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Introduction to Clinical Neurology.

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    Introduction to Clinical Neurology. By douglas j gelb (Pp86, £22.50). Published by Butterworth Heinemann, Oxford, 2000. ISBN0-7506-7202-1.

    This is the second edition of Gelb's systematic approach to the neurological problems likely to be encountered in general medical practice. The book seems to be aimed at general physicians in training, and medical students. Although it also contains much to engage the interest of specialist trainees in neurology, I suspect that most of them will use a more didactic text. Its appeal to medical students may be diminished by the relative lack of illustrations; pictorial material is mainly limited to anatomical line drawings in the early sections of the book. I did not encounter a single MR or CT brain scan; an omission giving the book questionable relevance to the starting point which is fundamental to contemporary diagnosis and understanding of neurological disease processes. At 365 text pages, it is a little on the long side for medical students, who are attached to neurology for only a few weeks. On the positive side, many students will be intrigued by the frequent use of case histories around which the authors build discussion of differential diagnosis.

    This second edition particularly introduces details of neurological examination which are said to be unavailable elsewhere. The authors' programme for neurological examination is highly detailed and comprehensive. It is my impression that such exhaustive rote neurological examination is falling out of favour in specialist neurological practice in Britain. Yet it seems popular still with North American neurologists who may benefit from the luxury of more time for patient consultation, or may suffer more from the fear of legal retribution if they miss something. At the end of the chapter on neurological examination there is a brief section on “how to modify it”. This includes a screening neurological examination. One could take issue with the summary range of tests which have been chosen, particularly the value of looking for pronator drift, testing finger tapping, and testing both heel-shin coordination and tandem gait. It always seems to me that a screening neurological examination must avoid redundancy, and be rich in tests which provide unequivocal evidence of pathology. So why is fundoscopic examination of the optic disc omitted from this recommended screening examination, given that it can reveal the crucial physical sign of papilloedema in a patient who might otherwise be thought to have non-specific headache?

    Each chapter starts with a set of thought provoking case histories. Some of us are of the mental disposition that enjoys learning from such games, although others find it more profitable to digest more formally presented textbook information. I admit that I tend to fall into the second group, finding it less easy to evaluate “paper patients” than real patients in a consulting room. My own thought processes were impeded by finding that the case histories, and the discussion of them, are dislocated to separate parts of the chapter, necessitating constant thumbing backwards and forwards.

    I suspect that this relatively wordy basic textbook will appeal more to students and junior doctors in North America than in the United Kingdom. In the United Kingdom medical students seem to want short pithy books. Junior staff in general medical training often seem to use the neurology entries in general medical textbooks. Neurology trainees and consultants seem to refer to specialist textbooks. But if you like problem orientated learning, you should flick through a copy of this book to see whether it suits you.