Clinical Medicine and the Nervous System - Böcker

Epilepsy is among the most common scourges afflicting the health of humankind and perhaps the most terrifying. In one form or another, it is suffered by one in everyone hundred people on earth, with a disproportionate prevalence at the early and late extremes of life. There is nothing sacred or sanctifying about it in spite of Hippoc­ rates' terming epilepsy "The Sacred Disease" in a famous treatise. There is nothing ennobling about it despite its occasional designa­ tion as a "noble disorder" by virtue of i ts having affected the likes of Alexander of Macedon, Julius Caesar and other persons of royal lineage. From time to time, epilepsy is hailed as a condition which is artistically inspirational; Fyodor Dostoyevsky's dependence on his own personal experience with complex partial epilepsy as a source of imagery in the transfiguration scenes of The Brothers Karamazov and as a source of experience in The Idiot is often cited in this respect. In fact, for all its victims in human history, epilepsy has been a sad burden which has disrupted and shortened life, causing suffering and castigation for the duration of their terrestrial journey.

Traditionally, investigation of the nervous system has been primarily a clinical matter. The great era of clinical assessment of patients with neurological disease in the first half of the century was determined by the necessity both to understand the phenomena of neurological disease in relation to structure and function and to localise lesions, in order to facilitate the twin processes of diagnosis and management. Over the years diverse techniques have been applied to clinical practice in order to improve the accuracy of diagnosis. These have comprised extensions of clinical method, for example clinical neuropsychology, electro­ encephalography, radiography of the skull and spine, angiography and other contrast procedures, including the now abandoned technique of air encephalography, and myel­ ography, perhaps itself soon to be little used. Isotope studies of the brain have possibly not realised their full potential in clinical neurology. All these different investigations found an integrated place in clinical management, enhancing the classical clinical database and its associated information, derived from biochemical, immunological and haematological studies. The advent of computerised tomographic X-ray scanning changed all this. The quality of the images derived from CT scanning was so much superior to that obtainable by conventional X-ray methods, and the method was so non-invasive in its conception, that clinical practice in both medical and surgical neurology changed profoundly.

Heart and brain interaction is an increasingly vital area of clinical investigation. This is the most comprehensive review of the subject available, presented by internationally recognized authorities in the field. The book offers extensive coverage of cardioembolic stroke, including a brand new contribution on the mechanism of hemorrhagic infarction. Controversial topics such as anticoagulation, combined carotid and coronary surgery and screening for silent coronary disease are covered. Also included are a comprehensive review of the cardiovascular/neurobiological role of the central nervous system in hypertension and sudden death, and a practical approach to the patient with syncope. This integrated, topical presentation makes essential reading for neurologists, cardiologists, internists and anyone caring for patients with stroke or cardiac disease.

Hughlings Jackson, the noted English neurologist, fathered many ideas that today still underlie our understanding of common clinical phenomena. This is a reappraisal of Jackson's work, both within its historical framework and in light of modern concepts of neurology. The approach is new, combining historical, clinical and basic scientific information in one synthesis on the organization and function of the nervous system. The concept of levels of function is addressed, specifically with regard to areas of brain function; and the hierarchical strategy is considered as part of the current concept of a distributed system of neurons. Clinicians and scientists alike will find much food for thought in this modern treatise of Jacksonian concepts.

The period that followed World War II has witnessed a dramatic change in neurology. From being a discipline in which its partici- pants were castigated for being interested solely in diagnosis, usually of disorders of unknown causation without effective therapy, neurology has evolved into a highly active treatment- orientated subject. This transition is clearly reflected in the ap- proach to diseases of the peripheral nervous system, and to the Guillain-Barre syndrome (GBS) in particular. In a state-of-the- art review made in 1952, Elkington (1952) observed that no less than 56% of neuropathies remained undiagnosed, and amongst those of unknown causation he listed GBS. With intensive in- vestigation and follow-up, the proportion of neuropathies seen at tertiary referral centres which elude diagnosis is now as little as 13% (McLeod et al. 1984). Overall, of course, the proportion is even less. This change is partly because of the introduction of new diagnostic techniques and partly because of the application of the great expansion in knowledge evident throughout medicine.In this book, Professor Richard Hughes has assembled current information on GBS and related disorders, including chronic in- flammatory demyelinating polyneuropathy (CIDP), the existence of which was not appreciated until Austin's perspicacious study published in 1958. In the Introduction, Professor Hughes gives an account of the way in which recognition of the GBS emerged and matured, and shows that it followed, pari passu, with the realisation that paral- ysis and sensory loss may result from peripheral nerve disorders.