AMA Manual of Style - Stacy L. Christiansen, Cheryl Iverson 2020
Neurology
Nomenclature
14.11.1 Nerves.
Most nerves have names (eg, ulnar nerve or nervus ulnaris). English names are preferred to Latin. For terminology, consult a medical dictionary, anatomy text, or Terminologia Anatomica.1
14.11.1.1 Cranial Nerves.
The cranial nerves are listed in Table 14.11-1.
Table 14.11-1. Cranial Nerves
Nerve |
English name |
Latin name |
I |
olfactory |
olfactorius |
II |
optic |
opticus |
III |
oculomotor |
oculomotorius |
IV |
trochlear |
trochlearis |
V |
trigeminal |
trigeminus |
VI |
abducens |
abducens |
VII |
facial |
facialis |
VIII |
vestibulocochlear |
vestibulocochlearis (acoustic) |
IX |
glossopharyngeal |
glossopharyngeus |
X |
vagus |
vagus |
XI |
accessory |
accessorius |
XII |
hypoglossal |
hypoglossus |
Use roman numerals or English names when designating cranial nerves:
Cranial nerves III, IV, and VI are responsible for ocular movement.
The oculomotor, trochlear, and abducens nerves are responsible for ocular movement.
Use ordinals when the numeric adjectival form is used:
The third, fourth, and sixth cranial nerves are responsible for ocular movement.
14.11.1.2 Vertebrae, Spinal Nerves, Spinal Levels, Dermatomes, and Somites.
These entities share a common nomenclature, deriving from spinal anatomic regions: cervical (neck), thoracic (trunk), lumbar (lower back), sacral (pelvis), and coccygeal (coccyx or tailbone).
Spinal nerves C1 through C7 are named for the vertebrae above which they emerge, while T1 through S5 are named for the vertebrae below which they emerge. Spinal nerve C8 emerges below vertebra C7; there is no C8 vertebra.
Vertebrae and spinal nerves are listed in Table 14.11-2.
Table 14.11-2. Vertebrae and Spinal Nerves
Region |
Vertebrae |
Spinal nerves |
cervical |
C1 through C7 |
C1 through C8 |
thoracic |
T1 through T12 |
T1 through T12 |
lumbar |
L1 through L5 |
L1 through L5 |
sacrum |
S1 through S5 |
S1 through S5 |
coccyx |
4 fused, not individually designated |
coccygeal nerve |
The alphanumeric terms need not be expanded and, when clear in context, vertebra and nerve need not be repeated:
The first cervical vertebra is also known as the atlas, C2 as the axis, and C7 as the vertebra prominens.
Portions of a vertebra may be referred to as follows, ie, without the term vertebra:
C5 spinous process
L3 lamina
T12 transverse process
Hyphens are used for intervertebral spaces (including neural foramina) and intervertebral disks (Table 14.11-3).
Table 14.11-3. Intervertebral spaces and Disks
Space |
Disk |
C2-3 (space between C2 and C3) |
C2-3 disk |
T2-3 (space between T2 and T3) |
T2-3 disk |
L2-3 (space between L2 and L3) |
L2-3 disk |
C7-T1 (space between C7 and T1) |
C7-T1 disk |
L5-S1 (space between L5 and S1) |
L5-S1 disk |
Note: L4-5 diskectomy is correct usage. Terminologia Anatomica uses disc, not disk. See 11.0, Correct and Preferred Usage.
The sacrum, because its vertebrae are fused, does not contain intervertebral spaces. Its 4 paired foramina are commonly referred to as the first sacral foramen (or S1 foramen), second sacral foramen (or S2 foramen), etc.
Ranges of vertebrae are expressed as in the following examples; use letters for both the first and last vertebra in the indicated range:
C3 through C7 |
third through seventh cervical vertebrae (not C3 through 7) |
T6 through S1 |
sixth thoracic through first sacral vertebrae |
Ranges of vertebrae when used as modifiers have one or more hyphens, eg,
C1-C3 arthrodesis
C2-T1 spinous processes
C4-T3 fusion
L1-L2-L3 motion segments
L1-L4 bone mass density
L2-S1 canal stenosis
L3-L4-L5 fusion
L4-L5 laminectomy
erosion of T9-T12 vertebrae
The same abbreviations are used for spinal segments or levels, spinal dermatomes, and somites (mesodermal structures on either side of the developing spinal cord). Text should indicate which is being referred to, eg, vertebra, spinal nerve (or root, radiculopathy, or distribution), spinal level, dermatome, or somite. Within a clear context, as noted above, the words vertebra, nerve, etc, need not be repeated.
Serious injury of the cervical cord at the level of the C2-C5 vertebrae causes respiratory paralysis due to injury of spinal nerves C3 through C5.
The first patient had herpes zoster in the T9 dermatomal distribution, the second patient in the C5 distribution.
L1-S2 radiculopathy
L3-L4-L5 periradicular infiltration
14.11.2 Electroencephalographic Terms.
Guidelines for electroencephalography (EEG) are available through the American Clinical Neurophysiology Society (formerly the American Electroencephalographic Society)2 and the International Federation of Clinical Neurophysiology3 (formerly the International Federation of Societies for Electroencephalography and Clinical Neurophysiology).4 Other helpful resources include Adams and Victor’s Principles of Neurology,5 the American Electroencephalographic Society guidelines in electroencephalography, evoked potentials, and polysomnography,6 Current Practice of Clinical Electroencephalography,7 and Niedermeyer’s Electroencephalography: Basic Principles, Clinical Applications, and Related Fields.8
The International 10-20 System specifies placement of electrodes used in electroencephalography. The 10-20 system, which originated in the 1950s,9,10 is so named because electrodes are spaced 10% or 20% apart along the head (Figure 14.11-1).
Figure 14.11-1. Electroencephalographic Lead Positions
Reproduced from Hughes11 by permission of Elsevier. Copyright Elsevier 1994.
The terms used in the 10-20 system are widely used and recognized. They are systematically derived, as follows:
■Letters refer to anatomical areas (primarily of the skull, which do not necessarily coincide with the brain areas from which the electrodes register electrical activity).
■Odd numbers are for electrodes placed on the left side, even numbers are for electrodes placed on the right side, and the letter z (“zero”) is for midline electrodes.
Table 14.11-4 lists the electrode designations and locations.
Table 14.11-4. Electrode Designations and Locations
Electrode designation |
Location |
A1, A2 |
earlobe |
Cz, C3, C4 |
central |
F7, F8 |
lateral frontal (anterior temporal) |
Fp1, Fp2 |
frontopolar or prefrontal |
Fz, F3, F4 |
superior frontal |
O1, O2 |
occipital |
Pz, P3, P4 |
parietal |
T3, T4 |
midtemporal |
T5, T6 |
posterior temporal |
Additional electrodes and other placement systems may be used, for instance, the “modified combinatorial nomenclature,” also known as the 10-10 electrode system, which adds electrodes at intermediate 10% positions.4,12,13,14,15,16 The same electrode may have a different name in the 10-20 and the 10% systems (eg, T3 and T4 in the 10-20 system are referred to as T 7 and T8 in the 10% system).7 The added electrodes result in additional numeric designations for existing regional electrodes (eg, C5, F10) and in new letters or letter-number combinations, as indicated in Table 14.11-5.
Table 14.11-5. Added Electrode Designations and Locations
Added electrode designation |
Location |
AFz, AF3, AF4, AF7, AF8 |
anterior frontal |
C1, C2, C5, C6 |
centrotemporal |
CPz, CP1, CP2, CP3, CP4, CP5, CP6 |
centroparietal |
FCz, FC1, FC2, FC3, FC4, FC5, FC6, FC7, FC8, FC9, FC10 |
frontocentral |
Fpz |
midprefrontal |
FT7, FT8, FT9, FT10 |
frontotemporal |
Iz |
inion |
Nz |
nasion |
Oz |
midoccipital |
P1, P2, P5, P6 |
parietal |
P7, P8, P9, P10 |
posterior temporal |
POz, PO3, PO4, PO7, PO8 |
parieto-occipital or temporal-occipital |
Sp1, Sp2 |
sphenoidal |
T1, T2 |
true anterior temporal |
T7, T8, T9, T10 |
midtemporal |
TP7, TP8, TP9, TP10 |
temporal-posterior temporal |
Neonatal electrodes may be placed differently (eg, the 12.5% to 25% system of the Children’s Hospital of British Columbia) and may (or may not) have different designations,7 as in the examples below:
LaF |
left anterior frontal |
LaT |
left anterior temporal |
LFC |
left frontocentral |
LO |
left occipital |
LP |
left parietal |
LST |
left superior temporal |
RaF |
right anterior frontal |
RaT |
right anterior temporal |
RFC |
right frontocentral |
RO |
right occipital |
RP |
right parietal |
RST |
right superior temporal |
In figures showing EEGs, electrode symbols usually will be paired. Usually, the symbols will be beside and to the left of each channel of the tracing but may be above and below each channel with connecting lines. Authors should include with tracings a time marker and an indicator of voltage, as in the top tracing (Figure 14.11-2).
Figure 14.11-2. Sample Electroencephalographic Tracings
Descriptions of EEG potentials include many qualitative terms for waveforms and frequencies. The following are a few of numerous descriptive terms (note that Greek letters are spelled out):
alpha rhythm, beta activity, polymorphic delta activity, sleep spindles, spike-wave complexes, paroxysms, spikes, sharp waves, delta brush, frontal sharp transient, mu rhythm, lambda waves
A comprehensive glossary of EEG terms has been provided by the IFCN.16
Frequency is given per second (/s). For cycles (c) per second, hertz (Hz) is preferred to c/s (see 17.1, SI Units):
10-Hz alpha activity
a theta frequency of 5 to 7.5 Hz
15-Hz spindles
60-Hz artifact
background rhythm of 8 to 10 Hz
14.11.3 Evoked Potentials or Responses.
Several types of evoked potentials or responses (stimulated electrical signals)5(pp13-39),6,17,18,19,20 may be recorded: brainstem auditory evoked potentials (BAEPs or BAERs), somatosensory evoked potentials (SSEPs, including various types such as the following, which are not mutually exclusive: short-latency, upper extremity, lower extremity, median nerve, posterior tibial nerve), and visual evoked potentials or responses (VEPs or VERs, including pattern shift [PSVEP] and flash [FVEP]). As in EEG, evoked potential testing uses recording electrodes and produces tracings.
Electrode terminology resembles that of EEGs (see above), with additional or modified electrodes such as the following,6 which may be used without expansion:
BAEP electrodes
Ac |
contralateral earlobe |
Ai |
ipsilateral earlobe |
EAM |
external auditory meatus |
EAMc |
contralateral EAM |
EAMi |
ipsilateral EAM |
M1, M2 |
mastoid processes |
Mc |
contralateral M |
Mi |
ipsilateral M |
SSEP electrodes
AC |
anterior cervical |
C1′, C2′, C3′, C4′ |
near EEG C1, C2, C3, C4 |
C2S, C5S |
C2, C5 spinous processes |
Cc |
contralateral C3′ or C4′ |
Ci |
ipsilateral C3′ or C4′ |
CP |
midway between C3 or C4 and P3 or P4 |
CPc |
contralateral CP |
CPi |
ipsilateral CP |
Cz′ |
near 10-20 Cz |
EP |
Erb point |
EP1, EP2 |
left and right EP |
EPi |
ipsilateral EP |
Fpz′ |
near EEG Fpz |
IC |
iliac crest |
L2S, L3S |
L2, L3 spinous processes |
LN |
lateral neck |
LNi |
ipsilateral LN |
PFd, PFp |
popliteal fossa (distal, proximal) |
REF |
reference |
T6S, T10S, T12S |
T6, T10, T12 spinous processes |
VEP electrodes
I |
inion |
LO |
left occipital |
LT |
left posterior temporal |
MF |
midfrontal |
MO |
midoccipital |
MP |
midparietal |
RO |
right occipital |
RT |
right posterior temporal |
V |
vertex |
Waveforms recorded in evoked potential testing are identified with P for positive or N for negative plus a number indicating milliseconds between stimulus and response in neurologically normal adults:
VEP: |
N75, N100, N155, P75, P100, P135 |
SSEP: |
N9, N11, N13, N15, N18, N20, N34, N35, P9, P11, P13, P15, P27, P37 |
SSEPs were recorded from the brachial plexus (Erb point), cervical spine at C2 (N13), and the contralateral parietal area (N19) with a frontal (Fz) reference.
SSEPs showed normal Erb point and cervical potentials and significant delay of scalp components (N20 latency >>3 SDs, N13-N20 central conduction time >3 SDs, bilaterally).
Persistent delay of the P100 wave of the pattern-reversal VEP after an episode of optic neuritis is considered to be compatible with residual demyelination within the optic nerve.
An additional SSEP wave is the LP (lumbar potential).
Other waves, eg, in BAEP, are designated with roman numerals:
I through VII |
vertex-positive waves |
I′ through VI′ |
vertex-negative waves |
BAEPs of the proband showed normal wave I, increased latency of waves II and III (>3 SDs), and absent IV and V components despite normal hearing acuity.
I-III interpeak interval
V/I amplitude ratio
14.11.4 Polysomnography and Sleep Stages.
Polysomnography is the monitoring of various physiologic parameters simultaneously during sleep,6,21 including the following:
■EEG: standard electrodes are used (see 14.11.2, Electroencephalographic Terms)
■Electro-oculogram (EOG): tracings are obtained from the left eye and right eye
■Electromyogram (EMG): submental (chin) EMG, leg muscle EMG, eg, left anterior tibialis, right anterior tibialis
■Respiratory function, eg, oxygen saturation (Sao2), expired CO2, and tidal volume (VT) (see 14.16, Pulmonary and Respiratory Terminology)
■Electrocardiogram (ECG): see 14.3.1, Electrocardiographic Terms
Sleep stages are as follows7,22:
rapid-eye-movement sleep (REM sleep)
non—rapid-eye-movement (non-REM) sleep (NREM sleep)
sleep stage 1 (N1 sleep)
sleep stage 2 (N2 sleep)
sleep stage 3 (N3 sleep)
sleep stage 4 (N4 sleep)
14.11.5 Molecular Neuroscience.
The following terms are provided for reference (a major source is Nestler et al23) (see 14.10, Molecular Medicine). Terms should be expanded at first mention unless noted otherwise in the Expansion or Explanation column.
Term |
Expansion or explanation |
α-adrenergic receptor, α receptor (subtypes: α1A, α1B, α1D, α2A, α2B, α2C) |
does not require expansion |
α-synuclein |
does not require expansion |
A1, A2 |
neuropeptide adenosine receptors (also known as purine receptors P1, P2; see 14.6.1, Nucleic Acids and Amino Acids); does not require expansion |
ACh |
acetylcholine |
AChE |
acetylcholinesterase |
AMPA |
α-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid |
β-adrenergic receptor, β receptor (subtypes: β1, β2, β3) |
does not require expansion |
BDNF |
brain-derived neurotrophic factor |
CCR3, CCR5, CXCR4 |
chemokine receptors (see 14.8.1, Chemokines) |
Ch1 through Ch8 |
cholinergic nuclei |
CNTF |
ciliary neurotrophic factor |
COMT |
catechol-O-methyltransferase |
cytokines |
(see 14.8.4, Nomenclature, Immunology, Cytokines) |
δ-receptor |
opioid δ receptor |
D1 through D5 |
dopamine receptors |
DAT |
dopamine transporters |
EAAT1, EAAT2, EAAT3, EAAT4, EAAT5 |
excitatory amino acid reuptake transporters |
EGF |
epidermal growth factor |
GABA |
γ-aminobutyric acid |
GABAA, GABAB |
GABA receptor classes |
GABAergic |
GABA-mediated |
GABA-T |
GABA transaminase |
GAT-1, GAT-2, GAT-3, GAT-4 |
GABA family transporters |
GDNF |
glial cell line—derived neurotrophic factor |
GFR |
GDNF-neurturin receptor |
GIRKs |
G protein—coupled Kir3 channels |
H1, H2, H3 |
histamine receptors |
5-HT |
5-hydroxytryptamine, serotonin (preferred expansion) |
5-HT1A, 5-HT1B, 5-HT2A, 5-HT5B, 5-HT7 |
5-HT receptors |
5-HTT |
serotonin transporter |
5HTTLPR |
a polymorphism of the serotonin transporter gene (LPR: length polymorphism region) (see 14.6.2, Human Gene Nomenclature) |
interleukins |
(see 14.8.4, Cytokines) |
IP3 |
inositol triphosphate |
κ-receptor |
opioid κ receptor |
K(ATP) channel |
potassium channel |
K(Ca) |
Ca2+-gated K+ channel |
Kir1, Kir2, Kir3, Kir4, Kir5 |
inwardly rectifying K+ channels; does not require expansion |
L channels, L-type channels |
large-current or long-open-time Ca2+ channels; does not require expansion |
μ-receptor |
opioid μ receptor |
M1 through M5 |
muscarinic receptors; does not require expansion |
MAO |
monoamine oxidase |
MAOA, MAOB |
major forms of MAO |
N channels |
neuronal Ca2+ channels; does not require expansion |
nAChRs |
nicotinic acetylcholine receptors |
NET |
norepinephrine GABA family transporter |
neuromedin B |
does not require expansion |
neuromedin K |
does not require expansion |
neuropeptide Y |
does not require expansion |
NGF |
nerve growth factor |
NK1, NK2, NK3 |
neuromedin K tachykinin receptors |
NMDA |
N-methyl-D-aspartate |
nNOS |
neuronal nitric oxide synthetase |
NSF |
N-ethylmaleamide sensitive factor |
NT-3, NT-4 |
neurotrophin 3 and neurotrophin 4 |
NTS1, NTS2 |
neurotensin receptors |
P channels |
Purkinje Ca2+ channels; does not require expansion |
P1, P2 |
neuropeptide purine receptors (also known as adenosine receptors A1, A2; see 14.6.1, Nucleic Acids and Amino Acids); does not require expansion |
R-PTK |
receptor-associated protein tyrosine kinase |
σ-receptor |
opioid σ receptor |
SERT |
serotonin GABA family transporter |
SNAP-25 |
synaptosomal-associated protein of 25 kDa |
SNAP |
soluble NSF attachment protein (note different expansion of SNAP than for SNAP-25) |
SNARE proteins |
SNAP receptors |
SNAREpins |
hairpin forms of SNARE proteins |
substance P |
does not require expansion |
T channels |
transient Ca2+ channels; does not require expansion |
t-SNARES |
t: target membranes |
VAChT |
vesicular transporters of ACh |
VAMP |
vesicle-associated membrane protein, synaptobrevin |
VGAT |
vesicular transporter for GABA |
VGLuT1 |
vesicular transporter for glutamate |
VMAT1 |
vesicular transporter for monoamines |
v-SNARE |
v: vesicle |
Y1, Y2, Y4, Y5, Y6 |
neuropeptide Y receptors |
Gene symbols for many of the above terms are found in the list of genes in 14.6.2, Human Gene Nomenclature. For reference, gene symbols are given in Table 14.11-6 for terms in the preceding list whose abbreviations do not closely resemble the gene symbol.
Table 14.11-6. Gene Symbols in Genes Whose Abbreviations Do Not Closely Resemble the Gene Symbol
Term |
Gene symbol |
A1 |
ADORA1 |
AMPA |
GRIA1 |
δ receptor |
OPRD1 |
D1 |
DRD1 |
H1 |
HRH1 |
5-HT1A |
HTR1A |
κ receptor |
OPRK1 |
μ receptor |
OPRM1 |
M1 |
CHRM1 |
nAChR |
CHRNA1 |
neuromedin K |
TAC3 |
NMDA |
GRIN1 |
σ receptor |
OPRS1 |
substance P |
TAC1 |
transporters (various) |
SLC genes (various, eg, SLC6A1) |
Y1 |
NPY1R |
Principal Author: Cheryl Iverson, MA
Acknowledgment
Thanks to Roger N. Rosenberg, MD, formerly with JAMA Neurology, and Department of Neurology, University of Texas Southwestern, Dallas; Jeffrey L. Saver, MD, JAMA, and Geffen School of Medicine at UCLA, Los Angeles, California; and Christopher C. Muth, MD, JAMA. Thanks also to David Song, JAMA Network, for obtaining permissions.
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