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The first two editions of Harrison’s Neurology in Clinical
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Medicine were unqualified successes.
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For many physicians, neurologic diseases represent
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particularly challenging problems.
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By the second edition, the section was
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considerably enlarged by Raymond D.
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Adams, whose
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influence on the textbook was profound.
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The third
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neurology editor, Joseph B.
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Thanks also to Dr.
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This new volume was championed by James Shanahan
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and impeccably managed by Kim Davis.
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We live in an electronic, wireless age.
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Information
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is downloaded rather than pulled from the shelf.
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Some
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have questioned the value of traditional books in this
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new era.
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Stephen L.
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Hauser, MD
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Preface xiv
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NOTICE
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Medicine is an ever-changing science.
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Readers are encouraged
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to confirm the information contained herein with other sources.
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This recommendation is of particular importance in connection with
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new or infrequently used drugs.
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The genetic icons identify a clinical issue with an explicit genetic relationship.
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Harrison’s Self-Assessment and Board Review, 18th ed.
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New York, McGraw-Hill, 2012, ISBN 978-0-07-177195-5.
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SECTION I
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INTRODUCTION TO
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NEUROLOGY
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Daniel H.
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Lowenstein ■ Joseph B.
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Martin ■ Stephen L.
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Hauser
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2
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Neurologic diseases are common and costly.
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Are the pain-sensitive meninges
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involved?
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A more detailed examina-
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tion of a particular region of the CNS or PNS is often
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indicated.
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In addition, this strategy safeguards against
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making serious errors.
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The history also helps to bring a focus to the neuro-
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logic examination that follows.
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For example, a patient complains
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of weakness of the right arm.
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What are the associated
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features?
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Negative
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associations may also be crucial.
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Other pertinent features of the
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history include the following:
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1.
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Temporal course of the illness.
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2.
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Patients’ descriptions of the complaint.
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The same words
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often mean different things to different patients.
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“Dizziness” may imply impending syncope, a
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sense of disequilibrium, or true spinning vertigo.
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3.
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Corroboration of the history by others.
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4.
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Family history.
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Many neurologic disorders have an
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underlying genetic component.
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5.
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Medical illnesses.
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Many neurologic diseases occur in
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the context of systemic disorders.
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Patients with malig-
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nancy may also present with a neurologic paraneo-
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plastic syndrome (Chap.
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44) or complications from
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chemotherapy or radiotherapy.
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Various neurologic disorders occur
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with dysthyroid states or other endocrinopathies.
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Most patients with coma in a hospital setting have a
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metabolic, toxic, or infectious cause.
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6.
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Drug use and abuse and toxin exposure.
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It is essential to
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inquire about the history of drug use, both prescribed
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and illicit.
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7.
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Formulating an impression of the patient.
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Use the
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opportunity while taking the history to form an
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impression of the patient.
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Is the information forth-
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coming, or does it take a circuitous course?
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Is there
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