A Dictionary of Neurological Signs A.J. Larner A Dictionary of Neurological Signs Fourth Edition A.J. Larner, MA, MD, MRCP(UK), DHMSA, PhD Walton Centre for Neurology and Neurosurgery Liverpool UK ISBN 978-3-319-29819-1 ISBN 978-3-319-29821-4 (eBook) DOI 10.1007/978-3-319-29821-4 Library of Congress Control Number: 2016938226 © Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland To Sue Nil satis nisi optimum The dictionary is the only place where success comes before work Arthur Brisbane Foreword to the First Edition (2001) Neurology has always been a discipline in which careful physical examination is paramount. The rich vocabulary of neurology replete with eponyms attests to this historically. The decline in the importance of the examination has long been predicted with the advent of more detailed neuroimaging. However, neuroimaging has often provided a surfeit of information from which salient features have to be identifi ed, dependent upon the neurological examina- tion. A dictionary of neurological signs has a secure future. A dictionary should be informative but unless it is unwieldy, it cannot be comprehensive, nor is that claimed here. Andrew Larner has decided sensibly to include key features of the history as well as the examination. There is no doubt that some features of the history can strike one with the force of a physical sign. There are entries for “palinopsia” and “environ- mental tilt” both of which can only be elicited from the history and yet which have consider- able signifi cance. There is also an entry for the “head turning sign” observed during the history taking itself as well as the majority of entries relating to details of the physical examination. This book is directed to students and will be valuable to medical students, trainee neu- rologists, and professions allied to medicine. Neurologists often speak in shorthand and so entries such as “absence” and “freezing” are sensible and helpful. For the more mature stu- dent, there are the less usual as well as common eponyms to entice one to read further than the entry which took you fi rst to the dictionary. Queen Square, London, UK Martin N. Rossor vii Preface to the Fourth Edition Those who have read Linda Mugglestone’s engaging book on the subject of dictionaries [1] might rightly object (and vehemently so) to this volume calling itself a dictionary. It is not, by any stretch of the imagination, an example of modern systematic corpus lexicography. Rather, it is based on “individual and ad hoc reading” (page 56) to gather evidence which, in a gener- ous mood, might be termed “fi eldwork” (59), or perhaps more accurately “armchair lexicog- raphy” (59), the fi nished work thus representing the author’s “fallibility of aspiration” (80). Such accusations cannot justly be rebutted, but in my defence I might state that this all too human product is like other dictionaries in that it is a highly mutable text, bound to change and not stasis (15) – this is the 4th edition in 15 years! – which seeks to probe the nature of words (19). The hope is that this endeavour to produce a lexicon of neurology will remain relevant to those engaged in the assessment and examination of individuals with neurological symptoms. Should dictionaries be simply descriptive, and neither prescriptive (a recommendation for what should be used) nor proscriptive (a recommendation for what should not be used)? [1]. A scientifi c vocabulary should surely err on the side of exactness. Possibly for this reason, I have been affl icted with an increasing sense of dissatisfaction with the largely descriptive nature of this book (one might almost say it is akin to fl ower arranging), perhaps prompted by experience with the use of diagnostic and screening tests where a more rigorous quantita- tive evaluation is required [2]. The same methodology based around conditional probabilities is certainly applicable to the assessment of neurological signs [3] and it is good to see this being applied to more of the signs described in this book (see, for example, Babinksi’s sign, Kernig’s sign), as well as evaluations of inter-rater agreement [4]. An attempt has been made to evaluate some of the signs used in cognitive neurology in this way (“attended alone” sign, “head turning” sign, applause sign) [5]. Nevertheless, a Pubmed search using terms such as “sign”, “sensitivity and specifi city”, “diagnostic accuracy”, etc., will afford few hits (<50 at time of writing, and even fewer specifi cally for neurological signs). Debate continues between those neurologists who appear to advocate less [6] or more [7] neurological examination in clinical practice, but the dichotomy is probably illusory, since most would agree that focused examination which aims to test the diagnostic hypotheses generated from the clinical history taking is the ideal. I’m sure that I examine far less than I used to, presumably because with increasing experience the likely differential diagnosis is pretty clear based on the history alone. Clinical examination never takes place in a vacuum. Thus Martin Rossor was (hopefully) prescient in his Foreword to the fi rst edition (2001) when he opined that “A dictionary of neurological signs has a secure future”. Liverpool, UK A. J. Larner ix x Preface to the Fourth Edition References 1. Mugglestone L. Dictionaries: a very short introduction. Oxford: Oxford University Press; 2011. 2. Larner AJ, editor. Cognitive screening instruments. A practical approach. London: Springer; 2013. 3. Larner AJ. Diagnostic test accuracy studies in dementia. A pragmatic approach. London: Springer; 2015. 4. Thaller M, Hughes T. Inter-rater agreement of observable and elicitable neurological signs. Clin Med. 2014;14:264–7. 5. Larner AJ. Neurological signs of possible diagnostic value in the cognitive disorders clinic. Pract Neurol. 2014;14:332–5. 6. Hawkes CH. I’ve stopped examining patients. Pract Neurol. 2009;9:192–4. 7. Warlow CP. Why I have not stopped examining patients. Pract Neurol. 2010;10:126–8. Acknowledgements In preparing this fourth edition, particular thanks are due to friends and colleagues who have commented on the earlier editions, namely (in alphabetical order) Alasdair Coles, Anu Jacob, Alex Leff, Miratul Muqit, Parashkev Nachev, and Sivakumar Sathasivam. At Springer, I am grateful for support and encouragement received from Joanna Bolesworth. All errors and shortcomings which remain are entirely my own work. xi Contents A . 1 Abadie’s Sign . 1 Abdominal Paradox . 1 Abdominal Refl exes . 1 Abducens (VI) Nerve Palsy . 2 Abductor Sign . 2 Absence . 2 Abulia . 3 Acalculia . 3 Accommodation Refl ex . 4 Achilles Refl ex . 4 Achromatopsia . 4 Acoasm . 5 Acousticopalpebral Refl ex . 5 Acroparaesthesia . 5 Action Dystonia . 5 Action Myoclonus . 5 Adiadochokinesia . 5 Adie’s Syndrome, Adie’s Tonic Pupil . 5 Adson’s Test . 5 Adventitious Movements . 6 Affective Agnosia . 6 Afferent Pupillary Defect (APD) . 6 Age-Related Signs . 6 Ageusia . 7 Agnosopsia . 8 Agnosia . 8 Agrammatism . 9 Agraphaesthesia . 9 Agraphia . 9 Agraphognosia . 10 xiii xiv Contents Agrypnia (Excitata) . 10 Akathisia . 10 Akinesia. 11 Akinetic Mutism . 12 Akinetic Rigid Syndrome . 12 Akinetopsia . 13 Alalia . 13 Alexia . 13 Alexithymia . 15 “Alice in Wonderland” Syndrome . 15 Alien Grasp Refl ex . 15 Alien Hand, Alien Limb . 16 Alienation Du Mot . 16 Alloacousia . 17 Alloaesthesia . 17 Allochiria . 17 Allodynia . 18 Allographia . 18 Allokinesia, Allokinesis . 18 Alternate Cover Test . 19 Alternating Fist Closure Test . ..