Basic clinical neuroscience

418 Pages·2008·65.89 MB·English

by  Paul A. Young

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Basic Clinical
Neuroscience
SECOND EDITION
PAUL A. YOUNG, Ph.D.
Professor and Chairman Emeritus
Department of Anatomy and Neurobiology
Saint Louis University School of Medicine
St. Louis, Missouri
PAUL H. YOUNG, M.D.
Clinical Professor of Neurosurgery
Department of Surgery
Clinical Professor of Anatomy
Center for Anatomical Science and Education
Department of Surgery
Saint Louis University School of Medicine
St. Louis, Missouri
DANIEL L. TOLBERT, Ph.D.
Professor of Anatomy and Surgery
Director Center for Anatomical Science and Education
Department of Surgery
Saint Louis University School of Medicine
St. Louis, Missouri
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Acquisitions Editor: Crystal Taylor
Managing Editor:Kelly Horvath
Illustration Planner:Jennifer Clements
Production Editor: John Larkin
Compositor: Circle Graphics
Copyright © 2008 Lippincott Williams & Wilkins
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Printed in the United States of America
Second Edition,
Library of Congress Cataloging-in-Publication Data
Young, Paul A., 1926–
Basic clinical neuroscience / Paul A. Young, Paul H. Young, Daniel L.
Tolbert.—2nd ed.
p. ; cm.
Rev. ed. of: Basic clinical neuroanatomy. c1997.
Includes bibliographical references and index.
ISBN-13: 978-0-7817-5319-7 (pbk.)
ISBN-10: 0-7817-5319-8 (pbk.)
1. Neuroanatomy. 2. Neurosciences. I. Young, Paul H. (Paul Henry),
1950– II. Tolbert, Daniel L. (Daniel Lee), 1946– III. Young, Paul A.,
1926– . Basic clinical neuroanatomy. IV. Title.
[DNLM: 1. Nervous System—anatomy & histology. 2. Nervous
System—physiopathology. WL 101 Y75b 2008]
QM451.Y68 2008
611.8—dc22
2007010589
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To our families and our past, present,
and future students.
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PREFACE TO
SECOND EDITION
The title of the second edition of this mono- ters 5–19), the functional systems are described.
graph has been changed to Basic Clinical Neuro- The motor and somatosensory paths continue to
science. This reflects substantial changes in its be described first owing to their paramount impor-
organization and content. Building on the funda- tance in localizing injury to the brain or spinal
mental objective of the first edition “to provide the cord. A new vestibular system chapter was taken
anatomical basis for neurologic abnormalities ...” from disparate information about this system from
so as to be able to answer the question “Where is a number of different chapters in the first edition
the lesion located?”, the emphasis of this second and brought together to complete the descriptions
edition remains to correlate neuroanatomic struc- of the special senses. The final section of the sec-
tures with clinically relevant functions. In addi- ond edition deals with accessory components and
tion, fundamental physiologic concepts underlying more general topics. There are new chapters on
normal nervous system function and the patho- the reticular formation, cranial nerves, develop-
physiologic basis for abnormal nervous system ment, aging, and recovery of function.
activity have been included. In this new edition The authors are most grateful to Ms. Susan
our goal continues to be to describe the subject in Quinn for her assistance in preparing the manu-
a succinct and simple manner so that it will facil- script. Mr. Larry Clifford prepared the illustrations
itate learning in students of all health science used in the first edition, many of which have been
fields. modified in the second edition by adding coloring
The chapters in the second edition, as in the to highlight significant structures and connec-
first edition, are organized in three main sections. tions. The authors are very grateful and much
The first includes four chapters that describe the indebted to the staff of Lippincott Williams &
microscopic and macroscopic organization of Wilkins for their interest and support, particu-
the brain and spinal cord. Clinically important larly Crystal Taylor and Jennifer Clements, and
structures and functional levels are introduced. In especially Kelly Horvath for her patience while
the next and largest section of the book (Chap- valiantly attempting to keep us on schedule.
v
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PREFACE TO THE
FIRST EDITION
The main objective of this monograph is to The second section deals with the functional
provide the anatomical basis for neurologic systems and their clinically relevant features. This
abnormalities. Knowledge of basic clinical neuro- section is arranged so that the motor and somato-
anatomy will enable medical students to answer sensory systems, of paramount importance because
the first question asked when examining a patient they include structures located in every subdivi-
with an injured or diseased nervous system: “Where sion of the brain and spinal cord, are described
is the lesion located?” Knowledge of basic clinical first. The remainder of this section includes the
neuroanatomy will enable students in health- pathways associated with the special senses, higher
related fields such as nursing, physical therapy, mental functions, and the behavioral and visceral
occupational therapy, physician assistants, to systems.
understand the anatomical basis of the neurologic In the third section, the vascular supply and
abnormalities in their patients. To accomplish the ventricular cerebrospinal fluid system are
these objectives, the anatomical relationships and presented.
functions of the clinically important structures are The visualization of three-dimensional ana-
emphasized. Effort is exerted to simplify as much tomical relationships plays a key role in localizing
as possible the anatomical features of the brain lesions and understanding the anatomical basis of
and spinal cord. neurologic disorders. Every effort has been made
This monograph is neither a reference book to include illustrations that enhance this visual-
nor a textbook of neuroanatomy. Most neuro- ization of three-dimensional images of the clin-
anatomy textbooks include much information ically important structures. In addition to the
about anatomical structures that aids in the under- three-dimensional illustrations, schematic dia-
standing of a particular system or mechanism, but grams of the functional systems and drawings of
when these structures are damaged clinical signs or myelin-stained sections from selected functional
symptoms do not result. Such superfluous informa- levels of the brain and spinal cord are used to pro-
tion is kept to a minimum in this book. vide the anatomical relationships that enhance
This basic clinical anatomy book is presented the understanding of the anatomical basis for
in three main sections: (1) the basic plan, (2) the neurologic disorders and their syndromes. Clinical
functional systems, and (3) the associated struc- relevance is emphasized throughout this book and
tures. The basic plan includes the organization illustrations of some neurologic abnormalities are
of the nervous system, its histologic features and included.
supporting structures, distinguishing anatomical Review questions are found at the end of each
characteristics of the subdivisions of the brain and chapter and an entire chapter is devoted to the
spinal cord, and an introduction to clinically principles of locating lesions and clinical illustra-
important brain and spinal cord functional levels. tions. Answers to the chapter questions are found
Only those structures needed to identify the sub- in the appendixes. Also in the appendixes are a
divisions and their levels are included in this part. section devoted to cranial nerve components and
vii
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viii Preface to the First Edition
their clinical correlations, a glossary of terms, a list Ms. Susan Quinn for her superb assistance in pre-
of suggested readings, and an atlas of the myelin- paring the manuscript and to Ms. Susan McClain
stained sections used throughout the book. for her computer expertise in preparing the charts
The authors are most grateful to Mr. Larry and tables. Finally, the authors are much indebted
Clifford for his artistic skills in creating the illus- to the publisher, Williams & Wilkins, and its edi-
trations, all of which are an invaluable part of torial and marketing staff for their interest, support,
this book. Our deep appreciation is expressed to and patience throughout the project.