^ Humana Press
How to Examine the Nervous System
How to Examine the Nervous System fourth edition
Member of the Order of Canada Doctor of Science of the University of Manitoba Fellow of the Royal College of Physicians of London Fellow of the Royal College of Physicians and Surgeons of Canada Professor of Medicine, Section of Neurology University of Manitoba, Health Sciences Centre
With a Foreword by Lewis P. Rowland, MD
Columbia University Medical Center,
Totowa, New Jersey
© 2006 Humana Press Inc. 999 Riverview Drive, Suite 208 Totowa, New Jersey 07512
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Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 e-ISBN 1-59745-081-2
This book is dedicated to the memory and influences of two men:
J.D. Adamson, MD (Manitoba), MRCP (Edinburgh), FRCP (Canada), Professor and Chairman, Department of Medicine, University of Manitoba, 1939-1951
L.G. Bell, OC, MBE, MD (Manitoba), LLD (Queens University, Kingston, Ontario), FRCP (London and Canada), FACP, Professor and Chairman, Department of Medicine, University of Manitoba, 1951-1964
I had the good luck to be taught by both of these doctors. J.D. Adamson could take a better history and elicit more information from a patient than anyone I have ever met. He considered every new patient a fascinating storyteller. He asked few questions, managed to keep the patient on the subject, and was completely enthralled as the history unwound. He knew the words and music of disease.
L.G. Bell could see more in 10 seconds at the bedside and do a better physical examination than anyone else. He had a great ability to find, see, and feel (or maybe smell) abnormal physical signs. One learned as much from watching him examine as from listening to J.D. Adamson listen.
Both of these men taught hundreds of students, interns, and residents. Each had great respect for the skills of the other. They were cultured, well-read, humorous humans and great bedside doctors who dearly loved medicine and teaching.
A man does not learn to understand anything unless he loves it.—Goethe
Foreword by Lewis P. Rowland ix
1. The Ophthalmoscope, the Fundus Oculi, and Central and Peripheral Vision 1
2. Loss of Vision 19
3. The Abnormal Retina 37
4. Eye Movements, Diplopia, and
Cranial Nerves 3,4, and 6 45
5. Ptosis and the Pupils: Myasthenia Gravis and Other Diseases of the Eye and Eyelid Muscles 61
6. Nystagmus 71
7. Conjugate Gaze Palsies and Forced Conjugate Deviation 79
9. Cranial Nerves 8-12 107
10. The Upper Limb 121
11. The Lower Limb 145
12. Stance, Gait, and Balance 157
13. Reflexes 163
14. Sensation 177
15. The Cerebellum 187
16. The Corticospinal System 191
17. Higher Cortical Functions: Intelligence and Memory 197
18. Disorders of Speech 205
Appendix: Neurological Examination Instruments 210
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