Mayo clinic - Neurology cases .chm

Introduction
This book is designed both to teach and to entertain. The format is simple. Fifty informative cases are presented succinctly with an emphasis on the critical aspects of each case (history, examination, investigations). The authors were given the challenge of including not more than one or two figures or tables and one reference. Just enough information has been presented in the title of each case (see the Table of Contents) and in the text to permit the reader to localize the lesion, identify the likely family of disorders (e.g., vascular, infectious, metabolic, degenerative, neoplastic), and, depending on the neurologic sophistication of the reader, to reach the correct diagnosis. When ready, the reader turns the page and is treated to a brief Commentary by a Mayo Clinic neurologist addressing the important elements of the case and the specific disease process. As such, the puzzle is presented and the solution revealed.
These cases present a graded challenge to our colleagues in medicine. Students and residents should find the exercise in localization and differential diagnosis to be both fun and stimulating. Physicians with considerable neurologic expertise (internists, psychiatrists, rehabilitation physicians, pediatricians, and geriatricians) will particularly appreciate the commentaries. Finally, neurologists and neurosurgeons will enjoy the full challenge of matching wits directly with the discussants. In doing so, perhaps readers will recall similar cases that have challenged them in their practice.
This little book will enhance learning for readers at each stage of their careers. Young students soon learn that clinical medicine in general, and neurology in particular, requires precision in extracting an accurate history and correctly identifying the abnormal physical findings. Neurology probably demonstrates as well as any medical specialty the breadth and precision of the examination and the value of this technique in localizing the site of the lesion. The medical student learns the essential elements of these tasks and, with proper mentoring and much practice, gradually develops proficiency. The resident and fellow learn to clarify and quantify the pertinent positive and negative features that characterize each case. For generations, neurologists have taught wisely that the combination of the temporal profile of the illness (i.e., acute, subacute, or chronic) and the presence or absence of focal signs informs on the likely pathogenesis (e.g., neoplastic, vascular, or degenerative disorder). These key elements are demonstrated in every case in this book.
As we mature as physicians, we learn the art of presenting our cases to our colleagues in an abbreviated and clearly focused manner. This ability to crystallize all the elements of a complex case into a few informative sentences demonstrates our maturity and competence as clearly as anything we do as physicians. In neurology, this skill enables the analytical listener to determine whether the patient has a neurologic disorder and to localize the site(s) of the lesion, to deduce the probable pathophysiologic process, to formulate a differential diagnosis, and to make the diagnosis. With these steps, the neurologist determines the studies that are needed to confirm the correct diagnosis. The format that has been selected for the book illustrates the value of this exercise in a manner that reflects the daily practice of neurology.
The cases have been selected to span child and adult neurology to demonstrate the spectrum of problems seen in an office practice. Several cases have unique features (e.g., a child with recurrent aseptic meningitis, arthropathy, deafness, and rash; an adult with drenching sweats, sleep talking, and weight loss). Others share a superficial similarity to emphasize the diversity of cases that may have a similar signature (e.g., intermittent diplopia and progressive ataxia). Finally, the commentaries, although brief, discuss the important points of differential diagnosis and recent advances in the understanding of the disorders responsible for each patient's illness.
The hope is that readers will enjoy these cases and, in doing so, will find lessons that will assist them in the care of their patients.