How to Examine the Nervous System 4th ed - R. Ross (Humana, 2006) WW.pdf

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How to Examine
the Nervous System
How to Examine
the Nervous System
fourth edition
R. T. Ross
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
Winnipeg, Canada
With a Foreword by
Lewis P. Rowland, MD
Columbia University Medical Center,
New York
© 2006 Humana Press Inc.
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Totowa, New Jersey 07512
All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted
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wise without written permission from the publisher.
All papers, comments, opinions, conclusions, or recommendations are those of the author(s), and do
not necessarily reflect the views of the publisher.
Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy
of the information published and to describe generally accepted practices. The contributors herein have
carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and
in accord with the standards accepted at the time of publication. Notwithstanding, as new research,
changes in government regulations, and knowledge from clinical experience relating to drug therapy
and drug reactions constantly occurs, the reader is advised to check the product information provided
by the manufacturer of each drug for any change in dosages and for additional warnings and con-
traindications. This is of utmost importance when the recommended drug herein is a new or infrequent
used drug. It is the responsibility of the treating physician to determine dosages and treatment strate-
gies for individual patients. Further it is the responsibility of the health care provider to ascertain the
Food and Drug Administration status of each drug or device used in their clinical practice. The pub-
lisher, editors, and authors are not responsible for errors or omissions or for any consequences from the
application of the information presented in this book and make no warranty, express or implied, with
respect to the contents in this publication.
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ANSI Z39.48-1984 (American Standards Institute) Permanence of Paper for Printed Library Materials.
Cover design by Patricia F. Cleary
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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
ISSN 1099-7768
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This book is dedicated to the memory and influences of two men:
J.D. Adamson, MD (Manitoba), MRCP (Edinburgh), FRCP (Canada), Pro-
fessor and Chairman, Department of Medicine, University of Manitoba,
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 story-
teller. 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 medi-
cine and teaching.
A man does not learn to understand anything unless he loves
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