Preface

Seven years after the second edition of this book, the era of precision medicine is upon us. Assuming that any genetic mutation has the potential to cause disease, it has been predicted that a comprehensive medical textbook of the future will have at least 20,000 chapters, one for each of our coding genes. (Following already established trends, such a book will be electronic only.)

In the meantime, clinicians continue to use more prosaic strategies in managing patients with neurologic disorders. Clinical conundrums persist, and management seldom addresses RNA splicing or histone acetylation. In fact, despite breathtaking scientific progress, most clinical decisions are made without understanding the root cause of the disorder in question. Calcitonin gene-related peptide antagonists might offer clues to the pathophysiology of migraine, but at the moment there is no consensus as to what migraine actually is.

As with previous editions, the focus of this book is practical, and the principal intended audience is primary care physicians. Specialists (including neurologists), surgeons, nurses, and physicians’ assistants are also invited. Introductory chapters address specific symptoms and diagnostic procedures. Subsequent chapters are disease-specific and adhere to a standard format, beginning with Essentials of Diagnosis (to help a clinician get a sense of being in the right ballpark), followed by Symptoms and Signs, Diagnostic Studies, Treatment, and Prognosis. Tables are abundant, and references are up-to-date. If you seek guidance in selecting one of the growing number of medications available to treat multiple sclerosis, you will find it here. But if you want to know the role of interleukin-2 signaling in demyelinating disease, you need to look elsewhere.

It is estimated that more than 20% of admissions to community hospitals in the United States involve patients with neurologic symptoms and signs. Too many non-neurologists are uneasy dealing with such patients. In steering a course between oversimplification and recondite detail, this book aims to instill clinical confidence and thereby, perhaps, to improve patient care.