What to Expect from This Book

(and What Not to) 1

Abstract
Neurologists take pride in their clinical bedside skills, perhaps even more
so than other physicians. Good clinical mentorship is mandatory in order
to develop such skills; however, due to an ever-increasing need for more
efficient working structures, the time and dedication that mentorship
requires may not always be available. The authors have therefore written
this book for neurology residents who are looking for a personal clinical
mentor, guiding them through the entire patient encounter: from a compre-
hensive history and an efficient clinical examination to a thorough differ-
ential diagnosis, ancillary investigations, and finally treatment options.

Keywords
Clinical skills • Clinical neurology • Examination • Differential diagnosis
• Examination • Mentorship • Neuroanatomy • Patient history • Treatment

Few things in medicine are as fascinating as
watching an experienced neurologist perform a
history and bedside examination to generate a dif-
ferential diagnosis prior to any laboratory investi-
gations. Good clinical skills are mandatory when
it comes to placing the patient on the right diag-
nostic track and to interpreting laboratory results
correctly. These skills are acquired through regu-
lar training, in-depth theoretical knowledge, and
good mentorship. The neurology trainee is
responsible for the first two aspects, while good
clinical mentorship requires a dedicated consul-
tant who may not always be available.
Neither a traditional textbook nor a pocket
manual, the aim of this book is to act as a clinical
mentor and provide information otherwise diffi-
cult to look up in the usual reference sources. It
tries to answer the sort of questions neurology
trainees typically would ask their consultants.
• How do I distinguish clinically between myas-
thenia gravis and Lambert-Eaton myasthenic
syndrome?
• What is the differential diagnosis of a rapidly
progressive dementia if the initial workup is
negative?

© Springer International Publishing AG 2017 1

D. Kondziella, G. Waldemar, Neurology at the Bedside, DOI 10.1007/978-3-319-55991-9_1
2 1
• Which anatomical lesions can lead to Horner’s
syndrome?
• Which neurophysiological features distinguish
axonal from demyelinating polyneuropathy?
• How do I treat autonomic dysreflexia in a
patient with chronic spinal injury?
To this end, the approach of the present book
reflects the course of the neurological consulta-
tion. The history, bedside examination, and gen-
eration of a working diagnosis are discussed first,
followed by a review of laboratory investigations
and medical treatment (Fig. 1.1).
Like any clinical mentor, this book demands
an active effort and commitment from you. It is
assumed that you have at least a superficial
knowledge of neurology and that you will consult
a good reference source if needed.
Chapters 2 and 3 review the relevant neuro-
anatomy from a clinical point of view and pro-
vide the tools to obtain an efficient clinical history
and bedside examination. These chapters can be
read straightforwardly from the first to the last
page.
Chapter 4 is somewhat more complicated and
demands greater flexibility. The chapter’s aim is
twofold.
First, using a specific clinical syndrome as its
case, it intends to teach the reader how to approach
differential diagnosis in a structured manner. This
is the bird’s-eye view. Although there are hun-
dreds of etiologies to a given polyneuropathy,
most can be diagnosed using a simple three-step
approach. Headache can be classified into pri-
What to Expect from This Book (and What Not to)
mary and secondary headache syndromes, the lat-
ter of which can be further divided into intracranial
and extracranial disorders and so on.
Second, this chapter provides a comprehen-
sive differential diagnosis of most of the disor-
ders encountered in neurological practice. Due to
space limitations, the background information is
limited, but the chances are minimal that a
patient, even at tertiary care level, has a neuro-
logical diagnosis not covered by this chapter.
Chapter 5 provides a short overview of the
main laboratory investigations performed in neu-
rology with emphasis on the clinical aspects.
Chapter 6 offers a reference of medical, surgi-
cal, and other treatment options for most neuro-
logical conditions. Again, this chapter is written
from a clinical mentor’s point of view. It sug-
gests the medication and dosage that may be
chosen for a given condition but assumes that the
reader is familiar with the pharmacodynamic
and pharmacokinetic data, contraindications,
and side effects. The main focus of this chapter
is to guide the residents on call. Thus, the empha-
sis is on treatment of cerebrovascular disorders
and epilepsy. Neurorehabilitation, counseling,
and regular follow-up, which should be an inte-
gral part of neurological management, will not
be covered.
The authors are grateful for any comments
and suggestions for improving future editions.
Also, they hope that upon completion of your
neurology training, you will know most of the
content of this publication like the back of your
hand.
3

To master the clinically relevant neuroanatomy

To recognize features in the clinical history pointing towards a specific anatomical site
Chapter 2
Clinical history and neuroanatomy
To learn how to ask for these features during the history
To learn how to generate an “anatomical hypothesis”
Chapter 3 To be able to perform an efficient bedside examination
“Neurology at the bedside”: learning objectives

Neurological bedside examination

To be able to modify the bedside examination according to the history and the “anatomical hypothesis”
To learn how to approach the differential diagnosis of neurological disorders systematically
Chapter 4
Differential diagnosis
What to Expect from This Book (and What Not to)

To be able to generate a working diagnosis for (almost) every neurological complaint

Fig. 1.1 Summary of chapter learning objectives

To understand the principles of the common ancillary investigations used in clinical neurology
Chapter 5
Ancillary investigations
To be able to interpret the results of ancillary investigations correctly
Chapter 6
To know the most common treatment options for neurological disorders
Treatment of neurological disorders
1