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Part I:Development, Structure, and Function 1

Preface 3

1.Overview of the Nervous System 3

Introduction 3

Overall development of the nervous system 3

Acknowledgements 4

Dedication 7

2.Cellular Physiology of the Nervous System 11

Neuronal structure and variation 11

The central nervous system environment 13

Synaptic transmission 17

Excitation and inhibition 21

Damage and repair in the nervous system 28

3.The Somatosensory System 31

The spinal cord and spinal tracts 31

Somatosensation and the sensory cortex 35

Nociception and the perception of pain 39

4.Motor Control 47

Movement control 47

Motor units and recruitment of muscle fibres 49

Reflex action and muscle tone 50

The motor cortex and pyramidal tracts 54

Basal ganglia and thalamus 57

The cerebellum 61

The vestibular system, posture, and locomotion 64

5.The Brainstem 69

The brainstem nuclei 69

The reticular formation 73

Brainstem-acting drugs and general anaesthetics 75

6.The Autonomic Nervous System 79

Introduction 79

Structure and function of the sympathetic nervous system 79

Structure and function of the parasympathetic nervous system 82

The enteric nervous system 83

7.Vision 85

The eye 85

Retinal function and image processing 87

Central visual pathways and the visual cortex 91

Attention and perception 94

8.Hearing 97

The ear and conduction of sound 97

The central auditory pathways and the auditory cortex 100

9.Olfaction and Taste 103

Receptions for taste and smell 103

Central pathways of taste and smell 104

10.Higher Centres of the Central Nervous System 107

Localization of brain function and behaviour 107

Learning and memory 109

The limbic system 110

Cognitive development and degeneration 113

Pharmacology of higher central nervous system function 115

Part II:Clinical Assessment 123

11.Taking a History 125

Things to remember when taking a history 125

The structure of the history 125

Common presenting complaints 127

12.The Neurological Examination 137

Speech 137

Mental state and higher function 138

Gait 142

The cranial nerves 145

The motor system 157

Sensation 164

The autonomic nervous system 166

Examination of the unconscious patien 167

13.Further Investigations 169

Neurophysiological investigations 169

Routine investigations 171

Imaging of the nervous system 175

Part III:Basic Pathology 181

14.The Central Nervous System 183

Common pathological features of the central nervous system 183

Malformations, developmental disease, and perinatal injury 186

Trauma of the central nervous system 188

Cerebrovascular disease 191

Infections of the central nervous system 194

Demyelination and degeneration 197

Metabolic disorders and toxins 200

Neoplasms ofthe central nervous system 202

Epilepsy 204

Diseases of the autonomic nervous system 207

15.Pathology of the Peripheral Nerves and Muscle 209

Hereditary neuropathies 209

Traumatic neuropathies 210

Inflammatory neuropathies 212

Infectious neuropathies 214

Neurocutaneous syndromes 216

Metobolic and toxic neuropathies 216

Diseases of the muscle and neuromuscular junction 217

Part IV:Self-assessment 219

Multiple-choice Questions 221

Short-answer Questions 226

Essay Questions 227

MCQ Answers 228

SAQ Answers 229

Appendices 231

Appendix 1:gross anatomy 231

Appendix 2:vascular supply to the central nervous system 232

Index 235