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The
NEUROLOGY
BOOK
Ever
11
Need

TheOnlyNEUROLOGYBOOKYou’llEver
Need
ALISONI.THALERMD
MALCOLMS.THALERMD

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Copyright©2023WoltersKluwer
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shop.lww.com

Foreword
Inthisbook,Drs.AlisonI.ThalerandMalcolmS.Thalerhavemanagedtocompleteanalmost
impossibletask:totakeaclinicaldisciplineascomplicatedasneurologyandbreakitdownintoits
simpleanddigestiblecomponents.Youwilllearnaboutstroke,seizures,aneurysms,neuropathies,
migraines,andallmannerofneurologicaldisease.Butyouwillalsolearntheapproachtothe
neurologicalpatient,toldwiththevoicesofthosewhohavebeenthereandseenitall.Itisacompanion
thatyouwantatyourside.
Intheearlyyearsofpreclinicaltraining,studentsareintroducedtotheendlesslycomplicated
neuroanatomicalpathways.Later,whentheyenterthewardsandareconfrontedwithpatientssuffering
fromneurologicaldiseaseorinjury,theycanfinditdifficulttoputthosepathwaysintoclinicalpractice.
Howshouldyouapproachapatientwhopresentswithaneurologicalproblem?Whenpatientstellyou
thattheyhaven’tbeenabletomovetheirrightlegforthepasttwohours,whatshouldyoudo?How
worriedshouldyoube,andshouldyoucallforhelp?Whatmightbegoingon,andwhatkindsofdisease
processesmightleavethepatientdevastatedifyoudon’treactquicklyandappropriately?Thisbook
providesyouwiththecriticaltoolsthatyou’llneedtobeabletothinkthroughquestionsliketheseina
clearandconcisemanner.
Thisisnotatextbookinneurology.Itisnotanencyclopedicreviewofneuroanatomyor
pathophysiology.Instead,ithighlightswhatyouneedtoknow—asathird-yearmedicalstudentstudying
fortheshelf;aneurologyresidentpreparingfornightfloat;oranurse,physician’sassistant,orphysician
facedwithevaluatingandtreatingneurologicdisease.Therelevantneuroanatomyandpathophysiology
arebroughttolifeandgivenclinicalcontext.
Looktothisbookforpearlsaboutwhattodoinvariousclinicalscenarios—howtotriage,howtogeta
senseofwhichkindsofneurologicalpresentationsareemergenciesandwhichcanwaituntilthenextday
totrytofigureout.Youwilllearnhowtodiagnoseandtreatthesepatientsinastraightforwardand
alwaysevidence-basedmanner.Andwhilelearningabouttheseneurologicalconditions,youwillalsobe
takenonawonderfultourofthefundamentalsofclinicalneurology.
MichaelFara,MD,PhD
AssistantProfessorofNeurology
InterimDirector,StrokeCenteratMountSinaiHospital
IcahnSchoolofMedicineatMountSinai
NewYork,NewYork
StevenGaletta,MD
ChairoftheDepartmentofNeurology
ProfessorofNeurologyandNeuro-Ophthalmology
NYUGrossmanSchoolofMedicine
NewYork,NewYork
https://t.me/med1917

Preface
Neurologyhasthereputation—well-deserved,ifperhapsoverstated—ofbeinghard.Fascinating—yes.
Intellectuallystimulating—ofcourse.Worththeinvestmentintimeandoverworkedneurons—withouta
doubt!Buthard.Sothat’swhywe’rehere,andwhywecreatedthisbook.Nottomakeiteasy—that
wouldbeaclaimyoucouldseethroughfromamileaway—buttomakeiteasier.Tohelpyoumakesense
ofitall.Totakeallthatanatomyandphysiology,allthosesyndromesandcategoriesandtreatment
protocols,andwrapthemupintomanageablebundlesthatareclear,concise,andpractical.Andwhile
we’reatit,wearegoingtomakeitfun.No,really.Wepromiseyouaregoingtoenjoymasteringthis
material(OK,weadmitthatmemorizingthebrachialplexusmaynotbeyouridealversionoffun,butwe
willdoourbest!).
Thisbookisdifferentfromotherneurologybooksyoumayhaveencountered.Thetextis
conversational.Therearetonsofillustrationsandimages.Clinicalpearls—thekindsofthingsyouwon’t
findinotherbooks—aresprinkledliberallythroughout.Mostimportantly,wefocusonthoseelementsof
neurologythatmattermostforpatientcare.Ourgoalisnottoimpressyouwithvastquantitiesof
neuroanatomicesoterica;rather,wewillstressoverandoveragainthebasicprinciplesunderlying
neurologicdiagnosisandmanagement.
Andthereissomethingelsethatwebelievemakesthisbookspecial.Itoffersadualperspectiveon
neurology.Oneofusisaneurologist,theotheraninternist.Bothofusdevotealargeportionofourtime
toacademicclinicalteaching.Bycombiningtheperspectivesofourtwospecialties,wecansharewith
youthemostreal-lifeandup-to-datedetailsthatonlyaneurologistwouldknow,aswellasthebroader
perspectiveandpatient-orientedapproachthatisaninternist’sstockintrade.Wedigdeepwhenwehave
toandthenpullbacktomakesurethateverythingwediscussisclinicallyrelevantandpatientcentered.
Thisbookcanandshouldbeuseddifferentlydependingonwhoyouareandwhatyouwantoutofit.It
coverseverythingyouneedforthemedicalstudentshelfexaminationbutattimesgoesaboveandbeyond,
soifyouwantonlystreamlinedandtestablematerial,focusontheflashcardsinthecompanionebookand
boldedtopicsinthetext;usetherestofthebookasareference,tohelpclarifywhensomethingdoesn’t
makesense,whenyoufindyourselfwantingtoknowmoreaboutaparticulartopic,orwhenyouneedto
prepareapresentationforrounds.Forpreliminaryinternsandjuniorneurologyresidents,readitcoverto-cover.Wehavedoneourbesttomakesureitreadslightlyandquickly(atleastasfarasmedical
textbooksgo!),anditcontainseverythingwewishwe’dknownatthestartofourcareers.Youwillbeas
wellpreparedforneurologyresidencyasispossible,wepromise.Andfornon-neurologytrained
physicians,nurses,NPAsandPAswhotreatpatientswithneurologicillness,keepthisbyyoursideasa
companion—aneasilydigestiblewhat-you-really-need-to-knowguidetothediagnosisandmanagement
ofneurologicdisease.
https://t.me/med1917

Wecan’tletyougetstartedwithoutfirstacknowledgingalloftheextraordinarycliniciansand
academicianswhoreviewedourchapters,offeredtheirsubspecializedwisdom,rolledtheireyesattimes
butwerealwayskind,supportive,andasexcitedaboutthisbookasweare.Inparticular,wewantto
thankDrs.LauraStein,MichaelFara,StephenKrieger,RajeevMotiwala,SusanShin,JoannaJen,Allison
Navis,MarkGreen,AnnaPace,AnuradhaSingh,CarolineCrooms,NoamHarel,AmyChan,Praveen
Raju,JoshuaFriedman,BenjaminBrush,KennethLeung,EmilySchorr,andStevenGaletta.Wecouldn’t
havedonethiswithoutyou.WealsowanttothanktheamazingfolksatWoltersKluwerwhosawthisbook
throughfrominceptiontoreality:SharonZinner,LindsayRies,OliRaj,ThomasCelona,ChrisTeja,Joe
Cho,andtheincrediblytalentedartistsatTNQ.Andlastly,wewanttoexpressourgratitudetoour
studentsformakingusbetterteachers,andourpatientswhoeverydaymakeusbetterhumanbeings.
Wededicatethisbooktoourfamilies.Itisatiresomeclichetostatehowtheystoodbyusevenaswe
drovethemcrazywithallthetimeandenergywedevotedtothisproject,butclichesareclichesfora
reason.SothankyouBenandNancyandJonandTracey—weloveyou,couldn’tlivewithoutyou,and
promisewewillbebackintouchassoonaswefinishplottingoutthenextedition!
AlisonI.Thaler
MalcolmS.Thaler
https://t.me/med1917

Contents
Chapter1
Let’sGetStarted:YourNeurologicToolbox
CASE1
Neuroanatomy:TheBasics
ElectrophysiologyinTwoPages
TheGoodNews!
TheNeurologicHistory
TheNeurologicExamination
MentalStatus
CranialNerves
TheMotorSystem
TheSomatosensorySystem
Reflexes
Coordination
Gait
NoteTemplate:AnExampleofHowYouMightDocumentaNormalNeurologicExamination
IsitNeurologic?
DiagnosticTools
AQuickOverviewofHeadImaging
LumbarPuncture
Electroencephalography
NerveConductionStudiesandElectromyography
CASE1:FOLLOW-UP
Chapter2
StrokeandCerebrovascularDisease
CASE2
BadNewsButGoodNewsToo
TheBasics
CerebrovascularAnatomy
IschemicStroke
Etiology
StrokeSyndromes
Management
IntracerebralHemorrhage(ICH)
Symptoms
Etiology
Management
SubarachnoidHemorrhage(SAH)
Presentation
Diagnosis
TreatmentandComplications
AFewOtherCerebrovascularDisorderstoKnow
CervicocephalicArterialDissection
https://t.me/med1917

CerebralVenousSinusThrombosis
ReversibleCerebralVasoconstrictionSyndrome(RCVS)
Vasculitis
CASE2:FOLLOW-UP
Chapter3
Headache
CASE3
HeadacheRedFlags
PrimaryHeadacheDisorders
Migraine
Tension-typeHeadache
TrigeminalAutonomicCephalalgias(TACs)
SinusHeadache
Neuralgias
EpisodicVersusChronicHeadache
SecondaryHeadacheDisorders
MedicationOveruseHeadache(MOH)
GiantCellArteritis(GCA)
SpontaneousIntracranialHypotension(SIH)
PseudotumorCerebri
PosteriorReversibleEncephalopathySyndrome(PRES)
CardiacCephalalgia
Post-traumaticHeadache
TheGeneralApproachtotheHeadachePatient
CASE3:FOLLOW-UP
Chapter4
Concussion(akaMildTraumaticBrainInjury)
CASE4
IsItMildorSevere?
SoWhatIsaConcussion?
Sports-relatedConcussion
PostconcussionSyndrome
ChronicTraumaticEncephalopathy
CASE4:FOLLOW-UP
Chapter5
Dizziness
CASE5
ASimpleWaytoCategorizeDizziness
Vertigo:AnOverview
Anatomy
PeripheralVersusCentralVertigo
PeripheralVertigo
CentralVertigo
ABriefWordonSyncope
CASE5:FOLLOW-UP
Chapter6
Seizures
CASE6
Epilepsy
ProvokedVersusUnprovokedSeizures
https://t.me/med1917

WhatConditionsIncreasetheRiskofRecurrenceAfteraSingleSeizure?
First-TimeSeizure
SeizureTypes
AQuickNoteontheDifferentialDiagnosisofSeizures
SeizureEtiology
EpileptogenicLesions
Toxic-MetabolicDerangements
MedicationsandOtherSubstances
EpilepsySyndromes
Anti-EpilepticDrugs(AEDs)
StatusEpilepticus
PsychogenicNonepilepticSeizures(PNES)
CASE6:FOLLOW-UP
Chapter7
NeurocognitiveDisordersandDementia
CASE7
CognitiveImpairment
Dementia(akaMajorNeurocognitiveDisorder)
AlzheimerDisease(AD)
VascularDementia
DementiaWithLewyBodies(DLB)
FrontotemporalDementia(FTD)
PrionDiseasesandCreutzfeldt-JakobDisease
ReversibleDementias
CASE7:FOLLOW-UP
Chapter8
Meningitis,Encephalitis,andOtherInfectiousDiseasesoftheNervousSystem
CASE8
Meningitis
BacterialMeningitis
OtherCausesofMeningitis
ChronicMeningitis
Encephalitis
AnOverview
HerpesEncephalitis
Arthropod-BorneEncephalitis
HIVInfection:NeurologicComplications
Neurosyphilis
LymeDisease:NeurologicManifestations
COVID-19:NeurologicManifestations
AFewOtherCNSInfectionstoKnowAbout
Neurocysticercosis
Leprosy
Poliomyelitis
Botulism
BrainAbscess
CASE8:FOLLOW-UP
Chapter9
MultipleSclerosis(andOtherImmunologicDiseasesoftheCentralNervousSystem)
CASE9
MultipleSclerosis(MS)
SomeBasicBackgroundFacts
https://t.me/med1917
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