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“A detailed neurological examination is . . . a test of concentration and cooperation (even) in those in good health.... It may be necessary to conduct the examination in more than one session”. These are not quotations from Michael Donaghy’s attractive book but from a book on clinical methods published in 1968. Comparison of this with Donaghy’s book provides a clear demonstration of how clinical neurology, not just neuroscience, has advanced in the intervening 30 years. Generations of medical graduates have been discouraged about neurology because of the overwhelming (and often overbearing) way in which it was taught. Donaghy’s book is representative of a more realistic way of teaching neurological clinical methods which hopefully will produce a new generation of clinicians practising neurology as a practical science. In particular the neurological examination is portrayed as a set of techniques to be applied as appropriate to the clinical problem at hand, rather than an arcane (and mentally taxing) ritual played out with the mind in neutral.
After an initial chapter discussing important parts of the neurological history a basic neurological examination is well described and illustrated. Here the only obvious omission is the valuable test of asking patients to outstretch their arms with supinated hands and closed eyes, a very sensitive screen for significant neurological deficit in the upper limbs, widely used by neurologists in practice. Subsequent chapters pursue more detailed examination techniques in the context of specific clinical problems. This approach works well and is complemented by the later chapters reviewing common neurological syndromes. Management is touched on, including telling patients about incurable disease, but assessment of disability, as opposed to deficit, is not much considered.
The aim of the book is to provide students with “a working knowledge of common clinical problems in neurology, and teach a simple, quick, and reliable neurological examination”. This is what medical students require to cope with the neurology they will meet as junior hospital doctors and on which they can build if they decide to become physicians, general practitioners, or even neurologists. In my view the author succeeds in his aims and is to be congratulated on producing a well illustrated and laid out paperback introduction to neurological clinical methods. Students in my university will be particularly amused to see the photographs of Donaghy testing the muscular strength of a member of the Oxford University Boat Club!
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