1. Clinical Neurology: A Primer Peter Gates MBBS FRACP Associate Professor of Neurology, University of Melbourne Associate Professor of Neurology, Deakin University Director of Stroke, Director of Neuroscience & Director of Physician Training, Barwon Health Geelong
2. About the book... A comprehensive guide. Equips medical students and doctors with knowledge and techniques to diagnose common neurological conditions Learning Tools to facilitate easy understanding of neurological anatomy > ‘Meridian of longitude’ and ‘parallels of latitude’ > Rule of Four > Principles & processes o f patient History taking & examination > How to diagnose the more common neurological diseases Key Knowledge & Techniques:
3. Learning tool #1: Understanding Neuroanatomy ‘ meridians of longitude’ and ‘parallels of latitude’ Figure 1.1 This unique concept was designed by the author to help simplify neuroanatomy
4. Learning tool #2: Cranial Nerves & the Brainstem The Rule of 4 The ‘Rule of 4’ was designed to facilitate easy localisation of a problem within the brainstem, in particular understanding brainstem vascular syndromes
5. Overview of Chapters The chapters are grouped as follows: Chapters 1 & 2 & 3: Neurology, Anatomy, Patient History & Examination Focus of these chapter are to provide underpinning knowledge for neurology: > How to identify the anatomy > Process of gathering the patient history > How to perform the examination
6. Chapter 4: Understanding the Brainstem > Anatomy and techniques for examining individual cranial nerves > Common abnormalities encountered > ‘Rule of 4’ Chapter 5: Higher Cognitive Function > How to perform a simplistic assessment of language disturbances and very basic higher cortical functions
7. Chapter 6: What Next? After the History & Examination Details the steps that you need to undertake after the patient history is taken and the examination performed Chapter 7 – 14: Assessment & Management Strategies The common neurological occurrences are detailed in regards to their assessment and possible management strategies: > Epilepsy > Headache and facial pain > Cerebrovascular disease > Common neck, arm and upper back problems > Common leg problems > Tremor and abnormal movements
8. About the DVD... Includes video demonstrations & explanations of: > Upper & lower limb examination > Taking patient history > Patient with difficultly walking with spasticity > Explanation of ‘rule of 4’ > Cranial nerve examination > ... and more!
9. Why choose this book? > Local, internationally acclaimed author > Benefit from Peter Gates’ years of experience and research > The most current book on the market > Two unique learning tools > Comprehensive - provides all underpinning knowledge necessary for the ‘non-neurologist’ > A comprehensive DVD which provides ‘real life’ examples and explanations of the clinical examples as discussed in the book
10. Foreword: Professor Edward Byrne AO “ In this book he [Peter Gates] sets out the lessons of a lifetime spent in clinical neurology and distils some of the principles which have led him to become a master diagnostician.... ... I would recommend it to senior medical students , to young doctors at all stages and also to those beginning their neurological training. ... ... It is the best introduction to the diagnosis and treatment of nervous system disorders that I have seen for many years and contains a font of wisdom about a speciality often perceived as difficult by the non-expert. Professor Edward Byrne AO Vice Chancellor & President Monash University, Melbourne, Australia
11. **Two groups of reviewers engaged. Group 1 - 3 rd /4 th year Medical Students, ANU & Group 2 – JMOs & Neurologists with academic appointments What the reviewers said.... **This text is appropriate for the senior medical student or the doctor not specialising in neurology. It introduces concepts to neurology that I wish were taught in medical school ** All you need to know at your fingertips at a glance ... It isn’t too complicated so as to confuse the junior medical officer, but yet in-depth enough that the right diagnosis is made. **The clinical examples are great – is a good way to see how history taking forms a major part of the diagnostic process **It’s main strength is the basic approach to the topics of localisation and pathophysiological process which will lead to accurate clinical diagnosis.
12. ... Available for purchase June 2010!! Purchase this text online @ shop.elsevier.com.au and save!! RRP: AU$ 90.00 Online Price: AU$ 81.00 Title: Clinical Neurology Author: Peter Gates ISBN: 9780729539357
13. As always, for more information, contact your local ANZ Elsevier representative: NSW/ACT/NT: Lucinda Frumar [email_address] NSW/WA: Alana Brittain [email_address] VIC/TAS: Carolyn Crowther [email_address] VIC/SA: Lou Thorn [email_address] QLD: Carolyn Crowther [email_address] NZ: Gopal Ramanathan [email_address]
Editor's Notes
Purpose >> Teach simple diagnostic techniques for neurological conditions Example: RAAF and “lost in space’ techniques Who is this book for? >> Student & Non-neurologists Key Features >> Frequent case studies and examples >> Review points >> Clinical questions >> Clinical Orientation with comprehensive references Key Focus: The way neurology is taught throughout the text – very difficult concept to understand for medical students Concept of ‘mapping the brain’’ facilitates understanding of the brain C
Chapter 1: Clinically Oriented Neuroanatomy This chapter discusses the concept of the nervous system being likened to a map grid with meridians of longitude (the long tracts) and parallels of latitude (dermatomes, myotomes, reflexes, brainstem nuclei and cortical signs) and using this concept to localise the site of the pathology within the nervous system. The chapter will predominantly contain illustrations with brief explanations. Chapter 2: The Neurological History This chapter explains the principles and process of taking a patient’s history, including the concept that the past history, family history and social history are ‘circumstantial evidence’ and should not be used to make the diagnosis. The chapter discusses the mode of onset, duration and progression of symptoms with a view to answering the question ‘what is the likely pathological process?’ and it discusses the nature and distribution of symptoms with a view to answering the question ‘where is the lesion?’
The first section of this chapter will describe the anatomy, the techniques for examining the individual cranial nerves and the more common abnormalities encountered. Th e second part will discuss the ‘Rule of 4’ to aid in localising the problem within the brainstem, in particular understanding brainstem vascular syndromes [1] .
Chapter 6: After the History and Examination, What Next? Upon completing the history and examination, the next step is determined by the following factors: • diagnostic certainty • the availability of tests to confi rm or exclude certain diagnoses • the potential complications of those tests • the severity and level of urgency in terms of the consequences of a particular illness not being diagnosed and treated promptly • the benefi t versus risk profi le of any potential treatment • the presence of any social factors or past medical history that could infl uence a course of action or treatment in this particular patient. Th is chapter will discuss each of these aspects and how they infl uence the course of action. Chapters 7 – 14 Focuses on the identification of common nuerological occurrences, management strategies and point of differentiation, when you need to call in a Nuerologist The common neurological occurrences explored are: Epilepsy Headace and facial pain Cerebrovascular disease Common neck, arm and upper back problems Common leg problems Tremor and abnormal movements Rarer conditions (including) Hypothyroidism Hypertrophy Paroxysmal Symptoms of MS Orthostatic tremor Th e assessment of patients with intermittent disturbances of neurological function is one of the most interesting and challenging aspects of clinical neurology. One needs to be an amateur detective like Sherlock Holmes, whom Arthur Conan Doyle modelled on Dr Joseph Bell, one of his teachers at the medical school of Edinburgh University. Dr Bell was a master at observation, logic, deduction and diagnosis [1] . Th is chapter discusses the various causes of episodic disturbance of neurological function. Th ere is only a brief discussion of epilepsy and cerebrovascular disease as they are covered in more detail in Chapter 8, ‘Seizures and epilepsy’, and Chapter 10, ‘Cerebrovascular disease’, respectively. Vertigo is discussed in this chapter as most often it is an episodic disturbance, but mainly because it seemed to fi t better in this chapter than in any other. Patients are rarely seen by the neurologist during the episode. Th erefore, the diagnosis of intermittent disturbances of neurological function is almost entirely dependent on the history. As the symptoms are episodic, these patients rarely if ever have any abnormal neurological signs and investigations only rarely yield a diagnosis. Sometimes it is not possible to diagnose the problem when the patient fi rst presents. A very useful technique is to send the patient away with a list of things to observe and record. Th is will often enable a diagnosis to be made at a subsequent consultation. However, this technique can only be employed if the episodes are likely to be benign and the patient is advised to avoid activities that could result in harm should an event recur during that activity. For example, where there is a suspicion of epilepsy patients should be advised not to drive, go swimming, have a bath alone etc. Chapter 7: Epilepsy This chapter describes the clinical features of the more common seizure types such as tonic-clonic, myoclonic, absence, simple-partial and complex-partial seizures. It discusses the principles of investigation and management without discussing any particular mode of imaging or specific therapy, as these change frequently. Instead, links to relevant reliable websites will be provided which will enable readers to access current information. Chapter 8: Headache and Facial Pain This chapter describes the clinical features of the common causes of headache and facial pain. The clinical characteristics of conditions such as dental pain, trigeminal neuralgia and atypical facial pain, tension headache, chronic daily headache, migraine, cluster headache, benign sex and benign exertional headache will be described. Once again principles of management will be discussed rather than specific therapies. Chapter 9: Cerebrovascular Disease This chapter consists of a clinically oriented approach to the patient with cerebrovascular disease. Concepts such as small versus large vessel territory ischaemia, carotid versus posterior circulation or vertebro-basilar insufficiency (VBI) will be described. Principles of management will be discussed. Chapter 10: Common Neck, Arm and Upper Back Problems This chapter describes the clinical features of the common problems encountered in clinical practice affecting the neck, arm and upper back. The clinical features and examination findings that differentiate the various causes of arm pain, weakness and sensory disturbance will be described. Conditions such as carpal tunnel syndrome, tardy ulnar palsy, cervical radiculopathy, brachial neuritis and radial nerve lesions will be discussed. Chapter 11: Common Leg Problems with or without Difficulty Walking This chapter describes the clinical features of the common clinical problems affecting the legs. The chapter includes conditions that do not result in difficulty walking such as restless legs, burning feet, tarsal tunnel syndrome, meralgia paraesthetica, as well as the common causes of difficulty walking such as atalgic gait disorders, lumbar canal stenosis and apraxia of gait. Chapter 12: Tremor and Abnormal Movements This chapter describes the clinical features of the more common causes of tremor and how to differentiate them. The more common movement disorders encountered in clinical practice will be discussed. The various causes of Parkinson’s syndrome and in particular Parkinson’s disease will be discussed. Principles of management will be discussed. The chapter will discuss the clinical features used to differentiate the various types of tremo Chapter 13: The ‘More Common’ Rare Neurological Conditions This chapter describes the clinical features of the more frequently encountered rare neurological disorders. These include hypothyroidism and muscle hypertrophy, paroxysmal symptoms of multiple sclerosis, orthostatic tremor, superior oblique myokymia and paroxysmal kinesogenic choreoathetosis to mention just a few.
Videos Chapter 1. None Chapter 2. 2.1 Video presentation of principles of the neurological history. 2.2 Video of Lord Walton taking a history Chapter 3. 3.1 Video of Author demonstration technique of examining the upper and the lower limbs. Chapter 4. 4.1 Video presentation explaining the rule of 4 of the brainstem. 4.2 Video of Author demonstrating technique of examining the cranial nerves. 4.3 Video of patient with lateral brainstem syndrome Chapter 5. 5.1 Video presentation explaining the concepts in this chapter. Chapter 6. None Chapter 7. 7.1. Video of author taking history from patient with recurrent seizures. 7.2 Video of author taking history from patient with recurrent headaches. Chapter 8. None Chapter 9. None Chapter 10. None Chapter 11. 11.1 Video of how to examine upper arm and then hand and forearm problems. Chapter 12. 12.1 Video of author showing how to examine lower leg problems. Chapter 13. 13.1 Video of patients with difficulty walking with spasticity Chapter 14. None Chapter 15. None Additional Video Video demonstrating upper motor neuron signs Video demonstrating lower motor neuron signs Photo Library **Eleanor and Sabrina have discussed the idea of putting all the colour images onto the DVD – if there is sufficient space after uploading all the videos etc.
