The sixth edition of Introduction to Clinical Neurology continues to present a straightforward and systematic approach to diagnosing diseases of the nervous system. Extensively revised to reflect medical advances and now including supplementary tables for quick reference, this engaging textbook explains the neurologic diseases and presenting symptoms that clinicians are likely to encounter in daily practice. It also provides streamlined summaries of clinically relevant nervous system pathways to help non-neurologists deduce the site of dysfunction. Each chapter begins with a set of clinical vignettes and associated questions, which are discussed at the end of the chapter. The final chapter provides twelve additional clinical vignettes and accompanying questions intended to allow the reader to practice applying the principles of localization and diagnostic reasoning covered in the first three chapters, and to review some of the specific disorders covered throughout the book.
Preface to the Sixth Edition Preface to the First Edition Contributors PART I: The Basic Approach 1. Where's the Lesion? (How We Localize) I. Sample Localization Problems II. The Game III. The Rules IV. The Play: The Long Version V. The Play: The Abbreviated Version VI. More Examples VII. Rules for Speed Play 2. The Neurologic Examination (What We Localize) I. More Localization Problems II. General Comments on the Neurologic Examination III. How to Do the Neurologic Examination A. Mental Status Examination B. Cranial Nerve Examination C. Motor Examination D. Reflex Examination E. Sensory Examination IV. Additional Comments on Terminology and Examination Technique A. Mental Status Examination B. Cranial Nerve Examination C. Motor Examination D. Reflex Examination E. Sensory Examination V. Interpretation of the Neurologic Examination A. Mental Status Examination B. Cranial Nerve Examination C. Motor Examination D. Reflex Examination E. Sensory Examination VI. Modifications of the Neurologic Examination A. Screening Neurologic Examination B. Video Examination C. Examination of Patients with Altered Level of Consciousness D. Inconsistent or Anomalous Examination Findings VII. Supplementary Table for Reference VIII. Discussion of Localization Problems 3. Diagnostic Reasoning: What's the Lesion? (Why We Localize) I. Case Histories II. Beyond Localization A. Localization B. Temporal Profile C. Epidemiology III. Etiology A. Degenerative Diseases B. Neoplastic Diseases C. Vascular Diseases D. Inflammatory Diseases E. Toxic and Metabolic Diseases F. Traumatic Diseases G. Congenital and Developmental Diseases IV. Discussion of Case Histories PART II: Common Diseases 4. Stroke I. Case Histories II. Approach to Stroke III. Background Information A. Definitions B. Classification of Strokes by Etiology C. Pathophysiology IV. Diagnosis A. Clinical Features B. Imaging V. Management of Acute Stroke A. Restoration of Blood Flow in Ischemic Stroke B. Limitation of Deficits C. Rehabilitation VI. Secondary Prevention of Ischemic Stroke A. Lipid Management B. Antiplatelet Medication C. Blood Pressure D. Other Risk Factors E. Cardioembolic Disease F. Cervical Carotid Stenosis G. Ischemic Stroke Mechanisms Other Than Cardioembolism and Cervical Carotid Stenosis H. Determining the Underlying Mechanism of Stroke VII. Secondary Prevention of Cerebral Hemorrhage VIII. Primary Prevention A. Hypertension B. Smoking C. Diabetes D. Dyslipidemia E. Mechanical Heart Valves F. Atrial Fibrillation G. Cervical Carotid Stenosis H. Sickle Cell Disease I. Other Factors IX. Supplementary Tables for Reference X. Discussion of Case Histories 5. Seizures I. Case Histories II. Approach to Seizures III. Background Information A. Definitions B. Clinical Characteristics of Seizures C. Seizures vs. Epilepsy D. Epilepsy Classification E. Electroencephalography F. Pathophysiology of Seizures and Epilepsy IV. Diagnosis A. Characterizing the Presenting Spell B. Identifying Prior Spells C. Recognizing Spells That Are Not Seizures V. Determining the Cause of Seizures A. Provoked Seizures B. Epilepsy C. The Diagnostic Evaluation VI. Management of Seizures and Epilepsy A. Patients with Seizures but No Proven Epilepsy B. Patients with Epilepsy C. Patient Education (for People with Isolated Seizures or Epilepsy) D. Restrictions (for People with Isolated Seizures or Epilepsy) VII. Special Clinical Problems A. Status Epilepticus B. Seizures and Pregnancy C. Refractory Seizures VIII. Supplementary Tables for Reference IX. Discussion of Case Histories 6. Neuromuscular Disorders I. Case Histories II. Approach to Neuromuscular Diseases III. Background Information A. Functional Divisions of the Peripheral Nervous System and Associated Symptoms B. Proximal-to-Distal Organization of the Peripheral Nervous System C. Electrodiagnostic and Other Laboratory Studies IV. Specific Neuromuscular Diseases A. Motor Neuron Diseases B. Nerve Root Disorders (Radiculopathies) C. Plexus Disorders (Plexopathies) D. Peripheral Nerve Disorders (Neuropathies) E. Neuromuscular Junction Disorders F. Muscle Disorders (Myopathies) V. Symptomatic Treatment A. Emergency Measures B. Non-Urgent Measures: Motor Symptoms C. Non-Urgent Measures: Sensory Symptoms VI. Supplementary Tables for Reference VII. Discussion of Case Histories 7. Dementing Illnesses Linda M. Selwa and Douglas J. Gelb I. Case Histories II. Approach to Dementing Illnesses A. Is It Abnormal? B. Are There Any Potentially Reversible Components? C. Which Primary Degenerative Dementing Illness Is Most Likely? III. Primary Dementing Illnesses A. Alzheimer Disease B. Dementia with Lewy Bodies (DLB) C. Frontotemporal Dementia (FTD) D. Vascular Cognitive Impairment E. Limbic-predominant Age-related TDP-43 Encephalopathy (LATE) F. Creutzfeldt-Jakob Disease (CJD) G. Other Neurologic Diseases That Produce Dementia IV. Supplementary Tables for Reference V. Discussion of Case Histories 8. Movement Disorders Linda M. Selwa and Douglas J. Gelb I. Case Histories II. Approach to Movement Disorders III. Background Information A. Anatomic Definitions B. Clinical Definitions C. Classification of Movement Disorders IV. Specific Movement Disorders A. Essential Tremor B. Parkinson Disease C. Other Parkinsonian Syndromes D. Hereditary Ataxias E. Huntington Disease F. Tardive Dyskinesia G. Dystonias H. Wilson Disease I. Tourette Syndrome V. Supplementary Tables for Reference VI. Discussion of Case Histories 9. Sleep Disorders I. Case Histories II. Approach to Sleep Disorders III. Background Information A. Definitions B. Sleep Physiology C. Diagnostic Tests D. Classification of Sleep Disorders IV. Trouble Staying Awake A. Insufficient Sleep B. Sleep Apnea C. Narcolepsy D. Other Causes of Hypersomnolence V. Trouble Sleeping A. Sleep-Onset Delay B. Early Morning Awakening C. Sleep Fragmentation D. Sleep State Misperception VI. Abnormal Behavior During Sleep A. Nonrapid Eye Movement (NREM) Sleep Parasomnias B. Rapid Eye Movement (REM) Sleep Parasomnias VII. Discussion of Case Histories 10. Multifocal Central Nervous System Disorders I. Case Histories II. Approach to Multifocal Disorders III. Focal Diseases with Multifocal Propagation A. Neurologic Manifestations of Systemic Cancer B. Central Nervous System Infections IV. Inherently Multifocal Diseases A. Multiple Sclerosis (MS) and Related Disorders B. Rheumatologic Diseases C. Sarcoidosis D. Coagulation Disorders E. Functional Disorders V. Supplementary Tables for Reference VI. Discussion of Case Histories PART III: Common Symptoms 11. Acute Mental Status Changes I. Case Histories II. Background Information A. Definitions B. Focal Mental Status Changes vs. Altered Level of Consciousness C. Physiology of Normal and Altered Consciousness III. Approach to Acute Changes in Level of Consciousness A. ABCs: Airway, Breathing, Circulation B. Oxygen, Glucose, Naloxone C. Pupils, Doll's Eyes, Motor Asymmetry D. Other Electrolytes, Renal, Hepatic, Temperature Abnormalities E. Everything Else IV. Special Circumstances A. Head Trauma B. Increased Intracranial Pressure C. Brain Death V. Discussion of Case Histories 12. Headache I. Case Histories II. Approach to Headache III. Background Information A. Primary vs. Secondary Headaches B. Pathophysiology of Migraine IV. Headache Emergencies: Subarachnoid Hemorrhage and Bacterial Meningitis V. Other Secondary Headaches A. Viral Meningitis or Encephalitis B. Fungal or Tuberculous Meningitis C. Mass Lesions D. Giant Cell (Temporal) Arteritis E. Idiopathic Intracranial Hypertension (IIH) F. Spontaneous Intracranial Hypotension G. Cerebral Venous Thrombosis H. Arterial Dissection I. Reversible Cerebral Vasoconstriction Syndrome (RCVS) J. Systemic Conditions K. Secondary Headache Syndromes with Diagnostic Ambiguity VI. Primary Headaches A. Migraine and Tension Headaches B. Trigeminal Neuralgia C. Glossopharyngeal Neuralgia D. Cluster Headaches E. Other Trigeminal Autonomic Cephalalgias (TACs) F. Primary Stabbing Headache G. Persistent Idiopathic Facial Pain VII. Supplementary Tables for Reference VIII. Discussion of Case Histories 13. Visual Symptoms I. Case Histories II. Background Information A. Definitions B. Overview of the Visual System III. Approach to Visual Symptoms IV. Monocular Vision Loss A. Acute or Subacute Monocular Vision Loss in Young People B. Acute, Subacute, or Chronic Monocular Vision Loss in Older People V. Transient Vision Loss (Monocular or Binocular) VI. Persistent Binocular Vision Loss VII. Diplopia A. Localization B. Differential Diagnosis and Management VIII. Discussion of Case Histories 14. Dizziness and Disequilibrium I. Case Histories II. Approach to Dizziness III. Localization IV. Differential Diagnosis A. Central Vertigo B. Peripheral Vertigo V. Disequilibrium VI. Discussion of Case Histories 15. Back Pain and Neck Pain I. Case Histories II. Approach to Back or Neck Pain A. Emergency Situations B. Non-Urgent Indications for Surgery III. Specific Conditions Causing Back or Neck Pain A. Musculoskeletal Pain B. Disc Herniation C. Spinal Stenosis IV. Discussion of Case Histories 16. Incontinence I. Case Histories II. Background Information III. Approach to Incontinence A. Non-neurologic Causes of Incontinence B. Central vs. Peripheral Nervous System Causes of Incontinence IV. Supplementary Table for Reference V. Discussion of Case Histories PART IV: Bookends 17. Pediatric Neurology I. Case Histories II. Developmental Considerations III. Hypotonic Infants IV. Developmental Delay and Developmental Regression V. Paroxysmal Symptoms A. Migraine B. Seizures C. Breath-Holding Spells D. Benign Paroxysmal Vertigo VI. Gait Disturbance A. Spasticity B. Weakness 434 C. Ataxia VII. Functional Disorders VIII. Discussion of Case Histories 18. Geriatric Neurology I. Case Histories II. Geriatric Issues III. The Neurologic Examination in Normal Aging A. Mental Status B. Cranial Nerves C. Motor System D. Reflexes E. Sensation IV. Common Neurologic Symptoms in the Elderly A. Dizziness B. Gait Disturbance C. Incontinence D. Dementia E. Pain V. Discussion of Case Histories 19. Practice Cases I. Case Histories II. Answers Index
Douglas J. Gelb is a general neurologist who received his MD and PhD degrees from the University of Chicago and completed neurology residency at the University of California San Francisco. Immediately after residency, he joined the faculty of the University of Michigan Neurology Department, where he is a Professor in the Clinical Track and the director of both the medical student neurology clerkship and pre-clinical education regarding diseases of the nervous system. He is a former Chair of the national Consortium of Neurology Clerkship Directors, and of the American Academy of Neurology's A.B. Baker Section of Neurologic Educators.
