nucleus,part of the globus pallidus (cf.p.217), and various fiber contingents that pass through it on their waytothe thalamus, Hypothalamus including the medial lemniscus, the spinothalamic tract, and the trigeminothalamic tract. All of these Location andComponents tracts terminateinthe ventroposterior region of the thalamus (Fig. 6.4,p.174). The substantia nigra Thehypothalamus (Fig. 6.8)iscomposedofgray and rednucleus border the subthalamus anteriorly matter in the walls of the third ventricle from the and posteriorly.Fibers of the dentatothalamic tract hypothalamic sulcus downward and in the floorof travel in the prerubral field H1 of Foreltoterminate the third ventricle,aswell as the infundibulum and in the ventro-oral posterior nucleus of the the mamillarybodies.The posterior pituitarylobe, thalamus (a part of the ventral lateral nucleus, VL); or neurohypophysis,isalso considered part of the fibers from the globus pallidus travel in the lentic- hypothalamus; this structureis, in asense, the en- ular fasciculus (Forel’s fasciculus H2) to the ventro- largedcaudal end of the infundibulum. The ante- oral anterior nucleus (another part of VL) and the rior pituitarylobe, on the other hand, is not ventral anterior nucleus (VA). These tracts are derivedfromthe neuroectoderm at all, but rather

Fig. 6.8Hypothalamic nuclei. a Lateral view. b and c Coronalsections in twodifferent planes.

Paraventricular nucleus Preoptic nucleus Dorsomedial nucleus Posterior nucleus Supraoptic nucleus

Ventromedial nucleus Mamillary Infundibular nucleus body Tuberal nuclei Neurohypophysis

Fornix

Optic tract Ventromedial nucleus Dorsomedial nucleus Lateral area III Dorsal area Supra- optic nucleus Tuberal nuclei Lateral area Paraventricular Medial area Optic chiasm nucleus

from Rathke’s pouch, an outcropping of the rostral The medial segment, in contrast, contains anum- end of the primitive alimentarytract. The two berofmoreorless clearly distinguishable nuclei pituitarylobes, though adjacent to eachother,are (Fig. 6.8a–c), whichare dividedintoananterior notfunctionallyconnected.RemnantsofRathke’s (rostral),amiddle (tuberal),and a posterior pouchinthe sellar region can grow intotumors, (mamillary) nuclear group. e.g., craniopharyngioma. The columns of the fornix, as theydescend Hypothalamic Nuclei through the hypothalamus to the mamillarybodies on either side, divide the hypothalamus of each Anterior nuclear group. Theimportant members of side intoamedial and a lateral segment (Fig. 6.8). this group arethe preoptic, supraoptic,and para- The lateral segment containsvarious groups of ventricular nuclei (Fig. 6.8). The latter twonuclei fibers, including the medial forebrain bundle,which project, by wayofthe supraoptico-hypophyseal runs from basal olfactoryareas to the midbrain. It tract, to the neurohypophysis (see Figs. 6.10 and also contains the lateral tuberal nuclei (see p. 180). 6.11).

Fig. 6.9Major afferent connections of the hy- Corpus callosum pothalamus (schematic drawing)

Stria terminalis

Fornix

Massa intermedia Medial forebrain bundle (from the paraolfactory region) Dorsomedial nucleus

Ventromedial nucleus Peduncle of mamillary body To the Amygdala reticular formation

Hippocampus

Middle nucleargroup. Theimportant members of hypothalamus can also be influencedbyhigher this group arethe infundibular nucleus,the tuberal centers. The major connections of the hy- nuclei,the dorsomedial nucleus,the ventromedial pothalamus aretothe cingulategyrus and frontal nucleus,and the lateral nucleus (or tuberomamil- lobe, the hippocampal formation, the thalamus, lary nucleus)(Fig. 6.8). the basal ganglia, the brainstem, and the spinal cord. Posterior nucleargroup. This group includes the Some of the moreimportant afferent connec- mamillary nuclei (the supramamillarynucleus, the tions (Fig. 6.9)will be described in the following mamillarynucleus, the intercalatenucleus, and section. others) and the posterior nucleus (Fig. 6.8). This area has been termedadynamogenic zone (Hess), Afferent Pathways from whichthe autonomic nervous system can be immediatelycalledintoaction, if necessary. The medial forebrain bundle originates in the basal olfactoryareas and the septal nuclei and runs as a Afferent and Efferent Projections of chain of neurons through the hypothalamus the Hypothalamus (lateral area) until it arrivesinthe midbrain reticular formation Along the way, it givesoff collateral Theneural connections of the hypothalamus (Figs. fibers to the preoptic nucleus, the dorsomedial nu- 6.9 and 6.10)are multifarious and complex. In cleus, and the ventromedial nucleus. The medial order to carryout its function as the coordinating forebrain bundle constitutes areciprocal connec- center of all autonomic processes in the body tion between olfactoryand preoptic nuclear areas (p. 190), the hypothalamus mustcommunicatevia and the midbrain. It has olfacto-visceral and ol- afferent and efferent pathways with very many facto-somatic functions. different areas of the nervous system. Information from the outside worldreaches it through visual, The striae terminales originateinthe amygdala in olfactory, and probablyalso auditorypathways. the temporal lobe, then form an arch over the The presence of cortical afferents implies that the thalamus, terminating in the preoptic area and to

Fig. 6.10 Majorefferent connections of the hypothalamus (schematic Mamillo- drawing) thalamic tract Anterior nucleus of the thalamus Striae medullares

Massa intermedia Paraventricular nucleus Supraoptic nucleus

Dorsal Supraopticohypo- longitudinal physeal tract fasciculus Tractus Tuberohypo- retroflexus physeal tract (fasciculus of Meynert) Mamillo- Neuro- tegmental hypophysis tract

the anterior hypothalamic nuclei. These fiber pothalamus along various pathways:through relay bundles arethought to transmit olfactoryinforma- nuclei in the brainstemreticular formation, from tion, as well as impulses relating to mood and drive. tegmental and interpeduncular nuclei, through reciprocal connections in the medial forebrain The fornix transmits corticomamillary fibers origi- bundle, through the dorsal longitudinal fasciculus, nating in the hippocampus and subiculum and and through the peduncle of the mamillarybody traveling to the mamillarybody,with collaterals to (Figs. 6.9 and 6.10). Somatosensoryinformation the preoptic nucleus, the anterior nucleus of the from the erogenous zones (genitalia and nipples) thalamus, and the habenular nucleus. The fornix is also reaches the hypothalamus by these pathways an important pathway in the limbic system and induces autonomic reactions. (p. 203). As it passes over the dorsal surface of the pulvinar,some of its fibers cross the midline to Finally, furtherafferent input comestothe hy- join the contralateral fornix (commissureofthe pothalamus from the medial nucleus of the fornices, psalterium). thalamus, the orbitofrontal neocortex,and the At the levelofthe psalterium, the twofornices globus pallidus. lie under the splenium of the corpus callosum, wheretheyare usuallynot directlyvisible in an Efferent Pathways uncut brain specimen. Lesions in the area of the psalterium oftenaffect both fornices, because Efferent fiberstothe brainstem. The mostimpor- these twothin structures areclose together at this tant efferent projections from the hypothalamus to point. The serious functional deficits producedby the brainstemare the dorsal longitudinal fasciculus bilateral limbic lesions arediscussedbelowon (of Schütz), whichcontains fibers traveling in both p. 208 ff. directions, and the medial forebrain bundle (Figs. 6.9 and 6.10). Hypothalamic impulses traveling in Ascending visceral impulses from the peripheral these pathways pass through multiple synaptic re- autonomic nervous system, and from the nucleus lays,mainlyinthe reticular formation, until they of the tractus solitarius (taste), reachthe hy- terminateinparasympathetic nuclei of the brain-

stem, including the oculomotornucleus (miosis), nucleus of the thalamus,which, in turn, is recipro- the superior and inferior salivatory nuclei (lacri- callyconnected with the cingulategyrus (Fig. 6.6). mation, salivation), and the dorsal nucleus of the The anterior thalamic nucleus and the cingulate vagus nerve. Other impulses travel to autonomic gyrus areimportant components of the limbic sys- centers in the brainstemthat coordinatecircula- tem. The main function of the limbic system is said tory,respiratory, and alimentaryfunction (etc.), as to be the regulation of affective behavior so as to well as to motorcranial nervenuclei that playa promote the survivalofthe individual and of the role in eating and drinking: the motornucleus of species (MacLean 1958; cf. p. 202). the trigeminal nerve(mastication), the nucleus of the facial nerve(facial expression), the nucleus The supraoptico-hypophyseal tract has already ambiguus (swallowing), and the nucleus of the hy- been mentionedasanefferent pathway to the neu- poglossal nerve(licking). Yetother impulses rohypophysis. Neurons in the supraoptic and para- derivedfromthe hypothalamus, relayedtothe spi- ventricular nuclei produce the hormones oxytocin nal cordthrough reticulospinal fibers, affect the and vasopressin (antidiuretic hormone), whichare activity of spinal neurons that participatein transported along the axons of the supraoptico- temperatureregulation (shivering). hypophyseal tract to the neurohypophysis, and are then releasedthere, from the axon terminals, into The mamillotegmental fasciculus (Fig. 6.10)runs the bloodstream (Figs. 6.10 and 6.11). The neurons from the mamillarybody to the midbrain tegmen- in these nuclei arethus comparable to the hor- tum, and then onward to the reticular formation. mone-producing cells of other organs, and arere- ferred to as neurosecretorycells. Oxytocin and The mamillothalamic tract (of Vicqd’Azyr) recipro- vasopressin mainlyexert their effectsoncells out- callyconnectsthe hypothalamus with the anterior side the nervous system: oxytocin induces con-

Fig. 6.11 Posterior lobe Cell of the of the pituitarygland paraventricular (neurohypophysis).Neu- nucleus rosecretory fibersreachthe posterior lobe directly by wayofthe supraoptico- hypophyseal tract. Capillary network Cell of the supraoptic nucleus

Supraoptic a.

Optic chiasm Axons of the neurosecretory neurons with Pars hormones intermedia (ADH, oxytocin)

Inferior hypophyseal a.

Neurohypophysis

Vein

Index

Page numbers in italics refertoillustrations or tables

A internal carotid artery273 lesions 101 microaneurysms 305 septal 82, 205 abasia 165, 166, 300 mycotic 307 striate abscess 264 posterior communicating artery inferior 85 acetylcholine 7 (PComm) 273 superior 85 muscarinic receptor7 saccular (berry) 307 subcallosal 83, 230 nicotinic receptor7 treatment 309 vestibular 75, 76 acidophil cells 185 anhidrosis 191 Wernicke’s 248 acopia 254 anisocoria 102 areflexia 44 acoustic meatus, internal 82, 111 annulus fibrosus 58 Argyll Robertson pupil 101 acoustic neuroma 120, 125–126, 167, anosmia 84 arteriovenous fistula 312–314 168 anosognosia 255, 297 case presentation 313, 313 acromegaly186 ansa arteriovenous malformations 306 ACTH-secreting adenoma 186–188 cervicalis 63 artery(ies) action potential 5 lenticularis 178 Adamkiewicz’s 53, 283, 283 Adamkiewicz’s artery53, 283, 283 anterograde transport 3, 4 basilar 75, 145, 146, 271,272, 272, adenohypophysis 183 anticoagulation 304 275, 276, 279 adenoma antidiuretic hormone (ADH) 184, 185 arteriosclerosis 155 ACTH-secreting 186–188 syndrome of inappropriateADH occlusion 147, 148, 149, 152, 298 growth-hormone-secreting 186 secretion (SADH) 184–185 thrombolysis case presentation adrenal gland aorta 271, 283 293–294, 293, 294, 295 innervation 194 aperture tip 276 medulla 191 lateral 75, 158, 159 aneurysm 308 adrenergic system 188 median 75, 158 calcarine 277, 299 agnosia 255 aphasia 249–253, 297 carotid somatosensory255 Broca 249–253 common 270–271, 271, 283 visual object 255 case presentation 250–251, 250– external 271–272 agrammatism 249 251 internal (ICA) 89, 91,270,271– agraphesthesia 29 selective 253 272, 271, 272,273, 279 agraphia 249 sensory118 aneurysm273 Alexander’s law124 types of 249 bifurcation, occlusion 296 alexia 249, 253, 255 Wernicke 253 dissection 192 allesthesia 255 case presentation 252–253, 252 stenosis 287, 290 allocortex 203, 231 apoptosis 9 cerebellar α motorneurons 43 apraxia 254 inferior Alzheimer disease 208 construction 254, 297 anterior (AICA) 108, 145, 271, amaurosis fugax 86, 296 motor254 272,275–276, 276,300 amenorrhea, secondary186 ideational 254 occlusion 147, 299–300 amnesia 207 ideomotor254 posterior (PICA) 108, 145, 146, anterograde 208–209 aqueduct 171 271,272, 272,275, 276,299– posttraumatic 208–209 cerebral 137, 217 300 retrograde 208–209 arachnoid 261,262, 284 superior (SCA) 91, 108, 145, 146, amnestic syndrome 208–209 granulations 266 271, 272,276, 276, 279 AMPAreceptor7 archicerebellum 122–123, 159 occlusion 149, 300–301 ampullae 115,120 archicortex 202, 203, 226–227, 231 cerebral amygdala 82, 180, 202,205–206, 215, area(s) anterior (ACA) 91, 145, 271, 272, 215 association 247–248, 247 274–275, 274, 275, 279 amyotrophic lateral sclerosis 48, 48 multimodal 247–248 infarct 290, 290, 291,296, 297 anarthria249 unimodal 247 middle (MCA) 145, 271, 272,274, anastomoses 278–279, 278 auditory117–118 274, 275, 279 callosal 279 Broca’s 248 infarct 256,296 leptomeningeal 279 infarct 250–251 occlusion 296–297 aneurysm306,307, 307 calcarine 86 thrombolysis case presentation anterior communicating artery entorhinal 202, 204,205 291, 292, 293 (AComm) 274 olfactory 216 posterior 91, 108, 145, 146, 271, basilar tip 308 postrema 76, 143 272, 274, 275,276–277, 276, 277, case presentations 308, 308,310, 310 prepiriform 83 279 fusiform 307 pretectal 100 fetal origin 273

aus: Baehr, Topical Diagnosis in Neurology (ISBN 9783136128053) © 2012 Georg Thieme Verlag KG 320 ·Index artery(ies) anterior 277, 299 body cerebral infarction 299 amygdaloid 83 posterior posterior 274,277, 279,299 geniculate infarct 298–299 thyroid, superior 271 lateral 76, 76,84–85, 85, 86, 87, occlusion 152, 153 vertebral 108, 145, 146,270, 271, 96, 100, 118,172,173–174, 173, chiasmatic, superior 279 272–273, 272,275, 276,282, 283 175, 204 choroidal occlusion 147, 150 medial 76, 76,117, 118,172,173– anterior 145, 272,273–274, 274, arthrosis, uncovertebral 58 174, 173, 175 279 asomatognosia 255 Lewy 219–220 ischemia 296 astasia 165, 166, 300 mamillary 76, 171, 175,178, 179, posterior 145, 146 thalamic 177 202, 216, 279 lateral 274,277,298 astereognosis 29, 32, 255 peduncle 180 medial 277, 298 astrocytes 8 restiform 162 occlusion 153, 298 astrocytoma 167 trapezoid 117, 118, 137, 139,140–141 circle of Willis 278–279, 279 cystic 167 bone communicating 278 pilocytic 167 petrous 89 anterior 274, 278, 279 ataxia 300 sphenoid 89 posterior 91, 145, 271, 272,273, Friedreich49 borreliosis 264 278, 279 gait 166 Bowman’sgland 81 emboli 296 limb 307 brachia conjunctiva 75 facial 271 stance 166 brachialgia paresthetic nocturna 67 Heubner’s 275, 279 truncal 165 brachiofacial weakness 41–42 hypophyseal athetosis 219 brachium pontis 75 inferior 182 atrophy, multiple system 220 brainstem superior 183, 279 attention disturbances 176 anatomy74–76, 76,134–145, 134–137 hypothalamic 183 audiometry119 blood supply 145 intercostal, posterior 283 auditoryperception 113 fiberconnections 138, 139 labyrinthine 145, 272,276 axonal transport 3 disorders 145–155 occlusion 300 axons 2–3 infarct 95, 95,97, 97,146, 298 lingual 271 myelination 3–4 subclavian steal syndrome 147 mamillary 279 vascular syndromes 302 maxillary 271 Broca aphasia 249–253 meningeal B case presentation 250–251, 250–251 anterior 260 Broca’s area 248–249 middle 260–261 Babinski sign 41,48, 49 infarct 250–251 posterior 260 Balint syndrome 255 Brodmann’s cytoarchitectural map occipital 278 ballism 219, 223 233 occipitotemporal 277 band of Baillarger Brown–Séquardsyndrome 49–50, 49, of Percheron 277, 299 external 231,232 56 ophthalmic 91, 271,273,278, 279 internal 231,232 bulb emboli 296 baroceptors 12 end, of Krause 12–13, 13 paraventricular 279 barrels, cortical 235 olfactory81–82, 82, 83 perforating, occlusion 155 basket cells 7, 160,232 bundle radicular basophil cells 185 macular 87 anterior 283 bedwetting 198 medial forebrain 83,84, 179, 180, great (of Adamkiewicz) 53, 283, behavior control 255–257 180,181,190 283 Bell palsy 111, 112 recurrent, of Heubner 275, 279 Benedikt syndrome 152–153, 155 segmental benign paroxysmal positional vertigo C lumbar 282 (BPPV) 124–125 thoracic 282 Betz cells 37 cacosmia 84 spinal Bielschowsky test 93,94 CAGtrinucleotide repeat, in Hunting- anterior 145, 146,272, 272,275, Bing–Horton syndrome 108 tondisease 221, 222 281–282, 282, 283 bladder Cajal–Retzius cells 227, 228,231 syndrome 55, 55 dysfunction 195–198 callosotomy 253 posterolateral 282, 282 neurogenic 196–197 canal infarction 312 nonneurogenic 197–198 carotid 82 subclavian 64, 271,282 function 195 hypoglossal 82, 133,134 occlusion 147 innervation 193–195, 193, 194 optic 82 sulco-commissural 281–282, 282 obstruction semicircular 115,120 supraoptic 182, 279 infravesical 197 canalolithiasis 125 temporal, superficial 271 neck196 capsule thalamogeniculate277 blink reflex102, 110 external 236 ischemia 299 blood pressureregulation 144, 184 internal 28, 29, 38, 171, 216, 227, thalamoperforating blood–CSF barrier 263 236

genu 37 shunt 268, 305 syndromes 46–47, 46,49, 49 lesions 42–43, 42, 288 volume 264 comma of Schultz 31, 41 cardiorespiratoryfunction 145 cerebrum commissure carotid-cavernous fistula 273 anatomy228–230, 228, 229, 230 anterior 82, 171, 183, 202, 216, 236, carpal tunnel syndrome 67, 68 connections 232, 233 237,238, 253 cauda equina 45, 54 development 226–227, 226, 228 habenular 177 syndrome 53, 54,61, 62 evolution 226–227, 227 of the fornices 202 cavernoma 306 functional localization 238–248, 238 posterior 171 cells histological organization 231–235, complexregional pain syndrome 67 acidophil 185 231, 234 compression air,ethmoid 89 ischemia 283–289, 295–297 brachial plexus 63 basket 7, 160,232 diagnosis 286–289 peripheral nerves 67 basophil 185 whitematter 235–237 spinal cord52, 52 Betz 37 chandelier cells 232 computerizedtomography(CT) 288– Cajal–Retzius 227, 228,231 charley-horse 61 289, 302–303 chandelier 232 Charlin neuralgia 108 cones 84 chromophobe185 chemoceptors 12 congestive myopathy312–314 Deiters 115, 116 chiasm, optic 84, 86, 87, 89, 103, 171, consciousness 144, 176, 299, 308 double bouquet232 179, 182, 183, 216 continence 195 granule 160, 160, 161,231,232 lesions 86 conus medullaris 45, 54 hair 115, 116, 118,120–121 cholinergic system 188 conus syndrome 53, 54 mitral 82 chorda tympani 109, 111,112, 113, 114 convergence of information transfer 6 olfactory81 chorea 219, 221 cordotomy 31 bipolar 82 chromophobecells 185 corneal reflex105 Pillar 116 cingulum 203, 237,238 light test 92 Purkinje 160, 160, 161 circle of Willis 278–279, 279 cornu Ammonis 203–205 pyramidal 203–205, 231–233 circulation corona radiata 28, 236 Renshaw44 anterior 270 corpora cavernosa 199 Schwann 3 cerebrospinal fluid 263, 263 corpus callosum 171, 175, 180, 216, tufted82 bottlenecks 264 217, 227, 237,238 center disturbances 264–267 agenesis 253 ciliospinal 102 collateral 278–279, 278 lesions 209 gaze, lesions 98 arterial circle of Willis 278–279, surgical transection 249 pontine micturition 195 279 corpus striatum 217, 218 central spastic paresis 41 external-carotid-to-vertebral col- corpuscles cerebellum 158–168, 217 lateralization 278 Golgi–Mazzoni 14, 14 blood supply 276 external-to-internal collateraliza- Meissner 12, 13 connections 161,162–164 tion 278 Ruffini 13, 13 flocculonodular lobe122–123, 159, importance of 285 Vater–Pacini 12,13–14, 13 159 posterior 270 cortex function 164 cistern(s) 262 auditory245–246, 246 hemorrhage167,306–307, 306 ambient 204 lesions 246 internal structure159 cisterna magna 262 cerebellar 159–160, 160 cortex 159–160, 159 Clarke’s column 26 afferent input 160 nuclei 160 classical conditioning 207 cerebral ischemia 167 claustrum 29, 37,215, 216 agranular 233 infarction case presentation 301, clawhand 67 association areas 247–248, 247 301 clivus 89 Brodmann’s cytoarchitectural surface anatomy158–159, 158, clonus 41 map 233 159 clusterheadache 108 development 226–227, 226, 227 syndromes 164–166 cochlea 114, 115, 116 frontal lobe247–248 vascular 299 colliculus(i) functional localization 238–246, tumors 167–168 brachium 137 238, 241, 242, 243, 244, 245 cerebrocerebellum 159 facial 76,109 granular 233 functions 166 inferior 76, 76, 96,117, 118, 139, higher functions 248–257 lesions 166–167 141 histological organization 231 cerebrospinal fluid (CSF) 263–266 superior 76, 76, 96,97, 137,141 laminar architecture231–235, circulation 263–266, 263 colon innervation 194 232, 234 bottlenecks 266 column(s) lesions 41–42, 42,242–246, 248– disturbances 264–267 Clarke’s 26 257 findings in diseases 264 cortical 242–244 primarycortical fields 239–247 pressure264,305 primaryauditorycortex 245–246 gustatory246 see also hydrocephalus; intra- primaryvisual cortex 245 hippocampal 203 cranial hypertension posterior 25, 26,28–30, 33 limbic 202, 202 resorption 266 lesions 29–30, 34 motor36, 36, 37,240–242

aus: Baehr, Topical Diagnosis in Neurology (ISBN 9783136128053) © 2012 Georg Thieme Verlag KG 322 ·Index cortex Duchenne–Erb palsy 63 excitation 6, 7 neocerebellar 163 duct excitatorypostsynaptic potential orbitofrontal 206 cochlear 114–115, 115, 116 (EPSP)5 prefrontal 248, 255 endolymphatic 115 exercise-dependent weakness 72 lesions 255–257 perilymphatic 115 exotropia 92 premotor248 dumbbell tumors 56,57 exteroceptors 12 somatosensory, primary240–244 duramater 260–261, 261, 284 extinction phenomenon 255 lesions 244 blood supply260–261 eyeinnervation striate85, 244 innervation 262 parasympathetic 102, 103, 194 vestibular 246–247 orbital262 sympathetic 102, 103, 104, 194 visual 85, 244–245, 244, 245 spinal 261 eyemovements 89–102 lesions 245 arteriovenous fistula 312–314, 313 accommodation99–101 craniosacral system 188 dysarthria 149,249,306 anatomical substrate100–101, crista ampullaris 120, 120 scanning 167 100 crocodile tears 111 dysarthrophonia 167 conjugate90, 94–99, 118 cruracerebri 38,75, 76, 171 dysdiadochokinesia 166, 299 anatomical basis 96 cubital tunnel syndrome 68, 68 dysequilibrium 123–124,165 reflexgaze movements 98–99 culmen 158, 159, 161 dysgraphia 249 convergence 99–101 cuneus 230 dyslexia 249 anatomical substrate100–101, 100 Cushing syndrome 186–188 dysmetria 166, 299 optokinetic nystagmus 98–99 dysphagia 149 pupillaryconstriction 100 dyssynergia 166 smooth pursuit movements 98 D dystonia 219, 223 voluntary98 focal 223 decussation generalized223 lemniscal 135 F pyramidal 38,39, 75, 76, 135, 139 superior cerebellar peduncles 137 E falx cerebelli 260 tegmental 137 falx cerebri 260, 281 Deiters cells 115, 116 ear 115 fascia dentata 203, 204 Dejerine syndrome 147, 150, 151 inner 114–117 fasciculus case presentation 151 middle 114 arcuate235, 236, 237 dementia 208 edema cuneatus (of Burdach) 26,28, 28, 31 dendrites 2 cerebral 284 frontotemporal 236, 237 dendritic spines 6 vasogenic 302 gracilis (of Goll) 26,28, 28, 31 dermatomes 17, 17, 18, 200 Edinger–Westphal nucleus 77, 78,90, lenticular 178 sensory deficits 17, 18 101, 103,142 longitudinal development 8–9 electroencephalography238 dorsal (of Schütz) 83, 137,181, cerebrum 226–227, 226, 228 emboli 285, 295–299 181,190 déviation conjuguée 98 paradoxical 285 inferior 237, 237 diabetes insipidus 184 see also ischemia; thromboses medial (MLF) 95–96, 96, 118, 121, diagonal band of Broca 83 embolism 147 122,123, 135, 137, 138, 139,142, diaphragm 69 eminence, collateral 204 164–165 diaphragma sellae 260 encephalitis 209, 264 lesions 97, 150, 152 diencephalon 8, 170–172, 171 case presentation 209, 209–210 superior 236–237, 237 digital subtraction angiography(DSA) end bulbs of Krause 12–13, 13 mamillotegmental 182 289, 290, 290, 291,304,309 endolymph 115 occipital, vertical 237, 237 diplopia 92, 92 endoneurium 14 occipitofrontal disconnection syndromes 253–254 enophthalmos 102, 191 inferior 236,237 olfactorysystem253 enteroceptors 12 superior 237 visual system 253–254 enuresis 198 of Meynert 181 disinhibition 6, 6 epiconus 54 olfactory 79 disk(s) syndrome 53, 54 optic 79 intervertebral epidural hematoma 311, 312 proprius 20, 20 degeneration 58–62, 59 spinal 314 semilunar 41 herniation 57, 58,59–61 epineurium 14 subthalamic 178 massive prolapse 61,62, 62 epiphysis 76, 171,177,178 thalamic 178 protrusion 57,60 epithalamus 171,172,177–178 uncinate(of Russell) 122,160, 236, optic 87 epithelium 237, 237 lesions 86 olfactory81, 83 see also tract(s) tactile, of Merkel13, 13 pigment 103 fecal incontinence 198 divergence of information transfer 6 equilibrium disturbances 123–124, fecal retention 198 dizziness123–124 165 fenestra dopamine 7 esotropia 92 cochleae 114, 115 double bouquetcells 232 ethmoid air cells 89 vestibuli 114, 115

aus: Baehr, Topical Diagnosis in Neurology (ISBN 9783136128053) © 2012 Georg Thieme Verlag KG Index · 323 fiber(s) 14,77, 78 forceps gapjunction 6 annulospiral 41 major 237,238 gastrointestinal motility 144 association 233, 236–238, 236, 237 minor 237,238 gaze 92, 93,95–97, 96 cerebral arcuate 236,237, 237 fornix 171, 175, 180,181, 203,205, 216 diagnostic directions of 91, 92 climbing 160, 160, 161 crux 171 horizontal 95 commissural 233, 237,238 fossa disturbances 95–96 corticonuclear 137, 156 interpeduncular 75 lesions of gaze centers 98 corticopontine 75 posterior 158 reflexgaze movements 98–99 corticospinal 137, 156 rhomboid 74–75 vertical 96–97 cranial nerve77–78 fovea84 vertical gaze palsy 176 Golgi 41 Foville syndrome 147 see also eyemovements gustatory111–112, 113,130, 173 free nerveendings 13, 13 genitalia, male intracortical 237 Friedreichataxia 49 dysfunction198–199 mossy 160, 160, 161 functional magnetic resonance imag- innervation 193, 194,198, 199 myelinated 235 ing (fMRI) 239, 243 genu parallel 159, 160 functional neural networks 239 facial nerve pontine 75 funicular myelosis 34, 34,47–48, 48 external 109 projection 235 funiculus, posterior 28, 28, 31 internal 109 radial glial 227 Gerstmann syndrome 255 radicular 90, 91 gland(s) subcortical 237 G adrenal 194 trigeminal104–107, 105, 106 Bowman’s 81 lesions 107 G-protein-coupledreceptors 5, 7 lacrimal 112, 114, 189, 194 motor107 gagreflex145 nasal 112, 114 pain 106–107 galactorrhea 186 pineal 178 somatosensory104–105, 105, 106 γ motorneurons 22–24, 22,43 salivary 189 temperature106–107 static and dynamic 24 parotid 114, 189, 194 vestibulocerebellar 121 gamma-aminobutyric acid (GABA) 7 sublingual 112, 114, 194 visceral receptors 7 submandibular 112, 114, 194 afferent 186 ganglion(a) sweat 104, 189 efferent 186 basal 39, 214 glial cells 7–8 see also nerve(s); neuron(s) connections 217–219, 218 globus pallidus 40, 171,172, 174, 175, fimbria hippocampi 204,205 function 219 178, 178,214,215, 215, 216,217,218 fissure hemorrhage177,305, 305 glutamate7 collateral 230 lesions 219–223 antagonists 160 hippocampal 204 nuclei 215–217, 215, 216, 217 receptors 7 longitudinal, cerebral 228, 230 phylogenetic aspects 214–215 glycine 7 inferior 236 celiac 189,191 receptors 7 superior 236 cervical Golgi tendon organs 13, 14 orbital, superior 82, 89 middle 190 Golgi–Mazzoni corpuscle 14, 14 posterolateral 159 superior 63, 103, 104, 129,190 Gordon reflex41 sylvian 228, 229 cervicothoracic (stellate) 190 Gradenigosyndrome 108 fistula ciliary 100,101, 103, 105, 189,192 granule cells 160, 160, 161,231,232 arteriovenous 312–314 dorsal root 16 granulization 233 case presentation 313, 313 syndrome of 46, 46 gray matter syndrome 47, 47 carotid-cavernous 273 geniculate 109, 111,112, 113, 114 Gray type Isynapses 5 fixation reflex98 glossopharyngeal Gray type II synapses 5 flocculus 122,159, 159 inferior (extracranial) 126, 127,130 growth-hormone-secreting adenoma flower-spray endings 22 superior (intracranial) 126, 127,130 186 Foix–Alajouanine disease 312 mesenteric Guillain–Barré syndrome 264 folium(a) 158, 161 inferior 189,191, 193, 198 gynecomastia 186 food intake145 superior 189,191 gyrus(i) 228–229 foramen(ina) otic 113, 114, 189,192 ambient 82, 83 interventricular,ofMonro170, 171, pterygopalatine 105, 109,112, 113, cingulate 175, 202 262 114, 189,192 dentate 203–205, 204, 230 intervertebral 59, 60 spiral 117, 117, 118 frontal, middle 229 jugular 82, 131 submandibular 112, 114, 189,192 fusiform 230 lacerum 82 trigeminal (gasserian) 79, 82, 89, 91, lingual 230 magnum 131 103–104, 105,141 occipitotemporal of Luschka 75, 76,158 vagal lateral 230 of Magendie 75, 76,158 inferior (nodose) 127,128, 129, medial 230 ovale 82,114 130, 131 orbital 230 rotundum 82,114 superior (jugular) 127,128, 129, parahippocampal 82, 204, 230 stenoses 57,58, 59, 60,61 131 paraterminal 230 stylomastoid 111 vestibular (of Scarpa) 117,121, 122 postcentral 28, 29,30

aus: Baehr, Topical Diagnosis in Neurology (ISBN 9783136128053) © 2012 Georg Thieme Verlag KG 324 ·Index gyrus(i) diagnosis 308–309 hyporeflexia 167 precentral 36, 36, 37, 230 grading 308, 309 hyposmia 84 rectus 230 rebleeding 310 hypothalamic–pituitaryaxis 185, 186 semilunar 82, 83 see also hematoma disturbances 185–186 temporal heparin 304 hypothalamus 170, 171,172,178–188, inferior 230 Hering’s law94–95 216 superior 231 herpes simplexencephalitis 209, 264 connections 180–183, 180, 181,190 transverse, of Heschl 117, 118, 231 case presentation 209, 209–210 functions 184–185 herpes zoster46 nuclei 179–180, 179 oticus 112 hypothermia 184 H Heubner’s artery275, 279 hypotonia 44,167 hippocampus 202,203–205, 204, 216, hypotropia 92 habenula 177 227, 227 hair cells 115, 116, 118,120–121 activation 205 headache 302, 304, 308 connections 205 I cluster108 homunculus 28, 241 occipital306 motor36–37 impotence 186, 198–199 hearing 113–119 horn incontinence diagnostic evaluation 119 Ammon’s 203–205, 204 fecal 198 disorders 119–120, 126 anterior 135 urinary196–197 heart anterior horn cells 43, 123 overflow196 innervation191, 194 inhibition by Renshawcells 44 stress 196–197 referred pain 199 syndrome 48, 48 urge 196 regulation 184 inferior 204, 216 incus 115 helicotrema 115, 115, 116 posterior 24–25, 30, 217 indusium griseum 202,227, 227 hemangioblastoma 167 lesions 34 infarction hematoma syndrome 47, 47 brainstem95, 95,97, 97,146, 298 epidural 311, 312,314 Horner syndrome 63, 102, 104, 149, Broca’s area 250–251 removal306,311 191–192 cerebellar,case presentation 301, spinal cord314 causes 192 301 subdural 311, 311 hourglass tumors 57 cerebral artery 256,290, 290, 291, hematomyelia 47,314 Huntington disease 221 296–297, 298–299 hemianesthesia 244, 299, 300 case presentation 222, 222 embolic 285 hemianopic light reflextest88 hydrocephalus 266–268, 309 hemodynamic 285–286 hemianopsia 245 active 266–267 case presentation 287, 287 binasal 86 children 268 lacunar 286 bitemporal 86 communicating 266 case presentation 288, 288 homonymous 86, 88, 296, 297, 299 diagnosis 268 midbrain 95, 95,97, 97 hemiataxia 177, 299 epidemiology 268 pontine 154 hemiballism178 ex vacuo 267 oral region 155 case presentation 223, 223 hypersecretory266 septal nuclei 209 hemicraniectomy285 malresorptive 266 spinalcord55, 55,282, 312 hemihypesthesia 244, 296, 297 case presentation 267, 267 subthalamic nucleus 223 hemiparesis noncommunicating 266 territorial 285, 290, 291 bilateral 43 normal pressure(NPH) 267 thalamic 209 contralateral 43, 244, 296, 297, 299, case presentation 265, 265 casepresentation 211, 211,300, 305 occlusive 266 300 flaccid 43, 244 treatment 268, 309 Wernicke’s area 252 spastic 43, 244 types of 266–267 see also ischemia hemiplegia hydromyelia 47 informationflow2 alternating 147, 148 hypercolumns 245 information processing 2, 2 spastic hyperkinesia 219 infundibulum 178, 279 contralateral 42–43, 148 choreiform 221 inhibition 6, 7 ipsilateral 43 hyperosmia 84 forward6,6 hemorrhage305–311 hyperreflexia 41 recurrent 6, 6 basal ganglia 177, 305, 305 detrusor muscle 196 inhibitory postsynaptic potential cerebellar 167, 306–307, 306 hypertension (IPSP) 5 intracerebral 305–307 arterial 286, 305 innervation 68, 69–71 hypertensive 305–306 intracranial 268, 285, 296, 297, 305 eye intraventricular rupture305 treatment 305, 306 parasympathetic 102, 103 nonhypertensive 306 hyperthermia 184 sympathetic 102, 103, 104 septal nuclei 209 hypertropia 92 somatosensory16–17 spinal cord314 hypokinesia 219, 220 insula 29, 37, 216,228, 231 subarachnoid (SAH) 267, 267,307– hypomimia 221 interneuron(s) 20,232 310, 309 hypophysis 171 GABAergic 205

aus: Baehr, Topical Diagnosis in Neurology (ISBN 9783136128053) © 2012 Georg Thieme Verlag KG Index · 325 intervertebral disks see disks ligament, spiral 116 Merkel’s disks13, 13 intestine innervation 194 ligand-gated ion channels 5 mesencephalon 8 intracranial hypertension 266–267, ligand-gated receptors 7 mesocortex 202 285, 296, 297, 305 limbic system metastases, drop 167 treatment 305, 306 anatomy202–203 Meyer’s loop 87,88 see also hydrocephalus connections 203 microaneurysms 305 intrafusal muscle fibers 13 functions 206–208 microangiopathic leukoen- ischemia limen insulae 83 cephalopathy286 cerebellar 167 lingula 159, 161 microelectrode recording 238 cerebral 283–289, 295–297 lobe(s) microglial cells 8 diagnosis 286–289 flocculonodular 122–123, 159, 159 microvascular decompression 107 peripheral nerves 67 frontal 228, 228, 229,247,248 micturition 193, 195 prolonged reversible ischemic neu- occipital 97,228, 228, 229 midbrain 75–76, 136, 137,141–143 rological defect (PRIND) 284 parietal 228, 228, 229,247–248 infarct 95, 95,97, 97 spinal cord55, 55 temporal 228, 228, 229 Millard–Gubler syndrome 147, 151 stroke 284 locus ceruleus 137, 143 miosis 191 transient ischemic attack(TIA) 284, lung innervation 191 modiolus 116 290 Lyme disease 264 monkey hand 67 see also infarction lymphoma 52, 52 monoplegia 43 isocortex 204,231 motorend plate44 motorsystem M central components 36–43 J lesions 41–43 macules 87, 115, 121 peripheral components 43–44 jacksonian seizures 32–33, 42, 244 saccular 115,120–121 motorunit 44 utricular 115,120–121 multiple sclerosis 86, 88, 88,96 magnetic resonance imaging (MRI) CSF findings 264 K 289, 290, 290, 291,303–304 trigeminal neuralgia and 108 functional (fMRI) 239, 243 multiple system atrophy220 kainatereceptors 7 magnetoencephalography239 muscle spindles 13, 14,20–21 kidneyinnervation 194 malleus 115 muscle tone 24 Klumpkepalsy 63 massa intermedia 171,172, 180, 181 abnormalities 41,219,221 Korsakoffsyndrome 208 mechanoreceptors 12 muscle(s) Meckel’s cave 260 abductor digiti quinti 70 medulla 38,74–75, 134, 135,136–140 abductor pollicis L adrenal 191 brevis 69 syndromes 147, 149 longus 70 labyrinth 116,120 medulloblastoma 167, 168 adductor lacrimal gland 112, 114, 189 membrane brevis 71 innervation 194 basilar 115, 116, 116 longus 71 lamina Reissner’s 115, 116, 118 magnus 71 basilar 116, 117, 118 tectorial 116, 118 pollicis 70 tension regulation 119 tympanic 115 anconeus 70 medullary memory206 biceps brachii 60, 69 external 171 dysfunction 208–209 biceps femoris 71 internal 171 episodic 206–207 brachialis 69 tectal 76, 171 explicit (declarative)207 brachioradialis 60, 70 terminalis 171 frontal-lobe-type functions 207–208 ciliary 100 language248–249 implicit (nondeclarative)207 constrictor pharyngeus 127 automatic 249 long-term (LTM) 206–208 coracobrachialis 69 nonautomatic 249 subtypes 206–207 deltoid 69 see also aphasia neural substrates 206 detrusor 193,195 lemniscus semantic 206–207 areflexia 196 lateral 118, 137, 138, 139 short-term (STM) 206 detrusor-sphincter dyssynergia 196 lesions 151, 152, 153 Squire’s taxonomyof207–208 hyperreflexia 196 medial 26, 27,28, 29, 33, 106, 118, testsof206 instability 196 127, 129, 135, 137, 138, 139,140, types of 206–208 digastric 108 142, 174, 217 Mendel–Bekhterev reflex41 dilator pupillae 103, 104 lesions 33, 150, 151, 152, 153, 155 Ménière’s disease 119–120 extensor carpi spinal 30, 33, 106 meninges 260, 261 radialis 70 trigeminal 33, 106,142 meningioma 57 ulnaris 70 lateral 137 meningitis extensor digiti quinti 70 lesions 33 bacterial 264 extensor digitorum 70 leukoaraiosis 286 fungal 264 brevis 61, 71 Lewy bodies 219–220 tuberculous 264 longus 71 viral 264

aus: Baehr, Topical Diagnosis in Neurology (ISBN 9783136128053) © 2012 Georg Thieme Verlag KG 326 ·Index muscle(s) pelvic floor 195 N extensor hallucis peroneal 71 brevis 71 peroneus nasal glands 112, 114 longus 61, 71 brevis 61 neglect 255 extensor indicis proprius 70 longus 61 case presentation 256, 256 extensor pollicis piriformis 71 neocerebellum 159 brevis 70 plantar,ofthe foot 71 neocortex 226–227, 227 longus 70 pronator teres 60, 69 nerve(s) extraocular 89–92, 89, 91,123 quadratus femoris 71 abducens (CN VI) 80, 81, 82,89, 89, pareses 92, 93 quadriceps femoris 70 91, 91, 96, 151 flexorcarpi rectus palsy 93,94 radialis 69 inferior 89, 90, 92 accessory(CN XI) 75, 80, 81, 82, 122, ulnaris 70 lateral 89, 92 126, 131–132, 131 flexordigiti quinti brevis 70 paresis 93 lesions 132 flexordigitorum medial 89, 90, 92, 100,101 alveolar,inferior 105 brevis 71 paresis 93 auricular longus 71 superior 89, 90, 92 great 19, 63 profundus 69, 70 rhomboids 69 posterior 109, 111 superficialis 69 sartorius 70 auriculotemporal 105, 106 flexorhallucis longus 71 scalene 69 axillary 19, 64, 66, 69 flexorpollicis anterior 64 buccal 105 brevis 70 segment-indicating 58, 60, 61 cardiac 191 longus 69 semimembranosus 71 cervical 19, 69 gastrocnemius 71 semitendinosus 71 transverse 19, 63 gemelli 71 serratus anterior 69 cluneal 19 genioglossus 133,134 soleus 71 coccygeal 15, 65 gluteus stapedius 114 cochlear 111,117, 118 maximus 71 sternocleinomastoid 132 cranial 77–78, 77–82 medius 71 sternothyroid 133 nuclei 77, 78, 79 minimus 71 styloglossus 134 see also specific nerves gracilis 71 stylopharyngeus 127 cutaneous hypoglossus 134 subscapularis 69 antebrachial hypothenar 60 supinator 70 lateral 19 iliopsoas 70 supraspinatus 69 medial 19 infraspinatus 69 syndromes 72 posterior 19 innervation 68, 69–71 tarsal brachial interossei inferior 104 medial 19 dorsal 70 superior 104 posterior 19 palmar 70 temporalis 105,107 femoral latissimus dorsi 69 tension regulation 20–21, 22 lateral 19, 65 length regulation 20–21, 22 tensor fasciae latae 71 posterior 19, 65 dysfunction 41 tensor tympani 114 facial (CN VII) 80, 81, 82,109–111, targetvalues 22–24 teres 109, 111 levator major 69 lesions 110–111, 111 palpebrae 89 minor 69 motorcomponent 109–111 superioris 90 thenar 60 palsy 43, 110–111, 110, 148 scapulae 69 thyrohyoid 133 central 110 lumbricals 70 tibialis idiopathic 111, 112 masseter 105,107 anterior 61, 71 femoral 19, 65, 66, 70 mental 105 posterior 71 fibular 19 oblique trapezius 132 frontal 105 inferior 89, 90, 92 triceps brachii 60, 70 genitofemoral 19, 65 superior 89, 92 triceps surae 61, 71 glossopharyngeal (CN IX) 75, 80, 81, paresis 93,95 vastus 82,112,126–127, 127,129–131, 189 obturator lateralis 61 branches 126 externus 71 medialis 61 lesions 126–127 internus 71 see also sphincter syndrome 126–127 omohyoid 133 muscular dystrophies 72 gluteal opponens digiti quinti 70 myasthenia 72 inferior 65, 66, 71 opponens pollicis brevis 70 gravis 72 superior 65, 66, 71 orbitalis 104 mydriasis 102 hypogastric 198 palmaris longus 69 myelin sheath 3–4, 4 hypoglossal (CN XII) 63,75, 80, 81, pectineus 71 myelitis 82,132–134, 133, 135 pectoralis parainfectious 51, 51 lesions 134, 150 major 69 transverse 50 palsy 43, 134, 148, 150 minor 69 myopathy72

aus: Baehr, Topical Diagnosis in Neurology (ISBN 9783136128053) © 2012 Georg Thieme Verlag KG Index · 327 iliohypogastric 19, 65 splanchnic nervus intermedius 78, 79, 80,109, ilioinguinal 19, 65 greater 189,191 111–112, 111, 189 intercostal 19, 70 lesser 189,191 neural tube8 intercostobrachial 19 pelvic 189,193, 193 neuralgia laryngeal subclavius 64 Charlin 108 recurrent 128, 129 suboccipital 63 glossopharyngeal 127 superior 128 subscapular 64 trigeminal 107–108, 108,302 lingual 105,111, 113, 114 supraclavicular 19, 63 idiopathic 107 lumbar 19 suprascapular 64, 69 neurinoma 57 mandibular 17, 19, 82,104, 105, 106 sural 19 neuroblasts 8 maxillary 17, 19, 82,104, 105, 106, thoracic 19 neuroborreliosis 264 114 long 64, 69 neurodevelopment 8–9 median 19, 64, 66, 69, 70 thoracodorsal 64, 69 neuroglia 235 lesions 67 tibial 65–66, 65, 66, 71 neurohypophysis 171,178, 179, 181, 182 palsy 67, 68 lesions 66 neuroma, acoustic 120, 125–126, 167, musculocutaneous 64, 66, 69 trigeminal (CN V) 17, 19, 33,75, 80, 168 mylohyoid 105 81, 82, 91,103–109, 137, 146 neuronal migration disorders 227 nasociliary 105 lesions 33–34, 107–108 neuron(s) 2–4, 3 obturator 19, 65, 66, 71 trochlear (CN IV) 76, 79, 81, 82,89, association 20 occipital 89,90–91, 91,142 cellular proliferation 8 greater 19, 63 nuclear lesion 95, 95 commissural 20 lesser 19, 63 palsy 93,94 EE 246 oculomotor(CN III) 75, 79, 81, 82, tympanic 126 EI 246 89, 90, 91, 96, 100, 103, 189, 279 ulnar 19, 64, 66, 70 excitatory6 palsy 93,94, 148 lesions 68 funicular 20,30 olfactory(CN I) 79,81–82, 81, 82, 83 palsy 67, 68 GABAergic 7 ophthalmic 17, 19, 82, 89,104, 105, vagus (CN X) 75, 80, 81, 82,112, 122, glutamatergic 7 106 126, 127,128–131, 129, 131, 189,192 growth of cellular processes 8 optic (CN II) 77, 79, 81, 82,84, 85, branches 128 inhibitory6 87, 91, 100, 103 lesions 128–129 motor 20,37–38 lesions 86, 101 vestibular 91, 111,120, 122 α 43, 123 pectoral vestibulocochlear (CN VIII) 80, 81, γ 22–24, 22,43, 123 lateral 64, 69 82,113–126 static and dynamic 24 medial 64, 69 zygomatic 114 postganglionic 188 pelvic 198 see also fiber(s); neuron(s) preganglionic 188 peripheral 14, 14,44, 66 nerveplexus see plexus programmedcell death 9 lesions 18,67 nerveroots 16,57 pyramidal 37 differential diagnosis 68 accessory131–132 see also fiber(s); interneuron(s); somatosensoryinnervation 16–17 cranial 131, 131 nerve(s) syndromes 67–68, 67 lesions 132 neuronal migration 8 peroneal 66 spinal 131,132 neuropathy, vestibular 125 common 19,65–66, 65 cochlear 117 neuropeptides 7 deep 19, 71 dorsal root entryzone (DREZ) 24 neurosecretion 185 lesions 66 facial 109 neurosyphilis 264 superficial 19, 71 oculomotor 155, 156 neurotransmitters petrosal spinal 15–16, 15 excitatory7 great 111, 113, 114 anterior 14, 15,44 inhibitory7 lesser 106, 114 posterior 14–15, 15,16 synaptic transmission 5 phrenic 63, 64, 69 syndromes 57–62 NMDAreceptor7 plantar cervical 58–59, 59, 60 nociceptors 12 lateral 19 lumbar 59–62, 60, 61, 62 node of Ranvier 3 medial 19 posterior 46, 46 nodulus 159, 159, 161 pterygoid trigeminal 106, 108, 154 norepinephrine 7 lateral 106 unmyelinated portions 108 notch, preoccipital 229 medial 106 vestibular 117,121 nucleus(i) pudendal 65, 71, 193, 198, 199 nervous system abducens 78,89, 91, 137 pulmonary191 autonomic 188–190 lesions 152 radial 19, 64, 66, 70 parasympathetic 184, 188, 189,192– accessory 77, 78, 90, 100, 131, 135 palsy 67 193, 194–195 ambiguus 77, 78, 127,129–130, 129, sacral 19 hypothalamic control 188–190 131, 135,140 saphenous 19, 66 sympathetic 184, 188, 189,190–192, lesions 149 scapular,dorsal 64, 69 194–195 arcuate 135 sciatic 65–66, 65, 66, 71 anatomy190, 191 basal, of Maynert 178 lesions 66 hypothalamic control 188–190 caudate 171,214,215, 215, 216,217 spinal 15–16, 57 lesions 191–192 head 37, 38, 40, 175, 215, 216, 227 tail 38, 204, 215, 216

aus: Baehr, Topical Diagnosis in Neurology (ISBN 9783136128053) © 2012 Georg Thieme Verlag KG 328 ·Index neuron(s) red 40, 91, 122, 137, 138, 139,141– vestibular 75, 77, 79,120, 121–123, central, superior 143 142, 163, 163,166,217 121, 137,140, 141, 161 cerebellar 160–162 syndrome of 152–153, 155 inferior (of Roller) 96,121, 121, cochlear 75, 77, 79, 135 reticular 137, 149 dorsal 117, 118 lateral 136 lateral (of Deiters) 40, 96,121, 121, lesions 149 of the thalamus 171,172 137 ventral 117, 118 reticular formation 127 lesions 149, 152 colliculus autonomic 144–145 medial (of Schwalbe) 96,121, 121, inferior 217 salivatory 137 superior 137 inferior 77, 78, 113, 114, 127,130, superior (of Bekhterev) 96,121, cuneate 26, 27, 33, 77, 106, 135,136, 144 121, 137 138, 139 superior 77, 78,112, 113, 114,144 nutritional intakeregulation 185 accessory 27, 135 septal 209 nystagmus 124, 149,165, 300 Darkshevich’s 96–97, 96 lesions212, 212 complex165 dentate 122, 137, 139,142, 161,162, Stilling’s 26 gaze-evoked165 163,166, 174 subthalamic 171,178, 178, 215, 216, optokinetic 98–99 Edinger–Westphal 77, 78,90, 101, 217 periodic alternating 165 103,142 infarct 223 rebound 165 emboliform 122, 137,142, 160–162, suprachiasmatic 178 161,165, 175 supraoptic 182 facial 78,109, 110,111, 137 tegmental 40, 83 O lesions 151, 152 pedunculopontine 143 obex 76 fastigial 40, 122, 137,160, 161,165 thalamic 171,172–176, 173, 174, 175 oculomotordisturbances 165 globose 122, 137,160–162, 161,165 anterior 172, 173,174, 175, 181, 203 olfactorysystem81–84, 227 gracile 26, 27, 33, 77, 106, 135,136, centromedian 172, 173, 175,176, disconnection 253 138, 139 178,217 oligodendrocytes 3, 4,8 habenular 83, 171,177–178, 205 dorsal 175 olive 75, 138, 150, 161, 163 hypoglossal 75, 77, 78,132–134, 133, intermediate 175 accessory138 135,140 medial 175,206 inferior 40, 76,136, 139 lesions 134 oral 175 lesions 138 hypothalamic 143,179–180, 179 superficial 175 ophthalmoplegia dorsomedial 179,180, 180 intralaminar 173,176 external 94 infundibular 179,180 lateral 172, 174, 175 internal 94 lateral (tuberomamillary) 180 dorsal 172, 173 internuclear (INO) 95–96, 97 mamillary180 posterior 172, 173 Oppenheim reflex41 paraventricular 179, 179, 181,184 lesions 176–177 optic radiation (of Gratriolet) 84–85, posterior 179,180 medial 174, 175 85, 86, 100 preoptic 179, 179 dorsal 173 lesions 88 supraoptic 179, 179, 181,184 nonspecific 173, 176 optokinetic nystagmus 98–99 tuberal 179,180 reticular 171,172 organ ventromedial 179,180, 180 specific 173–174 of Corti 115, 116, 118 intermediolateral 178, 191 ventral 172, 174,176 vestibular 160 interpeduncular 83 anterior (VA) 172, 173,174,176 oscillopsia 124 interstitial, of Cajal 96–97, 96, 122 intermediate(VI) 173 osmoceptors 12 lentiform/lenticular 37, 38,217 lateral (VL) 172, 173,176 osteochondrosis 58 mamillarybody 171 oral 174 cervical 58–59 mesencephalic 77, 79, 106, 127 posterolateral (VPL) 28, 30, 172, lumbar 59 oculomotor 77, 78,89, 90, 90, 91, 173, 173,176 oxytocin 182–183,185 100, 137,142 posteromedial (VPM) 112, 172, of Darkshevich 122 173, 173,176 of Perlia 90, 100,101,142 thoracic 26, 31 P olivary 118,136 tractus solitarius 77, 79,112, 113, 114, accessory 138, 139 127,140 pain inferior 75, 135 lesions 149 perception 240 superior 137 trigeminal 75, 103–107, 106, 127, phantom 242 para-abducens 97 135, 137, 139,140, 141 referred 199–200 paraventricular 182 lesions 149, 152, 153 visceral 199 pontine 40, 137, 154, 161, 163 motor 77, 78, 106, 137,141, 153 paleocerebellum 27,159 posterior commissure96 principal sensory 77, 79, 106, 127, paleocortex202, 226–227, 231 prestitial 96 137,141, 153 palsy pretectal 103,141 trochlear 77, 78,89, 90 abducens nerve 93,94 pulposus 58 lesion 95, 95 accessorynerve132 raphe 217 vagal75, 77, 78 brachial plexus dorsalis 143 dorsal 129,130, 135,140, 143, 149, lower(Klumpke) 63 magnus 143 192 upper (Duchenne–Erb) 63 pontis 143 bulbar,progressive 48

facial 43, 110–111, 110, 148 peduncles polyneuropathies 68 central 110 cerebellar 74–75, 159 polyradiculitis 264 idiopathic 111, 112 inferior 76, 118, 135, 137, 138, 139, polysensorymismatch124 hypoglossal 43, 134, 148, 150 149, 159,162 pons 38,75, 76, 136, 137,140–141 median 67, 67, 68 lesions 149, 152, 153, 154 lesions 42,43, 98, 99 oculomotor 93,94, 148 middle 75, 76, 137, 138, 139, 146, oral region infarct 155 peroneal 66 152, 154, 159,163, 217 paramedian infarct 154 radial 67 superior 75, 76, 137, 138, 139, 146, pontocerebellum 159 supranuclear,progressive 220 153, 159,163–164, 217 Pope’s blessing 67 tibial 66 cerebral 38,75, 141, 142–143 positron emission tomography(PET) tochlear 93,94 lesions 42,43 239, 289 ulnar 67,68, 68 syndrome of 153, 156 postherpetic neuralgia 46 vertical gaze palsy 176 mamillarybody 180 postsynaptic membrane 4–5 Pancoasttumor 192 penumbra285 precocious puberty 178 pancreas innervation 194 perfusion pressure285 preplate227, 228 panhypopituitarism 185–186 perikaryon3 presubiculum 204 Papez circuit 203, 203 perineurium 14 presynaptic membrane 4–5 papilledema 86, 167, 262, 302 periosteum 284 priming effect 207 paragrammatism 249 peripheral nerves see nerve(s) programmedcell death 9 paralysis peritrichial nerveendings 12, 13 progressive supranuclear palsy 220 flaccid 44–45 perseveration 257 prolactinoma 186 spastic spinal 48–49, 48 photoreceptors 84 case presentation 187, 187 paraparesis 297 pia mater 261,262–263 prolonged reversible ischemic neuro- flaccid 313 Pillar cells 116 logical defect (PRIND) 284 spastic 313 pineal gland 178 proprioceptors 12 spinal cordcompression and 52, 52 pinealocytes 178 prosencephalon 8, 226 paraplegia 43 pituitarygland prosopagnosia 255 paresis anteriorlobe(adenohypophysis) 183 pseudo-depressive patients 257 eyemuscles 92, 93,95 posterior lobe(neurohypophysis) pseudo-psychopathic patients 257 flaccid 42, 67,312 171,178, 179, 181, 182 ptosis 94,191 facial 111 plate pulvinar 76,172, 173,174, 174, 175 leg 297 cortical 227 pupillaryconstriction 100 spastic 41,312 cribriform 82, 82 pupillarylight reflex84, 101 sternocleinomastoid muscle 132 quadrigeminal 76, 76,141 afferent pathway lesions 101 trapezius muscle 132 plegia 44 efferent pathway lesions 101–102 upper limb 42 plexus 14–15, 16 regulation 101–102 see also hemiparesis brachial 63–64, 64, 69–70 Purkinje cells 160, 160, 161,162 Parinaud syndrome 97 lesions 63–64 putamen 40, 174, 175, 178,214,215, Parkinson disease 219–221 causes 63–64 215, 216,217 akinetic-rigid 220–221 lower(Klumpkepalsy) 63 pyramidal cells 203–205, 231–233 familial 220, 220 upper (Duchenne–Erb palsy) pyramidalization 233 idiopathic 219–220 63 pyramids case presentation 221 buccal 109 cerebellar 159, 161 mixed-type 221 cardiac 191 medullary 38,39, 40,75, 76 tremor-dominant 221 carotid decussation 38,39, 75, 76, 135, Parkinson-plus syndrome 220 external 190 139 parkinsonism 219–221 internal 191 lesions 42,43 parosmias 84 cervical 62, 63, 69 parotid gland 114, 189 syndromes 62 innervation 194 choroid 171, 204, 216 Q path, perforant 204,205 hypogastric 189, 193, 199 pathway inferior 193 quadrantanopsia 88, 245 auditory117, 118 superior 193 quadriparesis 43 cortico-striato-pallido-thalamo- lumbosacral 65 quadriplegia 43 cortical 218–219 lesions 65–66 corticopontocerebellar 140 lumbar 65, 65, 70–71 diencephalobulbar 129 sacral 65–66, 65, 71 R gustatory112, 113 venous olfactory82–83, 83 anterior external spinal 284 radiation reticular,descending 144 anterior internal spinal 284 auditory117, 118,174 sympathetic, central 135, 137,142 epidural 283 callosal 238 lesions 149, 152 posterior external vertebral 284 optic 173, 236, 245 visual 84, 85 poikilothermia 184 thalamocingulate203, 203 lesions 86 poliomyelitis 48 radicular lesions 17, 18,57–62 somatotopic organization 85–86 polyneuritis 68 differential diagnosis 68 see also tract(s)

aus: Baehr, Topical Diagnosis in Neurology (ISBN 9783136128053) © 2012 Georg Thieme Verlag KG 330 ·Index radionuclide studies 289 Rombergtest166 soma 3 ramus communicans roots see nerveroots somatosensorysystem gray 190, 191 central components 24–31 white190, 191 central processing 32–34 Rathke’s pouch179 S lesions 32–34, 33 rebound phenomenon 167 peripheral components 12–24 receptororgans 12–14 saccadic pursuitmovements 165 speech249 skin 12–13, 13 saccule 115,120 sphincter recess salivary glands 112, 114, 189 anal 71 infundibular 171 salivation 112 external 198, 198 optic 171 regulation 144 internal 198 rectum saltatoryconduction 3 pupillae 100, 103 emptying disorders 198 scala urethral innervation 194,198, 198 media 115 external 193,195 Redlich–Obersteiner zone 24 tympani 115, 115, 116 dysfunction 198 referred pain 199–200 vestibuli 115, 115, 116 internal 193,195 reflex(es) scalene syndrome 63–64, 64 vesical 71 ankle-jerk 61 Schwann cells 3 spinal automatisms 50 antagonistmuscle relaxation 18–19, Schwartz–Bartter syndrome 184–185 spinal cord45 21–22 sciatica 61–62 blood supply281–283, 282, 283 biceps 23, 60 seizures arterial hypoperfusion 312 blink 102, 110 epileptic 302 impaired venous drainage312– corneal 105 jacksonian 32–33, 42, 244 314 light test 92 sella turcica 91 compression 52, 52 crossedextensor 20 sensorimotorarea32 cordotomy 32 fixation 98 sensoryconflict 124 hemorrhage314 flight 19–20 sensorydeficits infarction 55, 55,282, 312 gag145 dissociated 31,47 syndromes 45–55 hemianopic light reflextest88 lesions along somatosensorypath- anterior spinal arterysyndrome intrinsic 18, 23 ways 32–34, 33 55, 55 masseteric (jaw-jerk) 107 peripheral nervelesions 18, 19,67 cauda equina syndrome 53, 54, monosynaptic 18, 24 radicular lesions 17, 18 61, 62 polysynaptic 19–20, 20, 21 septum pellucidum 171, 216 conus syndrome 53, 54 proprioceptive 18 serotonin 7 epiconus syndrome 53, 54 pupillarylight reflex84, 101 receptor7 hemisection syndrome 49–50, 49 regulation 101–102 Sherrington’s law95 transection syndromes 50–53, 50 quadriceps (knee-jerk) 21, 23, 61 single-photonemission computerized acute50, 50 sneeze 105 tomography(SPECT) 289 cervical 53 stapedius 110 sinus(es) 280–281, 281 incomplete 51, 51 suck105–106 cavernous 89,281, 281 lumbar 53 triceps 23, 60 frontal 89 progressive 52 triceps surae 23 occipital 280 thoracic 53 vestibulo-ocular (VOR) 124, 165 petrosal vascular 56–57, 312–314 viscerocutaneous 200, 200 inferior 281, 281 tumors 56–57 reflexsympathetic dystrophy67 superior 91,281, 281 epidural lymphoma 52, 52 Reissner’s membrane 115, 116, 118 sagittal extradural 56, 56 release-inhibiting factors 183, 183 inferior 280, 281 intradural extramedullary56–57, releasing factors 183, 183 superior 261,280, 280, 281,303, 56 Renshawcells 44 303 intradural intramedullary56, 56, respiration 144 sigmoid 280, 281 57 reticular formation 31,39, 40, 83, 122, sphenoid 89 venous drainage283, 284 127, 135, 137,140, 143–145, 143, sphenoparietal 281 spinal shock49, 50 149, 161,163, 175 straight 280, 280, 281 spinocerebellum 159 paramedian pontine (PPRF) 95 thromboses 302–304 functions 165 retina 84, 85, 87 case presentation 303, 303 lesions 165–166 retinopathy245 transverse 280, 280, 281 split-brain patients 253 retrobulbar neuritis 86 skin spondylarthrosis 58 retrograde transport 3, 4 receptors 12–13, 13 stapes 115 rhombencephalon 8 segmental innervation 17 Steele–Richardson–Olszewski syn- rib 64 sensorydeficits 17–18 drome 220 cervical 64 peripheral nervelesions 18, 19 Steinert–Batten–Curschmann dystro- rigidity 220 radicular lesions 17, 18 phy72 Rinne test 119 sleep–wakecycle 144 stereocilia 115, 116 rods 84 sneeze reflex105 stereognosis 32 Rombergsign 30, 46, 48,49 social behavior control 255–257 stereotaxy 238

Stilling’s nucleus 26 posterolateral 76 Korsakoff208 stratum precentral 229 medullary ganglionare160 rhinal 230 dorsolateral (Wallenberg) 147, granulosum 160 temporal 149, 150,299 moleculare159–160 inferior 229 case presentation 150 zonale 171 superior 229 medial (Dejerine) 147, 150, 151 striae swallowing 144–145 case presentation 151 longitudinal 83 sweat gland 104, 189 muscle 72 lateral 202,227 sympathectomy192 nerveroot(radicular) medial 202,227 synapses 4–5 cervical root 58–59, 59, 60 medullares 75, 76, 83, 118,177, 181 asymmetrical 5 differential diagnosis 68 thalami 84, 171 axo-axonal 6 lumbar root 59–62, 60, 61, 62 olfactory axodendritic 6 posterior root 46, 46 lateral 83 axosomatic 6 neuromuscular junction 72 medial 82, 83 chemical 6 Parinaud 97 terminalis 180–181, 180,205, 237 electrical 6 Parkinson-plus 220 striatum 217 input 6 peripheral nerves 67–68, 67 stroke 284 motortracts 41 plexus 62–67 see also infarction; ischemia structure4–5, 5 brachial 63–64, 64 subacutecombineddegeneration symmetrical 5 causes 63–64 (SCD) 34, 34,47–48 synaptic transmission 5–6, 5 lower(Klumpkepalsy) 63 subarachnoid hemorrhage(SAH) 267, synaptogenesis 8–9 upper (Duchenne–Erb palsy) 63 267,307–310, 309 syndrome(s) cervical 62, 63 diagnosis 308–309 amnestic 208–209 lumbosacral 65–66 grading 308, 309 anterior horn 48, 48 lumbar 65, 65 rebleeding 310 anterior spinal artery55, 55 sacral 65–66, 65 subclavian steal syndrome 147 Balint 255 pontine tegmentum subdural hematoma 311, 311 basal ganglia lesions 219–223 caudal 148, 152 subiculum 204,205 basis pontis oral 149, 153 sublingual gland 112, 114 caudal (Millard–Gubler/Foville) posterior column 46–47, 46 innervation 194 147, 161 posterior horn 47, 47 submandibular gland 112, 114 midportion 152, 154 rednucleus (Benedikt) 152–153, 155 innervation 194 Bing–Horton 108 scalene 63–64, 64 substance Brown–Séquard49–50, 49,56 spinal cord45–55 innominate 178 carpal tunnel 67, 68 cauda equina syndrome 53, 54, perforated 279 central spastic paresis 41 61, 62 anterior 83 cerebral peduncle (Weber) 153, 156 conus syndrome 53, 54 substantia cerebrovascular 295–302 epiconus syndrome 53, 54 gelatinosa 26, 31, 135 combinedanterior horn and py- hemisection syndrome 49–50, 49 nigra2,39, 40, 91, 137,141,142, 217, ramidal tract 48, 48 tethered cord197, 197 218 combinedinvolvement of posterior transection syndromes 50–53, 50 lesions 155, 156 columns, spinocerebellar tracts, acute50, 50 subthalamus 172, 178, 178 and (possibly) pyramidal tracts cervical 53 suckreflex105–106 49, 49 incomplete 51, 51 Sudecksyndrome 67 combinedposterior column and lumbar 53 sulcus(i) 228–229 corticospinal tract 47–48, 48 progressive 52 anterolateral 76 complexregional pain 67 thoracic 53 calcarine 85, 87,230, 230 corticospinal tract 48–49, 48 vascular 56–57, 312–314 callosal 230 costoclavicular 63 thalamic 176–177 central 229,230, 230 cubital tunnel68, 68 case presentation 177 cingulate230, 230 disconnection 253–254 vascular 295–302 collateral 230 olfactorysystem253 synkinesia, facial 111 frontal visual system 253–254 syringes 47 inferior 229 dorsal root ganglion 46, 46 syringobulbia 47 superior 229 flaccid paralysis 44–45 syringomyelia 47 hippocampal 230 frontalbrain 174 system hypothalamic 171 Gerstmann 255 adrenergic 188 lateral 228, 229 glossopharyngeal 126–127 ascending reticular activating lunate 229 Gradenigo108 (ARAS) 143–144,176 median, posterior 76 gray matter 47, 47 cholinergic 188 occipitotemporal 230 Guillain–Barré syndrome 264 craniosacral 188 olfactory 230 Horner 63, 102, 104, 149,191–192 descending reticular 190 orbital 230 causes 192 extrapyramidal 214 parieto-occipital 229,230, 230 hyperabduction 63 olfactory81–84, 227 postcentral 229 inappropriateADH secretion disconnection 253 (SADH) 184–185

aus: Baehr, Topical Diagnosis in Neurology (ISBN 9783136128053) © 2012 Georg Thieme Verlag KG 332 ·Index system corticonuclear 38,39, 127,133, 133, spinoreticular 31 pyramidal 214 138, 138, 139 spinotectal 25,31, 31,136, 137 thoracolumbar 188 lesions 148, 153 spinothalamic 138,140, 142, 174 vagal126–132 corticopontine 38, 137, 138, 156, 161, anterior 25, 26, 27,30, 31,136, ventricular 262, 262 163,166 282 vestibular 120, 124 corticopontocerebellar 39 lesions 30, 33, 33 lesions 124–126 corticospinal 29, 37,38–39, 38, 40, lateral 25, 26, 27, 29,30–31, 31, visual 84–88, 233 138, 138, 139, 163 106, 135,136, 137, 139, 282 disconnection 253 anterior 31, 38,39, 40, 41, 138, lesions 30–31, 33–34, 33, 149, see also limbic system; nervous 139 151, 152, 153 system lateral 31, 38,39, 41, 138, 139, 282 spinovestibular 31 lesions 148, 154 supraoptico-hypophyseal 181,182 syndromes of 47–49, 48 tectocerebellar 164 T cuneocerebellar 165 tectospinal 31, 40, 41, 135, 137,139– dentatorubral 161, 163 140 tabes dorsalis 46–47 dentatothalamic 161, 163,174, 174 lesions 153 tapetum 217 dentatothalamocortical 166 tegmental taste 111–112,130 dorsolateral 31 central 40, 135, 137, 138, 139, 161, taste bud 113 extrapyramidal 127 163 tectum 75–76, 141 fastigiobulbar 160, 162 lesions 138, 149, 152, 153 tegmentum frontopontine 37, 40, 138 temporopontine 37, 138 midbrain 141–142 frontothalamic 37 thalamocingulate 203 pontine 140 habenulointerpeduncular 83 thalamocortical 28, 30, 161, 163 caudal, syndrome of 148, 152 Lissauer 31 trigeminal 77, 79, 127, 129, 137, 138, oral, syndrome of 149, 153 mamillotegmental 181,190 139,142 tela choroidea 76, 171 mamillothalamic 171,174, 175, 181, trigeminothalamic teleceptors 12 182, 203, 203, 216 dorsal 141 telencephalon 8, 226 motor 40 ventral 141 temperatureregulation 184 lateral 39–40 tuberohypophyseal 181 tendinous ring 89 lesions 42–43, 42 vestibulospinal 31, 40, 41, 161,164– tentorium 260, 281 medial 39–40 165 cerebelli 158 synapses 41 lateral 121,123 tethered cordsyndrome 197, 197 occipitomesencephalic 40 medial 122,123 thalamocortical reciprocity 235–236 occipitopontine 138 see also fasciculus; pathway thalamus 26,28, 29, 33, 37, 38, 40, olfactory82, 83, 279 tractus 161,163, 170–177, 171, 215, 217,218, olivocerebellar 138, 139, 161,162, retroflexus 181 235 163,166 solitarius 135, 137 blood supply 277 olivospinal 31, 40, 41 transient ischemic attack(TIA) 284, functions 176 optic 75, 76,84, 85, 171, 216 290–291 infarction 209 lesions 86–87, 88 trauma case presentation 211, 211,300, parietopontine 138 brachial plexus lesions 63 300 parietotemporopontine 40 peripheral nerves 67 nuclei 171,172–176, 173, 174, 175 pontocerebellar 161,163 tremor 220, 221 lesions 176–177 pyramidal 37,38–39, 38, 129, 135, intention (action) 166–167 syndromes 176–177 137 triangle vascular 299 anterior 135 hypoglossal 75, 76 thermoreceptors 12 lateral 135 of Guillain and Mollaret 163 thoracolumbar system 188 lesions 42,43, 150, 151 vagal75, 76 thrombolysis case presentation signs 41 trigeminal neuralgia 107–108, 108, basilar artery293–294, 293, 294, syndromes of 48, 48,49, 49 302 295 reticulospinal 31, 40, 41, 122, 161, idiopathic 107 middle cerebral artery291, 292, 293 164–165 trigone, olfactory82 thromboses 302–304 rubroreticular 142, 165 trunk diagnosis 302–304 rubrospinal 31, 40, 41, 135, 137,138, brachiocephalic 271, 283 see also emboli 138, 139,142, 161,165 costocervical 282, 283 tic douloureux 107 semilunar 31 inferolateral 278 tonotopy 245 spino-olivary 25,31, 31, 138, 161 trunk tonsil, cerebellar 159 spinocerebellar thyrocervical 282, 283 tract(s) anterior 25,26–27, 26, 27, 31, 135, tube, auditory 115 bulbothalamic 28 136, 137, 138, 139, 161,164,165 tuber 158, 159, 161 cerebello-olivary 162 lesions 149, 152 cinereum 171, 279 cerebelloreticular 162 lateral 25 tubercles 75 cerebellorubral 138 posterior 25, 25, 26, 27, 31,75, 135, cuneate74, 76 corticobulbar 39 136, 137, 138, 139, 161,162, 165 facial 75 corticomesencephalic 38,39, 138 syndrome of 49, 49 gracile 74, 76

aus: Baehr, Topical Diagnosis in Neurology (ISBN 9783136128053) © 2012 Georg Thieme Verlag KG Index · 333 tuberculum cinereum 75, 76 superior rotatory125 tumors dorsal 279, 280 vestibular 124 cerebellar 167–168 middle 280 vestibular system 120, 124 Pancoast192 thromboses 302–304 lesions 124–126 pituitary186–188 cortical 279 vestibulocerebellum 159 case presentation 187, 187 intervertebral 284 functions 164–165 spinal cord56–57 jugular,internal 281 lesions 165 dumbbell (hourglass) tumors 56, occipital, internal 280 vestibulum 114 57 of the septum pellucidum 280 Virchow–Robin space 262 epidural lymphoma 52, 52 ophthalmic visceral pain 199 extradural 56, 56 inferior 281 visceroceptors 12 intradural, extramedullary56–57, superior 281 visual system 84–88, 235 56 radicular disconnection 253–254 intramedullary56, 56,57 anterior 284 vitamin B12deficiency 46, 47 posterior 284 vomiting 145 spinal U anterior 284 posterior 284 W ultrasonography289 posterolateral 284 uncus 83, 230 striate 280 Wallenbergsyndrome 147, 149, 150,299 urinarycontinence 195 sulcal 284 case presentation 150 see also incontinence sulcocommissural 284 wallerian degeneration 67 urinaryurgency 196 thalamostriate 216, 280 waterbalance 184–185 utricle 115,120 vertebral 284 Webersyndrome 153, 156 uvula 159, 161 velum, medullary Webertest119 anterior 137 Wernicke aphasia 253 superior 76, 146, 159 case presentation 252–253, 252 V venous outflowobstruction Wernicke’s area 248 acute302–304 infarct 252 vasodilation 191, 192 chronic 304–305 whitematter 235–237 vasopressin (ADH) 182, 183, 184, 185 ventricle Wilson disease 219 vasospasm 310 fourth 76, 135, 262,263 case presentation 224, 224 Vater–Pacini corpuscles 12,13–14, 13 floor 74–75, 76 window vein(s) 279–281, 280 roof 75, 135 oval 114, 115 anastomotic lateral 86, 215, 216, 227, 262,263 round 114, 115 inferior (of Labbé) 279, 280 third 171, 262,263 Wisconsin CardSorting Test 257 superior (of Trolard) 279, 280 ventricular system 262,263 Word Fluency Test 257 basal (of Rosenthal) 279, 280 vermis 122,158 wristdrop 67 basivertebral 284 inferior 159 central, posterior 284 lesions 165 cerebral superior 158 Z anterior 280 vertigo123–125 great (of Galen) 217,280, 280 positional 124–125 zona incerta 171,178, 178 internal 279, 280 benign paroxysmal (BPPV) 124– zones of Head 199, 199,200 middle 125 deep 280 central 125 superficial 279, 280 proprioceptive 124