Download Neuroanatomy through Clinical Cases 2nd Ed

Neuroanatomy through Clinical Cases 2nd Edition pdf

Neuroanatomy through Clinical Cases brings a pioneering interactive approach to the teaching of neuroanatomy, using over 100 actual clinical cases and high-quality radiologic images to bring the subject to life.

The second edition is fully updated with the latest advances in the field, and includes several exciting new cases. This approach allows students to appreciate the clinical relevance of structural details as they are being learned, and to integrate knowledge of disparate functional systems, since a single lesion may affect several different neural structures and pathways.

Table of Contents

Table of Contents – Neuroanatomy through Clinical Cases

How to Use This Book

Chapter 1. Introduction to Clinical Case Presentations
The General History and Physical Exam
Chief Complaint (CC)
History of the Present Illness (HPI)
Past Medical History (PMH)
Review of Systems (ROS)
Family History (FHx)
Social and Environmental History (SocHx/EnvHx)
Medications and Allergies
Physical Exam
Laboratory Data
Assessment and Plan
Neurologic Differential Diagnosis
Relationship between the General Physical Exam and the Neurologic Exam
References Neuroanatomy through Clinical Cases

Chapter 2. Neuroanatomy Overview and Basic Definitions
Basic Macroscopic Organization of the Nervous System
Main Parts of the Nervous System
Orientation and Planes of Section
Basic Cellular and Neurochemical Organization of the Nervous System
CNS Gray Matter and White Matter; PNS Ganglia and Nerves
Spinal Cord and Peripheral Nervous System
Cerebral Cortex: Basic Organization and Primary Sensory and Motor Areas
Lobes of the Cerebral Hemispheres
Surface Anatomy of the Cerebral Hemispheres in Detail
Primary Sensory and Motor Areas
Cell Layers and Regional Classification of the Cerebral Cortex
Motor Systems
Main Motor Pathways
Cerebellum and Basal Ganglia
Somatosensory Systems
Main Somatosensory Pathways
Stretch Reflex
Brainstem and Cranial Nerves
Limbic System
Association Cortex
Blood Supply to the Brain and Spinal Cord
References Neuroanatomy through Clinical Cases

Chapter 3. The Neurologic Exam as a Lesson in Neuroanatomy
Overview of the Neurologic Exam
The Neurologic Exam: Examination Technique and What Is Being Tested

  1. Mental Status
  2. Cranial Nerves
  3. Motor Exam
  4. Reflexes
  5. Coordination and Gait
  6. Sensory Exam
    The Neurologic Exam as a Flexible Tool
    Exam Limitations and Strategies
    Coma Exam
    General Physical Exam
  7. Mental Status
  8. Cranial Nerves
  9. Sensory Exam and 4. Motor Exam
  10. Reflexes
  11. Coordination and Gait
    Brain Death
    Conversion Disorder, Malingering, and Related Disorders
    The Screening Neurologic Exam
    References Neuroanatomy through Clinical Cases

Chapter 4. Introduction to Clinical Neuroradiology
Imaging Planes
Computerized Tomography
CT versus MRI
Magnetic Resonance Imaging
Functional Neuroimaging
References Neuroanatomy through Clinical Cases

Chapter 5. Brain and Environs: Cranium, Ventricles, and Meninges
Anatomical and Clinical Review
Cranial Vault and Meninges
Ventricles and Cerebrospinal Fluid
Blood-Brain Barrier
KCC 5.1. Headache
KCC 5.2. Intracranial Mass Lesions
KCC 5.3. Elevated Intracranial Pressure
KCC 5.4. Brain Herniation Syndromes
KCC 5.5. Head Trauma
KCC 5.6. Intracranial Hemorrhage
KCC 5.7. Hydrocephalus
KCC 5.8. Brain Tumors
KCC 5.9. Infectious Disorders of the Nervous System
KCC 5.10. Lumbar Puncture
KCC 5.11. Craniotomy
Clinical Cases
5.1. An Elderly Man with Headaches and Unsteady Gait
5.2. Altered Mental Status Following Head Injury
5.3. Delayed Unresponsiveness after Head Injury
5.4. Headache and Progressive Left-Sided Weakness
5.5. Sudden Coma and Bilateral Posturing during Intravenous Anticoagulation
5.6. Severe Head Injury
5.7. A Child with Headaches, Nausea, and Diplopia
5.8. Headaches and Progressive Visual Loss
5.9. An Elderly Man with Progressive Gait Difficulty, Cognitive Impairment, and Incontinence
5.10. A Young Man with Headache, Fever, Confusion, and Stiff Neck
Additional Cases
Brief Anatomical Study Guide
A Scuba Expedition through the Brain
References Neuroanatomy through Clinical Cases

Chapter 6. Corticospinal Tract and Other Motor Pathways
Anatomical and Clinical Review
Motor Cortex, Sensory Cortex, and Somatotopic Organization
Basic Anatomy of the Spinal Cord
Spinal Cord Blood Supply
General Organization of the Motor Systems
Lateral Corticospinal Tract
Autonomic Nervous System
KCC 6.1. Upper Motor Neuron versus Lower Motor Neuron Lesions
KCC 6.2. Terms Used to Describe Weakness
KCC 6.3. Weakness Patterns and Localization
KCC 6.4. Detecting Subtle Hemiparesis at the Bedside
KCC 6.5. Unsteady Gait
KCC 6.6. Multiple Sclerosis
KCC 6.7. Motor Neuron Disease
Clinical Cases
6.1 . Sudden Onset of Right Hand Weakness
6.2 . Sudden Onset of Left Foot Weakness
6.3 . Sudden Onset of Right Face Weakness
6.4 . Pure Motor Hemiparesis I
6.5 . Pure Motor Hemiparesis II
6.6 . Progressive Weakness, Muscle Twitching, and Cramps
Additional Cases
Brief Anatomical Study Guide
References Neuroanatomy through Clinical Cases

Chapter 7. Somatosensory Pathways
Anatomical and Clinical Review
Main Somatosensory Pathways
Posterior Column-Medial Lemniscal Pathway
Spinothalamic Tract and Other Anterolateral Pathways
Somatosensory Cortex
Central Modulation of Pain
The Thalamus
Relay Nuclei
Intralaminar Nuclei
Reticular Nucleus
KCC 7.1. Paresthesias
KCC 7.2. Spinal Cord Lesions
KCC 7.3. Sensory Loss: Patterns and Localization
KCC 7.4. Spinal Cord Syndromes
KCC 7.5. Anatomy of Bowel, Bladder, and Sexual Function
Clinical Cases
7.1. Sudden Onset of Right Arm Numbness
7.2. Sudden Onset of Right Face, Arm, and Leg Numbness
7.3. A Fall Causing Paraplegia and a Sensory Level
7.4. Left Leg Weakness and Right Leg Numbness
7.5. Sensory Loss over Both Shoulders
7.6. Body Tingling and Unsteady Gait
7.7. Hand Weakness, Pinprick Sensory Level, and Urinary Retention
Additional Cases
Brief Anatomical Study Guide
References Neuroanatomy through Clinical Cases

Chapter 8. Spinal Nerve Roots
Anatomical and Clinical Review
Segmental Organization of the Nervous System
Nerve Roots in Relation to Vertebral Bones, Discs, and Ligaments
Dermatomes and Myotomes
KCC 8.1. Disorders of Nerve, Neuromuscular Junction, and Muscle
KCC 8.2. Back Pain
KCC 8.3. Radiculopathy
Simplification: Three Nerve Roots to Remember in the Arm
Simplification: Three Nerve Roots to Remember in the Leg
KCC 8.4. Cauda Equina Syndrome
KCC 8.5. Common Surgical Approaches to the Spine
Clinical Cases
8.1. Unilateral Neck Pain and Tingling Numbness in the Thumb and Index Finger
8.2. Unilateral Occipital and Neck Pain
8.3. Unilateral Shoulder Pain and Weakness
8.4. Blisters, Pain, and Weakness in the Left Arm
8.5. Unilateral Shoulder Pain and Numbness in the Index and Middle Fingers
8.6. Unilateral Neck Pain, Hand Weakness, and Numbness in the Ring and Little Fingers
8.7. Pain and Numbness in the Medial Arm
8.8. Low Back Pain Radiating to the Sole of the Foot and the Small Toe
8.9. Unilateral Thigh Weakness with Pain Radiating to the Anterior Shin
8.10. Low Back Pain Radiating to the Big Toe
8.11. Saddle Anesthesia with Loss of Sphincteric and Erectile Function
Additional Cases
Brief Anatomical Study Guide
References Neuroanatomy through Clinical Cases

Chapter 9. Major Plexuses and Peripheral Nerves
Anatomical and Clinical Review
Brachial Plexus and Lumbosacral Plexus
Simplification: Five Nerves to Remember in the Arm
Simplification: Three Nerves Acting on the Thumb
Intrinsic and Extrinsic Hand Muscles
Simplification: Five Nerves to Remember in the Leg
KCC 9.1. Common Plexus and Nerve Syndromes
KCC 9.2. Electromyography (EMG) and Nerve Conduction Studies
Clinical Cases
9.1. Complete Paralysis and Loss of Sensation in One Arm
9.2 . A Newborn with Weakness in One Arm
9.3 . A Blow to the Medial Arm Causing Hand Weakness and Numbness
9.4 . Nocturnal Pain and Tingling in the Thumb, Pointer, and Middle Finger
9.5. Hand and Wrist Weakness after a Fall
9.6 . Numbness and Tingling in the Pinky and Ring Finger
9.7 . Shoulder Weakness and Numbness after Strangulation
9.8 . Unilateral Thigh Pain, Weakness, and Numbness in a Diabetic
9.9 . Tingling and Paralysis of the Foot after a Fall
9.10. A Leg Injury Resulting in Foot Drop
9.11. Lateral Thigh Pain and Numbness after Pregnancy
9.12. Dysarthria, Ptosis, and Decreased Exercise Tolerance
9.13. Generalized Weakness and Areflexia
9.14. Mysterious Weakness after Dinner
Additional Cases
Brief Anatomical Study Guide
References Neuroanatomy through Clinical Cases

Chapter 10. Cerebral Hemispheres and Vascular Supply
Anatomical and Clinical Review
Review of Main Functional Areas of Cerebral Cortex
Circle of Willis: Anterior and Posterior Circulations
Anatomy and Vascular Territories of the Three Main Cerebral Arteries
Vascular Territories of the Superficial Cerebral Structures
Vascular Territories of the Deep Cerebral Structures
KCC 10.1. Clinical Syndromes of the Three Cerebral Arteries
KCC 10.2. Watershed Infarcts
KCC 10.3. Transient Ischemic Attack and Other Transient Neurologic Episodes
KCC 10.4. Ischemic Stroke: Mechanisms and Treatment
KCC 10.5. Carotid Stenosis
KCC 10.6. Dissection of the Carotid or Vertebral Arteries
Venous Drainage of the Cerebral Hemispheres
KCC 10.7. Sagittal Sinus Thrombosis
Clinical Cases
10.1 . Sudden-Onset Worst Headache of Life
10.2 . Left Leg Weakness and Left Alien Hand Syndrome
10.3 . Decreased Vision on One Side
10.4 . Transient Episodes of Left Eye Blurriness or Right Hand Weakness
10.5 . Nonfluent Aphasia with Right Face and Arm Weakness
10.6 . 10.7 . Dysarthria and Hemiparesis
10.8 . Global Aphasia, Right Hemiplegia, and Hemianopia
10.9 . Left Face and Arm Weakness
10.10. Left Hemineglect
10.11. Left Hemineglect, Hemiplegia, and Hemianopia
10.12. Unilateral Proximal Arm and Leg Weakness
10.13. Right Frontal Headache and Left Arm Numbness in a Woman with Gastric Carcinoma
Additional Cases
Brief Anatomical Study Guide
References Neuroanatomy through Clinical Cases

Chapter 11. Visual System
Anatomical and Clinical Review
Eyes and Retina
Optic Nerves, Optic Chiasm, and Optic Tracts
Lateral Geniculate Nucleus and Extrageniculate Pathways
Optic Radiations to Primary Visual Cortex
Visual Processing in the Neocortex
Parallel Channels for Analyzing Motion, Form, and Color
Ocular Dominance Columns and Orientation Columns
KCC 11.1. Assessment of Visual Disturbances
KCC 11.2. Localization of Visual Field Defects
KCC 11.3. Blood Supply and Ischemia in the Visual Pathways
KCC 11.4. Optic Neuritis
Clinical Cases
11.1. A Dark Spot Seen with One Eye
11.2. Vision Loss in One Eye
11.3. Menstrual Irregularity and Bitemporal Hemianopia
11.4. Hemianopia after Treatment for a Temporal Lobe Tumor
11.5. Visual Changes Caused by Migraine Headaches?
11.6. Sudden Loss of Left Vision
Additional Cases
Brief Anatomical Study Guide
References Neuroanatomy through Clinical Cases

Chapter 12. Brainstem I: Surface Anatomy and Cranial Nerves
Anatomical and Clinical Review
Surface Features of the Brainstem
Skull Foramina and Cranial Nerve Exit Points
Sensory and Motor Organization of the Cranial Nerves
Functions and Course of the Cranial Nerves
CN I: Olfactory Nerve
KCC 12.1. Anosmia (CN I)
CN II: Optic Nerve
CN III, IV, and VI: Oculomotor, Trochlear, and Abducens Nerves
CN V: Trigeminal Nerve
Trigeminal Somatic Sensory Functions
Trigeminal Branchial Motor Functions
KCC 12.2. Trigeminal Nerve Disorders (CN V)
CN VII: Facial Nerve
KCC 12.3. Facial Nerve Lesions (CN VII)
KCC 12.4. Corneal Reflex and Jaw Jerk Reflex (CN V, VII)
CN VIII: Vestibulocochlear Nerve
Auditory Pathways
Vestibular Pathways
KCC 12.5. Hearing Loss (CN VIII)
KCC 12.6. Dizziness and Vertigo (CN VIII)
CN IX: Glossopharyngeal Nerve
CN X: Vagus Nerve
CN XI: Spinal Accessory Nerve
CN XII: Hypoglossal Nerve
KCC 12.7. Disorders of CN IX, X, XI, and XII
KCC 12.8. Hoarseness, Dysarthria, Dysphagia, and Pseudobulbar Affect
Review: Cranial Nerve Combinations
Clinical Cases Neuroanatomy through Clinical Cases
12.1. Anosmia and Visual Impairment
12.2. Cheek Numbness and a Bulging Eye
12.3. Jaw Numbness and Episodes of Loss of Consciousness
12.4. Isolated Facial Weakness
12.5. Hearing Loss and Dizziness
12.6. Hoarse Voice following Cervical Disc Surgery
12.7. Hoarseness, with Unilateral Wasting of the Neck and Tongue Muscles
12.8. Uncontrollable Laughter, Dysarthria, Dysphagia, and Left-Sided Weakness
Additional Cases
Brief Anatomical Study Guide
References Neuroanatomy through Clinical Cases

Chapter 13. Brainstem II: Eye Movements and Pupillary Control
Anatomical and Clinical Review
Extraocular Muscles, Nerves, and Nuclei
Extraocular Muscles
Extraocular Nerves and Nuclei
KCC 13.1. Diplopia
KCC 13.2. Oculomotor Palsy (CN III)
KCC 13.3. Trochlear Palsy (CN IV)
KCC 13.4. Abducens Palsy (CN VI)
The Pupils and Other Ocular Autonomic Pathways
KCC 13.5. Pupillary Abnormalities
KCC 13.6 Ptosis
Cavernous Sinus and Orbital Apex
KCC 13.7. Cavernous Sinus Syndrome (CN III, IV, VI, V1) and Orbital Apex Syndrome (CN II, III, IV, VI, V1)
Supranuclear Control of Eye Movements
Brainstem Circuits for Horizontal Eye Movements
KCC 13.8. Brainstem Lesions Affecting Horizontal Gaze
Brainstem Circuits for Vertical and Vergence Eye Movements
KCC 13.9. Parinaud’s Syndrome
Control of Eye Movements by the Forebrain
KCC 13.10. Right-Way Eyes and Wrong-Way Eyes
Cerebellar, Vestibular, and Spinal Control of Voluntary and Reflex Eye Movements
Clinical Cases
13.1. Double Vision and Unilateral Eye Pain
13.2. A Diabetic with Horizontal Diplopia
13.3. Vertical Diplopia
13.4. Left Eye Pain and Horizontal Diplopia
13.5. Unilateral Headache, Ophthalmoplegia, and Forehead Numbness
13.6. Ptosis, Miosis, and Anhidrosis
13.7. Wrong-Way Eyes
13.8. Horizontal Diplopia in a Patient with Multiple Sclerosis
13.9. Headaches and Impaired Upgaze
Additional Cases
Brief Anatomical Study Guide
References Neuroanatomy through Clinical Cases

Chapter 14. Brainstem III: Internal Structures and Vascular Supply
Anatomical and Clinical Review
Main Components of the Brainstem
Brainstem Sections
Cranial Nerve Nuclei and Related Structures
Long Tracts
KCC 14.1. Locked-In Syndrome
Cerebellar Circuitry
Reticular Formation and Related Structures
The Consciousness System
Widespread Projection Systems of Brainstem and Forebrain: Consciousness, Attention, and Other Functions
Anatomy of the Sleep-Wake Cycle
KCC 14.2. Coma and Related Disorders
Reticular Formation: Motor, Reflex, and Autonomic Systems
Brainstem Vascular Supply
KCC 14.3. Vertebrobasilar Vascular Disease
Clinical Cases
14.1. Face and Contralateral Body Numbness, Hoarseness, Horner’s Syndrome, and Ataxia
14.2. Hemiparesis Sparing the Face
14.3. Dysarthria and Hemiparesis
14.4. Unilateral Face Numbness, Hearing Loss, and Ataxia
14.5. Locked In
14.6. Wrong-Way Eyes, Limited Upgaze, Decreased Responsiveness, and Hemiparesis with an Amazing
Recovery Neuroanatomy through Clinical Cases
14.7. Diplopia and Unilateral Ataxia
14.8. Intermittent Memory Loss, Diplopia, Sparkling Lights, and Somnolence
14.9. Intractable Hiccups
Additional Cases
Brief Anatomical Study Guide

Chapter 15. Cerebellum
Anatomical and Clinical Review
Cerebellar Lobes, Peduncles, and Deep Nuclei
Microscopic Circuitry of the Cerebellum
Cerebellar Output Pathways
Cerebellar Input Pathways
Vascular Supply to the Cerebellum
KCC 15.1. Cerebellar Artery Infarcts and Cerebellar
KCC 15.2. Clinical Findings and Localization of Cerebellar
KCC 15.3. Differential Diagnosis of Ataxia
Clinical Cases
15.1. Sudden Onset of Unilateral Ataxia
15.2. Walking Like a Drunkard
15.3. A Boy with Headaches, Nausea, Slurred Speech, and Ataxia
15.4. Nausea, Progressive Unilateral Ataxia, and Right Face Numbness
15.5. A Family with Slowly Progressive Ataxia and Dementia
Additional Cases
Brief Anatomical Study Guide

Chapter 16. Basal Ganglia
Anatomical and Clinical Review
Basic Three-Dimensional Anatomy of the Basal Ganglia
Input, Output, and Intrinsic Connections of the Basal Ganglia
Inputs to the Basal Ganglia
Outputs from the Basal Ganglia
Intrinsic Basal Ganglia Connections
Hyperkinetic and Hypokinetic Movement Disorders
Parallel Basal Ganglia Pathways for General Movement, Eye Movement, Cognition, and Emotion
Ansa Lenticularis, Lenticular Fasciculus, and the Fields of Forel
KCC 16.1. Movement Disorders
KCC 16.2. Parkinson’s Disease and Related Disorders
KCC 16.3. Huntington’s Disease
KCC 16.4. Stereotactic Surgery and Deep Brain Stimulation
Clinical Cases
16.1. Unilateral Flapping and Flinging
16.2. Irregular Jerking Movements and Marital Problems
16.3. Asymmetrical Resting Tremor, Rigidity, Bradykinesia, and Gait Difficulties
16.4. Bilateral Bradykinesia, Rigidity, and Gait Instability with No Tremor
Additional Cases
Brief Anatomical Study Guide
References Neuroanatomy through Clinical Cases

Chapter 17. Pituitary and Hypothalamus
Anatomical and Clinical Review
Overall Anatomy of the Pituitary and Hypothalamus
Important Hypothalamic Nuclei and Pathways
Major Hypothalamic Nuclei
Hypothalamic Control of the Autonomic Nervous System
Hypothalamic-Limbic Pathways
Other Regionalized Functions of the Hypothalamus
Endocrine Functions of the Pituitary and Hypothalamus
KCC 17.1. Pituitary Adenoma and Related Disorders
KCC 17.2. Diabetes Insipidus and SIADH
KCC 17.3. Panhypopituitarism
Clinical Cases
17.1. Moon Facies, Acne, Amenorrhea, and Hypertension
17.2. Impotence, Anorexia, Polyuria, Blurred Vision, Headaches, and Hearing Loss
17.3. A Child with Giggling Episodes and Aggressive Behavior
Additional Cases
Brief Anatomical Study Guide
References Neuroanatomy through Clinical Cases

Chapter 18. Limbic System: Homeostasis, Olfaction, Memory, and Emotion
Anatomical and Clinical Review
Overview of Limbic Structures
Olfactory System
Hippocampal Formation and Other Memory-Related Structures
Hippocampal Formation and Parahippocampal Gyrus
Intrinsic Circuitry of the Hippocampal Formation
Input and Output Connections of the Medial Temporal Lobe Memory System
The Fornix and Medial Diencephalic Memory Pathways
KCC 18.1. Memory Disorders
The Amygdala: Emotions, Drives, and Other Functions
Other Limbic Pathways
KCC 18.2. Seizures and Epilepsy
KCC 18.3. Anatomical and Neuropharmacological Basis of Psychiatric Disorders
Clinical Cases
18.1. Sudden Memory Loss after a Mild Head Injury
18.2. Progressive Severe Memory Loss, with Mild Confabulation
18.3. Transient Diplopia, Lethargy, and Hemiparesis, Followed by a Sustained Memory Deficit
18.4. Episodes of Panic, Olfactory Hallucinations, and Loss of Awareness
18.5. Episodes of Staring, Lip Smacking, and Unilateral Semipurposeful Movements
Additional Cases
Brief Anatomical Study Guide
References Neuroanatomy through Clinical Cases

Chapter 19. Higher-Order Cerebral Function
Anatomical and Clinical Review
KCC 19.1. The Mental Status Exam
Unimodal and Heteromodal Association Cortex
Principles of Cerebral Localization and Lateralization
The Dominant Hemisphere: Language Processing and Related Functions
Anatomy of Language Processing
KCC 19.2. Differential Diagnosis of Language Disorders
KCC 19.3. Bedside Language Exam
KCC 19.4. Broca’s Aphasia
KCC 19.5. Wernicke’s Aphasia
KCC 19.6. Simplified Aphasia Classification Scheme
KCC 19.7. Other Syndromes Related to Aphasia
KCC 19.8. Disconnection Syndromes
The Nondominant Hemisphere: Spatial Processing and Lateralized Attention
Lateralized Aspects of Attention
Spatial Analysis and Integration
KCC 19.9. Hemineglect Syndrome
KCC 19.10. Other Clinical Features of Nondominant Hemisphere Lesions
The Frontal Lobes: Anatomy and Functions of an Enigmatic Brain Region
Regional Anatomy of the Frontal Lobes
Connections of the Prefrontal Cortex
Functions of the Frontal Lobes
KCC 19.11. Frontal Lobe Disorders
Visual Association Cortex: Higher-Order Visual Processing
KCC 19.12. Disorders of Higher-Order Visual Processing
KCC 19.13. Auditory Hallucinations
The Consciousness System Revisited: Anatomy of Attention and Awareness
General Mechanisms of Attention
Anatomy of Attention
Awareness of Self and Environment
KCC 19.14. Attentional Disorders
KCC 19.15. Delirium and Other Acute Mental Status Disorders
KCC 19.16. Dementia and Other Chronic Mental Status Disorders
Clinical Cases
19.1 . Acute Severe Aphasia, with Improvement
19.2 . Nonsensical Speech
19.3 . Aphasia with Preserved Repetition
19.4 . Impaired Repetition
19.5 . Inability to Read, with Preserved Writing Skills
19.6 . Left Hemineglect
19.7 . Abulia
19.8 . Blindness without Awareness of Deficit
19.9 . Sudden Inability to Recognize Faces
19.10. Musical Hallucinations
19.11. Progressive Dementia, Beginning with Memory Problems
Additional Cases
Brief Anatomical Study Guide

Epilogue: A Simple Working Model of the Mind
Case Index
Subject Index

Preface – Neuroanatomy through Clinical Cases

Neuroanatomy is a living, dynamic field that can bring both intellectual de-light and aesthetic pleasure to students at all levels. However, by nature, it isalso an exceedingly detailed subject, and herein lies the tragic pitfall of all toomany neuroanatomy courses. Crushing amounts of memorization are oftenrequired of students of neuroanatomy, leaving them little time to step back andgain an appreciation of the structural and functional beauty of the nervous sys-tem and its relevance to clinical practice.

This book has a different point of view: instead of making the mastery of anatomical details the main goal and then searching for applications of thisknowledge, actual clinical cases are used as both a teaching instrument andmotivating force to encourage students to delve into further study of normalanatomy and function. Through this approach, structural details take on im-mediate relevance as they are being learned. In addition, each clinical case isan ideal way to integrate knowledge of disparate functional systems, since asingle lesion may affect several different neural structures and pathways.Over 100 clinical cases, accompanied by neuroradiological images, arepresented in this text, and I am grateful to many neurologists, neurosurgeons,and neuroradiologists at the Columbia, Harvard, and Yale medical schools forhelping me to amass enough material to present clinically relevant discussionsof the entire nervous system.

I have used this book’s diagnostic method to teachneuroanatomy at these medical schools, and both students and faculty greetedthe innovation enthusiastically. Through publication ofNeuroanatomy throughClinical CasesI hope that students and faculty at many additional institutionswill find this to be an enjoyable and effective way to learn neuroanatomy andits real-life applications.

How to use this book

The goal of this book is to provide a treatment of neuroanatomy that is com-prehensive, yet enables students to focus on the most important “take-homemessages” for each topic. This goal is motivated by the recognition that, whileaccess to detailed information is often useful in mastering neuroanatomy,certain selected pieces of information carry the most clinical relevance, or aremost important for exam review

General Outline

The first four chapters of the book contain introductory material that will beespecially useful to students who have little previous clinical background.Chapter 1 is an introduction to the standard format commonly used for pre-senting clinical cases, including an outline of the medical history, physical ex-amination, neuroanatomical localization, and differential diagnosis. Chapter2 is a brief overview of neuroanatomy which includes definitions and descrip-tions of basic structures that will be studied in greater detail in later chapters.Chapter 3 builds on this knowledge by describing the neurologic examination.It includes a summary of the structures and pathways tested in each part of the exam, which is essential for localizing the lesions presented in the clinicalcases throughout the remainder of the book.

Much of the material in this chap-ter is also covered on the website described below, which pro-vides video demonstrations for each part of the exam. For readers who are un-familiar with neuroimaging techniques, Chapter 4 contains a conciseintroduction to CT, MRI, and other imaging methods. This chapter also in-cludes a Neuroradiological Atlas showing normal CT, MRI, and angiographicimages of the brain. Chapters 5–19 cover the major neuroanatomical systemsand present relevant clinical cases.

About the Author – Neuroanatomy through Clinical Cases

Hal Blumenfeld is Professor in the Departments of Neurology, Neurobiology, and Neurosurgery at Yale University School of Medicine. He has taught neuroanatomy at Harvard, Yale, and Columbia Universities using the approach of Neuroanatomy through Clinical Cases, which the students greeted with highly favorable feedback. He recently received the prestigious Francis Gilman Blake Award, as the most outstanding teacher of medical sciences at the Yale School of Medicine, and the Dreifuss-Penry Epilepsy Research Award from the American Academy of Neurology.

He has also been awarded several major grants (from the National Institutes of Health, and private foundations) to pursue his research, which focuses on epilepsy as a model system for investigating consciousness. Current projects include neuroimaging, neurophysiology, and behavioral experiments in animal models of epilepsy, and direct application to human patients.

His clinical training included an internship in Internal Medicine at Columbia Presbyterian Medical Center, a residency in Neurology at Massachusetts General Hospital, and a fellowship in Epilepsy at Yale University School of Medicine. He studied Bioelectrical Engineering at Harvard University, then earned a Ph.D. (in Physiology and Cellular Biophysics) as well as his M.D. at Columbia University. Dr. Blumenfeld’s previous publications include numerous articles in peer reviewed journals, as well as two volumes in the Let’s Go travel guidebook series.


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