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Copyright, iv
Preface, xvi
How to Use This Book, xx
CHAPTER 1 Introduction to Clinical Case Presentations, 3
Introduction, 4
The General History and Physical Exam, 4
Chief Complaint (CC), 5
History of the Present Illness (HPI), 5
Past Medical History (PMH), 6
Review of Systems (ROS), 6
Family History (FHx), 6
Social and Environmental History (SocHx/EnvHx), 6
Medications and Allergies, 6
Physical Exam, 6
Laboratory Data, 7
Assessment and Plan, 7
Neurologic Differential Diagnosis, 7
Relationship between the General Physical Exam and the Neurologic Exam, 8
Conclusions, 10
References, 10
CHAPTER 2 Neuroanatomy Overview and Basic Definitions, 13
Basic Macroscopic Organization of the Nervous System, 14
Main Parts of the Nervous System, 14
Orientation and Planes of Section, 16
Basic Cellular and Neurochemical Organization of the Nervous System, 17
CNS Gray Matter and White Matter; PNS Ganglia and Nerves, 21
Spinal Cord and Peripheral Nervous System, 22
Cerebral Cortex: Basic Organization and Primary Sensory and Motor Areas, 24
Lobes of the Cerebral Hemispheres, 24
Surface Anatomy of the Cerebral Hemispheres in Detail, 25
Primary Sensory and Motor Areas, 28
Cell Layers and Regional Classification of the Cerebral Cortex, 29
Motor Systems, 32
Main Motor Pathways, 32
Cerebellum and Basal Ganglia, 34
Somatosensory Systems, 34
Main Somatosensory Pathways, 34
Thalamus, 35
Stretch Reflex, 37
Brainstem and Cranial Nerves, 38
Limbic System, 41
Association Cortex, 41
Blood Supply to the Brain and Spinal Cord, 44
Conclusions, 46
References, 46
CHAPTER 3 The Neurologic Exam as a Lesson in Neuroanatomy, 49
Overview of the Neurologic Exam, 50
neuroexam.com, 52
The Neurologic Exam: Examination Technique and What Is Being Tested, 52
1. Mental Status, 52
2. Cranial Nerves, 58
3. Motor Exam, 63
4. Reflexes, 66
5. Coordination and Gait, 68
6. Sensory Exam, 71
The Neurologic Exam as a Flexible Tool, 72
Exam Limitations and Strategies, 73
Coma Exam, 74
General Physical Exam, 74
1. Mental Status, 75
2. Cranial Nerves, 76
3. Sensory Exam and 4. Motor Exam, 77
5. Reflexes, 77
6. Coordination and Gait, 79
Brain Death, 79
Conversion Disorder, Malingering, and Related Disorders, 79
The Screening Neurologic Exam, 81
Conclusions, 81
References, 82
CHAPTER 4 Introduction to Clinical Neuroradiology, 85
Introduction, 86
Imaging Planes, 86
Computerized Tomography, 86
CT versus MRI, 89
Magnetic Resonance Imaging, 90
Neuroangiography, 98
Functional Neuroimaging, 99
Conclusions, 101
NEURORADIOLOGICAL ATLAS, 102
References, 123
CHAPTER 5 Brain and Environs: Cranium, Ventricles, and Meninges, 125
ANATOMICAL AND CLINICAL REVIEW, 126
Cranial Vault and Meninges, 126
Ventricles and Cerebrospinal Fluid, 132
Blood-Brain Barrier, 137
KCC 5.1 Headache, 139
KCC 5.2 Intracranial Mass Lesions, 141
KCC 5.3 Elevated Intracranial Pressure, 142
KCC 5.4 Brain Herniation Syndromes, 145
KCC 5.5 Head Trauma, 146
KCC 5.6 Intracranial Hemorrhage, 147
KCC 5.7 Hydrocephalus, 155
KCC 5.8 Brain Tumors, 157
KCC 5.9 Infectious Disorders of the Nervous System, 159
KCC 5.10 Lumbar Puncture, 167
KCC 5.11 Craniotomy, 169
CLINICAL CASES, 170
5.1 An Elderly Man with Headaches and Unsteady Gait, 170
5.2 Altered Mental Status Following Head Injury, 173
5.3 Delayed Unresponsiveness after Head Injury, 180
5.4 Headache and Progressive Left-Sided Weakness, 183
5.5 Sudden Coma and Bilateral Posturing during Intravenous Anticoagulation, 187
5.6 Severe Head Injury, 190
5.7 A Child with Headaches, Nausea, and Diplopia, 195
5.8 Headaches and Progressive Visual Loss, 203
5.9 An Elderly Man with Progressive Gait Difficulty, Cognitive Impairment, and Incontinence, 208
5.10 A Young Man with Headache, Fever, Confusion, and Stiff Neck, 212
Additional Cases, 213
BRIEF ANATOMICAL STUDY GUIDE, 214
A Scuba Expedition through the Brain, 215
References, 217
CHAPTER 6 Corticospinal Tract and Other Motor Pathways, 223
ANATOMICAL AND CLINICAL REVIEW, 224
Motor Cortex, Sensory Cortex, and Somatotopic Organization, 224
Basic Anatomy of the Spinal Cord, 226
Spinal Cord Blood Supply, 229
General Organization of the Motor Systems, 230
Lateral Corticospinal Tract, 232
Autonomic Nervous System, 238
KCC 6.1 Upper Motor Neuron versus Lower Motor Neuron Lesions, 241
KCC 6.2 Terms Used to Describe Weakness, 242
KCC 6.3 Weakness Patterns and Localization, 242
KCC 6.4 Detecting Subtle Hemiparesis at the Bedside, 250
KCC 6.5 Unsteady Gait, 251
KCC 6.6 Multiple Sclerosis, 252
KCC 6.7 Motor Neuron Disease, 254
CLINICAL CASES, 255
6.1 Sudden Onset of Right Hand Weakness, 255
6.2 Sudden Onset of Left Foot Weakness, 256
6.3 Sudden Onset of Right Face Weakness, 257
6.4 Pure Motor Hemiparesis I, 263
6.5 Pure Motor Hemiparesis II, 264
6.6 Progressive Weakness, Muscle Twitching, and Cramps, 267
Additional Cases, 268
BRIEF ANATOMICAL STUDY GUIDE, 269
References, 270
CHAPTER 7 Somatosensory Pathways, 275
ANATOMICAL AND CLINICAL REVIEW, 276
Main Somatosensory Pathways, 276
Posterior Column-Medial Lemniscal Pathway, 279
Spinothalamic Tract and Other Anterolateral Pathways, 280
Somatosensory Cortex, 282
Central Modulation of Pain, 282
The Thalamus, 282
Relay Nuclei, 284
Intralaminar Nuclei, 286
Reticular Nucleus, 286
KCC 7.1 Paresthesias, 287
KCC 7.2 Spinal Cord Lesions, 288
KCC 7.3 Sensory Loss: Patterns and Localization, 290
KCC 7.4 Spinal Cord Syndromes, 292
KCC 7.5 Anatomy of Bowel, Bladder, and Sexual Function, 295
CLINICAL CASES, 298
7.1 Sudden Onset of Right Arm Numbness, 298
7.2 Sudden Onset of Right Face, Arm, and Leg Numbness, 302
7.3 A Fall Causing Paraplegia and a Sensory Level, 303
7.4 Left Leg Weakness and Right Leg Numbness, 305
7.5 Sensory Loss over Both Shoulders, 307
7.6 Body Tingling and Unsteady Gait, 309
7.7 Hand Weakness, Pinprick Sensory Level, and Urinary Retention, 311
Additional Cases, 313
BRIEF ANATOMICAL STUDY GUIDE, 313
References, 315
CHAPTER 8 Spinal Nerve Roots, 319
ANATOMICAL AND CLINICAL REVIEW, 320
Segmental Organization of the Nervous System, 320
Nerve Roots in Relation to Vertebral Bones, Discs, and Ligaments, 321
Dermatomes and Myotomes, 323
KCC 8.1 Disorders of Nerve, Neuromuscular Junction, and Muscle, 327
KCC 8.2 Back Pain, 330
KCC 8.3 Radiculopathy, 331
Simplification: Three Nerve Roots to Remember in the Arm, 334
Simplification: Three Nerve Roots to Remember in the Leg, 334
KCC 8.4 Cauda Equina Syndrome, 334
KCC 8.5 Common Surgical Approaches to the Spine, 335
CLINICAL CASES, 336
8.1 Unilateral Neck Pain and Tingling Numbness in the Thumb and Index Finger, 336
8.2 Unilateral Occipital and Neck Pain, 337
8.3 Unilateral Shoulder Pain and Weakness, 337
8.4 Blisters, Pain, and Weakness in the Left Arm, 340
8.5 Unilateral Shoulder Pain and Numbness in the Index and Middle Fingers, 341
8.6 Unilateral Neck Pain, Hand Weakness, and Numbness in the Ring and Little Fingers, 342
8.7 Pain and Numbness in the Medial Arm, 343
8.8 Low Back Pain Radiating to the Sole of the Foot and the Small Toe, 343
8.9 Unilateral Thigh Weakness with Pain Radiating to the Anterior Shin, 345
8.10 Low Back Pain Radiating to the Big Toe, 348
8.11 Saddle Anesthesia with Loss of Sphincteric and Erectile Function, 349
Additional Cases, 351
BRIEF ANATOMICAL STUDY GUIDE, 351
References, 353
CHAPTER 9 Major Plexuses and Peripheral Nerves, 357
ANATOMICAL AND CLINICAL REVIEW, 358
Brachial Plexus and Lumbosacral Plexus, 358
Simplification: Five Nerves to Remember in the Arm, 360
Simplification: Three Nerves Acting on the Thumb, 362
Intrinsic and Extrinsic Hand Muscles, 362
Simplification: Five Nerves to Remember in the Leg, 363
KCC 9.1 Common Plexus and Nerve Syndromes, 364
KCC 9.2 Electromyography (EMG) and Nerve Conduction Studies, 367
CLINICAL CASES, 369
9.1 Complete Paralysis and Loss of Sensation in One Arm, 369
9.2 A Newborn with Weakness in One Arm, 371
9.3 A Blow to the Medial Arm Causing Hand Weakness and Numbness, 372
9.4 Nocturnal Pain and Tingling in the Thumb, Pointer, and Middle Finger, 373
9.5 Hand and Wrist Weakness after a Fall, 374
9.6 Numbness and Tingling in the Pinky and Ring Finger, 375
9.7 Shoulder Weakness and Numbness after Strangulation, 376
9.8 Unilateral Thigh Pain, Weakness, and Numbness in a Diabetic, 377
9.9 Tingling and Paralysis of the Foot after a Fall, 377
9.10 A Leg Injury Resulting in Foot Drop, 379
9.11 Lateral Thigh Pain and Numbness after Pregnancy, 381
9.12 Dysarthria, Ptosis, and Decreased Exercise Tolerance, 381
9.13 Generalized Weakness and Areflexia, 383
9.14 Mysterious Weakness after Dinner, 385
Additional Cases, 386
BRIEF ANATOMICAL STUDY GUIDE, 386
References, 387
CHAPTER 10 Cerebral Hemispheres and Vascular Supply, 391
ANATOMICAL AND CLINICAL REVIEW, 392
Review of Main Functional Areas of Cerebral Cortex, 392
Circle of Willis: Anterior and Posterior Circulations, 393
Anatomy and Vascular Territories of the Three Main Cerebral Arteries, 395
Vascular Territories of the Superficial Cerebral Structures, 395
Vascular Territories of the Deep Cerebral Structures, 396
KCC 10.1 Clinical Syndromes of the Three Cerebral Arteries, 400
KCC 10.2 Watershed Infarcts, 402
KCC 10.3 Transient Ischemic Attack and Other Transient Neurologic Episodes, 403
KCC 10.4 Ischemic Stroke: Mechanisms and Treatment, 405
KCC 10.5 Carotid Stenosis, 410
KCC 10.6 Dissection of the Carotid or Vertebral Arteries, 411
Venous Drainage of the Cerebral Hemispheres, 411
KCC 10.7 Sagittal Sinus Thrombosis, 413
CLINICAL CASES, 413
10.1 Sudden-Onset Worst Headache of Life, 413
10.2 Left Leg Weakness and Left Alien Hand Syndrome, 415
10.3 Decreased Vision on One Side, 416
10.4 Transient Episodes of Left Eye Blurriness or Right Hand Weakness, 425
10.5 Nonfluent Aphasia with Right Face and Arm Weakness, 427
10.6 “Talking Ragtime”, 429
10.7 Dysarthria and Hemiparesis, 432
10.8 Global Aphasia, Right Hemiplegia, and Hemianopia, 434
10.9 Left Face and Arm Weakness, 437
10.10 Left Hemineglect, 438
10.11 Left Hemineglect, Hemiplegia, and Hemianopia, 439
10.12 Unilateral Proximal Arm and Leg Weakness, 446
10.13 Right Frontal Headache and Left Arm Numbness in a Woman with Gastric Carcinoma, 447
Additional Cases, 453
BRIEF ANATOMICAL STUDY GUIDE, 453
References, 454
CHAPTER 11 Visual System, 459
ANATOMICAL AND CLINICAL REVIEW, 460
Eyes and Retina, 460
Optic Nerves, Optic Chiasm, and Optic Tracts, 463
Lateral Geniculate Nucleus and Extrageniculate Pathways, 464
Optic Radiations to Primary Visual Cortex, 465
Visual Processing in the Neocortex, 467
Parallel Channels for Analyzing Motion, Form, and Color, 467
Ocular Dominance Columns and Orientation Columns, 469
KCC 11.1 Assessment of Visual Disturbances, 470
KCC 11.2 Localization of Visual Field Defects, 472
KCC 11.3 Blood Supply and Ischemia in the Visual Pathways, 476
KCC 11.4 Optic Neuritis, 477
CLINICAL CASES, 478
11.1 A Dark Spot Seen with One Eye, 478
11.2 Vision Loss in One Eye, 479
11.3 Menstrual Irregularity and Bitemporal Hemianopia, 481
11.4 Hemianopia after Treatment for a Temporal Lobe Tumor, 483
11.5 Visual Changes Caused by Migraine Headaches?, 485
11.6 Sudden Loss of Left Vision, 486
Additional Cases, 487
BRIEF ANATOMICAL STUDY GUIDE, 487
References, 491
CHAPTER 12 Brainstem I: Surface Anatomy and Cranial Nerves, 493
ANATOMICAL AND CLINICAL REVIEW, 494
Surface Features of the Brainstem, 495
Skull Foramina and Cranial Nerve Exit Points, 498
Sensory and Motor Organization of the Cranial Nerves, 500
Functions and Course of the Cranial Nerves, 503
CN I: Olfactory Nerve, 505
KCC 12.1 Anosmia (CN I), 506
CN II: Optic Nerve, 506
CN III, IV, and VI: Oculomotor, Trochlear, and Abducens Nerves, 506
CN V: Trigeminal Nerve, 508
Trigeminal Somatic Sensory Functions, 509
Trigeminal Branchial Motor Functions, 512
KCC 12.2 Trigeminal Nerve Disorders (CN V), 512
CN VII: Facial Nerve, 513
KCC 12.3 Facial Nerve Lesions (CN VII), 516
KCC 12.4 Corneal Reflex and Jaw Jerk Reflex (CN V, VII), 518
CN VIII: Vestibulocochlear Nerve, 518
Auditory Pathways, 519
Vestibular Pathways, 523
KCC 12.5 Hearing Loss (CN VIII), 525
KCC 12.6 Dizziness and Vertigo (CN VIII), 527
CN IX: Glossopharyngeal Nerve, 530
CN X: Vagus Nerve, 532
CN XI: Spinal Accessory Nerve, 534
CN XII: Hypoglossal Nerve, 534
KCC 12.7 Disorders of CN IX, X, XI, and XII, 535
KCC 12.8 Hoarseness, Dysarthria, Dysphagia, and Pseudobulbar Affect, 536
Review: Cranial Nerve Combinations, 537
CLINICAL CASES, 539
12.1 Anosmia and Visual Impairment, 539
12.2 Cheek Numbness and a Bulging Eye, 541
12.3 Jaw Numbness and Episodes of Loss of Consciousness, 542
12.4 Isolated Facial Weakness, 543
12.5 Hearing Loss and Dizziness, 548
12.6 Hoarse Voice following Cervical Disc Surgery, 549
12.7 Hoarseness, with Unilateral Wasting of the Neck and Tongue Muscles, 553
12.8 Uncontrollable Laughter, Dysarthria, Dysphagia, and Left-Sided Weakness, 555
Additional Cases, 559
BRIEF ANATOMICAL STUDY GUIDE, 559
References, 561
CHAPTER 13 Brainstem II: Eye Movements and Pupillary Control, 565
ANATOMICAL AND CLINICAL REVIEW, 566
Extraocular Muscles, Nerves, and Nuclei, 566
Extraocular Muscles, 566
Extraocular Nerves and Nuclei, 568
KCC 13.1 Diplopia, 571
KCC 13.2 Oculomotor Palsy (CN III), 572
KCC 13.3 Trochlear Palsy (CN IV), 574
KCC 13.4 Abducens Palsy (CN VI), 575
The Pupils and Other Ocular Autonomic Pathways, 576
KCC 13.5 Pupillary Abnormalities, 579
KCC 13.6 Ptosis, 582
Cavernous Sinus and Orbital Apex, 583
KCC 13.7 Cavernous Sinus Syndrome (CN III, IV, VI, V1) and Orbital Apex Syndrome (CN II, III, IV, VI, V1), 584
Supranuclear Control of Eye Movements, 584
Brainstem Circuits for Horizontal Eye Movements, 585
KCC 13.8 Brainstem Lesions Affecting Horizontal Gaze, 586
Brainstem Circuits for Vertical and Vergence Eye Movements, 587
KCC 13.9 Parinaud’s Syndrome, 588
Control of Eye Movements by the Forebrain, 588
KCC 13.10 Right-Way Eyes and Wrong-Way Eyes, 589
Cerebellar, Vestibular, and Spinal Control of Voluntary and Reflex Eye Movements, 590
CLINICAL CASES, 591
13.1 Double Vision and Unilateral Eye Pain, 591
13.2 A Diabetic with Horizontal Diplopia, 593
13.3 Vertical Diplopia, 594
13.4 Left Eye Pain and Horizontal Diplopia, 595
13.5 Unilateral Headache, Ophthalmoplegia, and Forehead Numbness, 596
13.6 Ptosis, Miosis, and Anhidrosis, 598
13.7 Wrong-Way Eyes, 602
13.8 Horizontal Diplopia in a Patient with Multiple Sclerosis, 603
13.9 Headaches and Impaired Upgaze, 604
Additional Cases, 605
BRIEF ANATOMICAL STUDY GUIDE, 607
References, 610
CHAPTER 14 Brainstem III: Internal Structures and Vascular Supply, 613
ANATOMICAL AND CLINICAL REVIEW, 614
Main Components of the Brainstem, 614
Brainstem Sections, 615
Cranial Nerve Nuclei and Related Structures, 622
Long Tracts, 624
KCC 14.1 Locked-In Syndrome, 625
Cerebellar Circuitry, 625
Reticular Formation and Related Structures, 626
The Consciousness System, 627
Widespread Projection Systems of Brainstem and Forebrain: Consciousness, Attention, and Other Functions, 630
Anatomy of the Sleep-Wake Cycle, 637
KCC 14.2 Coma and Related Disorders, 640
Reticular Formation: Motor, Reflex, and Autonomic Systems, 646
Brainstem Vascular Supply, 648
KCC 14.3 Vertebrobasilar Vascular Disease, 654
CLINICAL CASES, 661
14.1 Face and Contralateral Body Numbness, Hoarseness, Horner’s Syndrome, and Ataxia, 661
14.2 Hemiparesis Sparing the Face, 663
14.3 Dysarthria and Hemiparesis, 668
14.4 Unilateral Face Numbness, Hearing Loss, and Ataxia, 669
14.5 Locked In, 673
14.6 Wrong-Way Eyes, Limited Upgaze, Decreased Responsiveness, and Hemiparesis with an Amazing Recovery, 675
14.7 Diplopia and Unilateral Ataxia, 682
14.8 Intermittent Memory Loss, Diplopia, Sparkling Lights, and Somnolence, 683
14.9 Intractable Hiccups, 687
Additional Cases, 688
BRIEF ANATOMICAL STUDY GUIDE, 692
References, 693
CHAPTER 15 Cerebellum, 697
ANATOMICAL AND CLINICAL REVIEW, 698
Cerebellar Lobes, Peduncles, and Deep Nuclei, 698
Microscopic Circuitry of the Cerebellum, 703
Cerebellar Output Pathways, 705
Cerebellar Input Pathways, 708
Vascular Supply to the Cerebellum, 711
KCC 15.1 Cerebellar Artery Infarcts and Cerebellar Hemorrhage, 713
KCC 15.2 Clinical Findings and Localization of Cerebellar Lesions, 714
KCC 15.3 Differential Diagnosis of Ataxia, 719
CLINICAL CASES, 720
15.1 Sudden Onset of Unilateral Ataxia, 720
15.2 Walking Like a Drunkard, 721
15.3 A Boy with Headaches, Nausea, Slurred Speech, and Ataxia, 725
15.4 Nausea, Progressive Unilateral Ataxia, and Right Face Numbness, 727
15.5 A Family with Slowly Progressive Ataxia and Dementia, 731
Additional Cases, 732
BRIEF ANATOMICAL STUDY GUIDE, 733
References, 736
CHAPTER 16 Basal Ganglia, 739
ANATOMICAL AND CLINICAL REVIEW, 740
Basic Three-Dimensional Anatomy of the Basal Ganglia, 740
Input, Output, and Intrinsic Connections of the Basal Ganglia, 748
Inputs to the Basal Ganglia, 748
Outputs from the Basal Ganglia, 749
Intrinsic Basal Ganglia Connections, 749
Hyperkinetic and Hypokinetic Movement Disorders, 751
Parallel Basal Ganglia Pathways for General Movement, Eye Movement, Cognition, and Emotion, 752
Ansa Lenticularis, Lenticular Fasciculus, and the Fields of Forel, 754
KCC 16.1 Movement Disorders, 755
KCC 16.2 Parkinson’s Disease and Related Disorders, 762
KCC 16.3 Huntington’s Disease, 766
KCC 16.4 Stereotactic Surgery and Deep Brain Stimulation, 768
CLINICAL CASES, 770
16.1 Unilateral Flapping and Flinging, 770
16.2 Irregular Jerking Movements and Marital Problems, 771
16.3 Asymmetrical Resting Tremor, Rigidity, Bradykinesia, and Gait Difficulties, 775
16.4 Bilateral Bradykinesia, Rigidity, and Gait Instability with No Tremor, 779
Additional Cases, 784
BRIEF ANATOMICAL STUDY GUIDE, 785
References, 786
CHAPTER 17 Pituitary and Hypothalamus, 791
ANATOMICAL AND CLINICAL REVIEW, 792
Overall Anatomy of the Pituitary and Hypothalamus, 792
Important Hypothalamic Nuclei and Pathways, 794
Major Hypothalamic Nuclei, 794
Hypothalamic Control of the Autonomic Nervous System, 795
Hypothalamic-Limbic Pathways, 796
Other Regionalized Functions of the Hypothalamus, 796
Endocrine Functions of the Pituitary and Hypothalamus, 797
KCC 17.1 Pituitary Adenoma and Related Disorders, 800
KCC 17.2 Diabetes Insipidus and SIADH, 803
KCC 17.3 Panhypopituitarism, 804
CLINICAL CASES, 805
17.1 Moon Facies, Acne, Amenorrhea, and Hypertension, 805
17.2 Impotence, Anorexia, Polyuria, Blurred Vision, Headaches, and Hearing Loss, 809
17.3 A Child with Giggling Episodes and Aggressive Behavior, 811
Additional Cases, 815
BRIEF ANATOMICAL STUDY GUIDE, 815
References, 816
CHAPTER 18 Limbic System: Homeostasis, Olfaction, Memory, and Emotion, 819
ANATOMICAL AND CLINICAL REVIEW, 820
Overview of Limbic Structures, 821
Olfactory System, 827
Hippocampal Formation and Other Memory-Related Structures, 829
Hippocampal Formation and Parahippocampal Gyrus, 830
Intrinsic Circuitry of the Hippocampal Formation, 834
Input and Output Connections of the Medial Temporal Lobe Memory System, 835
The Fornix and Medial Diencephalic Memory Pathways, 836
KCC 18.1 Memory Disorders, 838
The Amygdala: Emotions, Drives, and Other Functions, 845
Other Limbic Pathways, 847
KCC 18.2 Seizures and Epilepsy, 848
KCC 18.3 Anatomical and Neuropharmacological Basis of Psychiatric Disorders, 856
CLINICAL CASES, 859
18.1 Sudden Memory Loss after a Mild Head Injury, 859
18.2 Progressive Severe Memory Loss, with Mild Confabulation, 860
18.3 Transient Diplopia, Lethargy, and Hemiparesis, Followed by a Sustained Memory Deficit, 863
18.4 Episodes of Panic, Olfactory Hallucinations, and Loss of Awareness, 865
18.5 Episodes of Staring, Lip Smacking, and Unilateral Semipurposeful Movements, 868
Additional Cases, 870
BRIEF ANATOMICAL STUDY GUIDE, 874
References, 875
CHAPTER 19 Higher-Order Cerebral Function, 879
ANATOMICAL AND CLINICAL REVIEW, 880
KCC 19.1 The Mental Status Exam, 880
Unimodal and Heteromodal Association Cortex, 881
Principles of Cerebral Localization and Lateralization, 883
The Dominant Hemisphere: Language Processing and Related Functions, 885
Anatomy of Language Processing, 885
KCC 19.2 Differential Diagnosis of Language Disorders, 888
KCC 19.3 Bedside Language Exam, 889
KCC 19.4 Broca’s Aphasia, 889
KCC 19.5 Wernicke’s Aphasia, 891
KCC 19.6 Simplified Aphasia Classification Scheme, 892
KCC 19.7 Other Syndromes Related to Aphasia, 894
KCC 19.8 Disconnection Syndromes, 897
The Nondominant Hemisphere: Spatial Processing and Lateralized Attention, 898
Lateralized Aspects of Attention, 898
Spatial Analysis and Integration, 899
KCC 19.9 Hemineglect Syndrome, 900
KCC 19.10 Other Clinical Features of Nondominant Hemisphere Lesions, 905
The Frontal Lobes: Anatomy and Functions of an Enigmatic Brain Region, 906
Regional Anatomy of the Frontal Lobes, 906
Connections of the Prefrontal Cortex, 907
Functions of the Frontal Lobes, 908
KCC 19.11 Frontal Lobe Disorders, 908
Visual Association Cortex: Higher-Order Visual Processing, 913
KCC 19.12 Disorders of Higher-Order Visual Processing, 914
KCC 19.13 Auditory Hallucinations, 917
The Consciousness System Revisited: Anatomy of Attention and Awareness, 918
General Mechanisms of Attention, 919
Anatomy of Attention, 920
Awareness of Self and Environment, 922
KCC 19.14 Attentional Disorders, 924
KCC 19.15 Delirium and Other Acute Mental Status Disorders, 926
KCC 19.16 Dementia and Other Chronic Mental Status Disorders, 928
CLINICAL CASES, 937
19.1 Acute Severe Aphasia, with Improvement, 937
19.2 Nonsensical Speech, 939
19.3 Aphasia with Preserved Repetition, 940
19.4 Impaired Repetition, 942
19.5 Inability to Read, with Preserved Writing Skills, 948
19.6 Left Hemineglect, 949
19.7 Abulia, 952
19.8 Blindness without Awareness of Deficit, 956
19.9 Sudden Inability to Recognize Faces, 960
19.10 Musical Hallucinations, 961
19.11 Progressive Dementia, Beginning with Memory Problems, 963
Additional Cases, 964
BRIEF ANATOMICAL STUDY GUIDE, 966
References, 968
Epilogue: A Simple Working Model of the Mind, 972
Case Index, 977
Subject Index, 983

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