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Lesion localization and differential diagnosis

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Abstract

Precise localization of the causative disorder within the nervous system (neuroanatomical diagnosis) and an understanding of the suspected disease processes (differential diagnosis) are key to an accurate neurological diagnosis. The advantages of using sophisticated neurodiagnostic tests are undeniable, but unfortunately, despite the relatively high sensitivity, these tests lack specificity in identifying the exact nature of the disease process. This chapter deals with functional neuroanatomy and anatomical diagnosis, forebrain, brainstem, cerebellum, spinal cord, peripheral nerves, neuromuscular junction, muscle, differential diagnosis.

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Figures

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2.1 General overview of the topographical anatomy of the central and peripheral nervous systems. This overview can be seen throughout the manual, highlighting the specific section(s) of the nervous system relevant to the particular clinical signs under discussion. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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2.2 The brain. Dorsal view showing the lobes of the cerebral hemispheres. Ventral view. Lateral view. C1 = cervical 1 segment of the spinal cord. Cranial nerves: I = olfactory; II = optic; III = oculomotor; IV = trochlear; V = trigeminal; VI = abducent; VII = facial; VIII = vestibulocochlear; IX = glossopharyngeal; X = vagus; XI = accessory; XII = hypoglossal. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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2.7 The spinal cord. Lateral view of the whole cord showing UMNs and LMNs. Cross-section of the cord showing the grey matter and spinal ganglia. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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2.8 Cross-section through the spinal cord showing the sensory and motor tracts. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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2.9 Spinal cord segments and their location relative to vertebral levels in the dog. With the exception of the first one or two cervical segments and segments L1 and L2, most spinal cord segments are positioned in the vertebral canal cranial to the vertebra of the same number. The disparity between the location of the spinal cord segments and their respective vertebrae is a result of the extra number of spinal cord segments in the cervical region (8 segments for 7 vertebrae) and the differential growth of skeletal and neural structures during embryological development. The cervical intumescence (C6–T2) lies within vertebrae C5–T1 and the lumbar intumescence (L4–S3) lies within vertebrae L3–L6. The C1 spinal nerves exit through the lateral foramina in the C1 vertebra. The other cervical spinal nerves exit the vertebral canal cranial to the vertebrae of the same annotation, except the C8 nerves, which exit between C7 and T1. All the other spinal nerves exit behind the same-named vertebrae. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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2.15 Cervicothoracic spinal cord segments, indicating nerve origins. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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2.16 Lumbosacral spinal cord segments, indicating nerve origins. Illustration created by Allison L. Wright, MS, CMI, Athens, Georgia, USA.
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2.19 Onset and progression of neurological diseases of differing causes.

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