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1 ORGANIZATION OF THE NERVOUS SYSTEM 1

Introduction 2

Overview of brain anatomy 2

Internal anatomy of the brain 5

Ventricular system 10

Forebrain 11

Hemisphere specialization 12

Limbic system 14

Orbitofrontal cortex 17

Basal ganglia 17

Diencephalon 17

Thalamus 18

Hypothalamus 19

Peripheral nervous system 21

Putting it all together:from anatomy to behaviour 29

2 ELEMENTS OF CELLULAR AND MOLECULAR NEUROSCIENCE 31

Introduction 32

Neurones 32

Glial cells 34

Neurone excitability 35

Neurotransmitters 41

Postsynaptic events and postsynaptic receptors 42

3 CLINICAL EXAMINATION 47

Introduction 48

Parts of the clinical examination 48

Other investigations 55

General comments 57

4 THE SPINAL CORD 59

Introduction 60

Gross anatomy of the spinal cord and vertebral column 60

Functional organization of the spinal cord 61

Spinal cord cell types 63

Receptive fields 64

Somatosensory pathways 65

Blood supply to the spinal cord 71

Damage to the spinal cord 72

Comments on the case history 78

5 PAIN AND ANALGESIA 79

Introduction 80

Nociceptors 81

Pain pathways 82

How does the central nervous system interpret a stimulus as painful? 84

Physiology of pain modulation 86

Pain mechanisms after tissue damage:peripheral and central sensitization 90

Neuropathic pain mechanisms 92

Pharmacology of pain 93

Other approaches to pain management 99

General comments on pain management 104

6 CRANIAL NERVES AND THE BRAINSTEM 105

Introduction 106

Anatomical organization of cranial nerves in the brain 106

Internal organization of the brainstem 107

Reticular formation 109

Blood supply to the brainstem 112

Brainstem reflexes 112

Brainstem lesions 116

Comments on the case history 118

7 THE VISUAL SYSTEM 121

Introduction 122

Structure of the eye 122

Visual pathways 125

Visual field defects 127

Pupillary light reflexes 127

Focusing of light on the retina 127

Control of eye movements 130

Structure and function of the retina 131

Processing of visual information 137

Summary 140

8 HEARING AND BALANCE:THE AUDITORY AND VESTIBULAR SYSTEMS 141

Introduction 142

The auditory system 142

The vestibular system 152

Comments on the case history 158

9 MOTOR SYSTEMS Ⅰ:DESCENDING PATHWAYS AND CEREBELLUM 159

Introduction 160

Skeletal muscle contraction 161

Reflexes 164

Descending pathways 167

Clinical importance of reflexes 172

The cerebellum 175

10 MOTOR SYSTEMS Ⅱ:THE BASAL GANGLIA 181

Introduction 182

The basal ganglia:structure and organization 182

Parkinson's disease 184

Huntington's disease 194

11 STROKE AND HEAD INJURY 199

Introduction 200

Physiological control of cerebral blood flow 200

Blood supply to the brain 201

Venous system 204

Functional anatomy of the cerebral vasculature 205

Angiography 206

Stroke 206

Head injury 219

Comments on the case history 225

12 INFECTION IN THE CENTRAL NERVOUS SYSTEM 227

Introduction 228

Types of infection of the central nervous system 228

The meninges 229

Cerebrospinal fluid production and circulation 230

The blood-brain barrier 232

Meningitis 232

Diagnosis and treatment of meningitis 234

Treatment of meningitis 235

Encephalitis 235

Cerebral abscesses 235

Brain infections in the immunocompromised patient 236

13 EPILEPSY 237

Introduction 238

General description of epilepsy 238

Epidemiology of epilepsy 238

Types of epileptic syndrome 239

Diagnostic investigations of epilepsy 239

Different types of seizure 242

Neurobiology of epilepsy 243

Pharmacological treatment of epilepsy 246

Other treatments for epilepsy 248

Treatment of status epilepticus 249

Social consequences of epilepsy 249

14 DEMENTIA 251

Introduction 252

Causes and diagnosis of dementia 252

Neurobiology of learning and memory 253

Alzheimer's disease 256

Treatment of Alzheimer's disease 261

Other types of dementia 263

General considerations in the management of Alzheimer's disease and other types of dementia 265

15 SCHIZOPHRENIA 267

Introduction 268

Schizophrenia:the clinical diagnosis 268

Aetiology of schizophrenia 271

Neurobiology of schizophrenia 272

Treatment of schizophrenia 275

Comments on the management of schizophrenia and the long-term prognosis 278

Other psychoses and schizophrenia-like syndromes 279

16 DEPRESSION AND ANXIETY 281

Introduction 282

Classification of mood disorders 282

Clinical features of mood disorders 282

Epidemiology of depression and natural evolution of the disease 283

Genetics of mood disorders 283

Neurobiology of depression 286

Treatment of depression 287

Bipolar disorder and its treatment 292

General comments on mood disorders 293

Need for new therapeutic targets 294

Comments on the case history 294

Anxiety disorders 294

Treatment of anxiety disorders 295

Insomnia 297

17 ADDICTION 301

Introduction 302

Addiction and drug misuse:general comments 302

Opiates 302

Cocaine and crack 304

Cannabis 305

Nicotine 307

Alcohol 308

Phencyclidine 309

Amphetamines 310

Ecstasy-or the beginning of agony? 310

Hallucinogens 311

Solvents 311

Neurobiology of addiction 312

Addiction and rehabilitation:general issues 313

Index 315