contentsodin.ces.edu.co/contenidos_web/41025755.pdfcontents preface xvi how to use this book xix...
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Contents
Preface xvi
How to UseThis Book xix
Chapter 1 Introductionto ClinicalCasePresentations3Introduction 4
The General History and Physical Exam 4Chief Complaint (CC) 5History of the Present Illness (HPI) 5Past Medical History (PMH) 6Review of Systems (ROS) 6Family History (FHx) 6Social and Environmental History (SocHx/EnvHx) 6
Medications and Allergies 6PhysicalExam 7Laboratory Data 7Assessmentand Plan 7
Neurologic Differential Diagnosis 8
Relationship between the General Physical Examand the Neurologic Exam 9
References 11
Chapter 2 NeuroanatomyOverviewandBasicDefinitions 13Basic Macroscopic Organization of the Nervous
System 14Main Parts of the NervousSystem 14Orientation and Planes of Section 16
Basic Cellular and Neurochemical Organizationof the Nervous System 17
CNSGray Matter and White Matter; PNS Gangliaand Nerves 21
Spinal Cord and Peripheral Nervous System 22
Cerebral Cortex: Basic Organization and PrimarySensory and Motor Areas 24
Lobesof the Cerebral Hemispheres 24Surface Anatomy of the Cerebral Hemispheres in
Detail 25
PrimarySensory and Motor Areas 28
CellLayersand Regional Classificationof the CerebralCortex 29
Motor Systems 32Main Motor Pathways 32Cerebellum and BasalGanglia 34
Somatosensory Systems 34Main Somatosensory Pathways 34Thalamus 35
Stretch Reflex 37
Brainstem and Cranial Nerves 38
Limbic System 41Association Cortex 41
Blood Supply to the Brain and Spinal Cord 44Conclusions 46References 46
Chapter 3 TheNeurologicExamasa Lessonin Neuroanatomy 49Overview of the Neurologic Exam 50neuroexam.com 52
The Neurologic Exam: Examination Techniqueand What Is Being Tested 521. MentalStatus 522. CranialNerves 58
3. Motor Exam '634. Reflexes 645. Coordination and Gait 68
6. Sensory Exam 70The Neurologic Exam as a Flexible Tool 72Coma Exam 73
viii CONTENTS
General PhysicalExam 731. Mental Status 732. Cranial Nerves 75
3. Sensory Exam and 4. Motor Exam 765. Reflexes 776. Coordination and Gait 78
Brain Death 78
Conversion Disorder, Malingering, and RelatedDisorders 78
The Screening Neurologic Exam 80Conclusions 81
References 81
Chapter 4 Introductionto ClinicalNeuroradiology83Introduction 84
Imaging Planes 84
Computerized Tomography 84CTversusMRI 87
Magnetic Resonance Imaging 87
Neuroangiography 93
Functional Neuroimaging 95Conclusions 97
NEURORADIOLOGICALATLAS 98
References 119
Chapter 5 BrainandEnvirons:Cranium,Ventricles,andMeninges 121ANATOMICALAND CLINICALREVIEW 122
Cranial Vault and Meninges 122
Ventricles and Cerebrospinal Fluid 128Blood-Brain Barrier 133KCC5.1 Headache 135
KCC5.2 Intracranial Mass Lesions 137KCC5.3 Elevated Intracranial Pressure 137
KCC5.4 Brain Herniation Syndromes 140KCC5.5 Head Trauma 142
KCC5.6 Intracranial Hemorrhage 143KCC5.7 Hydrocephalus 151KCC5.8 Brain Tumors 152
KCC5.9 Infectious Disorders of the Nervous System 154KCC5.10 Lumbar Puncture 161
KCC5.11 Craniotomy 163CLINICALCASES 164
5.1 An Elderly Man with Headaches and Unsteady Gait164
5.2 Altered Mental Status Following Head Injury 1665.3 Delayed Unresponsiveness after Head Injury 174
5.4 Headache and Progressive Left-Sided Weakness 1765.5 Sudden Coma and Bilateral Posturing during
IntravenousAnticoagulation 1805.6 SevereHeadInjury 1885.7 A Child with Headaches, Nausea, and Diplopia 1895.8 Headaches and Progressive Visual Loss 1965.9 An Elderly Man with Progressive Gait Difficulty,
Cognitive Impairment, and Incontinence 1995.10 A Young Man with Headache, Fever, Confusion, and
StiffNeck 203
Additional Cases 204
BRIEFANATOMICAL STUDY GUIDE 205
A Scuba Expedition through the Brain 206References 208
Chapter 6 CorticospinalTractand OtherMotor Pathways 213ANATOMICALAND CLINICALREVIEW 214
Motor Cortex, Sensory Cortex, and SomatotopicOrganization 214
BasicAnatomy of the Spinal Cord 216
Spinal Cord Blood Supply 219
General Organization of the Motor Systems 220Lateral Corticospinal Tract 222
Autonomic Nervous System 228KCC6.1 Upper Motor Neuron versus Lower Motor Neuron
Lesions 231KCC6.2 Terms Used to Describe Weakness 232
KCC6.3 Weakness Patterns and Localization 232
KCC6.4 Detecting Subtle Hemiparesis at the Bedside 239KCC6.5 Unsteady Gait 241
KCC6.6 Multiple Sclerosis 241KCC6.7 Motor Neuron Disease 243
CLINICALCASES 244
6.1 Sudden Onset of Right Hand Weakness 2446.2 Sudden Onset of left Foot Weakness 245
6.3 Sudden Onset of Right Face Weakness 249
CONTENTS ix
6.4 Pure Motor Hemiparesis I 251
6.5 Pure Motor Hemiparesis II 2536.6 Progressive Weakness, Muscle Twitching, and Cramps
256
Additional Cases 258
BRIEFANATOMICALSTUDY GUIDE 258
References 259
Chapter 7 SomatosensoryPathways 263ANATOMICALAND CLINICALREVIEW 264
Main Somatosensory Pathways 264
Posterior Column-Medial Lemniscal Pathway 267
Spinothalamic Tract and Other AnterolateralPathways 268
Somatosensory Cortex 270Central Modulation of Pain 270
The Thalamus 271
Relay Nuclei 273Intralaminar Nuclei 274Reticular Nucleus 275
KCC7.1 Paresthesias 276
KCC7.2 Spinal Cord lesions 276KCC7.3 Sensory loss: Patterns and localization 277
KCC7.4 Spinal Cord Syndromes 279
Chapter 8 SpinalNerveRoots 303ANATOMICAL AND CLINICALREVIEW 304
Segmental Organization of the Nervous System304
Nerve Roots in Relation to Vertebral Bones, Discs,and Ligaments 305
Dermatomes and Myotomes 307KCC8.1 Disorders of Nerve, Muscle, and Neuromuscular
Junction 311
KCC8.2 Back Pain 314
KCC8.3 Radiculopathy 315
Simplification: Three Nerve Roots to Remember inthe Arm 317
Simplification:Three Nerve Roots to Remember inthe Leg 317
KCC8.4 CaudaEquina Syndrome 318KCC8.5 Common Surgical Approaches to the Spine 318CLINICALCASES 319
8.1 Unilateral Neck Painand TinglingNumbnessin theThumb and Index Finger 319
KCC7.5 Anatomy of Bowel, Bladder, and Sexual Function282
CLINICALCASES 285
7.1 SuddenOnset of RightArm Numbness 285
7.2 Sudden Onset of Right Face, Arm, and leg Numbness286
7.3 A Fall Causing Paraplegia and a Sensory level 288
7.4 left leg Weakness and Right leg Numbness 291
7.5 Sensory loss over Both Shoulders 293
7.6 Body Tingling and Unsteady Gait 295
7.7 Hand Weakness, Pinprick Sensory level, and UrinaryRetention 296
Additional Cases 297
BRIEF ANATOMICAL STUDY GUIDE 297
References 300
8.2 Unilateral Occipital and Neck Pain 3208.3 Unilateral Shoulder Pain and Weakness 321
8.4 Blisters, Pain, and Weakness in the left Arm 3238.5 Unilateral Shoulder Pain and Numbness in the Index
and Middle Fingers 324 .
8.6 Unilateral Neck Pain, Hand Weakness, and Numbnessin the Ringand little Fingers 325
8.7 Painand Numbnessin the MedialArm 326
8.8 low Back Pain Radiating to the Sole of the Foot andthe Small Toe 327
8.9 Unilateral Thigh Weakness with Pain Radiating tothe AnteriorShin 328
8.10 low BackPain,Radiatingto the BigToe 3298.11 Saddle Anesthesia with loss of Sphincteric and
ErectileFunction 332Additional Cases 335
BRIEFANATOMICAL STUDY GUIDE 335
References 336
X CONTENTS
Chapter 9 MajorPlexusesandPeripheralNerves 339ANATOMICAL AND CLINICALREVIEW 340Brachial Plexus and Lumbosacral Plexus 340Simplification: Five Nerves to Remember
in the Arm 342
Simplification:Three Nerves Acting onthe Thumb 344
Intrinsic and Extrinsic Hand Muscles 344Simplification: Five Nerves to Remember
in the Leg 345KCC9.1 CommonPlexus and Nerve Syndromes 346KCC9.2 Electromyography (EMG)and Nerve Conduction
Studies 349
CLINICALCASES 351
9.1 Complete Paralysis and Lossof Sensationin One Arm 351
9.2 A Newborn with Weakness in One Arm 353
9.3 A Blow to the Medial Arm Causing Hand Weaknessand Numbness 353
9.4 Nocturnal Pain and Tingling in the Thumb, Pointer,and Middle Finger 355
9.5 Hand and Wrist Weakness after a Fall 355
9.6 Numbness and Tingling in the Pinkyand Ring Finger 356
9.7 Unilateral Thigh Pain, Weakness, and Numbness in aDiabetic 357
9.8 Tingling and Paralysis of the Foot after a Fall 358
9.9 A leg Injury Resulting in Foot Drop 3599.10 lateral Thigh Pain and Numbness after
Pregnancy 3619.11 Dysarthria, Ptosis, and Decreased Exercise
Tolerance 362
Additional Cases 363BRIEFANATOMICAL STUDY GUIDE 363References 363
Chapter 10 CerebralHemispheresand VascularSupply 367ANATOMICAL AND CLINICALREVIEW 368Review of Main Functional Areas of Cerebral
Cortex 368
Circle of Willis: Anterior and Posterior Circulations369
Anatomy and Vascular Territories of the ThreeMain Cerebral Arteries 371
Vascular Territories of the Superficial CerebralStructures 371
Vascular Territories of the Deep Cerebral Structures373
KCC10.1 ClinicalSyndromes of the Three Main CerebralArteries 376
KCC10.2 Watershed Infarcts 378
KCC10.3 Transient Ischemic Attack and Other TransientNeurologic Episodes 379
KCC10.4 Ischemic Stroke: Mechanisms and Treatment380
KCC10.5 Carotid Stenosis 384
KCC10.6 Dissection of the Carotid or Vertebral Arteries385
Venous Drainage of the Cerebral Hemispheres386
KCC10.7 Sagittal Sinus Thrombosis 387
CLINICAL.CASES 38810.1 Sudden-Onset Worst Headache of life 388
10.2 left leg Weakness and left Alien Hand Syndrome389
10.3 Decreased Vision on One Side 390
10.4 Transient Episodes of left Eye Blurriness or RightHand Weakness 398
10.5 Nonfluent Aphasia with Right Face and ArmWeakness 399
10.6 Talking Ragtime 403
10.7 Dysarthria and Hemiparesis 404
10.8 Global Aphasia, Right Hemiplegia, and Hemianopia405
10.9 left Face and Arm Weakness 408
10.10 left Hemineglect 411
10.11 left Hemineglect, Hemiplegia, and Hemianopia413
10.12 Unilateral Proximal Arm and leg Weakness 41510.13 Right Frontal Headache and left Arm Numbness in a
Woman with Gastric Carcinoma 419
Additional Cases 421
BRIEFANATOMICAL STUDY GUIDE 421References 424
Chapter 11 VisualSystem 427ANATOMICAL AND CLINICAL REVIEW 428
Eyes and Retina 428
Optic Nerves, Optic Chiasm, and Optic Tracts 431
Lateral Geniculate Nucleus and ExtrageniculatePathways 432
Optic Radiations to Primary Visual Cortex 433
Visual Processing in the Neocortex 435
Parallel Channels for Analyzing Motion, Form, andColor 435
Ocular Dominance Columns and OrientationColumns 437
KCC11.1 Assessment of Visual Disturbances 438
KCC11.2 Localization of Visual Field Defects 440
KCC11.3 Blood Supply and Ischemia in the VisualPathways 443
CONTENTS xi
KCC11.4 Optic Neuritis 445
CLINICAL CASES 446
11.1 A Dark Spot Seen with One Eye 446
11.2 Vision Lossin One Eye 447
11.3 Menstrual Irregularity and BitemporalHemianopia 448
11.4 Hemianopia after Treatment for a Temporal LobeTumor 449
11.5 Visual Changes Caused by Migraine Headaches? 451
Additional Cases 453
BRIEF ANATOMICAL STUDY GUIDE 453
References 456
Chapter 12 BrainstemI: SurfaceAnatomy and CranialNerves 459ANATOMICALAND CLINICALREVIEW 460Surface Features of the Brainstem 461Skull Foramina and Cranial Nerve Exit Points 464
Sensory and Motor Organization of the CranialNerves 466
Functions and Course of the Cranial Nerves 469
CN I: Olfactory Nerve 471KCC12.1Anosmia(CNI) 472CN II: Optic Nerve 472CN III, IV,and VI: Oculomotor, Trochlear, and
Abducens Nerves 472
CN V: Trigeminal Nerve 474KCC12.2 Trigeminal Nerve Disorders (CN V) 478CN VII: Facial Nerve 479
KCC12.3 Facial Nerve Lesions (CN VII) 482KCC12.4 Corneal Reflex and Jaw Jerk Reflex (CN V, VII)
484
CN VIII: Vestibulocochlear Nerve 484
Auditory Pathways 485
Vestibular Pathways 489
KCC12.5 Hearing Loss(CN VIII) 491KCC12.6 Dizziness and Vertigo (CN VIII) 492
CN IX: Glossopharyngeal Nerve 495
CN X: Vagus Nerve 496CN XI: Spinal Accessory Nerve 499CN XII:Hypoglossal Nerve 499KCC12.7 Disorders of CNIX,X, XI,and XII 500KCC12.8 Hoarseness, Dysarthria, Dysphagia, and
Pseudobulbar Affect 500Review: Cranial Nerve Combinations 502
CLINICAL CASES 504
12.1Anosmiaand VisualImpairment 50412.2 CheekNumbnessand a BulgingEye 50512.3 Jaw Numbnessand Episodesof Lossof Consciousness
50812.4 IsolatedFacialWeakness 50912.5 Hearing Lossand Dizziness 51212.6 Hoarse Voice Following Cervical DiscSurgery 51612.7 Hoarseness, with Unilateral Wasting of the Neck and
Tongue Muscles 51712.8 Uncontrollable Laughter, Dysarthria, Dysphagia, and
Left-Sided Weakness 521Additional Cases 522
BRIEFANATOMICAL STUDY GUIDE 523
References 526
xii CONTENTS
Chapter 13 BrainstemII:EyeMovementsandPupillaryControl 529
Chapter 14 BrainstemIII:InternalStructuresandVascularSupply576576
ANATOMICAL AND CLINICAL REVIEW 530
Extraocular Muscles, Nerves, and Nuclei 530
Extraocular Muscles 530
Extraocular Nerves and Nuclei 532
KCC13.1 Diplopia 535
KCC13.2 Oculomotor Palsy (CN III) 536
KCC13.3 Trochlear Palsy(CN IV) 538
KCC13.4 Abducens Palsy (CN VI) 539
The Pupils and Other Ocular Autonomic Pathways540
KCC13.5 Pupillary Abnormalities 543KCC13.6 Ptosis 546
Cavernous Sinus and Orbital Apex 546
KCC13.7 Cavernous Sinus Syndrome (CN III, IV, VI, V,) andOrbital Apex Syndrome (CN II, III, IV,VI, V,) 547
Supranuclear Control of Eye Movements 548
Brainstem Circuits for Horizontal Eye Movements 548
KCC13.8 Brainstem lesions Affecting Horizontal Gaze 549
ANATOMICALAND CLINICALREVIEW
Main Components of the BrainstemBrainstem Sections 577
Cranial Nerve Nuclei and Related Structures 584
Long Tracts 586KCC14.1locked-in Syndrome 587Cerebellar Circuitry 587Reticular Formation and Related Structures 588
Widespread Projection Systems of Brainstem andForebrain: Consciousness,Attention, andOther Functions 589
Brainstem Reticular Formation and Thalamus 590
Identified Neurotransmitter Systems 592Anatomy of the Sleep-Wake Cycle 598KCC14.2 Comaand RelatedDisorders 601Reticular Formation Motor, Reflex, and
Autonomic Systems 605
Brainstem Vascular Supply 607
KCC13.9 Parinaud's Syndrome 551
KCC13.10 Right-Way Eyesand Wrong-Way Eyes 552
CLINICAL CASES 554
13.1 Double Vision and Unilateral Eye Pain 554
13.2 A Diabetic with Horizontal Diplopia 555
13.3 Vertical Diplopia 557
13.4 left Eye Pain and Horizontal Diplopia 558
13.5 Unilateral Headache, Ophthalmoplegia, andForehead Numbness 559
13.6 Ptosis, Miosis, and Anhidrosis 560
13.7 Wrong-Way Eyes 562
13.8 Horizontal Diplopia in a Patient with MultipleSclerosis 563
13.9 Headaches and Impaired Upgaze 567Additional Cases 568
BRIEFANATOMICAL STUDY GUIDE 568
References 572
575KCC14.3 Vertebrobasilar Vascular Disease 612
CLINICALCASES 620
14.1 Faceand Contralateral Body Numbness, Hoarseness,Horner's Syndrome, and Ataxia 620
14.2 Hemiparesis Sparing the Face 622
14.3 Dysarthria and Hemiparesis 626
14.4 Unilateral FaceNumbness, Hearing loss, and Ataxia626
14.5 locked In 629
14.6 Wrong-Way Eyes,limited Upgaze, DecreasedResponsiveness,and Hemiparesis with an AmazingRecovery 632
14.7 Diplopia and Unilateral Ataxia 639
14.8 Intermittent Memory loss, Diplopia, Sparkling lights,and Somnolence 641
14.9 Intractable Hiccups 644
Additional Cases 645
BRIEF ANATOMICAL STUDY GUIDE 649
References 650
Chapter 15 Cerebellum653ANATOMICALAND CLINICALREVIEW 654
Cerebellar lobes, Peduncles, and Deep Nuclei654
Microscopic Circuitry of the Cerebellum 658
Cerebellar Output Pathways 660
Cerebellar Input Pathways 664
Vascular Supply to the Cerebellum 668
KCC15.1CerebellarArtery Infarctsand CerebellarHemorrhage 669
KCC15.2ClinicalFindingsand Localizationof CerebellarLesions 670
Chapter 16 BasalGanglia 689ANATOMICALAND CLINICALREVIEW 690
BasicThree-Dimensional Anatomy of the BasalGanglia 690
Input, Output, and Intrinsic Connections of theBasal Ganglia 698
Inputs to the Basal Ganglia 698Outputs from the Basal Ganglia 699Intrinsic Basal Ganglia Connections 699Hyperkinetic and Hypokinetic Movement Disorders
701
Parallel Basal Ganglia Pathways for Movement,Eye Movement, Cognition, and Emotion 702
Ansa lenticularis, lenticular Fasciculus,and theFields of Forel 704
KCC16.1 Movement Disorders 705
CONTENTS xiii
KCC15.3 Differential Diagnosis of Ataxia 675
CLINICAL CASES 67615.1 Sudden Onset of Unilateral Ataxia 676
15.2 Walking Like a Drunkard 67715.3 A Boy with Headaches, Nausea, Slurred Speech, and
Ataxia 680
15.4 Nausea, Progressive Unilateral Ataxia, and Right FaceNumbness 682
Additional Cases 686
BRIEF ANATOMICAL STUDY GUIDE 686
References 687
KCC16.2Parkinson'sDiseaseand RelatedDisorders 712
KCC16.3 Huntington'sDisease 716KCC16.4 Stereotactic Surgery for Movement Disorders and
Other Conditions 717
CLINICALCASES 719
16.1 Unilateral Flappingand Flinging 71916.2 IrregularJerking Movementsand MaritalProblems
720
16.3 Asymmetrical Resting Tremor, Rigidity,Bradykinesia,and Gait Difficulties 723
16.4 Bilateral Bradykinesia, Rigidity, and Gait Instabilitywith NoTremor 726
BRIEFANATOMICAL STUDY GUIDE 732
Additional Cases 733
References 733
Chapter 17 PituitaryandHypothalamus737ANATOMICALAND CLINICALREVIEW 738
Overall Anatomy of the Pituitary andHypothalamus 738
Important Hypothalamic Nuclei and Pathways740
Major Hypothalamic Nuclei 740Hypothalamic Control of the Autonomic Nervous
System 741
Hypothalamic-Limbic Pathways 742Other Regionalized Functions of the Hypothalamus
742
Endocrine Functions of the Pituitary andHypothalamus 743
KCC17.1 Pituitary Adenoma and Related Disorders 746
KCC17.2 Diabetes Insipidus and SIADH 749
KCC17.3 Panhypopituitarism 750
CLINICAL CASES 751
17.1 Moon Facies,Acne, Amenorrhea, and Hypertension751
17.2 Impotence, Anorexia, Polyuria, Blurred Vision,Headaches, and Hearing Loss 754
Additional Cases 756
BRIEF ANATOMICAL STUDY GUIDE 757
References 759
xiv CONTENTS
Chapter 18 LimbicSystem:Homeostasis,Olfaction,Memory,andEmotion 761
ANATOMICAL AND CLINICALREVIEW 762Overview of Limbic Structures 763
Olfactory System 770
Hippocampal Formation and Other Memory-Related Structures 771
Hippocampal Formation and Parahippocampal Gyrus772
Intrinsic Circuitry of the Hippocampal Formation776
Input and Output Connections of the MedialTemporal Lobe Memory System 777
The Fornix and Medial Diencephalic MemoryPathways 778
KCC18.1 MemoryDisorders 780The Amygdala: Emotions, Drives, and Other
Functions 787
Other Limbic Pathways 789
KCC18.2 Seizures and Epilepsy 790
KCC18.3 Anatomical and Neuropharmacological BasisofPsychiatricDisorders 798
CLINICAL CASES 800
Case 18.1 Sudden Memory Lossafter a Mild Head Injury800
Case 18.2 Progressive Severe Memory Loss,with MildConfabulation 802
Case18.3 TransientDiplopia,Lethargy,and Hemiparesis,Followedby a SustainedMemoryDeficit 804
Case18.4 Episodesof Panic,OlfactoryHallucinations,andLossof Awareness 806
Case18.5 Episodesof Staring,LipSmacking,and UnilateralSemipurposefulMovements 809
BRIEFANATOMICAL STUDY GUIDE 816Additional Cases 817
References 817
Chapter 19 Higher-OrderCerebralFunction 821ANATOMICAL AND CLINICALREVIEW 822KCC19.1 The Mental Status Exam 822Unimodal and Heteromodal Association Cortex
823
Principles of Cerebral Localization andLateralization 825
The Dominant Hemisphere: Language Processingand Related Functions 827
KCC19.2 Differential Diagnosis of Language Disorders 829KCC19.3 Bedside Language Exam 830KCC19.4 Broca's Aphasia 831KCC19.5 Wernicke's Aphasia 832KCC19.6 Simplified Aphasia Classification Scheme 833KCC19.7 Other Syndromes Related to Aphasia 835KCC19.8 Disconnection Syndromes 838The Nondominant Hemisphere: Mechanisms of
Attention and Spatial Processing 839LateralizedAspects of Attention 839Spatial Analysisand Integration 840
KCC19.9 Hemineglect Syndrome 841KCC19.10 Other Clinical Features of Nondominant
HemisphereLesions 846
The Frontal Lobes: Anatomy and Functions of anEnigmatic Brain Region 847
Regional Anatomy of the Frontal Lobes 847Connections of the Prefrontal Cortex 848Functions of the Frontal Lobes 849
KCC19.11FrontalLobeDisorders 850
Visual Association Cortex: Higher-Order VisualProcessing 854
KCC19.12Disordersof Higher-OrderVisualProcessing 855KCC19.13 Auditory Hallucinations 858Attention, Awareness, and Other General Network
Functions of The Brain 859General Mechanismsof Attention 859
Awareness of Self and Environment 862KCC19.14 Attentional Disorders 864KCC19.15Deliriumand Other Acute Mental Status
Disorders 865KCC19.16Dementiaand Other ChronicMental Status
Disorders 868
CLINICAL CASES 876
19.1 AcuteSevereAphasia,with Improvement 87619.2 Nonsensical Speech 879
19.3 Aphasia with Preserved Repetition 88119.4 Impaired Repetition 88219.5 Inability to Read, with Preserved Writing Skills 88319.6 Left Hemineglect 88819.7 Abulia 89119.8 Blindness without Awareness of Deficit 894
19.9 Sudden Inability to Recognize Faces 898
CONTENTS XV
19.10 Musical Hallucinations 899
19.11 Progressive Dementia, Beginning with MemoryProblems 901
Additional Cases 902
BRIEF ANATOMICAL STUDY GUIDE 904
References 906
Epilogue: A SimpleWorkingModelof the Mind 911CASEINDEX 915
SUBJECTINDEX 924