Neurology: A Clinician’s Approach

437 Pages·2016·12.45 MB·English

by  Andrew Tarulli (auth.)

Andrew Tarulli
Neurology
A Clinician’s Approach
Second Edition
123
Neurology

Andrew Tarulli
Neurology
A Clinician’s Approach
Second Edition
Andrew Tarulli
Beth Israel Deaconess Medical Center
Harvard Medical School
Boston , MA , USA
ISBN 978-3-319-29630-2 ISBN 978-3-319-29632-6 (eBook)
DOI 10.1007/978-3-319-29632-6
Library of Congress Control Number: 2016931864
© Springer International Publishing Switzerland 2016
T his work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of
the material is concerned, specifi cally the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microfi lms or in any other physical way, and transmission or information
storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology
now known or hereafter developed.
T he use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
T he publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, express or implied, with respect to the material contained herein or for any errors
or omissions that may have been made.
Printed on acid-free paper
This Springer imprint is published by Springer Nature
The registered company is Springer International Publishing AG Switzerland
To my wife, Susan, and my daughter,
Madeline.

Foreword
A month before I started my neurology residency, a copy of Andrew’s book was
given to me by the departing neurology chief residents. Attached was a letter, the
thinly veiled point being that this should be read (and possibly re-read) prior to
starting the junior year. What an invaluable early infl uence it became. Perhaps so
much so, in fact, that I now fi nd it hard to remember a time when my cognitive
framework for analyzing a patient’s complaint seriously differed from that which
Andrew’s book provides.
T herein lies its strength; as the title suggests, this really gives the student an
insight into the clinician’s approach. Clinical reasoning is the absolute bedrock of
neurology; knowledge of a thousand obscure diagnoses or mastery of neuroradiol-
ogy or neuropathology is useless unless there is a level-headed approach to using
the history and a focused exam to sort out a complaint. Though there are many
published compendia of facts, no other book provides this conceptual framework of
learning how to think properly at a level which can be accessed by the medical stu-
dent or junior resident. They need to be taught how to think like a neurologist from
the start. This niche, crucially important, is rarely fi lled.
I had the privilege of being the chief resident on the stroke service in July and
when my junior residents arrived, they asked me which books they ought to buy. I
gave them a long list, but I made sure to explain why Andrew’s should be the fi rst
to be read. I think that is true for any medical student, future neurology resident (or
current resident who has not done so), and internist.
Beth Israel Deaconess Medical Center Marc Albert Bouffard, M.D.
Harvard Medical School
Boston, MA, USA
vii

Foreword
S ince the time of Hippocrates, there has always been, and there probably always
will be an element of apprenticeship in learning to be a physician: both fi guratively,
in that by reading a single-author text we absorb the condensed insights of an expe-
rienced predecessor, and quite literally since the art of history taking and technique
of the physical exam cannot truly be grasped from reading alone. In neurology in
particular, where even today modern imaging and sophisticated electrophysiology
cannot supplant a careful history and exam, our clinical skills are a composite of
what we once saw particularly well demonstrated by one or another of our teachers,
adapted to and modifi ed by our own needs and experiences. We are always indebted
to the ones who taught us.
At the very beginning of my neurology training, I was doubly fortunate to work
with Andrew as the fi rst attending on my fi rst month on the neurology wards and, at
nearly the same time, to read N eurology. A Clinician’s Approach as my fi rst clinical
neurology book in residency.
T he move from the previous year of medical internship to neurology proper was
at fi rst exciting, even exhilarating (it was, after all, my chosen fi eld) but even so it
was not easy. The year in internal medicine was of course an important preparation
in many ways. It taught me the mechanics of being a doctor and an understanding
of the inner workings of the hospital, and it certainly provided a solid clinical foun-
dation. Nevertheless, it could not have prepared me for the subtleties and complexi-
ties of clinical neurology, where the difference between a trivial condition and a
malignant brain disease sometimes hinges on the size of a pupil or the exact pattern
of weakness in a limb. From big textbooks to online databases, there was certainly
no lack of information, and everyone from my chief residents to Dr. Clifford Saper,
the neurologist-in-chief, was handing out papers and references. But where was the
key to all this knowledge? Andrew’s book provided exactly the guidance I needed
at this time of transition—to paraphrase William Osler, it became the fi rst chart to
help me sail the sea of neurology. It went straight to the point: here were the 23 most
common neurological chief complaints and diseases, and practical approaches to
each one of them. Just like Andrew’s personal teaching, his writing is easy to follow
and logical in its organization, and while always concise, it does not shy away from
ix