David Greenberg - Clinical Neurology

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To our families

Clinical Neurology is intended to introduce medical students and house officers to the field of neurology and to serve them as a continuing resource in their work on the wards and in the clinics. This eighth edition reflects the books evolution over more than 20 years and is based on the authors clinical experience and teaching at a variety of institutions in the United States and United Kingdom.

The new edition has been extensively revised and thoroughly updated. Major changes include new introductory chapters on the neurologic history and examination and on laboratory investigations; state-of-the-art discussions of the molecular basis of Alzheimer disease and other dementias, spinocerebellar ataxias, motor neuron disease, muscular dystrophies, Parkinson disease, Huntington disease, multiple sclerosis, epilepsy, and stroke; and coverage of recent advances in the treatment of neurologic complications of general medical disorders, headache and facial pain, movement disorders, seizures, and cerebrovascular disease, among other conditions.

Not leastand probably most noticeableof the new features is the incorporation of full-color illustrations, which should help to clarify neuroanatomic principles, clinicalanatomic correlations, pathophysiologic mechanisms, and clinical signs.

Many of our colleagues have generously provided advice or material for this edition. In this regard we are especially grateful to Drs. Megan M. Burns, Allitia DiBernardo, Vanja Douglas, Alisa Gean, J. Handwerke, Rock Heyman, Justin Hill, Charles Jungreis, James Keane, Nancy J. Newman, and Howard Rowley. The staff at McGraw-Hill have been enormously helpful in the editing and production of this volume.

Finally, we hope that students, house officers, and other practitioners who read this book will find it helpful in demystifying and communicating the excitement of neurology.

David A. Greenberg

Michael J. Aminoff

Roger P. Simon

Novato, San Francisco, and Atlanta

May 2012

A thorough but directed history and neurologic examination are the keys to neurologic diagnosis and treatment. Laboratory studies, discussed in , can provide valuable additional information, but cannot replace the history and exam.

Taking a history from a patient with a neurologic complaint is fundamentally the same as taking any history.

The patients age can be a major clue to the likely causes of a neurologic problem. For example, epilepsy, multiple sclerosis, and Huntington disease usually have their onset by middle age, whereas Alzheimer disease, Parkinson disease, brain tumors, and stroke predominantly affect older individuals.