By Klaus Poeck
Throughout the process historical past it has continually been famous that any rules approximately mind functionality depended upon the top technological version of the day. for that reason, within the Greek or Roman period the ventricular process used to be singled out as a result devel opment of hydraulics. Early during this century we drew the analo gy among cellphone circuits and the mind. Now it's renowned to signify neural functionality as that of a cosmopolitan com puter. certainly, in lots of methods it can be. yet, as but, the pre pared human mind will most likely succeed within the checking out of knowledge precious for a formal prognosis. during this handbook, POECK has supplied the floor paintings for such prepara Dr. tion. all of us recognize the smart diagnostician, and typically ascribe the ability to nice instinct. no longer so! it's the clinician who has noticeable many sufferers, and has compiled a menu of decisions. Dr. POECK is this type of clinician, and he has supplied us along with his menu of decisions. Use of those lists will most likely relief the coed or resident medical professional in coming to a formal prognosis yet, extra importantly, can assist teach his or her brain to imagine in a logical and systematic manner. ROBERT J. JOYNT, M.D., Ph.D.
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5 Paraneoplastic Polyneuropathy More common is the connection of para neoplastic polyneuropathy with the restless legs syndrome. As in all paraneoplastic affections of the nervous system, the underlying malignancy may still be undetected and even undetectable. 6 Avitaminosis The same considerations as given for burning feet syndrome apply to avitaminosis as a cause of restless legs. Unfortunately, vitamin deficiency is not easily demonstrated. In some cases diagnosis can be made only on the basis of substitution therapy.
Diagnosis is made on the basis of laboratory tests, which should be applied freely in acute hemiplegia of unknown etiology. With adequate therapy, signs and symptoms resolve rapidly. Hypoglycemia leads not only to convulsions and confusion, but also to hemiplegia. The diagnostic clues described in the preceding paragraphs also apply here. 7 Multiple Sclerosis The presence of multiple sclerosis should be suspected in young individuals especially when there is sensorimotor hemiplegia with ataxia, and when vigilance is well preserved.
Atrophy of the optic nerve may also occur. 9 Olivopontocerebellar Atrophy A similar condition is olivopontocerebellar atrophy, although this runs a much faster course. Usually, it begins with extrapyramidal symptoms reminiscent of the akinetic variant of Parkinson's disease, which are 40 followed by cerebellar ataxia. Slowly but surely progressive dementia appears. Brain stem signs may include horizontal gaze paralysis. 10 Combined Degeneration of the Spinal Cord The syndrome of combined degeneration of the spinal cord will be described in Chap.