| dc.description.abstract | A major focus of clinical neuropsychology and cognitive-behavioral neurology is the
assessment and management of cognitive and behavioral changes that result from brain
injury or disease. In most instances, the task of the neuropsychologist can be divided into
one of two general categories. Perhaps the most common is where patients are known to be
suffering from identified neurological insults, such as completed strokes, neoplasms, major
head traumas or other disease processes, and the clinician is asked to assess the impact of
the resulting brain damage on behavior. The second involves differential diagnosis in cases
of questionable insults to the central nervous system. Examples of the latter might be milder
forms of head trauma, anoxia and dementia or suspected vascular compromise. In either
instance, understanding the underlying pathology and its consequences depends in large part
on an analysis of cognitive and behavioral changes, as well as obtaining a good personal
and medical history. The clinical investigation will typically include assessing problems or
changes in personality, social and environmental adaptations, affect, cognition, perception,
as well as sensorimotor skills. Regardless of whether one approaches these questions having
prior independent confirmation of the pathology versus only a suspicion of pathology, a fairly
comprehensive knowledge of functional neuroanatomy is considered critical to this process.
Unfortunately as neuropsychologists we too frequently adopt a corticocentric view of
neurological deficits. We recognize changes in personality, memory, or problem solving
capacity as suggestive of possible cerebral compromise. We have been trained to think
of motor speech problems as being correlated with the left anterior cortices, asymmetries
in sensory or motor skills as a likely sign of contralateral hemispheric dysfunction, and
visual perceptual deficits as being associated with the posterior lobes of the brain. At the
same time there should be an awareness that multiple and diverse behavioral deficits can
frequently result from strategically placed focal lesions, and that many such deficits might
reflect lesions involving subcortical structures, the cerebellum, brainstem, spinal cord, or
even peripheral or cranial nerves. As first noted by Hughlings Jackson in the 19th century,
while the cortex is clearly central to all complex human behavior, most cortical activities
begin and end with the peripheral nervous system, from sensory input to motor expression.
This current work was an outgrowth of seminars given by the principal author (JEM)
at the request of neuropsychology interns and residents at the VA to broaden their clinical
appreciation and application of functional neuroanatomy. In working closely with neurologists
and neurosurgeons, these students also recognized the advantage of being able converse
knowledgeably about patients with subtentorial deficits. While all the intricate details of the
nervous system may be beyond the immediate needs of most clinicians, a general appreciation
of its gross structural makeup and functional relationships is viewed as essential in
working with neurological populations.
To this end, the book begins with a brief review of the gross anatomy, functional correlates,
and behavioral syndromes of the spinal cord and peripheral nervous system. From there,
the text carries one rostrally, looking at these same features in the cerebellum, brainstem and
cranial nerves. Where this volume deviates from most textbooks of functional neuroanatomy
is in its expanded treatment of supratentorial structures, particularly the cerebral cortex
itself, which more directly impacts on those aspects of behavior and cognition that often
represent the primary focus or interests of neuropsychologists and behavioral neurologists. | en_US |
