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Diagnosis of nervous diseases

Table of contents
Diagnosis of nervous diseases
Diagnostic interpretation of neurologic symptoms
What represents defeat, the anamnesis
Differential diagnosis
Anatomic level of defeat
Coma - an assessment of neurologic symptoms
Dizziness - an assessment of neurologic symptoms
Headache - an assessment of neurologic symptoms
Craniocereberal injuries - an assessment of neurologic symptoms
Syncope - an assessment of neurologic symptoms
Lumbar pain - an assessment of neurologic symptoms
Attacks - an assessment of neurologic symptoms
Stroke - an assessment of neurologic symptoms
Pain and paresthesias in upper extremities - an assessment of neurologic symptoms
The anatomic image of defeats is lower than a big occipital opening
Anatomic images - Fridreykh's ataxy, a lateral amyotrophic sclerosis, Verdniga-Goffmann's illness
Anatomic images - pernicious anemia, the progressing muscular atrophy, multiple sclerosis
Anatomic images - a myelosyringosis, inflammatory diseases of a spinal cord, an infectious polyneuritis
Anatomic images - the surrounding herpes, poliomyelitis, a syphilitic meningomyelitis
Anatomic images - tabes dorsalis, epidural abscess, tumors of a spinal cord
Anatomic images - an intramedullary tumor of a spinal cord, a metastatic cancer, a tumor of a horse tail
Anatomic images - an extramedullary tumor of a spinal cord, vascular diseases of a spinal cord, occlusion of a front spinal artery
Anatomic images - compression spinal fracture, a protruded disk
Anatomic images - an osteoarthritis, a spinal tuberculosis, a cervical spondylosis
Anatomic images - an alimentary and diabetic neuropathy, hereditary neural amyotrophy
Anatomic images - a porphyria, a lead neuropathy, a syndrome of a front scalene
Anatomic images - a nodular periarteritis, the progressing muscular dystrophy
Defeats are higher than a big occipital opening
Anatomic images - a lateral amyotrophic sclerosis, Alzheimer's disease, gepatotserebralny dystrophy
Anatomic images - multiple sclerosis, a syringobulbia, a chorea of Gentington
Anatomic images - abscess of a temporal share, cerebellum abscess, a hemorrhagic polioencephalitis
Anatomic images - intoxication Dilantinum, lethargic encephalitis, a general paralysis
Anatomic images - Gradenigo's syndrome, tubercular meningitis, encephalitis
Anatomic images - a glioblastoma of a frontal lobe, a bridge glioma, a medulloblastoma
Anatomic images - a meningioma of a crest of a wedge-shaped bone, a meningioma of an olfactory bulb, metastatic cancer
Anatomic images - a tumor of a mostomozzhechkovy corner, a nasopharynx tumor, a parasagittal meningioma
Anatomic images - a pinealoma, chromophobic adenoma
Anatomic images - aneurism of an internal carotid artery, an aneurysm of a front brain artery, an aneurysm of a vertebral artery
Anatomic images - a hematencephalon, Weber's Syndrome, aneurism Miyyara-Gyubler's syndrome
Anatomic images - thrombosis of arteries of a lenticular kernel and striate body, a basilar artery, fibrinferments of an upper sagittal sine
Anatomic images - thrombosis of an internal carotid artery, a back lower cerebellar artery, fibrinferments of a front brain artery
Anatomic images - thrombosis of a cavernous sine, fibrinferments of an average brain artery, an embolism of a back brain artery
Anatomic images - a chronic subdural hematoma, an epidural hematoma, an embolism of a back brain artery
Anatomic images - a platybasia, Menyer's illness, a hook vklineniye
Anatomic images - trembling paralysis, a myasthenia, paralysis Bella
Neurologic inspection of separate conduction paths, kernels, areas
Characteristic symptoms of defeat
The diseases which are shown symptomatology in extremities, diagnostic testings
Researches necessary for confirmation of the diagnosis
Glossary

Диагностика нервных болезней

 
R. D. COLLINS
DIAGNOSIS
NERVOUS
DISEASES
ILLUSTRATED
MANAGEMENT
Transfer from the English M. S. MURTAZAYEV
Moscow
"Medicine" of 1986

In the management the principles of topical diagnosis of diseases of a nervous system are provided. The main information on a functional neuroanatomy in combination with clinical aspects of the most widespread neurologic syndromes and diseases is supplied. Clinical supervision are illustrated with original schemes with the indication of localization of the pathological center in a head and spinal cord
For neuropathologists
INTRODUCTION
It is difficult to reach a clear understanding of numerous diseases of a nervous system even at good knowledge of anatomy, physiology and pathology as there are big gaps both in evident representation, and in transfer of already known facts in the knowledge necessary for clinical interpretation. Feeling of disappointment and the lack of interest arising after it the initiating and coordinating systems of neural complexes which we call a nervous system still prevent many doctors and medical students to gain practical knowledge of a large number of the diseases affecting huge. Any attempt to learn this labyrinth, educated as if the web, from a set of the thinnest threads (which are actually located in strictly certain order), meets with approval and support.
Some students are inclined to postpone studying of nervous diseases for the second plan, preferring them sections which are easier acquired, or including nervous diseases not so widespread or not so important among human sufferings. However the facts show that most of doctors when maintaining patients should make the serious decisions connected with neurology.
In recent years certain efforts are made to fill the existing gap between fundamental strict ratios of anatomic formations of a nervous system and their true functionality in the conditions of norm and pathology. It needs to be done without prejudice to valuable time of doctors and students which is required for improvement of practical skills and replenishment of knowledge in studying of other disciplines. The few are able to afford to spend years or even months only for studying of neurology. It is unlikely it will make sense for the doctors who are engaged mainly in other sections of medicine. Perhaps, it is better to develop techniques for obtaining necessary practical information and its use according to circumstances that in the professional plan will promote accumulation of experience, knowledge and wisdom.
This book contains necessary and original approach to recognition, lighting and explanation of the neuroanatomic and neurophysiological facts in relation to problems of clinical neurology. Color illustrations simplify visual perception and improve storing in order that it was possible to reproduce at once necessary combinations of the facts at creation of an overall picture of each well-known clinical syndrome. The short and accurate description of the basic neurologic principles and a symptomatology serves as a necessary reference point at systematic approach to the represented problem. It as it seems to me, is extremely important both for beginners, and for the experienced doctors who are in all problems of medicine actively interested.
I believe that this book will make a valuable contribution to wider circulation of neurologic knowledge and interest in neurologic sciences.
Rudolph Jaeger, M. of D.

PREFACE

I would like to express gratitude in response to a wide response which was got by the first edition of the illustrated guide to diagnosis of nervous diseases. More than 60 000 copies of the book are in hands of students and doctors. I resisted processing of the book, being afraid to lose that simplicity which promoted its popularity.
However huge progress to neurologic diagnosis over the past few years induced me to make it. Undoubtedly, one of the most impressive achievements is development of the computer tomography (CT). By means of this remarkable radiological technique 98% of tumors of a brain can be revealed. It is possible to establish localization of cerebral hemorrhages and heart attacks of a brain which till this time could not be distinguished. KT almost completely replaced a pneumoencephalography at diagnosis of an atrophy of a cerebral cortex. Many of the clinical examples given in this book are processed taking into account this achievement.
In spite of the fact that the miyelografiya continues to remain a cornerstone in diagnosis of diseases of a spinal cord, many new methods in addition find application. So, badly distinguishable hernias of intervertebral disks can be revealed by means of a discography and a lumbar venografiya. Scanning of bones helps to reveal metastasises of cancer and a multiple myeloma of a backbone before they manage to be seen on the usual roentgenogram. Resolving power of KT today such is that it is reasonable to apply it also at diagnosis of damages of a spinal cord.
The angiography of the main vessels of a brain allows to diagnose more precisely diseases with damage of carotid and vertebral arteries, especially if it is applied in combination with subtraction and magnifying equipment. It is extremely important now that endarterectomy of carotid arteries becomes a reliable and valuable form of therapy of the tranzitorny ischemic attacks (TIA).
Besides, various laboratory, radiographic and special diagnostic techniques are developed. For example, autoimmune diseases are often diagnosed by test for antinuclear antibodies (ANA). Multiple sclerosis with a bigger accuracy can be diagnosed by means of the analysis of the main protein of a myelin in cerebrospinal fluid. Elektronistagmografiya allows to carry out more exact assessment of caloric test at Menyer's illness and neurinoma of an acoustical nerve.
Despite these achievements, neurologic inspection and the anamnesis remain a basis of neurologic diagnosis. Lean on them at an assessment of the symptoms which are most often found in clinical practice. Taking into account it absolutely new section "Assessment of Common Neurologic Symptoms" was included.
In view of the achievements noted above in neurologic diagnosis, I made the following additions to the text:

  1. tab. 9 in the 1st edition ("Special diagnostic testings") is replaced with the Appendix G in which the diagnostic testings conducted at each neurologic symptom and the Appendix D where the diseases of a nervous system and research which are often carried most out for confirmation of the diagnosis are in alphabetical order listed are stated;
  2. examples of stories of diseases are reconsidered to include researches which find application in diagnosis now (for example. KT, etc.);
  3. tab. 10 (in the present edition 1.9) "Kurabelny nervous diseases" is expanded and processed taking into account the last achievements of therapy. The reader should remember that clinical tests still remain a valuable diagnostic technique.

With the changes stated above this illustrated management represents rather simple and very useful book for students and doctors to whom it originally also was addressed.
R. Douglas Collins, M. of D.

FROM THE PREFACE TO THE FIRST EDITION

This book does not replace the special guides to nervous diseases. Rather it in the simplified form promotes to induce the doctor to suspect, at least, a disease of a nervous system. At attentive reading it provides systematic approach to the differential diagnosis.
Practical neurology — not so mysterious and esoteric science as it can seem. The long hours spent behind studying of a neuroanatomy in the first years of medical training are not useless at all. At the appropriate appendix the understanding of a neuroanatomy will allow to remove a secret cover from clinical neurology in many respects.

ILLNESS, NEUROANATOMIC LEVEL OF DEFEAT, NEUROLOGIC SYMPTOMS

Two well made neuroanatomic drawings become a background on which 80 major diseases of a nervous system are imprinted, Neurologic symptoms of each illness are designated by means of the dark stains or points applied on images of the corresponding kernels, conduction paths or the struck areas — the method applied by Esopoto in 1924 and used in many standard neurologic grants. In neurology the knowledge of localization of defeat is a basis for interpretation and storing of the leading symptoms of each disease. Francis Walshe speaks: "When at statement of the neurologic diagnosis it is possible to find an explanation for all not anatomic factors, it is necessary to recognize that the main features of a disease, especially at chronic options of a current, mainly are defined by localization of pathological process in a nervous system".
Explanation of this basic principle simple. Reaction of neuron to damage is stereotypic. He either perishes, or its function is temporarily broken. Therefore, in most cases neurologic symptoms are connected with defunctionalization (paralysis, a blindness, anesthesia) of the struck area, or with manifestation or reorganization of function (a tremor, spasticity) of other area on which the struck area exerted the braking impact before.

NEUROLOGIC SYMPTOM, NEYROANATOMICHESNY LEVEL OF DEFEAT, DIFFERENTIAL DIAGNOSIS

Localization of defeat is also "common denominator" of a neurologic symptom and the differential diagnosis. The knowledge of where there is a defeat center, defines differential approach to what represents this defeat. It is connected with the fact that various pathological processes strike different functional components of a nervous system.
This fundamental principle is the cornerstone of approach to neurologic diagnosis and the diagnostic tables provided in this book. Neurologic researches, symptoms of a disease are compared with neuroanatomical structures. In spite of the fact that at the disposal of the students studying neurology there is rather bigger number of the neuroanatomic and neurophysiological facts, the considerable part of these facts is presented is separate. Diagnostic tables aggregate and compare these facts so that they could be applied with advantage in the solution of clinical neurologic problems. Besides, they can serve as a reference point when using of standard neurologic grants.
Representing to students and practical doctors neurology in the short arranged statement, we tried to adhere to the following criteria:

  1. the basis of this material is made by the standard information therefore detailed discussion of inconsistent theories, rare nervous diseases and atypical cases is excluded;
  2. neuroanatomical structures with not clear or rare clinical appendix are excluded from drawings;
  3. full discussion of each disease is replaced with the statement of typical cases emphasizing characteristics with the expanded clinical appendix;
  4. descriptions of the diagnostic testings conducted mainly by means of specialists are excluded;
  5. questions of treatment are briefly generalized in the form of the list of "kurabelny diseases" and possible types of therapy.

Representation in the simplified type of any subject, especially neurology, is inevitably accompanied by risk to mislead, despite care of selection and supply of material. However the risk looks justified if means to teach something that otherwise is represented impossible and to involve in studying of all those who otherwise would consider it as an impracticable task.
R. Douglas Collins



 
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