Table Of Contentn
clinical
ec
u
l
ri
neurology
n
Concise but comprehensive, Clinical Neurology continues to build on the success
o
of its three previous editions in helping junior doctors and practising physicians
i
to acquire a thorough understanding of the principles and practice of clinical c
l
neurology. o
a
For the fourth edition: gl
Edited by
n New chapters on clinical neurophysiology, neuro-oncology and craniofacial
y
pain ensure that coverage of these topics is comprehensive, complementing John W. Scadding and Nicholas A. Losseff
the existing topic and disease-based chapters.
n Many chapters have been lengthened, reflecting developments in knowledge FOURTH
F o u rT H e D i T i o n
and clinical practice, with many new high quality images and figures. EDITION
n Emphasis is again placed on the clinical skills and knowledge needed to
practice neurology competently and safely.
n The 36 contributing authors include many internationally-recognised clinicians
and researchers in their fields.
n The book provides succinct, practical accounts of the common and less
common neurological disorders encountered in primary care, at the primary-
secondary care interface, and in specialist neurological practice.
Clinical Neurology is written in an accessible and engaging style. It is intended
for neurologists, clinical neurophysiologists, general physicians, trainees in these
S
disciplines, GPs with a special interest in neurology, and for medical students
c
a
wishing to develop an interest in neurology.
d
d
i
n
About the editors
g
John Scadding is Honorary Consultant Neurologist, National Hospital for
n
Neurology and Neurosurgery, London, UK
L
Nicholas Losseff is Consultant Neurologist, National Hospital for Neurology o
s
and Neurosurgery, London, UK
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e
f
f
ISBN 978-0-340-99070-4
9 780340 990704
CLINICAL
NEUROLOGY
ClinicalNeurology.indb 1 08/11/2011 08:43
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CLINICAL
NEUROLOGY
Edited by
John W. Scadding MD FRCP
National Hospital for Neurology and Neurosurgery, London
Nicholas A. Losseff MD FRCP
National Hospital for Neurology and Neurosurgery, London
FOURTH EDITION
ClinicalNeurology.indb 3 08/11/2011 08:43
CRC Press
Taylor & Francis Group
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© 2011 by Taylor & Francis Group, LLC
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CONTENTs
Colour plates appear between pages 86 and 87
Contributors vii
Preface ix
Acknowledgements x
1. Introduction 1
John Scadding and Nick Losseff
2. symptoms of neurological disease 15
Tim Fowler, Nick Losseff and John Scadding
3. Examination of the nervous system 44
Tim Fowler, John Scadding and Nick Losseff
4. Neuroimaging 92
Philip Rich
5. Clinical neurophysiology 118
Veronica Tan
6. Cranial nerve syndromes 148
Tim Fowler, John Scadding and Nick Losseff
7. Nerve and root lesions 163
Tim Fowler, Nick Losseff and John Scadding
8. Neurogenetics 179
Sonia Gandhi, Sarah Tabrizi and Nicholas Wood
9. Raised intracranial pressure 197
Laurence Watkins
10. Headache 217
Peter Goadsby
11. Craniofacial pain 240
John Scadding
12. Head injury 254
Andrew McEvoy and Nick Losseff
13. Epilepsy and sleep disorders 269
Matthew Walker and Ley Sander
14. Neuro-oncology 299
Jeremy Rees and Naomi Fersht
ClinicalNeurology.indb 5 08/11/2011 08:43
vi Contents
15. spinal disease 328
James Allibone and Vivian Elwell
16. Peripheral neuropathies 343
Gareth Llewelyn and Robert Powell
17. Motor neurone disease and spinal muscular atrophy 366
Katherine Sidle
18. Diseases of muscle and the neuromuscular junction 378
Chris Turner and Anthony Schapira
19. Dementia 402
Catherine Mummery
20. Movement disorders 426
Niall Quinn
21. The cerebellar ataxias and hereditary spastic paraplegias 452
Nicholas Fletcher
22. Multiple sclerosis and related conditions 471
Raju Kapoor
23. Cerebrovascular disease 488
Nick Losseff and Martin Brown
24. Neurological rehabilitation 525
Roshni Beeharry
25. Infections of the central nervous system 538
Nick Davies
26. HIV 564
Carolyn Gabriel
27. Neurological manifestations of medical disorders 580
David Werring and John Scadding
28. Paediatric neurology 625
Elaine Hughes and Helen Cross
29. Respiratory aspects of neurological disease 645
Robin Howard and Nicholas Hirsch
30. Pain in neurological disease 655
John Scadding
31. Psychiatry and neurological disorders 675
Simon Fleminger
Index 701
ClinicalNeurology.indb 6 08/11/2011 08:43
CONTRIBUTORs
James Allibone BsC FRCs (sN) Peter Goadsby MD PhD Dsc FRACP FRCP
Consultant spinal Neurosurgeon, National Hospital Professor of Neurology, University of California,
for Neurology and Neurosurgery, London san Francisco
Roshni Beeharry MA MRCP Nicholas Hirsch MBBs FRCA
Consultant in Rehabilitation Medicine, National Consultant Anaesthetist, National Hospital for
Hospital for Neurology and Neurosurgery, London Neurology and Neurosurgery, London
Martin Brown MA MD FRCP Robin Howard PhD FRCP
Professor of stroke Medicine, Institute of Consultant Neurologist, National Hospital for
Neurology, UCL, London Neurology and Neurosurgery, London
Helen Cross PhD FRCP FRCPH Elaine Hughes FRCP FRCPCH
Reader in Paediatric Neurology, Institute of Child Consultant Paediatric Neurologist, Kings College
Health, UCL, London Hospital and Evelina Children’s Hospital, London
Nicholas Davies PhD MRCP Raju Kapoor DM FRCP
Consultant Neurologist, Chelsea & Westminster Consultant Neurologist, National Hospital for
Hospital, London Neurology and Neurosurgery, London
Vivian Elwell MA MBBs MRCs Gareth Llewelyn MD FRCP
specialist Registrar in Neurosurgery, National Consultant Neurologist, Royal Gwent Hospital,
Hospital for Neurology and Neurosurgery, London swansea
Naomi Fersht PhD MRCP FRCR Nick Losseff MD FRCP
Consultant Clinical Oncologist, University College Consultant Neurologist, National Hospital for
London Hospital, London Neurology and Neurosurgery, London
Simon Fleminger PhD FRCP FRCPsych Andrew McEvoy MD FRCs (sN)
Consultant Neuropsychiatrist, Blackheath Brain Consultant Neurosurgeon, National Hospital for
Injury Rehabilitation Centre, Kings College, London Neurology and Neurosurgery, London
Nicholas Fletcher MD FRCP Catherine Mummery PhD FRCP
Consultant Neurologist, Walton Centre NHs Consultant Neurologist, National Hospital for
Foundation Trust, Liverpool Neurology and Neurosurgery, London
Timothy Fowler DM FRCP Robert Powell PhD MRCP
Formerly Consultant Neurologist, Maidstone and Consultant Neurologist, Morriston Hospital,
Tunbridge Wells NHs Trust and Kings College swansea
Hospital, London
Niall Quinn MA MD FRCP FAAN
Carolyn Gabriel MD FRCP Emeritus Professor of Clinical Neurology, Institute
Consultant Neurologist, st Mary’s Hospital, London of Neurology, UCL, London
Sonia Gandhi PhD MRCP Jeremy Rees MD FRCP
NIHR Lecturer in Neurology, University of Reader in Neurology, Institute of Neurology, UCL,
California, san Francisco London
ClinicalNeurology.indb 7 08/11/2011 08:43
viii Contributors
Philip Rich Bsc FRCs FRCR Veronica Tan MD FRCP
Consultant Neuroradiologist, st George’s Hospital, Consultant Clinical Neurophysiologist, st Thomas’
London Hospital, London
Ley Sander MD PhD FRCP Christopher Turner PhD MRCP
Professor of Neurology, Institute of Neurology, Consultant Neurologist, National Hospital for
UCL, London Neurology and Neurosurgery, London
John Scadding MD FRCP Matthew Walker PhD FRCP
Honorary Consultant Neurologist, National Professor of Neurology, Institute of Neurology,
Hospital for Neurology and Neurosurgery, London UCL, London
Anthony Schapira MD Dsc FRCP FMedsci Laurence Watkins MA FRCs (sN)
Professor of Clinical Neurology, Royal Free and senior Lecturer in Neurosurgery, Institute of
University College Medical school, UCL, London Neurology, UCL, London
Katherine Sidle PhD MRCP David Werring MD FRCP
Consultant Neurologist, National Hospital for senior Lecturer in Neurology, Institute of
Neurology and Neurosurgery, London Neurology, UCL, London
Sarah Tabrizi PhD FRCP Nicholas Wood PhD FRCP FMedsci
Professor of Clinical Neurology, Institute of Galton Professor of Genetics, Institute of
Neurology, UCL, London Neurology, UCL, London
ClinicalNeurology.indb 8 08/11/2011 08:43
PREFACE
The clinical neurosciences continue to move forward at a great pace, with impact in numerous areas of clinical
practice. In the last few years there have been advances in both basic neuroscience and the understanding
of disease, and their translation into clinical practice. We hope that the fourth edition of Clinical Neurology
reflects these and provides an up-to-date account of the specialty.
However, we have not lost sight of the fact that the essential clinical skills needed to practise competently
and safely remain as important as ever. This cannot be over-emphasised and the early chapters again pro-
vide detailed descriptions of the assessment of neurological symptoms and the conduct of the neurological
examination.
One of the two founder editors of Clinical Neurology, Tim Fowler, has decided to stand down as editor. While
we are saddened by his departure in this role, we are delighted that he has contributed to the fourth edition
as an author. Indeed, his influence continues to be strongly felt in this edition. The establishment of Clinical
Neurology as a successful and widely read text owes a great deal to his vision, expertise and wide clinical
experience.
We welcome many new authors for existing chapters, and in addition to the disease and topic based chapters
in the third edition, we have introduced a new stand-alone chapter on Clinical Neurophysiology, and new
chapters on Craniofacial Pain and Neuro-oncology.
Neurology has become a vast and rich specialty within internal medicine. The aim of this book remains to
provide a succint but comprehensive and readable neurology text, which we hope will appeal as a primary
source for neurologists, clinical neurophysiologists, general physicians, trainees in these disciplines, for GPs
with a special interest in neurology, and indeed as an approachable introduction to the breadth and complexity
of clinical neurology for medical students wishing to explore the specialty. We hope that it will continue to
be of help in those preparing for examinations, both at the stage of entry to higher medical training, and for
more senior examinations including the recently introduced Specialty Certificate Examination in neurology.
We wish to express our indebtedness to our patients, from whom we learn constantly and who provide the
stimulus and challenge to improve the understanding and treatment of their neurological disorders.
John scadding and Nick Losseff
London, 2011
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