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The first two editions of Harrison’s Neurology in Clinical |
Medicine were unqualified successes. |
For many physicians, neurologic diseases represent |
particularly challenging problems. |
By the second edition, the section was |
considerably enlarged by Raymond D. |
Adams, whose |
influence on the textbook was profound. |
The third |
neurology editor, Joseph B. |
Thanks also to Dr. |
This new volume was championed by James Shanahan |
and impeccably managed by Kim Davis. |
We live in an electronic, wireless age. |
Information |
is downloaded rather than pulled from the shelf. |
Some |
have questioned the value of traditional books in this |
new era. |
Stephen L. |
Hauser, MD |
Preface xiv |
NOTICE |
Medicine is an ever-changing science. |
Readers are encouraged |
to confirm the information contained herein with other sources. |
This recommendation is of particular importance in connection with |
new or infrequently used drugs. |
The genetic icons identify a clinical issue with an explicit genetic relationship. |
Harrison’s Self-Assessment and Board Review, 18th ed. |
New York, McGraw-Hill, 2012, ISBN 978-0-07-177195-5. |
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SECTION I |
INTRODUCTION TO |
NEUROLOGY |
Daniel H. |
Lowenstein ■ Joseph B. |
Martin ■ Stephen L. |
Hauser |
2 |
Neurologic diseases are common and costly. |
Are the pain-sensitive meninges |
involved? |
A more detailed examina- |
tion of a particular region of the CNS or PNS is often |
indicated. |
In addition, this strategy safeguards against |
making serious errors. |
The history also helps to bring a focus to the neuro- |
logic examination that follows. |
For example, a patient complains |
of weakness of the right arm. |
What are the associated |
features? |
Negative |
associations may also be crucial. |
Other pertinent features of the |
history include the following: |
1. |
Temporal course of the illness. |
2. |
Patients’ descriptions of the complaint. |
The same words |
often mean different things to different patients. |
“Dizziness” may imply impending syncope, a |
sense of disequilibrium, or true spinning vertigo. |
3. |
Corroboration of the history by others. |
4. |
Family history. |
Many neurologic disorders have an |
underlying genetic component. |
5. |
Medical illnesses. |
Many neurologic diseases occur in |
the context of systemic disorders. |
Patients with malig- |
nancy may also present with a neurologic paraneo- |
plastic syndrome (Chap. |
44) or complications from |
chemotherapy or radiotherapy. |
Various neurologic disorders occur |
with dysthyroid states or other endocrinopathies. |
Most patients with coma in a hospital setting have a |
metabolic, toxic, or infectious cause. |
6. |
Drug use and abuse and toxin exposure. |
It is essential to |
inquire about the history of drug use, both prescribed |
and illicit. |
7. |
Formulating an impression of the patient. |
Use the |
opportunity while taking the history to form an |
impression of the patient. |
Is the information forth- |
coming, or does it take a circuitous course? |
Is there |
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