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Clinical Neurology

2008 Edition, February 1, 2008

Complete Document

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Active, Most Current

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ISBN: 978-1-84076-518-2
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Product Details:

  • Revision: 2008 Edition, February 1, 2008
  • Published Date: February 1, 2008
  • Status: Active, Most Current
  • Document Language: English
  • Published By: CRC Press (CRC)
  • Page Count: 696
  • ANSI Approved: No
  • DoD Adopted: No

Description / Abstract:


Neurology is an exciting and evolving clinical science. Since we began our training in neurology (GJH) and neuroradiology (JMW) in the 1980s, the understanding and practice of clinical neurology and neuroradiology have been transformed. Traditionally, the essence of neurology was the rigorous application of meticulous clinical skills to localize the presence (or absence) and precise location of neurological lesions. Clinical findings were correlated with pathological findings at autopsy, but understanding of disease mechanisms was poor and therapeutic options were limited. Indeed, most neurological disorders like stroke, epilepsy, Alzheimer's disease, multiple sclerosis, and motor neuron disease were considered untreatable. Neurology was thus regarded by many outside the specialty as rather erudite and nihilistic.

However, in the past 15 years, advances in neuroimaging, basic neuroscience, molecular genetics, and the consequent development and evaluation of therapies have brought new meaning and life to the clinical features elicited at the bedside. Furthermore, new diseases with potentially devastating consequences have emerged, and traditional rigid boundaries between neurology and psychiatry have blurred with increased recognition of the interaction between mind and body. Thus, clinical neurology has emerged as one of the most exciting frontiers in medicine. The array of new and emerging diagnostic and therapeutic options include:

• Superb, safe, and noninvasive diagnostic imaging of the vasculature and the structure, metabolism and function of the brain and spinal cord by magnetic resonance. This has added a new dimension to clinico-pathologic correlation, optimized diagnosis, exposed new insights into pathophysiology, and facilitated new treatments.

• Advances in catheter technology and interventional neuroradiology. The better availability of these less invasive techniques is changing the focus of neurosurgery, neurology and neuroimaging.

• The introduction of DNA analysis as a diagnostic and prognostic tool. The enormous advances in molecular biology have revolutionized our understanding of the pathogenesis of many inherited and degenerative neurologic conditions and facilitated accurate diagnosis, predictive testing, and genetic counselling.

• Effective treatments have been recognized in large, randomized controlled clinical trials for many neurologic disorders, such as acute migraine, stroke, limb spasticity and other movement disorders, partial epilepsy, multiple sclerosis, Parkinson's disease, Alzheimer's disease, Guillain- –Barré syndrome and other immune-mediate peripheral neuropathies, myopathies, and myasthenia gravis. However, many treatments are still not very effective and there is enormous opportunity for improvement.

The fact that many previously untreatable diseases are now known to be not only treatable but preventable, has raised new optimism for the probability that treatments will emerge for other currently incurable neurologic disorders. To take full advantage of the breadth of techniques, knowledge and skills now available requires increased collaboration between neurologists, neuroradiologists and other clinical neuro disciplines.

These developments have been one of the prompts to writing this book. Where appropriate and possible, we have incorporated them, but only if their clinical effectiveness is supported by high quality evidence. For therapies, the level of evidence required is a systematic review of all (published and unpublished) randomized trials, as published and regularly updated in the Cochrane Library and Clinical Evidence. Where such evidence is not available, we have indicated so, and offered empirical recommendations based on the best available evidence and our own experience.

Another prompt has been our impression of a void in middle-sized clinical neurology texts which have some flesh added to the raw, skeletal content of many handbooks, yet which are not as bulky as comprehensive texts which we find difficult to carry, read and use. We have therefore taken this rapidly changing field and focused on the essentials. The book is written and illustrated for students of clinical neurology, particularly neurologists-in-training and practicing neurologists, who wish to have ready access to a comprehensive, up-to-date, and evidence-based guide to the understanding, diagnosis and management of common and important neurologic disorders.

We have included more than 800 illustrations in the text. Many are images taken from our own patients, whom we would like to thank for allowing us to photograph them or the outcome of their investigations. Furthermore, we would also like to thank Professor John Best, Dr Andrew Chancellor, Professor Byron Kakulas, Dr Robin Sellar, Mr Matthew Wade, and the Department of Medical Illustrations, Royal Perth Hospital, for all providing illustrations, as indicated throughout the book, and Dr Peter Silbert for helpful comments on sections of the text. Finally, we would like to thank our families and colleagues for supporting us in this endeavour. We hope you enjoy the book and welcome any comments and criticisms.