Skip to content

enemies - welcome to the punch

thought differently, many thanks forThe Darkest Minds

Zeki mГјller

Zeki MГјller similar documents

Abb. 3: Die vier Segmente der Retina Quelle: nach Zeki , S. 23 A.; MГјller- Brand, J. (): Kortikale Blindheit nach Herointoxikation. 03 20 04 20 05 59 17 MГјller Dieter, lic. iur​. 15 52 GefГ¤ngnisleiter Kogumtekin Zeki FlughafengefГ¤ngnis Postfach. German Reality Star Melanie MГјller aka Scarlet Young Hardcore Genießen Kostenlose Deutsche Porno - Sorgfältige Auswahl von HD Nude deniz seki. Seki, der mittels Determinanten versuchte, schematische Lösungsformeln für sistematica sui piccoli mammiferi dell' Alto Adige (Ladurner & MГјller ).

03 20 04 20 05 59 17 MГјller Dieter, lic. iur​. 15 52 GefГ¤ngnisleiter Kogumtekin Zeki FlughafengefГ¤ngnis Postfach. German Reality Star Melanie MГјller aka Scarlet Young Hardcore Genießen Kostenlose Deutsche Porno - Sorgfältige Auswahl von HD Nude deniz seki. Seki, der mittels Determinanten versuchte, schematische Lösungsformeln für sistematica sui piccoli mammiferi dell' Alto Adige (Ladurner & MГјller ).

Abdominal reflexes are said to be lost early in multiple sclerosis, but late in motor neurone disease, an observation of possible clinical use, particularly when differentiating the progressive lateral sclerosis variant of motor neurone disease from multiple sclerosis.

However, no prospective study of abdominal reflexes in multiple sclerosis has been reported. Reference Dick JPR. The deep tendon and the abdominal reflexes.

Isolated weakness of the lateral rectus muscle may also occur in myasthenia gravis. Diagnosing multiple sclerosis: expect the unexpected.

British Journal of Hospital Medicine ; Abduction of a paretic leg is associated with the sound leg remaining fixed in organic paresis, but in non-organic paresis there is hyperadduction.

Hence the abductor sign is suggested to be useful to detect non-organic paresis. Reference Sonoo M. Abductor sign: a reliable new sign to detect unilateral non-organic paresis of the lower limb.

Cross Reference Functional weakness and sensory disturbance Absence An absence, or absence attack, is a brief interruption of awareness of epileptic origin.

This may be a barely noticeable suspension of speech or attentiveness, without postictal confusion or awareness that an attack has occurred, as in idiopathic generalized epilepsy of absence type absence epilepsy; petit mal , a Abulia A disorder exclusive to childhood and associated with 3 Hz spike and slow wave EEG abnormalities.

More plausibly, abulia has been thought of as a minor or partial form of akinetic mutism. There may also be some clinical overlap with catatonia.

Abulia may result from frontal lobe damage, most particularly that involving the frontal convexity, and has also been reported with focal lesions of the caudate nucleus, thalamus, and midbrain.

Treatment is of the underlying cause where possible. There is anecdotal evidence that the dopamine agonist bromocriptine may help.

Clinical features and current management of abulia. Progress in Neurology and Psychiatry ; 5 4 : 14, 15, The behavioural and motor consequences of focal lesions of the basal ganglia in man.

Fisher CM. Abulia minor versus agitated behaviour. In: Bogousslavsky J, Caplan L eds. Stroke syndromes.

Abulia: a Delphi survey of British neurologists and psychiatrists. Cross References Akinetic mutism; Apathy; Bradyphrenia; Catatonia; Frontal lobe syndromes; Psychomotor retardation Acalculia Acalculia, or dyscalculia, is difficulty or inability in performing simple mental arithmetic.

This depends on two processes, number processing and calculation; a deficit confined to the latter process is termed anarithmetia.

Secondary: In the context of other cognitive impairments, for example of language aphasia, alexia, or agraphia for numbers , attention, memory, or space perception e.

Secondary acalculia is the more common variety. Impairments may be remarkably focal, for example one operation e. Aphasia: a clinical perspective.

Boller F, Grafman J. Acalculia: historical development and current significance. Butterworth B. The mathematical brain.

London: Macmillan, Acalculia and disturbances of body schema. Clinical neuropsychology 4th edition. Gitelman DR. Acalculia: a disorder of numerical cognition.

Neurological foundations of cognitive neuroscience. Selective acalculia with sparing of the subtraction process in a patient with a left parietotemporal hemorrhage.

The isolation of calculation skills. This reflex may be elicited in several ways: by a blow with a tendon hammer directly upon the Achilles tendon patient supine, prone with knee flexed, or kneeling or with a plantar strike.

The latter, though convenient and quick, is probably the least sensitive method, since absence of an observed muscle contraction does not mean that the reflex is absent; the latter methods are more sensitive.

The Achilles reflex is typically lost in polyneuropathies and S1 radiculopathy. References Ross RT. How to examine the nervous system 4th edition.

The meaning of distal sensory loss and absent ankle reflexes in relation to age. A meta-analysis. Cross References Age-related signs; Neuropathy; Reflexes Achromatopsia Achromatopsia, or dyschromatopsia, is an inability or impaired ability to perceive colours.

This may be ophthalmological or neurological in origin, congenital or acquired; only in the latter case does the patient complain of impaired colour vision.

Ishihara plates , although these were specifically designed for detecting congenital colour blindness and test the red-green channel more than blue-yellow.

Difficulty performing these tests does not always reflect achromatopsia see Pseudoachromatopsia. These inherited dyschromatopsias are binocular, symmetrical, and do not change with time.

Acquired achromatopsia may result from damage to the optic nerve or the cerebral cortex. Cerebral achromatopsia results from cortical damage most usually infarction to the inferior occipitotemporal area.

Area V4 of the visual cortex, which is devoted to colour processing, is in the occipitotemporal fusiform and lingual gyri.

Unilateral lesions may produce a homonymous hemiachromatopsia. Lesions in this region may also produce prosopagnosia, alexia, and visual field defects, either a peripheral scotoma, which is always in the upper visual field, or a superior quadrantanopia, reflecting damage to the inferior limb of the calcarine sulcus in addition to the adjacent fusiform gyrus.

Transient achromatopsia in the context of vertebrobasilar ischaemia has been reported. The differential diagnosis of achromatopsia encompasses colour agnosia, a loss of colour knowledge despite intact perception; and colour anomia, an inability to name colours despite intact perception.

Zeki S. A century of cerebral achromatopsia. Loss of the radial pulse may occur in normals but a bruit over the brachial artery is thought to suggest the presence of entrapment.

Impairments of gait; parkinsonism. There does seem to be an age-related loss of distal sensory axons and of spinal cord ventral horn motor neurones accounting for sensory loss, loss of muscle bulk and strength, and reflex diminution.

References Franssen EH. Neurologic signs in ageing and dementia. In: Burns A ed. Ageing and dementia: a methodological approach.

Neurological signs of aging. Chichester: Wiley, in press. Aging and extrapyramidal function.

Cross References Frontal release signs; Parkinsonism; Reflexes Ageusia Ageusia or hypogeusia is a loss or impairment of the sense of taste gustation.

This may be tested by application to each half of the protruded tongue the four fundamental tastes sweet, sour, bitter, and salt.

Isolated ageusia is most commonly encountered as a transient feature associated with coryzal illnesses of the upper respiratory tract, as with anosmia.

Indeed, many complaints of loss of taste are in fact due to anosmia, since olfactory sense is responsible for the discrimination of many flavours.

Neurological disorders may also account for ageusia. Afferent taste fibres run in the facial VII and glossopharyngeal IX cranial nerves, from taste buds Agnosia A in the anterior two-thirds and posterior one-third of the tongue, respectively.

Central processes run in the solitary tract in the brainstem and terminate in its nucleus nucleus tractus solitarius , the rostral part of which is sometimes called the gustatory nucleus.

Fibres then run to the ventral posterior nucleus of the thalamus, hence to the cortical area for taste adjacent to the general sensory area for the tongue insular region.

Lesions of the facial nerve proximal to the departure of the chorda tympani branch in the mastoid vertical segment of the nerve i.

Lesions of the glossopharyngeal nerve causing impaired taste over the posterior one-third of the tongue usually occur in association with ipsilateral lesions of the other lower cranial nerves X, XI, XII; jugular foramen syndrome and hence may be associated with dysphonia, dysphagia, depressed gag reflex, vocal cord paresis, anaesthesia of the soft palate, uvula, pharynx and larynx, and weakness of trapezius and sternocleidomastoid.

Anosmia and dysgeusia have also been reported following acute zinc loss. Disturbances of smell and taste.

Neurology in clinical practice 5th edition. Sudden-onset ageusia in the antiphospholipid syndrome. As a corollary of this last point, some argue that there should be no language disorder aphasia to permit the diagnosis of agnosia.

Intact perception is sometimes used as a sine qua non for the diagnosis of agnosia, in which case it may be questioned whether apperceptive agnosia is truly agnosia.

However, others retain this category, not least because the supposition that perception is normal in associative visual agnosia is probably not true.

Moreover, the possibility that some agnosias are in fact higher-order perceptual deficits remains: examples include some types of visual and tactile recognition of form or shape e.

The difficulty with definition perhaps reflects the continuing problem of defining perception at the physiological level.

Theoretically, agnosias can occur in any sensory modality, but some authorities believe that the only unequivocal examples are in the visual and auditory domains e.

With the passage of time, agnosic defects merge into anterograde amnesia failure to learn new information. Anatomically, agnosias generally reflect dysfunction at the level of the association cortex, although they can on occasion result from thalamic pathology.

Some may be of localizing value. The neuropsychological mechanisms underpinning these phenomena are often ill understood.

Critchley M. The citadel of the senses and other essays. Farah MJ. Visual agnosia: disorders of object recognition and what they tell us about normal vision.

Ghadiali E. Lissauer H. Cross References Agraphognosia; Alexia; Amnesia; Anosognosia; Aprosodia, Aprosody; Asomatognosia; Astereognosis; Auditory agnosia; Autotopagnosia; Dysmorphopsia; Finger agnosia; Phonagnosia; Prosopagnosia; Pure word deafness; Simultanagnosia; Tactile agnosia; Visual agnosia; Visual form agnosia Agrammatism Agrammatism is a reduction in, or loss of, the production or comprehension of the syntactic elements of language, for example articles, prepositions, conjunctions, verb endings i.

Agrammatic speech may also be dysprosodic. Cross References Aphasia; Aprosodia, Aprosody Agraphaesthesia Agraphaesthesia, dysgraphaesthesia, or graphanaesthesia is a loss or impairment of the ability to recognize letters or numbers traced on the skin, i.

It occurs with damage to the somatosensory parietal cortex. It may occur in corticobasal degeneration syndrome. Cross References Agnosia; Tactile agnosia Agraphia Agraphia or dysgraphia is a loss or disturbance of the ability to write or spell.

Since writing depends not only on language function but also on motor, visuospatial, and kinaesthetic function, many factors may lead to dysfunction.

Oral spelling is impaired. Writing disturbance due to abnormal mechanics of writing is the most sensitive language abnormality in delirium, possibly because of its dependence on multiple functions.

Roeltgen DP. Relapsing-remitting autoimmune agrypnia. Agrypnia excitata: current concepts and future prospects in management.

Akathisia Akathisia is a feeling of inner restlessness, often associated with restless movements of a continuous and often purposeless nature, such as rocking to and fro, repeatedly crossing and uncrossing the legs, standing up and sitting down, and pacing up and down forced walking, tasikinesia.

Moaning, humming, and groaning may also be features. Voluntary suppression of the movements may exacerbate inner tension or anxiety.

Dopamine-depleting agents e. The Barnes Akathisia Rating Scale is the standard assessment scale. Treatment of akathisia by reduction or cessation of neuroleptic therapy may help, but may exacerbate coexistent psychosis.

A rating scale for drug-induced akathisia. Sachdev P. Akathisia and restless legs. Cambridge: Cambridge University Press, Cross References Parkinsonism; Tasikinesia; Tic Akinesia Akinesia is a lack of, or an inability to initiate, voluntary movements.

More usually in clinical practice there is a difficulty reduction, delay , rather than complete inability, in the initiation of voluntary movement, perhaps better termed bradykinesia, or reduced amplitude of movement or hypokinesia.

These difficulties cannot be attributed to motor unit or pyramidal system dysfunction. Reflexive motor activity may be preserved kinesis paradoxica.

There may be concurrent slowness of movement, also termed bradykinesia. Akinesia may coexist with any of the other clinical features of extrapyramidal system disease, particularly rigidity, but the presence of akinesia is regarded as an absolute requirement for the diagnosis of parkinsonism.

Hemiakinesia may be a feature of motor neglect of one side of the body possibly a motor equivalent of sensory extinction.

Bilateral akinesia with mutism akinetic mutism may occur if pathology is bilateral. Neurophysiologically, akinesia is associated with loss of dopamine projections from the substantia nigra to the putamen.

Akinesia resulting from nigrostriatal dopamine depletion i. Clinicophysiological features of akinesia. Blinking spontaneous and to threat is preserved.

Frontal release signs, such as grasping and sucking, may be present, as may double incontinence, but there is a relative paucity of upper motor neurone signs affecting either side of the body, suggesting relatively preserved descending pathways.

Akinetic mutism represents an extreme form of abulia, hence sometimes referred to as abulia major.

Akinetic mutism with disturbances of vertical eye movements and hypersomnia: associated with paramedian thalamic and thalamomesencephalic strokes.

Other structures e. Pathology may be vascular, neoplastic, or structural subacute communicating hydrocephalus , and evident on structural brain imaging.

Akinetic mutism may be the final state common to the end-stages of a number of neurodegenerative pathologies. EEG may show slowing with a lack of desynchronization following external stimuli.

Occasionally, treatment of the cause may improve akinetic mutism e. Agents such as dopamine agonists e. References Cairns H.

Disturbances of consciousness with lesions of the brain stem and diencephalon. Freemon FR. Akinetic mutism and bilateral anterior cerebral artery occlusion.

Akinetic mutism from hypothalamic damage: successful treatment with dopamine agonists. Akinetopsia reflects a lesion selective to area V5 of the visual cortex.

Clinically, it may be associated with acalculia and aphasia. Selective disturbance of movement vision after bilateral brain damage.

Cerebral akinetopsia cerebral visual motion blindness. Lordat used it to describe the aphasia following a stroke. Reference Bogousslavsky J, Assal G.

The word dyslexia, though in some ways equivalent, is often used to denote a range of disorders in people who fail to develop normal reading skills in childhood.

Alexia may be described as an acquired dyslexia. This is the archetypal peripheral alexia. Patients lose the ability to recognize written words quickly and easily; they seem unable to process all the elements of a written word in parallel.

They can still access meaning but adopt a laborious letter-by-letter strategy for reading, with a marked wordlength effect i.

Strikingly the patient can write at normal speed i. Alexia without agraphia often coexists with a right homonymous hemianopia, and colour anomia or impaired colour perception achromatopsia ; this latter may be restricted to one hemifield, classically right-sided hemiachromatopsia.

Pure alexia has been characterized by some authors as a limited form of associative visual agnosia or ventral simultanagnosia.

Hemianopic alexia: This occurs when a right homonymous hemianopia encroaches into central vision.

Patients tend to be slower with text than single words as they cannot plan rightward reading saccades. Neglect alexia: Or hemiparalexia, results from failure to read either the beginning or end of a word more commonly the former in the absence of a hemianopia, due to hemispatial neglect.

The various forms of peripheral alexia may coexist; following a stroke, patients may present with global alexia which evolves to a pure alexia over the following weeks.

Pure alexia is caused by damage to the left occipitotemporal junction, its afferents from early mesial visual areas, or its efferents to the medial temporal lobe.

Global alexia usually occurs when there is additional damage to the splenium or white matter above the occipital horn of the lateral ventricle.

Hemianopic alexia is usually associated with infarction in the territory of the posterior cerebral artery damaging geniculostriate fibres or area V1 itself, but can be caused by any lesion outside the occipital lobe that causes a macular splitting homonymous field defect.

Neglect alexia is usually caused by occipitoparietal lesions, right-sided lesions causing left neglect alexia. Phonological dyslexia: Reading by sight: difficulties with suffixes, unable to read non-words; left temporoparietal lobe pathology.

Deep dyslexia: The inability to translate orthography to phonology, manifesting as an inability to read plausible non-words as in phonological dyslexia , plus semantic errors related to word meaning rather than sound e.

Deep dyslexia is seen with extensive left hemisphere temporoparietal damage. The topography of callosal reading pathways: a case control analysis.

Coslett HB. Acquired dyslexia. Leff A. Advances in Clinical Neuroscience and Rehabilitation ; 4 3 : 18, 20, This may contribute to various physical and behavioural disorders.

There is evidence from functional imaging studies that alexithymics process facial expressions differently from normals, leading to the suggestion that this contributes to disordered affect regulation.

Alexithymia is a common finding in split-brain patients, perhaps resulting from disconnection of the hemispheres. Alexithymia: an experimental study of cerebral commissurotomy patients and normal control subjects.

Other conditions may also give rise to the phenomena of microsomatognosia or macrosomatognosia, including epilepsy, encephalitis, cerebral mass lesions, schizophrenia, and drug intoxication.

The Alice in Wonderland syndrome. Todd J. The syndrome of Alice in Wonderland. Cross References Aura; Metamorphopsia. Alien Grasp Reflex The term alien grasp reflex has been used to describe a grasp reflex occurring in full consciousness, which the patient could anticipate but perceived as alien i.

These phenomena were associated with an intrinsic tumour of the right non-dominant frontal lobe. The alien grasp reflex. Cross References Alien hand, Alien limb; Grasp reflex Alien Hand, Alien Limb An alien limb, most usually the arm but occasionally the leg, is one which manifests slow, involuntary, wandering levitating , quasi-purposive movements.

These phenomena are often associated with a prominent grasp reflex, forced groping, intermanual conflict, and magnetic movements of the hand.

Frontal type: shows features of environmental dependency, such as forced grasping and groping, and utilization behaviour. Sensory or posterior variant: Resulting from a combination of cerebellar, optic, and sensory ataxia; rare.

A paroxysmal alien hand has been described, probably related to seizures of frontomedial origin. More generally, it seems that these areas are involved in the execution of learned motor programs, and damage thereto may lead to the release of learned motor programs from voluntary control.

A propos de trois observations de tumeurs du corps calleux. Alien hand phenomena: a review with the addition of six personal cases.

Goldberg G, Bloom KK. The alien hand sign. Localization, lateralization and recovery. The alien hand: cases, categorizations, and anatomical correlates.

Reference Poeck K, Luzzatti C. Slowly progressive aphasia in three patients: the problem of accompanying neuropsychological deficit.

Alloacousia Alloacousia describes a form of auditory neglect seen in patients with unilateral spatial neglect, characterized by spontaneous ignoring of people addressing the patient from the contralesional side, failing to respond to questions, or answering as if the speaker were on the ipsilesional side.

Reference Heilman K, Valenstein E. Auditory neglect in man. Cross Reference Neglect Alloaesthesia Alloaesthesia allesthesia, alloesthesia is the condition in which a sensory stimulus given to one side of the body is perceived at the corresponding area on the other side of the body after a delay of about half a second.

The trunk and proximal limbs are affected more often than the face or distal limbs. Tactile alloaesthesia may be seen in the acute stage of right putaminal haemorrhage but seldom in right thalamic haemorrhage and occasionally with anterolateral spinal cord lesions.

The mechanism of alloaesthesia is uncertain: some - 20 - Allodynia A consider it a disturbance within sensory pathways, others consider that it is a sensory response to neglect.

A mirror in the mind: a case of visual allaesthesia in homonymous hemianopia. Cross References Allochiria; Allokinesia, Allokinesis; Neglect Allochiria Allochiria is the mislocation of sensory stimuli to the corresponding half of the body or space, a term coined by Obersteiner in There is overlap with alloaesthesia, originally used by Stewart to describe stimuli displaced to a different point on the same extremity.

Transposition of objects may occur in patients with neglect, e. Left on the right: allochiria in a case of left visuospatial neglect.

Allochiria vs allesthesia. Is there a misperception? Examples of allodynia include the trigger points of trigeminal neuralgia, the affected skin in areas of causalgia, and some peripheral neuropathies; it may also be provoked, paradoxically, by prolonged morphine use.

The treatment of neuropathic pain is typically with agents such as carbamazepine, amitriptyline, gabapentin, and pregabalin.

Interruption of sympathetic outflow, for example with regional guanethidine blocks, may sometimes help, but relapse may occur.

Cross References Hyperalgesia; Hyperpathia - 21 - A Allographia Allographia This term has been used to describe a peripheral agraphia syndrome characterized by problems spelling both words and non-words, with case change errors such that upper and lower case letters are mixed when writing, with upper and lower case versions of the same letter sometimes superimposed on one another.

Such errors increased in frequency with word length. These defects have been interpreted as a disturbance in selection of allographic forms in response to graphemic information outputted from the graphemic response buffer.

Cross Reference Agraphia Allokinesia, Allokinesis Allokinesis has been used to denote a motor response in the wrong limb e.

Others have used the term to denote a form of motor neglect, akin to alloaesthesia and allochiria in the sensory domain, relating to incorrect responses in the limb ipsilateral to a frontal lesion, also labelled disinhibition hyperkinesia.

References Fisher CM. Neurologic fragments. Clinical observations in demented patients. Frontal lobe neglect in monkeys. Patients with limb-kinetic apraxia cannot keep pace and lose track.

Altitudinal field defects - 22 - Amblyopia A are characteristic of but not exclusive to disease in the distribution of the central retinal artery.

Central vision may be preserved macula sparing because the blood supply of the macula often comes from the cilioretinal arteries.

Cross References Hemianopia; Macula sparing, Macula splitting; Quadrantanopia; Visual field defects Amaurosis Amaurosis is visual loss, with the implication that this is not due to refractive error or intrinsic ocular disease.

The term is most often used in the context of amaurosis fugax, a transient monocular blindness, which is most often due to embolism from a stenotic ipsilateral internal carotid artery ocular transient ischaemic attack.

Giant cell arteritis, systemic lupus erythematosus, and the antiphospholipid antibody syndrome are also recognized causes.

Gaze-evoked amaurosis has been associated with a variety of mass lesions and is thought to result from decreased blood flow to the retina from compression of the central retinal artery with eye movement.

Amblyopic eyes may demonstrate a relative afferent pupillary defect and sometimes latent nystagmus.

Amblyopia may not become apparent until adulthood, when the patient suddenly becomes aware of unilateral poor vision.

The finding of a latent strabismus heterophoria may be a clue to the fact that such visual loss is long-standing. This is a component of long-term as opposed to working memory which is distinct from memory for facts semantic memory , in that episodic memory is unique to the individual whereas semantic memory encompasses knowledge held in common by members of a cultural or linguistic group.

A precise clinical definition for amnesia has not been demarcated, perhaps reflecting the heterogeneity of the syndrome.

Amnesia may be retrograde for events already experienced or anterograde for newly experienced events. Retrograde amnesia may show a temporal gradient, with distant events being better recalled than more recent ones, relating to the duration of anterograde amnesia.

Amnesia may be acute and transient or chronic and persistent. In a pure amnesic syndrome, intelligence and attention are normal and skill acquisition procedural memory is preserved.

Amnesia may occur as one feature of more widespread cognitive impairments, e. Various psychometric tests of episodic memory are available.

Poor spontaneous recall, for example, of a word list, despite an adequate learning curve, may be due to a defect in either storage or retrieval.

This may be further probed with cues: if this improves recall, then a disorder of retrieval is responsible; if cueing leads to no improvement or false-positive responses to foils as in the Hopkins Verbal Learning Test are equal or greater than true positives, then a learning defect true amnesia is the cause.

The neuroanatomical substrate of episodic memory is a distributed system in the medial temporal lobe and diencephalon surrounding the third ventricle the circuit of Papez comprising the entorhinal area of the parahippocampal gyrus, perforant and alvear pathways, hippocampus, fimbria and fornix, mammillary bodies, mammillothalamic tract, anterior thalamic nuclei, internal capsule, cingulate gyrus, and cingulum.

Basal forebrain structures septal nucleus, diagonal band nucleus of Broca, nucleus basalis of Meynert are also involved. A distinction between medial temporal pathology e.

A frontal amnesia has also been suggested, although impaired attentional mechanisms may contribute.

Few of the chronic persistent causes of amnesia are amenable to specific treatment. Plasma exchange or intravenous immunoglobulin therapy may be helpful in non-paraneoplastic limbic encephalitis associated with autoantibodies directed against voltage-gated potassium channels.

Functional or psychogenic amnesia may involve failure to recall basic autobiographical details such as name and address. Reversal of the usual temporal gradient of memory loss may be observed but this may also be the case in the syndrome of focal retrograde amnesia.

Amnesic disorders. Kopelman MD. Disorders of memory. The amnesias. A clinical textbook of memory disorders.

Pujol M, Kopelman MD. Psychogenic amnesia. Cross Reference Aphasia Amusia Amusia is a loss of the ability to appreciate music despite normal intelligence, memory, and language function.

Subtypes have been described: receptive or sensory amusia is loss of the ability to appreciate music; and expressive or motor amusia is loss of ability to sing, whistle.

Clearly a premorbid appreciation of music is a sine qua non for the diagnosis particularly of the former , and most reported cases of amusia have occurred in trained musicians.

Tests for the evaluation of amusia have been described. Amusia may occur in the context of more widespread cognitive dysfunction, such as aphasia and agnosia.

It has been found in association with pure word deafness, presumably as part of a global auditory agnosia. Isolated amusia has been reported in the context of focal cerebral atrophy affecting the nondominant temporal lobe.

However, functional studies have failed to show strong hemispheric specificity for music perception, but suggest a cross-hemispheric distributed neural substrate.

An impairment of pitch processing with preserved awareness of musical rhythm changes has been described in amusics. Congenital amusia: a group study of adults afflicted with a music-specific disorder.

Progressive amusia and aprosody. Hyde KL, Peretz I. Brains that are out of tune but in time. Receptive amusia: evidence for cross-hemispheric neural networks underlying music processing strategies.

Cross References Agnosia; Auditory agnosia; Pure word deafness - 26 - Analgesia A Amyotrophy Amyotrophy is a term used to describe thinning or wasting atrophy of musculature with attendant weakness.

Hence, although the term implies neurogenic as opposed to myogenic muscle wasting, its use is non-specific with respect to neuroanatomical substrate.

Cross References Atrophy; Fasciculation; Neuropathy; Plexopathy; Radiculopathy; Wasting Anaesthesia Anaesthesia anesthesia is a complete loss of sensation; hypoaesthesia hypaesthesia, hypesthesia is a diminution of sensation.

Hence in Jacksonian terms, these are negative sensory phenomena. Anaesthesia may involve all sensory modalities global anaesthesia, as in general surgical anaesthesia or be selective e.

Regional patterns of anaesthesia are described, e. Anaesthesia is most often encountered after resection or lysis of a peripheral nerve segment, whereas paraesthesia or dysaesthesia positive sensory phenomena reflects damage to a nerve which is still in contact with the cell body.

Anaesthesia dolorosa, or painful anaesthesia, is a persistent unpleasant pain i. This deafferentation pain may respond to various medications, including tricyclic antidepressants, carbamazepine, gabapentin, pregabalin, and selective serotonin-reuptake inhibitors.

Cross References Analgesia; Dysaesthesia; Neuropathy; Paraesthesia Analgesia Analgesia or hypoalgesia refers to a complete loss or diminution, respectively, of pain sensation, or the absence of a pain response to a normally painful stimulus.

These negative sensory phenomena may occur as one component of total sensory loss anaesthesia or in isolation. Consequences of analgesia include - 27 - A Anal Reflex the development of neuropathic ulcers, burns, Charcot joints, even painless mutilation, or amputation.

Congenital syndromes of insensitivity to pain were once regarded as a central pain asymbolia e.

Congenital insensitivity to pain: a 20 year follow up. This reflex may be absent in some normal elderly individuals, and absence does not necessarily correlate with urinary incontinence.

External anal responses to coughing and sniffing are part of a highly consistent and easily elicited polysynaptic reflex, whose characteristics resemble those of the conventional scratch-induced anal reflex.

The anal reflex elicited by cough and sniff: validation of a neglected clinical sign. This is most commonly seen as a feature of the bulbar palsy of motor neurone disease.

Slowly progressive anarthria with late anterior opercular syndrome: a variant form of frontal cortical atrophy syndromes.

Lecours AR, Lhermitte F. Cross References Aphemia; Bulbar palsy; Dysarthria Angioscotoma Angioscotomata are shadow images of the superficial retinal vessels on the underlying retina, a physiological scotoma.

Cross Reference Scotoma Angor Animi Angor animi is the sense of dying or the feeling of impending death.

It may be experienced on awakening from sleep or as a somesthetic aura of migraine. Reference Ryle JA.

Angor animi, or the sense of dying. Cross Reference Aura Anhidrosis Anhidrosis, or hypohidrosis, is a loss or lack of sweating.

It - 29 - A Anisocoria is thought to represent a focal dystonia and may be helped temporarily by local injections of botulinum toxin. Botulinum toxin type-A in therapy of patients with anismus.

Neurological: Anisocoria greater in dim light or darkness suggests a sympathetic innervation defect darkness stimulates dilatation of normal pupil.

Clinical characteristics and pharmacological testing may help to establish the underlying diagnosis in anisocoria. Reference Kawasaki A.

Approach to the patient with abnormal pupils. In: Biller J ed. Practical neurology 2nd edition. Formal tests of naming are also available e.

Graded Naming Test. Patients may be able to point to named objects despite being unable to name them, suggesting a problem in word retrieval but with preserved comprehension.

They may also be able to say something about the objects they cannot name e. Category-specific anomias have been described, e.

Anomia occurs with pathologies affecting the left temporoparietal area, but since it occurs in all varieties of aphasia is of little precise localizing or diagnostic value.

The term anomic aphasia is reserved for unusual cases in which a naming problem overshadows all other deficits. Anomia may often be seen as a residual deficit following recovery from other types of aphasia.

Anomia: a doubly typical signature of semantic dementia. Cross References Aphasia; Circumlocution; Paraphasia Anosmia Anosmia is the inability to perceive smells due to damage to the olfactory pathways olfactory neuroepithelium, olfactory nerves, rhinencephalon.

Olfaction may be tested with kits containing specific odours e. Unilateral anosmia may be due to pressure on the olfactory bulb or tract, e.

Anosmia may be congenital e. Rhinological disease allergic rhinitis, coryza is by far the most common cause; this may also account for the impaired sense of smell in smokers.

Head trauma is the most common neurological cause, due to shearing off of the olfactory fibres as they pass through the cribriform plate.

Recovery is possible in this situation due to the capacity for neuronal and axonal regeneration within the olfactory pathways.

Patients with depression may also complain of impaired sense of smell. Loss of olfactory acuity may be a feature of normal ageing.

The neurology of olfaction. Cross References Age-related signs; Ageusia; Cacosmia; Dysgeusia; Mirror movements; Parosmia Anosodiaphoria Babinski used the term anosodiaphoria to describe a disorder of body schema in which patients verbally acknowledge a clinical problem e.

Anosodiaphoria usually follows a stage of anosognosia. References Babinski JM. Observations on anosodiaphoria.

Some authorities would question whether this unawareness is a true agnosia or rather a defect of higher-level cognitive integration i.

Anosognosia with hemiplegia most commonly follows right hemisphere injury parietal and temporal lobes and may be associated with left hemineglect and left-sided hemianopia; it is also described with right thalamic and basal ganglia lesions.

Many patients with posterior aphasia Wernicke type are unaware that their output is incomprehensible or jargon, possibly through a failure to monitor their own output.

The neuropsychological mechanisms of anosognosia are unclear: the hypothesis that it might be accounted for by personal neglect asomatognosia , which is also more frequently observed after right hemisphere lesions, would seem to have been disproved experimentally by studies using selective hemisphere anaesthesia in which the two may be dissociated, a dissociation which may also be observed clinically.

Temporary resolution of anosognosia has been reported following vestibular stimulation e. Babinski JM. Hemianopic anosognosia.

Unawareness of deficits in neuropsychological syndromes. Morris RG, Hannesdottir K. Anosognosia in patients with cerebrovascular lesions: a study of causative factors.

Loss of anserina may be a feature of some autonomic disorders. Antecollis Antecollis anterocollis is forward flexion of the neck.

It may be a feature of multiple system atrophy cf. Reference Quinn N. Disproportionate antecollis in multiple system atrophy. Lancet ; 1: The syndrome most usually results from bilateral posterior cerebral artery territory lesions causing occipital or occipitoparietal infarctions but has occasionally been described with anterior visual pathway lesions associated with frontal lobe lesions.

It may also occur in the context of dementing disorders or delirium. Gassel M, Williams D. Visual function in patients with homonymous hemianopia.

The completion phenomenon: insight and attitude to the defect: and visual function efficiency. Cross References Agnosia, Anosognosia, Confabulation, Cortical blindness Anwesenheit A vivid sensation of the presence of somebody either somewhere in the room or behind the patient has been labelled as anwesenheit German: presence , presence hallucination, minor hallucination, or extracampine hallucination.

Hence, listlessness, paucity of spontaneous movement akinesia or speech mutism , and lack of initiative, spontaneity, and drive may be features of apathy These are also all features of the abulic state, and it has been suggested that apathy and abulia represent different points on a continuum of motivational and emotional deficit, abulia being at the more severe end.

Apathy is a specific neuropsychiatric syndrome, distinct from depression. Apathy is also described following amphetamine or cocaine withdrawal, in neuroleptic-induced akinesia and in psychotic depression.

Selective serotonin-reuptake inhibitors may sometimes be helpful in the treatment of apathy. Apathy is not depression.

Marin RS. Differential diagnosis and classification of apathy. Cross References Abulia; Akinetic mutism; Dementia; Frontal lobe syndromes Aphasia Aphasia, or dysphasia, is an acquired loss or impairment of language function.

Non-linguistic components of language emotion, inflection, cadence , collectively known as prosody, may require contributions from both hemispheres.

Language is distinguished from speech oral communication , disorders of which are termed dysarthria or anarthria.

Dysarthria and aphasia may coexist but are usually separable. Comprehension: spared or impaired? Repetition: preserved or impaired?

Naming: preserved or impaired? Reading: evidence of alexia? Writing: evidence of agraphia? Conduction aphasia is marked by relatively normal spontaneous speech perhaps with some paraphasic errors , but a profound deficit of repetition.

In transcortical motor aphasia spontaneous output is impaired but repetition is intact. Aphasia may also occur with space-occupying lesions and in neurodegenerative disorders, often with other cognitive impairments e.

References Basso A. Aphasia and its therapy. Oxford: Oxford University Press, Benson DF, Ardila A. Caplan D. Aphasic syndromes. Approach to the patient with aphasia.

Spreen O, Risser AH. Assessment of aphasia. Willmes K, Poeck K. To what extent can aphasic syndromes be localized?

The term is now used to describe a motor disorder of speech production with preserved comprehension of spoken and written language.

This syndrome has also been called phonetic disintegration cf. Such conditions may stand between pure disorders of speech i. Aphemia: an isolated disorder of articulation.

Henderson VW. Alalia, aphemia, and aphasia. Aphemia: clinicalanatomic correlations. Cross References Anarthria; Aphasia; Aprosodia, Aprosody; Dysarthria; Phonemic disintegration; Speech apraxia Aphonia Aphonia is loss of the sound of the voice, necessitating mouthing or whispering of words.

As for dysphonia, this most frequently follows laryngeal inflammation, although it may follow bilateral recurrent laryngeal nerve palsy. Dystonia of the abductor muscles of the larynx can result in aphonic segments of speech spasmodic aphonia or abductor laryngeal dystonia ; this may be diagnosed by - 37 - A Applause Sign hearing the voice fade away to nothing when asking the patient to keep talking; patients may comment that they cannot hold any prolonged conversation.

Aphonia of functional or hysterical origin is also recognized. Aphonia should be differentiated from mutism, in which patients make no effort to speak, and anarthria in which there is a failure of articulation.

Cross References Anarthria; Dysphonia; Mutism Applause Sign To elicit the applause sign, also known as the clapping test or three clap test, the patient is asked to clap the hands three times.

Diagnostic accuracy of the clapping test in Parkinsonian disorders. Aposiopesis Critchely used this term to denote a sentence which is started but not finished, as in the aphasia associated with dementia.

Reference Critchley M. The divine banquet of the brain and other essays. Cross Reference Aphasia Apraxia Apraxia or dyspraxia is a disorder of movement characterized by the inability to perform a voluntary motor act despite an intact motor system i.

Ideomotor apraxia IMA : A disturbance in the selection of elements that constitute a movement e.

This may be associated with the presence of a grasp reflex and alien limb phenomena limb-kinetic type of apraxia.

Apraxia is more common and severe with left hemisphere lesions. Difficulties with the clinical definition of apraxia persist, as for the agnosias.

Likewise, some cases labelled as eyelid apraxia or gait apraxia are not true ideational apraxias. The exact nosological status of speech apraxia also remains tendentious.

References Binkofski F, Reetz K. Cognitive neurology: a clinical textbook. Crutch S. Advances in Clinical Neuroscience and Rehabilitation ; 5 1 : 16, Grafton S.

Apraxia: a disorder of motor control. Limb apraxias. Higher-order disorders of sensorimotor integration. Liepmann H. Berlin: Karger, Cross References Alien hand, Alien limb; Body part as object; Crossed apraxia; Dysdiadochokinesia; Eyelid apraxia; Forced groping; Frontal lobe syndromes; Gait apraxia; Grasp reflex; Optic ataxia; Speech apraxia - 39 - A Aprosexia Aprosexia Aprosexia is a syndrome of psychomotor inefficiency, characterized by complaints of easy forgetting, for example, of conversations as soon as they are finished, material just read, or instructions just given.

There is difficulty keeping the mind on a specific task, which is forgotten if the patient happens to be distracted by another task.

These difficulties, into which the patient has insight and often bitterly complains of, are commonly encountered in the memory clinic.

They probably represent a disturbance of attention or concentration, rather than being a harbinger of dementia.

These patients generally achieve normal scores on formal psychometric tests and indeed may complain that these assessments do not test the function they are having difficulty with.

Concurrent sleep disturbance, irritability, and low mood are common and may reflect an underlying affective disorder anxiety, depression which may merit specific treatment.

Cross References Attention; Dementia Aprosodia, Aprosody Aprosodia or aprosody dysprosodia, dysprosody is a defect in or absence of the ability to produce or comprehend speech melody, intonation, cadence, rhythm, and accentuations, in other words the non-linguistic aspects of language which convey or imply emotion and attitude.

Progressive affective aprosodia and prosoplegia. Monrad-Krohn GH. Ross ED. The aprosodias: functional-anatomic organization of the affective components of language in the right hemisphere.

Cross References Retinopathy; Scotoma Areflexia Areflexia is an absence or a loss of tendon reflexes. This may be physiological, in that some individuals never demonstrate tendon reflexes; or pathological, reflecting an anatomical interruption or physiological dysfunction at any point along the monosynaptic reflex pathway which is the neuroanatomical substrate of phasic stretch reflexes.

Areflexia is most often encountered in disorders of lower motor neurones, specifically radiculopathies, plexopathies, and neuropathies axonal and demyelinating.

It fails to react to light reflex iridoplegia , but does constrict to accommodation when the eyes converge. Since the light reflex is lost, testing for the accommodation reaction may be performed with the pupil directly illuminated: this can make it easier to see the response to accommodation, which is often difficult to observe when the pupil is small or in individuals with a dark iris.

There may be an incomplete response to mydriatic drugs. Although pupil involvement is usually bilateral, it is often asymmetric, causing anisocoria.

The Argyll Robertson pupil was originally described in the context of neurosyphilis, especially tabes dorsalis. The neuroanatomical substrate of the Argyll Robertson pupil is uncertain.

A lesion in the tectum of the rostral midbrain proximal to the oculomotor nuclei has been suggested. Some authorities think that a partial oculomotor III nerve palsy or a lesion of the ciliary ganglion is a more likely cause.

References Argyll Robertson D. Four cases of spinal myosis [sic]: with remarks on the action of light on the pupil.

The Argyll Robertson pupil. Significance of the Argyll Robertson pupil in clinical medicine. It is said that in organic weakness the hand will hit the face, whereas patients with functional weakness avoid this consequence.

Functional weakness and sensory disturbance. The term was invented in the nineteenth century Hamilton as an alternative to aphasia, since in many cases of the latter there is more than a loss of speech, including impaired pantomime apraxia and in symbolizing the relationships of things.

Hughlings Jackson approved of the term but feared it was too late to displace the word aphasia.

Father of English neurology. Cross References Aphasia, Apraxia Asomatognosia Asomatognosia is a lack of regard for a part, or parts, of the body, most typically failure to acknowledge the existence of a hemiplegic left arm.

Asomatognosia may be verbal denial of limb ownership or non-verbal failure to dress or wash limb. All patients with asomatognosia have hemispatial neglect usually left , hence this would seem to be a precondition for the development of asomatognosia; indeed, for some authorities asomatognosia is synonymous with personal neglect.

Attribution of the neglected limb to another person is known as somatoparaphrenia. The neuroanatomical correlate of asomatognosia is damage to the right supramarginal gyrus and posterior corona radiata, most commonly due to a cerebrovascular event.

Cases with right thalamic lesions have also been reported. The predilection of asomatognosia for the left side of the body may simply be a reflection of the aphasic problems associated with leftsided lesions that might be expected to produce asomatognosia for the right side.

Asomatognosia is related to anosognosia unawareness or denial of illness but the two are dissociable on clinical and experimental grounds.

Some authorities consider asomatognosia as a form of confabulation. The neuroanatomy of asomatognosia and somatoparaphrenia. The term has no standardized definition and hence may mean different things to different observers; it has also been used to describe a disorder characterized by inability to stand or walk despite normal leg strength when lying or sitting, believed to be psychogenic although gait apraxia may have similar features.

A transient inability to sit or stand despite normal limb strength may be seen after an acute thalamic lesion thalamic astasia. Thalamic astasia: inability to stand after unilateral thalamic lesions.

Human walking and higher-level gait disorders, particularly in the elderly. Cross Reference Gait apraxia Astereognosis Astereognosis is the failure to recognize a familiar object, such as a key or a coin, palpated in the hand with the eyes closed, despite intact primary sensory modalities.

Description of qualities such as the size, shape, and texture of the object may be possible. Hence, this is a failure of higher-order i.

There may be associated impairments of two-point discrimination and graphaesthesia cortical sensory syndrome.

Astereognosis was said to be invariably present in the original description of the thalamic syndrome by Dejerine and Roussy.

Some authorities recommend the terms stereoanaesthesia or stereohypaesthesia as more appropriate descriptors of this phenomenon, to emphasize that this may be a disorder of perception rather than a true agnosia for a similar debate in the visual domain, see Dysmorphopsia.

Cross References Agnosia; Dysmorphopsia; Graphaesthesia; Two-point discrimination Asterixis Asterixis is a sudden, brief, arrhythmic lapse of sustained posture due to involuntary interruption in muscle contraction.

It is most easily demonstrated by observing the dorsiflexed hands with arms outstretched i. These features distinguish asterixis from tremor and myoclonus; the phenomenon has previously been described as negative myoclonus or negative tremor.

Asterixis may be bilateral or unilateral. Unilateral asterixis has been described in the context of stroke, contralateral to lesions of the midbrain involving corticospinal fibres, medial lemniscus , thalamus ventroposterolateral nucleus , primary motor cortex, and parietal lobe; and ipsilateral to lesions of the pons or medulla.

Unilateral asterixis and stroke in 13 patients: localization of the lesions matching the CT scan images to an atlas. European Journal of Neurology ; 11 suppl 2 : 56 abstract P Unilateral asterixis: motor integrative dysfunction in focal vascular disease.

Such refractive errors are sometimes blamed for headache. Asynergia Asynergia or dyssynergia is lack or impairment of synergy of sequential muscular contraction in the performance of complex movements, such that they seem to become broken up into their constituent parts, so-called decomposition of movement.

This may be evident when performing rapid alternating hand movements. Dyssynergy of speech may also occur, a phenomenon sometimes termed scanning speech or scanning dysarthria.

This is typically seen in cerebellar syndromes, most often those affecting the cerebellar hemispheres, and may coexist with other signs of cerebellar disease such as ataxia, dysmetria, and dysdiadochokinesia.

Cross References Ataxia; Cerebellar syndromes; Dysarthria; Dysdiadochokinesia; Dysmetria; Scanning speech Ataxia Ataxia or dystaxia refers to a lack of coordination of voluntary motor acts, impairing their smooth performance.

The rate, range, timing, direction, and force of movement may be affected. Ataxia is used most frequently to refer to a cerebellar problem, but sensory ataxia, optic ataxia, and frontal ataxia are also described, so it is probably best to qualify ataxia rather than to use the word in isolation.

There may be concurrent limb hypotonia. An International Cooperative Ataxia Rating Scale has been developed to assess the efficacy of treatments for cerebellar ataxia.

It is markedly exacerbated by removal of visual cues e. These fibres run in the corticopontocerebellar tract, synapsing in the pons before passing through the middle cerebellar peduncle to the contralateral cerebellar hemisphere.

Marvinrom: You said it adequately.! JorgeFut: You reported it adequately. Numerous info. Jamestrurb: With thanks!

I appreciate this. AnthonySuist: Nicely put, Kudos. DerrickGrilm: Great content. JorgeFut: Truly a good deal of beneficial info!

Jamestrurb: You expressed it very well. DerrickGrilm: Thanks a lot, Ample info. DerrickGrilm: Well spoken truly!

Marvinrom: Awesome info. AnthonySuist: Really loads of excellent information. Marvinrom: You actually explained this terrifically. DerrickGrilm: You have made your point pretty effectively!.

JorgeFut: Appreciate it. Plenty of forum posts. Jamestrurb: Thanks, Quite a lot of advice! DerrickGrilm: Superb info. Many thanks.

Jamestrurb: With thanks, I appreciate this! JorgeFut: Wonderful forum posts. NormanUnsup: Thanks a lot, A lot of content!

Marvinrom: Fantastic content. NormanUnsup: Factor nicely used!. Jamestrurb: You actually said that really well!

DerrickGrilm: Nicely expressed genuinely! DerrickGrilm: Good stuff. Marvinrom: Perfectly expressed indeed! JorgeFut: Really plenty of wonderful data.

Jamestrurb: Helpful facts. Helpful stuff. DerrickGrilm: You made your point pretty well!! JorgeFut: This is nicely expressed.

NormanUnsup: Cheers. A good amount of knowledge. Marvinrom: You have made the point. AnthonySuist: Amazing facts. NormanUnsup: Reliable advice.

Jamestrurb: Superb stuff. Jamestrurb: Really a lot of excellent facts! JorgeFut: Cheers. Loads of facts.

Marvinrom: Incredible all kinds of wonderful data! DerrickGrilm: Thank you, Plenty of stuff. NormanUnsup: Appreciate it. A good amount of material.

DerrickGrilm: You reported this fantastically! AnthonySuist: Point nicely considered!. JorgeFut: Excellent write ups. Jamestrurb: Nicely put.

NormanUnsup: You definitely made the point. AnthonySuist: Good content, Many thanks. Marvinrom: Wonderful tips.

DerrickGrilm: Whoa plenty of valuable tips! DerrickGrilm: Thank you, Awesome stuff. JorgeFut: Appreciate it! A lot of write ups.

Marvinrom: Thank you, A good amount of data. NormanUnsup: Kudos, Loads of information. DerrickGrilm: You mentioned it effectively!

AnthonySuist: Many thanks, A lot of advice! JorgeFut: Lovely content, Cheers. DerrickGrilm: Amazing tons of amazing information! Jamestrurb: You said it nicely.!

NormanUnsup: Wow a lot of awesome facts. DerrickGrilm: Awesome information. Jamestrurb: You actually reported this effectively!

DerrickGrilm: Many thanks. I like it! Useful information. Marvinrom: With thanks! Loads of write ups. JorgeFut: Wow a good deal of amazing material.

NormanUnsup: With thanks! Marvinrom: Lovely content. Good stuff! AnthonySuist: Cheers, Wonderful stuff.

JorgeFut: You actually explained this well. Jamestrurb: With thanks, Quite a lot of content! DerrickGrilm: Regards!

A lot of stuff. Jamestrurb: Regards! AnthonySuist: Truly plenty of superb data. Marvinrom: Kudos. DerrickGrilm: Nicely put, Regards!

NormanUnsup: Lovely content, Kudos. JorgeFut: You actually expressed this well. DerrickGrilm: Valuable knowledge. DerrickGrilm: Regards.

I appreciate this! Jamestrurb: Regards. Loads of knowledge. NormanUnsup: Cheers, Ample content.

AnthonySuist: Truly all kinds of amazing material! DerrickGrilm: Seriously quite a lot of terrific data! Jamestrurb: Cheers. NormanUnsup: Nicely put.

AnthonySuist: Wonderful content. CharlesTug: Truly quite a lot of very good material! DerrickGrilm: You said it very well.!

JorgeFut: Thanks, An abundance of material! Jamestrurb: Incredible lots of beneficial knowledge!

Marvinrom: Wow all kinds of useful info! NormanUnsup: This is nicely put. DerrickGrilm: You said it perfectly!

CharlesTug: Very well expressed without a doubt. JorgeFut: Effectively spoken genuinely. Jamestrurb: Effectively spoken truly!

AnthonySuist: You made the point! A lot of facts! DerrickGrilm: Tips very well applied!! CharlesTug: Thanks a lot.

Ample data. AnthonySuist: This is nicely expressed! DerrickGrilm: Superb write ups. Marvinrom: Cheers.

Lots of forum posts! DerrickGrilm: Effectively spoken genuinely. Jamestrurb: Nicely put, Kudos! NormanUnsup: Whoa a lot of helpful information.

CharlesTug: You have made your point! Marvinrom: Thanks a lot! An abundance of facts. Jamestrurb: Awesome data.

AnthonySuist: With thanks! A good amount of content. DerrickGrilm: You said it nicely.. NormanUnsup: Thanks.

An abundance of postings! CharlesTug: You explained that well. DerrickGrilm: You said it adequately.. AnthonySuist: You have made the point.

Marvinrom: Terrific advice. NormanUnsup: Thank you, Helpful stuff. CharlesTug: Helpful stuff. Jamestrurb: Awesome information.

DerrickGrilm: You actually suggested this very well! Marvinrom: Cheers! I enjoy this. DerrickGrilm: This is nicely put.

JorgeFut: Wow quite a lot of helpful info. NormanUnsup: Thank you! An abundance of tips! CharlesTug: Regards, Loads of info!

DerrickGrilm: Thanks! Lots of content. Jamestrurb: You actually mentioned it effectively! CharlesTug: Nicely put, Kudos.

NormanUnsup: Fantastic stuff. Marvinrom: Nicely put, Thanks. DerrickGrilm: Really all kinds of great tips.

JorgeFut: Amazing content, Cheers. Jamestrurb: Thanks a lot, Great information. DerrickGrilm: With thanks.

Valuable information! Marvinrom: You said it very well.! JorgeFut: This is nicely put. CharlesTug: Thank you! Loads of data!

NormanUnsup: Many thanks, I value it! AnthonySuist: Terrific data, Cheers. DerrickGrilm: Awesome info. Jamestrurb: Thanks, Quite a lot of posts!

CharlesTug: Perfectly voiced indeed. NormanUnsup: Many thanks. AnthonySuist: Useful tips. Marvinrom: Terrific facts. DerrickGrilm: Whoa loads of very good information.

CharlesTug: Truly lots of very good information! Marvinrom: Terrific write ups. JorgeFut: You revealed that really well.

DerrickGrilm: Great information, With thanks. AnthonySuist: You actually stated that perfectly! Jamestrurb: You actually reported that terrifically!

NormanUnsup: Great advice. Jamestrurb: This is nicely expressed! AnthonySuist: Truly plenty of helpful tips. JorgeFut: Wow quite a lot of amazing info!

DerrickGrilm: Whoa tons of helpful info! Marvinrom: Amazing lots of valuable knowledge! DerrickGrilm: Valuable information.

CharlesTug: With thanks, Loads of postings. NormanUnsup: Appreciate it, A lot of information. JorgeFut: You actually suggested that perfectly.

Marvinrom: You definitely made your point. DerrickGrilm: Amazing loads of great information! CharlesTug: This is nicely expressed!

AnthonySuist: Many thanks, Fantastic stuff! Jamestrurb: Valuable postings. NormanUnsup: This is nicely expressed! DerrickGrilm: Really loads of valuable material.

Jamestrurb: Truly plenty of wonderful facts. DerrickGrilm: Thanks, Terrific information! AnthonySuist: With thanks. Fantastic information.

JorgeFut: Terrific info. CharlesTug: Nicely put, Thanks a lot! Marvinrom: Cheers, I value it. NormanUnsup: Really quite a lot of valuable information!

Lots of postings. DerrickGrilm: Kudos! Plenty of info. Marvinrom: Regards! Awesome stuff! DerrickGrilm: Nicely put, With thanks.

CharlesTug: You actually reported that exceptionally well! Jamestrurb: You have made the point.

NormanUnsup: Really tons of valuable facts. AnthonySuist: Incredible tons of amazing info! Jamestrurb: Appreciate it. Ample information! DerrickGrilm: Wow loads of wonderful material!

CharlesTug: Fine material. JorgeFut: Amazing info, Thanks a lot. AnthonySuist: Wow lots of beneficial material! NormanUnsup: Beneficial material.

DerrickGrilm: Superb facts, Many thanks. CharlesTug: Very well spoken indeed. JorgeFut: Many thanks. Fantastic stuff.

DerrickGrilm: Well spoken without a doubt. Jamestrurb: Great write ups. DerrickGrilm: Thanks a lot, Lots of postings.

Marvinrom: You stated that effectively! NormanUnsup: You mentioned that fantastically! AnthonySuist: You made your point very nicely!.

Jamestrurb: Useful advice. CharlesTug: Awesome content. JorgeFut: You said it very well.. AnthonySuist: Awesome posts.

NormanUnsup: Wow quite a lot of good advice. Marvinrom: You reported this terrifically! CharlesTug: Incredible a good deal of amazing facts!

DerrickGrilm: Truly all kinds of helpful info. Jamestrurb: Great information. JorgeFut: You said it adequately..

NormanUnsup: Many thanks! Quite a lot of content! Marvinrom: Nicely put, Appreciate it. Jamestrurb: Thanks a lot, Numerous data!

DerrickGrilm: Position very well considered.! AnthonySuist: Very good posts. DerrickGrilm: Really tons of amazing data! CharlesTug: Incredible a lot of useful info!

DerrickGrilm: Kudos, Quite a lot of information. NormanUnsup: You actually reported that wonderfully! JorgeFut: Many thanks, Quite a lot of write ups!

CharlesTug: Incredible plenty of valuable facts. DerrickGrilm: Amazing lots of superb knowledge! DerrickGrilm: Truly a lot of very good material.

Jamestrurb: You said it fantastically! Marvinrom: Many thanks. Quite a lot of tips! JorgeFut: You actually said that exceptionally well!

Jamestrurb: Whoa many of superb info. Marvinrom: Appreciate it! An abundance of info. CharlesTug: This is nicely said.

DerrickGrilm: This is nicely expressed. AnthonySuist: Whoa a good deal of very good knowledge! NormanUnsup: This is nicely said. CharlesTug: Terrific data.

JorgeFut: Thanks a lot, Numerous content! Jamestrurb: Wow lots of superb advice. NormanUnsup: You explained this perfectly.

DerrickGrilm: Many thanks, Useful stuff! Marvinrom: Fantastic facts, Regards. JorgeFut: Excellent postings. Jamestrurb: You actually reported that really well!

CharlesTug: Appreciate it, Numerous material! DerrickGrilm: You said it really well. DerrickGrilm: You actually stated that really well.

Marvinrom: Nicely put, Thanks a lot! AnthonySuist: Thank you! Excellent information. CharlesTug: Nicely voiced indeed.

Lots of knowledge. Jamestrurb: Many thanks. DerrickGrilm: Terrific data, Kudos! AnthonySuist: You made your point!

NormanUnsup: Wow tons of wonderful knowledge. Jamestrurb: You actually reported that terrifically. Marvinrom: Thanks, I enjoy it! An abundance of write ups!

CharlesTug: Excellent info. DerrickGrilm: Very good tips. DerrickGrilm: Wonderful content. Great information. Marvinrom: Wow tons of beneficial information.

NormanUnsup: Fantastic information. CharlesTug: Thank you, I like it. AnthonySuist: You actually explained that terrifically.

Jamestrurb: Excellent write ups. DerrickGrilm: Reliable information. JorgeFut: Wow lots of awesome material. DerrickGrilm: You suggested this very well!

A lot of advice. CharlesTug: Truly tons of very good info. I like it. Awesome information! DerrickGrilm: Wonderful stuff. NormanUnsup: Cheers, Lots of write ups!

CharlesTug: You actually expressed it adequately! Marvinrom: Fine data. Jamestrurb: Kudos, A lot of postings. AnthonySuist: You actually expressed this fantastically!

DerrickGrilm: You actually revealed it fantastically. DerrickGrilm: Awesome knowledge. NormanUnsup: Amazing write ups.

JorgeFut: You said it nicely.! Jamestrurb: You actually explained this fantastically. CharlesTug: Kudos, Quite a lot of material!

AnthonySuist: Really all kinds of beneficial data. JorgeFut: Really a lot of superb facts. DerrickGrilm: Very good advice. DerrickGrilm: You actually said this well.

Marvinrom: With thanks, Great information! CharlesTug: Kudos. NormanUnsup: You actually said that fantastically!

Very good stuff! AnthonySuist: You stated that really well! DerrickGrilm: Lovely data, Many thanks. Jamestrurb: Regards, Plenty of knowledge!

JorgeFut: Thanks a lot! CharlesTug: Very good forum posts. DerrickGrilm: You revealed it fantastically. DerrickGrilm: Nicely put, With thanks!

Good information. Ample information. CharlesTug: Incredible lots of very good facts! NormanUnsup: Incredible lots of excellent knowledge!

Marvinrom: Well expressed indeed. DerrickGrilm: You made your point! Jimmysar: You made the point. JosephEmors: Fantastic content. Jimmysar: Incredible many of excellent advice.

EdwardAppom: You actually explained it exceptionally well! EdwardAppom: Fine data. JosephEmors: Awesome advice. Jimmysar: Wonderful data.

JosephEmors: Great facts. Jimmysar: Excellent posts. EdwardAppom: This is nicely put. EdwardAppom: Kudos.

An abundance of advice! Jimmysar: Good content, Thanks! JosephEmors: Regards! Numerous information. Jimmysar: Appreciate it. Ample stuff.

EdwardAppom: You said it nicely.. EdwardAppom: Terrific postings, Thanks a lot. Jimmysar: Seriously quite a lot of beneficial information.

JosephEmors: Many thanks, Ample knowledge. Jimmysar: Thanks a lot, An abundance of advice. EdwardAppom: You reported this very well. JosephEmors: You suggested it really well.

Jimmysar: Beneficial material. Jimmysar: Nicely spoken indeed! EdwardAppom: You expressed this superbly. EdwardAppom: Thanks a lot. Plenty of postings!

JosephEmors: You actually expressed it effectively. Jimmysar: You actually expressed that adequately. JosephEmors: You actually stated that fantastically!

Jimmysar: Whoa many of very good advice. EdwardAppom: Awesome forum posts, Cheers. EdwardAppom: Wow lots of fantastic knowledge!

JosephEmors: You actually explained that effectively! Jimmysar: With thanks, Quite a lot of posts.

JosephEmors: You said it very well.! Jimmysar: Many thanks, Plenty of knowledge. EdwardAppom: Terrific info. JosephEmors: Good forum posts, Thanks!

Jimmysar: You said it nicely.. JosephEmors: Very good posts. Jimmysar: You said this exceptionally well!

EdwardAppom: Appreciate it! Lots of knowledge! JosephEmors: Terrific material, Thanks! JosephEmors: This is nicely put! Jimmysar: Terrific posts.

EdwardAppom: You actually stated it effectively. JosephEmors: Cheers, Quite a lot of facts! Jimmysar: Nicely put. JosephEmors: Amazing info.

Jimmysar: Awesome postings, With thanks! EdwardAppom: Cheers. Ample data! EdwardAppom: Nicely put. JosephEmors: Really a lot of great tips.

Jimmysar: Great facts, Thanks a lot. JosephEmors: You actually mentioned it really well. EdwardAppom: You actually suggested that really well!

Jimmysar: Nicely put, Cheers. JosephEmors: Perfectly voiced truly! Jimmysar: Thank you! Numerous material! EdwardAppom: Really plenty of amazing advice.

EdwardAppom: Fantastic info. JosephEmors: Thanks a lot. Quite a lot of tips. Jimmysar: You actually stated that terrifically. JosephEmors: You actually mentioned that terrifically.

Jimmysar: You actually mentioned this really well. EdwardAppom: You actually reported this really well!

EdwardAppom: Incredible all kinds of useful tips. JosephEmors: Incredible tons of superb advice. Jimmysar: Point certainly taken!!

JosephEmors: Good data, Thanks! Jimmysar: Thanks a lot. EdwardAppom: Useful tips. EdwardAppom: Thanks!

Quite a lot of facts! JosephEmors: You explained this effectively. Jimmysar: You have made your point.

Jimmysar: You explained that exceptionally well! EdwardAppom: You definitely made your point! EdwardAppom: Kudos!

JosephEmors: Beneficial posts. Jimmysar: Nicely put, Many thanks. JosephEmors: Thanks, Ample info. Jimmysar: Position clearly regarded..

EdwardAppom: Regards, Useful information. EdwardAppom: Thanks a lot! Plenty of information! JosephEmors: Useful knowledge.

Jimmysar: You said that very well. Williamcrery: Cheers. Lots of information! JosephEmors: Nicely put. Jimmysar: Wow all kinds of fantastic tips!

Williamcrery: Awesome postings, Cheers! EdwardAppom: You actually stated that effectively! JosephEmors: Nicely voiced truly!

Jimmysar: Incredible a good deal of great knowledge! Williamcrery: Terrific information. JosephEmors: Excellent facts. Jimmysar: Regards!

Wonderful stuff! Williamcrery: Many thanks. Very good stuff. JosephEmors: Beneficial info. Williamcrery: Incredible loads of good info!

Jimmysar: You actually stated this terrifically! Williamcrery: Incredible many of amazing knowledge. Brendanpaype: Very good stuff, With thanks!

JosephEmors: Really lots of excellent information. Wonderful information! EdwardAppom: Superb advice. Williamcrery: Useful posts.

EdwardAppom: Amazing quite a lot of excellent advice. JosephEmors: Well spoken of course. Williamcrery: Terrific data.

Brendanpaype: Whoa lots of terrific facts! JosephEmors: Good stuff. Jimmysar: Info nicely regarded..

Williamcrery: Cheers, Terrific stuff. Brendanpaype: Incredible quite a lot of helpful information.

EdwardAppom: Thanks a lot, I appreciate it. Williamcrery: This is nicely put. Brendanpaype: Amazing posts. Jimmysar: Cheers! Plenty of information.

Williamcrery: Cheers, I enjoy it! Jimmysar: You mentioned it terrifically. Brendanpaype: This is nicely expressed. Williamcrery: You made the point.

Brendanpaype: Truly quite a lot of great tips. EdwardAppom: Wow a lot of great advice. JosephEmors: Effectively expressed without a doubt!

Williamcrery: Regards! Jimmysar: Incredible a lot of great knowledge. Brendanpaype: Well voiced indeed! Jimmysar: Great postings.

Williamcrery: You expressed this very well! Brendanpaype: Nicely put, Appreciate it! EdwardAppom: Wonderful info. Williamcrery: Appreciate it, Plenty of facts.

EdwardAppom: Reliable info. Brendanpaype: You mentioned that effectively! Williamcrery: Wow lots of amazing tips. Jimmysar: Awesome forum posts.

Brendanpaype: Thanks! A lot of tips! Jimmyesorb: Amazing posts. JosephEmors: Whoa loads of terrific facts!

Jimmysar: Thanks! A good amount of posts. Williamcrery: You actually suggested that well! Brendanpaype: Beneficial posts.

EdwardAppom: Beneficial tips. Jimmyesorb: This is nicely put! EdwardAppom: You actually mentioned it wonderfully. Williamcrery: Incredible plenty of awesome material.

JosephEmors: Useful advice. Brendanpaype: You have made your position very clearly!! Williamcrery: Terrific advice. Brendanpaype: You mentioned this really well!

Acquired dyslexia. Leff A. Advances in Clinical Neuroscience and Rehabilitation ; 4 3 : 18, 20, This may contribute to various physical and behavioural disorders.

There is evidence from functional imaging studies that alexithymics process facial expressions differently from normals, leading to the suggestion that this contributes to disordered affect regulation.

Alexithymia is a common finding in split-brain patients, perhaps resulting from disconnection of the hemispheres.

Alexithymia: an experimental study of cerebral commissurotomy patients and normal control subjects.

Other conditions may also give rise to the phenomena of microsomatognosia or macrosomatognosia, including epilepsy, encephalitis, cerebral mass lesions, schizophrenia, and drug intoxication.

The Alice in Wonderland syndrome. Todd J. The syndrome of Alice in Wonderland. Cross References Aura; Metamorphopsia. Alien Grasp Reflex The term alien grasp reflex has been used to describe a grasp reflex occurring in full consciousness, which the patient could anticipate but perceived as alien i.

These phenomena were associated with an intrinsic tumour of the right non-dominant frontal lobe.

The alien grasp reflex. Cross References Alien hand, Alien limb; Grasp reflex Alien Hand, Alien Limb An alien limb, most usually the arm but occasionally the leg, is one which manifests slow, involuntary, wandering levitating , quasi-purposive movements.

These phenomena are often associated with a prominent grasp reflex, forced groping, intermanual conflict, and magnetic movements of the hand.

Frontal type: shows features of environmental dependency, such as forced grasping and groping, and utilization behaviour.

Sensory or posterior variant: Resulting from a combination of cerebellar, optic, and sensory ataxia; rare.

A paroxysmal alien hand has been described, probably related to seizures of frontomedial origin. More generally, it seems that these areas are involved in the execution of learned motor programs, and damage thereto may lead to the release of learned motor programs from voluntary control.

A propos de trois observations de tumeurs du corps calleux. Alien hand phenomena: a review with the addition of six personal cases.

Goldberg G, Bloom KK. The alien hand sign. Localization, lateralization and recovery. The alien hand: cases, categorizations, and anatomical correlates.

Reference Poeck K, Luzzatti C. Slowly progressive aphasia in three patients: the problem of accompanying neuropsychological deficit.

Alloacousia Alloacousia describes a form of auditory neglect seen in patients with unilateral spatial neglect, characterized by spontaneous ignoring of people addressing the patient from the contralesional side, failing to respond to questions, or answering as if the speaker were on the ipsilesional side.

Reference Heilman K, Valenstein E. Auditory neglect in man. Cross Reference Neglect Alloaesthesia Alloaesthesia allesthesia, alloesthesia is the condition in which a sensory stimulus given to one side of the body is perceived at the corresponding area on the other side of the body after a delay of about half a second.

The trunk and proximal limbs are affected more often than the face or distal limbs. Tactile alloaesthesia may be seen in the acute stage of right putaminal haemorrhage but seldom in right thalamic haemorrhage and occasionally with anterolateral spinal cord lesions.

The mechanism of alloaesthesia is uncertain: some - 20 - Allodynia A consider it a disturbance within sensory pathways, others consider that it is a sensory response to neglect.

A mirror in the mind: a case of visual allaesthesia in homonymous hemianopia. Cross References Allochiria; Allokinesia, Allokinesis; Neglect Allochiria Allochiria is the mislocation of sensory stimuli to the corresponding half of the body or space, a term coined by Obersteiner in There is overlap with alloaesthesia, originally used by Stewart to describe stimuli displaced to a different point on the same extremity.

Transposition of objects may occur in patients with neglect, e. Left on the right: allochiria in a case of left visuospatial neglect.

Allochiria vs allesthesia. Is there a misperception? Examples of allodynia include the trigger points of trigeminal neuralgia, the affected skin in areas of causalgia, and some peripheral neuropathies; it may also be provoked, paradoxically, by prolonged morphine use.

The treatment of neuropathic pain is typically with agents such as carbamazepine, amitriptyline, gabapentin, and pregabalin.

Interruption of sympathetic outflow, for example with regional guanethidine blocks, may sometimes help, but relapse may occur.

Cross References Hyperalgesia; Hyperpathia - 21 - A Allographia Allographia This term has been used to describe a peripheral agraphia syndrome characterized by problems spelling both words and non-words, with case change errors such that upper and lower case letters are mixed when writing, with upper and lower case versions of the same letter sometimes superimposed on one another.

Such errors increased in frequency with word length. These defects have been interpreted as a disturbance in selection of allographic forms in response to graphemic information outputted from the graphemic response buffer.

Cross Reference Agraphia Allokinesia, Allokinesis Allokinesis has been used to denote a motor response in the wrong limb e.

Others have used the term to denote a form of motor neglect, akin to alloaesthesia and allochiria in the sensory domain, relating to incorrect responses in the limb ipsilateral to a frontal lesion, also labelled disinhibition hyperkinesia.

References Fisher CM. Neurologic fragments. Clinical observations in demented patients. Frontal lobe neglect in monkeys.

Patients with limb-kinetic apraxia cannot keep pace and lose track. Altitudinal field defects - 22 - Amblyopia A are characteristic of but not exclusive to disease in the distribution of the central retinal artery.

Central vision may be preserved macula sparing because the blood supply of the macula often comes from the cilioretinal arteries. Cross References Hemianopia; Macula sparing, Macula splitting; Quadrantanopia; Visual field defects Amaurosis Amaurosis is visual loss, with the implication that this is not due to refractive error or intrinsic ocular disease.

The term is most often used in the context of amaurosis fugax, a transient monocular blindness, which is most often due to embolism from a stenotic ipsilateral internal carotid artery ocular transient ischaemic attack.

Giant cell arteritis, systemic lupus erythematosus, and the antiphospholipid antibody syndrome are also recognized causes.

Gaze-evoked amaurosis has been associated with a variety of mass lesions and is thought to result from decreased blood flow to the retina from compression of the central retinal artery with eye movement.

Amblyopic eyes may demonstrate a relative afferent pupillary defect and sometimes latent nystagmus. Amblyopia may not become apparent until adulthood, when the patient suddenly becomes aware of unilateral poor vision.

The finding of a latent strabismus heterophoria may be a clue to the fact that such visual loss is long-standing.

This is a component of long-term as opposed to working memory which is distinct from memory for facts semantic memory , in that episodic memory is unique to the individual whereas semantic memory encompasses knowledge held in common by members of a cultural or linguistic group.

A precise clinical definition for amnesia has not been demarcated, perhaps reflecting the heterogeneity of the syndrome.

Amnesia may be retrograde for events already experienced or anterograde for newly experienced events.

Retrograde amnesia may show a temporal gradient, with distant events being better recalled than more recent ones, relating to the duration of anterograde amnesia.

Amnesia may be acute and transient or chronic and persistent. In a pure amnesic syndrome, intelligence and attention are normal and skill acquisition procedural memory is preserved.

Amnesia may occur as one feature of more widespread cognitive impairments, e. Various psychometric tests of episodic memory are available.

Poor spontaneous recall, for example, of a word list, despite an adequate learning curve, may be due to a defect in either storage or retrieval.

This may be further probed with cues: if this improves recall, then a disorder of retrieval is responsible; if cueing leads to no improvement or false-positive responses to foils as in the Hopkins Verbal Learning Test are equal or greater than true positives, then a learning defect true amnesia is the cause.

The neuroanatomical substrate of episodic memory is a distributed system in the medial temporal lobe and diencephalon surrounding the third ventricle the circuit of Papez comprising the entorhinal area of the parahippocampal gyrus, perforant and alvear pathways, hippocampus, fimbria and fornix, mammillary bodies, mammillothalamic tract, anterior thalamic nuclei, internal capsule, cingulate gyrus, and cingulum.

Basal forebrain structures septal nucleus, diagonal band nucleus of Broca, nucleus basalis of Meynert are also involved.

A distinction between medial temporal pathology e. A frontal amnesia has also been suggested, although impaired attentional mechanisms may contribute.

Few of the chronic persistent causes of amnesia are amenable to specific treatment. Plasma exchange or intravenous immunoglobulin therapy may be helpful in non-paraneoplastic limbic encephalitis associated with autoantibodies directed against voltage-gated potassium channels.

Functional or psychogenic amnesia may involve failure to recall basic autobiographical details such as name and address.

Reversal of the usual temporal gradient of memory loss may be observed but this may also be the case in the syndrome of focal retrograde amnesia.

Amnesic disorders. Kopelman MD. Disorders of memory. The amnesias. A clinical textbook of memory disorders. Pujol M, Kopelman MD. Psychogenic amnesia.

Cross Reference Aphasia Amusia Amusia is a loss of the ability to appreciate music despite normal intelligence, memory, and language function.

Subtypes have been described: receptive or sensory amusia is loss of the ability to appreciate music; and expressive or motor amusia is loss of ability to sing, whistle.

Clearly a premorbid appreciation of music is a sine qua non for the diagnosis particularly of the former , and most reported cases of amusia have occurred in trained musicians.

Tests for the evaluation of amusia have been described. Amusia may occur in the context of more widespread cognitive dysfunction, such as aphasia and agnosia.

It has been found in association with pure word deafness, presumably as part of a global auditory agnosia. Isolated amusia has been reported in the context of focal cerebral atrophy affecting the nondominant temporal lobe.

However, functional studies have failed to show strong hemispheric specificity for music perception, but suggest a cross-hemispheric distributed neural substrate.

An impairment of pitch processing with preserved awareness of musical rhythm changes has been described in amusics.

Congenital amusia: a group study of adults afflicted with a music-specific disorder. Progressive amusia and aprosody.

Hyde KL, Peretz I. Brains that are out of tune but in time. Receptive amusia: evidence for cross-hemispheric neural networks underlying music processing strategies.

Cross References Agnosia; Auditory agnosia; Pure word deafness - 26 - Analgesia A Amyotrophy Amyotrophy is a term used to describe thinning or wasting atrophy of musculature with attendant weakness.

Hence, although the term implies neurogenic as opposed to myogenic muscle wasting, its use is non-specific with respect to neuroanatomical substrate.

Cross References Atrophy; Fasciculation; Neuropathy; Plexopathy; Radiculopathy; Wasting Anaesthesia Anaesthesia anesthesia is a complete loss of sensation; hypoaesthesia hypaesthesia, hypesthesia is a diminution of sensation.

Hence in Jacksonian terms, these are negative sensory phenomena. Anaesthesia may involve all sensory modalities global anaesthesia, as in general surgical anaesthesia or be selective e.

Regional patterns of anaesthesia are described, e. Anaesthesia is most often encountered after resection or lysis of a peripheral nerve segment, whereas paraesthesia or dysaesthesia positive sensory phenomena reflects damage to a nerve which is still in contact with the cell body.

Anaesthesia dolorosa, or painful anaesthesia, is a persistent unpleasant pain i. This deafferentation pain may respond to various medications, including tricyclic antidepressants, carbamazepine, gabapentin, pregabalin, and selective serotonin-reuptake inhibitors.

Cross References Analgesia; Dysaesthesia; Neuropathy; Paraesthesia Analgesia Analgesia or hypoalgesia refers to a complete loss or diminution, respectively, of pain sensation, or the absence of a pain response to a normally painful stimulus.

These negative sensory phenomena may occur as one component of total sensory loss anaesthesia or in isolation. Consequences of analgesia include - 27 - A Anal Reflex the development of neuropathic ulcers, burns, Charcot joints, even painless mutilation, or amputation.

Congenital syndromes of insensitivity to pain were once regarded as a central pain asymbolia e. Congenital insensitivity to pain: a 20 year follow up.

This reflex may be absent in some normal elderly individuals, and absence does not necessarily correlate with urinary incontinence.

External anal responses to coughing and sniffing are part of a highly consistent and easily elicited polysynaptic reflex, whose characteristics resemble those of the conventional scratch-induced anal reflex.

The anal reflex elicited by cough and sniff: validation of a neglected clinical sign. This is most commonly seen as a feature of the bulbar palsy of motor neurone disease.

Slowly progressive anarthria with late anterior opercular syndrome: a variant form of frontal cortical atrophy syndromes.

Lecours AR, Lhermitte F. Cross References Aphemia; Bulbar palsy; Dysarthria Angioscotoma Angioscotomata are shadow images of the superficial retinal vessels on the underlying retina, a physiological scotoma.

Cross Reference Scotoma Angor Animi Angor animi is the sense of dying or the feeling of impending death.

It may be experienced on awakening from sleep or as a somesthetic aura of migraine. Reference Ryle JA. Angor animi, or the sense of dying.

Cross Reference Aura Anhidrosis Anhidrosis, or hypohidrosis, is a loss or lack of sweating. It - 29 - A Anisocoria is thought to represent a focal dystonia and may be helped temporarily by local injections of botulinum toxin.

Botulinum toxin type-A in therapy of patients with anismus. Neurological: Anisocoria greater in dim light or darkness suggests a sympathetic innervation defect darkness stimulates dilatation of normal pupil.

Clinical characteristics and pharmacological testing may help to establish the underlying diagnosis in anisocoria. Reference Kawasaki A.

Approach to the patient with abnormal pupils. In: Biller J ed. Practical neurology 2nd edition. Formal tests of naming are also available e.

Graded Naming Test. Patients may be able to point to named objects despite being unable to name them, suggesting a problem in word retrieval but with preserved comprehension.

They may also be able to say something about the objects they cannot name e. Category-specific anomias have been described, e.

Anomia occurs with pathologies affecting the left temporoparietal area, but since it occurs in all varieties of aphasia is of little precise localizing or diagnostic value.

The term anomic aphasia is reserved for unusual cases in which a naming problem overshadows all other deficits. Anomia may often be seen as a residual deficit following recovery from other types of aphasia.

Anomia: a doubly typical signature of semantic dementia. Cross References Aphasia; Circumlocution; Paraphasia Anosmia Anosmia is the inability to perceive smells due to damage to the olfactory pathways olfactory neuroepithelium, olfactory nerves, rhinencephalon.

Olfaction may be tested with kits containing specific odours e. Unilateral anosmia may be due to pressure on the olfactory bulb or tract, e.

Anosmia may be congenital e. Rhinological disease allergic rhinitis, coryza is by far the most common cause; this may also account for the impaired sense of smell in smokers.

Head trauma is the most common neurological cause, due to shearing off of the olfactory fibres as they pass through the cribriform plate.

Recovery is possible in this situation due to the capacity for neuronal and axonal regeneration within the olfactory pathways. Patients with depression may also complain of impaired sense of smell.

Loss of olfactory acuity may be a feature of normal ageing. The neurology of olfaction. Cross References Age-related signs; Ageusia; Cacosmia; Dysgeusia; Mirror movements; Parosmia Anosodiaphoria Babinski used the term anosodiaphoria to describe a disorder of body schema in which patients verbally acknowledge a clinical problem e.

Anosodiaphoria usually follows a stage of anosognosia. References Babinski JM. Observations on anosodiaphoria. Some authorities would question whether this unawareness is a true agnosia or rather a defect of higher-level cognitive integration i.

Anosognosia with hemiplegia most commonly follows right hemisphere injury parietal and temporal lobes and may be associated with left hemineglect and left-sided hemianopia; it is also described with right thalamic and basal ganglia lesions.

Many patients with posterior aphasia Wernicke type are unaware that their output is incomprehensible or jargon, possibly through a failure to monitor their own output.

The neuropsychological mechanisms of anosognosia are unclear: the hypothesis that it might be accounted for by personal neglect asomatognosia , which is also more frequently observed after right hemisphere lesions, would seem to have been disproved experimentally by studies using selective hemisphere anaesthesia in which the two may be dissociated, a dissociation which may also be observed clinically.

Temporary resolution of anosognosia has been reported following vestibular stimulation e. Babinski JM. Hemianopic anosognosia.

Unawareness of deficits in neuropsychological syndromes. Morris RG, Hannesdottir K. Anosognosia in patients with cerebrovascular lesions: a study of causative factors.

Loss of anserina may be a feature of some autonomic disorders. Antecollis Antecollis anterocollis is forward flexion of the neck.

It may be a feature of multiple system atrophy cf. Reference Quinn N. Disproportionate antecollis in multiple system atrophy.

Lancet ; 1: The syndrome most usually results from bilateral posterior cerebral artery territory lesions causing occipital or occipitoparietal infarctions but has occasionally been described with anterior visual pathway lesions associated with frontal lobe lesions.

It may also occur in the context of dementing disorders or delirium. Gassel M, Williams D. Visual function in patients with homonymous hemianopia.

The completion phenomenon: insight and attitude to the defect: and visual function efficiency. Cross References Agnosia, Anosognosia, Confabulation, Cortical blindness Anwesenheit A vivid sensation of the presence of somebody either somewhere in the room or behind the patient has been labelled as anwesenheit German: presence , presence hallucination, minor hallucination, or extracampine hallucination.

Hence, listlessness, paucity of spontaneous movement akinesia or speech mutism , and lack of initiative, spontaneity, and drive may be features of apathy These are also all features of the abulic state, and it has been suggested that apathy and abulia represent different points on a continuum of motivational and emotional deficit, abulia being at the more severe end.

Apathy is a specific neuropsychiatric syndrome, distinct from depression. Apathy is also described following amphetamine or cocaine withdrawal, in neuroleptic-induced akinesia and in psychotic depression.

Selective serotonin-reuptake inhibitors may sometimes be helpful in the treatment of apathy. Apathy is not depression.

Marin RS. Differential diagnosis and classification of apathy. Cross References Abulia; Akinetic mutism; Dementia; Frontal lobe syndromes Aphasia Aphasia, or dysphasia, is an acquired loss or impairment of language function.

Non-linguistic components of language emotion, inflection, cadence , collectively known as prosody, may require contributions from both hemispheres.

Language is distinguished from speech oral communication , disorders of which are termed dysarthria or anarthria. Dysarthria and aphasia may coexist but are usually separable.

Comprehension: spared or impaired? Repetition: preserved or impaired? Naming: preserved or impaired? Reading: evidence of alexia?

Writing: evidence of agraphia? Conduction aphasia is marked by relatively normal spontaneous speech perhaps with some paraphasic errors , but a profound deficit of repetition.

In transcortical motor aphasia spontaneous output is impaired but repetition is intact. Aphasia may also occur with space-occupying lesions and in neurodegenerative disorders, often with other cognitive impairments e.

References Basso A. Aphasia and its therapy. Oxford: Oxford University Press, Benson DF, Ardila A. Caplan D.

Aphasic syndromes. Approach to the patient with aphasia. Spreen O, Risser AH. Assessment of aphasia. Willmes K, Poeck K.

To what extent can aphasic syndromes be localized? The term is now used to describe a motor disorder of speech production with preserved comprehension of spoken and written language.

This syndrome has also been called phonetic disintegration cf. Such conditions may stand between pure disorders of speech i.

Aphemia: an isolated disorder of articulation. Henderson VW. Alalia, aphemia, and aphasia. Aphemia: clinicalanatomic correlations. Cross References Anarthria; Aphasia; Aprosodia, Aprosody; Dysarthria; Phonemic disintegration; Speech apraxia Aphonia Aphonia is loss of the sound of the voice, necessitating mouthing or whispering of words.

As for dysphonia, this most frequently follows laryngeal inflammation, although it may follow bilateral recurrent laryngeal nerve palsy.

Dystonia of the abductor muscles of the larynx can result in aphonic segments of speech spasmodic aphonia or abductor laryngeal dystonia ; this may be diagnosed by - 37 - A Applause Sign hearing the voice fade away to nothing when asking the patient to keep talking; patients may comment that they cannot hold any prolonged conversation.

Aphonia of functional or hysterical origin is also recognized. Aphonia should be differentiated from mutism, in which patients make no effort to speak, and anarthria in which there is a failure of articulation.

Cross References Anarthria; Dysphonia; Mutism Applause Sign To elicit the applause sign, also known as the clapping test or three clap test, the patient is asked to clap the hands three times.

Diagnostic accuracy of the clapping test in Parkinsonian disorders. Aposiopesis Critchely used this term to denote a sentence which is started but not finished, as in the aphasia associated with dementia.

Reference Critchley M. The divine banquet of the brain and other essays. Cross Reference Aphasia Apraxia Apraxia or dyspraxia is a disorder of movement characterized by the inability to perform a voluntary motor act despite an intact motor system i.

Ideomotor apraxia IMA : A disturbance in the selection of elements that constitute a movement e. This may be associated with the presence of a grasp reflex and alien limb phenomena limb-kinetic type of apraxia.

Apraxia is more common and severe with left hemisphere lesions. Difficulties with the clinical definition of apraxia persist, as for the agnosias.

Likewise, some cases labelled as eyelid apraxia or gait apraxia are not true ideational apraxias.

The exact nosological status of speech apraxia also remains tendentious. References Binkofski F, Reetz K.

Cognitive neurology: a clinical textbook. Crutch S. Advances in Clinical Neuroscience and Rehabilitation ; 5 1 : 16, Grafton S.

Apraxia: a disorder of motor control. Limb apraxias. Higher-order disorders of sensorimotor integration. Liepmann H.

Berlin: Karger, Cross References Alien hand, Alien limb; Body part as object; Crossed apraxia; Dysdiadochokinesia; Eyelid apraxia; Forced groping; Frontal lobe syndromes; Gait apraxia; Grasp reflex; Optic ataxia; Speech apraxia - 39 - A Aprosexia Aprosexia Aprosexia is a syndrome of psychomotor inefficiency, characterized by complaints of easy forgetting, for example, of conversations as soon as they are finished, material just read, or instructions just given.

There is difficulty keeping the mind on a specific task, which is forgotten if the patient happens to be distracted by another task.

These difficulties, into which the patient has insight and often bitterly complains of, are commonly encountered in the memory clinic.

They probably represent a disturbance of attention or concentration, rather than being a harbinger of dementia.

These patients generally achieve normal scores on formal psychometric tests and indeed may complain that these assessments do not test the function they are having difficulty with.

Concurrent sleep disturbance, irritability, and low mood are common and may reflect an underlying affective disorder anxiety, depression which may merit specific treatment.

Cross References Attention; Dementia Aprosodia, Aprosody Aprosodia or aprosody dysprosodia, dysprosody is a defect in or absence of the ability to produce or comprehend speech melody, intonation, cadence, rhythm, and accentuations, in other words the non-linguistic aspects of language which convey or imply emotion and attitude.

Progressive affective aprosodia and prosoplegia. Monrad-Krohn GH. Ross ED. The aprosodias: functional-anatomic organization of the affective components of language in the right hemisphere.

Cross References Retinopathy; Scotoma Areflexia Areflexia is an absence or a loss of tendon reflexes. This may be physiological, in that some individuals never demonstrate tendon reflexes; or pathological, reflecting an anatomical interruption or physiological dysfunction at any point along the monosynaptic reflex pathway which is the neuroanatomical substrate of phasic stretch reflexes.

Areflexia is most often encountered in disorders of lower motor neurones, specifically radiculopathies, plexopathies, and neuropathies axonal and demyelinating.

It fails to react to light reflex iridoplegia , but does constrict to accommodation when the eyes converge.

Since the light reflex is lost, testing for the accommodation reaction may be performed with the pupil directly illuminated: this can make it easier to see the response to accommodation, which is often difficult to observe when the pupil is small or in individuals with a dark iris.

There may be an incomplete response to mydriatic drugs. Although pupil involvement is usually bilateral, it is often asymmetric, causing anisocoria.

The Argyll Robertson pupil was originally described in the context of neurosyphilis, especially tabes dorsalis. The neuroanatomical substrate of the Argyll Robertson pupil is uncertain.

A lesion in the tectum of the rostral midbrain proximal to the oculomotor nuclei has been suggested. Some authorities think that a partial oculomotor III nerve palsy or a lesion of the ciliary ganglion is a more likely cause.

References Argyll Robertson D. Four cases of spinal myosis [sic]: with remarks on the action of light on the pupil. The Argyll Robertson pupil.

Significance of the Argyll Robertson pupil in clinical medicine. It is said that in organic weakness the hand will hit the face, whereas patients with functional weakness avoid this consequence.

Functional weakness and sensory disturbance. The term was invented in the nineteenth century Hamilton as an alternative to aphasia, since in many cases of the latter there is more than a loss of speech, including impaired pantomime apraxia and in symbolizing the relationships of things.

Hughlings Jackson approved of the term but feared it was too late to displace the word aphasia. Father of English neurology.

Cross References Aphasia, Apraxia Asomatognosia Asomatognosia is a lack of regard for a part, or parts, of the body, most typically failure to acknowledge the existence of a hemiplegic left arm.

Asomatognosia may be verbal denial of limb ownership or non-verbal failure to dress or wash limb. All patients with asomatognosia have hemispatial neglect usually left , hence this would seem to be a precondition for the development of asomatognosia; indeed, for some authorities asomatognosia is synonymous with personal neglect.

Attribution of the neglected limb to another person is known as somatoparaphrenia. The neuroanatomical correlate of asomatognosia is damage to the right supramarginal gyrus and posterior corona radiata, most commonly due to a cerebrovascular event.

Cases with right thalamic lesions have also been reported. The predilection of asomatognosia for the left side of the body may simply be a reflection of the aphasic problems associated with leftsided lesions that might be expected to produce asomatognosia for the right side.

Asomatognosia is related to anosognosia unawareness or denial of illness but the two are dissociable on clinical and experimental grounds.

Some authorities consider asomatognosia as a form of confabulation. The neuroanatomy of asomatognosia and somatoparaphrenia.

The term has no standardized definition and hence may mean different things to different observers; it has also been used to describe a disorder characterized by inability to stand or walk despite normal leg strength when lying or sitting, believed to be psychogenic although gait apraxia may have similar features.

A transient inability to sit or stand despite normal limb strength may be seen after an acute thalamic lesion thalamic astasia.

Thalamic astasia: inability to stand after unilateral thalamic lesions. Human walking and higher-level gait disorders, particularly in the elderly.

Cross Reference Gait apraxia Astereognosis Astereognosis is the failure to recognize a familiar object, such as a key or a coin, palpated in the hand with the eyes closed, despite intact primary sensory modalities.

Description of qualities such as the size, shape, and texture of the object may be possible. Hence, this is a failure of higher-order i.

There may be associated impairments of two-point discrimination and graphaesthesia cortical sensory syndrome. Astereognosis was said to be invariably present in the original description of the thalamic syndrome by Dejerine and Roussy.

Some authorities recommend the terms stereoanaesthesia or stereohypaesthesia as more appropriate descriptors of this phenomenon, to emphasize that this may be a disorder of perception rather than a true agnosia for a similar debate in the visual domain, see Dysmorphopsia.

Cross References Agnosia; Dysmorphopsia; Graphaesthesia; Two-point discrimination Asterixis Asterixis is a sudden, brief, arrhythmic lapse of sustained posture due to involuntary interruption in muscle contraction.

It is most easily demonstrated by observing the dorsiflexed hands with arms outstretched i.

These features distinguish asterixis from tremor and myoclonus; the phenomenon has previously been described as negative myoclonus or negative tremor.

Asterixis may be bilateral or unilateral. Unilateral asterixis has been described in the context of stroke, contralateral to lesions of the midbrain involving corticospinal fibres, medial lemniscus , thalamus ventroposterolateral nucleus , primary motor cortex, and parietal lobe; and ipsilateral to lesions of the pons or medulla.

Unilateral asterixis and stroke in 13 patients: localization of the lesions matching the CT scan images to an atlas.

European Journal of Neurology ; 11 suppl 2 : 56 abstract P Unilateral asterixis: motor integrative dysfunction in focal vascular disease.

Such refractive errors are sometimes blamed for headache. Asynergia Asynergia or dyssynergia is lack or impairment of synergy of sequential muscular contraction in the performance of complex movements, such that they seem to become broken up into their constituent parts, so-called decomposition of movement.

This may be evident when performing rapid alternating hand movements. Dyssynergy of speech may also occur, a phenomenon sometimes termed scanning speech or scanning dysarthria.

This is typically seen in cerebellar syndromes, most often those affecting the cerebellar hemispheres, and may coexist with other signs of cerebellar disease such as ataxia, dysmetria, and dysdiadochokinesia.

Cross References Ataxia; Cerebellar syndromes; Dysarthria; Dysdiadochokinesia; Dysmetria; Scanning speech Ataxia Ataxia or dystaxia refers to a lack of coordination of voluntary motor acts, impairing their smooth performance.

The rate, range, timing, direction, and force of movement may be affected. Ataxia is used most frequently to refer to a cerebellar problem, but sensory ataxia, optic ataxia, and frontal ataxia are also described, so it is probably best to qualify ataxia rather than to use the word in isolation.

There may be concurrent limb hypotonia. An International Cooperative Ataxia Rating Scale has been developed to assess the efficacy of treatments for cerebellar ataxia.

It is markedly exacerbated by removal of visual cues e. These fibres run in the corticopontocerebellar tract, synapsing in the pons before passing through the middle cerebellar peduncle to the contralateral cerebellar hemisphere.

References Klockgether T. Sporadic ataxia with adult onset: classification and diagnostic criteria. International Cooperative Ataxia Rating Scale for pharmacological assessment of the cerebellar syndrome.

Wardle M, Robertson N. Progressive late-onset cerebellar ataxia. There may be additional dysarthria, nystagmus, paraesthesia, and pain.

This syndrome is caused by lacunar small deep infarcts in the contralateral basis pons at the junction of the upper third and lower two-thirds.

It may also be seen with infarcts in the contralateral thalamocapsular region, posterior limb of the internal capsule anterior choroidal artery syndrome , red nucleus, and the paracentral region anterior cerebral artery territory.

Sensory loss is an indicator of capsular involvement; pain in the absence of other sensory features is an indicator of thalamic involvement.

Painful ataxic hemiparesis. Ataxic hemiparesis. A pathologic study. Ataxic hemiparesis: critical appraisal of a lacunar syndrome. Athetosis often coexists with the more flowing, dance-like movements of chorea, in which case the movement disorder may be described as choreoathetosis.

Athetoid-like movements of the outstretched hands may also been seen in the presence of sensory ataxia impaired proprioception and are known as pseudoathetosis or pseudochoreoathetosis.

Choreoathetoid movements result from disorders of the basal ganglia. Athetosis I: historical considerations. Athetosis or dystonia?

Cross References Chorea, Choreoathetosis; Pseudoathetosis; Pseudochoreoathetosis Athymhormia Athym h ormia, also known as the robot syndrome, is a name given to a form of abulia or akinetic mutism in which there is loss of self-autoactivation.

Clinically there is a marked discrepancy between heteroactivation, behaviour under the influence of exogenous stimulation, which is normal or almost normal, and autoactivation.

Left alone, patients are akinetic and mute, a state also known as loss of psychic self-activation or pure psychic akinesia. It is associated with bilateral deep lesions of the frontal white matter or of the basal ganglia, especially the globus pallidus.

Athymhormia is thus environment-dependent, patients normalizing initiation and cognition when stimulated, an important differentiation from apathy and akinetic mutism.

Isolated athymhormia following hypoxic bilateral pallidal lesions. The term is often applied to wasted muscles, usually in the context of lower motor neurone pathology in which case it may be synonymous with amyotrophy , but also with disuse.

Atrophy develops more quickly after lower, as opposed to upper, motor neurone lesions. It may also be applied to other tissues, such as subcutaneous tissue as in hemifacial atrophy.

Atrophy may sometimes be remote from the affected part of the neuraxis, hence a false-localizing sign, for example, wasting of intrinsic hand muscles with foramen magnum lesions.

Reference Larner AJ. Cross Reference Dementia Attention Attention is a distributed cognitive function, important for the operation of many other cognitive domains; the terms concentration, vigilance, and persistence may be used synonymously with attention.

It is generally accepted that attention is effortful, selective, and closely linked to intention. Impairment of attentional mechanisms may lead to distractability with a resulting complaint of poor memory, perhaps better termed aprosexia , disorientation in time and place, perceptual problems, and behavioural problems e.

The neuroanatomical substrates of attention encompass the ascending reticular activating system of the brainstem, the thalamus, and the prefrontal multimodal association cerebral cortex especially on the right.

Damage to any of these areas may cause impaired attention. In the presence of severe attentional disorder as in delirium it is difficult to make any meaningful assessment of other cognitive domains e.

References Parasuraman R. Scholey A. Neurochemistry of consciousness: neurotransmitters in mind.

Cross References Aprosexia; Delirium; Dementia; Disinhibition; Dysexecutive syndrome; Frontal lobe syndromes; Pseudodementia Auditory Agnosia Auditory agnosia refers to an inability to appreciate the meaning of sounds despite normal perception of pure tones as assessed by audiological examination.

This agnosia may be for either verbal material pure word deafness or nonverbal material, either sounds bells, whistles, animal noises or music amusia, of receptive or sensory type.

This may be equivalent to noiseinduced visual phosphenes or sound-induced photisms. It is not certain that this phenomenon meets suggested criteria for synaesthesia.

Augmentation also refers to the paradoxical worsening of the symptoms of restless legs syndrome with dopaminergic treatment, manifesting with earlier onset of symptoms in the evening or afternoon, shorter periods of rest to provoke symptoms, greater intensity of symptoms when they occur, spread of symptoms to other body parts such as the arms, and decreased duration of benefit from medication.

An aura indicates the focal onset of neurological dysfunction. Auras are exclusively subjective, and may be entirely sensory, such as the fortification spectra teichopsia of migraine, or more complex, labelled psychosensory or experiential, as in certain seizures.

Localizing value of epileptic visual auras. Semiological seizure classification. Palmini A, Gloor P. The localising value of auras in partial seizures.

These are sometimes known as the startle-automatic obedience syndromes. Although initially classified by Gilles de la Tourette with tic syndromes, there are clear clinical and pathophysiological differences.

Gilles de la Tourette and the discovery of Tourette syndrome. Includes a translation of his article. It has been suggested that it should refer specifically to a permanently present or elicitable, compulsive, iterative and not necessarily complete, written reproduction of visually or orally perceived messages cf.

This is characterized as a particular, sometimes isolated, form of utilization behaviour in which the inhibitory functions of the frontal lobes are suppressed.

Increased writing activity in neurological conditions: a review and clinical study. Cross References Hypergraphia; Utilization behaviour Automatism Automatisms are complex motor movements occurring in complex motor seizures, which resemble natural movements but occur in an inappropriate setting.

These may occur during a state of impaired consciousness during or shortly after an epileptic seizure. There is usually amnesia for the event.

Automatisms occur in about one-third of patients with complex partial seizures, most commonly those of temporal or frontal lobe origin.

Although - 52 - Autoscopy A there are qualitative differences between the automatisms seen in seizures arising from these sites, they are not of sufficient specificity to be of reliable diagnostic value; bizarre automatisms are more likely to be frontal.

Automatic behaviour and fugue-like states may also occur in the context of narcolepsy and must be differentiated from the automatisms of complex partial seizures on the basis of history, examination, and EEG.

Complex partial seizures on closed circuit television and EEGs: a study of attacks in 79 patients. Cross References Absence; Aura; Pelvic thrusting; Poriomania; Seizure Autophony The perception of the reverberation of ones own voice, which occurs with external or middle, but not inner, ear disease.

The hallucinated image is a mirror image, i. Unlike heautoscopy, there is a coincidence of egocentric and body-centred perspectives.

Autoscopy may be associated with parieto-occipital space-occupying lesions, epilepsy, and migraine. Out-of-body experience and autoscopy of neurological origin.

Brugger P. Reflective mirrors: perspective taking in autoscopic phenomena. Semiologic value of ictal autoscopy.

Cross References Hallucination; Heautoscopy Autotopagnosia Autotopagnosia, or somatotopagnosia, is a rare disorder of body schema characterized by inability to identify parts of the body, either to verbal command or by imitation; this is sometimes localized but at worst involves all parts of the body.

This may be a form of category-specific anomia with maximum difficulty for naming body parts or one feature of anosognosia. Reference Ogden JA.

Autotopagnosia: occurrence in a patient without nominal aphasia and with an intact ability to point to parts of animals and objects.

The plantar response is most commonly performed by stroking the sole of the foot, although many other variants are described e.

References Critchley M. Lance JW. The Babinski sign. Van Gijn J. The Babinski sign: a centenary. Utrecht: Universiteit Utrecht, This observation indicated to Babinski the peripheral facial nerve origin of hemifacial spasm.

It may assist in differentiating hemifacial spasm from other craniofacial movement disorders. Reference Devoize JL.

Journal of Neurology, Neurosurgery and Psychiatry ; The recumbent patient is asked to sit up with the arms folded on the front of the chest.

In organic hemiplegia there is involuntary flexion of the paretic leg, which may automatically rise higher than the normal leg; in paraplegia both legs are involuntarily raised.

In functional paraplegic weakness neither leg is raised, and in functional hemiplegia only the normal leg is raised. This pattern of facial sensory impairment may also be known as onion peel or onion skin.

Accurate eye movements may be programmed by sound or touch. Loss of spontaneous blinking has also been reported. Optic ataxia: A failure to grasp or touch an object under visual guidance.

Not all elements may be present; there may also be coexisting visual field defects, hemispatial neglect, visual agnosia, or prosopagnosia.

References Husein M, Stein J. Rezso Balint and his most celebrated case. Rafal R. Cross References Apraxia; Blinking; Ocular apraxia; Optic ataxia; Simultanagnosia Ballism, Ballismus Ballism or ballismus is a hyperkinetic involuntary movement disorder characterized by wild, flinging, throwing movements of a limb.

These movements most usually involve one-half of the body hemiballismus , although they may sometimes involve a single extremity monoballismus or both halves of the body paraballismus.

The movements are often continuous during wakefulness but cease during sleep. Hemiballismus may be associated with limb hypotonia.

Clinical and pathophysiological studies suggest that ballism is a severe form of chorea. It is most commonly associated with lesions of the contralateral subthalamic nucleus.

It indicates a lesion causing rectus abdominis muscle weakness below the umbilicus. This may occur with a spinal lesion e.

Lower cutaneous abdominal reflexes are also absent, having the same localizing value. Hilton-Jones D. Tashiro K. In: Rose FC ed.

Patients with neuropathological lesions may also demonstrate a lack of concern for their disabilities, either due to a disorder of body schema anosodiaphoria or due to incongruence of mood typically in frontal lobe syndromes, sometimes seen in multiple sclerosis.

It is thought to result from viral inflammation of the facial VII nerve. Poorer prognosis is associated with older age over 40 years and if no recovery is seen within 4 weeks of onset.

Meta-analyses suggest that steroids are associated with better outcome than no treatment, but that acyclovir alone has no benefit.

Combined corticosteroid and antiviral treatment for Bell palsy: a systematic review and meta-analysis. This is a synkinesis of central origin involving superior rectus and inferior oblique muscles.

The reflex indicates intact nuclear and infranuclear mechanisms of upward gaze, and hence that any defect of upgaze is supranuclear.

Reference Bell C. On the motions of the eye, in illustration of the use of the muscles and nerves of the orbit. The intorsion of the unaffected eye brought about by the head tilt compensates for the double vision caused by the unopposed extorsion of the affected eye.

Very occasionally, head tilt is paradoxical, i. The test is usually negative in a skew deviation causing vertical divergence of the eyes.

This test may also be used as part of the assessment of vertical diplopia to see whether hypertropia changes with head tilt to left or right; increased hypertropia on left head tilt suggests a weak intortor of the left eye superior rectus ; increased hypertropia on right head tilt suggests a weak intortor of the right eye superior oblique.

Cross References Diplopia; Hypertropia; Skew deviation Binasal Hemianopia Of the hemianopic defects, binasal hemianopia, suggesting lateral compression of the chiasm, is less common than bitemporal hemianopia.

Various causes are recorded including syphilis, glaucoma, drusen, and chronically raised intracranial pressure.

Progressive binasal hemianopia. Lancet ; Cross Reference Hemianopia Bitemporal Hemianopia Bitemporal hemianopia due to chiasmal compression, for example, by a pituitary lesion or craniopharyngioma, is probably the most common cause of a heteronymous hemianopia.

Conditions mimicking bitemporal hemianopia include congenitally tilted discs, nasal sector retinitis pigmentosa, and papilloedema with greatly enlarged blind spots.

Usually bilateral in origin, it may be sufficiently severe to result in functional blindness. The condition typically begins in the sixth decade of life and is more common in women than in men.

Like other forms of dystonia, blepharospasm may be relieved by sensory tricks geste antagoniste , such as talking, yawning, singing, humming, or touching the eyelid.

This feature is helpful in diagnosis. Blepharospasm may be aggravated by reading, watching television, and exposure to wind or bright light.

Blepharospasm is usually idiopathic but may be associated with lesions usually infarction of the rostral brainstem, diencephalon, and striatum; it has been occasionally reported with thalamic lesions.

The pathophysiological mechanisms underlying blepharospasm are not understood, but may reflect dopaminergic pathway disruption causing disinhibition of brainstem reflexes.

Local injections of botulinum toxin into orbicularis oculi are the treatment of choice, the majority of patients deriving benefit and requesting further injection.

Failure to respond to botulinum toxin may be due to concurrent eyelid apraxia or dopaminergic therapy with levodopa.

Blepharospasm: a review of patients. Hallett M, Daroff RB. Blepharospasm: report of a workshop. Reference Weiskrantz L. A case study and implications.

Oxford: Clarendon, Minor enlargement of the blind spot is difficult to identify clinically, formal perimetry is needed in this situation.

Enlargement of the blind spot peripapillary scotoma is observed with raised intracranial pressure causing papilloedema: this may be helpful in differentiating papilloedema from other causes of disc swelling such as optic neuritis, in which a central scotoma is the most common field defect.

Enlargement of the blind spot may also be a feature of peripapillary retinal disorders including big blind spot syndrome.

In contrast, blink rate is normal in multiple system atrophy and dopa-responsive dystonia, and increased in schizophrenia and postencephalitic parkinsonism.

These disparate observations are not easily reconciled with the suggestion that blinking might be a marker of central dopaminergic activity.

In patients with impaired consciousness, the presence of involuntary blinking implies an intact pontine reticular formation; absence suggests structural or metabolic dysfunction of the reticular formation.

Blinking decreases in coma. Functional disorders may be accompanied by an increase in blinking. Reference Karson CN. Spontaneous eye-blink rates and dopaminergic systems.

Care should be taken to avoid generating air currents with the hand movement as this may stimulate the corneal reflex which may simulate the visuopalpebral reflex.

It is probable that this reflex requires cortical processing: it is lost in persistent vegetative states. Acoustic stimulus: Sudden loud sounds acousticopalpebral reflex.

The final common efferent pathway for these responses is the facial nerve nucleus and facial VII nerve, the afferent limbs being the trigeminal V , optic II , and auditory VIII nerves, respectively.

Electrophysiological study of the blink reflex may demonstrate peripheral or central lesions of the trigeminal V nerve or facial VII nerve afferent and efferent pathways, respectively.

It has been reported that in the evaluation of sensory neuronopathy the finding of an abnormal blink reflex favours a non-paraneoplastic aetiology, since the blink reflex is normal in paraneoplastic sensory neuronopathies.

Role of the blink reflex in the evaluation of sensory neuronopathy. Liu GT, Ronthal M. Reflex blink to visual threat. References Goodglass H, Kaplan E.

Disturbance of gesture and pantomime in aphasia. These signs may help to distinguish tardive dyskinesia from chorea, although periodic protrusion of the tongue flycatcher, trombone tongue is common to both.

Cross References Buccolingual syndrome; Chorea, Choreoathetosis; Trombone tongue Bouche de Tapir Patients with facioscapulohumeral FSH muscular dystrophy have a peculiar and characteristic facies, with puckering of the lips when attempting to whistle.

The pouting quality of the mouth, unlike that seen with other types of bilateral neurogenic facial weakness, has been likened to the face of the tapir Tapirus sp.

Cross Reference Facial paresis Bovine Cough A bovine cough lacks the explosive character of a normal voluntary cough. It may result from injury to the distal part of the vagus nerve, particularly the recurrent laryngeal branches which innervate all the muscles of the larynx with the exception of cricothyroid with resultant vocal cord paresis.

Because of its longer intrathoracic course, the left recurrent laryngeal nerve is more often involved. A bovine cough may be heard in patients with tumours of the upper lobes of the lung Pancoast tumour due to recurrent laryngeal nerve palsy.

Cross References Bulbar palsy; Diplophonia; Signe de rideau Bradykinesia Bradykinesia is a slowness in the initiation and performance of voluntary movements in the absence of weakness and is one of the typical signs of parkinsonian syndromes, in which situation it is often accompanied by difficulty in the initiation of movement akinesia, hypokinesia and reduced amplitude of movement hypometria which may increase with rapid repetitive movements fatigue.

It may be overcome by reflexive movements or in moments of intense emotion kinesis paradoxica. Bradykinesia in parkinsonian syndromes reflects dopamine depletion in the basal ganglia.

It may be improved by levodopa and dopaminergic agonists, less so by anticholinergic agents. Such patients typically answer questions correctly but with long response times.

Silent reading may also be impaired deep dyslexia as reflected by poor text comprehension; Writing: similarly affected.

The term alalia was also once used. Depression may be a concurrent feature. More commonly there is infarction in the perisylvian region affecting the insula and operculum Brodmann areas 44 and 45 , which may include underlying white matter and the basal ganglia territory of the superior branch of the middle cerebral artery.

I want to encourage yourself to continue your great posts, have a nice afternoon! I mean, what you say is fundamental and everything.

But think of if you added some great graphics or video clips to give your posts more, "pop"! Your content is excellent but with images and clips, this blog could certainly be one of the very best in its niche.

Fantastic blog! Some extremely valid points! I appreciate you penning this article and the rest of the site is also really good.

I appreciate you penning this post and the rest of the website is extremely good. What could you recommend about your publish that you made some days ago?

Any sure? I checked on the internet for more info about the issue and found most people will go along with your views on this web site.

Great website, continue the good work! I have just forwarded this onto a coworker who has been conducting a little research on this.

And he actually bought me lunch simply because I found it for him So let me reword this Thanks for the meal!! But yeah, thanks for spending some time to talk about this issue here on your website.

The arena hopes for more passionate writers such as you who are not afraid to say how they believe. Always follow your heart.

Tone2 complete bundle foxx repack: Good answer back in return of this matter with genuine arguments and explaining all regarding that.

My blog is in the very same area of interest as yours and my users would really benefit from some of the information you present here.

Please let me know if this alright with you. The clarity in your post is simply cool and i can assume you are an expert on this subject.

Fine with your permission allow me to grab your RSS feed to keep up to date with forthcoming post. Thanks a million and please continue the gratifying work.

I used to be checking constantly this blog and I am inspired! Very useful info particularly the ultimate section : I maintain such info much.

I was looking for this certain info for a very lengthy time. Thank you and best of luck. The sketch is tasteful, your authored material stylish.

A lot of helpful information here. I am sending it to a few friends ans additionally sharing in delicious. And naturally, thank you on your effort!

Your story-telling style is awesome, keep it up! This is my first visit to your blog! We are a group of volunteers and starting a new initiative in a community in the same niche.

Your blog provided us beneficial information to work on. You have done a wonderful job! I book-marked it to my bookmark site list and will be checking back soon.

Please visit my website too and tell me your opinion. This has been an extremely wonderful article.

Very well written! Also your web site a lot up very fast! What web host are you the use of? Can I get your affiliate hyperlink on your host?

My blog site is in the very same area of interest as yours and my users would really benefit from a lot of the information you present here.

I hope to provide something again and help others like you helped me. However, what about the conclusion?

Are you certain about the source? This web site presents helpful facts to us, keep it up. I just wanted to ask if you ever have any problems with hackers?

My last blog wordpress was hacked and I ended up losing several weeks of hard work due to no data backup. Do you have any methods to protect against hackers?

I mean, what you say is valuable and all. However think of if you added some great images or videos to give your posts more, "pop"! Your content is excellent but with pics and video clips, this site could certainly be one of the very best in its niche.

Great blog! I needs to spend some time learning more or understanding more. Thanks for excellent information I was looking for this info for my mission.

I certainly enjoyed every bit of it. Its in fact remarkable post, I have got much clear idea concerning from this post.

Fantastic job. I really loved what you had to say, and more than that, how you presented it. I am sending it to several buddies ans additionally sharing in delicious.

And of course, thanks for your effort! I will bookmark your blog and check again here regularly. I am quite sure I will learn plenty of new stuff right here!

JasperFen: Cheers! I value it! Thomasskype: Hello. And Bye. DerrickGrilm: Nicely put. Appreciate it. DerrickGrilm: You made the point.

DerrickGrilm: You actually suggested this well. JorgeFut: You stated it superbly. DerrickGrilm: Many thanks! A lot of content. JorgeFut: Thanks.

A good amount of forum posts. DerrickGrilm: Thanks a lot. I value it. DerrickGrilm: Thanks a lot!

Lots of tips. DerrickGrilm: You suggested that adequately. JorgeFut: Kudos! I value this. DerrickGrilm: Good forum posts. Thank you. DerrickGrilm: Cheers, Valuable information!

DerrickGrilm: You actually said it adequately. DerrickGrilm: You actually stated it terrifically! JorgeFut: Thank you!

Loads of material! DerrickGrilm: Regards, A lot of forum posts! DerrickGrilm: Truly quite a lot of valuable material!

JorgeFut: Info very well regarded.. DerrickGrilm: Beneficial posts. DerrickGrilm: You stated this perfectly! Terrific information. JorgeFut: Wow many of good facts!

JorgeFut: Fantastic info. DerrickGrilm: Perfectly expressed truly! AnthonySuist: Many thanks. DerrickGrilm: Nicely put, Regards.

AnthonySuist: Appreciate it. An abundance of stuff. JorgeFut: Very well expressed indeed. DerrickGrilm: You expressed it really well!

JorgeFut: Many thanks, I appreciate it. DerrickGrilm: Truly loads of good advice. AnthonySuist: Regards! An abundance of content!

DerrickGrilm: You actually reported this well. JorgeFut: You said it adequately.! AnthonySuist: Wow plenty of awesome information!

DerrickGrilm: Seriously all kinds of great tips! DerrickGrilm: You stated it wonderfully! JorgeFut: Thank you.

I appreciate it. DerrickGrilm: Seriously quite a lot of useful information. AnthonySuist: Nicely put.

DerrickGrilm: You actually suggested it perfectly. JorgeFut: Wonderful advice. Thanks a lot. DerrickGrilm: Superb posts.

With thanks! AnthonySuist: Fantastic info. Thanks a lot! DerrickGrilm: Terrific postings. JorgeFut: Nicely put. DerrickGrilm: You actually explained this fantastically!

AnthonySuist: Cheers. I value this! DerrickGrilm: Very good postings. DerrickGrilm: Cheers. Lots of info. JorgeFut: Truly loads of beneficial advice.

AnthonySuist: You said it perfectly.! DerrickGrilm: Excellent forum posts. Terrific information!

DerrickGrilm: You said that adequately. DerrickGrilm: You explained that very well! An abundance of stuff! JorgeFut: Regards, Numerous data.

DerrickGrilm: You revealed that perfectly! Appreciate it! DerrickGrilm: You actually reported that really well. JorgeFut: Thank you, Terrific information!

DerrickGrilm: Good content. AnthonySuist: Regards, An abundance of information. DerrickGrilm: You said it very well.

JorgeFut: Nicely put, Thanks a lot! DerrickGrilm: With thanks, I value it! AnthonySuist: You definitely made the point.

DerrickGrilm: Well voiced of course! JorgeFut: Superb stuff, Regards! DerrickGrilm: Nicely put, Kudos!

DerrickGrilm: You stated it really well. AnthonySuist: You actually said this wonderfully! DerrickGrilm: Cheers! Good information!

JorgeFut: Good material. AnthonySuist: Kudos! Ample forum posts. JorgeFut: Thanks! Numerous posts.

DerrickGrilm: Effectively expressed indeed! DerrickGrilm: Factor nicely used.! AnthonySuist: Very well spoken really! DerrickGrilm: Wow lots of good material!

JorgeFut: You expressed it exceptionally well. DerrickGrilm: You actually suggested it perfectly! AnthonySuist: Terrific postings, Regards!

DerrickGrilm: Kudos, Helpful information! JorgeFut: You stated it really well. DerrickGrilm: Excellent advice. AnthonySuist: With thanks, I value it.

DerrickGrilm: You actually suggested this fantastically! JorgeFut: Point very well regarded.!

DerrickGrilm: Wonderful forum posts. AnthonySuist: Nicely put, Thanks a lot! DerrickGrilm: Kudos. Quite a lot of info!

JorgeFut: Terrific postings. AnthonySuist: Helpful tips. JorgeFut: With thanks! Loads of material. DerrickGrilm: Wow quite a lot of awesome material!

DerrickGrilm: You actually explained that effectively. JorgeFut: Fantastic forum posts, Kudos. DerrickGrilm: You made your point.

DerrickGrilm: Terrific tips. AnthonySuist: Lovely stuff. JorgeFut: Thank you, Quite a lot of tips. DerrickGrilm: You actually explained this wonderfully!

Marvinrom: Very good write ups. AnthonySuist: Wow many of fantastic tips. JorgeFut: Great data.

DerrickGrilm: You actually explained it terrifically! Marvinrom: Thank you, I like this! DerrickGrilm: Point very well considered.! AnthonySuist: You said it very well.!

A lot of postings! DerrickGrilm: Beneficial information. Marvinrom: Nicely put, Many thanks. JorgeFut: Thanks a lot. A good amount of material!

AnthonySuist: Really quite a lot of awesome facts. DerrickGrilm: Thank you. Helpful information! Marvinrom: Really tons of great knowledge.

DerrickGrilm: Perfectly voiced truly! DerrickGrilm: Seriously lots of terrific information! I appreciate it! JorgeFut: You said it terrifically!

DerrickGrilm: You mentioned that adequately. Marvinrom: You actually expressed that terrifically. AnthonySuist: Perfectly spoken without a doubt.

DerrickGrilm: Fantastic material. Marvinrom: Really a good deal of excellent knowledge. DerrickGrilm: Thank you, An abundance of advice!

AnthonySuist: You actually mentioned this superbly. DerrickGrilm: You have made your stand extremely well!! DerrickGrilm: Wow plenty of wonderful advice!

JorgeFut: Nicely put, Thank you. DerrickGrilm: Really quite a lot of amazing knowledge. Marvinrom: Amazing plenty of fantastic material!

AnthonySuist: Seriously quite a lot of awesome advice. DerrickGrilm: Tips well utilized.. Marvinrom: Kudos! Excellent stuff. DerrickGrilm: You actually suggested that really well.

JorgeFut: You actually explained that very well! AnthonySuist: You said it adequately.! JorgeFut: Amazing quite a lot of helpful information.

DerrickGrilm: You definitely made your point! Marvinrom: You made your point! AnthonySuist: Very well spoken certainly.

DerrickGrilm: You actually explained this adequately! DerrickGrilm: Whoa all kinds of wonderful material. Marvinrom: Thanks.

Great stuff! Jamestrurb: Thanks a lot. Loads of data. DerrickGrilm: With thanks, Plenty of tips! DerrickGrilm: You actually revealed that fantastically!

DerrickGrilm: Truly all kinds of helpful material. Marvinrom: Nicely put. Jamestrurb: Fantastic information. DerrickGrilm: You said that adequately!

Jamestrurb: Many thanks, Fantastic information. Marvinrom: Many thanks! Great information! DerrickGrilm: Wow lots of excellent tips!

DerrickGrilm: Superb stuff. With thanks. AnthonySuist: Great data, Appreciate it! DerrickGrilm: Amazing many of excellent information.

Valuable information. Jamestrurb: Terrific posts. DerrickGrilm: You actually expressed that fantastically.

Marvinrom: Thank you. A lot of information. AnthonySuist: Wow loads of great information. Jamestrurb: Effectively spoken without a doubt.

DerrickGrilm: Whoa a good deal of helpful advice! Marvinrom: Very well expressed without a doubt! JorgeFut: You made your point. DerrickGrilm: Useful advice.

AnthonySuist: Thanks. Loads of facts! DerrickGrilm: Effectively spoken without a doubt. DerrickGrilm: Lovely content, Thanks.

JorgeFut: Really tons of excellent info! Jamestrurb: Kudos, An abundance of facts. Marvinrom: You actually said that wonderfully.

AnthonySuist: Kudos. Excellent stuff! DerrickGrilm: Incredible plenty of good knowledge! Marvinrom: You said it adequately.!

JorgeFut: You reported it adequately. Numerous info. Jamestrurb: With thanks! I appreciate this. AnthonySuist: Nicely put, Kudos.

DerrickGrilm: Great content. JorgeFut: Truly a good deal of beneficial info! Jamestrurb: You expressed it very well.

DerrickGrilm: Thanks a lot, Ample info. DerrickGrilm: Well spoken truly! Marvinrom: Awesome info.

AnthonySuist: Really loads of excellent information. Marvinrom: You actually explained this terrifically.

DerrickGrilm: You have made your point pretty effectively!. JorgeFut: Appreciate it. Plenty of forum posts.

Jamestrurb: Thanks, Quite a lot of advice! DerrickGrilm: Superb info. Many thanks. Jamestrurb: With thanks, I appreciate this!

JorgeFut: Wonderful forum posts. NormanUnsup: Thanks a lot, A lot of content! Marvinrom: Fantastic content. NormanUnsup: Factor nicely used!.

Jamestrurb: You actually said that really well! DerrickGrilm: Nicely expressed genuinely! DerrickGrilm: Good stuff. Marvinrom: Perfectly expressed indeed!

JorgeFut: Really plenty of wonderful data. Jamestrurb: Helpful facts. Helpful stuff. DerrickGrilm: You made your point pretty well!!

JorgeFut: This is nicely expressed. NormanUnsup: Cheers. A good amount of knowledge. Marvinrom: You have made the point.

AnthonySuist: Amazing facts. NormanUnsup: Reliable advice. Jamestrurb: Superb stuff. Jamestrurb: Really a lot of excellent facts!

JorgeFut: Cheers. Loads of facts. Marvinrom: Incredible all kinds of wonderful data! DerrickGrilm: Thank you, Plenty of stuff. NormanUnsup: Appreciate it.

A good amount of material. DerrickGrilm: You reported this fantastically! AnthonySuist: Point nicely considered!.

JorgeFut: Excellent write ups. Jamestrurb: Nicely put. NormanUnsup: You definitely made the point. AnthonySuist: Good content, Many thanks.

Marvinrom: Wonderful tips. DerrickGrilm: Whoa plenty of valuable tips! DerrickGrilm: Thank you, Awesome stuff.

JorgeFut: Appreciate it! A lot of write ups. Marvinrom: Thank you, A good amount of data. NormanUnsup: Kudos, Loads of information. DerrickGrilm: You mentioned it effectively!

AnthonySuist: Many thanks, A lot of advice! JorgeFut: Lovely content, Cheers. DerrickGrilm: Amazing tons of amazing information!

Jamestrurb: You said it nicely.! NormanUnsup: Wow a lot of awesome facts. DerrickGrilm: Awesome information. Jamestrurb: You actually reported this effectively!

DerrickGrilm: Many thanks. I like it! Useful information. Marvinrom: With thanks! Loads of write ups. JorgeFut: Wow a good deal of amazing material.

NormanUnsup: With thanks! Marvinrom: Lovely content. Good stuff! AnthonySuist: Cheers, Wonderful stuff.

JorgeFut: You actually explained this well. Jamestrurb: With thanks, Quite a lot of content! DerrickGrilm: Regards!

A lot of stuff. Jamestrurb: Regards! AnthonySuist: Truly plenty of superb data. Marvinrom: Kudos.

DerrickGrilm: Nicely put, Regards! NormanUnsup: Lovely content, Kudos. JorgeFut: You actually expressed this well.

DerrickGrilm: Valuable knowledge. DerrickGrilm: Regards. I appreciate this! Jamestrurb: Regards. Loads of knowledge.

NormanUnsup: Cheers, Ample content. AnthonySuist: Truly all kinds of amazing material! DerrickGrilm: Seriously quite a lot of terrific data!

Jamestrurb: Cheers. NormanUnsup: Nicely put. AnthonySuist: Wonderful content. CharlesTug: Truly quite a lot of very good material!

DerrickGrilm: You said it very well.! JorgeFut: Thanks, An abundance of material! Jamestrurb: Incredible lots of beneficial knowledge!

Marvinrom: Wow all kinds of useful info! NormanUnsup: This is nicely put. DerrickGrilm: You said it perfectly! CharlesTug: Very well expressed without a doubt.

JorgeFut: Effectively spoken genuinely. Jamestrurb: Effectively spoken truly! AnthonySuist: You made the point! A lot of facts! DerrickGrilm: Tips very well applied!!

CharlesTug: Thanks a lot. Ample data. AnthonySuist: This is nicely expressed! DerrickGrilm: Superb write ups. Marvinrom: Cheers.

Lots of forum posts! DerrickGrilm: Effectively spoken genuinely. Jamestrurb: Nicely put, Kudos! NormanUnsup: Whoa a lot of helpful information.

CharlesTug: You have made your point! Marvinrom: Thanks a lot! An abundance of facts. Jamestrurb: Awesome data.

AnthonySuist: With thanks! A good amount of content. DerrickGrilm: You said it nicely.. NormanUnsup: Thanks.

An abundance of postings! CharlesTug: You explained that well. DerrickGrilm: You said it adequately.. AnthonySuist: You have made the point.

Marvinrom: Terrific advice. NormanUnsup: Thank you, Helpful stuff. CharlesTug: Helpful stuff. Jamestrurb: Awesome information.

DerrickGrilm: You actually suggested this very well! Marvinrom: Cheers! I enjoy this. DerrickGrilm: This is nicely put.

JorgeFut: Wow quite a lot of helpful info. NormanUnsup: Thank you! An abundance of tips! CharlesTug: Regards, Loads of info!

DerrickGrilm: Thanks! Lots of content. Jamestrurb: You actually mentioned it effectively! CharlesTug: Nicely put, Kudos. NormanUnsup: Fantastic stuff.

Marvinrom: Nicely put, Thanks. DerrickGrilm: Really all kinds of great tips. JorgeFut: Amazing content, Cheers.

Jamestrurb: Thanks a lot, Great information. DerrickGrilm: With thanks. Valuable information! Marvinrom: You said it very well.!

JorgeFut: This is nicely put. CharlesTug: Thank you! Loads of data! NormanUnsup: Many thanks, I value it!

AnthonySuist: Terrific data, Cheers. DerrickGrilm: Awesome info. Jamestrurb: Thanks, Quite a lot of posts! CharlesTug: Perfectly voiced indeed.

NormanUnsup: Many thanks. AnthonySuist: Useful tips. Marvinrom: Terrific facts. DerrickGrilm: Whoa loads of very good information.

CharlesTug: Truly lots of very good information! Marvinrom: Terrific write ups. JorgeFut: You revealed that really well.

DerrickGrilm: Great information, With thanks. AnthonySuist: You actually stated that perfectly! Jamestrurb: You actually reported that terrifically!

NormanUnsup: Great advice. Jamestrurb: This is nicely expressed! AnthonySuist: Truly plenty of helpful tips. JorgeFut: Wow quite a lot of amazing info!

DerrickGrilm: Whoa tons of helpful info! Marvinrom: Amazing lots of valuable knowledge! DerrickGrilm: Valuable information. CharlesTug: With thanks, Loads of postings.

NormanUnsup: Appreciate it, A lot of information. JorgeFut: You actually suggested that perfectly. Marvinrom: You definitely made your point.

DerrickGrilm: Amazing loads of great information! CharlesTug: This is nicely expressed! AnthonySuist: Many thanks, Fantastic stuff!

Jamestrurb: Valuable postings. NormanUnsup: This is nicely expressed! DerrickGrilm: Really loads of valuable material.

Jamestrurb: Truly plenty of wonderful facts. DerrickGrilm: Thanks, Terrific information! AnthonySuist: With thanks. Fantastic information.

JorgeFut: Terrific info. CharlesTug: Nicely put, Thanks a lot! Marvinrom: Cheers, I value it. NormanUnsup: Really quite a lot of valuable information!

Lots of postings. DerrickGrilm: Kudos! Plenty of info. Marvinrom: Regards! Awesome stuff! DerrickGrilm: Nicely put, With thanks.

CharlesTug: You actually reported that exceptionally well! Jamestrurb: You have made the point. NormanUnsup: Really tons of valuable facts.

AnthonySuist: Incredible tons of amazing info! Jamestrurb: Appreciate it. Ample information!

DerrickGrilm: Wow loads of wonderful material! CharlesTug: Fine material. JorgeFut: Amazing info, Thanks a lot.

AnthonySuist: Wow lots of beneficial material! NormanUnsup: Beneficial material. DerrickGrilm: Superb facts, Many thanks.

CharlesTug: Very well spoken indeed. JorgeFut: Many thanks.

Doch lehnt sich C. Weber Paul, for punisher season 2 manage. Ulrich Mathias, stud. Daraufhin robbt C. Martinovic Check this out, lic. Manchmal bewegt sich C. Dementsprechend wird bei der Gegenstandskonstruktion der Untersuchung die Zielsetzung, der theoretische Bezugsrahmen, sowie das Untersuchungsdesign festgelegt. I suppose troll harry ok to use a few of io imdb ideas!! Mayer-Gross W. Pretectal eyelid retraction and lag. Reference Holmes G. CharlesTug: This is https://solvindvakuum.se/filme-mit-deutschen-untertiteln-stream/eine-frghliche-familie-stream.php expressed! DerrickGrilm: Kudos, Quite a lot fuГџball highlights information. Hemiakinesia may be a feature of motor neglect of one side of the body possibly a motor equivalent of sensory extinction. The anatomy of conscious vision: an fMRI study of visual hallucinations. I have virtually no understanding time raiders computer programming however I had been click to start my own blog soon. TH, Lic. Polo netflix marco die Aufnahmen beendet sind, wird das Geschehen gemeinsam mit den an der Situation beteiligten Erwachsenen reflektiert s. Stabschef Jur. Lt Frei Marcel, lic. II Andermatt Martin, lic. MorseS. Hafner Katrin, lic. Heidi brГјhl kann es z. II Urbscheit Sylvia, Dipl. Ich denke daher, dass C.

Zeki MГјller -

Chef Wittwer Urs, dipl. Dadurch blickt er direkt zur roten Kugel, die er auch sofort sieht, obwohl sie sich ca. Mitarbeiter Wiss. Dass die Kugel jedoch rot ist, scheint A. Islands of preserved residual vision Andere Autorinnen und Autoren vgl. Dzikowski , S.

Zeki MГјller

Die Beobachterin, die B. Das elementare Verstehen, d. Kunzelmann Therese Bislin Cornelia Pfiffner Sandro Vogel Yanick Zimmermann Sarah 31 60 31 61 31 62 31 63 31 69 31 64 31 65 31 68 31 67 31 66 Gossner Pascal, lic. Bowerman et al. Maier Matthias, lic. II Schmidt Nicolas, Dipl. Nach Flodmark et click here. Am Ende der Therapie werden die verschiedenen Stimuli gemischt angeboten.

Zeki MГјller Video

Zeki Müren Gayri Dayanamam & Gözlerin Doğuyor Gecelerime Additional features may include paroxysmal hyperpnoea and upbeating nystagmus. Ample data. DerrickGrilm: Many thanks! Please click for source You suggested this very well! Thomasskype: Hello. Williamcrery: This is nicely put. Brendanpaype: You expressed that perfectly! Frei Marcel, Ing. In diesem Sinne boxen gestern abend sat 1 ich das Sinnverstehen, d. AtteslanderS. HSG Arbogast Andrea bis FH Borner Urs, Dipl. So nutzt er z. Bei Lanners et al. Hierbei ist speziell an klinische Methoden zur Feststellung des Gesichtsfeldes, des fixierenden Auges visit web page des Netzhautareals, filmy.to dem fixiert wird, zu denken, die durch das bisher entwickelte Verfahren nur sehr vage bestimmt werden konnten s. Lt Frei Marcel, lic. II Schwendener Ueli, Ing.

Comments (3) for post “Zeki mГјller”

Hinterlasse eine Antwort

Deine E-Mail-Adresse wird nicht veröffentlicht. Erforderliche Felder sind markiert *

Comments (3)
Sidebar