Oxford handbook of neurology PDF
Preview Oxford handbook of neurology
Cutaneous distribution of the nerves of the body First of four views. The anterior cutaneous nerve of the neck has been renamed the transverse cutaneous nerve of the neck. The lower lateral cutaneous nerve of the arm is now recognized as part of the posterior cutaneous nerve of the forearm. Lumboinguinal nerve refers to the femoral branch of the genitofemoral nerve. Reproduced with permission from Haymaker, W. and Woodhall, B. (1998). Peripheral Nerve Injuries: Principles of Diagnosis, 2nd edn. American Association of Neurological Surgeons. Second of four views. See comment opposite regarding the lower lateral cutaneous nerve of the arm. Reproduced with permission from Haymaker, W. and Woodhall, B. (1998). Peripheral Nerve Injuries: Principles of Diagnosis, 2nd edn. American Association of Neurological Surgeons. Cutaneous distribution of the nerves of the body Third of four views. The inferior lateral and inferior medical clunical nerves have been renamed perineal branches of the posterior cutaneous of the thigh. See comment in Fig. A4 legend regarding the lower lateral cutane- ous nerve of the arm. Reproduced with permission from Haymaker, W. and Woodhall, B. (1998). Peripheral Nerve Injuries: Principles of Diagnosis, 2nd edn. American Association of Neurological Surgeons. Fourth of four views. The names of some nerves have been changed as follows: The clunical nerves (inferoir lateral and inferior medial) are now termed the perineal branches of the posterior cutaneous nerve of the thigh; the inferior hemorrhoidal nerve is now called the inferior rectal nerve. Reproduced with permission from Haymaker, W. and Woodhall, B. (1998). Peripheral Nerve Injuries: Principles of Diagnosis, 2nd edn. American Association of Neurological Surgeons. OXFORD MEDICAL PUBLICATIONS Oxford Handbook of Neurology Published and forthcoming Oxford Handbooks Oxford Handbook of Clinical Medicine 6/e (also available for PDAs and in a Mini Edition) Oxford Handbook of Clinical Specialties 7/e Oxford Handbook of Acute Medicine 2/e Oxford Handbook of Anaesthesia 2/e Oxford Handbook of Applied Dental Sciences Oxford Handbook of Cardiology Oxford Handbook of Clinical Dentistry 4/e Oxford Handbook of Clinical and Laboratory Investigation 2/e Oxford Handbook of Clinical Diagnosis Oxford Handbook of Clinical Haematology 2/e Oxford Handbook of Clinical Immunology and Allergy 2/e Oxford Handbook of Clinical Surgery 2/e Oxford Handbook of Critical Care 2/e Oxford Handbook of Dental Patient Care 2/e Oxford Handbook of Dialysis 2/e Oxford Handbook of Emergency Medicine Oxford Handbook of Endocrinology and Diabetes Oxford Handbook of ENT and Head and Neck Surgery Oxford Handbook for the Foundation Programme Oxford Handbook of Gastroenterology and Hepatology Oxford Handbook of General Practice 2/e Oxford Handbook of Genitourinary Medicine, HIV and AIDS Oxford Handbook of Geriatric Medicine Oxford Handbook of Medical Sciences Oxford Handbook of Obstetrics and Gynaecology Oxford Handbook of Oncology 2/e Oxford Handbook of Ophthalmology Oxford Handbook of Palliative Care Oxford Handbook of Practical Drug Therapy Oxford Handbook of Psychiatry Oxford Handbook of Public Health Practice 2/e Oxford Handbook of Rehabilitation Medicine Oxford Handbook of Respiratory Medicine Oxford Handbook of Rheumatology 2/e Oxford Handbook of Tropical Medicine 2/e Oxford Handbook of Urology Oxford Handbook of Neurology Hadi Manji Consultant Neurologist and Honorary Senior Lecturer National Hospital for Neurology and Neurosurgery Queen Square, London; and Consultant Neurologist Ipswich Hospital NHS Trust, UK Seán Connolly Consultant in Clinical Neurophysiology St Vincent’s University Hospital Dublin, Ireland Neil Dorward Consultant Neurosurgeon and Honorary Senior Lecturer Royal Free Hospital London, UK Neil Kitchen Consultant Neurosurgeon, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK Amrish Mehta Consultant Neuroradiologist, Hammersmith Hospitals NHS Trust, London, UK Adrian Wills Consultant Neurologist, Queen’s Medical Centre, Nottingham, UK iv Great Clarendon Street, Oxford OX2 6DP Oxford University Press is a department of the University of Oxford. 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ISBN 0–19–850973–1 (flexicover: alk. paper) 978–0–19–850973–8 (flexicover: alk. paper) 10 9 8 7 6 5 4 3 2 1 1 v Foreword Pass any young doctor in the corridor of a busy general hospital and the chances are that person will be carrying an Oxford Handbook relevant to their current clinical attachment. Surprise any consultant reviewing notes from a recent clinic in the office and the same book may also be (more discreetly) close at hand. Previously, those dealing with the intri- cacies of clinical neurology were disadvantaged. Now, Hadi Manji, Seán Connolly, Neil Dorward, Neil Kitchen, Amrish Mehta, and Adrian Wills have put right this defect. The team offers expertise in clinical neurology, neurosurgery, neurophysiology, and neuroradiology. And, as consultants working in busy clinical neuroscience centres, each brings to his contribu- tion the discipline of a classical approach to the neurological encounter together with pragmatism, much common sense, and a good deal of clinical experience. This is not a book to read expecting the rich and discursive prose narra- tives of the eloquent clinical expositor; nor, equally, one in which to be ensnared by the weeds of descriptive reflexology or shackled by the competitive impedimenta of eponymous hagiography—although a useful appendix lists some names that have echoed through the corridors of neurological establishments down the ages. Rather, it is a book for both the specialist and generalist to consult when faced with the typical, but nonetheless complex, presentations of neurological and neurosurgical disorders; one from which to be reminded of how best to investigate and manage the many conditions—common and otherwise—that affect the central and peripheral nervous systems and muscle; and one that wisely sets out what to expect from laboratory investigations, and how these inform clinical formulations that remain the substance of clinical neurol- ogy. Bullet points, lists, and algorithms for diagnosis and management may not make for bedtime reading but they do provide an economic and invaluable synthesis for others of what needs to be known in order to manage diseases of the nervous system effectively. Having done this successfully for themselves on many occasions in the clinic and on the wards, the team of experts now passes on its experience and under- standing of neurological and neurosurgical disease to a wider readership. Do not look for copies of the Oxford Handbook of Neurology sitting undis- turbed on dusty office shelves. This book will only be found alongside the many dog-eared and well-thumbed copies of its 35 companion volumes in the pockets and on the desktops of busy students of neurological disease. Professor Alastair Compston University of Cambridge October 2006 vi Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplica- tion of material in this work. 1 vii Preface General physicians have always found neurology difficult and perhaps intimidating. This is a reflection of inadequate training and perhaps per- petuated by the neurologists of a bygone era. Neurology still remains the most clinical of the medical subspecialities—investigative tools such as MRI and DNA analysis will never replace the basic neurological history- taking and examination, which when performed skilfully, is wonderful to watch. This is not some voodoo technique revealed to the chosen few but can be learnt from good role models and practise. Even today, neurological training remains a clinical apprenticeship with hints and ‘clinical handles’ that are passed down from teacher to pupil and are not in the standard textbooks. In this book we have tried to pepper these in when appropriate. In keeping with the style of the Oxford Handbook series the format is necessarily didactic and hopefully clear for the reader when faced with a patient with neurological symp- toms and signs. Neurology and neurologists have had a reputation for ‘being elephan- tine in their diagnostic skills but murine in their therapeutic strategies’. This has changed with numerous treatment options now being available. Although neither dramatic in their benefit nor curative, options now exist for patients with multiple sclerosis, Alzheimer’s disease, motor neuron disease, Parkinson’s disease, and ischaemic stroke. Our hope is that this book will go some way to smooth the neuro- logical pathways for juniors in training and perhaps even some senior colleagues! ‘…few patients oblige with the symptoms it is their duty to have and not many refrain from complaining of those they ought not to have. When I tried to teach the art of medical diagnosis to students, I often used to ask them this riddle: “what runs about farm yards, flaps its wings, lays eggs and barks like a dog?” …the answer is a hen! Usually one of the more earnest and innocent of the students would say: “but sir! I don’t understand the bit about barking like a dog”. Ah yes, I must explain. That was just put in to make it difficult.’ [Richard Asher quoted in British Medical Association (1984). A sense of Asher; a new miscellany. BMA, London.] Hadi Manji September 2006 This page intentionally left blank 1 ix Acknowledgements Dr Mike Lunn and Dr Andrew Graham for reading the manuscript and making helpful suggestions; Dr Chris Hawkes for his help with ‘Clinical Pearls’; Catherine Barnes and Elizabeth Reeve for their steadfast support and encouragement. This page intentionally left blank
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